After a tiring day, you snuggle under the covers, hoping to drift off to dreamland. But instead, you lie awake, and the minutes (or hours) tick by without a dream in sight. Or maybe you fall asleep quickly, but wake up at 3 a.m. and can’t get back to sleep.  

Such scenarios are not uncommon for women in perimenopause and menopause with declining hormone levels, as lower levels of estrogen and progesterone are associated with sleep disturbances. In fact, almost 50% of perimenopausal women and up to 60% of menopausal women suffer from some type of insomnia.

For many women, nighttime awakenings are the biggest sleep disruptor, with hot flashes being a frequent contributor. Studies show that women with moderate to severe hot flashes are about 3 times more likely to wake up at night compared to those who don’t have hot flashes. Another sleep-robbing culprit is bladder issues that lead to traipsing to the bathroom during the night.

No matter the reason for the sleep interruptions, the lack of rest has many of us waking up just as tired as when we crawled into bed.  

Why sleep matters  

Is getting 7-8 hours of sleep each night really that important? Yes! Sleep is crucial for wellness.

Your body performs all kinds of health-promoting processes while you sleep, like repairing cells, storing new information in your brain, and removing toxic byproducts. Sleep supports your immune system, heart health, and efficient insulin function.

So, it makes sense that poor sleep may put you at higher risk for chronic health conditions, including high blood pressure, heart disease, and obesity. And when you’re sleep-deprived, you may have trouble concentrating, suffer from memory issues, and have a higher risk of accidents from drowsy driving.

Improve your sleep hygiene during perimenopause and menopause

To protect your vitality and get adequate rest, make better sleep hygiene part of your self-care routine. Try these strategies to up your sleep game.

1. Avoid caffeine and alcohol after lunch. That means coffee, tea, and even chocolate. Caffeine may keep you from falling asleep, and alcohol may make it difficult to stay asleep.  

2. Get some exercise every day. Go for a walk, dance in your living room, ride a bike, or do whatever activity you enjoy. Studies show that moderate-intensity exercise is associated with better sleep quality.

3. Create a sleep-friendly routine. Go to bed and get up at the same time every day, even on weekends. At bedtime, have a relaxing ritual to help you wind down from the day. Sip herbal tea, like chamomile or mint. Listen to soft music or read a book.  

4. Stop using screens at least an hour before bedtime. To help your body prepare for sleep, power down your TV, computer, tablet, and phone. The harsh light from these screens prevents your pineal gland from releasing melatonin, a sleep-promoting hormone. If you must view a screen, wear blue light-blocking glasses.  

5. Make your bedroom totally dark. Unplug the night light. Use light-blocking curtains to quash outside light. Cover pinpoint lights on devices, because even the tiniest light, like the red dot on a smoke detector or air cleaner, can seem bright in total darkness. If your bed partner watches TV or uses their phone at night, consider wearing an eye mask.

If you’ve worked on your sleep hygiene, but still have insomnia, melatonin supplements may be an option. Melatonin plays a role in helping you fall asleep faster and stay asleep. For more help with sleep, ask your provider if bioidentical hormone replacement therapy (BHRT) might be a good solution for restoring your sleep-promoting hormones.

1. Schaedel Z, Holloway D, Bruce D, Rymer J. Management of sleep disorders in the menopausal transition. Post Reprod Health. 2021;27(4):209-214.  
2. Tandon VE, Sharma S, Mahajan A, et al. Menopause and sleep disorders. J Midlife Health. 2022;13(1):26-33.
3. Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and sleep disorder in the the menopausal transition. Sleep Med Clin. 2018;13(3):443-456. doi: 10.1016/j.jsmc.2018.04.011
‍4. Kim HK, Kang SY, Chung YJ, et al. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015;21(2):65-71. doi:10.6118/jmm.2015.21.2.65
5. Nunez K, Lamoreux, K. What is the purpose of sleep? Healthline.com. Updated August 9, 2024.
6. Alnawwar MA, et al. The effect of physical activity on sleep quality and sleep disorder: a systematic review. Cureus. 2023;15(8):e43595.
7. Savage RA, Zafar N, Yohannan S, Miller JM. Melatonin. StatPearls Publishing. 2024.
8. Lee J, Han Y, Cho HH, Kim M. Sleep disorders and menopause. J Menopausal Med. 2019;25(2):83-87.