Menopause and Sleep Problems: How to Cope with Perimenopausal Insomnia
Perimenopause and menopause are associated with increased risk of sleep problems, with sleep disorders being one of the top concerns of menopausal women.
So in this article, I’ll be exploring what the menopause is, how it can affect your sleep and my top tips for sleeping better during the menopause.
Disclaimer: Please remember that this blog post is for educational purposes only and is not a substitute for medical advice. If you feel you need more help I encourage you to seek support from a qualified health professional or contact your GP.
Table of Contents
What is the difference between perimenopause and menopause?
Perimenopause is a physiological transition period, referring to the last years of a woman’s reproductive period before menopause.
There are many symptoms of perimenopause, including but not limited to:
Changes to your periods
Changes to your mood
Brain fog or trouble concentrating
Hot flushes
Headaches
Joint pain
Weight gain
Skin changes
The NHS states that perimenopause ends, and menopause is reached, when you have not had a period for 12 months due to lower hormones. Menopause can happen naturally or due to other reasons, such as surgery.
Perimenopause and menopause symptoms can last for many years and have a big impact on your life and work, including sleep.
The link between menopause and sleep problems
Sleep issues in menopause are really common. Research has shown that the incidence of sleep problems in perimenopausal women is 1.3 to 1.6 times that of premenopausal women (Zeng et al., 2025).
Other studies suggest that 40-60% of postmenopausal women experience insomnia (Hachul et al., 2023 and Pengo et al., 2018). We’ll take a look at exactly what insomnia is in a moment.
The main changes relating to sleep in the menopause include increased sleep fragmentation, awakenings & poor sleep quality.
The decline in oestrogen & progesterone experienced during the menopause may be one factor contributing to an increase in sleep disorders.
⏰ Research suggests that these hormonal changes affect our body clock, or circadian rhythm, due to the impact on serotonin.
Our circadian rhythm is also affected by aging and this may be related to hormonal changes in women. Normally, as you prepare to fall asleep, your core body temperature naturally drops. This is also strongly associated with secretion of melatonin.
🌡️ But in postmenopausal women, this drop in core body temperature is blunted, which may impact ease of falling asleep or staying asleep.
Additionally, postmenopausal women are more likely to express a morning or “lark” chronotype rather than an evening “owl” chronotype.
Aging is also associated with sleep fragmentation, insomnia and changes to sleep structure, independent of hormonal changes. As people age, they tend to go to bed earlier and wake up earlier, sleep tends to get shorter and lighter, and they may wake more often during the night.
🧠 Another factor that may affect sleep in the menopause is mood disorders, such as depression and anxiety. The relationship between sleep and mood may be bidirectional, with mood impacting sleep and vice versa.
Aside from insomnia, menopausal women are also more at risk of sleep apnoea and restless leg syndrome.
What is insomnia?
Insomnia involves difficulty falling asleep, staying asleep or waking too early and being unable to get back to sleep. You don’t have to experience all three to have insomnia.
This non-restorative sleep also leads to trouble with day-to-day functioning, such as fatigue, irritability, difficulty concentrating or increased anxiety.
Insomnia can be short-term or chronic, but to receive a diagnosis, symptoms must be experienced at least three nights per week for three months or longer.
Insomnia can be diagnosed by a qualified professional, such as your GP. It is also important to rule out any other potential causes of poor sleep, such as anaemia & thyroid problems, or other sleep disorders.
Whether you experience poor sleep or insomnia, there are things you can do to help you sleep better during the perimenopause and menopause.
As a sleep therapist, I help my clients to make sustainable improvements to their sleep, so they can feel calmer and have more energy, regardless of whether they have an insomnia diagnosis.
Menopause symptoms and sleep
There are several factors that may be involved in triggering & maintaining trouble sleeping during the perimenopause and menopause. These include:
Hormonal fluctuations
Hot flushes
Night sweats
Anxiety, low mood or stress
Other health conditions or pain
It is likely that a combination of factors together trigger trouble sleeping during the menopause.
How trouble sleeping can become a long-term problem
In order to cope with the discomfort and poor sleep, you may unintentionally engage in unhelpful thinking and behaviour patterns or habits. These habits may serve a short-term purpose, but inadvertently make sleep worse in the long-term.
These thoughts, beliefs and behaviours play a key role in maintaining poor sleep or insomnia, even if the initial trigger has passed.
Some examples of unhelpful habits include:
🛌🏻 Regularly lying-in on weekends or when you’ve had a bad night – this can make it harder to sleep the following night and confuse your body clock, making it difficult for your body to get into a healthy sleep-wake rhythm
⌚ Monitoring or tracking your sleep using an app or fitness watch – this can increase anxiety around sleep, making it more difficult to sleep
Fortunately, these maintaining factors are within our control. Addressing these thoughts and behaviours can make a big difference to improving your sleep.
How to sleep better during the menopause
It is important to speak to a medical professional about your individual symptoms and concerns. You may also consider speaking to your GP about whether hormone replacement therapy (HRT) is right for you, if you haven’t already.
