You feel so tired when you go to bed. You hope tonight will be better. But you wake up at 2:30 a.m. again. You feel hot and try to cool down. You kick off the covers. Then, you get cool, but now you are wide awake. You look at the clock. You start to worry about the next day. Will you feel tired? Will you be able to do your work? Will this happen again tomorrow night? Wearing light clothes and taking a warm bath may help you relax but may be not enough.
Disturbed sleep difficulties are more common when you go through menopause. Many women feel that the way they sleep is not the same as before. Hot flushes and night sweats can wake you up during the night. But these things are not the only reason you may have trouble sleeping. Other things like your daily routine, stress, mood, your thoughts about sleep, and how you act when you are awake can also be part of why you are having sleep difficulties.
Research now gives us a better idea about this topic. Studies have looked at behaviour change just for women in the early stage of perimenopause and postmenopause. A randomised clinical trial with 106 women showed that a six-session behaviour programme helped much more than menopause education alone. A 2024 review of eight randomised controlled trials also found steady improvements in sleep quality and in how bad insomnia was for these women.
In this article, you will read about why menopause can change your sleep at night. It will cover why some people wake up at night again and again. You will also learn what research says about ways to change habits for better sleep. This article will also tell you how a sleep coach can help with these changes.
You don’t have to figure this out alone, there’s a proven way to reset your sleep with me. Book a free 20-minute consultation and we’ll explore which approach may be the best fit for you.
Why Can Menopause Change Your Sleep?
Menopause can be different for each woman. Not all women feel the same changes or signs during this time.
Some women do not feel much difference in their sleep at night. But there are others who start to wake up many times. They might also have trouble falling asleep. Some even wake up much earlier than they want to.
One reason for this is the physical change that happens during menopause. In this time, your body may have changes in reproductive hormones. You might feel hot flushes and night sweats. These can disturb your sleep at night.
Think about going to sleep feeling good. Then, you wake up because your body feels very hot all of a sudden.
You remove the duvet.
You wait for your body to cool.
Then you notice that you are fully awake.
The physical feeling may have lasted just a few minutes. But going back to sleep after that can take more time.
Research reviews say that sleep difficulties during menopause can happen for many reasons. These include things like hot flashes, mood changes and factors in your environment or habits.
This difference is important because it shows that menopausal women experience going through menopause does not cause just one kind of sleep issue.
Instead, it can change the way things are when you sleep.
A woman who used to have no trouble sleeping might start to wake up many times at night. After a few weeks, she may feel more awake at night. She could notice every feeling in her body and not be able to rest as she did before.
That can create a second layer to the problem related to estrogen levels.
It can be easy to think that night sweats are the reason for everything.
Sometimes they clearly contribute.
But, research shows you do not always have to get rid of every hot flush to sleep better.
The 2016 JAMA Internal Medicine trial is worth talking about here. In this study, researchers looked at 106 women who were between 40 and 65 years old. All women were either perimenopausal or postmenopausal. Each woman had moderate trouble sleeping and got at least two hot flashes every day. The researchers put these women into two groups at random. One group took part in a six-session program that focused on changing behavior. The other group got menopause education.
The group that got the behavior treatment saw a bigger drop in how bad their insomnia was.
After eight weeks, the group’s average Insomnia Severity Index score dropped by 9.9 points. In the menopause education group, the drop was 4.7 points. This gap stayed important at 24 weeks.
There was another important finding.
The two groups had about the same number of hot flashes. There was not much difference in how often they happened.
Still, the group that worked on behaviour changes said they had fewer problems from those symptoms. They also had better sleep and felt more rested.
This tells us something useful.
You cannot always control if a hot flush happens at 3:00 a.m. But you can change what you do after you wake up.
This could mean you stop checking the clock so much at night. You may need to change how you feel when you lay there awake. It can help to look at the habits you have made during hard nights and try to fix them.
