Perimenopause and Sleep Issues: Why Midlife Sleep Feels Impossible

If you're like me, you probably have woken up drenched in sweat, gasping for breath, and staring at the ceiling. Welcome to the nightly battle many women face as their bodies struggle with perimenopause. Perimenopause typically occurs in your 40s (but can start in your 30s and last well into your 50s) and brings hormonal changes that can make sleep feel impossible. You're not alone if you've been tossing and turning, waking up multiple times a night, or struggling with daytime fatigue. Studies suggest up to 85% of women in perimenopause experience some form of sleep disturbance.

The Hormonal Rollercoaster and Its Effect on Sleep

At the heart of perimenopausal sleep struggles are fluctuating levels of estrogen and progesterone. These hormones influence sleep, from regulating melatonin production to keeping stress hormones like cortisol in check.

The Estrogen-Melatonin Connection

Estrogen is key in regulating melatonin production, the hormone responsible for signaling sleep. As estrogen levels fluctuate wildly during perimenopause, melatonin production can become erratic, leading to difficulty falling and staying asleep. Many women notice that their once-predictable sleep patterns become disrupted, with increased difficulty winding down at night and waking up feeling unrested.

Progesterone's Role in Sleep

Progesterone, sometimes called the "relaxation hormone," has natural sedative properties that help promote restful sleep. However, during perimenopause, progesterone levels decline significantly, which can contribute to increased anxiety, trouble falling asleep, and more frequent night wakings. Lower progesterone can also make women more prone to restless leg syndrome (RLS), a condition that causes an uncontrollable urge to move the legs at night, further disrupting sleep.

Cortisol, Stress, and Midnight Wake-Ups

Cortisol, the body's primary stress hormone, follows a natural rhythm, peaking in the morning and tapering off in the evening for restful sleep. But in perimenopause, stress levels tend to rise due to hormone fluctuations, and cortisol production can become dysregulated. This often results in elevated nighttime cortisol levels, leading to frequent midnight wake-ups, increased feelings of anxiety, and difficulty returning to sleep. Many women (including me!) report waking up between 2-4 AM with racing thoughts—this is often due to cortisol spikes.

Common Sleep Disruptions in Perimenopause

Insomnia and Difficulty Staying Asleep

Hormonal shifts can throw your sleep cycles into disarray, making falling and staying asleep harder. Racing thoughts, increased anxiety, and body temperature fluctuations all contribute to insomnia, leaving many women feeling exhausted the next day.

Night Sweats and Hot Flashes

Estrogen also helps regulate body temperature, and as levels drop, thermoregulation becomes erratic. This is why hot flashes and night sweats are so disruptive—sudden heat surges can wake women up multiple times a night, leaving them drenched and struggling to cool down. Without deep, uninterrupted sleep, energy levels plummet, and mood swings intensify.

Sleep Apnea: An Overlooked Factor

Many women don't realize that perimenopause increases the risk of sleep apnea, a condition where breathing repeatedly stops and starts during sleep. Declining estrogen and progesterone levels contribute to muscle relaxation in the airway, making it more likely to collapse during sleep. Weight gain, which often accompanies perimenopause, can also contribute to sleep apnea. Symptoms include loud snoring, gasping for breath during sleep, waking up frequently, and excessive daytime fatigue. If left untreated, sleep apnea can increase the risk of high blood pressure, heart disease, and cognitive decline.

The Circadian Rhythm Disruption

Your circadian rhythm is your body's internal 24-hour clock that regulates when you feel awake and sleepy. It's controlled by light exposure, hormone production, and lifestyle factors like meal timing and exercise. Estrogen helps keep the circadian rhythm in balance. Still, many women experience sleep-wake cycle disruptions as their sleep-wake cycle declines, leading to feeling wired at night, struggling to fall asleep, and experiencing grogginess in the morning.

One way to reset your circadian rhythm is to get morning sunlight exposure, which helps regulate melatonin production and improve overall sleep quality. 

Additionally, reducing blue light exposure from screens in the evening can prevent further disruptions to melatonin release.

How to Improve Sleep in Perimenopause

While hormonal changes make sleep more challenging, there are ways to improve sleep quality:

Optimize Your Sleep Environment: Keep your bedroom cool, dark, and quiet. Using breathable bedding and moisture-wicking pajamas can help combat night sweats.

Support Melatonin Production Naturally: Avoid screens an hour before bed, get morning sunlight, and consider foods rich in tryptophan (such as turkey, nuts, and dairy) to support melatonin levels.

Regulate Cortisol Levels: To lower nighttime cortisol spikes, practice stress reduction techniques like meditation, deep breathing, or journaling before bed.

Address Nutrient Deficiencies: Magnesium, glycine, and L-theanine can help calm the nervous system and improve sleep.

Consider Gentle Evening Exercise: Intense workouts too close to bedtime can raise cortisol, but activities like yoga or stretching can promote relaxation.

Stick to a Consistent Sleep Schedule: Going to bed and waking up at the same time daily helps regulate your body's internal clock.

Sleep disruptions have been one of the most frustrating perimenopause symptoms that I deal with. One thing that I've noticed is that alcohol plays a significant role in my ability to sleep. In fact, the sleep disruptions last for more than just the one night that I drink. I've found that for the 2 nights after I drink, I also will wake up in the middle of the night. It takes my body much longer than 24 hours to fully process the alcohol. 

Supplements can certainly help, although, as you know, everyone is different, and what works for one person may not work for another. Many women find that magnesium supplements before bed help—this is the one I take. I've recently discovered a supplement called Cortisol Regulator, which has improved my sleep by 100%. You can find it here. 

The Bottom Line

Perimenopause sleep disruptions are frustrating, but understanding the root causes can help you take steps to improve rest. By balancing hormones, managing stress, and optimizing sleep hygiene, you can reclaim restorative sleep and wake up feeling more energized and focused.