Mood, anxiety and sleep

Worry, low mood and broken sleep turn up together so often in perimenopause that it can be hard to say which one is the problem. The NHS symptoms page lists anxiety among the effects of a hot flush and says that poor sleep can leave you irritable, stressed and anxious. It also warns that as the flushes and night sweats ease, low mood and anxiety can take their place. The pages here deal with that side of the night: what goes on in your head at 3am and how you feel the next day.

If you wake with a pounding heart and a head full of dread, start with anxiety at night in perimenopause. It covers why fear and heat arrive together and what helps in bed, from a slow breathing exercise to keeping caffeine and alcohol well away from the evening. The link may run in both directions. In the Penn Ovarian Aging Study, Freeman and colleagues found that women with moderate anxiety were nearly three times as likely to report hot flashes as women in the normal range, and those with high anxiety nearly five times as likely.

Low mood follows a similar pattern. A 2018 review of the SWAN and Penn studies reports a 2 to 5-fold rise in the risk of major depression during perimenopause for a subset of women. In one study it cites, midlife women who had sleep problems at the start were eight times more likely to have depression that lasted or came back over 13 years. Across adults in general, a pooled analysis of 21 studies found that insomnia roughly doubled the chance of depression later. Low mood and broken sleep in menopause looks at which one tends to start first and the signs that low mood has become depression.

Then there is the day after. Forgetting words, losing your train of thought and feeling slowed down are often put down to hormones alone, but lost sleep plays a large part. Tired after bad nights: menopause brain fog sets out what the studies found and which kinds of tiredness need blood tests or a sleep check.

What helps most is a record. Add a line for mood and worry to each night of the printable night diary, rated mild, moderate or severe, and after two weeks you can see whether the bad days follow the sweaty nights or turn up on quiet ones too. The NHS depression page advises seeing a GP when low mood lasts most of the day, every day, for more than two weeks. In England adults can also refer themselves to NHS talking therapies. If you feel unable to keep yourself safe, call Samaritans on 116 123 in the UK or the 988 Lifeline in the US straight away.

For the nights themselves, the insomnia and 3am waking section covers sleep habits, early waking and CBT for insomnia. To take your notes to an appointment, see tracking and your doctor.