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What Causes Sleep Disruptions In Perimenopause?

by Samaira Farid,
Dr Shree Datta
Medically reviewed by Dr Shree Datta
A person covering their face with their hand, lying in bed.
The information in this article is for general informational purposes only and does not substitute for professional medical or dietary advice, particularly during pregnancy. If you are outside the UK, please consult your local doctor, midwife, or healthcare provider for guidance that reflects your country's recommendations.

Waking at 3am with your heart racing, lying awake with a restless mind, or finding that sleep feels lighter and less restorative than it used to. These are some of the most common shifts that come with perimenopause. The sleep changes at this stage are real and physical. Fluctuating oestrogen and falling progesterone affect how easily you fall asleep, how deeply you sleep, and how often you wake in the night. Understanding what is driving these changes can help you make sense of what is happening and know which options are worth raising with your GP.1

The hormones behind disrupted sleep in perimenopause

Two hormones sit behind most of these sleep changes: oestrogen and progesterone. During perimenopause, oestrogen rises and dips unpredictably before it settles lower, while progesterone falls more steadily. Each one affects your sleep in its own way.2

Progesterone has a calming, sleep-promoting effect. As it falls during perimenopause, you may find it harder to drift off, notice your sleep feels lighter, and wake more often through the night. Together these point back to one underlying change in your hormones.3

Oestrogen affects your sleep in more than one way. It helps regulate the hypothalamus, the part of your brain that controls body temperature. When oestrogen drops or swings around, the hypothalamus can set off hot flushes and night sweats.4

Woman lying in bed, looking to her right with a contemplative expression.

How shifting oestrogen ties sleep and anxiety together

Shifting oestrogen can also lift your anxiety, and anxiety and sleep tend to feed each other. A poor night can leave you more on edge the next day, and that tension makes it harder to fall and stay asleep the following night. Over time the two can build on each other, with each restless night rolling into the next. If anxiety is weighing on your daily life or your sleep, it is worth raising with your GP, who can talk through the support available to you.5

Night sweats and the structure of your sleep

Hot flushes and night sweats, known together as vasomotor symptoms, are among the most common parts of this stage. Night sweats are especially hard on sleep because of the way they break into its structure.6

Your sleep moves through cycles of lighter and deeper stages, including slow-wave sleep, the most restorative part of the night. Night sweats wake you again and again, breaking up these cycles and cutting short the time you spend in the deeper stages. You wake feeling unrested, and the tiredness through the day can feel out of step with the hours you actually spent in bed. That fatigue comes from broken sleep stages, and going to bed earlier rarely fixes it on its own.7

What helps, from everyday changes to medical options

Several approaches can support your sleep during perimenopause, and they work well together. You may find that a combination helps more than any single change on its own.

Everyday changes to your routine and bedroom

Small changes to your routine and bedroom can make a real difference. Going to bed and waking at a consistent time, keeping your bedroom cool, easing off caffeine in the afternoon and evening, and winding down in the hour before bed all help. These steps ease the pressure on your sleep and go further when paired with other support if hormones are the main driver.8

Cognitive Behavioural Therapy for sleep and mood

Cognitive Behavioural Therapy, or CBT, is a well-evidenced option for sleep problems, low mood, and anxiety during perimenopause and menopause. It works by helping you shift the thought patterns and habits that keep insomnia and anxiety going, without involving hormones. You can access CBT through NHS Talking Therapies by referring yourself online, or by asking your GP to refer you.9

HRT as an option for disrupted sleep

Hormone Replacement Therapy, or HRT, can help with hot flushes and night sweats, which are a major cause of disrupted sleep in perimenopause. By treating the hormonal cause behind these symptoms, HRT can improve sleep for many. It is a prescription medicine in the UK, and whether it suits you depends on your health history, your symptoms, and what you prefer. Your GP can talk through the possible benefits and risks and help you decide.10

Frequently Asked Questions

Sources

  • [1] Symptoms of menopause and perimenopause

    Fluctuating oestrogen and declining progesterone directly affect how easily you fall asleep, how deeply you sleep, and how often you wake in the night.

  • [2] Symptoms of menopause and perimenopause

    During perimenopause, oestrogen fluctuates irregularly before eventually declining, while progesterone falls more steadily. Both shifts affect sleep through different mechanisms.

  • [3] Sleep and sleep disorders in the menopausal transition

    Progesterone has sleep-promoting, sedative properties. As its levels fall during perimenopause, you may find it harder to fall asleep, notice that your sleep feels lighter, and wake more frequently during the night.

  • [4] Sleep and Perimenopause

    Oestrogen plays a role in regulating the hypothalamus, the part of the brain that controls body temperature. When oestrogen levels drop or fluctuate, the hypothalamus can trigger hot flushes and night sweats. Oestrogen also influences serotonin production, and research suggests this may in turn affect the production of melatonin.

  • [5] Symptoms of menopause and perimenopause

    Poor sleep can worsen anxiety, and heightened anxiety makes it harder to fall and stay asleep. This cycle can become self-reinforcing over time.

  • [6] Sleep Problems and Menopause: What's the Connection?

    Studies suggest vasomotor symptoms affect up to 80% of women going through the menopausal transition.

  • [7] Menopause and sleep disturbance

    Night sweats cause repeated awakenings that fragment sleep cycles and prevent sufficient time in deep, restorative slow-wave sleep, resulting in daytime fatigue.

  • [8] Things you can do to help menopause and perimenopause symptoms

    Keeping a consistent sleep and wake time, keeping your bedroom cool, reducing caffeine in the afternoon and evening, and establishing a settling routine in the hour before bed can support sleep during perimenopause.

  • [9] Recommendations | Menopause: diagnosis and management

    Cognitive Behavioural Therapy (CBT) is recommended for sleep problems, low mood, and anxiety in the context of perimenopause and menopause. You can access CBT through NHS Talking Therapies by self-referring via the NHS website.

  • [10] Recommendations | Menopause: diagnosis and management

    HRT is recommended in UK clinical guidance as a treatment for vasomotor symptoms such as night sweats, which are a primary driver of sleep disruption in perimenopause. HRT is a prescription medicine in the UK requiring individual assessment.