Perimenopause, the transitional phase leading up to menopause, often brings a variety of physical and emotional changes, with sleep disturbances being one of the most common, yet frustrating symptoms. As fluctuating hormone levels — especially estrogen and progesterone —begin to impact the body, many women find themselves tossing and turning at night, waking up frequently, or struggling to fall asleep altogether. Studies have noted that 33-51% of women experience sleep disturbance in the transition into menopause.
These sleep issues can affect energy levels, mood, and overall well-being, making it harder to navigate daily life. But the good news is that understanding the connection between perimenopause and sleep can help you take actionable steps to reclaim restful nights. Below is an in-depth look at why perimenopause disrupts sleep and, more importantly, what you can do about it. From lifestyle changes and nutrition to stress management techniques that promote better sleep, this is how to navigate this natural life stage.
Perimenopause Is a Transitional Period
Menopause is diagnosed after a woman has gone 12 months without a menstrual period. Due to decreases in ovarian function and reduced levels of hormones, such as estrogen, this time also marks the end of a woman’s fertile or reproductive years. Natural menopause (as opposed to medically, surgically induced menopause) generally occurs in a woman’s 40s or 50s, but the average age in the United States is 51.
In addition to sleep changes, common menopause symptoms include menstrual cycle changes (due largely to changes in hormones such as estrogen and progesterone), hot flashes, night sweats, abnormal uterine bleeding, mood changes, brain fog, vaginal dryness, discomfort during sex, and urinary symptoms like urgency and nocturia (urination during the night). Weight and body composition changes also commonly occur during this time.
Perimenopause is the transition phase leading up to menopause. It begins with the onset of changes to the menstrual cycle (many women find that their periods become less regular) and extends through the last menstrual period through the first year of menopause. Again, this can begin earlier or later, depending on the person — and it typically lasts between two to eight years — but the average duration of perimenopause is four years.
Read More: Deepak Chopra on Menopause, Reconnecting With Yourself at Midlife, and His Favorite Supplements
How Perimenopause Affects Sleep
The decrease in estrogen and progesterone impacts many systems and processes in the body beyond the menstrual cycle and fertility, including some that impact sleep. Hot flashes, mood disturbances, and changes in brain function may all contribute to sleep issues. Many women begin to find it harder to fall asleep, stay asleep, or both.
Sleep disturbances can be especially frustrating, given the toll that poor sleep can take on mental health, energy, fitness, and weight. Because chronic sleep deprivation also contributes to inflammation and impaired immune system function, consistently getting poor sleep has been linked to an increased risk of health conditions including heart disease, dementia, type 2 diabetes, and even certain cancers.
Simply telling women why it’s so important to get quality sleep, without addressing the underlying factors of their sleep issues, does them a huge disservice. It can also foster feelings of shame and make them feel like they’re losing control over their health.
Getting to Know Your Body Again
If you struggle with the unknowns that perimenopause brings, educating yourself about which hormones are changing and how that can impact your health may help demystify the situation and help you put a plan into action. This can be especially helpful if you’re someone who’s prone to tossing, turning, and fuming.
Talk to your doctor and get the appropriate bloodwork done to help get an idea of where your hormones levels are. Additionally, tracking your cycle basal body temperature (which is not affected by hot flashes, but can be affected by poor sleep), and indicators such as cervical fluid texture and volume — and symptoms like breast tenderness, fatigue, pelvic pain, backaches, and headaches — can be useful for noticing patterns and anticipating when you may be most likely to struggle with sleep. This will help you put a plan in place.
Even just tracking your basal body temperature to help estimate when ovulation occurred can be a good starting place, as it typically rises by about half a degree once ovulation has happened. You can also take advantage of the wide range of cycle tracking apps, wearables, and home hormone testing kits available.
For example, during the luteal phase (the days after ovulation, before your period starts), sleep disturbance is more likely to occur, so being able to identify when you are in that phase allows you to implement some additional sleep-supporting techniques.
Read More: 10 Ways to Improve Your Sleep Health
5 Tips to Improve Your Sleep Hygiene
There are a few sleep hygiene essentials that everyone should implement. If you’re not already, start with these:
- Keep the sleeping environment cool (about 65 degrees).
- Keep your room dark in order to avoid hindering the production of melatonin, a hormone that regulates your sleep cycle. If you have to be around lights or screens in the evening, consider wearing tinted blue light-blocking glasses. Eye masks are also a great choice if you can’t prevent light from coming into the bedroom.
- Keep your room quiet. Limiting distracting noises will help you drift off. If you need to, you can use a fan, white noise machine, or something else with a steady sound to help you drift off.
- Give yourself time to wind down. Give yourself at least 30 minutes to “power down.” Perhaps do some stretches, change into comfortable sleep clothes, do a meditation a or skincare routine, journal, or read.
