Key takeaways:
Perimenopause is when your estrogen levels start to decline before you reach menopause.
It’s common to have trouble sleeping during perimenopause. Common reasons for poor sleep are hot flashes, night sweats, and depression.
Good sleep habits, medications, and natural remedies can improve perimenopause insomnia.
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 having trouble falling asleep or staying asleep is also one of the symptoms of perimenopause. And it can start much earlier than you may think.
Reproductive hormones, like estrogen, start to decline in perimenopause. This often happens about 4 to 8 years before menopause starts. And this drop in hormone levels can cause insomnia and leave you feeling sleepy.
Let’s take a closer look at perimenopause insomnia and how to treat it so you can get a good night’s rest.
Is insomnia a common symptom of perimenopause?
Yes, perimenopause insomnia is common. In fact, close to half of perimenopausal women report regularly having trouble getting a good night’s sleep. Insomnia is a condition that makes it difficult to fall asleep, stay asleep, or both. And in perimenopause, you may notice these symptoms happening regularly.
If you’re in perimenopause and notice a sudden change in your sleep patterns, it’s a good idea to let a healthcare professional know. They’ll help you figure out if you’ve developed a sleep disorder or have another underlying cause for your sleep issues.
Why does perimenopause cause sleep problems?
Sleep problems in perimenopause are caused by a few factors. Let’s take a closer look at how perimenopause might cause you to get less sleep.
Hormonal changes
The drop in reproductive hormones, like estrogen and progesterone, can directly and indirectly affect your sleep. This can cause hormonal insomnia in perimenopause. Higher estrogen and progesterone levels help to promote restful sleep. And they decrease the likelihood of frequent awakening throughout the night. Lower levels of these hormones can also trigger other symptoms like night sweats, which can disrupt sleep as well.
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, which can make it harder to have a good night’s sleep.
Cortisol, the stress hormone, can also be elevated during perimenopause. Having high cortisol levels can lead to trouble falling asleep and staying asleep — and just poor-quality sleep in general.
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. 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.
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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 — as well as the quality of sleep. It can also raise the risk of sleep apnea, a common condition that disrupts your sleep.
Quiz: Are you in perimenopause?
How long does perimenopause insomnia last?
Perimenopause insomnia can last throughout the entire transition to menopause. This timeframe varies from person to person, but it can last anywhere from 4 to 10 years. However, insomnia can also continue for some people once they enter menopause. In fact, research shows that if you had sleep problems during perimenopause, you’re more likely to have sleep problems after menopause.
The good news is that there are treatments that can help you decrease the symptoms of perimenopause insomnia and get better rest at night.
How to get better sleep during perimenopause
Trouble sleeping can be difficult to treat. But when it’s related to perimenopause, there are several lifestyle changes you can try.
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 perimenopause insomnia
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
Menopause hormone therapy (MHT) — also known as hormone replacement therapy (HRT) — is an effective treatment for perimenopausal symptoms like hot flashes and night sweats. This treatment 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. It can help decrease the number and severity of hot flashes.
Antidepressants can help with mood issues that are affecting your sleep. And some have been shown to be effective for reducing hot flashes. A commonly prescribed antidepressant is paroxetine (Brisdelle).
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 during perimenopause
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:
Supplements: Herbal teas, melatonin, and phytoestrogens (like black cohosh and red clover) may help improve sleep.
Dietary changes: Eating more fruits and veggies and avoiding certain foods high in spice or sugar can improve your sleep.
Exercise: Adding exercise to your routine can improve your mood, quality of sleep, and overall energy.
Acupuncture: Research is mixed, but this ancient remedy may help to keep you cool and improve your hormone balance.
Always talk to your primary care provider or gynecologist before trying any natural remedies to make sure they’re safe for you.
Frequently asked questions
Hot flashes aren’t worse at night, but they can seem worse. Hot flashes actually happen any time during the day or night, but they can be more bothersome because of their effect on sleep. Hot flashes can keep you from falling asleep. Or they can cause you to get overheated in the middle of the night. These can both be very disruptive to your overall sleep time and sleep quality, making it feel worse.
Night sweats are typically thought to occur from a drop in both estrogen and progesterone, the reproductive hormones in women. There’s also evidence that a drop in melatonin during perimenopause may also be linked to both night sweats and insomnia.
There’s limited research showing that magnesium may help improve quality of sleep, but it’s not solid evidence. There’s currently no evidence that magnesium can help with perimenopause insomnia, but it’s an exciting area of research. Studies are currently underway to figure out if it’s helpful in decreasing sleep issues related to menopause.
Hot flashes aren’t worse at night, but they can seem worse. Hot flashes actually happen any time during the day or night, but they can be more bothersome because of their effect on sleep. Hot flashes can keep you from falling asleep. Or they can cause you to get overheated in the middle of the night. These can both be very disruptive to your overall sleep time and sleep quality, making it feel worse.
Night sweats are typically thought to occur from a drop in both estrogen and progesterone, the reproductive hormones in women. There’s also evidence that a drop in melatonin during perimenopause may also be linked to both night sweats and insomnia.
There’s limited research showing that magnesium may help improve quality of sleep, but it’s not solid evidence. There’s currently no evidence that magnesium can help with perimenopause insomnia, but it’s an exciting area of research. Studies are currently underway to figure out if it’s helpful in decreasing sleep issues related to menopause.
The bottom line
Many people in perimenopause report having trouble getting a good night’s sleep. Fluctuating hormones can cause hot flashes, night sweats, mood disorders, and weight gain — all of which have an impact on quality sleep. Medications, lifestyle changes, and herbal supplements may help you get a better night’s sleep. Talk to a healthcare professional about your treatment options. They can give you some guidance on the next steps you can take to get more sleep.
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