1-page guide · 5 min read
The 3 a.m. Guide
Why perimenopause wakes you up in the middle of the night, and how to get back to sleep.
By Julie Murphy, FNP-BC, PMHNP-BC, MSCP
Sleep problems rise sharply during perimenopause. The classic pattern is falling asleep fine, then waking at 2 or 3 a.m. with a racing mind and not getting back to sleep.
Weeks of this drive anxiety, brain fog, cravings, and irritability. Fixing sleep often improves everything else.
Why 3 a.m.
- Night sweats and hot flashes wake you, sometimes without you remembering the heat
- Falling progesterone removes some of its natural calming effect
- Cortisol naturally begins rising in the early morning hours, and a stressed system rises earlier and harder
- Alcohol in the evening helps you fall asleep but fragments the second half of the night
- Sleep apnea becomes more common after menopause
What helps
- Keep the same wake time every day, including weekends
- Keep your bedroom cool and use layers you can kick off
- Stop alcohol a few hours before bed, and caffeine by noon
- If you are awake for more than about 20 minutes, get up and do something calm in dim light, then return when sleepy
- Write down what is on your mind earlier in the evening so it is not waiting for you at 3 a.m.
Treatment that works
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia, and it works well in midlife women.
If night sweats are driving the wake-ups, treating them helps. Hormone therapy is the most effective option for hot flashes, and there are also non-hormonal prescription options.
Ask about sleep apnea if you have
- Loud snoring, or being told you stop breathing
- Morning headaches
- Daytime sleepiness even after a full night in bed
Questions to ask your clinician
- Are night sweats the main thing waking me up?
- Should I be screened for sleep apnea?
- Is CBT-I a good fit for me?
- What are my hormonal and non-hormonal options for hot flashes?
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