5 Reasons You Can’t Sleep—and What to Do About Them

By Claire Gillespie
Reviewed by Daniel Lew, M.D.
January 26, 2024

If you’re over 40 and can’t sleep, you’re not alone. Women transitioning into menopause—a time of major hormonal, physical, and psychological change—often report difficulties falling asleep and/or staying asleep, known as insomnia. In fact, according to the Sleep Foundation, sleep disorders affect up to 47 percent of perimenopausal women and up to 60 percent of postmenopausal women.

“Disturbed sleep is a common but lesser discussed side effect or symptom that many women experience during the stages of menopause,” says Uma Naidoo, M.D., a nutritional psychiatrist at Massachusetts General Hospital in Boston.

Those sleep disturbances during perimenopause and menopause aren’t limited to insomnia, explains Robert Yapundich, M.D., a board-certified neurologist and sleep medicine specialist in Hickory, North Carolina, who is also medical director of Aeroflow Sleep, a company that helps patients obtain sleep-apnea supplies. A wide range of sleep disorders may occur independently or at the same time, including obstructive sleep apnea and periodic limb movement.

Figuring out how to improve sleep during menopause—or any time of life, for that matter—starts with pinpointing what’s disrupting it. Here are five reasons you may be struggling to sleep, and what you can do about them.

Sleep Disrupter #1: Hormone Changes

Although the causes of sleep issues during perimenopause and menopause can vary widely, experts believe that hormone changes, namely falling levels of estrogen and progesterone, are a leading factor.

“Estrogen can help regulate body temperature, mood, and the sleep-wake cycle, and progesterone can also provide sedative and anti-anxiety effects,” says Yapundich.

It's also "noted to play a role in metabolizing serotonin and the various other neurotransmitters that regulate our sleep-wake cycle,” adds Naidoo. “So, when levels are reduced, the cycle is disturbed.”

Also, decreased levels of progesterone may lead to obstructive sleep apnea, which can manifest as irregular breathing, gasping, or even choking during sleep.

To relieve symptoms of menopause, including insomnia, some women take hormone therapy (HT), which replaces hormones that are at a lower level. Before taking HT, it’s important to discuss the risks and benefits with your care provider.

Sleep Disrupter #2: Night Sweats

One of the most common side effects of menopause is hot flashes (sudden surges and drops in body temperature), which are known as night sweats when they occur during the night.

“Many women note that the intensity of hot flashes in the middle of the night is what causes them to wake up,” says Naidoo. But that’s only part of the problem. Hot flashes cause a surge in adrenaline—the same chemical responsible for your reaction to stress or a “fight or flight” situation—which then makes it harder to fall back asleep.

These frequent awakenings throughout the night impact sleep quality and can lead to fatigue throughout the following day.

If you’re bothered by night sweats, the National Institute on Aging recommends keeping your bedroom cooler and drinking small amounts of cold water before bed. If you layer your bedding instead of having one thick covering, you can quickly adjust your coverage as needed throughout the night. A bed fan, a device that attaches to your bed and blows cool air under your sheets, may also help.

Night sweats may be triggered by certain things such as drinking alcohol, feeling stressed, or wearing tight clothing. So keep an eye out for potential triggers for night sweats and try to avoid them before you sleep.

Sleep Disrupter #3: Medications

Many prescribed medications and over-the-counter supplements can impact your sleep cycle, whether you’re taking them for menopause or another health concern.

For example, SSRI antidepressants, beta-blockers (commonly prescribed for high blood pressure), cholesterol-lowering statins, and the asthma drug theophylline are some of the prescription medications that may cause insomnia. Plus, over-the-counter painkillers sometimes contain caffeine, which can stimulate the brain and make it more difficult to nod off. If you think your medications are messing with your sleep, ask your doctor about alternatives.

One supplement that’s proven to help with sleep is melatonin, which may be prescribed or taken over the counter. Your body actually produces melatonin (known as the sleep hormone) naturally. Melatonin regulates your circadian rhythm, and it plays an important role in the initiation and maintenance of sleep. Unfortunately, like estrogen and progesterone, melatonin decreases with age.

“Melatonin is very important in helping regulate the sleep cycle,” Yapundich says. In a study published in Sleep Science, low doses of melatonin improved mood in postmenopausal women and helped them fall asleep faster.

Sleep Disrupter #4: Stress

Menopause is associated with mood changes, decreased energy levels, and anxiety. While hormonal fluctuations can certainly play a part, other life stressors occurring around the same time may make the problem worse. Women going through perimenopause and menopause may be supporting their children as they move into adulthood, caring for a spouse or aging parents, or have other age-related health concerns of their own. They may be anxious and even depressed during menopause because it may be difficult to accept the changes they’re experiencing. Work, family, and personal relationships can also create stress.

Many studies have found a link between stress and sleep, and it can be a vicious cycle. According to the Anxiety & Depression Association of America (ADAA), when you’re stressed, you might experience poor sleep quality or duration. And, not getting enough quality sleep can increase stress levels.

By addressing stress and mental-health issues, you might find that your sleep improves. “Cognitive behavioral therapy (CBT) has been consistently shown to be one of the best methods for managing insomnia,” Yapundich says. One study, published in JAMA Internal Medicine, found that telephone-based CBT was effective for easing both insomnia and hot flashes associated with menopause.

Sleep Disrupter #5: Poor Eating Habits

Naidoo often suggests dietary changes as an effective way to improve sleep, beginning with foods that help to reduce inflammation in the body. She recommends eating a high-fiber, nutrient-rich diet full of colorful plant foods, healthy sources of protein, and unsaturated fats as a great way to reduce inflammation and promote both the length and quality sleep.

“Omega-3s, found in foods like fatty fish, nuts, and seeds, have specifically been shown to be anti-inflammatory, but also to aid in sleep and melatonin production, which would be of benefit to menopausal women,” she says. “Have salmon for dinner or add some walnuts or chia and flax seeds to a leafy green salad to include these fats in your evening meal.”

When it comes to your evening beverage, try to avoid caffeine and alcohol. Naidoo suggests drinking a calming cup of chamomile tea before bed. And, if you’re hungry, eat a handful of tart cherries, which are naturally rich in melatonin.

Don’t Forget the Basics

Remember, there’s no point doing any of this if you don’t have a good handle on the fundamentals of sleep hygiene. As part of a holistic sleep-healing plan, Naidoo advises eating meals at least two hours before going to bed, shutting off devices (including the television) at least 30 minutes before bedtime, avoiding being under bright fluorescent lights at night, and spending time outdoors daily.

Other good sleep habits include going to bed and waking up at the same times each day, exercising in the morning, ensuring a quiet and dark room to sleep in, and only using the bed for sleep and sex.

Yapundich agrees that any approach should start with lifestyle modifications and adherence to sleep-hygiene principles, adding that managing sleep disorders can be difficult and rarely involves just one approach.

“Any treatment approach should be done in consultation with a medical professional, as many seemingly harmless therapies or products can sometimes be harmful or contraindicated for certain individuals,” Yapundich adds. So, if you're struggling with disrupted sleep, it’s time to make an appointment to see your doctor.

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