You’re Not the Only One Awake at 3 A.M.: Why Sleep Problems Are So Common in Perimenopause
Up at 3 a.m. again? You’re not alone. Nearly half of perimenopausal women struggle with sleep. Here’s why it happens—and how you can finally rest again.
Sleepless Nights in Perimenopause: You’re Not Alone
You’re not imagining it—your sleep really has changed. Maybe you fall asleep easily but wake up at 2 or 3 a.m. and can’t drift back off. Maybe you toss and turn, wake up drenched in sweat, or feel like your brain won’t shut off no matter how tired you are.
My favorite is the middle of the night clock math… “If I fall asleep now, I’ll get 3 hours of sleep…If I fall asleep now, I’ll get 2.5 hours of sleep…If I fall asleep now…” You get the idea. It’s not helpful and it can worsen your chances of actually falling back to sleep!
If this sounds familiar, you’re far from alone. For many women, perimenopause brings a noticeable shift in sleep quality that can leave you feeling exhausted, foggy, and frustrated. The good news? Understanding why it happens is the first step toward getting your nights—and your energy—back.
How Common Are Sleep Problems During Perimenopause?
Sleep problems are one of the most common symptoms of perimenopause. Research from the shows that 40–60% of women experience some form of sleep disturbance during this hormonal transition (Troia et al., 2025).
Hormonal fluctuations, stress, lifestyle changes, and physical symptoms all play a role—but certain types of sleep issues are more prevalent than others.
The Most Common Perimenopause Sleep Disruptions
The most common issues include (Coborn et al., 2022):
Difficulty staying asleep
Waking too early
Difficulty falling asleep
Night sweats and hot flashes
How Poor Sleep Affects Women in Perimenopause
Sleep is more than rest—it’s how your body resets hormones, repairs tissues, and regulates mood. When that process breaks down, the effects reach far beyond fatigue.
1. Emotional and Cognitive Health
Lack of restorative sleep can leave you feeling irritable, anxious, or emotionally drained. Research links perimenopausal sleep loss to higher rates of depression and anxiety. Many women describe being “tired but wired”—mentally exhausted but unable to calm their minds. Sleep deprivation also impairs focus, memory, and decision-making, adding to the frustration.
2. Physical Well-Being
Hormonal changes already challenge metabolism, and insufficient sleep only makes it worse. Disrupted sleep has been associated with weight gain, insulin resistance, and increased cardiovascular risk. It also makes exercise and healthy eating harder to maintain, fueling a cycle of fatigue and frustration.
3. Relationships and Daily Functioning
When you’re constantly tired, everything feels harder. Patience wears thin, motivation dips, and even small tasks can feel overwhelming. Many women report that poor sleep affects not just their productivity but also their relationships and self-esteem.
Finding Rest Again
If you’re lying awake at night wondering what’s wrong with you—the answer is nothing. These sleep disruptions are a normal, temporary part of perimenopause, caused by hormonal shifts and changes in how your body regulates temperature and stress.
But “common” doesn’t mean “permanent.” You do not have to accept poor sleep as your new normal. With the right tools—balancing your daily habits, managing stress, supporting hormone health, and retraining your sleep rhythm—you can absolutely start sleeping better again.
Check out my perimenopause sleep audit and discover solutions for YOUR unique sleep challenges.
References
Coborn J, de Wit A, Crawford S, Nathan M, Rahman S, Finkelstein L, Wiley A, Joffe H. (2022). Disruption of sleep continuity during the perimenopause: Associations with female reproductive hormone profiles. J Clin Endocrinol Metab. Sep 28;107(10):e4144-e4153. doi: 10.1210/clinem/dgac447. PMID: 35878624; PMCID: PMC9516110.
Troìa L, Garassino M, Volpicelli AI, Fornara A, Libretti A, Surico D, Remorgida V. (2025). Sleep disturbance and perimenopause: A narrative review. J Clin Med. Feb 23;14(5):1479. doi: 10.3390/jcm14051479. PMID: 40094961; PMCID: PMC11901009.