Perimenopause sleep issues are common. You might experience insomnia, night sweats, and difficulty staying asleep.
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Key Takeaways:
More than 40 percent of women report sleep problems during perimenopause.
Perimenopause sleep issues can include trouble falling and staying asleep, waking up too early, insomnia, and sleep apnea.
Hormone replacement therapy, non-hormonal medications, and lifestyle changes can ease perimenopause symptoms and improve your sleep during this time.
Perimenopause sleep issues are common. You might experience insomnia, night sweats, and sleep apnea as you get closer to menopause, or the end of your menstrual period. Changes in hormone levels typically bring on these sleep problems.
Hormone replacement therapy, sleep medications, and lifestyle adjustments can help ease symptoms and improve sleep.
Keep reading for more on perimenopause sleep problems, including the causes and treatments.
You might experience several different sleep issues during perimenopause, such as:
Trouble falling asleep
Trouble staying asleep
Waking up too early
Sleep-related breathing disorders, like sleep apnea
Movement disorders, like restless legs syndrome and periodic limb movement disorder
You’re not alone if your sleep is suffering: More than 40 percent of women report sleep problems during perimenopause.
And it’s not something you should ignore: A lack of sleep doesn’t just lead to low energy, trouble focusing, and poor overall well-being. Sleep deprivation can increase your risk of conditions like cardiovascular disease, obesity, and depression, among others.
And, unfortunately, sleep problems don’t necessarily go away when you enter menopause, either.
Perimenopause sleep issues are caused by a few different factors, including:
Hormones. Estrogen and progesterone levels start to fluctuate during perimenopause. These hormones play a role in sleep quality, sleep-disordered breathing, and helping you fall asleep faster and stay asleep longer. Falling hormone levels can also reduce melatonin production, the hormone that regulates your sleep-wake cycle.
Night sweats. Suddenly feeling extremely hot and sweaty (aka night sweats or hot flashes) is a common symptom of menopause. But it also affects up to 80 percent of women in perimenopause and can cause sleep disruption.
Increased urination. Needing to use the bathroom at night (nocturia) disrupts your rest, and you might struggle to fall back to sleep after a bathroom trip.
Sleep disorders. Insomnia, restless legs syndrome, and sleep apnea are more common during perimenopause, after menopause, and with age.
Mood changes. Perimenopause symptoms include mood swings, anxiety, and depression, all of which can cause trouble sleeping.
Aging. As we age, our sleep-wake cycles and melatonin production become more dysregulated. You might also experience more back pain, joint pain, or medical issues that cause poor sleep.
Weight gain. Hormonal changes during perimenopause can affect your appetite, metabolism, and fat distribution, leading to weight gain. Overweight and obesity are risk factors for obstructive sleep apnea and other sleep issues. Learn more about menopause weight gain.
Hormone replacement therapy, non-hormonal medications, and lifestyle changes can help you get better sleep during perimenopause and beyond.
Here are more details on your treatment options.
Hormone replacement therapy (HRT) — sometimes called menopause hormone therapy — is when you take hormone treatments to top up low levels in your body.
Healthcare providers usually prescribe HRT to women after menopause, but you can also get HRT during perimenopause to reduce symptoms and sleep problems.
This can include taking estrogen or progesterone, which come in pills, capsules, patches, creams, gels, and sprays.
Studies are mixed, but research shows HRT may improve:
How much sleep you get in total
How quickly you fall asleep
How often you wake up during the night
Sleep satisfaction
Insomnia
Sleep apnea
HRT can also help with hot flashes, which can improve your sleep if you get them at night.
Different types of HRT, such as estrogen, estradiol, and progestin, can improve different sleep symptoms. A healthcare provider can look at your medical history and symptoms to determine if HRT is right for you and which type would be most beneficial.
Starting HRT younger than 60 or within 10 years of starting menopause can help treat vasomotor symptoms (like hot flashes) without as many health risks, according to the North American Menopause Society. Reach out to a healthcare provider sooner rather than later.
Beyond HRT, non-hormonal medications can improve perimenopause symptoms and sleep problems.
Some options include:
Antidepressants to improve depression, anxiety, and hot flashes
Melatonin to regulate your sleep-wake cycle and reduce insomnia
Gabapentin to reduce hot flashes
Sleep medications like benzodiazepines and Z-drugs, when appropriate
Sleep hygiene is the set of habits that can make or break your sleep. Improving your sleep hygiene can help you fall and stay asleep, even during perimenopause.
Here’s what to do:
Keep stress in check. Try winding down before bed with calming activities like journaling, meditating, or breathing exercises. Perimenopause mood changes or challenging events during this time of life (like caring for aging parents) may mean you have more stress to manage these days.
Keep your bedroom cool. This is especially important if you’re experiencing night sweats. Cool down your bedroom, wear lightweight PJs, and use cooling bedding or layers you can easily throw off during the night.
Cut down on caffeine. Avoid caffeine in the late afternoons and evenings to fall asleep more easily. Caffeine (at any time) can also trigger hot flashes, so cutting back is a win-win.
Exercise. Regular exercise can help you manage your weight and improve your sleep and mood. Just be sure to avoid high-intensity exercise within an hour before bed, as it might keep you up.
Stick to a regular sleep schedule. Try to go to sleep and wake up at the same times every day, even on weekends and holidays. This helps regulate your circadian rhythm, making it easier to fall asleep at bedtime.
If you’re noticing symptoms of a sleep disorder, reach out to a healthcare provider. They can help diagnose you and recommend the best treatments to try.
For example, for insomnia, a provider may recommend cognitive behavioral therapy for insomnia (CBT-I). CBT-I is made up of:
Sleep hygiene improvements
Cognitive therapy to debunk misguided beliefs contributing to poor sleep
Sleep restriction, or temporarily reducing time in bed
Stimulus control, or using your bed for sleep and sex only, and getting out of bed if you can’t fall asleep
Research shows telephone-based CBT-I can improve perimenopausal sleep issues, including insomnia, sleep quality, the time it takes to fall asleep, time awake at night, and even how much hot flashes interfere with sleep.
For sleep apnea, your provider may recommend:
A continuous positive airway pressure (CPAP) machine
Sleeping with a mouthpiece
Weight loss if you have overweight or obesity
Perimenopause sleep problems are common, but they are also treatable. Here’s a reminder of the key facts:
Sleep is tough during perimenopause. You’re not alone. Many women struggle with insomnia, sleep apnea, and night sweats during perimenopause.
Shifting hormone levels interfere with sleep. Falling progesterone and estrogen levels contribute to many of the perimenopause symptoms and other sleep issues that disrupt your rest.
Treatments are available. Hormone replacement therapy, non-hormonal medications, and good sleep hygiene habits can help you manage perimenopause sleep issues so you can get better rest.
It’s key to consult a healthcare provider about your symptoms and treatment options. They’ll help you decide if hormone replacement therapy is right for you, or if other perimenopause treatments are more suitable.
You may be in perimenopause if you’re in your mid to late 40s and you’re starting to experience:
Irregular periods
Mood changes
Sleep problems
Hot flashes
Vaginal dryness
Pain during sex
Perimenopause symptoms include:
Irregular periods
Longer or shorter periods
Sleep issues
Hot flashes
Mood changes
Vaginal dryness
Painful sex
Low libido
Some women also experience more unusual perimenopause symptoms, such as digestion issues, breast soreness, and dry mouth or eyes.
Perimenopause insomnia treatments include cognitive behavioral therapy for insomnia, supplements like melatonin, medications for hot flashes like gabapentin, and sleep medications like benzodiazepines and Z-drugs, when appropriate.
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