Sleep plays a critical role in overall well-being, yet women are around 50% more likely than men to report suffering from insomnia, especially around hormonal changes like menstruation, pregnancy, menopause and perimenopause.
In this blog, Dr Lindsay Browning explains exactly what perimenopause is and the common negative effects in can have on some women’s sleep. She also offers some tips and hints on improving sleep, despite some symptoms which may disrupt it.
Defining perimenopause
Strictly speaking, “menopause” refers to a single point in time when a woman has gone exactly 12 consecutive months without a period. However, the term is often used more broadly to describe the whole transition.
The first part of the whole transition is the perimenopause. It can begin several years before “menopause”, sometimes as early as in your late 30s or early 40s.
Perimenopause is the stage leading up to menopause, when hormone levels (especially oestrogen and progesterone) begin to fluctuate and decline. This is typically when many women first notice what are often menopausal symptoms, such as night sweats, sleeping issues, mood changes and irregular menstrual cycles. The symptoms tend to be more erratic and unpredictable, during perimenopause, because hormone levels are fluctuating.
There is also a post-menopause phase, which refers to the years after the moment of “menopause” itself, when periods have permanently ceased. Some symptoms (such as night sweats, hot flashes, mood swings, etc) may continue for a while before declining in frequency, but others, like increased risk of sleep apnoea or restless legs syndrome may start to become more common.
Why does perimenopause affect sleep?
Hormonal changes disrupting sleep patterns
Not only do the physical symptoms associated with perimenopause and menopause (such as night sweats and hot flashes) directly impact sleep, the varying hormone levels around this time, especially fluctuating levels of oestrogen and progesterone, can cause sleep disturbances.
Low levels of progesterone, for example, can make it harder to fall asleep or stay asleep since progesterone has a calming, sleep-promoting effect. This is why progesterone supplements are sometimes recommended to be taken in the evening.
Because oestrogen affects temperature regulation, when oestrogen levels decrease night sweats and hot flashes are also more likely. Additionally, mood changes and anxiety can be related to fluctuating oestrogen levels, which can contribute to insomnia.
Improving sleep
If your perimenopause symptoms, such as night sweats and hot flushes, are disrupting your sleep, there are some practical steps that you can take.
- make sure that your bedding, mattress and nightwear are breathable and allow air to flow
- keep your bedroom relatively cool
- use layers or make it easy to adjust the covers you need, if you start to overheat in bed.
- consider using a cooling mattress pad
A 2024 study looked at sleepwear and bedding fibre types, and concluded that natural fibres like wool, especially as sleepwear, tend to help people fall asleep in cooler environments. Linen sheets may be especially helpful when it’s warm because people do not overheat as easily. Goose down duvets seem to support deeper sleep when the room is cool. However, they concluded that there was no strong evidence that one material was definitively best for everybody in every condition as it depends on temperature and individual differences. So, it can come down to personal preference.
Tracking and monitoring your sleep pattern during perimenopause
Keeping a sleep diary can help you to spot patterns (such as time of the month) and potential triggers (such as certain foods, alcohol intake, or activities before bed) that disrupt your sleep.
Also, by recording your bedtime, wake time, how much sleep you’ve had and how much time you spent awake during the night, you can have a record of how your sleep is over a period of days and weeks – rather than just a single night snapshot. If you have growing concerns about your sleep, you can take this diarised information to discuss with your GP. It will give them a really good overview of what has been happening.
As an aside, using a wearable sleep tracker can be a convenient way to track your sleep, although remember that they are not always 100% accurate and writing your own sleep diary can be a useful comparison too.
Want further support?
As discussed, perimenopause can certainly affect sleep, but there can also be other reasons. Perhaps, you had trouble sleeping before this hormone change too.
You may also be concerned about the effect on your sleep in later life too. Do not worry alone.
If you have any concerns, please do not hesitate to get in touch.
References
Baker, F. C., & Lee, K. A. (2022). Menstrual cycle effects on sleep. Sleep Medicine Clinics, 17(2), 283–294.
Li, X., Halaki, M., & Chow, C. M. (2024). How do sleepwear and bedding fibre types affect sleep quality: A systematic review. Journal of Sleep Research, 33(6), e14217.
Zeng, L.-N., Zong, Q.-Q., Yang, Y., Zhang, L., Xiang, Y.-F., Ng, C. H., Chen, L.-G., & Xiang, Y.-T. (2020). Gender difference in the prevalence of insomnia: A meta-analysis of observational studies. Frontiers in Psychiatry, 11, 577429.
Zhang, B., & Wing, Y. K. (2006). Sex differences in insomnia: A meta-analysis. Sleep, 29(1), 85–93.