Why Sleep Gets Harder in Perimenopause and Menopause (and What Helps)

I’m a woman in perimenopause, and I want to say first: I have so much compassion for what you’re going through. If your nights feel restless, fragmented, or just plain exhausting, you are far from alone. Sleep difficulties are one of the most common—and most disruptive—symptoms of perimenopause and menopause.

During this time, many of us need more sleep, e.g. nine hours rather than the typical eight, and we rely on a consistent, structured sleep schedule to get truly restorative rest. Self-care becomes not just helpful, but essential. When sleep suffers, it’s harder to meet life’s demands, feel like ourselves, and enjoy our days. Sleep isn’t a luxury—it’s a basic biological need.

For years, many people have pushed through with poor sleep, sacrificing rest for children, aging parents, or careers. But during this hormonal transition, our bodies often insist we learn—sometimes the hard way—that our basic needs aren’t just basic, they are central.

Why Sleep Changes

The root cause is largely hormonal. As estrogen and progesterone levels fluctuate and eventually decline, the body’s natural sleep regulation is disrupted.

• Estrogen and progesterone shifts – Progesterone has calming, sleep-promoting effects. When it drops, it’s harder to fall and stay asleep. Estrogen influences serotonin and dopamine (mood regulators) and melatonin (the body’s sleep hormone), which can throw the sleep–wake cycle out of balance.

• Increased anxiety and mood changes – Lower estrogen can heighten anxiety and depression, making stress harder to manage and relaxation harder to access at night.

• Hot flashes and night sweats – These sudden heat surges can jolt you awake and prevent deep, restorative sleep.

• Circadian rhythm disruption – Shifts in estrogen, dopamine, and melatonin can alter your sleep timing, leaving you waking too early or feeling wired when you should be winding down.

  
  

What Can Help

The good news: there are proven strategies to support better sleep during perimenopause and menopause.

• Sleep hygiene basics: To name a few: keep a consistent bedtime and wake time, limit caffeine and alcohol (especially later in the day), and keep your bedroom cool, dark, and quiet.

• Slowing Down and Prioritizing: In perimenopause, our bodies and minds often work so much HARDER to adjust to hormonal changes that can bring brain fog, low motivation, pain, and increased sensitivity (to name a few symptoms). Taking breaks, practicing  self-compassion/gentleness, saying no, and prioritizing how we spend our precious time becomes essential.

• Medical support: For some women, hormone replacement therapy (HRT) or non-hormonal medications can ease hot flashes, mood changes, and sleep disruption. Talk to your healthcare provider about options. Often this is the first line of help for sleep and peri/menopause symptoms. After your hormones are more stabilized, engaging in sleep skills becomes more effective.

• Healthy daily rhythms: Regular meals and snack times help stabilize your body’s internal clock and support deeper rest.

• Cooling strategies for night sweats: Choose lightweight, breathable bedding and clothing made of natural fibers that wick moisture and allow airflow. Layering lets you adjust as your body temperature shifts. Cooling pillows or blankets can also bring relief, though I have not tried them.

• Supplements: Some supplements may help peri/menopause symptoms. For safe, effective options, seek guidance from a naturopath or functional medicine doctor trained in perimenopause who can recommend high-quality supplements suited to your needs.

• Mind-body practices: Breathing exercises, guided meditations, or gentle stretching before bed can calm the overstressed body.

• Movement: Regular physical activity supports hormone regulation, reduces stress, and improves sleep quality.

• Cognitive Behavioral Therapy for Insomnia (CBT-I): Research shows CBT-I is one of the most effective treatments for insomnia, often outperforming medication.

  
  

A Compassionate Note

If your sleep feels broken, it’s not your fault. These changes are part of your body’s natural transition—and they are real. With the right tools, support, and care, it is possible to reclaim restorative rest. You may already be the best expert on your own body. I know I’ve learned more about mine through this process than I ever expected.