• Menopause

Menopause and Sleep: Why it Changes and How to Improve it

Medically reviewed and edited by Lauren Cramer, PA- C

Published: November 05, 2025
Updated: January 07, 2026
4 mins

Menopause is a natural stage in life that marks the end of a woman’s reproductive years, perimenopause typically starts occurring in the late 30s to mid 40s. Along with well-known symptoms like hot flashes and mood changes, perimenopause often brings challenges with sleep. Many women notice difficulty falling asleep, staying asleep, or waking up feeling fully rested.

Sleep quality is more than just a nightly comfort – it plays a crucial role in overall health during perimenopause. Poor sleep can affect mood, memory, heart health, metabolism, and even bone strength, making it essential to address sleep changes rather than dismiss them as “just part of aging.”

This guide takes a practical, evidence-based approach to help women understand why sleep changes occur during perimenopause through menopause and what strategies – from lifestyle adjustments to medical treatments – can support better rest and overall well-being.

Why Does Menopause Disrupt Sleep? 

Hormonal changes

As menopause approaches, levels of estrogen and progesterone gradually decline, and that shift can have a big impact on sleep. Both hormones help regulate the body’s internal clock, sleep cycles, and nervous system activity. When estrogen drops, it can disrupt temperature regulation in the brain, making you more prone to hot flashes and night sweats that wake you up or prevent deep, restorative sleep. Lower estrogen is also linked with changes in serotonin and melatonin, which can affect mood and sleep quality.

At the same time, progesterone – often called a naturally “calming” hormone – also falls. Progesterone has mild sedative and anti-anxiety effects, so when levels decline, many women notice more restlessness, racing thoughts, and lighter, more fragmented sleep. Together, these hormonal changes can lead to a pattern of difficulty falling asleep, frequent awakenings, early morning waking, and overall feeling less rested – even if you’re technically in bed for the same number of hours.

These hormonal shifts may also interfere with your circadian rhythm, the body’s natural sleep-wake cycle, and can influence mood, making restful sleep even more elusive.

Hot flashes and night sweats

Hot flashes and night sweats are hallmark symptoms that  menopause is approaching that can abruptly wake you from sleep. Even brief awakenings can disrupt your sleep cycles, leaving you feeling unrested the next day.

Mood changes and anxiety

Menopause can bring mood swings, anxiety, or feelings of irritability. These emotional changes can make it harder to relax at night, contributing to insomnia or fragmented sleep.

Other physical symptoms

Beyond hormonal and mood-related factors, physical changes such as joint pain, frequent urination, or other discomforts can interfere with uninterrupted sleep. These symptoms, though less talked about, are common contributors to poor sleep during the years leading to menopause.

Feel like yourself again

A licensed provider can help you understand your symptoms and determine if hormone replacement therapy is the right next step.

Get Started

Common Sleep Problems During Menopause

Perimenopause often brings a variety of sleep disruptions, each affecting rest in different ways.

Insomnia

Many women notice difficulty falling asleep or staying asleep during perimenopause into post-menopausal years. Hormonal fluctuations, stress, and night sweats can make it challenging to get the deep, restorative sleep the body needs.

Fragmented sleep

Even if you do fall asleep, you may wake multiple times throughout the night. These frequent awakenings can prevent you from reaching the deeper stages of sleep, leaving you tired and groggy the next day.

Early morning awakenings

Some women find themselves waking unusually early and unable to return to sleep. This can be linked to changes in circadian rhythms,  stress, abnormal cortisol curves, or hormonal shifts, making mornings feel exhausting rather than refreshing.

Restless leg syndrome (RLS) and sleep apnea

Certain conditions, like restless leg syndrome or sleep apnea, can become more common around midlife. RLS causes uncomfortable sensations in the legs that make it hard to fall asleep, while sleep apnea leads to interrupted breathing during sleep, both of which contribute to poor sleep quality.

Why Sleep Matters During Perimenopause

Sleep isn’t just a nightly routine – it’s a cornerstone of overall health, and its importance becomes even more pronounced during perimenopause through the post menopausal years.

