Why Can’t I Sleep? The Real Reasons for Perimenopause Sleep Issues (and What Actually Helps)

If you’re in your 40s and suddenly waking up at 3 a.m.—wide-eyed, sweating, and wondering if something is seriously wrong with you—please know you’re not alone. Sleep disturbances are one of the most common and frustrating symptoms of perimenopause, affecting between 40-60% of menopausal women¹, and they often show up even before your periods start changing. 

Despite how common perimenopause sleep problems are, they're still wildly misunderstood and too often dismissed as “just stress” or “getting older.” 

Below, let’s set the record straight and discuss the science behind poor sleep during perimenopause (and menopause), as well as strategies for getting more restorative rest so you feel more “like yourself.”

Why Sleep Often Falls Apart in Perimenopause

There are a number of reasons you might be getting bad sleep² during perimenopause. Common causes can include:

• Hormonal changes³, especially fluctuations in estrogen and progesterone, as well as FSH (follicle-stimulating hormone)
• Vasomotor symptoms, including hot flashes and night sweats
• Circadian changes, meaning shifts in your body’s natural sleep-wake cycle
• Chronic stress
• Age-related changes that can cause decreased melatonin production
• Mood disorders, such as anxiety and depression
• Other medical conditions and medications⁴, such as sleep apnea, chronic pain, or restless leg syndrome

Hormones are one of the most overlooked but most powerful drivers of sleep disruption⁵ during midlife. Which hormones impact sleep? As estrogen and progesterone begin to decline (and fluctuate unpredictably) during perimenopause, they can take a direct toll on the very systems that regulate your sleep-wake cycle.

If you're experiencing poor sleep during perimenopause or menopause, here’s what’s likely happening inside your body:

• Estrogen plays a major role in the production of serotonin and melatonin, which are two hormones that are needed to fall and stay asleep.

• Progesterone has calming, sedative effects, acting on GABA receptors in the brain to promote deep sleep.

• When these hormones drop, it affects melatonin levels, cortisol rhythms, and neurotransmitter balance.

• Melatonin production also naturally declines with age, which compounds sleep problems during perimenopause.

Note: Many women also experience elevated nighttime cortisol, especially if they’re under chronic stress, which can cause 2 to 4 a.m. wake-ups that feel impossible to fall back asleep from. If you're constantly feeling rushed, overwhelmed, anxious, and stressed, high cortisol may (at least in part) be to blame.

Related: 
What Is Perimenopause? Perimenopause Symptoms and Solutions Explained
When Does Perimenopause Start and How Long Does it Last?

More About The Hormone-Sleep Connection: How Perimenopause Impacts Sleep 

To really understand why your sleep is suffering, let’s look closer at the deeper hormonal imbalances⁶ that underlie it:

Progesterone and GABA:

Progesterone enhances the effects of GABA, a neurotransmitter that promotes relaxation and sleep. When progesterone drops, so do GABA's calming effects, often resulting in more anxiety, insomnia, and racing thoughts at bedtime. These same effects can be experienced during PMS and PMDD, in which sleep might also be disrupted. 

Estrogen, Serotonin, and Melatonin:

Estrogen helps regulate serotonin, which is a precursor to melatonin. When estrogen fluctuates or falls, serotonin and melatonin can dip, making it harder to feel calm, safe, and to fall asleep or maintain deep rest through the night.

Cortisol and the Stress-Sleep Cycle:

Cortisol should be high in the morning and low at night. That's because cortisol has energizing effects and is supposed to motivate you to act and get things done. But during perimenopause, stress, blood sugar instability, and inflammation can flip this pattern, raising cortisol at night and leaving you wired before bed but then groggy in the morning.

Blood Sugar and 3 a.m. Wakeups:

Estrogen also affects insulin sensitivity. When blood sugar dips too low during the night, it triggers cortisol to spike, which can wake you up. If you wake up feeling hungry, anxious, or jittery, these can be signs of poor blood sugar balance (you'll find tips on handling this below).

Related: Connection Between Gut Health, Menopause, and Perimenopause

Common Symptoms of Perimenopausal Sleep Disruptions

How do you know if perimenopause/menopause is to blame for your poor quality of sleep rather than factors like stress or an illness? 

Signs of sleep problems due to perimenopaus⁷e can include:

• Trouble falling asleep despite exhaustion
• Waking up in the middle of the night, unable to drift back into sleep
• Frequent awakenings in the early morning hours
• Night sweats and overheating
• Restless, non-restorative sleep
• Waking up anxious, sweaty, and hungry⁸
• Experiencing sluggishness in the morning because you were tossing and turning all night

Related: PODCAST EPISODE: Struggling with Sleep & Anxiety? Are Low Progesterone Symptoms to Blame | Dr. Carrie Jones

How to Know if Your Sleep Struggles Are Hormone-Related (Not Just Stress):

If you’re wondering whether your insomnia is hormonally driven, here are some signs to look for:

• You’re exhausted but still can’t fall asleep
• You feel anxious or irritable as bedtime approaches
• You wake up sweating, hot, or with a racing heart
• Caffeine, sugar, or wine mess with your sleep more than they used to
• You fall asleep fine, but wake up between 2–4 a.m. and can’t get back to sleep

Related: Perimenopause Symptoms and Treatment

Nutrition Strategies to Support Better Sleep in Perimenopause

Food is a powerful tool for regulating hormones and supporting better sleep, especially when it comes to balancing blood sugar and calming your nervous system.

