Why am I waking up at 3am? Sleep disturbances in menopause
You’re exhausted. You’ve done your evening routine, gone to bed at a reasonable time and yet you wake up at 3am, mind racing, unable to drift back off.
If this sounds familiar, you’re not alone.
Up to 60% of women in perimenopause and menopause experience disrupted sleep. [1,2] For some, it’s trouble falling asleep. For others, it’s waking in the night or far too early.
And while the odd bad night is frustrating, when it becomes a pattern, it can leave you running on empty; physically, mentally, and emotionally.
Why sleep matters more than ever in midlife?
Sleep isn’t just “switching off.” It’s when your body does its deepest repair work.
During Stage 3 non-REM sleep (the deepest stage), your heart rate slows, blood pressure drops, and your brain shifts into maintenance mode — repairing tissues, strengthening your immune system, and consolidating memories from the day.
Most of this deep sleep happens in the first few hours of the night. That’s why going to bed at a consistent time really matters.[3]
Why menopause can mess with your sleep
Hormonal changes during perimenopause and menopause affect much more than your periods they also impact your brain’s ability to regulate sleep, temperature, and stress responses.
- Oestrogen: Supports production of serotonin and melatonin, both vital for healthy sleep-wake cycles. Falling oestrogen levels can mean:
- More night-time awakenings
- Reduced REM sleep
- Temperature dysregulation and night sweats[4,5]
- Progesterone: Has a calming, sedative effect by enhancing GABA activity in the brain. When progesterone drops, it’s harder to relax and fall asleep. Micronised progesterone (e.g., Utrogestan) in HRT can improve sleep quality[6]
- Melatonin:This “sleep timing” hormone naturally declines with age, which can further fragment sleep and make it harder to stay asleep.[7]
- Seep Apnoea: After menopause, changes in airway tone and body composition can increase the risk of sleep apnoea, often underdiagnosed in women because symptoms may be fatigue or poor sleep rather than loud snoring.[8]
The link between hot flushes and waking up at night
In the SWAN study, women in the menopause transition reported significantly more frequent sleep disturbances than premenopausal women, with hot flushes and night sweats strongly linked to poor sleep quality.[1]
How long does it last?
It varies. For some women, symptoms last a few months. For others, they can persist for several years. The positive news? With the right approach, sleep often improves.
What can help?
There is no one-size-fits-all approach, but the following strategies are backed by evidence and used widely by menopause specialists:
1. Hormone Replacement Therapy (HRT)
Replacing oestrogen (and in some cases progesterone) can reduce hot flushes, improve mood, and support more restful sleep [9]. A study conducted by the Mayo Clinic in 2022 found that low-dose HRT significantly improved both sleep quality and duration in recently menopausal women [10].
2. Cognitive Behavioural Therapy for Insomnia (CBT-I)
CBT-I is a structured, non-drug treatment that helps you identify and change thoughts and behaviours that interfere with sleep. It’s recommended by NICE and the British Menopause Society as an effective treatment for sleep problems in menopause [1,11].
3. Lifestyle and Sleep Hygiene
These strategies form a key part of many treatment plans and can support significant improvements in sleep quality:
Daily Habits:
Stick to a consistent bedtime and wake time. Routine helps train your body for sleep.
Avoid long daytime naps. If needed, keep them under 40 minutes and early in the afternoon.
Exercise regularly, but not within two hours of bedtime.
Understand how much sleep you personally need. Six to eight hours is average, but this varies between individuals and may decrease with age.
Evening Routine:
Establish a relaxing pre-bed routine, such as a warm bath or light reading.
Avoid going to bed too full or too hungry. A small snack is fine.
Cut out caffeine and fizzy drinks from late afternoon onward.
Avoid alcohol, which can disrupt sleep quality.
Bedroom Environment:
Keep your bedroom cool, quiet, dark, and comfortable.
Invest in good bedding and a supportive mattress.
Use the bedroom only for sleep and intimacy. Avoid using screens or working in bed.
If You Wake in the Night:
If you cannot fall back asleep within 20 minutes, get up and do something quiet in another room. Return to bed when you feel sleepy.
Avoid looking at the clock or turning on the TV.
Try not to dwell on worries or problems during the night. Set them aside for the morning.
4. Medical Checks
Fatigue and sleep problems may also be linked to low iron, thyroid dysfunction, vitamin D or B12 deficiency. Blood tests can help identify and treat these issues.
When to seek help
If sleep is affecting your daily life, your ability to function, or your mental health, it’s time to get support. Speak to a menopause-informed clinician who can explore both hormonal and non-hormonal options with you.
Sleep should not feel like a nightly battle. With the right treatment and support, better nights are possible.
¹- Kravitz, H.M., et al., 2003. Sleep difficulty in women at midlife: a SWAN study. Sleep
, 26(3), pp.267–272. https://pubmed.ncbi.nlm.nih.gov/12544673/
²- Polo-Kantola, P., et al., 2001. Climacteric symptoms and sleep quality. Obstetrics & Gynecology, 97(3), pp.404–410. https://pubmed.ncbi.nlm.nih.gov/10432131/
³- National Institute on Aging, 2022. How Does Sleep Affect Your Heart Health? (Accessed 15th Aug 2025) https://www.nia.nih.gov/health/heart-health/heart-health-and-aging
⁴- Cintron, D., et al., 2017. Efficacy of estrogen therapy for sleep disturbance in menopausal women. Journal of Women’s Health, 26(5), pp.509–517. https://pubmed.ncbi.nlm.nih.gov/27515805/
⁵- NICE, 2015. Menopause: diagnosis and management. NG23. Available at: https://www.nice.org.uk/guidance/ng23
⁶- Haufe, Annika, and Brigitte Leeners. "Sleep disturbances across a woman's lifespan: what is the role of reproductive hormones?." Journal of the Endocrine Society 7.5 (2023): bvad036. https://pmc.ncbi.nlm.nih.gov/articles/PMC10117379/
⁷- Jehan, Shazia, et al. "Sleep, melatonin, and the menopausal transition: what are the links?." Sleep Science 10.01 (2017): 11-18. https://pmc.ncbi.nlm.nih.gov/articles/PMC5611767/
⁸- Jordan AS et al. Sleep-disordered breathing in postmenopausal women: causes and consequences. J Clin Sleep Med. 2014;10(12):1279–1286. https://www.jacc.org/doi/abs/10.1016/j.jacc.2021.05.048
⁹- British Menopause Society. The management of urogenital symptoms of menopause. 2023. https://thebms.org.uk/wp-content/uploads/2024/04/09-BMS-ConsensusStatement-Urogenital-atrophy-MARCH2024-A.pdf
¹⁰- Baker, Fiona C., et al. "Sleep problems during the menopausal transition: prevalence, impact, and management challenges." Nature and science of sleep (2018): 73-95. https://pubmed.ncbi.nlm.nih.gov/29445307/
¹¹- Women’s Health Concern. Menopause and Insomnia 17-WHC-FACTSHEET-Menopause-and-insomnia-NOV2022-B.pdf https://thebms.org.uk/wp-content/uploads/2022/12/01-BMS-TfC-CBT-NOV2022-A.pdf
