Falling asleep is rarely the problem in perimenopause — staying asleep is. Sleep disruption is often the first symptom to appear and the one that makes every other symptom worse.
Falling progesterone removes a calming, sleep-holding effect, oestrogen swings trigger night sweats that wake you, and repeated bad nights create conditioned sleep anxiety that outlasts the flashes.
Core body temperature dips and cortisol begins rising in the second half of the night. With lighter sleep architecture, that transition becomes a full waking rather than a brief shift.
Cognitive behavioural therapy for insomnia is first line, ahead of sleeping tablets. Where night sweats cause the waking, menopausal hormone therapy or non-hormonal options for vasomotor symptoms can help.
Fix one wake time seven days a week, cool the bedroom, cut evening alcohol, get morning daylight, and keep a two-week sleep log to bring to your clinician.
Sleep problems lasting over three months, heavy snoring or gasping, unintentional daytime sleep, or insomnia with low mood all warrant medical assessment — sleep apnoea becomes more common after the transition.