Sleep and menopause: why you wake at 3 a.m. and what helps
According to the NHS, sleep problems are among the symptoms of perimenopause and menopause, and menopause is among the conditions that can cause insomnia. Night sweats make sleep worse still, and poor sleep makes the other symptoms worse. What helps is a regular routine for going to bed and getting up, a cool and dark bedroom, avoiding caffeine and alcohol for hours before bed, and cognitive behavioural therapy (CBT) if changing your habits is not enough.
- The NHS includes menopause among the conditions that can cause insomnia, and sleep problems among the symptoms of perimenopause.
- Night sweats make sleep problems worse, and poor sleep makes the other symptoms worse.
- According to the NHS, adults need on average 7 to 9 hours of sleep.
- The NHS recommends avoiding coffee, tea, alcohol and cigarettes for at least 6 hours before bed and not exercising within 4 hours of sleep.
- Cognitive behavioural therapy (CBT) helps with sleep problems, low mood and anxiety in menopause.
Why does sleep fall apart in perimenopause?
If you fall asleep normally but wake in the middle of the night and cannot get back to sleep, you are not alone. According to the NHS, sleep problems are among the symptoms of perimenopause and menopause, and on its insomnia page the NHS lists menopause among the conditions that can cause it, alongside an overactive thyroid and some medicines.
The NHS notes that disturbed sleep can make the other symptoms worse – mood, concentration, daytime tiredness. On top of that come the other common causes of insomnia according to the NHS: stress, anxiety or depression, noise, an uncomfortable room temperature, an uncomfortable bed, alcohol, caffeine and nicotine.
What do night sweats have to do with waking in the middle of the night?
According to the NHS, hot flushes make the face, neck and chest suddenly feel very hot (or cold), can cause heavy sweating, palpitations, anxiety or dizziness, and each episode lasts a few minutes. When they happen at night, they are called night sweats. The NHS states that sleep problems can be worse if you also have night sweats.
That is why part of looking after your sleep in this period is also looking after the hot flushes: the NHS recommends light nightwear, a cool bedroom, a fan or a cold drink, and cutting down on spicy food, caffeine, hot drinks, cigarettes and alcohol, which can trigger them.
How do you know you have insomnia and not just a bad night?
According to the NHS, insomnia means regularly having problems sleeping. It is short-term if it lasts less than 3 months, and long-term if it lasts 3 months or more. The signs the NHS lists are familiar to many women in perimenopause:
- you find it hard to fall asleep or lie awake at night
- you wake up several times during the night
- you wake up early and cannot get back to sleep
- you feel tired after waking up and during the day you are tired and irritable
- you find it hard to concentrate because of tiredness
As a guide, the NHS states that adults need on average 7 to 9 hours of sleep, and constant daytime tiredness can be a sign that you are not sleeping enough.
What does the NHS recommend for better sleep?
According to the NHS, insomnia usually improves by changing your sleep habits. What to do:
- go to bed only when you feel sleepy and get up at the same time every day – even after a bad night, do not sleep in
- set aside at least an hour to wind down before bed – a bath, a book
- keep the bedroom dark, quiet and cool; if needed – thick curtains, an eye mask, earplugs
- exercise regularly during the day
- check that your mattress, pillows and covers are comfortable
What to avoid according to the NHS: cigarettes, alcohol, tea and coffee for at least 6 hours before bed; a big meal late in the evening; exercise within 4 hours of sleep; TV and phone right before bed (the blue light keeps you awake); napping during the day; driving when you are sleepy.
On its menopause page the NHS adds: a regular sleep routine, enough rest, relaxation such as yoga, tai chi or meditation, and not smoking, which can make symptoms worse.
Do sleeping pills and herbal supplements help?
According to the NHS, pharmacies sell products without a prescription – some with herbal ingredients such as valerian or lavender, others with an antihistamine. They do not cure insomnia: they may help for 1 to 2 weeks and should not be used for longer. They can cause drowsiness that makes driving dangerous, so check with a doctor before taking anything for sleep. The NHS also recommends talking to a doctor before any herbal or complementary remedies for menopause.
Doctors now rarely prescribe sleeping tablets – because of serious side effects and the risk of dependence – and usually only for a few days or weeks for severe insomnia, when other approaches have not helped. The approach the NHS prefers is cognitive behavioural therapy (CBT) – in person or as an online self-help programme – which changes the thoughts and behaviours that get in the way of sleep. The NHS states that CBT also helps with low mood, anxiety and hot flushes in menopause.
When should you see a doctor?
According to the NHS, see a doctor (non-urgently) if:
- changing your sleep habits has not helped
- you have had sleep problems for months
- insomnia is getting in the way of coping with daily life
- you suspect symptoms of perimenopause or menopause and want to discuss your options – early advice, according to the NHS, reduces the impact on your health, relationships and work
- you have symptoms such as palpitations
The doctor will look for the cause of the insomnia, may suggest CBT, discuss HRT (which according to the NHS helps with sleep problems) or refer you to a sleep clinic if they suspect another disorder such as sleep apnoea.
Frequently asked questions
Can HRT improve my sleep?
According to the NHS, sleep problems are among the symptoms that hormone replacement therapy helps with, as are the night sweats that often cause them. Whether it is suitable for you is decided with a doctor.
Should I sleep in after a bad night?
The NHS advises not to sleep in after a bad night and not to nap during the day – stick to your usual times for going to bed and getting up.
Is snoring or stopping breathing at night linked to menopause?
The NHS lists snoring and interrupted breathing during sleep (sleep apnoea) as separate factors that disturb sleep. If you have them, your doctor may refer you to a sleep clinic.
Sources
- NHS – Things you can do to help menopause and perimenopause symptoms – last reviewed by the NHS: 19 May 2026
- NHS – Insomnia – last reviewed by the NHS: 19 March 2024
- NHS – Symptoms of menopause and perimenopause – last reviewed by the NHS: 19 May 2026
Informational article retold in our own words from the sources listed. It does not replace a consultation with a doctor; in an emergency call 112. If you spot an inaccuracy, write to [email protected].