Understanding Sleep Changes in Perimenopause

Perimenopause |
4 min read

Written By

Brittany Dick

Published

January 19, 2026

Medically reviewed by

Alyssa Dweck MS, MD, FACOG, MSCP, Chief Medical Officer

Does perimenopause suddenly have you feeling restless, anxious, and occasionally sweaty as you lay in bed at night? Around half of all women in transitioning through menopause report difficulties sleeping, with the majority struggling with no answers or explanation for these disruptive symptoms.¹

In this article, we’ll break down why you may be experiencing hormone-related sleep changes during the menopause transition—and what you can do to improve your rest during this time and beyond.

What to Expect with Changing Perimenopause Sleep Patterns

Not sure what to expect as menopause nears or wondering if what you’re experiencing in regard to the recent change to your sleep is normal? Here are some of the most common perimenopause sleep changes to be aware of, followed by why they may be keeping you up at night.

Night Sweats

Sweating is the body’s natural way of regulating temperature when hot, nervous, or stressed.²

But, if you’re soaking through your clothes and/or sheets at night with none of those variables at play, you may be experiencing night sweats, associated with the hormonal fluctuations of perimenopause – also known as a vasomotor symptom.

Night sweats are the nocturnal version of hot flashes, that causes sudden waves of heat throughout the nighttime hours.³ These nighttime hot flashes may also be followed by a rapid heartbeat, reddening skin, and intense sweating.⁴

Anxiety and Other Mood Changes

Are your evenings filled with worries, regrets, or thoughts that are disrupting your sleep?

A woman’s risk for mood changes, including disorders like anxiety and depression, may increase during the menopause transition.⁵ Unfortunately, these impacts of these mood changes may trickle into nighttime hours, negatively affecting sleep.

The hormonal changes experienced during menopause result in levels of serotonin and GABA—two of the brain’s neurotransmitters crucial for feelings of happiness, calm and well-being—dropping.⁶ For this reason, women are unfortunately and uniquely vulnerable to heightened emotional distress during menopause compared to most other life stages.⁷

Sleep-Related Breathing Disorders

The same hormonal changes driving night sweats and anxious thoughts may also contribute to the development of sleep apnea during menopause. Women with obstructive sleep apnea may experience: ^8,9

Loud snoring
Night waking followed by gasping or choking
Pauses in breathing during sleep
Frequent urination at night
Restless legs
Mood changes
Morning headaches

Sleep apnea does more than disrupt sleep; it’s a serious medical condition that can cause heart arrhythmias, high blood pressure, heart damage, and, in rare cases, cardiac death.¹⁰ Women who experience the symptoms listed above should make an appointment with their primary care providers as soon as possible for proper diagnosis and treatment.

Causes of Perimenopause Sleeplessness

Combined with common midlife stressors, the following physical symptoms may collide with emotional stressors to cause enhanced perimenopause sleep issues. These fall under the umbrella of hormone-related sleep changes that can occur as a result of declining estrogen and progesterone levels.¹¹

Both of these hormones help to regulate body temperature, mood, and strength of the throat muscles during sleep.^12,13 As they decline during menopause, women may be vulnerable to developing night sweats, nighttime anxiety, and sleep-related breathing disorders.

Addressing Changing Perimenopause Sleep Patterns

Fortunately, there are ways to help battle sleeplessness due to hormone-related sleep changes in perimenopause and menopause.

Night sweats^14,15: Consider wearing lightweight, moisture wicking pajamas, manage stress, keep the bedroom cool, avoid or reduce caffeine and alcohol before bed, and consider reputable supplementation for night sweats and hot flashes.
Nighttime anxiety^16,17: Practice mindfulness, seek guidance from a professional therapist, exercise regularly, and eat foods that support mental health
Sleep-related breathing disorders^18,19: Consider lifestyle changes, oral appliances, or sleep devices that offer positive airway pressure (CPAP)

Improving Rest During Menopause Is Possible

While sleep disruption in menopause is common, feeling eternally exhausted doesn’t have to be. Small adjustments in your nighttime routine may have a big impact on improving your overall sleep.

If small changes don’t help—and if consistent poor sleep is affecting your quality of life—be sure to reach out to a healthcare provider for other options, which could include things like talk therapy, medication, or additional lifestyle changes.

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