10 Steps to Restorative Sleep in Perimenopause and Menopause: A Comprehensive Plan to Get You Back to Sleep
Menopause marks a profound transition in a woman’s life. But for many, it brings an unwelcome companion: insomnia. Trouble falling asleep, waking up multiple times during the night, and waking up too early are extremely common during perimenopause and menopause.
Research estimates that 40–60% of women experience sleep disturbances during the menopausal transition.¹ Insomnia during perimenopause and menopause isn’t just a nuisance — it can worsen mood disorders, impair memory and cognitive function, contribute to metabolic dysfunction, and lower quality of life.
Exploring and addressing the root causes of sleep difficulty restores balance across the body’s interconnected systems and helps women achieve deeper, more restful sleep naturally.
This post explores:
Why menopause disrupts sleep
How to investigate the root causes
Evidence-based treatments to improve sleep after menopause
Why Sleep is Disrupted in Perimenopause and Menopause
1. Hormonal Fluctuations
The steep decline in estrogen and progesterone during menopause plays a significant role in sleep difficulties.
Estrogen influences the regulation of serotonin and melatonin, critical neurotransmitters for sleep. Lower estrogen levels disrupt circadian rhythms.
Progesterone acts as a natural sedative. As progesterone declines, women often experience more fragmented and lighter sleep.
A study in Sleep Medicine Clinics found that lower estradiol levels were significantly associated with difficulty initiating and maintaining sleep in menopausal women.²
2. Vasomotor Symptoms (hot flashes)
Hot flashes and night sweats disrupt sleep architecture. Frequent temperature surges during the night cause awakenings and make it harder to return to sleep.
Research shows that the severity of vasomotor symptoms is strongly correlated with the severity of insomnia during menopause.³
3. Mood Disorders
Fluctuating hormones can trigger or exacerbate anxiety and depression, both of which are closely linked to sleep disturbances.
Women with depressive symptoms are more than twice as likely to report severe insomnia.⁴
Anxiety can increase sleep latency (time to fall asleep) and nighttime awakenings.
4. Circadian Rhythm Changes
Aging itself independently impacts the circadian system, leading to:
Earlier sleep and wake times (advanced sleep phase)
Reduced melatonin secretion
Lighter, more fragmented sleep
Melatonin production naturally declines after age 50, contributing to menopause-related sleep issues.⁵
A Holistic Approach to Managing Insomnia in Perimenopause and Menopause
Anyone who has tried to get sleep advice from a conventional medicine provider knows the options there are limited. Sure, there are pills that will bring sleep, but they come with undesirable side effects and eventually stop working. A more effective and more sustainable approach is to identify and address the root causes of insomnia.
This includes assessing:
Hormonal imbalances
Neurotransmitter deficiencies
Inflammatory status
Stress response (HPA axis function)
Nutritional deficiencies
Gut health
Lifestyle patterns
The most effective treatment plans are highly personalized, and combine conventional evidence-based care with complementary therapies like acupuncture, herbal medicine, functional nutrition, mind-body therapies, and lifestyle interventions.
Let's explore the most effective approaches:
10 Strategies to Improve Perimenopause and Menopause Insomnia
1. Bioidentical Hormone Replacement Therapy
Bioidentical hormones are molecularly identical to the hormones naturally produced by the human body.
Estrogen therapy can improve sleep quality by reducing hot flashes and supporting neurotransmitter balance.
Progesterone therapy has a calming, sleep-promoting effect. Oral micronized progesterone is particularly effective for improving sleep in menopausal women.⁶
A randomized trial published in Menopause showed that progesterone improved sleep quality and decreased nighttime awakenings in postmenopausal women.⁷
Note: Hormone therapy must be personalized, monitored, and discussed carefully with a trained clinician.
2. Herbal Medicine
Certain botanicals have strong evidence for improving menopausal symptoms and promoting sleep:
Valerian root (Valeriana officinalis): Shown to decrease sleep latency and improve sleep quality.⁸
Black cohosh (Cimicifuga racemosa): Reduces hot flashes and may indirectly improve sleep.
Passionflower (Passiflora incarnata): Anxiolytic (antianxiety) and sedative properties help calm the nervous system.
Ashwagandha (Withania somnifera): An adaptogen that lowers cortisol and promotes deeper sleep.⁹
A systematic review in Menopause journal supports the role of herbal therapies in managing menopause-related insomnia.¹⁰
3. Mind-Body Medicine
Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the first-line treatment for chronic insomnia, including menopause-related sleep issues.
Teaches relaxation techniques
Reframes anxious thoughts about sleep
Improves sleep efficiency
A study in Sleep showed CBT-I led to sustained sleep improvements in midlife women experiencing menopause-related insomnia.¹¹
Other mind-body approaches:
Mindfulness meditation: Reduces rumination and improves sleep onset.
Yoga and tai chi: Promote relaxation and regulate the circadian system.
4. Functional Nutrition
Nutrition plays a critical role in sleep regulation.