In the meantime, below are some actions you can take yourself to improve sleep quality during the menopause too.
Dealing with night sweats and hot flushes
During the menopause, the body produces increasingly less oestrogen which means the brain becomes more sensitive to shifts in temperature. This inability to correctly regulate body temperature leads to hot flushes and night sweats.
Hot flushes are frequently linked to poor sleep and insomnia. Hot flushes and night sweats can sometimes trigger feelings of panic, a racing heart, feeling hot and sweaty, and experiencing an adrenaline rush.
Although you can’t control hot flushes, is there anything you can do to adapt to this physiological shift? Are there any changes you can make to your sleep environment to make it more comfortable? Here are some examples:
Keep the bedroom cool, for example using a fan or having the window open
Wear cotton pyjamas rather than synthetic materials as this will help regulate your body temperature better. You could keep a fresh pair by your bed so you can quickly change in the night if required
Have a separate duvet to your partner that you can take on and off as needed
If you can’t get back to sleep straight away, can you use this time in bed as an opportunity to rest and restore your energy? By resisting being awake, it becomes even harder to fall asleep.
Paradoxically, by accepting wakefulness and allowing yourself to relax, without the pressure of getting to sleep, you cultivate the conditions needed for sleep to occur naturally again.
Managing anxiety
Anxiety and worry are key factors in keeping poor sleep going. You may experience general anxiety or anxiety specifically about your sleep.
If you’ve been struggling to sleep for several weeks, months or even years, it’s understandable you may feel anxious about your lack of sleep.
Tiredness can also make it harder to regulate your emotions, such as anxiety.
The trouble is this increased anxiety activates your body’s ‘threat’ response, sending a signal that you’re not safe. This makes it even harder to sleep, keeping you stuck in a cycle of anxiety and poor sleep.
As a therapist, I help my clients learn ways to manage anxiety and worry, so that they can feel calmer and start sleeping better.
Check out my free masterclass below, where I share more about how what sleep anxiety is, how it fuels poor sleep and practical techniques you can start using tonight to help you feel calmer and get back to sleep.
Focus on adaptation
Focus on adaptation rather than ‘fixing’ your trouble sleeping.
Your body is going through a physiological process and it is normal for your sleep to be affected by this. Trying to force sleep is counterproductive, increasing anxiety and frustration, making it even harder to get a good night’s rest.
Remember that your body knows how to sleep and it can adjust. Your body isn’t broken but is going through a big transition. You’re coping better than you think.
Avoid naps
Although it may be tempting to take an afternoon nap, this is generally not helpful, particularly in the late afternoon or evening. This is because you need a high sleep drive in order to sleep at night.
Sleep drive is what makes you sleepy, increasing the likelihood of you falling asleep and staying asleep. It builds up throughout the day, the longer you are awake, and reduces when you sleep.
If you take a nap, you are reducing your sleep drive which may mean you are not sleepy until later at night, or that you struggle to stay asleep.
Further reading: Sleep Hygiene: 6 Healthy Habits for a Better Night’s Rest
Sleep therapy
If you struggle with insomnia or simply would like more personalised support, sleep therapy may be helpful.
Further reading: What Is Sleep Therapy? How to Overcome Insomnia Without Medication
As a sleep therapist, I combine Cognitive Behavioural Therapy for Insomnia (CBT-I) with other evidence-based approaches to tailor therapy to you.
CBT-I is commonly recommended as the first-line treatment for insomnia, with multiple research studies indicating its effectiveness.
Together we can address the specific factors maintaining your trouble sleeping, including thinking and behaviour patterns, so that you can feel calmer, sleep better and have more energy for the things that are important to you - whether that’s spending time with family, focussing on your career or achieving your fitness goals.
References
Buysse, D. J., Germain, A., Hall. M., Monk, T. H., Nofzinger, E. A. (2011) A Neurobiological Model of Insomnia. https://pmc.ncbi.nlm.nih.gov/articles/PMC3212043/
Hachul, H., de Campos, B., Lucena, L., Tufik, S. (2023) Sleep during menopause. https://pubmed.ncbi.nlm.nih.gov/38501515/
NHS (2022) Menopause. https://www.nhs.uk/conditions/menopause/
Pengo, M. F., Won, C. H., Bourjeily, G. (2018) Sleep in Women Across the Life Span. https://pmc.ncbi.nlm.nih.gov/articles/PMC6045782/
Tandon, V. R., Sharma, S., Mahajan, A., Mahajan, A., Tandon, A. (2022) Menopause and sleep disorders. https://pmc.ncbi.nlm.nih.gov/articles/PMC9190958/
Zeng, W., Xu, J., Yang, Y., Lv, M., Chu, X. (2025) Factors influencing sleep disorders in perimenopausal women: a systematic review and meta-analysis. https://www.frontiersin.org/articles/10.3389/fneur.2025.1460613/full