When Sleep Won't Come

3 AM. You’re awake again.

Maybe you’re drenched in sweat, throwing off covers that felt essential twenty minutes ago. Maybe your mind started running and won’t stop—replaying the day, rehearsing tomorrow, circling anxieties you thought you’d resolved. Maybe you simply… woke, and now sleep has retreated somewhere you can’t reach.

Why This Is Happening

Sleep disturbance during perimenopause isn’t one problem—it’s several, often layered:

Night sweats fracture your sleep architecture. Every time your body triggers that heat-dissipation response, it pulls you toward waking—whether fully or just enough to disrupt the deep sleep you need. See Hot Flashes for what’s happening physiologically.

Progesterone is declining. Progesterone works on the same brain receptors as anti-anxiety medications (GABA receptors). It has a natural calming, sedating effect. As ovulation becomes less reliable and progesterone production drops, that calming voice goes quiet.

Your mood may be affecting your sleep—or your sleep may be affecting your mood. Depression and anxiety are more common during perimenopause, and they have a bidirectional relationship with insomnia. Poor sleep worsens mood; low mood disrupts sleep.

Some changes are age-related, independent of hormones. Sleep architecture shifts as we age—lighter sleep, more awakenings. Perimenopause happens to coincide with this.

Hormones may directly affect sleep centers. Research is still emerging, but there’s evidence that estrogen and FSH fluctuations affect the brain regions that regulate sleep and waking.

What Changes

You might notice:

• Longer time to fall asleep
• More awakenings through the night
• Less deep, restorative sleep
• Changed REM patterns
• Waking too early and not being able to return to sleep
• Sleep that doesn’t refresh you even when you get “enough” hours

The Cascade

Poor sleep doesn’t stay contained. It bleeds into:

• Brain fog and memory—cognitive function depends on sleep
• Mood—sleep deprivation looks a lot like depression
• Pain sensitivity—aches feel worse when you’re exhausted
• Patience, relationships, work, everything

This is why sleep isn’t a minor concern. It’s foundational. Tracking your symptoms over time can help you see how sleep connects to everything else.

What Might Help

For night sweats specifically:

• Cooling mattress pads, moisture-wicking pajamas, bedroom temperature management
• Addressing hot flashes directly through the options in Support

For the racing mind:

• CBT for insomnia (CBT-I) has strong evidence—often more effective long-term than medication
• Limiting screens before bed
• A consistent wind-down routine
• Writing down tomorrow’s concerns before bed to externalize them

Medical options:

• Hormone therapy can improve sleep, especially if night sweats are the driver
• Low-dose progesterone at bedtime helps some women (it has that natural sedating effect)
• Gabapentin, which also helps hot flashes, can improve sleep
• Some antidepressants with sedating properties
• Short-term sleep medications (with caution about dependence)

What probably won’t help:

• Telling yourself to just relax
• Wine before bed (it may help you fall asleep but fragments sleep later)
• Suffering through it because “it’s just part of aging”

Permission to Take This Seriously

Sleep problems get dismissed. “Everyone’s tired.” “Have you tried melatonin?” “Just go to bed earlier.”

But chronic sleep deprivation is a health issue with real consequences—for your heart, your immune system, your mental health, your relationships, your ability to function.

You’re allowed to seek help for this. You’re allowed to take it seriously. You’re allowed to be furious at 3 AM when sleep won’t come.

And you’re allowed to keep trying different approaches until something works.