It’s 2 a.m., and you’re wide awake again. You toss, you turn, you adjust your pillow for the hundredth time, but sleep just isn’t coming. The nights seem to get longer, and the quality of sleep keeps getting worse.
For so many women in perimenopause, this nightly battle with sleeplessness feels all too familiar. As a pharmacist, I have seen so many of my patients struggle with sleep…and have even struggled with it myself!
But here’s the good news: you don’t have to settle for restless nights. And you don’t have to resort to prescription sleep aids!
When you understand what’s behind those sleepless nights, you can take back control and start building the foundation for quality sleep again.
In this article, we’ll explore why sleep is essential, the science behind it, and the top five sleep disruptors that could be keeping you up at night. Plus, I’ll share some practical tips that have helped my patients (and myself!) fall asleep and – more importantly – stay asleep!
The Science Behind Sleep: Why Your Body Needs Rest
Our sleep-wake cycle, also known as the circadian rhythm, is regulated by the interaction between two hormones: melatonin and cortisol.
Melatonin, often called the “sleep hormone,” is produced by the pineal gland in response to darkness. As it rises in the evening, it signals to the body that it’s time to wind down and prepare for sleep.
Cortisol, commonly known as the “stress hormone,” is secreted by the adrenal glands. It plays an important role in waking us up and keeping us alert. Cortisol levels typically peak in the morning and gradually decrease throughout the day, reaching their lowest at night.
However, during perimenopause, hormonal fluctuations can disrupt the balance of melatonin and cortisol, leading to irregular sleep patterns.
Understanding how these hormones impact the sleep-wake cycle can help you recognize why rest is sometimes hard to come by and give you clues on how to restore balance.
Why Sleep is Non-Negotiable in Perimenopause
Sleep is much more than rest; it’s when your body restores, repairs, and rebalances. During perimenopause, when hormonal changes already challenge your mood, metabolism, and immune function, quality sleep becomes even more essential.
Without enough sleep:
• Brain fog and irritability can worsen.
• Stress feels harder to manage.
• Weight gain and inflammation are more likely.
But when you prioritize rest, everything becomes easier! Hormones stabilize, energy returns, and the challenges of this phase feel much more manageable.
5 Common Sleep Disruptors in Perimenopause
So, what exactly is getting in the way of a peaceful night? Here are the top five culprits and how they impact sleep:
Hot Flashes and Night Sweats
Hot flashes and night sweats are among the most common sleep disruptors in perimenopause. Estrogen plays a role in regulating the body’s thermostat, so when estrogen levels fluctuate, they can trigger sudden temperature changes that cause sweating and wakefulness.
Additionally, these hot flashes can increase adrenaline and cortisol, making it even harder to drift back into a restful state.
Increased Stress and Cortisol Levels
Perimenopause often brings a heightened sensitivity to stress, which can increase nighttime cortisol levels. High cortisol disrupts melatonin production and keeps your body in a more alert state, which is counterproductive to sleep.
When cortisol rises at night, it can create a sense of restlessness, racing thoughts, or even a sudden jolt of wakefulness. Over time, chronic stress can lead to a vicious cycle, as poor sleep can further increase cortisol levels, making it increasingly difficult to get the rest you need.
Blood Sugar Imbalances
During perimenopause, the body can experience shifts in how it processes glucose, making it easier to experience blood sugar imbalances.
Low blood sugar during the night stimulates the production of stress hormones (cortisol and adrenaline) to raise blood glucose back to a safe level. Unfortunately, this stress response often causes mid-night awakenings, which can be difficult to recover from.
Digestive Changes
Digestive health can change during perimenopause, with many women experiencing slower digestion, bloating, and discomfort. Eating heavy meals or snacks late at night can activate digestion when your body should be winding down, leading to discomfort and interrupted sleep.
Additionally, certain foods can trigger digestive issues like acid reflux, which makes it hard to fall or stay asleep. These digestive disruptions also signal to your body that it’s still in an active state, counteracting the production of melatonin and your natural sleep cues.
Alcohol Consumption in the Evening
Alcohol can seem like a sleep aid because it initially promotes relaxation, but it actually disrupts the balance of GABA and glutamate, two neurotransmitters involved in sleep. Alcohol enhances GABA, which promotes relaxation, but as it wears off, glutamate levels increase, which stimulates the brain and causes wakefulness.
Furthermore, alcohol disrupts REM sleep—the restorative phase of sleep where memory and learning are consolidated. This interference can lead to lighter sleep and early morning wakefulness, making you feel less refreshed.
Food & Lifestyle Upgrades to Improve Sleep
Now that we know what’s causing those sleepless nights, let’s look at some changes you can make to start improving your sleep:
Prioritize Protein and Healthy Fats
Keeping your blood sugar steady is essential for uninterrupted sleep. A dinner rich in protein and healthy fats can help keep blood sugar stable throughout the night, minimizing cortisol-driven wakefulness.
Try Calming Herbal Teas
Chamomile, lavender, and valerian teas are known for their calming effects and can help signal to your body that it’s time to unwind.
Limit Caffeine and Alcohol
Both caffeine and alcohol can interfere with sleep quality. Try to avoid caffeine after lunchtime and keep alcohol to a minimum to give your body the best chance for restful sleep.
Create a Relaxing Bedtime Routine
Consistency is key! Set a regular bedtime and create a relaxing ritual—whether it’s reading, journaling, or taking a warm bath. When your body knows it’s time for sleep, it can help you fall asleep faster and stay asleep longer.
Cool Down Your Bedroom
Since hot flashes and night sweats are common in perimenopause, a cool bedroom can make a big difference. Aim for a temperature between 65–68°F, and consider breathable, moisture-wicking bedding.
Oral Progesterone & Sleep
Many times, the reason behind those sleepless nights in perimenopause is the natural decline in progesterone. For this reason, oral progesterone is often a game-changer!
Oral progesterone is metabolized in the liver into a compound called allopregnanolone, which has a calming effect on the brain. This metabolite interacts with GABA receptors, promoting relaxation and reducing anxiety.
Now, this metabolite is only formed with oral progesterone (compounded creams do not typically have this side effect). Progesterone can be dispensed at your regular pharmacy (brand name is Prometrium in the US) or compounded in smaller dosages and sustained release formulations at a compounding pharmacy.
I personally did not see any improvement with my sleep until I changed from progesterone cream to oral progesterone. So this may be worth talking to your doctor about!
Reclaiming Restful Nights in Perimenopause
Perimenopause may bring changes, but sleepless nights don’t have to define this phase of life! By understanding what’s happening in your body and making intentional lifestyle adjustments, you can take meaningful steps toward better rest.
