Insomnia and 3am waking

Sleep often changes in perimenopause in two ways. ACOG names insomnia, meaning trouble falling asleep, and waking long before your usual time. Many women describe the second as the same hour every night, often in the small hours. Why it tends to be around three, and what to do while you are awake, is in waking at 3am in menopause.

The National Institute on Aging links poor sleep in these years to hot flashes, especially night sweats, and to low mood and depression. It also points out how full midlife tends to be: ageing parents, grown children, more work. The NHS adds that lost sleep can leave you irritable, stressed and anxious, and can make memory and concentration feel worse.

NIA's list of habits is plain and worth taking in full: the same bedtime and waking time every day, no naps late in the afternoon or evening, a bedtime routine, no screens in the bedroom, a room that is cool and quiet, exercise at regular times but not close to bed, no large meals late, no caffeine late in the day. On alcohol it is blunt: even small amounts make it harder to stay asleep.

If habits are not enough, NIA says cognitive behavioural therapy for insomnia has been shown to help women with menopausal symptoms, ideally with a therapist who knows this stage of life. Sleep medicines are a question for your doctor. NIA notes they are not a cure for insomnia and are not meant for long-term use.

Not every bad night is insomnia. Our overview of menopause and sleep problems sorts the other usual causes, including sleep apnoea, which becomes more common after menopause, and getting up to pee at night. The article on insomnia in menopause explains why it happens, how anxiety feeds it, how long it tends to last and what the CBT-I trial in menopausal women found. The pieces below cover the rest of the night.