Quality Sleep in Perimenopause: Understanding the Challenges

Women entering perimenopause often find that sleep, once a natural and easy process, becomes an elusive and sometimes frustrating experience. This phase brings unique challenges for women over 40, and understanding the underlying causes of disrupted sleep can help you regain control and improve sleep quality.

Why Do Women Over 40 Struggle with Quality Sleep?

Here are the five primary reasons women in perimenopause experience sleep difficulties:

1. Sex hormone changes
2. Adrenal hormone dysregulation
3. Depression
4. Sleep-Disordered Breathing (SDB), including sleep apnea
5. Fibromyalgia and other pain syndromes

Let’s explore each one.

1. Sex Hormone Changes Impact

During perimenopause, your estrogen and progesterone levels shift dramatically, often impacting sleep.

• Progesterone: Typically the first hormone to decrease in perimenopause, progesterone has calming effects that promote restful sleep. Low progesterone levels are often linked to anxiety and poor sleep. Signs of low progesterone include shorter menstrual cycles, PMS, and spotting before periods.
• Estrogen: Estrogen generally declines closer to menopause and often contributes to fluctuating temperatures and sleep disturbances. It isn’t necessarily low estrogen alone that affects sleep but the changes in brain signaling due to fluctuating estrogen. These shifts impact your body’s temperature regulation, which can lead to hot flashes, night sweats, and sudden awakenings.

2. Adrenal Hormone Dysregulation

In perimenopause and menopause, your adrenal glands begin to support estrogen and progesterone production as ovarian function slows. This adrenal shift impacts cortisol, the hormone that regulates your sleep-wake cycle.

When estrogen declines, cortisol can spike earlier, causing early-morning awakenings. Additionally, hot flashes and night sweats may be tied to adrenaline surges, further disrupting sleep. In holistic practices, adrenal support is often a priority to help regulate these hormones and improve sleep quality.

3. Depression

Depression can be both a cause and a consequence of sleep disruptions during perimenopause. The relationship between declining estrogen, depression, and insomnia is complex:

• Changes in estrogen can affect mood, leading to emotional shifts, vaginal discomfort, and body changes, which can impact mental well-being and sleep.
• Sleep issues can worsen or even trigger depressive symptoms, leading to a vicious cycle of poor sleep and mood instability.

Women with a history of depression are more susceptible to sleep problems during perimenopause.

4. Sleep-Disordered Breathing (SDB)

Many women in perimenopause experience changes in breathing during sleep, such as sleep apnea. Unlike men, women’s SDB symptoms can be subtle, sometimes involving only mild snoring, with the primary symptom being daytime fatigue.

This increase in SDB is likely due to hormonal changes and potential weight gain around menopause. Both estrogen and progesterone support respiration, so their decline during perimenopause can contribute to breathing problems that interrupt sleep. For more about women and apnea read my article Women & Sleep Apnea: Busting the Myths.

5. Fibromyalgia and Pain

Perimenopause is also a time when some women may develop fibromyalgia, which is often associated with poor sleep. Women are seven times more likely than men to develop fibromyalgia after menopause. Sleep disruption can exacerbate fibromyalgia pain, creating a cycle of discomfort and sleeplessness.

Other pain conditions like arthritis, hip pain, and frozen shoulder are more common in perimenopausal women and often interfere with sleep. Pain raises cortisol and adrenaline levels, which disrupt sleep.

How to Achieve Quality Sleep in Perimenopause

The good news? All the factors that can disrupt your sleep during perimenopause—from hormone shifts to adrenal imbalances, mood changes, breathing issues, and pain—are treatable with a tailored, root-cause approach.

First, we identify what’s affecting your sleep, and from there, we explore solutions that work best for you as an individual. Whether it’s a comprehensive sleep study, herbal medicine, targeted supplements, hormone support, acupuncture, or cognitive behavioral therapy, there’s a broad array of safe and effective options that can help.

Reach Out for Help Restoring Quality Sleep

If perimenopause has made sleep elusive and you’re not sure where to begin, don’t hesitate to reach out for a discovery call. Together, we can find the solutions that will restore your rest and help you feel rejuvenated and energized each morning. To learn more about perimenopause, go to my article 5 Ways To Prepare for a Healthy Perimenopause.

Questions about perimenopause or sleep? Please ask below,