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Perimenopause Insomnia & Sleep: Causes & Treatments

By A Member of the Lina Team (Licensed Psychologist, PsyD)

What is perimenopause insomnia?

Perimenopause insomnia refers to sleep difficulties that begin to occur during a woman’s menopause transition, defined as the time frame in which a woman’s period frequency decreases until one year following her final menstrual period.

Can perimenopause cause sleep problems?

Insomnia and fatigue are common symptoms in the perimenopause period. One study of perimenopausal women found that fatigue and insomnia were two of the top three most commonly endorsed symptoms, and that sleep disturbances were one of the two symptoms clusters that had the greatest impact on quality of life. In its discussion of sleep-wake disorders, the Diagnostic and Statistical Manual of Mental Disorders (5th edition) notes that it is not uncommon for insomnia conditions to first onset during perimenopause. Insomnia is just one of a host of symptoms that can occur during perimenopause, including hot flashes, muscle pains, and changes in mood.

How can I sleep better during perimenopause?

There are several tips that can help you sleep better during perimenopause and reduce insomnia. During perimenopause, it is important to practice good sleep hygiene including limiting screen time in the half-hour before bed-time, ensuring that the bedroom is dark and cool (especially as body temperatures are likely to shift due to hormonal changes), and practicing a consistent bed-time and wake-time each day.

Is there a connection between perimenopause insomnia and anxiety?

There is a connection between perimenopause insomnia and anxiety. Insomnia and anxiety are two common clusters of symptoms in perimenopause. Both anxiety and insomnia may result from changing hormone levels during the perimenopause period. The two are also likely to influence each other: increased anxiety can make it harder to fall asleep, while poor sleep can result in irritability and anxiety during the daytime.

Can you have perimenopause insomnia before your period?

Yes, you can have perimenopause insomnia before your period. Perimenopause encompasses several years in which a woman continues to experience menstrual periods (albeit at reduced frequency). A woman in the perimenopausal stage may start to experience symptoms of perimenopause syndrome, including anxiety or insomnia, and also experience menstrual periods.

Will perimenopause insomnia go away with time?

Longitudinal research suggests that most women with perimenopause-onset insomnia will experience improvement in sleep following the completion of menopause. So yes, perimenopause insomnia will go away with time. However for many women, the rate of sleep difficulties might increase with time to due other aging-related processes even after menopause.

What are the best perimenopause insomnia treatments?

Menstrual hormone therapy (MHT) has been found to be an effective treatment for perimenopuase-related symptoms including insomnia, hot flashes, and anxiety and mood symptoms. Hormone therapy works by replenishing levels of estradiol (or, estrogen) that diminish during the perimenopause phase. There is also research to suggest that certain herbal medicines or a low dose of antidepressant SSNRIs can improve insomnia. Other treatment options include melatonin supplements or psychotherapy focused on sleep problems such as cognitive behavior therapy for insomnia (CBT-i).

Are there sleeping pills for perimenopause insomnia?

Perimenopause insomnia has been found to improve with medications including certain antidepressants. Insomnia is also responsive to other medications for sleep including prescription medications (e.g., sleeping pills like Ambien, Lunesta) and over-the-counter options like diphenhydramine (brands Unisom & Benadryl).

What are natural remedies for perimenopause insomnia that do not require medicine?

Some non-medicine options for perimenopause-onset insomnia include menopause hormone therapy (MHT) to supplement the body’s estrogen levels, melatonin supplements to help regulate the body’s circadian rhythm, or therapy options such as cognitive-behavior therapy for insomnia.

Does perimenopause insomnia go away?

Longitudinal research suggests that most women with perimenopause-onset insomnia will experience improvement in sleep over time following the completion of menopause. So typically women do see perimenopause insomnia go away. However for many women, the rate of sleep difficulties might increase with time due to other aging-related processes that are not related to perimenopause.

Resources:

  • Greenblum CA, Rowe MA, Neff DF, Greenblum JS. Midlife women: symptoms associated with menopausal transition and early postmenopause and quality of life. Menopause. 2013 Jan;20(1):22-7. doi: 10.1097/gme.0b013e31825a2a91. PMID: 22929034.
  • https://doi.org/10.1177/2053369119841166
  • Ensrud KE, Guthrie KA, Hohensee C, Caan B, Carpenter JS, Freeman EW, LaCroix AZ, Landis CA, Manson J, Newton KM, Otte J, Reed SD, Shifren JL, Sternfeld B, Woods NF, Joffe H. Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep. 2015 Jan 1;38(1):97-108. doi: 10.5665/sleep.4332. PMID: 25325454; PMCID: PMC4262961