Perimenopause—the transitional stage leading up to menopause—can be a confusing and sometimes frustrating time. It usually begins in a woman’s 40s (though it can start earlier) and can last several years before the menstrual cycle fully stops. One of the most common yet overlooked symptoms during this phase is disrupted sleep.
Hormonal fluctuations are at the heart of most perimenopausal symptoms, and they play a major role in sleep disturbances:
Estrogen Decline
Estrogen helps regulate serotonin and other neurotransmitters that affect sleep. As estrogen levels dip, women may notice more frequent insomnia, nighttime awakenings, and mood-related sleep issues.
Progesterone Decline
Progesterone has a natural calming, sedative-like effect. Lower levels can reduce this soothing influence, making it harder to fall asleep and stay asleep.
Hot Flashes and Night Sweats
Sudden surges of heat and sweating at night are classic perimenopausal symptoms. They often wake women suddenly, sometimes multiple times per night, leading to fragmented and unrestful sleep.
Mood and Stress Changes
Hormonal shifts can also contribute to anxiety, irritability, or depression—all of which can make restful sleep harder to achieve.
Other Health Changes
During perimenopause, women may be at higher risk for sleep apnea, restless legs syndrome, or increased nighttime urination, further adding to sleep difficulties.
Trouble falling asleep
Waking up multiple times at night
Night sweats soaking sleepwear or sheets
Early morning waking and inability to return to sleep
Daytime fatigue despite “enough” hours in bed
While sleep challenges may feel overwhelming, there are ways to improve rest during this transition:
Cool the Bedroom: Lowering the thermostat, using breathable bedding, or trying moisture-wicking pajamas can ease night sweats.
Consistent Bedtime Routine: Sticking to regular sleep/wake times supports circadian rhythms.
Mind-Body Practices: Meditation, yoga, or deep breathing can reduce stress and help calm the nervous system before bed.
Limit Triggers: Alcohol, caffeine, and spicy foods can worsen hot flashes and disrupt sleep.
Exercise: Regular physical activity can improve sleep quality, but try to avoid vigorous workouts too close to bedtime.
Consider Medical Support: Hormone replacement therapy (HRT), non-hormonal medications, or supplements may be options for women with severe sleep disruption—always discuss with a healthcare provider.
Sleep problems in perimenopause are common, but they don’t have to be endured in silence. Understanding the role of shifting hormones, making supportive lifestyle changes, and seeking medical guidance when needed can all help improve rest.
Better sleep during perimenopause doesn’t just ease fatigue—it supports mood, memory, heart health, and overall quality of life during this important stage of transition.
If you or someone you know struggles with sleep, please click the orange button below to take a free online sleep test and talk with one of our sleep health professionals.