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You know that feeling? It's 3 a.m., and you're lying wide awake in bed, while your partner slumbers peacefully beside you. During perimenopause, such nighttime waking phases are not uncommon. The reason lies in the complex hormonal changes that occur during this phase of life.
When hormones disrupt sleep – the scientific background
Progesterone – the calming sleep hormone
Estrogen – more than just a sex hormone
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Altered sleep architecture
Estrogen and progesterone also directly influence our REM sleep —the crucial phase in which body and mind recover. As their levels decline, the entire sleep architecture changes: Deep sleep phases become shorter, while light sleep phases increase.
Hot flashes and impaired thermoregulation
Melatonin – the key to the day-night rhythm
As we age, our bodies also produce less melatonin, the hormone that regulates our sleep-wake cycle. Declining estrogen levels during perimenopause can further exacerbate this natural decline, further contributing to sleep disturbances.
The consequences of disturbed sleep are noticeable: You feel tired during the day, are more irritable, and struggle with concentration. Typical symptoms include difficulty falling asleep or waking up early in the morning without being able to get back to sleep. Many women also report nighttime hot flashes, heart palpitations, or sudden feelings of anxiety, which further disrupt sleep.
More than just tiredness – when lack of sleep becomes a health risk
Chronic sleep disorders are more than just annoying—they can have serious health consequences. The risk of the following conditions increases:
Obesity
Cardiovascular diseases
diabetes
Depression
It is therefore worth taking sleep problems seriously and actively addressing them in order to minimize long-term health risks.
More than just hormones – other sleep disruptors during menopause
Menopause often coincides with significant life changes: children move out, career changes are imminent, or caring for parents becomes necessary. These changes can cause additional stress, which disrupts sleep. A vicious cycle develops: Hormonal fluctuations increase sensitivity to stress, while stress, in turn, disrupts hormonal balance.
The risk of sleep-related breathing disorders such as sleep apnea also increases during menopause. The decline in estrogen and progesterone can impair breathing regulation during sleep, leading to brief pauses in breathing and thus to frequent nighttime awakenings – often without the affected person being aware of it.
When a visit to the doctor is advisable
If you're unsure whether there might be more to your sleep problems, or if your previous attempts haven't improved, it's a good idea to see a doctor. It's important to rule out medical causes such as sleep apnea (breathing pauses), thyroid problems, or other illnesses. Certain medications can also cause sleep problems as a side effect and should be adjusted if necessary.
A doctor can also help analyze the exact pattern of your sleep problems and find individually tailored treatment options. For persistent or particularly stressful sleep problems, professional support is always beneficial—it can save you unnecessary detours and provide more targeted help.
Natural sleep aids – ways to better sleep without medication
Optimize your bedroom
A cool, well-ventilated bedroom can work wonders. The ideal room temperature is between 16 and 18 degrees Celsius. Light cotton bedding supports sleep by allowing the body to breathe and reducing sweating. Also, make sure the room is sufficiently dark and avoid bright or bluish light before bedtime.
Pay attention to your diet in the evening
What you eat affects your sleep. Avoid caffeine and sugar in the evening—they can seriously disrupt sleep. Unfortunately, the same applies to alcohol. While alcohol initially has a relaxing effect and can make it easier to fall asleep, it has a negative impact on sleep quality. A diet rich in vitamin E, such as nuts, seeds, or green leafy vegetables, can, however, have a supportive effect and contribute to relaxation.
Use the daylight
Regular exposure to daylight is important for our sleep-wake cycle. It promotes the production of melatonin, which causes tiredness in the evening. A morning walk can stabilize your body clock and make it easier to fall asleep in the evening.
Establish a sleep routine
Our bodies thrive on regularity. A consistent bedtime and calming evening routines signal to your body: "Now it's time to unwind." Whether it's a warm bath, a cup of herbal tea, or ten minutes of reading – find your own personal bedtime routine. Even skipping a nap can improve your nighttime sleep.
