Getting Better Sleep During Perimenopause
Understanding why sleep changes and the evidence-based strategies that can help
If you’re waking up in the middle of the night and lying there wondering why your brain has suddenly decided it’s time to be awake, you’re not alone. And if you’re exhausted from broken nights, it can feel incredibly frustrating when your body seems to have changed the rules on sleep.
Sleep disruption is one of the most common and frustrating symptoms of perimenopause and menopause. Research suggests that around 40–60% of women experience sleep problems during this transition, including trouble falling asleep, waking during the night, or waking up feeling like sleep hasn’t actually done its job.
And this isn’t just about feeling tired.
Poor sleep can affect your mood, concentration, stress levels, appetite regulation and ability to cope with everyday life. When you’re already dealing with the physical and emotional changes of perimenopause, broken sleep can make everything feel harder.
The important thing to know is that sleep disruption during perimenopause is not something you simply have to accept and suffer through.
Why does sleep change during perimenopause?
There is rarely one single cause. Sleep is affected by a combination of hormonal changes, physical symptoms, lifestyle factors and stress.
During perimenopause, fluctuations in oestrogen and progesterone can affect the systems involved in sleep regulation. For some women, this shows up as hot flushes and night sweats interrupting sleep. For others, it may look like waking frequently during the night, feeling more restless, or finding it harder to switch off.
Hormones are also not the only factor. Perimenopause often happens during a demanding stage of life, and stress, busy schedules and changes in routine can all affect sleep. Hormonal changes may also make some women more sensitive to stress and anxiety.
It’s also worth remembering that not every sleep problem is caused by menopause. Issues such as sleep apnoea, thyroid problems, reflux or chronic pain can also affect sleep and are worth discussing with a healthcare professional if they apply to you.
Why middle-of-the-night waking can become a cycle
One of the hardest parts of middle-of-the-night waking is that frustration can quickly make things worse.
You wake up → you start worrying about being awake → your stress response increases → falling asleep becomes even harder.
Over time, your brain can start associating your bed with frustration and struggle rather than a place for sleep and rest.
What can help?
There is no single magic solution, evidence-based behaviour change strategies can make a real difference.
Some of the most effective approaches include:
Keeping your bed for sleep and intimacy rather than scrolling, watching TV or working
If you’re awake for a while, getting out of bed and doing something calm in dim light until you feel sleepy again
Creating a consistent wind-down routine before bed
Keeping regular sleep and wake times where possible
Looking at factors such as exercise, stress, caffeine, alcohol, nutrition and daylight exposure
These changes may sound simple, but they are not always easy. When you’re running on broken sleep, even small changes can feel like a huge effort. That’s why a realistic approach matters.
Don’t ignore ongoing sleep problems
Sleep problems in perimenopause are common, but they are not something you just have to put up with.
For some women, addressing menopause symptoms with a healthcare professional, including discussing HRT, may be part of improving sleep. For others, behaviour and lifestyle changes can make a significant difference. Often, it’s about identifying which pieces of the puzzle matter most for you.
Sleep is one of the areas I coach women through because I know how much it affects everything else. When you’re exhausted, making changes to your health, routines and habits, or even just getting through the day, can feel so much harder.
My role is to help women understand what may be contributing to their sleep struggles, identify realistic changes, and build routines that actually fit their life.
If you’re struggling with sleep and would like support, please get in touch.
