Perimenopause Insomnia: Why You Can't Sleep Anymore

You used to be a good sleeper. You'd lie down, close your eyes, and drift off. Sleep was something you could count on.

Now you lie awake for hours. Or you fall asleep fine but wake at 2am or 3am, alert, heart racing, mind spinning, unable to fall back asleep. Or you sleep through the night but wake exhausted, as if you never rested at all.

Sleep disruption during perimenopause is one of the most common and most debilitating symptoms of this transition. It affects everything: your mood, your energy, your ability to think clearly, your patience, your health. And it often feels like there's nothing you can do about it.

There is. Sleep responds to intervention. But you have to understand what's driving the problem to address it effectively.

Why Sleep Falls Apart During Perimenopause

Several factors converge to disrupt sleep during this transition.

The Loss of Progesterone

This is often the first domino to fall. Progesterone has a calming, sedating effect on the brain. It activates the same receptors as certain sleep medications. Throughout your reproductive years, progesterone helped you sleep, and you never knew it.

Progesterone typically declines before estrogen does. Many women experience sleep disruption as one of their first perimenopause symptoms, sometimes before their periods become irregular. The calming influence you didn't know you had is withdrawing, and sleep suffers.

Night Sweats

Waking drenched in sweat, throwing off covers, sometimes needing to change your clothes or sheets, this obviously disrupts sleep. But night sweats can also be subtle. You might not fully wake, but the temperature dysregulation still fragments your sleep, leaving you unrested even when you think you slept through the night.

A Nervous System That Can't Settle

This is often the central issue. Your autonomic nervous system regulates sleep, and if that system is stuck in overdrive, sleep becomes difficult or impossible.

Many women arrive at perimenopause with nervous systems that have been chronically activated for years. They've been managing stress through willpower, pushing through exhaustion, never really settling. Their bodies have forgotten what deep rest feels like.

Perimenopause often exposes this. The hormonal shifts reduce your capacity to compensate. The nervous system dysregulation that was always there becomes impossible to ignore.

The Racing Mind

You wake in the middle of the night and your mind immediately starts going. Worries, to-do lists, replaying conversations, anticipating problems. Once it starts, you can't stop it.

It's your nervous system in a vigilant state. A settled nervous system allows the mind to quiet. A dysregulated one keeps scanning for threats, even in the middle of the night when there's nothing to do about any of them.

Blood Sugar Crashes

If you wake at a consistent time each night, especially between 2am and 4am, blood sugar may be involved. When blood sugar drops too low during the night, your body releases cortisol and adrenaline to bring it back up. These stress hormones wake you, often with a racing heart and a sense of alertness that makes falling back asleep difficult.

Anxiety

Anxiety and insomnia feed each other. Anxiety makes it hard to sleep. Sleep deprivation increases anxiety. Many women find themselves caught in this cycle during perimenopause, not sure which came first or how to break free.

The Weight of Everything

Sometimes insomnia isn't just physical. Sometimes there are things keeping you awake that go beyond hormones and blood sugar. Situations in your life that aren't working. Emotions you haven't processed. Grief you haven't felt. A pace that isn't sustainable.

Sleep requires a certain surrender. If part of you is holding on, bracing against something, not wanting to let go, that resistance can show up as sleeplessness.

Why This Matters

Chronic sleep deprivation isn't just uncomfortable. It has real consequences.

Poor sleep increases inflammation, impairs immune function, and affects hormone balance. It worsens every other symptom of perimenopause: hot flashes, mood changes, weight gain, brain fog. It affects your ability to handle stress, to be patient, to think clearly.

Sleep is foundational. Without it, nothing else works as well as it should.

What Actually Helps

The approaches that work address the underlying causes, not just the symptoms.

Regulate Your Nervous System

If your nervous system can't settle, neither can your sleep. This is often the most important work.

Nervous system regulation isn't something you do once. It's a practice, a way of teaching your body what safety and rest feel like. Simple practices done consistently over time change your baseline. You become someone whose system can settle, rather than someone who's always braced.

Slow breathing with extended exhales activates the parasympathetic nervous system. A few minutes of intentional breathing before bed can help signal to your body that it's safe to rest. When you wake in the middle of the night, slow breathing can help you fall back asleep instead of spiraling into anxious thoughts.

