Changes in Sleep
Roughly 40% of women in perimenopause are estimated to suffer from changes in sleep. (Kravitz et al., 2003)
TLDR. Roughly 40% of women in perimenopause are estimated to suffer from changes in sleep. There are actions which can help alleviate these sleep disturbances.
Sleep struggles are among the most common experiences women share during perimenopause, affecting roughly 40% of women (Kravitz et al., 2003). A systematic review of eight longitudinal studies involving more than 13,000 midlife women found a small but consistent increased risk of sleep disturbance as women move through the menopausal transition, even after adjusting for age, mood, vasomotor symptoms, and health behaviors (Xu et al., 2014). For most women, the most familiar culprit is waking during the night, and can also be driven by other physiological challenges like hot flashes (Xu et al., 2014; Maki et al., 2024; Lampio et al., 2017).
What changes, and what do we know about why?
Sleep is influenced by many things at once — hormones, body temperature, mood, aging, and life circumstances — and during the menopausal transition, several of these are shifting simultaneously. A systematic review of eight longitudinal studies involving more than 13,000 midlife women found a small but consistent increased risk of sleep disturbance as women move through the transition, even after adjusting for age, mood, vasomotor symptoms, and health behaviors (Xu et al., 2014). These changes most often involve waking during the night, though they can take different forms for different women (Maki et al., 2024; Lampio et al., 2017).
Vasomotor symptoms (hot flashes and night sweats)
Large longitudinal studies consistently find that women who report more frequent or severe vasomotor symptoms also report worse sleep.
In a study of 3,045 midlife women across multiple racial and ethnic groups, more frequent VMS were associated with significantly higher odds of trouble falling asleep, staying asleep, and waking early (Kravitz et al., 2008). However, when sleep is measured objectively — using polysomnography rather than self-report — the picture becomes more complicated.
A large community-based PSG study of 589 women found that peri- and postmenopausal women, despite reporting significantly less sleep satisfaction, actually showed better objective sleep architecture than premenopausal women, including more deep sleep and longer total sleep time (Young et al., 2003).
Important limitation: 98% of participants in the Young et al. study were white; these findings may not generalize across racial and ethnic groups.
One smaller laboratory study found that approximately 69% of objectively recorded hot flashes coincided with an awakening, but that roughly 20% occurred without disturbing sleep at all — and not all nighttime wakefulness was attributable to hot flashes (de Zambotti et al., 2014). Sleep disturbances have also been identified in women without vasomotor symptoms, confirming that VMS alone do not explain the full picture (Hung et al., 2014).
This gap between subjective experience and objective measurement is important: the distress women report is real, even when it doesn't correspond to measurable changes in sleep architecture.
Hormonal changes
Estrogen and progesterone both appear to influence sleep regulation, and both decline during the menopausal transition. Evidence suggests these hormonal changes may affect sleep independently of hot flashes, possibly through direct effects on brain regions that regulate sleep and body temperature (Haufe & Leeners, 2023). Poor sleep also affects reproductive hormone levels through activation of the hypothalamic-pituitary-adrenal (HPA) axis (Klussman et al., 2022). Researchers are still working to understand whether hormonal changes cause sleep disruption, sleep disruption affects hormones, or both are true simultaneously.
Aging
One of the most important and sometimes overlooked contributors is aging itself. Sleep architecture changes naturally as we get older: sleep becomes lighter, more fragmented, and total sleep time tends to decrease (Ohayon et al., 2004). A six-year longitudinal study following women from age 46 to 52 found that aging independently worsened sleep continuity regardless of hormonal status (Lampio et al., 2017). Because aging and the hormonal transition happen at the same time, separating their effects is genuinely difficult (Guidozzi, 2013).
Mood
Anxiety and depression are strongly associated with sleep difficulties, and the menopausal transition is also a period of increased vulnerability to mood disturbances. The relationship is bidirectional, and both are connected to vasomotor symptoms (Baker et al., 2018). Screening for mood disorders is an important part of understanding sleep difficulties during this time.
Sleep-specific conditions
Beyond general sleep disruption, the menopausal transition is associated with increased rates of certain sleep disorders.
Insomnia
Insomnia — dissatisfaction with sleep quantity or quality that causes daytime impairment — is among the most common sleep disorders during the menopausal transition. Estimates suggest roughly 37% of women in peri- and postmenopause experience insomnia (Benjafield et al., 2025). If you're unhappy with your sleep quantity or quality because of difficulties falling asleep, waking too early, or difficulty staying asleep, insomnia may be the right framework for conversation with your care team (Haufe & Leeners, 2023).
Sleep-disordered breathing
Sleep-disordered breathing, including obstructive sleep apnea, becomes more common and more severe as women progress through the menopausal transition. A longitudinal study of 219 midlife women with repeated in-home PSG studies found that peri- and postmenopausal women had higher Apnea-Hypopnea Index (AHI) scores compared to premenopausal women, even after adjusting for age and BMI (Mirer et al., 2018).
Importantly, women with sleep-disordered breathing often present differently than the classic picture. Rather than snoring and daytime sleepiness, women may present with insomnia, restless legs, mood disturbances, palpitations, and nightmares — which can lead to underdiagnosis (Lin et al., 2008; Baker et al., 2018). If you're experiencing these symptoms, raising the possibility of sleep-disordered breathing with your provider — even without snoring — is worth doing.
Restless Legs Syndrome (RLS)
Restless Legs Syndrome is more common during the menopausal transition, though prevalence estimates vary widely across studies (Salari et al., 2023). RLS occurs more often in women (9%) than men (5%), and risk increases with age. One cohort study found that women who underwent bilateral oophorectomy before natural menopause had a 44% higher risk of developing RLS, suggesting hormonal changes may play a role in its onset or worsening (Huo et al., 2021).
Will this go away on its own?
This is hard to answer with certainty — the research is mixed. Some studies suggest sleep difficulties stabilize or improve after the transition to postmenopause; others suggest they persist (Lampio et al., 2017; Soares et al., 2026). What the evidence does support is that untreated sleep disorders tend not to resolve on their own, and that addressing contributing factors — vasomotor symptoms, mood, sleep hygiene, and where appropriate medical treatment — can meaningfully improve sleep quality (Maki et al., 2024). The uncertainty about long-term course is itself a reason to take sleep difficulties seriously rather than waiting them out.
You're not alone. Not being able to rely on old habits and patterns to feel like your best self can be really challenging. Know you're not alone. More than half of the women going through perimenopause are also dealing with changes in sleep. The changes may persist into post menopause so addressing any concerns here may help to provide decades of relief.
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