Perimenopause · Sleep
Perimenopause insomnia: why you wake at 3am, and what can help
Lying awake in the small hours is one of the most common things I hear about from women in their 40s. Here's what we know about sleep in perimenopause, what the research says, and how I work with it in Östermalm.
Yes, perimenopause can cause insomnia. Trouble falling asleep or staying asleep is one of the common symptoms of this phase, and night sweats can wake you in the middle of the night [1][2]. Sleep habits, CBT-I and support for night sweats are where most people start, and new, severe or long-lasting sleep problems are worth taking to your vårdcentral (local primary care clinic) or 1177.
If you’re reading this at 3am, you’re far from alone. I’m a US-trained naturopath and acupuncturist in Östermalm, and sleep is one of the things women in perimenopause bring up with me most often.
How sleep changes in perimenopause
Perimenopause can start years before your periods stop for good. One of the first signs is usually a change in your periods, and menopause symptoms often last 7 to 9 years, sometimes longer [1].
Sleep is on that list. The NHS describes it simply: not being able to get to sleep or stay asleep can affect your daily life, and it can leave you irritable, stressed and anxious [1]. Swedish 1177 says the same thing: many people sleep worse during menopause [2].
Insomnia can look like this [3]:
- it takes a long time to fall asleep
- you wake several times during the night
- you lie awake and can’t get back to sleep
- you wake too early in the morning
- you feel tired and irritable during the day
Insomnia that lasts 3 months or more is called long-term insomnia [3].
Why you might wake at 3am
There’s rarely one cause. Often a few things add up.
Night sweats. Hot flashes and sweats often come at night and can disturb your sleep [2]. In a 2025 meta-analysis, women in perimenopause who had hot flashes were more likely to have sleep problems [4]. You can read more in my article on perimenopause night sweats.
Mood and worry. The same review found that depression was linked to sleep problems in perimenopause, and several of the studies also pointed to anxiety [4]. These were observational studies, so they show a link, not what causes what. Many women tell me the 3am wake-up is when the to-do list starts running. More on that in perimenopause anxiety.
Everyday triggers. Stress, alcohol, caffeine, nicotine, noise and an uncomfortable bedroom temperature can all cause insomnia [3]. So can conditions like an overactive thyroid and some medicines [3]. That’s one reason I always ask what else is going on, and what you take.
What the research says
Sleep habits
The NHS suggests these habits for insomnia [3]:
- go to bed and wake up at regular times
- relax for an hour before bed
- keep the bedroom dark and quiet
- avoid alcohol, caffeine and smoking for 6 hours before bed
- avoid screens right before bed
- exercise during the day, but not within 4 hours of bedtime
- avoid naps during the day
None of this is new, I know. But when night sweats are part of the picture, a cool bedroom and a lighter duvet often matter more than they used to.
CBT-I
CBT-I is cognitive behavioral therapy for insomnia. It works on the thoughts and habits that keep you awake, face-to-face or through an online program [3].
A 2025 meta-analysis looked at 11 randomized trials with 973 menopausal women [5]. CBT-I improved sleep quality and lowered insomnia scores, both face-to-face and remotely. The authors note limits, too: results varied between studies, and about half came from the US [5]. Your vårdcentral can tell you what’s available in Sweden.
Acupuncture
I want to be honest about this one. A Cochrane review from 2022 looked at 33 trials of acupuncture for insomnia in general [6]. The authors concluded that the evidence isn’t rigorous enough to support or refute acupuncture for insomnia, and all the trials had a high risk of bias.
A 2025 review focused on perimenopausal insomnia: 12 trials with 994 women, all in China [7]. It found better sleep scores with acupuncture compared with sleep medication or sham acupuncture. Only 4 of the trials reported side effects, so the safety data are limited. Most trials weren’t blinded, publication bias was likely, and the authors call for larger, double-blind studies [7].
So the picture is promising in places and uncertain overall. Many people tell me they feel calm during a session. I see acupuncture as one part of a plan.
