Why does perimenopause wake you up at night?

Insomnia gets more common in the years around menopause, especially waking in the night. Hot flashes and night sweats are a big part of it. You can get the hot flashes treated and work on the sleep at the same time, and there's good evidence for both.

Why it gets harder to stay asleep

You often wake just as a hot flash starts, and sometimes you cool down and stay awake long after it's passed. After enough nights like that, lying awake at 3am can become a pattern of its own, as it does for anyone with insomnia. Then it keeps going even on nights without a flash.

Sleep apnea also gets more likely. A study of almost 600 women found that those past menopause were more than twice as likely to have it as those who weren't there yet, even after accounting for age and weight. In women, apnea can show up as broken sleep and tiredness rather than loud snoring. If you've started snoring, wake with headaches, or feel tired in the day however long you sleep, ask your doctor about a sleep test.

What helps with hot flashes?

Hormone therapy is the most effective treatment for hot flashes and night sweats, according to The Menopause Society. If you can't take it or would rather not, there are non-hormone options with good evidence too. One is cognitive behavioral therapy, which mostly makes hot flashes bother you less rather than come less often. A doctor can also check for things that look like menopause, such as thyroid problems.

Does CBT-I work around menopause?

CBT-I, cognitive behavioral therapy for insomnia, has good evidence for insomnia around menopause, even if you're still having hot flashes. In a trial of 106 women with both, half had six phone sessions of CBT-I. At eight weeks, 70% of them no longer scored as having insomnia, compared with 24% of the women given menopause education instead. CBT-I didn't make the hot flashes less frequent than education did, but they got in the way of daily life less.

Ask your doctor about it. Much of it can be done by phone or online, and there are free ways to get it.

At night

Most of what we suggest for waking at 3am works after a hot flash too. Turn the clock so you can't see it. If you're lying there getting frustrated, get up for a while and come back when you're sleepy. If you're unsteady on your feet or you've taken anything that can make you drowsy at night, sit up in bed with a low light instead.

Keep water, a dry top and a cover you can throw off within reach, so a hot flash doesn't turn into a trip to the kitchen.

The next morning, get up at your usual time however the night went. If you nap, keep it short and before 3pm. If you're too sleepy to drive safely, don't drive.

When to see a doctor

If you wake short of breath, with chest pain or pressure, or with your heart pounding and it won't settle, get help straight away. For chest pain, call 911 or your local emergency number.

See a doctor if:

• hot flashes or night sweats are bothering you, or they started before you turned 40.
• night sweats come with a fever or weight loss you can't explain. Hot flashes are the usual cause at this age, but night sweats can have others worth checking.
• you feel low, anxious or flat most days.
• you snore, gasp in your sleep, or feel tired or sleepy in the day however long you sleep.
• an urge to move your legs keeps you from settling at night. Heavy periods can leave you low on iron, which makes this more likely.
• it started around when you began a new medicine. Your doctor or pharmacist can tell you if it might be the cause.
• you've slept badly three or more nights a week for three months, or sooner if it's wearing you down.

If you take something for sleep, take it only as prescribed, with no extra dose in the night unless your doctor has said so, and talk to your doctor before changing it.

If you're having thoughts of suicide or harming yourself, call or text 988 in the US, or your local emergency number.