Perimenopause, Hormones and Sleep: A Guide to Managing Insomnia
- Apr 3, 2024
- 5 min read
Miyara Women | Apr 3, 2024 | Updated: Nov 30, 2024
The prevalence of sleep disorders, especially insomnia, is up to 2 times higher in women than men — and a majority of those women are from the perimenopausal age bracket. A 2025 systematic review in Frontiers in Neurology puts the overall prevalence of sleep disturbances in perimenopausal women at 50–55%, with insomnia occurring at 1.3–1.6 times the rate seen in premenopausal women.
Midlife women are super busy — caring for children and the elderly, shouldering more at work, supporting family physically, emotionally, and financially. The stress and anxiety of this phase alone is enough to wreck a sleep routine. Add menopausal symptoms like hot flashes and cold sweats, and sleep can fly out of the window entirely. This hugely impacts daily life and opens a Pandora's box of new health concerns, leaving women feeling out of control and overwhelmed.
This article intends to equip you with the right information and some strategies for coping with sleep disturbances during the menopausal transition.
Imagine yourself lying wide awake in the stillness of the night. Your mind is in hyperactive mode — turbulent thoughts bouncing everywhere. The worries, regrets, and anxieties choose this moment to surface, as various aches make their presence felt. You can hear a pin drop. A large part of the night passes in tossing and turning.
Now imagine going through this day after day. This is the reality of countless women battling insomnia.
How Do You Know If You Have It?
According to the NHLBI, insomnia is a common sleep disorder involving difficulties in falling asleep, staying asleep, or both. Insomniacs may also experience daytime fatigue, irritability, or difficulty concentrating. The condition is assessed based on its impact on daily functioning when symptoms persist for several weeks.
The best person to diagnose this is a sleep specialist. Insomnia requires a comprehensive assessment of medical history and sleep patterns, as individual experiences vary widely. Sleep studies (polysomnography) are commonly used to confirm the condition, and most sufferers need a customised treatment plan.
In India, a West Bengal tertiary care study found that 45% of middle-aged women (40–60 years) met criteria for insomnia — a figure that points to a largely unaddressed clinical gap, since many women attribute their symptoms to stress or aging rather than seeking a formal diagnosis.
What Keeps an Insomniac Awake at Night?
The most common contributors to insomnia are stress and anxiety, physical ailments, and hormonal imbalance.
Stressors are individual-specific. Some people tend to overthink or worry, and these individuals are more likely to suffer from insomnia because they cannot calm their racing minds when they hit the bed.
Women invariably deal with hormonal imbalances for much of their lives — and menopause is the stage when insomnia is most likely to surface due to decreasing estrogen levels. Other inflammatory conditions can also be triggered or worsened during this phase. For instance, a relative of mine suffering from fibromyalgia — which causes chronic pain and persistent discomfort — would constantly shift positions for relief but rarely settle down.
Substance abuse and certain medications also contribute. Caffeine is known to block adenosine receptors, disrupting sleep. And in current times, light exposure from excessive screen time — phones, laptops, TV — is actively disrupting our sleep cycles.
Why Is It Necessary to Take Action?
Perimenopausal sleep issues are not only indicators of anxiety and depression — they are also independent risk factors for developing depression later in life. A 2024 meta-analysis in Sleep and Breathing found that the overall prevalence of sleep disorders in postmenopausal women reaches 51.6%, and that sleep disturbances are strongly associated with impairments in physical, psychological, and social functioning — even in women without vasomotor symptoms like hot flashes.
Navigating the Path to Better Sleep
Though I am not a sleep specialist, I have found the following approaches genuinely helpful.
Sleep management. Maintain a consistent sleep schedule — same bedtime every night. Keep the room well-ventilated and at a comfortable temperature. Draw the curtains; use blackout curtains if needed. If your partner snores, sleeping in a separate room, even occasionally, can make a real difference.
Physical activity. Staying active throughout the day benefits sleep at any age. However, avoid intense exercise by late evening — a gym session at 8 PM is not ideal for an insomniac.
Managing screen time. Cut exposure to laptops and smartphones by dinnertime. Set your phone to DND mode to avoid notifications pulling you back in.
Breathwork and meditation. Deep breathing, sitting calmly in Padmasana (or any comfortable position), and allowing thoughts to settle reduces stress levels. A scented candle or incense can help set the mood. I was a skeptic until I tried it intentionally — now I return to it regularly when my mind is racing.
Low GI food and meal timing. Foods high in glycemic index — processed carbohydrates and sweets — cause blood glucose and insulin to spike and crash steeply, which can trigger sleep disruptions. Plan dinner early and keep portions moderate, with a plate that leans low-GI.
If insomnia persists despite these steps, it's time to see a sleep specialist.
Is Insomnia Treatable?
Yes — and more effectively than most people realise. A 2024 scoping review in Life (MDPI), evaluating RCTs of CBT-I specifically in menopausal women, found that Cognitive Behavioral Therapy for Insomnia (CBT-I) significantly improves sleep quality and reduces insomnia severity — with improvements persisting up to six months after treatment, and fewer side effects than medication. CBT-I is now considered a first-line intervention for menopausal insomnia.
Medications are available for acute symptom relief, and specialist guidance is essential to ensure the right prescription and dosage. Complementary therapies including acupuncture and yoga have also shown promising results. With the right support and approach, sound sleep is within reach.
In Quest of Restful Nights
Insomnia is treatable — but only when you know you have it. Start by keeping a journal. Note your sleep observations for 60–90 days and try the suggestions above in parallel.
If the condition persists, visit a sleep specialist with your journal. Resolving insomnia is a collaborative effort. The more context you give your specialist, the better equipped they will be to arrive at the right diagnosis and offer evidence-based treatment.
A restful night's sleep is vital for your overall well-being.
Track your sleep and find relief by downloading the Miyara App here
Written by: Dr. Ipshita Basu Guha | Edited by: Dr. Ayshwarya Ravichandran PhD
About the author
Dr. Ipshita Basu Guha is a twin entrepreneur who is passionate about women's health and mental health in general. It is incredible that she not only took a step toward her personal health but also talked her women's tribe into this and drove the campaign on the ground.
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