Creating transition time between your day and sleep matters. Your nervous system needs time to downshift. If you're working or scrolling until the moment you try to sleep, your system hasn't had a chance to settle.

Stabilize Blood Sugar

If you're waking consistently in the early morning hours, blood sugar may be a factor. Try eating a small snack with protein and fat before bed. Make sure you're eating enough during the day, especially in the evening. Reduce refined carbohydrates and sugar, which cause blood sugar spikes followed by crashes.

Address Night Sweats

If night sweats are disrupting your sleep, addressing them helps. Keep your bedroom cool (60-67°F is ideal). Use breathable bedding and sleepwear. Reduce alcohol and caffeine, which can trigger night sweats. Have a fan nearby and cold water by your bed.

The interventions for night sweats overlap significantly with the interventions for nervous system regulation. Addressing one often helps the other.

Create Conditions for Sleep

The basics matter. A dark, cool, quiet room. A consistent sleep schedule. Limiting screens before bed. No caffeine after noon, or earlier if you're sensitive.

But also recognize that if your nervous system is in overdrive, these basics alone won't be enough. They're necessary but not sufficient.

Reduce Alcohol

Alcohol might seem like it helps you sleep, but it disrupts sleep architecture, particularly in the second half of the night. Many women find that eliminating alcohol significantly improves their sleep quality.

Move Your Body, But Not Too Late

Regular physical activity supports better sleep. But exercising too close to bedtime can be activating. Aim to finish exercise at least a few hours before you want to sleep.

Consider What's Keeping You Awake

Sometimes there are real things that need your attention. A relationship that isn't working. A situation that needs to change. Grief or fear or anger that hasn't been processed.

Sleep isn't always willing to cooperate when there's something important you're avoiding. Sometimes insomnia is a messenger, pointing to something that needs attention while you're awake.

What This Looks Like in Practice

A woman came to us at 47, exhausted in a way that frightened her. She hadn't slept through the night in eighteen months. She would fall asleep fine but wake around 3am, heart racing, mind immediately spiraling into worry. She'd lie there for two or three hours before finally falling back asleep, only to wake when her alarm went off, feeling like she'd barely rested.

She'd tried everything she could find: melatonin, magnesium, CBD, various herbal supplements, sleep meditations, white noise. Nothing worked consistently. She was starting to feel desperate.

When we talked, her nervous system's state was clear. She'd been running a small business while raising three kids, managing most of the household responsibilities alone. Her husband traveled frequently for work. She was the one holding everything together, and she'd been doing it for years without real support.

She was proud of her capacity to handle it all. But she was also depleted in ways she hadn't fully acknowledged. Her body had been telling her for years that this pace wasn't sustainable, and she'd been overriding those signals. The insomnia was her body finally refusing to be overridden.

We started with nervous system practices. She began doing slow breathing twice a day, and used it when she woke in the middle of the night. She started eating a small snack with protein before bed. She cut back on alcohol, which she'd been using to unwind in the evenings.

The practical changes helped, but the deeper conversation was about her life. What would need to change for her body to actually feel safe enough to rest? What was she carrying that wasn't hers to carry alone? What support did she need that she hadn't been asking for?

She started having difficult conversations with her husband about how the responsibilities were divided. She started saying no to things she'd been reflexively saying yes to. She started protecting time for herself in ways she never had before.

The sleep came back gradually. First, she started waking only once instead of staying up for hours. Then the quality of her sleep improved. By month three, she was sleeping through most nights. Not perfectly, but well enough that she felt like herself again.

What she told me: "I kept trying to fix my sleep like it was a separate problem. But my body wasn't going to let me sleep until I changed how I was living."

Your Next Step

If you're struggling with perimenopause insomnia, please know that this is common, it's not permanent, and it responds to intervention. But the intervention often needs to go deeper than sleep hygiene tips.

Your sleep is connected to your nervous system, your hormones, your blood sugar, and sometimes to the circumstances of your life. Addressing sleep effectively often means addressing all of it.

This is the heart of our Embody & Heal path. Our Embodied Perimenopause Coaching program focuses on nervous system healing and lifestyle medicine. We help women understand what's driving their sleeplessness and make the changes that allow their bodies to rest.

Contact us at 212.432.1110 or info@fafwellness.com.