Practice calming breathing techniques
Deep, slow breathing can activate the parasympathetic nervous system, significantly improving sleep quality. Try breathing consciously for a few minutes before falling asleep: Inhale while counting to four, hold your breath briefly, and then exhale slowly while counting to six. This simple technique has been proven to reduce stress hormones and optimally prepare the body for the night.
Reduce blue light in the evening
Electronic devices such as smartphones, tablets, and computers emit blue light, which can suppress the production of the sleep hormone melatonin. You should avoid using these devices one hour before bedtime. If that's not possible, you can use blue light filters or special apps that reduce the amount of blue light. Dimming the lights in your home in the evening can also signal to your body that it's time to prepare for sleep mode.
The green pharmacy for better sleep
Nature offers effective remedies for sleep problems. There are a variety of herbal preparations containing hops, lemon balm, or valerian. These natural remedies gently promote relaxation and can improve sleep. They are available without a prescription and usually have fewer side effects than synthetic sleep aids.
Melatonin as a sleep aid
When natural remedies are not enough: Medicinal options
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Sleeping pills – to be used with caution
For persistent sleep problems, sleeping pills can provide short-term relief. However, caution is advised. Many of these medications can be addictive and carry side effects:
Daytime fatigue that limits your ability to react
-
Increased risk of falls, especially in older people
Cognitive impairments that affect concentration and memory
These medications should therefore only be taken under medical supervision and for a limited period of time.
Antidepressants – more than mood enhancers
Low-dose antidepressants can be an alternative. They not only help with sleep problems but can also alleviate accompanying symptoms such as anxiety and restlessness. Some can even reduce hot flashes. However, antidepressants should only be taken after consulting a doctor and under ongoing medical supervision.
Hormone replacement therapy: Targeted help for hormonally-induced sleep disorders
If hormonal fluctuations are the primary cause of your sleep problems, hormone replacement therapy (HRT) may be beneficial. Modern HRT primarily uses bioidentical hormones, which have an exact chemical structure similar to the body's own hormones. This allows for a more natural effect in the body and can reduce the risk of side effects.
In contrast to the past, hormone therapy is now usually administered through the skin—i.e., transdermally. This modern form of administration has key advantages: It places significantly less strain on the circulatory system and, in healthy women, is not associated with an increased risk of high blood pressure, stroke, thrombosis, or pulmonary embolism. Even in women with blood clotting disorders, the transdermal method is often well tolerated because it has minimal impact on coagulation.
Properly adjusted HRT can promote REM sleep again, thus ensuring better nighttime rest. The result is more restful nights and an improved quality of life during the day. However, it's important to understand that HRT is not a one-size-fits-all solution. It should always be individually tailored and discussed in detail with a doctor. Only then can the risks and benefits be carefully weighed and the right treatment for you be found.
Conclusion: Individual ways to restful sleep
The path to better sleep during menopause is as individual as you are. Which measures are best for you depend on the type and intensity of your symptoms. For mild sleep disturbances, natural methods and improved sleep hygiene may be sufficient. For more severe symptoms, it is sometimes beneficial to speak directly with your doctor about medication options or hormone replacement therapy.
There's no "one-size-fits-all" approach—what's important is that you find the support that's right for you. With the right approach and a little patience, you can find your way back to restful nights and better manage the challenges of perimenopause.
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Questions & answers about sleep during menopause
How long do typical perimenopausal sleep disorders last?
Sleep problems can occur with varying degrees of intensity throughout the perimenopause (4-8 years). For about half of women, sleep improves significantly after menopause.
How do electronic devices affect sleep during perimenopause?
Blue light from smartphones and tablets can inhibit melatonin production and exacerbate sleep problems. Avoid screens at least an hour before bedtime or use blue light filters.
Does hormone replacement therapy always help with sleep disorders?
Hormone replacement therapy can be very effective for hormonally related sleep problems, but it doesn't work equally well for everyone. The benefits and risks should be weighed individually with your doctor.
Marianna Papagallo Dörnemann
gynecologist
As a gynecologist, I have been supporting women through the hormonal changes of perimenopause and menopause for many years. I know how individual this phase of life is—and how much quality of life we can gain if we approach it with knowledge and openness.
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