Perimenopause, the transitional phase leading to menopause, is marked by a cascade of hormonal shifts that can have a profound impact on a woman’s sleep patterns. Sleep disturbances during this time are not uncommon, leaving many women tossing and turning in the middle of the night. So, what’s behind these sleepless nights, and how can you get the rest you need during perimenopause? Let’s explore the hormonal fluctuations responsible for these nocturnal interruptions and discover holistic approaches to achieve better sleep.
In this blog post, we will explore why perimenopause often corresponds with sleep problems, which hormone fluctuations are responsible for waking women up in the middle of the night, and what you can do to get better sleep during this time. We’ll also take a look at traditional Eastern medicine, as well as holistic and integrative medicine, for additional tips and insights.
For more on how to navigate life’s hormonal shifts with ease, check out my latest book, The Hormone Shift.
Understanding Hormonal Rollercoasters & Sleep Problems
Up to 60% of women experience sleep issues during perimenopause and menopause (1), making them not only some of the most common symptoms, but also the most bothersome. Hormones play a critical role in sleep quality. During perimenopause, several different hormones are in flux, which are often the culprit behind sleep issues.
One of the primary hormones affected during perimenopause is estrogen. This hormone plays a crucial role in regulating the sleep-wake cycle, and in the timing and duration of REM sleep, which is important for memory consolidation and emotional regulation. As estrogen levels decline, women often experience increased wakefulness during the night, hot flashes, and night sweats, which can disrupt sleep (1).
Progesterone, another key hormone, helps promote relaxation and sleepiness (2). During perimenopause, progesterone production can become erratic, leading to mood swings, anxiety, and sleep problems.
Cortisol, the body’s main stress hormone, typically follows a diurnal rhythm, peaking in the morning and declining at night. However, during perimenopause and the menopausal transition, cortisol levels may rise at inappropriate times, disrupting sleep and causing 3 a.m. wake-up calls (3).
Melatonin is the primary hormone responsible for regulating sleep. Its production decreases with age, and is further disrupted during perimenopause, leading to difficulty falling asleep and staying asleep throughout the night (4).
Holistic Approaches to Better Sleep
In Chinese medicine, perimenopause is thought to be a time when a woman’s “qi” (or energy) begins to decline. From an Eastern medicine perspective, perimenopause can be viewed as a time of transition from the reproductive phase of life to a more reflective and introspective time. It’s often our daily routines, high stress lifestyles, and trying to keep up with the same demands as we always have that makes these hormonal changes so difficult.
Traditional Eastern medicine, particularly Ayurveda, emphasizes the importance of diet in achieving restful sleep. Incorporate foods that promote relaxation, such as warm milk, herbal teas like chamomile, and magnesium-rich nuts and seeds into your evening routine.
A magnesium supplement with magnolia bark can also help a busy mind relax at the end of the day (5).
Nearing perimenopause, many women struggle to adapt to their changing capacity to cope with daily stressors—what you could once handle with ease in your 20s may significantly tax your hormones now, and negatively affect sleep. Eastern practices like yoga, meditation, and tai chi can help reduce cortisol levels and promote relaxation to help you fall asleep (6,7). Integrative medicine practitioners often recommend mindfulness techniques and deep-breathing exercises to manage stress.
Traditional Chinese Medicine (TCM) has long utilized acupuncture to restore balance in the body, including regulating sleep patterns. According to TCM theory, acupuncture can stimulate the production of endorphins and other “feel-good” hormones, leading to better sleep.
One meta-analysis found that acupuncture may not only be helpful for poor sleep, but also for other common menopausal symptoms, like hot flashes and night sweats, with the effects of an acupuncture session lasting up to 3 months (8).
Herbal medicine has been used for centuries in both Eastern and Western cultures to manage various health conditions. Black cohosh, a flowering plant native to North America, is commonly recommended for menopausal symptoms, including sleep problems (9). Other herbal remedies that may be helpful for sleep during perimenopause include valerian root, magnolia bark, passionflower, and ashwagandha (10).
Learn more about adaptogenic herbs for better sleep quality during hormonal shifts.
Integrative medicine emphasizes the importance of regular physical activity to support overall health, and decades of research show that it can help you fall asleep faster and improve sleep quality overall.
To get better sleep during perimenopause, you may benefit from moving away from higher-intensity exercise to more strength-training, or restorative movement like tai chi, yoga, or Pilates.
Holistic approaches often involve mind-body practices like biofeedback and guided imagery to address sleep disruptions. These techniques help calm the mind and promote relaxation.
Meditation and mindfulness techniques are effective ways to improve sleep issues, especially those that happen during perimenopause and menopause (11).
Creating a comfortable sleep environment is essential, but especially if you’re struggling with sleep. A calm, welcoming sleep environment brings balance to an overactive nervous system that has trouble winding down at the end of the day. Ensure your bedroom is dark, quiet, and at a comfortable temperature. Consider investing in a quality mattress and pillows.
Hormone Therapy (if needed) under the guidance of an Integrative Practitioner
In some cases, hormone replacement therapy (HRT) may be recommended if your sleep difficulties are severe. Speak with a qualified functional practitioner about bioidentical hormone replacement therapy that can help alleviate hormonal symptoms. Unlike synthetic hormones, bio-identical HRT matches the structure and function of the body’s own hormones.
Holistic and integrative medicine practitioners take a comprehensive approach to health. Consulting with a qualified provider can help you develop an individualized plan that addresses your unique sleep challenges during perimenopause.
I talk more about how to approach hormone therapy in my book, The Hormone Shift.
What to remember about sleep during perimenopause
Sleep disturbances during perimenopause are often driven by hormonal fluctuations, including declining estrogen, erratic progesterone, cortisol surges, and disrupted melatonin production. Combining the wisdom of Eastern and Western medicine, adopting a holistic approach that includes nutrition, stress management, mind-body practices, and, if necessary, hormone therapy, can help you achieve restful sleep and navigate the perimenopausal journey with greater ease and vitality. Remember, a well-rested body and mind are essential for embracing the changes that this transformative phase brings.