Women Deserve Better Sleep
I was recently invited onto the podcast with the wonderful Beth Mason at Move Me Happy who is dedicated to helping women feel stronger, healthier and more like themselves again. Beth works with many women who are in perimenopause or menopause and I was so glad to be part of the conversation.
Because there's one topic that comes up again and again for women in midlife, and yet so often gets pushed to the back of the queue: sleep.
We talk a lot about nutrition, movement and stress management. These are all vital pillars of health. But sleep? Sleep is the foundation that all of those other pillars rest on. And for women going through perimenopause and menopause, poor sleep isn't just an inconvenience. It's one of the most significant and under acknowledged challenges of this life stage.
(Once the podcast is live I’ll share a link here.)
It's More Common Than You Think
If you're struggling to sleep right now, please know: you are not alone, and you are not imagining it.
Research suggests that somewhere between 30 and 40% of women report sleep difficulties during perimenopause and menopause. That's roughly one in every three women consistently struggling to get a good night's rest. And yet, so many of the women I speak to have been quietly putting up with it, assuming it's just part of getting older, or that there's nothing to be done.
There is. But first, let's understand why it's happening.
What's Actually Going On in Your Body
During perimenopause our hormones begin to shift, and those hormones have a direct relationship with your sleep.
Oestrogen plays a quiet but crucial role in helping you sleep well. It supports the production of serotonin, a neurotransmitter that helps regulate your sleep-wake cycle and it also helps your body maintain a stable temperature. As oestrogen begins to fluctuate and decline, both of these functions are disrupted.
And body temperature matters enormously for sleep. We need to cool down to fall asleep, and to stay cool to stay asleep. When that regulation goes awry, sleep goes with it.
This is also why hot flushes and night sweats are such significant sleep disruptors. Up to 85% of women experience hot flushes and for many, these happen at night, causing the body to wake the brain up just as sleep should be deepening.
Progesterone, meanwhile, has natural sedative properties. Its decline and fluctuation in perimenopause is another reason why sleep can feel lighter, more broken, and harder to come by.
The Four Ways Menopause Disrupts Sleep
Not every woman experiences all of these, and some experience a combination but it's worth knowing the full picture:
1. Insomnia: which is difficulty falling asleep, staying asleep, or waking far too early. This is the most commonly reported sleep issue in menopause. Insomnia is either acute or chronic. With acute insomnia only lasting a few days or weeks. While chronic insomnia occurs at least three nights a week for 3 or more months.
2. Sleep-disordered breathing and sleep apnoea: the decline in oestrogen can reduce muscle tone in the upper airway, making breathing during sleep less smooth. This is an underdiagnosed issue in women.
3. Restless Leg Syndrome: some women develop deeply uncomfortable sensations in their legs that compel them to move, making falling or staying asleep very difficult.
4. Changes in sleep stages: menopause can selectively impair REM sleep, the stage that's particularly sensitive to temperature changes. REM sleep is also where we emotionally process the events of our lives, which is why disrupted REM can contribute to mood challenges, something many perimenopausal women are already navigating.
What Can Actually Help
This is where I want to be clear with you, because I think women deserve honest information rather than vague reassurance.
HRT is worth a conversation with your GP if you haven't already had one. The data on HRT and sleep is largely positive, it can improve sleep quality both subjectively (how you feel) and objectively (what sleep studies show), reduce the frequency of night-time waking, and improve deep sleep. Its effect on sleep apnoea is more moderate, but for many of the other sleep disruptions, it can make a meaningful difference. Every woman is different though, and this is a conversation best had with a qualified medical professional who knows your full picture..
The lifestyle factors; good nutrition, regular movement, and stress reduction all genuinely support better sleep. Hormones, blood sugar, cortisol they're all interconnected. These things matter.
Meditation and nervous system regulation — practices like NSDR (Non-Sleep Deep Rest) used before bed (not during the night when you can't sleep) can help calm a wired nervous system and prepare the body for rest. These are worth exploring.
A note on sleep hygiene
While sleep hygiene alone won't resolve chronic insomnia, it's still worth getting the basics right, think of it as creating the best possible conditions for sleep to happen.
Make sure you're giving yourself enough opportunity to sleep, not too little, but not excessively long windows in bed either, as this can actually weaken your sleep over time. Build a good sleep drive throughout the day by staying active and avoiding napping where possible. A consistent wake time (yes, even at weekends) is one of the most powerful things you can do to anchor your body clock.
In the evening, dim your lights as bedtime approaches this signals to your brain that it's time to wind down. Give yourself some distance from stimulating screens, particularly mobile phones held close to your face, which are especially good at keeping the brain alert when you want it to be doing the opposite. And keep your bedroom cool remember, your body needs to lower its temperature to fall and stay asleep, which is why this matters even more during menopause.
Why Good Sleep Hygiene Alone Isn't Enough
Here's something I say to almost every client I work with, especially those who've been struggling for a long time: chronic sleep problems are not a sleep hygiene problem.
Reading all the sleep hygiene tips in the world, limiting caffeine, keeping a regular bedtime, avoiding screens, won't resolve chronic insomnia. And I say this gently, because I know how frustrating it is to be handed a checklist when what you actually need is proper support.
This is where CBT-I, Cognitive Behavioural Therapy for Insomnia, comes in. It has the strongest evidence base of any treatment for insomnia, including in women going through perimenopause and menopause. It works by addressing the thoughts, behaviours and patterns that keep sleep problems locked in place. It has no side effects, and the results are lasting.
It's not a magic wand, and I'll never promise that. But it's the gold standard for a reason and it's the approach that underpins all the work I do with my clients.
You Don't Have to Just Put Up With It
This is perhaps the most important thing I want you to hear. Poor sleep in midlife is common but it is not inevitable, and it is not something you simply have to accept.
Your sleep deserves as much attention as your diet and your exercise routine. It's not a luxury or an afterthought. It's a pillar of health in its own right, and you are absolutely worth investing in it.
If you're struggling and would like to explore what proper, personalised support could look like for you, I'd love to help. You can find out more about working with me atsleepcoach.im.