Cognitive health

Restorative sleep is essential for memory, focus, and mental clarity. Without it, you may notice forgetfulness, difficulty concentrating, or a slower mental pace, which can impact daily life and work performance.

Emotional wellbeing

Poor sleep can exacerbate mood swings, irritability, and anxiety, which are already common during perimenopause. Getting consistent rest helps stabilize emotions and supports mental resilience.

Metabolic and cardiovascular health

Disrupted sleep can affect metabolism, making it harder to maintain a healthy weight. It can also influence blood pressure and heart health, increasing the risk of cardiovascular issues over time.

Bone and muscle health

Sleep is a time for the body to repair and restore itself. Adequate rest supports bone density and muscle repair, which is particularly important during menopausal years when women face an increased risk of bone loss and muscle weakness.

Lifestyle Changes to Manage Sleep During Menopause

Making intentional changes to daily habits and your environment can have a significant impact on sleep quality during menopause.

Sleep environment

Creating a bedroom that supports rest is crucial. Keep the room cool, dark, and quiet, and consider using blackout curtains, fans, or white noise machines to minimize disruptions. A comfortable mattress and bedding can also make a noticeable difference, especially for managing night sweats.

Consistent sleep schedule

Going to bed and waking up at the same time every day helps regulate your body’s internal clock. Even on weekends, maintaining a consistent schedule can improve the ease of falling asleep and staying asleep.

Evening routine

Wind down in the evening by avoiding stimulating activities, bright screens, or heavy meals close to bedtime. Gentle activities like reading, stretching, or a warm bath can signal to your body that it’s time to relax.

Physical activity

Regular movement is one of the most powerful, drug-free tools for better sleep. Consistent exercise helps regulate circadian rhythm, reduce stress hormones, boost mood-stabilizing chemicals like serotonin, and improve deep, restorative stages of sleep. Strength training supports metabolic and bone health, while walking, cycling, or other aerobic activity can reduce anxiety and “mental buzz” that keeps you awake at night.

Whenever possible, aim to get most of your moderate-to-vigorous activity earlier in the day – especially in the morning or early afternoon. This timing reinforces your natural wake-sleep cycle and gives your body time to cool down and relax before bed. Intense workouts too close to bedtime can temporarily raise core body temperature, heart rate, and adrenaline, which may make it harder to fall asleep, even if you feel physically tired.

Stress management

Stress and anxiety are some of the most common – and underestimated – sleep disruptors. When your nervous system is stuck in “fight-or-flight” mode, your brain stays hyper-alert, your heart rate and cortisol remain elevated, and it becomes much harder to drift into deep, restorative sleep (or stay there). This is especially true in perimenopause and menopause, when hormonal shifts can amplify feelings of worry, irritability, or overwhelm.

Building a wind-down routine that actively signals “it’s safe to relax now” can make a big difference. Practices like meditation, deep breathing, gentle yoga, progressive muscle relaxation, or journaling help shift the body into a more parasympathetic (“rest-and-digest”) state. Even 5–10 minutes of slow breathing, guided meditation, or writing down worries and to-dos before bed can quiet racing thoughts, relax tense muscles, and prepare both mind and body for sleep. The key is consistency – treat these tools like daily training for your nervous system, not one-time fixes. Over time, they can improve how quickly you fall asleep, how often you wake up, and how rested you feel in the morning.

Practical Tips for Better Sleep During Menopause

Beyond lifestyle changes, there are small, practical strategies that can make nights more restful during perimenopause through postmenopausal years.

Layer bedding for night sweats

Using lightweight, breathable layers allows you to adjust easily if you wake up hot, helping you stay comfortable without overheating.

Use a fan or cooling mattress pad

A fan or cooling mattress pad can help regulate body temperature, which is especially useful for managing night sweats and hot flashes.

Limit caffeine and alcohol

Both caffeine and alcohol can quietly sabotage sleep, even when you don’t feel wired or “buzzed.”

Caffeine blocks adenosine, a brain chemical that helps build sleep pressure over the day. Because its half-life is around five to seven hours (or longer for some people), that 2-3 pm coffee or tea can still be in your system at bedtime. The result can be:

• Taking longer to fall asleep

• Lighter, more fragmented sleep

• Less deep (slow-wave) sleep, even if total time in bed looks okay

For most people, it helps to cut off caffeine by late morning or early afternoon and be mindful of hidden sources (tea, soda, energy drinks, pre-workout, chocolate).