Here’s how to eat for better rest during perimenopause and menopause:

1. Stabilize Your Blood Sugar Before Bed

Blood sugar dips during the night can trigger cortisol spikes, causing you to wake up between 2 and 4 a.m. to manage this, eat a balanced dinner that includes protein, healthy fats, and fiber-rich carbohydrates to prevent glucose rollercoasters later. 

If you are struggling with the best way to eat for perimenopause hormones, grab the Perimenopause Plan here.

You might also try having a protein-rich snack 1-2 hours before bedtime (like turkey, hard-boiled eggs, or pumpkin seeds) to help prevent blood sugar crashes that wake you up.

Be sure to avoid eating sugary or carb-heavy desserts late at night, as these can spike blood sugar and lead to crashes while you sleep. The same goes for alcohol, which negatively impacts blood sugar.

Here are ideas for a protein-rich bedtime snack 30–60 minutes before bed if you’re prone to early wake-ups:

• A hard-boiled egg with a few almonds
• Turkey roll-ups with avocado
• Pumpkin seeds or sunflower seed butter on a rice cake
• A small serving of plain Greek yogurt

2. Eat Melatonin-Boosting Foods

Production of melatonin, the hormone that signals your body it’s time for sleep, can be supported by certain foods. Add these melatonin-rich or melatonin-promoting foods into your evening meals or snacks:

• Tart cherries (fresh or unsweetened juice)
• Kiwis (studies show 2 kiwis before bed may improve sleep onset and duration)
• Bananas (contain magnesium and tryptophan)
• Pumpkin seeds (rich in tryptophan, magnesium, and zinc—all cofactors in melatonin production)

3. Add Magnesium-Rich Foods & a Magnesium Supplement

Magnesium can help to calm your nervous system, including by relaxing muscles and supporting GABA, the neurotransmitter that promotes sleep.

Include these magnesium-rich foods in your daily routine:

• Leafy greens like spinach, chard, and kale
• Dark chocolate (choose 70%+ cocoa and limit to 1 oz in the afternoon, not right before bed)
• Avocados
• Almonds, cashews, and pumpkin seeds
• Black beans, lentils, and quinoa

Tip: If you still struggle with restlessness at night, consider supplementing with magnesium glycinate, which is gentle on the stomach and well-absorbed.

4. Avoid Caffeine After Noon

Caffeine sensitivity often increases during perimenopause, and what didn’t affect you in your 30s might be wreaking havoc now.

• Limit coffee, black tea, green tea, chocolate, and energy drinks after 12 p.m.
• Remember: caffeine has a half-life of 6–8 hours, so even a late afternoon latte can interfere with your sleep that night.
• Instead, consider herbal teas like chamomile, lemon balm, or rooibos in the evening.

5. Limit Alcohol

It may help you fall asleep, but alcohol disrupts REM sleep and worsens night sweats and insomnia in perimenopause. While alcohol may help you feel sleepy initially, it's one of the most disruptive factors to the quality and depth of your sleep, especially in perimenopause when you're already sensitive.

Alcohol:

• Disrupts REM sleep, which is essential for mental restoration and memory
• Triggers night sweats and hot flashes
• Interferes with blood sugar stability and melatonin production
• Try skipping alcohol for a week and track your sleep—it can be one of the most impactful changes you make.

Supplements That Can Help Support Sleep (Backed by Research)

Certain nutrients and compounds can support sleep quality by calming the nervous system and supporting hormone balance. Among the best supplements for improving sleep are:

• Magnesium (glycinate or bisglycinate, the type found in Magnesium Plus): Both magnesium foods and magnesium supplements can help muscles relax and promote a calm mood without grogginess.
• L-theanine: Found in green tea, this amino acid (which does not contain caffeine) can ease stress and help your brain shift into a restful state.
• Phosphatidylserine: May help reduce cortisol levels at night, supporting a more natural circadian rhythm.
• Ashwagandha (Sensoril®): Traditionally used to promote a healthy stress response, which can support sleep quality in chronically stressed individuals.
• Lemon Balm Extract: Shown in research to help calm the nervous system and support more restful sleep in those experiencing occasional stress.
• Magnesium (as Magnesium Bisglycinate Chelate): Plays a critical role in regulating neurotransmitters and supporting relaxation pathways in the brain and body.
• Vitamin B6 (as Pyridoxal-5-Phosphate): Involved in the synthesis of serotonin and melatonin, both key for healthy sleep patterns.
• Taurine: Supports GABA production and may reduce nighttime anxiety.
• Melatonin: A small dose (0.3–1 mg) can help reset your sleep-wake cycle. Less is often more.
• Bioidentical progesterone: For some women, especially those with significant sleep issues, progesterone cream or therapy can improve GABA activity and restore restful sleep.

