Why Am I Waking Up at 3 A.M. During Perimenopause?

By Trevor Davis, Chief People Officer at Nest Bedding. Trevor is a Nest Bedding employee and discusses products sold by the company.

You fall asleep just fine.

Then you look at the clock.

3:07 a.m.

You're awake. Maybe you're hot. Maybe you're sweaty. Maybe you need to use the bathroom. Or maybe you're simply lying there wondering why your brain has suddenly decided that right now would be a great time to think about everything happening in your life.

If you're going through perimenopause, you're definitely not alone.

I've watched some of this happen in my own home. My wife spent most of our marriage being the cold one. I could be perfectly comfortable and she would be looking for another blanket.

Now that she's in her 50s, things have changed.

She's suddenly the hot one. And there are nights when staying comfortable and staying asleep simply isn't as easy as it used to be.

So what's happening?

Why Does Perimenopause Affect Sleep?

Perimenopause is the transition leading up to menopause. During this time, hormone levels fluctuate and eventually decline, and sleep can become one of the casualties.

The Office on Women's Health notes that many women during perimenopause and menopause have difficulty sleeping through the night. Changes involving estrogen and progesterone can be part of the picture, while hot flashes, night sweats and urinary symptoms can further interrupt sleep.

The National Institute on Aging also lists trouble sleeping and hot flashes among common changes around menopause.

But what about 3 a.m.?

Is There Really Something Special About 3 A.M.?

Probably not.

There isn't good evidence showing that perimenopause hormones suddenly activate at 3 a.m.

What is real is waking during the middle or latter part of the night, and once you're awake, getting back to sleep can be difficult.

That can happen for several reasons.

1. Night Sweats Can Interrupt Sleep

A hot flash that happens while you're sleeping is often experienced as a night sweat.

You may suddenly become hot, start sweating, throw off the covers and then become cold afterward.

That's not exactly a recipe for uninterrupted sleep.

Hot flashes are one of the most common symptoms associated with the menopausal transition, and they can continue for years for some women.

Interestingly, researchers are still learning exactly how sleep and hot flashes interact. The National Institute on Aging notes that nighttime hot flashes can disrupt sleep, and sleep problems during this stage can have more than one cause.

2. Your Hormones Are Changing

During the menopausal transition, estrogen and progesterone levels change.

According to the Office on Women's Health, lower hormone levels and symptoms such as hot flashes can contribute to difficulty getting a good night's sleep.

In other words, you may be doing everything you've always done at bedtime, but your body isn't responding exactly the way it used to.

3. Your Brain Decides 3 A.M. Is Thinking Time

This is the part almost everyone who has experienced middle-of-the-night insomnia understands.

You wake up for one reason, and then your brain takes over.

Work. Kids. Parents. Finances. Tomorrow's schedule. Something you said three days ago.

One thought becomes another, and suddenly you've been awake for 45 minutes.

Midlife can already be a busy season. Add changing hormones and interrupted sleep, and falling back asleep can become even harder.

4. You May Be Waking Up to Use the Bathroom

Menopause can also bring changes in urinary and bladder function.

Needing to urinate can wake you during the night, after which getting back to sleep may be the bigger challenge.

That means the original reason you woke up might have nothing to do with temperature, but once you're awake, other sleep problems can take over.

Your Bedroom Can't Fix Perimenopause, But It Can Help With Comfort

This is where I think we need to be careful.

At Nest Bedding, we're passionate about sleep, but a mattress or set of sheets isn't a treatment for perimenopause.

What we can do is help create a sleep environment that isn't working against you.

You can't necessarily control what your hormones decide to do at 3 a.m.

You can control your mattress, sheets, blankets, pillow and bedroom temperature.

For someone suddenly experiencing night sweats or sleeping much hotter than they used to, those choices may make the sleep environment feel more comfortable.

The National Institute on Aging recommends keeping the bedroom at a comfortable temperature and using practical strategies to stay comfortable when hot flashes interfere with sleep.

That idea of layers is particularly practical.

Instead of one giant comforter that leaves you with two choices, hot or freezing, build a bed that can easily adjust throughout the night.

Start With the Sheets

The layer directly against your body is a logical place to start.

Our Nest Bedding Bamboo Sheet Set is designed for a soft, smooth and breathable sleep surface. For someone waking up hot or sweaty, choosing bedding with breathability and moisture management in mind can be a practical part of building a more comfortable bed.

Then use lighter bedding layers that can easily be removed or added during the night.

