Difficulty falling asleep, staying asleep, and then feeling tired all day is incredibly common in perimenopause.
If you are struggling to get some Zzzs at night, you're definitely not alone!
A major complaint women have in perimenopause is trouble staying asleep. They oftentimes will find themselves falling asleep on the couch watching TV after dinner, but then wake up at 2 or 3 AM (often referred to as the "witching hour") and struggling to get back to bed.
Oftentimes, we assume these changes are entirely hormonal. And, sure, hormones play a role! There's a lot that can be happening:
We all know we need an environment of darkness at night to produce melatonin (which naturally decreases during perimenopause and menopause, anyway!).
This is about more than blue light exposure. If and when you spend your evening doomscrolling to get some "me time" at the end of the day, it might feel relaxing in the moment, but you may be overstimulating your nervous system simply because social media is designed to keep you on it! Your brain isn't made for taking in that much rapid-fire information, which activates your sympathetic nervous system. To sleep, you need to activate the parasympathetic "rest and digest" system.
In a recent conversation with Dr. Nishi Bhopal, a board-certified MD in psychiatry and sleep medicine, she said the "bookend strategy" is something to keep in mind: put your phone away one hour before bed, and keep it away for one hour after you wake up. A good rule of thumb is to never use your phone while horizontal.
And what about TV before bed? I have patients tell me that they fall asleep easier in front of the TV.
It's a bit controversial, but if a comforting, predictable show helps you get your mind off things so you don't lay in bed with racing thoughts, it can actually be a useful wind-down tool. Just make sure you set a sleep timer so it doesn't run all night, and avoid true-crime dramas right before bed!
I actually sometimes recommend watching TV in bed instead of on the couch because getting up to get into bed can disrupt the whole sleep rhythm!
I love coffee! I also know that I cannot have it past 3pm otherwise it will affect my sleep. We all metabolize caffeine a bit differently. Then, we need to think about adenosine.
Throughout the day, a neurotransmitter called adenosine builds up in your body. Adenosine is what makes you feel sleepy at night. Caffeine works by blocking adenosine receptors, preventing you from feeling tired.
The problem is that adenosine builds up throughout the day, and when that caffeine wears off, you can get even more tired (for which you may have extra caffeine later in the day) and it will make you feel more tired the next day.
A great rule of thumb is to cut off caffeine by 12:00 PM.
Alcohol can be confusing for some people because it's a depressant, so a glass of wine might help you fall asleep faster. BUT, in the second half of the night, alcohol suppresses your restorative REM sleep. As your body metabolizes it, you're way more likely to wake up. Alcohol also makes your airway more collapsible (worsening sleep apnea) and can lead to "hangxiety" and fatigue the next day by disrupting your calming neurotransmitters.
Not only that, alcohol can lead to more night sweats in some people ... aaaand, it really isn't good for your health.
If you find yourself craving a bag of chips or cookies after a bad night of sleep, or if you simply cannot stop yourself from eating, it's your sleep!
Poor sleep directly impacts your hunger hormones. It decreases leptin (the hormone that tells your body you are full and satisfied) and increases ghrelin (the "gremlin" hormone that makes your stomach growl and tells you to eat).
Metabolic health and body composition changes (midsection weight gain) are common in perimenopause. Getting on top of your Zzzs is an important priority for these other aspects of your health.
I can't offer medical advice here, and really, there's no one-size fits-all solution here. It depends on what's going on. Here are some helpful tips to consider shared by Dr. Bhopal:
Lifestyle: Work on the simple stuff: set a caffeine curfew, cut (back on) alcohol, and find a wind-down routine (something flexible, consider a bedtime menu of 7-10 relaxing activities to choose depending on how you're doing and how much time you want to spend).
Circadian Rhythm: Get bright light exposure in the mornings (even if it's a light therapy device in the darker winter months) to regulate your daily body clock.
Sleep Drive or Sleep Pressure: Build up your sleep drive or sleep pressure by staying active and moving your body during the day, not having caffeine too late, and avoiding thrilling activities before bed.
Hyperarousal: Work on giving your nervous system breaks throughout your day, especially in the evening to wind down. If your nervous system is on the go all day, it cannot flip off like a switch at night, which is where a bedtime menu to wind-down is a great idea.
If you're doing all of these things and still struggling, talk to your medical team, like your GP, ND, NP. Hormone therapy, targeted supplements like magnesium, melatonin, certain herbal formulations, acupuncture, treating underlying sleep apnea, and Cognitive Behavioral Therapy for Insomnia (CBT-I) are all highly effective, evidence-based tools that can help you finally get the rest you deserve.
If you're looking for a Menopause Society Certified Naturopathic Doctor in Ontario, Canada (virtual or in-person in Newmarket and Innisfil), then feel free to book an appointment here.
This blog post is inspired by all my patients who struggle with sleep issues and by a conversation with Dr. Nishi Bhopal, a board-certified medical doctor in psychiatry and sleep medicine as part of The Perimenopause Summit coming up Sept 22-25, 2026 virtually--get on the waitlist here.
