Why Can’t I Sleep? Understanding Menopause and Your Midnight Mind

If you're finding yourself wide awake at 3am, flipping the pillow for the cool side (again), wondering why your body seems to have forgotten how to sleep — you’re not alone. Sleep disruption is one of the most common, frustrating (and often overlooked) symptoms women experience during menopause. And no, you’re not imagining it — your hormones are very much involved.

Let’s break it down in a way that makes sense — and more importantly, let’s talk about what you can actually do about it.

So, What’s Actually Happening?

During menopause, your levels of oestrogen and progesterone drop — and while we usually focus on how that affects mood or periods, it also wreaks havoc on your sleep cycles.

These hormones help regulate your body’s internal clock (your circadian rhythm), influence your body temperature, and even calm your brain enough to ease into restful sleep. Without them doing their usual jobs, you may find yourself:

• Taking ages to fall asleep

• Waking up often through the night

• Or waking too early and not being able to get back to sleep

Add to that the joy of hot flushes or night sweats, and it’s easy to see why many women say sleep becomes a nightly battle.

“I Feel Like a Zombie the Next Day”

Yes. Because that’s what chronic sleep deprivation can feel like. And here’s the kicker — women are more likely than men to develop obstructive sleep apnoea (OSA) after menopause, even though we don’t always present in the same way (less snoring, more “I’m just tired all the time”).

There’s also Restless Legs Syndrome — that awful creeping, crawling feeling in your legs at night that makes you want to move constantly — and the often invisible impact of anxiety, low mood, and brain fog that all feed into poor sleep.

Sleep and mental health go hand-in-hand — and menopause can affect both.

What Can Help?

Good news: there are things you can do to get your nights back on track.

1. Get Your Symptoms Under Control First

If night sweats or hot flushes are waking you up, managing these symptoms often improves sleep dramatically. This might mean hormone therapy, non-hormonal options, or other approaches tailored to your medical history.

2. Look at the Bigger Picture

Are you drinking wine in the evening? Having a sneaky square (or three) of chocolate before bed? Watching one more episode while doom-scrolling in the dark? These things matter more than we think.

Some practical steps:

• Cut back on caffeine (yes, even in that green tea!) after 2pm

• Limit alcohol — it may help you fall asleep, but it messes with your ability to stay asleep

• Get morning sunlight — this helps reset your body clock

• Stick to a consistent wake-up time, even on weekends

3. Check for Underlying Sleep Disorders

If you’re constantly waking unrefreshed, snore, feel exhausted by mid-morning, or your partner says you stop breathing in your sleep — you could have OSA. Don’t brush this off. A sleep study (either at home or in a lab) can help confirm this, and treatment can be life-changing.

4. Still Not Sleeping? It Might Be Time for CBTi

Cognitive Behavioural Therapy for Insomnia (CBTi) is the gold standard treatment if poor sleep has become a long-term pattern. It’s not about talking through feelings — it’s structured, practical, and backed by serious science.

CBTi helps rewire the brain’s connection to sleep — changing both behaviours and the anxious thinking that often comes with insomnia. It’s available via trained psychologists, or in some excellent online programs like This Way Up.

Please Don’t Just Push Through

We often see women who’ve been struggling with sleep for years — convincing themselves it’s just part of being busy, part of aging, part of life. But poor sleep affects everything: your mood, memory, metabolism, relationships, even your cardiovascular and bone health.

You deserve better rest. And there are things we can do.

If sleep has become something you dread, talk to your GP or book a consultation with us at WA Menopause Clinic. We’ll help you unpack what’s going on, rule out underlying causes, and guide you through options that work — for your body, your lifestyle, and your future.

The benefits of sleep are often overlooked.

References Summary

• Prevalence and meta-analyses support high incidence of sleep disorders in menopause (Salari et al., 2023)

• Hormonal changes, particularly rapid shifts (e.g. surgical menopause), linked with worse sleep (Sowers et al., 2008; Dennerstein et al., 2007)

• OSA underdiagnosed in women; presents differently than in men (Zhou et al., 2021; Orbea et al., 2020)

• CBTi shown to be effective long-term (Trauer et al., 2015)