The Sleep Struggle Is Real: How to Rest Better in Perimenopause and Menopause

By Dr. Mary Knudsen, ND

If you’ve been lying awake at 2 a.m., staring at the ceiling and wondering why your brain won’t switch off—or waking up drenched in sweat and tangled in the sheets—you’re not alone. Sleep disturbances are among the most common and frustrating symptoms women experience in perimenopause and menopause.

Sleep disruption affects nearly half of perimenopausal women and up to 60% of postmenopausal women. And this isn’t just about tossing and turning—it can seriously impact your physical health, mental clarity, and overall quality of life.

Let’s unpack what’s going on—and what can actually help.

Why Does Menopause Mess With Sleep?

Hormonal shifts are at the heart of it. Estrogen and progesterone both play sleep-supportive roles:

• Estrogen helps regulate body temperature, serotonin, and REM sleep.

• Progesterone has calming, sedative effects that promote deeper, restorative sleep.

As these hormones decline during the menopause transition, sleep becomes more fragmented and less refreshing. But how it shows up can depend on where you are in the journey:

• In perimenopause, many women experience sleeping fewer than 7 hours per night, with frequent nighttime awakenings—often triggered by hot flashes, hormonal surges, or anxiety.

• In menopause, the pattern often shifts to trouble falling asleep and poor sleep quality. Even when you get “enough” hours, you may wake feeling exhausted, foggy, or moody.

4 Common Causes of Sleep Disruption in Menopause

1. Vasomotor Symptoms
   Hot flashes and night sweats can spike body temperature suddenly, waking you from sleep drenched and uncomfortable.

2. Mood Changes & Anxiety
   Fluctuating estrogen impacts brain chemistry. This can trigger anxiety, low mood, or racing thoughts—especially at night when everything feels louder.

3. Sleep-Disordered Breathing (OSA)
   Obstructive sleep apnea becomes more common after menopause. Unlike the typical male presentation of loud snoring, women often experience frequent awakenings, headaches, irritability, brain fog, and fatigue during the day.

4. Circadian Rhythm Disruption
   Changes in melatonin production and internal clock timing make it harder to fall asleep at your usual time—or cause you to wake up way too early.

The Impact of Poor Sleep

Sleep loss isn’t just annoying—it affects everything.

• Hot flashes and mood symptoms often worsen with poor sleep

• Memory, focus, and decision-making can suffer

• Risk for heart disease, insulin resistance, and weight gain goes up

• Emotional resilience and stress tolerance go down

• Over time, it can contribute to burnout, anxiety, and even depression

Your body and brain need rest to reset, repair, and function—and that’s especially true during the menopause transition.

What Actually Helps?

There’s no one-size-fits-all answer—but there are effective, evidence-based options that can make a real difference.

Before we dive into solutions, it’s important to say this:

Sleep hygiene alone—while helpful—is not enough to treat chronic insomnia.
Things like limiting screens, keeping a cool bedroom, and having a consistent routine can support better sleep quality, but they often don’t address the root causes of persistent sleep struggles in menopause.

1. Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is the gold standard for treating chronic insomnia. It helps you rewire unhelpful sleep patterns and reduce the anxiety around sleep itself. It’s especially powerful for menopause-related sleep disruptions.

2. Hormone Therapy (HT)

Estrogen therapy can significantly improve sleep for women experiencing hot flashes and night sweats. When started early in menopause and personalized to your health history, HT can be a safe and effective part of a broader sleep strategy.

3. Lifestyle Strategies (Sleep Hygiene)

These habits won’t “fix” insomnia alone—but they create a strong foundation:

• Consistent bedtime and wake-up time (yes, even weekends!)

• Cool, dark, quiet, screen-free sleep environment

• Avoiding caffeine, alcohol, and heavy meals late in the day

• Gentle evening wind-down routine (stretching, journaling, deep breathing)

• Daily movement and exposure to natural light

4. Targeted Supplements & Natural Support

Some women find benefit from magnesium, melatonin, L-theanine, or herbal therapies like ashwagandha or valerian. These should be tailored to your needs—and ideally guided by a provider who understands both hormonal and natural therapies.

When to Reach Out for Help

If your sleep problems are impacting your mood, energy, work, or relationships—it’s not “just stress” and you’re not imagining it.

You deserve support that takes your whole health picture into account: hormones, lifestyle, mental health, and beyond.

Bottom Line:

Sleep isn’t a luxury—it’s a lifeline. And during perimenopause and menopause, it often requires more care, support, and strategy. From CBT-I to hormone therapy to smarter sleep habits, you can reclaim your rest.

Because you’re not here to just survive this phase—you’re here to thrive. And that starts with sleep.