Alcohol may make you feel drowsy or help you fall asleep faster, but it disrupts sleep architecture later in the night. Common effects include:

• More awakenings in the second half of the night

• Reduced REM sleep (critical for mood and memory)

• Increased snoring and sleep apnea events

• Early-morning waking with racing thoughts or a “tired but wired” feeling

Even moderate amounts – a glass or two of wine – can be enough to disturb sleep quality, especially in midlife and menopausal years when sleep is already more fragile. As a rule of thumb, it’s best to:

• Avoid caffeine in the afternoon and evening

• Keep alcohol earlier in the evening, and not every night – ideally with at least three to four hours – before bedtime.

For many women, simply tightening up caffeine and alcohol timing leads to fewer night awakenings, deeper sleep, and feeling more rested the next day.

Try relaxation techniques before bed

Gentle breathing exercises, meditation, or light stretching can help signal to your body that it’s time to wind down, making it easier to drift into sleep.

Consider journaling or wind-down rituals

Writing down worries or planning for the next day can reduce racing thoughts and mental tension, allowing your mind to relax and focus on rest.

Medical Treatment Options

When lifestyle changes and practical strategies aren’t enough, medical treatments like ramelteon or doxepin may offer additional support for sleep during perimenopause and postmenopausal years. It’s important to work with a qualified healthcare provider to find an approach that’s safe, effective, and tailored to your needs.

Hormone replacement therapy (HRT)

HRT can help restore hormone levels, improving sleep quality while also reducing hot flashes and night sweats. A healthcare provider can help weigh the benefits and risks based on your medical history and preferences.

Non-hormonal medications

Certain medications, including some antidepressants or anti-anxiety drugs, can be prescribed to help with sleep difficulties. These can be effective for insomnia linked to menopause-related mood changes, but they may come with side effects such as daytime drowsiness or dependency risks. Careful medical supervision is essential.

Supplements

• Melatonin: Can help regulate the sleep-wake cycle, especially for early morning awakenings or difficulty falling asleep. Timing and dosage are important to maximize effectiveness.

• Magnesium: Supports relaxation and may improve sleep quality. Often used in combination with other strategies.

• Other supplements: Some women find relief with valerian root, chamomile, or herbal blends, though evidence varies. Always discuss supplements with a healthcare provider to ensure safety and avoid interactions.

Ultimately, treatment should be individualized. A healthcare provider can help determine whether HRT, non-hormonal medications, or supplements – or a combination – fits your health profile and sleep needs.

Where Can I Learn More About Relieving Menopause Symptoms?

Struggling with sleep during perimenopause through postmenopause doesn’t have to be something you manage alone. The LifeMD Women’s Health Program offers personalized support, connecting you with healthcare providers who can help address sleep issues, hormone changes, and other menopausal symptoms. 

Schedule a consultation today to explore strategies – from lifestyle adjustments to medical treatments – designed to help you rest better and feel your best.

Lauren Cramer, PA- C

Lauren is a passionate and dedicated board-certified physician assistant. She received her Bachelor’s degree in Kinesiology and Exercise Science from SUNY Cortland — graduating magna cum laude while competing as a three-sport collegiate athlete in indoor and outdoor track and cross country. She went on to complete her Master’s degree in Biological Sciences and earn her Physician Assistant degree from Daemen College in Buffalo, New York. Lauren has years of focused experience in perimenopause, menopause, and postmenopause care, specializing in hormone replacement therapy (HRT), bone health optimization, and a functional medicine approach to women’s wellness. She integrates evidence-based hormone therapy with lifestyle, nutrition, and metabolic strategies to support long-term vitality, cognitive health, and bone density. In addition to her women’s health expertise, Lauren has a well-rounded background in allergy, asthma, otology, laryngology, and rhinology. Functional medicine has always been a passion of hers, and she continues to pursue advanced certification to deepen her ability to deliver personalized, root-cause care to her patients.

Talk To A Doctor

How does LifeMD work?