How a Few Difficult Nights Can Become a Repeating Pattern
A hard night of sleep does not always mean that you have a sleep problem for a long time. Sometimes, you just have a bad night. It does not have to be an issue that goes on. If you feel tired after one night, it does not mean you will feel that way all the time.
Everyone experiences occasional poor nights.
It can get hard when you start to think that the next night will be hard too.
Think about how you feel when you wake up at 3:00 in the morning for several days straight.
The first night, you simply notice it.
The second night, you become concerned.
By the fifth night, you will start to think about it before you even go to sleep.
You may start checking the clock.
You may go to bed earlier because you want to have more time to sleep.
You can stay in bed longer in the morning to get back some of the sleep you missed.
You might stop your evening plans because you feel you will be too tired.
Your mind starts to think more about sleep. You feel the need for rest grow as time goes on. All you want now is to get some sleep.
This can create a cycle:
Awakening → feel worry → be alert → stay awake for a longer time → feel more concern the next night
The cycle does not mean that the first physical signs were made up or just in the mind.
It means that several factors can interact.
The 2022 review by Carmona and colleagues looked at how well different ways work for sleep problems in women during menopause. They studied cognitive-behavioural, behavioural, and mindfulness-based methods. The authors said that CBT-I has strong proof that it can help people sleep better. Mindfulness and relaxation ideas also look good, but we do not know for sure how helpful they are over a long time.
Knowing the cycle can help you stop trying to find just one cause.
Why Spending More Time in Bed May Not Always Help
When you feel very tired, it seems like a good idea to stay in bed more.
If you usually sleep for six hours, you might choose to stay in bed for nine hours.
You can go to bed at 9:30 p.m. instead of 11:00 p.m.
You can stay in bed until 8:00 a.m. because you feel that you need time to get better.
But just because you spend more time in bed, it does not mean you get more sleep.
If you often stay awake for a long time in your bed, you may begin to link your bed with not sleeping. You might feel upset, or let your mind wander with many thoughts.
This is one reason why structured sleep programmes look at how much time people spend in bed and how much they really sleep.
The JAMA study set sleep times based on what people said about their sleep. At first, the sleep window was the same as the average time people reported sleeping. Everyone had at least 5.5 hours in bed. The researchers gave more time in bed when diary notes showed people had at least 85% sleep efficiency.
This is not the same as just telling someone to go to bed at a later time.
The way we did this was to keep checking things often. We made changes when we needed to.
This also shows an important point for people who look for insomnia menopause support in the UK.
Structured sleep scheduling is a set way to help people with their sleep. This is different from basic sleep tips you may see or read about. People who help with this need to be well trained. They should also know what their job lets them do and what it does not.
What Does the Research Say About CBT-I for Menopause?
CBT-I is now one of the top ways to help with long-term trouble sleeping. Many people have studied how this way works.
It brings together several parts and does not just use one way to do something.
Depending on the programme, these can include setting a sleep schedule, learning how to control what keeps you awake, understanding more about sleep, working on the ideas you have about sleep, relaxing, and doing practice tasks at home.
The 2024 scoping review by Ntikoudi and the team looked at randomised controlled trials that included menopausal women. They found 459 records to start with. In the end, they picked eight studies that fit what they wanted to look at. The studies used a few ways to reach people, such as face-to-face meetings, talking on the phone and online programmes.
The review showed there be steady changes in sleep quality. It also found that insomnia was not as bad after doing this.
The authors did find some limits in the research. A lot of the people who took part were white and had a lot of education. So, there needs to be more studies that include different groups of people.
This is a good way to look at scientific evidence and understand it in the right way.
The findings are encouraging.
They do not mean that all women will react in the same way.
They also do not mean that every programme called “CBT-I” will have the same quality or setup.
When you pick support, it is good to ask about the person’s training. You should also find out what the programme covers. This can help you know if their help is right for you.
What Happened in the Six-Session JAMA Programme?
The JAMA trial gives good information. The researchers gave clear details about what took place in the six sessions.
The programme took place over eight weeks.
