Sleep is often one of the first things affected during perimenopause. Sleep disturbances affect 40-60% of women during this period, making them 1.3-1.5x more likely to report poor sleep than premenopausal women, according to the SWAN Sleep Study (Kravitz et al., 2008).

Why it happens:

  • Progesterone, which has a calming effect and promotes sleep, decreases during perimenopause
  • Night sweats can fragment deep sleep — the arousal from a sweat episode wakes you even if you don't feel hot
  • Sleep-disordered breathing increases in prevalence in perimenopause (SWAN Study)
  • Restless legs syndrome is also more common in midlife
  • Stress and anxiety around the transition complete the picture

From SWAN data: Objectively measured (actigraphy) sleep worsened across the menopause transition even after controlling for VMS, hot flashes, and depression — suggesting hormonal factors independent of night sweats also contribute.

What you can do:

  • Maintain a regular sleep schedule, even on weekends
  • The bedroom should be cool (18-20°C)
  • Avoid screens for 1 hour before bed
  • CBT-I (Cognitive Behavioral Therapy for Insomnia) is the first-line non-pharmacological intervention with Level I evidence
  • Talk to your doctor about options if the problem persists — hormonal therapy and non-hormonal options like low-dose antidepressants can help