Sleep problems can often appear with perimenopause and menopause. Discover ways to get better sleep, such as by trying menopausal hormone therapy (MHT) and avoiding nicotine.

If you’re going through menopause or you will be soon, sleep issues may be an unfortunate fact of life.

You may have trouble falling asleep, find your sleep interrupted, or experience sleepless nights in general. Sleep issues can then make symptoms of perimenopause (the transition into menopause) and menopause worse.

Lifestyle changes can help reduce the frequency of your hot flashes or make it easier to sleep through them. In some cases, your doctor may also prescribe menopausal hormone therapy (MHT) or other treatments.

Keep reading to discover other helpful strategies you can use to improve your sleep during perimenopause and menopause.

Both perimenopause and menopause can lead to severe sleep disturbances.

If you’re experiencing hot flashes, night sweats, and anxiety during perimenopause, you may find that these symptoms start affecting your sleep.

You may even enter a frustrating cycle where a restless night can cause stress and tiredness that sometimes worsen your perimenopause symptoms and sleep problems.

A 2017 study on insomnia and perimenopause analyzed data obtained from various regions across the United States over a 10-year period. The researchers found that, during any 1-year study interval, 31–42% of perimenopausal women had symptoms severe enough to qualify as insomnia. Symptoms were more likely in the later stages of perimenopause than in the earlier stages.

One possible cause is hormonal changes. As you near menopause, your ovaries stop producing the hormones estrogen and progesterone. The decrease in these hormones can lead to hot flashes and night sweats.

As your body’s temperature begins to rise during sleep, you may wake up. By the time your hot flash has passed, you may have been awake for several uncomfortable minutes. Many people find it hard to fall back asleep afterward.

Another potential cause is obstructive sleep apnea (OSA), a condition where you momentarily stop breathing, prompting you to wake up from your sleep. OSA symptoms may also lead to low quality sleep overall.

According to a 2018 study, people who have surgically induced menopause may be at a higher risk of developing OSA than people who experience natural menopause. OSA may also be the result of weight gain or low levels of progesterone.

Finally, restless leg syndrome may contribute to insomnia during menopause. Restless leg syndrome causes a tingling feeling in the legs that can be uncomfortable and cause you to lose sleep at night.

During menopause, you may experience other sleep problems as a result of depression, anxiety, or mood disorders. If you’re facing extra emotional stress, the mental toll may prevent you from sleeping.

If your mind can’t free itself from the worries and anxieties you face during the day, you may find it hard to fall and stay asleep.

On top of that, lack of sleep can lead to other issues, including:

  • daytime drowsiness
  • fatigue
  • shifts in mood

A doctor may suggest menopausal hormone therapy (MHT), also known as hormone therapy, to help manage your perimenopause and menopause symptoms.

People undergoing MHT are typically prescribed estrogen and a progestin (synthetic progesterone). If you have had a hysterectomy or otherwise don’t have a uterus, you’ll only receive estrogen.

MHT was once routinely prescribed for hot flashes and other menopause symptoms. This practice nearly stopped several years ago amid concerns of MHT causing health issues such as stroke, heart disease, and breast cancer.

According to a 2019 literature review on the history of hormone replacement therapy, previous studies on its side effects weren’t well designed. The researchers stated that its benefits far outweigh the risks, and they recommended continued studies to determine its safety for people going through menopause.

In a 2020 study, researchers assessed the risk of breast cancer associated with MHT. They noted that generalized risk may be affected, but risk primarily increased with multiple hormone treatments and increased length of treatment.

Talk with a doctor about the potential benefits and risks of MHT. There are also nonhormonal medications that have been shown to help the symptoms of perimenopause and menopause. The doctor can help you discover which treatments may be best for you.

Other medications a doctor may suggest include:

  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may help with hot flashes.
  • Anticonvulsant medications: Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica, Lyrica CR) may help with hot flashes too.
  • Clonidine (Catapres‑TTS, Nexiclon XR): This medication may help with flushing. It’s typically used to help treat high blood pressure.

When used to treat the symptoms of insomnia, they’re referred to as off-label drugs.


Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat their patients.

So your doctor can prescribe a drug however they think is best for your care.

Insomnia related to perimenopause or menopause can go away or improve over time.

Talk with your doctor about medications to help you manage your symptoms. Also, consider making lifestyle changes that help you fall asleep or get back to sleep if you wake in the middle of the night.

Research suggests that proactively treating insomnia, menopause, and other conditions that may be present, such as depression, can help reduce the impact of insomnia.

Medications can help suppress some symptoms related to perimenopause or menopause, which can lead to better sleep. In some cases, they may not be enough.

Making lifestyle changes as well can help you fall asleep, get back to sleep in the middle of the night, or stay asleep. Below are some strategies to try.

1. Eat well, and get plenty of exercise

To help prevent hot flashes, it’s important to eat regular, well-balanced meals that aren’t high in fat or sugar and to exercise daily.

The timing of these activities also matters.

For some people, eating or exercising too close to bedtime can interrupt their body’s natural clock and may inhibit their sleep. Others find they can sleep better if they exercise in the evening.

Experiment, and see what works for you.

2. Wear loose-fitting clothing to bed

Sleep in clothes made from natural fibers, such as cotton. This allows your skin to “breathe” more easily. The fabric helps wick moisture away from your skin.

3. Use cotton sheets

Compared to some other fabrics, cotton stays cooler against your skin. It helps keep heat from building up around you, which can prevent sweating.

4. Keep your bedroom cool

A cool room is more conducive to sleep than a warm one. Consider lowering the temperature in your home at night.

Ceiling fans or standing fans also help circulate air and keep your bedroom cool.

5. Avoid spicy foods

Foods that cause you to sweat may lead to sleep disturbances if you eat them shortly before bedtime. Spicy foods are a common culprit.

6. Limit caffeine, nicotine, and alcohol

If you have soda, coffee, or a cigarette too close to bedtime, your body may struggle to counteract the natural boost of energy that comes with caffeine and nicotine.

A glass of wine before bed may help you fall asleep, but it can also interfere with your natural sleep cycle. In other words, you may fall asleep more easily after drinking it, but you’re more likely to wake up earlier and feel less rested.

According to a 2019 study focused on African Americans, using nicotine and alcohol for up to 4 hours before bedtime can potentially cause issues with disturbed sleep.

The National Institute on Aging recommends that people with hot flashes avoid alcohol altogether due to its negative effect on menopausal symptoms.

You can still consume alcohol if you choose, but the Centers for Disease Control and Prevention (CDC) recommends women have one or fewer drinks per day.

7. Manage your stress

Emotional stress can heighten your sensitivity to temperature changes, which may bring on sweating and hot flashes.

To help manage the stress or anxiety that you’re facing, try relaxation techniques such as:

  • yoga
  • breathing exercises
  • massage

If you feel chronically stressed, anxious, or depressed, speak with a doctor. They may be able to suggest strategies to manage your stress and improve your mood.

In some cases, they may recommend lifestyle changes, medications, or therapy.

Loss of sleep can leave you feeling tired, confused, and irritable during the day. It can also raise your risk of accidental injuries and certain health conditions.

If hot flashes or other perimenopause and menopause symptoms are keeping you awake, consider speaking with a doctor.

They can recommend appropriate treatment options and may make suggestions about helpful lifestyle changes too.