Participants kept electronic sleep diaries. They also talked with intervention coaches over the phone at set times. In these sessions, they discussed how sleep changes during menopause. The coaches shared ways to help with sleep, talked about sleep scheduling, and how to control things in the bedroom that affect sleep. They also helped change unhelpful thoughts about sleep, deal with worry in a good way, and plan for ways to keep up these new sleep habits.
The programme was not just about sleep hygiene. There was much more to it than that.
This distinction is important.
Sleep hygiene is about the way you sleep and the things around you. It looks at what you do before bed and where you sleep. These things can help you get better rest.
For example, you might hear people talk about caffeine, exercise, bedroom temperature, or what you do in the evening.
Those habits can be useful.
But the JAMA study looked at a wider group behaviour program.
People kept track of their sleep. They looked at how they were doing. They made changes to their plan when needed.
The researchers said there were big improvements in how well people sleep.
At eight weeks, people in the behavioural group had a 12.1 point rise in sleep efficiency. At the same time, those in the menopause education group saw a 5.1 point rise.
The people in the study said they went to sleep faster. They also did not wake up as much after they first fell asleep.
This is why it is good to use a science-based approach that does more than give a simple list of tips.
The question is not just, “What should I do before bed?”
It is also, “What is going on through the whole night, and what could be keeping this pattern going?”
Why Your Thoughts at 3 a.m. Can Matter
Imagine you wake up in the middle of the night. Right away, you start to think:
“I have to get back to sleep.”
Then:
“I only have four hours left.”
Then:
“If I do not sleep soon, tomorrow will be awful.”
These thoughts are understandable.
When you feel really tired, you just want the problem to end.
But when you try hard to force sleep, it can take even more mental effort.
You may start monitoring yourself.
Am I sleepy yet?
How long have I been awake?
Is my heart beating too fast?
Why am I still awake?
That kind of attention can make the night feel like a task you have to finish.
Behavioural sleep programmes often work to change how people feel and think about sleep. They look at beliefs and ideas you have about sleep. The aim is to help you feel better and sleep well.
The JAMA programme used thinking methods that help to lower stress. It also worked to change wrong beliefs about what happens if you do not get enough sleep.
This does not mean you should tell yourself that feeling tired is good.
It means developing a more balanced response.
You do not need to see every time you wake up as a crisis. You can learn to handle these moments with less stress and find it easier to get back to sleep.
This can help a lot during menopause. At that time, you may not have much control over the thing that started the problem in your body, which can disrupt sleep when hot flushes occur.
You cannot always stop a hot flush.
But you can work on what happens next.
Mindfulness and Relaxation May Also Have a Role
Mindfulness gets a lot of focus in studies about trouble sleeping that comes with menopause.
The review done by Carmona and the team says that mindfulness meditation and relaxation methods look helpful. But, the researchers also said that there is not a lot of proof yet about how these work over the long term.
That distinction is important.
You should not say that mindfulness will always help you fall asleep. It is not a promise or a sure thing.
Instead, it can help you change how you feel about thoughts, what you feel, and your emotions.
For example, you may wake up and feel hot right away. You might start to think:
“Not again.”
You might feel upset and begin to worry about what will happen tomorrow.
A mindfulness approach can help you see how you feel and what you think. You notice these things, but you do not get pulled in right away.
You might notice the warmth.
You might notice frustration.
You may think that you will feel tired by tomorrow.
The goal is not to make these experiences go away.
It is to reduce the struggle with them.
This is important during menopause. Some changes in your body happen, and you may not be able to control all of them right away.
You may not be able to stop every time you wake up, but you can choose how you feel about it.
That is one reason why mindfulness can work well as a part of a bigger plan that looks at how people act.
Why Personalisation Matters During Menopause
There is no single menopause sleep pattern.
One woman might mostly have trouble with night sweats. This can make it hard for her body to keep its temperature normal.
Another person may go to sleep fast but wake up at 4:00 a.m.
Some people may stay awake for a long time before they fall asleep.