Key strategies:
Magnesium: Promotes activity of GABA, a calming neurotransmitter. Supplementing with magnesium glycinate can significantly improve sleep quality.¹²
Vitamin D: Deficiency is associated with poor sleep; supplementation may improve sleep outcomes.¹³
Tryptophan-rich foods: Turkey, oats, and dairy support serotonin and melatonin production.
5. Acupuncture
Acupuncture modulates neurotransmitters like serotonin, dopamine, and GABA while regulating the autonomic nervous system and inducing relaxation.
A 2016 meta-analysis in Menopause concluded that acupuncture significantly improved sleep quality and reduced hot flashes in menopausal women.¹⁴
6. Adaptogens for Stress and HPA Axis Regulation
The menopausal transition often brings HPA axis dysregulation, another way of describing a chronic stress response.
Adaptogenic herbs can support resilience:
Rhodiola rosea: Reduces fatigue and supports stress adaptation.
Holy basil (Tulsi): Balances cortisol and promotes relaxation.
Eleuthero (Siberian ginseng): Enhances endurance and stress tolerance.
Chronic stress elevates cortisol, which disrupts sleep architecture. Addressing it is vital for restoring sleep.
7. Gut Health Optimization
The gut produces and regulates many neurotransmitters involved in sleep.
Strategies related to gut health include:
Probiotics: Certain strains like Lactobacillus plantarum and Bifidobacterium longum improve sleep quality.¹⁵
Prebiotic fibers: Support beneficial bacteria and enhance neurotransmitter production.
Identifying food sensitivities: Gluten, dairy, or other sensitivities may trigger inflammation, worsening sleep disturbances.
Functional stool testing can guide personalized gut-healing protocols.
8. Light and Circadian Rhythm Therapy
Circadian rhythms can be supported naturally by light exposure.
Morning sunlight: Regulates melatonin and cortisol rhythms.
Limiting blue light at night: Avoid screens 1–2 hours before bedtime.
Dim lights in the evening: Signal the brain that it's time to wind down.
Bright light therapy using a home light machine has been shown to improve sleep efficiency and duration in menopausal women.¹⁶
9. Anti-Inflammatory Lifestyle
Low-grade systemic inflammation is common in perimenopause and menopause and contributes to sleep disturbances.
Anti-inflammatory strategies:
Omega-3 supplementation (EPA/DHA)
Regular moderate exercise
Stress management techniques
Anti-inflammatory diet: Vegetables, fruits, turmeric, green tea, nuts
An anti-inflammatory approach supports brain health, neurotransmitter balance, and restorative sleep.
10. Creating a Personalized Sleep Hygiene Plan
Optimizing sleep hygiene is fundamental to any integrative insomnia plan.
Key tips:
Keep the bedroom cool (65°F / 18°C)
Maintain a consistent sleep and wake schedule
Avoid heavy meals, alcohol, and caffeine close to bedtime
Use calming bedtime rituals: stretching, journaling, herbal tea
Small, sustainable changes can dramatically improve sleep quality over time.
Final Thoughts
Insomnia during perimenopause and menopause is not just a symptom to tolerate — it's a sign of deeper biological transitions.
The most effective management plans bring better rest by addressing:
Hormonal shifts
Neurotransmitter deficiencies
HPA axis stress
Inflammation
Gut health
Lifestyle patterns
By embracing a whole-person approach, perimenopausal and menopausal women can not only overcome insomnia but also reclaim their vitality, cognitive sharpness, emotional balance, and sense of well-being.
Deep, restorative sleep is possible — and it’s one of the most powerful gifts you can give yourself during and after menopause.
References
Kravitz HM, et al. "Sleep disturbance in menopausal women: A systematic review." Sleep Med Clin. 2007.
Polo-Kantola P. "Sleep problems in midlife and beyond." Maturitas. 2011.
Joffe H, et al. "Vasomotor symptoms and sleep disturbance." Menopause. 2010.
Freeman EW, et al. "Anxiety as a risk factor for major depression during the menopausal transition." Arch Gen Psychiatry. 2002.
Brzezinski A. "Melatonin in humans." N Engl J Med. 1997.
Shaver JL, et al. "Progesterone and sleep." Sleep Med Clin. 2006.
Friess E, et al. "Effects of progesterone on sleep." Psychoneuroendocrinology. 1997.
Fernandez-San-Martin MI, et al. "Effectiveness of valerian on insomnia: A meta-analysis." Sleep Med. 2010.
Langade D, et al. "Clinical evaluation of the anti-stress effects of Ashwagandha." Indian J Psychol Med. 2012.
Leach MJ, et al. "Herbal medicines for menopausal symptoms." Menopause. 2013.
Garland SN, et al. "Mindfulness-Based Stress Reduction for insomnia." Sleep. 2014.
Wienecke T, et al. "Magnesium and sleep." Nutr Rev. 2016.
McCarty DE, et al. "Vitamin D and sleep regulation." J Clin Sleep Med. 2012.
Chiu HY, et al. "Acupuncture and sleep quality in menopausal women: A systematic review." Menopause. 2016.
Smith RP, et al. "Gut microbiome and sleep physiology." PLoS One. 2019.
Pail G, et al. "Bright-light therapy and sleep." Neuropsychobiology. 2011.