Why Am I Awake at 3 AM in Menopause?
“I’m just awake at 3 a.m.”
One statement from many women. I hear it almost daily.
The data tells us that 40-60% of menopausal women will report sleep disturbance.
Why Do I Keep Waking Up At 3 a.m. in Menopause?
Nighttime awakenings are the most common sleep complaint of the menopausal transition.
There is evidence that higher follicle stimulating hormone (FSH), which naturally increases with menopause, is associated with waking up several times during the night.
Decreasing estradiol (E2), the estrogen that drops significantly in menopause, is associated with trouble falling and staying asleep.
Progesterone, the hormone that rises to support a pregnancy, also decreases in menopause. This hormone acts as a relaxing hormone in the brain because it becomes allopregnenolone which acts on GABA receptors, which have a calming, anxiety-lowering effect.
This is why progesterone in HRT is typically taken before bed.
Studies looking at the sleep architecture of menopause have not found a consistently negative change. Self reports are often used for sleep data, which can be affected by many other factors.
Why Does Sleep Matter?
This is a topic in itself. Particularly in menopause, sleep disturbances impact:
Quality of life
Mood
Long-term health outcomes
Work productivity
Healthcare utilization
Why Is This Worse For Some Women Than Others?
There is a correlation for women with vasomotor symptoms (hot flashes, night sweats) and worse sleep.
Night sweats are an obvious association because it’s causing women to wake up. If you're drenched in sweat, you’re probably going to get up and change. Then it may be difficult to get back to sleep.
Mood is also a factor. Mood and sleep feed each other. Poorer mood or depression can lead to worse sleep, and vice versa. Menopause is a risk factor for depression in itself, so this is a vicious cycle.
Women with a history of:
Depression
Postpartum depression
PMDD
Are at higher risk for depressive symptoms in menopause.
Is It Menopause, Or Could Something Else Be Going On?
While menopause is finally being studied and understood like never before, it's not the only culprit for poor sleep.
Other causes of sleep disruption that need investigated are:
Chronic insomnia
Sleep disordered breathing (sleep apnea)
Restless leg syndrome
Mental health disorders
I’ll also mention urinary frequency. Waking up to urinate once or multiple times a night is disruptive, whether that's because of behavior (late night drinking or caffeine), medication, or urinary conditions, it's worth discussing with a doctor.
What Actually Helps When Menopause Is Waking You Up at 3 a.m.?
Yes, sleep hygiene is important. This is our routine that should honor our circadian rhythm, our natural sleep-wake cycle that impacts the function of our bodies.
Sleep hygiene measures include:
Sleeping and waking at the same time every day (or pretty close)
Avoiding screens before sleep
Avoiding eating and drinking before sleep
Sleeping in a cool, dark room
Struggling to get a good night’s sleep during menopause? You don’t have to navigate this alone. Our Midlife Foundations Guide helps you understand your hormones, sleep patterns, and simple strategies to improve rest and wellness.
In addition, there are some supplements that can be effective, including:
Magnesium glycinate (I use this which is a powder, I actually like the slight citrus taste.)
Melatonin
Hormone replacement therapy can help the underlying cause if sleep disruption is due to hormonal changes of menopause. I frequently hear, "I'm sleeping through the night" and “my sleep is better”, after starting HRT.
Non-hormonal options exist that improve vasomotor symptoms (hot flashes and night sweats) and improve sleep. The most recent is Lynkuet, elinzanetenant.
For chronic insomnia, Cognitive Behavioral Therapy (CBT) is the treatment of choice.
For meditative and soul-care purposes, I support prayer as a mind-body technique to relax the nervous system. The rosary is repetitive to be meditative.
Avoid screens if you're up at this time.
If you need to remember something, write it down! Put a pen and pad of paper next to your bed.
If you’re ready to get personalized support for your menopause-related sleep issues, hormone changes, or overall wellness, we’re here to help. Join the telehealth waitlist today and take the next step toward better sleep and energy.
Resources:
Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.
The author can earn commissions through affiliate links.
Disclaimer: This is not medical advice. This is for educational purposes only. Discuss with your doctor.
Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018 Sep;13(3):443-456. doi: 10.1016/j.jsmc.2018.04.011. PMID: 30098758; PMCID: PMC6092036.