Someone else might sleep pretty well but still wake up a few times during the night. The next day, they feel tired and not fresh.
The same advice may not be right for all of them.
A sleep coach should start by learning about the person’s sleep pattern.
This may include looking at:
- Bedtime and waking up time are important. A consistent sleep schedule helps.
- Notice how often you wake up.
- Pay attention to naps, caffeine, and alcohol intake.
- Make exercise a part of your day.
- Try to get daytime light exposure.
- Your evening habits can affect how well you sleep.
- Think about your thoughts regarding sleep.
- The time you stay awake in the night can matter.
- Watch your alcohol intake.
The point here is not to make a huge list of things to check.
It is to identify which factors deserve attention.
The 2024 scoping review showed that there was a lot of difference in the eight randomised trials. For example, these trials did not all have the same programme length. The number of sessions and the way they were given also changed from one to another.
That variation reinforces an important point.
There is no need for all women to do the same program.
A good way is to have a clear plan. But it is also important to let the person’s own story help lead the talk.
What Should a Sleep Coach Do?
A sleep coach can help you with the way you act when it comes to your sleep.
This can help you with your sleep diary. You may get help to find patterns. You can also talk about your daily habits. You and someone can think together about sleep and how you feel about it. You can try some relaxing or mindfulness methods too.
A coach can help you stay on track as you make changes. The coach will be there for you and check in with you often. This may help you feel good about your work and keep you moving toward your goals.
For example, you can say you will try a change for one week.
At the next session, you can review what happened.
Perhaps it helped.
Perhaps it did not.
Perhaps it worked on weekdays but not weekends.
Perhaps another factor became more noticeable.
This creates a learning process.
You are not simply being handed a list of rules.
You are learning more about your own pattern.
However, there are important boundaries.
A sleep coach should not say they can take the place of good healthcare.
Menopause brings changes to the body. There are some signs that need you to get advice from a GP or another well-trained healthcare professional.
A coach should not tell you to start, stop, or change any medication or hormone therapy.
If your symptoms feel like more than what the coach can handle, you should get medical advice from a health professional.
A good coach knows when it is right to help someone with their behaviour. They also know when it is time to ask another professional for help.
What Does the Research Say About Long-Term Improvement?
One of the most interesting things from the JAMA study was that the good changes did not go away right after the sessions. This will help people who have some common cognitive difficulties.
At 24 weeks, people in the behavioral group showed much better improvements on the Insomnia Severity Index and Pittsburgh Sleep Quality Index, especially concerning insomnia disorder. According to the National Institutes of Health, these scores were higher compared to the menopause education group. This means the behavioral group had better sleep quality.
The number of people in the group with no insomnia stayed higher.
At eight weeks, 70% of people in the behavioural group showed scores in the no-insomnia range. At the same time, only 24% of the menopause education group got scores that showed no insomnia.
At 24 weeks, the figures were 84% and 43%.
These are notable results.
But, this does not mean that 84% of women who get sleep coaching will all get the same results.
The study used a set list of rules for who could take part. It looked at how well a planned CBT-I program works.
The people in the group also had a lot of hot flashes. They also had trouble sleeping most nights.
The results here show us what took place with the people in that research group.
They do not say for sure what will happen to every woman who looks for insomnia menopause help.
Still, these findings give us a good reason to think about using behavioural methods when sleep difficulties from menopause last for a long time.
Why Sleep Hygiene Alone May Not Be Enough
You may already know the standard advice.
Avoid caffeine late in the day.
Keep your bedroom cool.
Reduce screen use before bed.
Engage in regular exercise regularly.
Keep a consistent schedule.
These suggestions can be sensible.
But if you have tried those things before and you still stay awake for a long time, reading the same list again may not be what you need. It might not get to the real problem.
The JAMA study demonstrates this clearly.
Both groups got some educational information. But the behavioural group also got extra help. This included things like sleep scheduling, ways to control your habits, ways to help your thinking, doing homework, and working on problems.
The behavioural group had much better improvements.
This does not mean sleep hygiene has no value.