The key ingredients in Dr. Brighten Essentials Adrenal Calm were chosen for their ability to support a healthy stress response and gently nudge the body into a restful state without next-day grogginess.

These ingredients don’t force sleep; instead, they help bring the body back into balance by calming the nervous system, promoting relaxation, and supporting the body’s natural sleep-wake cycle. Whether it’s racing thoughts, cortisol spikes, or the overwhelm of an overstimulated brain, the nutrients below are backed by emerging research for their role in supporting better rest.

Always work with a qualified practitioner before starting new supplements or hormones, especially if you take other medications or have an existing health condition.

For help choosing supplements during perimenopause, check out this article: 

15 Perimenopause Supplements for Happy Hormones

Lifestyle Tools for Restoring Sleep (Without Meds)

Hormone-friendly sleep habits⁹ make a big difference in midlife—and they’re about more than just getting off your phone before bed. We cover this in my Perimenopause Plan, which also includes 21 tasty recipes to help you optimize your hormone health. 

Here’s what I recommend to patients:

• Get morning light within 30–60 minutes of waking to reset your circadian clock.
• Cool your room to 65–68°F to help reduce night sweats and support melatonin.
• Move gently in the evening, such as by doing yoga, stretching, or taking a walk after dinner, which helps lower cortisol.
• Practice nervous system regulation with help from breathwork, meditation, and progressive muscle relaxation to calm your mind and downshift into sleep.
• Track your sleep using a journal or wearable to identify patterns tied to your cycle or evening habits.
• Stay off screens during the 1-2 hours leading up to bedtime.
• Consider working with a therapist who specializes in cognitive behavioral therapy¹⁰ (CBT), which can be helpful for women dealing with poor sleep tied to stress and anxiety.

When to Get Help (And What to Ask For)

If you're consistently getting poor sleep, especially during or post menopause, it's important to work on improving your sleep habits¹¹ to feel more rested, especially since sleep deprivation is a leading risk factor¹² for cardiovascular disease, obesity, diabetes, psychiatric disorders, and increased mortality risk. 

If you've tried the approaches above but your sleep isn’t improving, it’s time to investigate deeper hormone imbalances.

Consider asking your doctor for their advice and testing that includes:

• Hormone testing: estradiol, progesterone, testosterone, DHEA
• Morning cortisol levels
• Glucose and insulin (especially if you’re waking at 3 a.m).
• FULL thyroid panel (TSH, free T3, free T4, and antibodies)

For some women, HRT (hormone replacement therapy) does wonders for improving menopause symptoms. Others do better with lifestyle shifts, targeted supplements, or natural hormone support.

Related: HRT for Menopause & Perimenopause: Benefits, Side Effects & Menopause Solutions | Dr. Amy Killen

Something else important to mention: Don’t overlook sleep apnea, as rates rise in perimenopause¹³ due to factors like weight gain and airway changes. If your sleep is unrestful despite 8 hours in bed, snoring, or waking gasping, ask your provider about sleep testing. 

For additional help with weight loss during perimenopause, check out my detailed Perimenopause Weight Loss Action Plan. 

You might also find this article to be helpful: How to Lose Weight During Perimenopause

Final Thoughts: You Deserve Good Sleep! 

If your sleep has become a nightly battle, it’s not because you’re doing something wrong, and you’re not alone. Sleep problems during perimenopause are real, hormone-driven, and solvable with the right support. The most effective path forward usually involves a mix of:

• Supporting your hormones
• Calming your nervous system
• Nourishing your body with the right nutrients
• Getting individualized care, not one-size-fits-all sleep hacks

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC6092036/ ↩︎
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC9190958/ ↩︎
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5. https://journals.lww.com/co-obgyn/abstract/2025/04000/sleep_disturbance_and_menopause.8.aspx ↩︎
6. https://www.mdpi.com/2077-0383/14/5/1479 ↩︎
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC11901009/ ↩︎
8. https://chronobiologyinmedicine.org/journal/view.php?doi=10.33069/cim.2024.0027 ↩︎
9. https://www.allabouthercentre.com.au/sleep-fatigue ↩︎
10. https://journals.sagepub.com/doi/10.1177/20533691211039151?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed ↩︎
11. https://www.nia.nih.gov/health/menopause/sleep-problems-and-menopause-what-can-i-do ↩︎
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13. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep ↩︎