Sleep
Why sleep breaks down around menopause, and the approaches with evidence for getting it back.
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Sleep: the overview
Trouble sleeping is one of the most common complaints of the menopause years. Some of it is night sweats waking you up. Some of it is classic insomnia: lying awake at 3am with a busy mind even on nights without a flush. Anxiety and a need to pee in the night add to it.
What helps
Treating the sweats often fixes a large part of the problem, which is why HRT can improve sleep for women whose nights are broken by flushes. For insomnia itself, the treatment with the strongest evidence is cognitive behavioural therapy for insomnia (CBT-I). A 2024 review found it improves sleep quality and reduces insomnia severity in menopausal women, with gains lasting months after treatment ended (scoping review in PMC). NICE also recommends menopause-specific CBT for sleep problems (NICE NG23).
What the guides here cover
The articles in this topic look at sweating at night, insomnia, what over-the-counter sleep aids can and cannot do, and how to set up a bedroom that stays cool.
Ines Kovac's view: work out which kind of waking you have first. If you wake hot and damp, treat the sweats. If you wake dry and wide awake, CBT-I is the better first step.
Questions readers ask
Why do I wake at 3am in menopause?
Does HRT help sleep?
What is CBT-I?
Other topics
- PerimenopauseWhen cycles start to change: the first signs, how long this stage lasts and how it gets diagnosed.
- SymptomsBrain fog, anxiety, aches and the less-talked-about changes, with what each one usually means.
- Hormone therapy (HRT)What HRT is, the forms it comes in, who it suits and how the risks really stack up.
- Hot flashesWhy the heat comes on, and the treatments with real evidence, hormonal and not.
- Weight and dietWhat really changes with weight at midlife, and how to eat for energy, bones and heart.