This means that sleep hygiene is just one piece of a bigger set of things people can do to help with behavior.
If you lie awake for an hour every night, maybe the better thing to ask is not if your bedroom is dark enough.
It may be what happens during that hour.
Are you watching the clock?
Are you worrying?
Are you staying in bed while frustrated?
Are you going to bed early because you worry that you will feel tired the next day?
Are you in bed for longer than you should be?
These questions can lead to more useful changes.
Can deadly insomnia be part of menopause?
Deadly insomnia is not directly caused by menopause, but hormonal changes can exacerbate sleep disturbances. Many women experiencing insomnia during menopause may face heightened anxiety, night sweats, or mood fluctuations. Addressing these symptoms can significantly improve sleep quality for those dealing with insomnia related to menopause in the UK.
How to Find the Right Support for Insomnia Menopause UK
If you search for insomnia menopause, you will see there are many kinds of services out there.
Some focus on menopause education.
Some focus on nutrition and lifestyle.
Some provide general sleep advice.
Some people get special training in ways to help with sleep problems that use behaviour change.
The title “sleep coach” does not always make it clear what a person is trained to do.
So ask questions before choosing a programme.
What training have you completed?
What approach do you use?
How do you personalise the programme?
Do you use sleep diaries?
How many sessions are included?
What happens between sessions?
If someone tells you that they use CBT-I, ask them what kind of training they have finished in CBT-I.
This is very important if the program has rules for sleep or includes other steps that need you to know certain things.
You should also be cautious about promises.
Nobody can truly say you will sleep perfectly every night.
A coach who follows science should be able to say that people do not always improve at the same pace. Changes take time and can be different for each person. A good coach understands this and shares it with others.
They need to be able to tell you why they think their way of doing things works. They should say this in a way that is easy for you to understand.
So What is menopause insomnia in a nutshell?
Menopause insomnia happens when women have sleep problems during menopause. This is mostly because of hormonal changes, including fluctuations in hormone levels like progesterone. Women may find it hard to fall asleep. There can also be times when they wake up often or feel restless at night, which can affect their mental health. It is important to know about this condition. This can help you find good ways to improve sleep quality and feel better overall during this time in life. Sleep disturbances are common, but help is available.
When Should You Speak With a Healthcare Professional?
Sleep difficulties can happen for many reasons during menopause.
Sometimes behavioural factors play a major role.
Sometimes physical symptoms are more important.
Sometimes several factors occur together.
If you have very bad symptoms that do not go away, or if they happen a lot during the day, talk to a healthcare professional. Talk to your doctor if you snore loudly, stop breathing when you sleep, move in strange ways during sleep, or feel worried about other problems. A healthcare professional can help you know what steps to take next.
Do not think that every problem you have at night is because of menopause.
This is important because the research often does not include people who have other conditions that can affect sleep. For example, the JAMA study did not include women who had a main sleep problem, a major illness that made sleep hard, and some other reasons.
That means these findings from the study might not apply to all women who have poor sleep.
A sleep coach should understand this boundary.
They can help you with the things they know well from their training. They will also tell you to get the right healthcare advice if you need it.
This is not about picking one thing, like medical care, or another, like coaching.
It is about making sure you get the right kind of help for the right problem.
What Can You Take From the Science?
The work on insomnia menopause gives us a lot of good things to learn.
Menopause can cause sleep difficulties. This is real, and many people go through it.
Second, hot flushes and night sweats can play a part, but they do not explain the whole pattern.
Third, cognitive behavioural therapy can play an important part when people have several nights where their sleep is broken.
Fourth, plans that help change the way you act have more proof that they work than just giving people basic facts about sleep.
CBT-I has been tested with menopausal women experiencing different menopausal symptoms. The results show that this way helps a lot. Many trials have found good improvements.
Mindfulness and relaxation can help support people. But there needs to be more research to know how they work over a long time.
Finally, more research is still needed.
The 2024 scoping review looked at eight randomised trials. But it showed that many of the study groups did not have much diversity.
