Perimenopause and Insomnia: What’s Really Going On with Your Sleep

Sleep is often one of the first things to shift during perimenopause. Changes often begin with symptoms like insomnia — difficulty falling or staying asleep, as well as stress, anxiety, and depression. Many of these signs or symptoms may occur months to years before irregular periods, the first hot flash, or the onset of brain fog.

So why does sleep disruption so often arrive first? Dr. Jennifer Wagner, our chief health and performance officer, breaks down the delicate hormonal dance happening behind the scenes — and what happens when that rhythm starts to change.

Why are Sleep Disruptions Often the First Symptom of Perimenopause?

Let’s look at the physiology that’s going on behind the scenes during this time. Throughout a menstrual cycle, estrogen, progesterone, and other key hormones play a sophisticated symphony in a specific order. As a woman enters perimenopause, this symphony often gets disrupted, sometimes skipping ovulation altogether.

When the ovaries do not develop a follicle and release an egg, it is termed an anovulatory cycle. This is important because ovulation triggers the creation of the corpus luteum — the structure that produces progesterone. And progesterone is the calming hormone: It soothes anxious feelings and supports sleep. Without it, nights can feel restless, and days, more on edge.

As women progress through perimenopause, hot flashes, night sweats, increased restless leg syndrome, and even rising incidences of sleep apnea — difficulty breathing while asleep — can continue to disrupt your nights. These come from fluctuating and declining levels of estrogen. Estrogen plays an important role in almost every organ in the body. Estrogen regulates temperature in the brain and helps keep muscles — including those in the throat — toned. When levels dip, you might experience everything from overheating at night to more disrupted breathing.

Tools That Can Help Preserve and Improve Sleep

While hormone shifts are part of the process, there are ways to support deeper, more restorative sleep. A few sleep rituals we recommend include:

1. Consistent sleep and wake times

2. Cool, dark, quiet sleep environments

3. Avoidance or limitation of caffeine and/or alcohol

4. Avoidance of a large meal 2-3 hours before bed

5. Creating a “wind down” routine

6. A warm bath or shower prior to bed (helps bring blood to the surface and allows the body to cool faster once in a cool environment)

7. Keeping the bed reserved for sleep and intimacy only

For more, explore our expert approved sleep tips for a better bedtime.

Hormone and Medication Options for Better Sleep

Progesterone therapy has been shown to ease anxiety, irritability, and insomnia. Estrogen therapy is the preferred therapy for hot flashes and night sweats (it does need to be combined with progesterone if you have a uterus). Specific anti-depressants and anti-anxiety medications have also been approved specifically to help with sleep disorders.

How Canyon Ranch Can Help You Sleep Better in Perimenopause 

At Canyon Ranch, we take sleep seriously. Our physicians and mental health therapists are trained to diagnose and treat sleep disorders, and we have tools and services designed to investigate your sleep during your stay. In addition to quiet, comfortable rooms outfitted with white noise machines and a pillow bar, we do our absolute best to help you get the sleep you need and deserve. 

And for a deeper dive on the link between sleep and perimenopause, our M/Power retreat offers a comprehensive, holistic approach to menopause — combining science-backed testing, expert insights, and personalized tools to help you navigate this chapter with clarity and vitality. 

Because better nights mean brighter days.