- Have a consistent bedtime and wake-up time to train your body to know when it’s time to settle down.
4 Ways to Upgrade Your Sleep Routine
If you’ve already mastered the basics, a few upgrades to your nighttime routine can make a significant difference.
- Take a shower or a bath before bed. Exposure to warm water helps lower your core body temperature as your body works to cool itself, helping you fall asleep.
- Incorporate a mindfulness practice such as breathwork or meditation, or take a moment for gratitude to help you get into a calm, positive headspace to prepare for sleep.
- Journal it out! A pre-bed brain dump can help offload any lingering thoughts that may be making it difficult for you to drift off. This is also a great tool if you wake up in the night with a lot on your mind.
- Wear layers and consider investing in cooling sheets.
3 Healthy Daytime Habits for Improved Sleep
- Get daylight exposure, especially in the morning, to train your circadian rhythm — aka your inner clock — which regulates your sleep cycle.
- Exercise can also be helpful for promoting restful sleep and managing stress. The National Sleep Foundation suggests doing aerobic or resistance training in the morning, high-intensity training in the afternoon, and light resistance and aerobic exercise in the evenings. But what’s most important is that you have a sustainable physical activity routine.
- Address mental health concerns, as issues such as stress, anxiety, and low mood may impact sleep.
Read More: How Your Sleep Changes During Different Phases of Life
4 Nutrition Tips That Will Help You Sleep at Night
What you eat can also play a role in how you sleep. Here are a few things to keep in mind:
- Cap your caffeine intake at 400 mg per day (if not less) and try to consume it early in the day. If you struggle with sleep, aim to finish drinking caffeine by noon and switch to decaffeinated beverages later in the day.
- Consider taking a break from alcohol, as it can disrupt your sleep cycle, spike feelings of anxiety, and exacerbate hot flashes.
- If you eat late, keep it light so your body’s not working hard to digest as you’re trying to settle down. Aim to finish eating dinner two or three hours before bed. If you need a bedtime snack, aim for something small that is easy to digest about an hour before bed.
- Incorporate foods that contain sleep-promoting nutrients such as tryptophan (in poultry, fish, eggs, dairy, nuts, seeds, chickpeas, and oats); vitamin B6 (in fish, poultry, eggs, bananas, potatoes, spinach, and legumes); potassium (in avocados, bananas, tomatoes, leafy greens, potatoes, winter squash, and kiwi); magnesium (in nuts, seeds, dark chocolate, poultry, and leafy greens); calcium (in dairy products, tofu, broccoli, white beans, and almonds); carbohydrates (in fruit, starchy vegetables, grains, and certain dairy products); vitamin D (in oily fish and eggs yolks); and omega-3s (in oily fish, eggs, ground flaxseeds, chia seeds, and walnuts).
Sleep supplements have become very popular. A few that have been shown to be effective are magnesium glycinate, magnesium citrate or magnesium L-threonate, L-theanine and GABA, and tart cherry extract.
If you already take a calcium and/or vitamin D supplement, try taking it at night. Melatonin is best used in small doses for a short period of time when you want to re-establish your sleep cycle, such as when crossing time zones, during a daylight saving time change, or if you are adjusting to a new sleep schedule.
Always touch base with your healthcare provider before starting a supplement to avoid interactions and overdoses. Ideally, you want to introduce one at a time, unless otherwise directed, so you can get a sense of whether it’s helping. When shopping for sleep supplements, look for products that are third-party tested, are verified for efficacy and safety, and are distributed from reputable brands.
What to Do When You Can’t Sleep
If you’re finding it hard to stay asleep, you are not alone. This is an incredibly common occurrence for women in perimenopause. Here are a few things to do when you can’t sleep:
- Don’t look at the clock, as this can cause you to start doing math in your head. (If I fall asleep now, I can get this many hours…)
- Don’t pick up your phone or tablet or turn on the TV. This will disrupt melatonin levels and could trigger anxiety or active thoughts that keep you up.
- If what feels like 15-20 minutes go by (or you start to get frustrated), get out of bed and go into another room. Do a calming activity such as reading, journaling, a puzzle, or a word search.
- Take a warm shower or bath (especially if you didn’t before bed) to help lower your core body temperature.
- Jot down any to-do list items or anxious thoughts that are making it hard to drift back off to sleep. This helps your brain recognize that you’re safe, and you don’t have to worry about remembering these things. Rather than turning on a light, use a dim lamp or a clip-on light.
When Should You See a Sleep Specialist?
A sleep specialist can be a very valuable resource. If you feel like you’ve tried everything above yet are still struggling, a sleep specialist can conduct an individualized assessment, order the appropriate sleep tests, and rule out or diagnose an underlying condition that may be contributing to your sleep struggles.
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