You used to sleep like a log. Now you lie there with your head buzzing, kick the covers off, pull them back on, and do the maths on how many hours are left before the alarm. Even when you do drop off, you wake again and again.
If this is you, you're in very good company. Sleep problems are one of the most common complaints of perimenopause and menopause, and one of the most exhausting. The reassuring part is that there's a lot you can do, and good treatments to ask about.
Is insomnia a symptom of perimenopause?
Yes. The NHS lists sleep problems as a common symptom of perimenopause and menopause. That includes difficulty falling asleep and difficulty staying asleep. Poor sleep can then leave you irritable, stressed and anxious, and night sweats can make it worse.
A review of the research found that the menopause transition comes with an increase in insomnia symptoms. Difficulty staying asleep is the one that rises most (Baker and others, 2018). So if you can get to sleep but keep waking, that's a very typical pattern.
Why can't I sleep during perimenopause?
There's rarely one cause. More often it's several things at once.
- Night sweats and hot flushes. The same review describes hot flushes and night sweats as a key part of sleep disruption at this time. A flush can wake you suddenly, hot and with your heart racing.
- Changing hormones. Shifting levels of oestrogen and progesterone can affect sleep, mood and how your body controls temperature.
- Anxiety and low mood. Both are common in perimenopause, and both make it harder to switch off.
- Needing the loo. The NHS notes that menopause can mean needing to pee more often, including at night.
- Worrying about sleep. This one is easy to miss, but it matters. Women's Health Concern, the patient arm of the British Menopause Society, explains that worrying at night about being awake, and how you'll cope tomorrow, can cause anxiety that makes sleep even less likely.
That last point is important. After a few weeks of bad nights, bed can start to feel like a place of struggle rather than rest. Your brain learns to expect to be awake there. The good news is that this can be unlearned.
How long does menopause insomnia last?
There's no fixed answer. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer, and that they change over that time. Hot flushes and night sweats often ease eventually.
But sleep problems don't always settle on their own when the flushes do. Habits and worries that built up during bad patches can keep insomnia going. That's exactly what the approaches below are designed to tackle. So whatever stage you're at, it's worth acting now rather than waiting.
What helps with perimenopause insomnia?
Start with your sleep habits
These sound simple, but they work best when you stick with them for a few weeks. The NHS insomnia advice and Women's Health Concern suggest:
| Try to... | Try not to... |
|---|---|
| Only go to bed when you feel sleepy | Have caffeine or alcohol in the 6 hours before bed |
| Get up at the same time every day, even after a bad night | Eat a big meal late at night |
| Relax for at least an hour before bed, with a bath or a book | Exercise in the 4 hours before bed |
| Keep the bedroom dark, quiet and cool | Use your phone or watch TV right before bed |
| Keep to your normal plans the next day | Nap in the day (if you must, keep it before 3pm) |
Keeping the bedroom cool is especially important if you're having night sweats. Women's Health Concern points out that the body naturally cools as we sleep.
CBT for insomnia
CBT for insomnia (often called CBT-I) is a structured talking therapy that targets the thoughts and habits that keep you awake. The NHS says a GP may offer it face to face or through an online self-help programme.
In 2024, NICE's menopause guideline (NG23) added menopause-specific CBT as an option for sleep problems, such as night-time waking, that come with hot flushes and night sweats.
Some core ideas from CBT that you can start using now:
- Keep bed for sleep. If you've been lying awake for what feels like a long time, get up and do something calm in dim light. Go back to bed when you feel sleepy.
- Fix your wake-up time. Lie-ins after a bad night feel kind, but they make the next night harder.
- Give worries a daytime slot. Women's Health Concern suggests setting aside time in the day to deal with problems that might otherwise keep you awake.
- Answer the 3am thoughts. Swap "I'll never sleep properly again" for "This is hard right now, but it will pass."
Slow your breathing
Women's Health Concern recommends slow breathing from your stomach as part of a wind-down routine. If you practise it during the day, it becomes much easier to use at night when you need it.
Move in the day
Regular activity, ideally outdoors in daylight, helps your body clock. Just keep anything strenuous away from the last few hours before bed.
What about sleeping pills?
The NHS says GPs now rarely prescribe sleeping pills for insomnia. They can have serious side effects and you can become dependent on them. When they are used, it's usually only for a few days or weeks.
Treatments to talk to your GP about
If sleep problems are tied up with hot flushes and night sweats, treating those may help your sleep too.
- HRT. The 2018 review found that hormone therapy improves sleep problems as women report them, especially when hot flushes are part of the picture. NICE says doctors should offer HRT for hot flushes and night sweats.
- Menopause-specific CBT, either alongside HRT or on its own.
- Help with low mood or anxiety, if these are keeping you awake.
When to see your GP
The NHS suggests seeing a GP if:
- changing your sleep habits hasn't helped
- you've had trouble sleeping for months
- poor sleep is affecting your daily life in a way that makes it hard to cope
It's also worth mentioning if you snore loudly, someone has noticed you stop breathing in your sleep, or you're feeling low. If you take any medicines, please don't stop or change them without talking to your GP or pharmacist first.
Where relaxation and hypnosis recordings fit in
Some women like to use a relaxation or hypnosis recording as part of their wind-down. It can be an easy way to build a calm bedtime routine, and to give a busy head something gentle to follow instead of the to-do list.
Our bedtime recording, Deep Sleep Through the Change, is a slow, guided relaxation designed to help you let go of the day and drift off. The voice simply fades at the end, with no count back up. It's a relaxation recording, not a medical treatment, and it doesn't replace advice from your GP.
If you'd like to try our style first, listen to our free Ten-Minute Calm Reset.
This article is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
