“I’m always uncomfortable, and I can’t sleep at night,” said one woman surveyed by ThisIsMenopause. Another said, “The sleeplessness is the biggest challenge.”

Healthy sleep helps your body manage stress, fight infections, and improve your quality of life. However, getting a good night’s sleep is often easier said than done. About half of women in perimenopause have sleep disruptions, including insomnia and frequent waking at night.

Keep reading to discover six factors that can cause sleep problems in perimenopause. You’ll also learn what you can do to get more high-quality sleep.

How Does Perimenopause Affect Sleep?

Perimenopause can lead to several changes in your body that cause sleep issues, explained Sirimon Returakul, M.D., an endocrinologist with University of Illinois Hospital & Health Sciences System. “Hormonal issues like low estrogen, high FSH, or low progesterone, vasomotor symptoms (hot flashes), and mood disorders can all contribute to sleep issues,” Dr. Returakul noted.

“Other medical issues like pain, chronic medical conditions, smoking, and psychological stressors can disturb sleep,” she added. “Actual sleep disorders like insomnia, restless legs syndrome, and sleep apnea can be factors as well.”

1. Hormone Changes

During perimenopause, your hormone levels change. As the progesterone and estrogen levels drop, it can affect your sleep. One reason is that progesterone helps promote sleep.

If your progesterone levels drop, you lose the hormone’s calming effects. This can make it harder to fall asleep and stay asleep. It can also affect sleep quality, which directly affects how refreshed you feel when you wake up.

2. Hot Flashes and Night Sweats

Vasomotor symptoms are among the most common symptoms of menopause. The most well-known are night sweats and hot flashes. When estrogen levels drop, your body has a harder time figuring out how to regulate your body temperature. As a result, you may feel your body get hotter. You might even sweat so much that it soaks through your pajamas or bedsheets. These flashes can last up to five minutes and can easily wake you up or disturb your sleep.

One study found that women with moderate to severe hot flashes woke up three times more often at night compared to those without these symptoms. “Hot flashes disrupted my sleep, mood swings increased, energy dipped, and my focus changed daily,” one ThisIsMenopause survey respondent said. Another added, “The night sweats were horrible, causing me to lose sleep, which led me to being in a horrible mood.”

3. Mood Disorders

Estrogen changes during perimenopause can lead to mood changes. Researchers have found that these changes may include new symptoms of anxiety and depression, which can affect your sleep.

Poor sleep can make mood issues worse because not sleeping well can increase depression and anxiety. Some people get caught up in this cycle, and it significantly affects their quality of life.

4. Pain

Some women develop new pain symptoms during menopause. For example, one study found that between 48 percent and 72 percent of midlife women had muscle or joint pain as menopause symptoms. Lower estrogen levels in the body affect the entire musculoskeletal system. Studies have found that postmenopausal women had more stiffness and joint pain than premenopausal women of the same age. This kind of pain can keep you up at night and make it harder to sleep well.

5. Ongoing Medical Conditions

Other medical conditions may also affect your sleep quality. For instance, restless legs syndrome and obstructive sleep apnea affect how well you sleep. They’re also both more common as women age and enter menopause. Other conditions that may affect your sleep include:

• Multiple sclerosis
• Parkinson’s disease
• Heart disease
• Lung disease
• Traumatic brain injury
• Diabetes
• Chronic (ongoing) pain
• Depression
• Stress
• Anxiety

If you have a chronic condition, it may be the cause of your sleep difficulties. But it’s important to always have a doctor evaluate you to pinpoint the cause.

6. Bladder Changes

Many women experience bladder changes during perimenopause, which may affect their sleep. One study found that women in perimenopause needed to urinate more urgently than other women. Hormonal changes during menopause can cause an overactive bladder. This means you’ll need to go to the toilet more often.

If you need to use the bathroom during the night, it may wake you up, and then it may be difficult to fall back asleep.

Insomnia’s Effect on Quality of Life

Getting restful sleep at night improves your quality of life, including your productivity, mood, and attentiveness. Plus, getting a good night’s sleep helps you reduce the risk of developing illnesses like heart disease, stroke, and type 2 diabetes.

Poor sleep quality can raise your risk of diabetes in several ways. “Sleep disturbances can lead to increased inflammation and insulin resistance, causing glucose to be elevated,” Dr. Returakul said.

Being fatigued after sleeping poorly can prompt you to be less physically active, which is a risk factor for both weight gain and diabetes, Dr. Returakul added. “Another sleep disturbance is sleep apnea, which is more common in people with overweight/obesity. It’s also linked to diabetes and elevated blood pressure.”

Tips To Improve Your Sleep

For many people, better sleep habits and other lifestyle changes may help them sleep better. Others may need medications to treat the underlying cause of sleep issues. For example, “Menopausal hormone therapy can reduce vasomotor symptoms, which can help improve sleep,” Dr. Returakul said. In addition, some women find that taking progesterone helps them sleep better.

The solution that helps improve sleep quality will be different for everyone. That’s why it’s important to talk to a healthcare provider about your sleep challenges.

If you’re having trouble sleeping, start by creating a comfortable sleep environment. This is sometimes called “sleep hygiene,” said Maariya Bassa, MSN, CNM, WHNP-BC. Bassa is the medical director for quality and certified nurse midwife and women’s health practitioner with Unity Healthcare in Washington, DC.

“Sleep hygiene is going to involve establishing a daily routine,” Bassa explained. This may include the following steps:

• Setting up a bedtime routine that’s the same every night, including practicing relaxing activities like taking a warm bath or reading
• Going to bed at the same time nightly
• Getting natural light during the day and reducing it at night
• Reducing how frequently you nap during the daytime so you’re tired at night
• Avoiding caffeine and alcohol late in the day, as these can disrupt sleep

Some people find that cognitive behavioral therapy, a type of talk therapy, can help treat insomnia. Your healthcare provider can help you develop a plan to improve your sleep and well-being. If you need a referral to a menopause specialist or sleep medicine expert, your doctor can help with that, too.