Perimenopause Sleep Problems: Why You’re Waking Up Tired

As you get older, you may notice that your sleep isn’t as refreshing as it was in the past. This is because aging itself can take a toll on your sleep. 

But poor sleep is also one of the symptoms of menopause — and it can start much earlier than you may think. Reproductive hormones, like estrogen, start to decline in perimenopause — often about 4 to 8 years before menopause starts. And you can get your first glimpse of hormone-related sleep problems during perimenopause. 

Let’s take a closer look at how perimenopause can cause sleep issues and how to treat them, so you can get a good night’s rest.

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Quiz: Are you in perimenopause?

Is insomnia a common symptom of perimenopause?

Yes, you can develop insomnia during perimenopause. Close to half of perimenopausal women report regularly having trouble getting a good night’s sleep. 

Waking up in the middle of the night is the most common type of sleep issue in perimenopause. You may wake up overheated and drenched in sweat due to hot flashes or night sweats. And you may have trouble falling back asleep, especially if you have to cool off or change your sleepwear or bed sheets. 

But insomnia in perimenopause can also mean that it takes a while to fall asleep or that you wake up too early in the morning. Any type of sleep disruption can leave you feeling overly tired the next day.

EXPERT PICKS: WHAT TO READ NEXT

• Perimenopause symptoms? Find out the range of symptoms that may be caused by a dip in estrogen.

• Insomnia can arise at any point in life. Here are some reasons you may be having trouble falling asleep.

• Night sweats: What may be causing you to wake up in a pool of sweat?

Perimenopause sleep problems

Perimenopause is caused by a decline in reproductive hormones, like estrogen and progesterone. This can directly and indirectly affect your sleep. 

As you age, you also produce less melatonin — the hormone that’s released at night and helps you feel sleepy. In perimenopause, you can see a significant drop in melatonin levels. And melatonin levels can dip even further in menopause.

Here are some ways that your changing hormones can affect your sleep. 

Hot flashes and night sweats

The dip in estrogen during perimenopause may lead to a change in the hypothalamus. This is the part of the brain that helps control body temperature. Normally, if the hypothalamus detects that you’re too warm, it triggers your body to get rid of your excess body heat. 

During perimenopause, the slightest rise in body temperature can cause this response — leading to hot flashes, flushing, and night sweats. This can cause you to wake up in the middle of the night.

Mood issues

Shifting hormones can contribute to mood swings, depression, and anxiety. About 4 in 10 women in perimenopause have mood symptoms. 

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Mood disorders can make it harder to fall asleep, and they can affect the quality of your sleep. In fact, about 80% of people with depression have insomnia. 

At the same time, if you consistently don’t get enough sleep, it can also contribute to depression. It’s not entirely clear why, but poor sleep can make you less able to regulate your emotions. Insomnia may also affect brain chemicals related to depression.

Weight gain

The hormonal changes that occur in perimenopause may cause some people to gain weight. It’s also natural to gain weight with age. 

But excess weight may contribute to poor sleep. The reasons aren’t well understood. But having a larger body size has been shown to affect how long it takes to fall asleep — and the quality of sleep. It can also raise the risk of sleep apnea, a common condition that disrupts your sleep.

Why are hot flashes worse at night?

Hot flashes aren’t worse at night, but they can seem worse. Hot flashes actually happen any time during the day or night. 

“They don’t necessarily happen more at night, but they’re more bothersome because of their effect on sleep,” said Robert Kauffman, MD, MSCP, professor of obstetrics and gynecology at Texas Tech University School of Medicine in Amarillo, TX. 

At night, hot flashes can keep you from falling asleep. Or they can cause you to get overheated in the middle of the night. They can also cause night sweats, which can be very disruptive to your overall sleep time and sleep quality.

If you’re waking up in a pool of sweat, you can try adjusting your bedroom and sleepwear:

• Adjust your thermostat to about 65°F.

• Wear lightweight sleepwear to bed.

• Use cooling bedding and lightweight blankets.

How to get better sleep during perimenopause

Trouble sleeping can be difficult to treat. But when it’s related to perimenopause, there are several strategies you can try. 

Let’s review some tips to help you get better sleep during perimenopause.

Lifestyle changes

Tweaking your daily habits can help you fall asleep — and stay asleep for the night. Try these sleep hygiene tips for better sleep in perimenopause:

• Keep it regular. Go to sleep and get up at the same time every day — even on the weekends. Creating a consistent sleep schedule makes it easier to fall asleep faster and stay asleep all night.

• Avoid taking naps. Napping late in the afternoon or in the evening can make you less tired when it’s time to turn in.

• Wind down. Do relaxing activities before bed like reading a book, listening to soothing music, or taking a warm bath.

• Avoid screens. Keep television sets, computers, and mobile devices out of your bedroom. The light from these devices can disrupt sleep.

• Drink alcohol less often. Even moderate amounts of alcohol, like a drink a day for women, can decrease sleep quality. 

It’s important to note that sleep issues tend to get worse in menopause. That’s why it’s a good idea to try to work on improving your sleep now. That way, it’ll be potentially less disruptive later on.

Medications that help with hot flashes

If lifestyle changes haven’t helped your symptoms of perimenopause, there are medications that you can take. These may help reduce hot flashes and other symptoms that affect your sleep. 

There are both hormonal and non-hormonal options.

Hormone therapy

Hormone replacement therapy (HRT) is an effective treatment for perimenopausal symptoms like hot flashes and night sweats. HRT replaces reproductive hormones. It typically contains estrogen, progestin, or a combination of the two. 

There are a range of hormonal options available, including: 

• Patches

• Oral medications

• Gels

• Creams

• Injections

Non-hormonal treatments

A number of medications are available to treat perimenopause symptoms that don’t contain hormones:

• Veozah (fezolinetant) is a non-hormonal medication that plays a role in how the brain regulates body temperature.

• Antidepressants can help with mood issues that are affecting your sleep. And some have been shown to be effective for reducing hot flashes.

• Gabapentin (Neurontin) is an anti-seizure medication that may help reduce hot flashes and sleep problem symptoms. 

• Clonidine (Catapres-TTS) is a blood pressure medication that may help hot flashes and sleep problems. 

Natural remedies to improve sleep

There are natural remedies that can help your sleep during perimenopause as well. These supplements and herbal remedies may help with sleep or in reducing hot flashes and night sweats:

• Melatonin

• Herbal tea

• Phytoestrogens (like black cohosh and red clover) 

Always talk to your primary care provider or gynecologist before trying any supplements to make sure they’re safe for you to take.

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Written by:

Cathy Garrard

Cathy Garrard is a journalist with more than 20 years of experience writing and editing health stories. Her work has appeared in print and online for Everyday Health, Reader’s Digest, Prevention, USA Today, Self, Men’s Fitness, and dozens of other media outlets and healthcare brands.

Edited by:

Laurie Tarkan

Laurie Tarkan is a senior health editor for general health and well-being at GoodRx. She has an extensive background in health journalism, and wrote regularly for The New York Times for a decade.

Reviewed by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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