Menopause and Sleep Problems: How to Cope with Perimenopausal Insomnia
If you hit perimenopause and suddenly found yourself tossing & turning, waking in the night and feeling exhausted, you’re not alone.
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, why it affects sleep and how you can sleep 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. It usually starts between the ages of 45-55 and can last anywhere between a few months to over a decade.
There are many symptoms of perimenopause, including but not limited to:
Changes to your periods
Mood changes
Brain fog or trouble concentrating
Hot flushes
Night sweats
Headaches
Joint pain
Weight gain
Dizziness
Genitourinary symptoms
Skin changes
Sleep problems
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 or medical treatment.
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
Trouble sleeping is one of the most common menopause symptoms. 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 research states that 40-56% of menopausal women report difficulty sleeping (British Menopause Society, 2025).
The main changes relating to sleep in the menopause include increased sleep fragmentation, awakenings & poor sleep quality.
Why does menopause cause sleep disturbances?
Difficulty sleeping during the menopause is often considered to be an inevitable consequence of a biological transition.
But sleep problems during the menopause often have multiple contributing factors, with biological, psychological and social factors combining to contribute to sleep disturbance.
This is why The British Menopause Society states that managing trouble sleeping during the menopause often requires a “comprehensive, multidisciplinary approach”.
Factors contributing to menopausal trouble sleeping may include:
✅ Nature and severity of menopause symptoms
✅ Hormonal changes are associated with more frequent waking during the night
Although oestrogen, progesterone and testosterone decline during the perimenopause, this doesn’t happen in a linear way. Hormone levels can go up and down, fluctuating dramatically and these fluctuations are responsible for vasomotor symptoms which often impact sleep.
Research also suggests that these hormonal changes affect our body clock, or circadian rhythm, due to the impact on serotonin.
✅ Mood changes and stress
The relationship between sleep and mood is bidirectional (two-way), with mood impacting sleep and vice versa.
✅ Medical conditions and medications
✅ Sleep disorders (such as sleep apnoea, restless leg syndrome or chronic insomnia)
✅ Contextual considerations
These might include general health & lifestyle, cultural attitudes towards menopause and aging, caring responsibilities to children or aging parents and work demands.
✅ Vasomotor symptoms
Hot flushes are strongly associated with increased awakenings.
✅ Aging
Sleep quality often decreases with age. 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, which may be due to the gradual shift in circadian rhythm.
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.
✅ Nocturia (waking during the night to use the bathroom)
Insomnia and the menopause
It is estimated that 26% of perimenopausal women meet the criteria for an insomnia diagnosis (BMS, 2025).
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.
Symptoms must be experienced at least three nights per week for three months or longer to meet the official criteria for chronic insomnia.
It is also important to rule out any other potential causes of poor sleep, such as anaemia & thyroid problems, or other sleep disorders.
Treating menopausal insomnia
As discussed above, various biological, psychological and social factors can trigger or contribute to menopausal trouble sleeping and insomnia. You may have resigned yourself to thinking that poor sleep is just something you have to put up with now, but this is not the case.
While poor sleep may initially be caused by hormonal changes, if it develops into insomnia, multiple factors become involved in maintaining the problem.
These maintaining factors might include sleep anxiety, stress, unhelpful habits, a negative association between the bed & sleep or a new learned sleep pattern.
Maintaining factors play a key role in keeping insomnia going, even if the initial trigger has passed. For example, maybe your difficulty sleeping was triggered by hot flushes or night sweats and taking HRT helped to reduce them, yet you still can’t sleep. This is where those maintaining factors come into play.
Fortunately, these factors are within our control and addressing them makes a big difference to improving sleep.
Evidence-based, therapeutic approaches, such as CBT for Insomnia and Acceptance & Commitment Therapy for Insomnia are highly effective in treating insomnia, helping you identify and address the specific factors keeping your trouble sleeping going.
How to sleep better during the menopause
Menopause is a highly individual experience and it’s really important to understand your options when it comes to navigating this transition. It is important to speak to a medical professional about your individual symptoms and concerns, to find the right support for you.
There are various actions you can take yourself to improve sleep quality during the menopause too.
Dealing with night sweats and hot flushes (vasomotor symptoms)
During the menopause, the body produces less and 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.
In your brain is the hypothamlamus, which you can think of as being like a thermostat. Before menopause, your body could tolerate quite a broad temperature range before overheating or underheating.
In the perimenopause, that temperature range narrows, so small temperature changes in your body or environment can trigger hot flushes, which are your body’s way of cooling you down.
Hot flushes are frequently linked to poor sleep and insomnia. Hot flushes and night sweats can sometimes trigger feelings of panic, a racing heart, palpitations, feeling hot and sweaty, and experiencing an adrenaline rush.
NICE guidelines recommend offering HRT to people with menopausal vasomotor symptoms. The guidelines also suggest considering menopause-specific CBT for vasomotor symptoms either in addition to HRT or on it’s own (for people who prefer not to try other options or where other options are not suitable). Where treatment of vasomotor symptoms does not lead to sleep improvements or symptoms suggest chronic insomnia, CBT for Insomnia (CBT-I) is recommended by the British Menopause Society.
You may also be able to make lifestyle adjustments to help 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 multiple layers of bedding or a separate duvet to your partner that you can take on and off as needed
Waking multiple times in the night can be really frustrating and you may feel the pressure to get back to sleep quickly. But this pressure to get back to sleep is often the exact thing keeping you awake for longer.
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?Paradoxically, by accepting wakefulness and allowing yourself to relax, without the pressure of getting to sleep, you set the stage 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.
Focus on adaptation
Your body is going through a physiological process and it is normal for your sleep to be affected by this. Focussing on adaptation can be a more helpful approach than trying to “fix” your sleep.
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. You can think of it as your ‘appetite’ for sleep. 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
Therapy
You might be thinking, “How will therapy help? It’s not going to stop me experiencing the menopause.”
But what therapy can do is help with some of the factors contributing to trouble sleeping and the menopause experience.
This may look like:
🛋️ Supporting you in navigating the menopause transition & building psychological skills, so that it has less control over your life
🥵 Dealing with hot flushes & night sweats using menopause-specific CBT or hypnotherapy
🪴 Managing worry & stress which can contribute to symptom intensity
💤 And addressing chronic insomnia symptoms
Further reading: What Is Sleep Therapy? How to Overcome Insomnia Without Medication
As a therapist, I draw on evidence-based approaches, such as Cognitive Behavioural Therapy for Insomnia (CBT-I) and Acceptance & Commitment Therapy (ACT) to tailor therapy to you. So that you can feel calmer in day-to-day life, have better quality sleep and continue doing the things that matter most to you.
References
British Menopause Society (2025) Managing sleep disturbance during the menopause transition.
British Menopause Society (2026) Cognitive Behavioural Therapy (CBT) for menopausal symptoms.
BUPA (2023) What is the perimenopause? https://www.bupa.co.uk/newsroom/ourviews/perimenopause
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/
Hickey, M., LaCroix, A. Z., Doust, J., Mishra, G. D., Sivakami, M., Garlick, D., Hunter, M. S. (2024) An empowerment model for managing menopause. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext
NICE (2026) Menopause: identification and management https://www.nice.org.uk/guidance/ng23/chapter/recommendations
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