Not sleeping in perimenopause? Dr Amir Khan reveals 5 reasons why the hormonal change is so disruptive at night

If you're not sleeping as well as you used to in perimenopause, you're far from the only one. From changes in mood to bathroom habits, many women struggle to drift off and stay asleep during this life stage.

As Dr Amir Khan, who is also woman&home's resident GP, says, hot flushes and night sweats are the "hallmark" of menopause. The symptoms that comes to mind when we think of what perimenopause feels like.

However, there's more to it than meets the eye, with a recent symptom report suggesting that 78% of women report sleep issues in menopause while 65% report hot flushes and night sweats respectively.

In the video, the doctor reveals the key changes happening in perimenopause that makes good sleep harder to come by - and what you can do about it.

Why you're not sleeping in perimenopause

1. Vasomotor symptoms

"These are the hot flushes and the night sweats," says the doctor. "They are the hallmarks of the menopause and are caused by fluctuating and declining oestrogen levels affecting the hypothalamus, which is the body's temperature regulator in the brain."

The sudden heat surges wake you up from sleep and can make it hard to sleep better, or even get off to sleep in the first place.

2. Changes in circadian rhythms

Circadian rhythms are the name for the body's internal clock, controlled by a cluster of cells in the hypothalamus. It helps control our sleep-wake cycle, hormone release, body temperature, and other vital bodily processes.

"Oestrogen and progesterone influence the brain's sleep-wake cycle. Decreased levels can lead to decreased production melatonin. That's the hormone that helps regulate sleep timing and quality, causing fragmented and lighter sleep," he says.

3. Increased anxiety

Mood disorders and increased anxiety in menopause could be getting in the way of good sleep.

"Menopause is linked to changes in neurotransmitters like serotonin and gaba, contributing to mood swings, anxiety, and even depression, all of which can make it difficult to initiate and maintain good sleep," says Dr Khan.

4. Nocturia

This is the proper name for needing to get up and use the bathroom in the middle of the night.

"Oestrogen decline affects the urine retract and bladder function, often causing increased frequency of urination at night, which interrupts sleep continuity," he says.

5. Sleep disordered breathing

Sleep disordered breathing includes conditions like sleep apnea, which can have longer-term health implications.

"Menopause is linked to weight gain and changes in the upper airway muscle tone, increasing the risk of obstructive sleep apnea," the doctor says. "This leads to repeated breathing interruptions during sleep, causing fatigue, and poor sleep quality."

What to do about sleep issues in menopause

Understanding the symptoms and why they are happening can help you "take targeted steps towards better sleep in menopause", says Dr Khan. "So please, speak to your GP about it."

In the meantime, if you're not sleeping in perimenopause, take a look at the following advice from the National Institute on Aging:

• Stick to a regular sleep schedule: Going to sleep at the same time every night and waking up in the morning at the same time can help your circadian rhythms get back to normal.
• Avoid naps: Sleeping in the late afternoon or evening can make it harder to sleep at night.
• Practice good sleep hygiene: A good bedtime routine and the right environment can make a big difference. That could mean reading a book before bed, rather than looking at our phone, listening to music, or having a bath if you're not sleeping in perimenopause.
• Keep your bedroom at the right temperature: Making sure your bedroom isn't too hot or too cold will help you sleep in the heat of the summer.
• Exercise regularly: Keep a regular exercise routine, but make sure you're not working out too close to bedtime, otherwise you might find it harder to fall asleep.
• Avoid large meals: Eating lots of food in the evening can prevent good sleep as the body is trying to digest the food while settling down for sleep.
• Avoid caffeine: Stay away from coffee, tea, and chocolate too late in the day.
• Avoid alcohol: While a glass of wine in the evening is tempting, even small amounts can make it harder to stay asleep.