Don't Forget Your Pillow

If you're flipping your pillow over all night looking for the cool side, take a look at what you're sleeping on.

The Nest Bedding Easy Breather Pillow has adjustable fill, so you can customize the loft and firmness to your preference.

A pillow isn't going to stop a hot flash, but it is another comfort layer worth evaluating.

Think About What's Under You, Too

People often focus entirely on sheets when they think about sleeping hot.

But you're spending seven or eight hours lying directly against your mattress.

Mattress construction can influence airflow and how much heat gets trapped around your body.

For sleepers looking for a more breathable mattress design, the Nest Bedding Owl Natural Latex Hybrid combines natural latex comfort layers with individually wrapped coils and a breathable natural-fiber cover.

And you don't necessarily need to replace your entire mattress.

Look at the whole sleep system: mattress, mattress protector, sheets, pillow, blankets and room temperature.

Sometimes several relatively small changes can create a noticeably more comfortable environment.

The goal isn't to treat perimenopause with bedding.

It's much simpler than that: make your bedroom one less thing your body has to fight against.

A Few Other Things Worth Trying

The National Institute on Aging and Office on Women's Health recommend healthy sleep habits that may help during the menopausal transition:

• Keep a consistent sleep and wake schedule.
• Keep your bedroom cool, comfortable, dark and quiet.
• Exercise regularly, but not too close to bedtime.
• Avoid large meals near bedtime.
• Limit caffeine later in the day.
• Be careful with alcohol. It may make you sleepy initially but can interfere with sleep later in the night.
• Develop a consistent bedtime routine.

And here's one that can be difficult:

Don't turn 3 a.m. into phone time.

If every awakening becomes an opportunity to check email, social media or tomorrow's calendar, you're giving your brain even more reasons to stay awake.

When It Might Be More Than Perimenopause

Don't automatically blame every sleep problem on hormones.

Persistent insomnia deserves attention, and so do symptoms such as loud snoring, gasping or choking during sleep, morning headaches or significant daytime fatigue.

Sleep apnea is particularly important for women approaching and going through menopause. The National Heart, Lung, and Blood Institute notes that women's risk of sleep apnea increases during and after menopause, and symptoms in women may include insomnia, tiredness, morning headaches and frequent waking.

If sleep problems are persistent or significantly affecting your life, talk with your healthcare provider rather than simply accepting poor sleep as part of getting older.

The 3 A.M. Bottom Line

If you've suddenly become a member of the 3 a.m. club, the clock probably isn't the problem.

Perimenopause can bring changing hormones, hot flashes, night sweats, bladder changes and disrupted sleep, all at a stage of life when many women are already juggling careers, relationships, kids, aging parents and a dozen other responsibilities.

You may not be able to control all of those things tonight.

But you can make your bedroom work with you instead of against you.

Cool the room. Choose breathable bedding. Create layers you can easily remove. Pay attention to what's underneath you as well as what's on top of you.

And most importantly, don't assume that constantly waking up exhausted is something you simply have to live with.

Sometimes a more comfortable night starts with a better sleep environment.

And sometimes it starts with a conversation with your doctor.

Either way, 3 a.m. doesn't have to become your new morning.

Frequently Asked Questions

Why do I keep waking up around 3 a.m. during perimenopause?

There isn't evidence that 3 a.m. itself has special significance during perimenopause. Hormonal changes, night sweats, insomnia, stress and urinary symptoms can all contribute to waking during the night.

Can changing estrogen levels cause sleep problems?

Hormonal changes during the menopausal transition can contribute to hot flashes and night sweats, which may disrupt sleep. Other hormonal, medical and life changes can also play a role.

Why can't I fall back asleep after waking during perimenopause?

The initial awakening may come from temperature changes, needing to use the bathroom or another sleep disruption. Once awake, stress and increased alertness can make returning to sleep difficult.

Should I keep my bedroom cooler during perimenopause?

A cool, comfortable bedroom may help people experiencing hot flashes and night sweats feel more comfortable. Federal health guidance recommends keeping the sleep environment at a comfortable temperature.

When should I talk to my doctor about waking during the night?

Talk with your healthcare provider if sleep problems persist, interfere with daily life or are accompanied by symptoms such as gasping, choking, significant snoring, morning headaches or excessive daytime fatigue.

Sources & Further Reading

• Office on Women's Health: Menopause symptoms and relief
• National Institute on Aging: Sleep Problems and Menopause: What Can I Do?
• National Heart, Lung, and Blood Institute: Sleep Apnea and Women