What’s going on with sleep during perimenopause and menopause?

By Dr Paula Bradley, GP, Women’s Health & Menopause Specialist at TMC

If you are navigating your 40’s or 50’s and suddenly your sleep has gone from deep and restorative to waking at 3 am again? You are absolutely not alone.

What changes

During the perimenopause and menopause transition (which typically spans from the 40s into the early 50s, though everyone’s timeline is different), your levels of oestrogen and progesterone begin to fluctuate and then decline. These hormone changes can significantly affect sleep.

The result?

Hot flushes or night sweats that wake you up or make getting comfortable tricky.
Waking up earlier than you used to (or at odd hours) and not being able to get back to sleep.
Other symptoms – like restless legs, needing to pee during the night (nocturia), low mood or anxiety – all of which can ripple into sleep issues.

It’s common. For example: “up to 57% of women suffer from sleep disturbance during the perimenopause/menopause.”

Why it matters

Poor sleep doesn’t just leave you feeling tired the next day. It can affect mood, focus, physical health and wellbeing in general.

The good news, there are things you can do to help, including approaches backed by evidence.

What helps? Behaviour-based strategies

Sleep hygiene basics

Start with the more “doable” practical steps:

Go to bed and wake up at roughly the same time each day.
Give yourself a wind-down routine: avoid screens for a little while, try a relaxing activity, and avoid heavy meals right before bed.
Keep the bedroom cool and comfortable (especially important if night sweats are a factor).
Watch caffeine, alcohol and smoking – these can all mess with sleep and also trigger menopausal symptoms like flushes/night sweats.

These things help, but when sleep disruption is chronic – particularly due to the combined effect of hormonal changes, hot flushes/night sweats and insomnia – you might need to go further.

Cognitive Behavioural Therapy for Insomnia (CBT-I)

Here’s the big one. Evidence shows that when sleep issues slide into more entrenched insomnia (difficulty falling asleep or staying asleep on a frequent basis), then CBT-I is the gold standard treatment.

CBT-I means working on the thoughts, behaviours and habits around sleep: for instance, what you believe about your sleep, how you respond when you wake up, how much time you spend in bed awake, etc.

Importantly: many women with menopausal sleep disturbance do respond well to CBT-I – even if they’re also getting hot flushes/night sweats.

Apps & digital help via the NHS and beyond

Given limited access to face-to-face CBT-I (because specialist therapists are few and waiting lists long), digital tools are becoming a really helpful option.

Apps: Sleepio, Sleepstation, Sleepful

In May 2022, National Institute for Health and Care Excellence (NICE) recommended Sleepio as a cost-saving treatment for insomnia in primary care – as an alternative to sleeping pills.

The app delivers a structured 6-week programme of digital CBT-I: sleep test, weekly interactive sessions, sleep diary etc.

The app is accessible via sleepio.com/nhs and in some regions is offered free to adults.

What does that mean for you: If your sleep is suffering badly, you could speak to your GP and ask whether you can access a digital CBT-I platform via your local NHS service.

If not, there are also private providers and self-help options (but costs will vary).

Putting it into practice: what you can do

Here’s how to approach things in a gentle, step-by-step way:

This week:

Pick one practical change: e.g., lower the bedroom temperature, try lighter sleepwear, reduce caffeine after midday.
Keep a simple sleep diary: what time you got in bed, what time you got up, how many times you woke up, how you felt in the morning.
If you wake at 2–3am and can’t get back to sleep, avoid lying there worrying: consider getting up briefly and doing something soothing (low-level light, no screens) and go back when you feel sleepy.

In the next 2–4 weeks:

If sleep remains poor, consider asking your GP about whether sleep disruption might be connected to menopausal symptoms (like night sweats) and whether it’s time to explore options like hormone replacement therapy (HRT).
Explore whether you can access a CBT-I programme – ask: “Can my practice refer me for CBT-I or digital CBT-I via the NHS?”

Final thoughts: you’re not doomed to poor sleep

Menopause-related sleep issues are very common, but they are manageable. You don’t have to just wait for “it to pass”. By combining practical adjustments + targeting sleep habits/thoughts + exploring digital or in-person CBT-I + addressing any hormonal/physical contributors, you can significantly improve your nights.