Sleep and the Menopause : Why It Changes and What Can Help
Article written by Dr Mari Walling, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, November 2025
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
In this article we outline why sleep is disrupted in perimenopause and menopause and the practical ways to improve sleep.
Good sleep is something many of us take for granted - until it disappears. During perimenopause and menopause, changes in sleep are incredibly common.
Many women describe finding it harder to fall asleep, waking frequently, or lying awake for hours in the early morning. For others, sleep is disrupted by night sweats, anxiety, or a mind that suddenly won’t switch off.
If this sounds familiar, you’re not alone. Sleep problems affect up to two-thirds of women during the transition to menopause.
The good news is that there are clear, evidence-based ways to understand what’s happening and practical steps that genuinely improve things.
Why sleep matters so much for health
Sleep is not just a period of rest, it is an active repair process. While we sleep the brain clears waste products, supports memory and learning, and resets emotional balance.
Good quality sleep helps regulate mood, supports cardiovascular health, strengthens the immune system and stabilises blood sugar.
Sleep also plays a powerful role in metabolic health. Hormones linked to appetite and weight regulation shift when we do not sleep well. Leptin, the hormone that helps you feel full, drops. Ghrelin, the hormone that increases hunger, rises.
This can make weight management harder, especially during perimenopause and menopause when metabolism is already changing.
Knowing this can help women understand why disrupted sleep feels so impactful, both physically and emotionally.
Why sleep changes during perimenopause and menopause
Oestrogen naturally declines during the menopause transition. Lower levels affect temperature regulation, which is why many women wake suddenly feeling hot or sweaty. Night sweats can interrupt sleep repeatedly and make it difficult to settle again. Oestrogen also supports serotonin and other neurotransmitters linked to mood and sleep quality.
Progesterone levels also fall as ovulation becomes irregular. Progesterone has calming, sedating and anti anxiety effects for many women. It supports steady breathing at night and its natural breakdown products influence GABA receptors in the brain, which help the body relax. When progesterone drops, sleep can feel lighter and more fragmented.
Other hormones shift too. Melatonin, the hormone that signals that it is time for sleep, naturally reduces with age. Cortisol, our stress hormone, can rise. Together, these changes create a perfect storm for disrupted sleep in midlife.
Perimenopausal and Menopausal symptoms that disturb sleep
Many symptoms of perimenopause and menopause feed directly into sleep quality.
Night sweats. Rapid changes in body temperature can wake you abruptly. Some women need to change nightwear or bedding, which makes it harder to settle again. Keeping your bedroom cool and having spare sheets or a fresh top to hand can help.
Mood changes and anxiety. Waking in the night often triggers racing thoughts. Some women find it difficult to fall asleep because their mind feels too alert. Setting aside time during the day to write down worries can train your brain to understand that bedtime is not the place for problem solving.
Stress and daily load. Women often juggle work, parenting, caring responsibilities and household demands. It is easy to go to bed too late, skip wind down time or rely on habits like late meals, irregular bedtimes or evening alcohol that make sleep less restorative.
Other conditions that can disturb sleep
Obstructive sleep apnoea causes breathing to stop and start at night. Signs include loud snoring, gasping or choking noises, waking frequently, morning headaches or significant daytime sleepiness.
Restless legs syndrome causes uncomfortable sensations and an urge to move the legs. It can affect arms too. Women are more likely than men to experience it, and it often worsens in the evening.
Chronic insomnia: when difficulty falling asleep or staying asleep occurs at least three times a week for three months or more. Over time, the brain starts to link bedtime with wakefulness instead of rest. CBT i and sleep restriction therapy can be so helpful. They retrain the brain, rebuild a healthy sleep pattern and restore confidence in your ability to sleep.
If you recognise these symptoms, speak with a healthcare professional.
Simple lifestyle changes and practical steps that can help:
Small daily habits often shift sleep more than people expect. Consistency really matters.
Keep a regular sleep–wake routine, even at weekends.
Build a gentle wind-down period before bed: dim lights, warm shower, relaxing activities.
Manage worry earlier in the day. Schedule worry time and jot things down. It trains the brain to switch off more easily at night.
Avoid screens in the last hour if possible - bright light tells the brain it’s daytime.
Keep the bedroom cool; even slight temperature increases can trigger waking.
Avoid caffeine after midday and limit alcohol, which fragments sleep.
Move your body daily - even light activity improves sleep regulation.
If you’re awake for a long time during the night, get up, do something quiet, and return to bed when sleepy.
How HRT can support better sleep
Hormone Replacement Therapy can be very effective when sleep disturbance is linked to symptoms such as hot flushes, night sweats, low mood, or anxiety.
Oestrogen improves temperature regulation and often reduces nighttime wakings.
Progesterone has a naturally calming effect on the brain and, for many women, supports deeper, restorative sleep.
HRT isn’t the answer for everyone, but for many women it is a safe, evidence-based option that helps sleep quality.
Non-hormonal treatments that help
Not everyone wants or can take HRT. There are effective alternatives:
Cognitive Behavioural Therapy for Insomnia (CBT-I) is one of the most effective treatments for chronic sleep problems.
Mind–body approaches such as paced breathing, mindfulness, and gentle evening routines support the nervous system.
Local vaginal oestrogen can ease bladder symptoms that cause nighttime waking.
Supplements like magnesium or omega-3s may help, although responses vary.
Medication isn’t usually first-line but can be appropriate short-term if insomnia is severe and affecting daily function.
How Lemala Health can help
If sleep has been difficult for more than a few months, or is affecting your mood, concentration, work, or relationships, it’s reasonable to seek specialist help. You don’t need to struggle through it alone. Targeted treatment - whether hormonal, non-hormonal, or lifestyle-based - can make an enormous difference.
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