The evidence looks good, but it is not perfect.
That is just the way good science should be shared.
You do not need exaggerated promises.
You need to know what the researchers really found.
Key Takeaways
If you notice your sleep is different during perimenopause or after menopause, you might start to think you just have to accept it.
The evidence suggests otherwise.
Hormonal changes can lead to hot flushes and night sweats. These things can break up your sleep at night. The way you sleep can also start to change with your habits, how you feel, what you expect, and how much time you stay awake in bed.
That is why you do not have to get rid of every hot flush to improve your nights. There are other ways you can feel better at night.
The 2016 study showed that a six-session telephone CBT-I program helped people more than menopause education. The benefits were still there 24 weeks after the program ended.
The 2024 review looked at eight randomised controlled trials. It found that there are steady gains in sleep quality and insomnia severity for menopausal women who get CBT-I. The review also noted that mindfulness and relaxation methods can give some extra help.
The message here is not to say that menopause is the stage of life problem. It is also not to say that people’s behavior is the problem.
Many things can work together, and some of these things can be changed.
If you need help in the UK with sleep apnoea or obstructive sleep apnoea, it is good to see people who are trained for this. Try to get help from experts who know what it is like to go through the menopause and also understand how people sleep and why they may have trouble.
A good sleep coach will not say you will have perfect sleep every night. A good sleep coach can help you feel better and have better sleep, but no one can make sure you will never wake up at night. A coach can show you ways to make your sleep good, but bad nights can still happen sometimes.
They should help you see your pattern. They will show you how to make changes that you can do in real life. This can help you feel more sure about how you handle tough nights.
You should not have to sit up at 3:00 a.m. and feel worried about what tomorrow will be like. You do not need to spend your life feeling tired all the time. There is a better way for you.
There is good proof that you can learn to sleep better, even if menopause has changed how you rest at night.
If you feel like this article is talking to you, know that you do not have to face sleep struggle on your own. You can have a free 20-minute chat with me. In this call, we will talk about what has been going on with you these days and see if working together is the right choice for you.
References
McCurry, S. M., Guthrie, K. A., Morin, C. M., et al. (2016). Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial. JAMA Internal Medicine, 176(7), 913-920. DOI: 10.1001/jamainternmed.2016.1795. Read the JAMA Internal Medicine study
Ntikoudi, A., Owens, D. A., Spyrou, A., Evangelou, E., & Vlachou, E. (2024). The Effectiveness of Cognitive Behavioral Therapy on Insomnia Severity Among Menopausal Women: A Scoping Review. Life, 14(11), 1405. DOI: 10.3390/life14111405.Read the Life scoping review
Carmona, N. E., Millett, G. E., Green, S. M., & Carney, C. E. (2023). Cognitive-behavioral, behavioural and mindfulness-based therapies for insomnia in menopause. Behavioral Sleep Medicine, 21(4), 488-499. DOI: 10.1080/15402002.2022.2109640.Read the Behavioral Sleep Medicine review
CBT-I Protocols Across the Female Lifespan. In Cognitive-Behavioural Therapy for Insomnia Across the Life Span. Wiley. DOI: 10.1002/9781119891192.ch9.Read the Wiley chapter
Wilkins, V. M. (2025). Cognitive Behavioral Therapy for Menopause Symptoms. Current Obstetrics and Gynecology Reports.Read the Springer article
No More Sleepless Nights in Perimenopause: An Open-Label, Randomized, Parallel-Group, Active Controlled Intervention Study in Perimenopausal Women With Vasomotor Symptoms and Insomnia: Study Protocol. Trials (2025). DOI: 10.1186/s13063-025-09366-9.Read the Trials study protocol
The Korean Journal of Internal Medicine / Korean medical literature source supplied for this article, covering menopause and sleep-related research.Read the Korean medical literature article
The information shared above is only for your information regarding the quality of your sleep. The things you read in this post are not medical advice. You should not use any part of this post for your health without first talking to a doctor.