Why can’t I sleep during menopause?

You fall asleep easily enough, then you’re wide awake at three.

Or you wake up soaked, and spend the next hour throwing the covers off and pulling them back on.

If your sleep fell apart around the same time your periods started changing, the two may well be connected. Broken sleep around menopause is common, and there’s usually more than one reason for it.

Why does menopause affect sleep?

Perimenopause is the stretch of years leading up to your last period, when your hormone levels start to shift. Menopause is the point when your periods have stopped for a full year.

Sleep can change in either one.

Falling estrogen and progesterone set off hot flashes and night sweats. A night sweat can wake you outright, or pull you out of deep sleep without you fully noticing.

Either way, you lose the deep, restoring part of the night. That’s why you can wake up tired even when you were in bed for eight hours.

An illustration of a common pattern, not measured data.

Falling hormones also affect your mood and your stress response, which can make it harder to settle back down once you’re awake. Our menopause and hormones page explains how these changes connect.

Why do I wake up at 3am every night?

Waking at the same time every night is one of the most frustrating parts of this.

Several things can cause it. Two of the most common are blood sugar dropping overnight and stress hormones rising too early.

When stress hormones run high at night, your body stays switched on long after you’ve gone to bed. Many women tell us they feel wired at night and drained by day.

Long-term stress can make menopause feel much harder in general. And the less you sleep, the harder stress is to handle the next day.

Is it only my hormones?

Hormones are rarely the whole story. Estrogen gets most of the attention, so what’s working alongside it can get missed.

• Thyroid
• Nutrients
• Your gut
• Your liver

Your thyroid. Your thyroid is a small gland in your neck that helps set your body’s pace. A slow thyroid can look a lot like menopause, and the two often overlap, so one can hide the other.

Nutrients and minerals. Low levels of key minerals can make it harder for your body to settle and stay asleep. What your body needs also shifts at this stage.

Your gut. Reflux, bloating or discomfort after a late meal can keep pulling you out of sleep.

Your liver. Your liver helps clear hormones your body has finished with. If that isn’t working well, it may be one reason symptoms drag on.

When sleep is being disrupted from two or three of these at once, a better bedtime routine rarely fixes it on its own. Our sleep page goes through each one in more detail.

What can help me sleep better during menopause?

A few simple changes can take the edge off while you find out what’s behind it.

Keep your bedroom cool, and use layers you can throw off easily. A fan by the bed helps many women get through the night.

Notice what happens when you cut back on caffeine and wine, especially later in the day. It can help some women, and it’s easy to test.

Try not to eat a large meal late in the evening, particularly if reflux is part of the picture.

Keep a simple sleep note for two weeks: when you wake, whether you’re hot, and what you ate and drank the evening before. Patterns show up quickly.

These steps work on the symptoms. If they don’t make enough of a difference, it’s worth looking at what’s feeding the problem underneath.

If you’re on HRT, considering it, or taking something to help you sleep, that decision stays between you and your physician. Please don’t change anything on your own.

At Back to Wellness, Dr. Anthony Alphonso looks at your hormones alongside your thyroid, stress, liver, nutrients and blood sugar. He has been in practice since 2007, and we work alongside your physician.

One patient, who had struggled with sleep for years, wrote in her Google review: “Today I sleep 7 hours a night, my energy level is awesome.” That was her own experience, and results vary from person to person.

You can read more on our menopause and hormones page and our sleep page.

When to talk to someone

Some symptoms need a doctor first. Please see your physician or urgent care right away if you have:

• any bleeding after your periods have stopped, or very heavy bleeding
• a new lump in your breast
• chest pain (call 911) or waking up breathless
• loud snoring, and someone has noticed you stop breathing or gasp in your sleep
• falling asleep while driving or in the middle of conversations
• very low mood or thoughts of harming yourself (call or text 988)

If none of those apply and you want to find out what’s keeping you awake, book a free 15-minute call.

It’s by phone, with no cost and no obligation. We’ll hear the whole story and tell you honestly whether we can help.