Trouble staying asleep is one of the most common complaints in perimenopause and menopause. Sometimes it’s because of night sweats and temperature changes. Sometimes it’s not about sweating at all — you just snap awake and cannot get back down.
Progesterone, which has a naturally calming, settling effect on the nervous system, starts to drop in perimenopause. Less progesterone can mean more nighttime anxiety, restlessness, and “tired but wired.”
Estrogen shifts can disrupt how your body regulates temperature and how deeply you sleep. Even small temperature swings (not full drenched hot flashes) can nudge you out of deep sleep.
Cortisol (your stress hormone) can spike in the very early morning hours. That 2–3 a.m. wake-up with a racing mind and tight chest? That’s often cortisol, not “overthinking.”
Blood sugar swings can wake you up. If your body runs low overnight, it can send an alert signal to get you up and hunting for fuel.
You’re carrying too much. Mental load alone — keeping track of everyone and everything — keeps the brain in “on-call mode,” not true rest mode.
Low magnesium can make it harder for your muscles and nervous system to fully relax and stay asleep.
Being chronically depleted (under-slept, under-recovered, undernourished) turns bedtime into collapse instead of repair, which means you never reach deep, restorative sleep.
You fall asleep fine, then wake at 1–3 a.m. either sweaty, wired, or both.
You wake too early and can’t fall back asleep.
You technically “slept,” but you feel unrefreshed and irritable all day.
We don’t just hand you “sleep hygiene” tips and walk away. We look at hormone shifts, nighttime anxiety, temperature changes, blood sugar patterns, magnesium status, and nervous system tone. Depending on what’s actually driving your awakening, support may include hormone therapy, non-hormonal options for nighttime symptoms, targeted magnesium when appropriate, strategies to keep blood sugar more stable overnight, and down-regulation techniques that are realistic in a real life, not a spa fantasy.
You’re allowed to sleep through the night, and it’s not unreasonable to ask for that.
Compassionate, evidence-based hormone health care for women, delivered through secure telemedicine.