How I work with perimenopause insomnia
Your first visit is 60 minutes and costs 3,500 SEK, in person or online, in English or Swedish. I ask what a typical night looks like: when you fall asleep, when you wake, what wakes you, and how you feel the next day. We also talk about your cycle, stress, food, digestion and what you’ve already tried.
It helps to bring a short sleep diary from the last week or two. That gives us something concrete to work with, and you can bring it to your doctor too.
After the visit, you get a written plan. It can include:
- advice on evenings, meals and stress
- support for night sweats
- Chinese and Western herbs
- homeopathy and supplements
- Japanese acupuncture, my main style
If you take sleep medication or other medicines, tell me, and I’ll factor them in when we choose herbs and supplements. Questions about changing a medicine go to your doctor or pharmacist.
I work in parallel with your doctor, whether or not you take HRT. The decision about hormone therapy is one you make with your doctor, and the plan for sleep, food and stress works either way. If you’d like to read more, see perimenopause without HRT and my main page on perimenopause.
If you’d like to start with acupuncture only, a first acupuncture visit is 50 minutes and 1,750 SEK. All options are on the prices page, and you can read how a first visit works.
When to see a doctor
Contact your vårdcentral or call 1177 (Sweden’s healthcare advice line) if:
- you’ve had trouble sleeping for months, or changing your habits hasn’t helped [3]
- poor sleep makes daily life hard to cope with [3]
- you start bleeding again more than a year after your last period (1177 advises a gynecology clinic for this) [2]
- your low mood doesn’t lift
- you have new, severe or unclear symptoms
If you have thoughts of not wanting to live, or in an emergency, call 112.
Not sure where to start? Book a free 15-minute call with me on a Tuesday between 13:00 and 14:00, or send me a message.
Sources
- NHS. Symptoms of menopause. Page last reviewed 19 May 2026. Accessed 2026-11-09. https://www.nhs.uk/conditions/menopause/symptoms/
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- Klimakteriebesvär (in Swedish). Updated 2026-09-17. Accessed 2026-11-09. https://www.1177.se/sjukdomar--besvar/hormoner/klimakteriet/klimakteriebesvar/
- NHS. Insomnia. Page last reviewed 19 March 2024. Accessed 2026-11-09. https://www.nhs.uk/conditions/insomnia/
- Zeng W, Xu J, Yang Y, Lv M, Chu X. Factors influencing sleep disorders in perimenopausal women: a systematic review and meta-analysis. Frontiers in Neurology, 2025. Accessed 2026-11-09. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1460613/full
- Moon H-J, Yu S-N, Hur M-H. Effects of cognitive behavioral therapy on sleep quality and insomnia severity index in women with menopausal insomnia: a systematic review and meta-analysis. Women’s Health Nursing, 2025;31(4):304–319. Accessed 2026-11-09. https://pmc.ncbi.nlm.nih.gov/articles/PMC12835450/
- Cheuk DKL, Yeung W-F, Chung K, Wong V. Acupuncture for insomnia. Cochrane Database of Systematic Reviews, 2022. Accessed 2026-11-09. https://www.cochrane.org/evidence/CD005472
- Yang R, Zhang S, Huang G, et al. Acupuncture for perimenopausal insomnia: a systematic review and meta-analysis. Frontiers in Medicine, 2025. Accessed 2026-11-09. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1673994/full
Common questions
Can perimenopause cause insomnia?
Yes, it can. Sleep problems are listed among the common symptoms of perimenopause and menopause, alongside night sweats and mood changes. Many people sleep worse during this phase, and hot flashes and night sweats at night can wake you up. If trouble sleeping goes on for months or makes daily life hard, talk to your vårdcentral (local primary care clinic) or 1177.
Why do I wake up at 3am in perimenopause?
There isn't one single answer. Night sweats, a racing mind, stress, alcohol in the evening and a warm bedroom can all wake you in the middle of the night, and several often play a part at once. Writing down when you wake and what you notice helps you and your doctor see a pattern. We go through the same notes at a first visit with me.
What is CBT-I, and does it work in menopause?
CBT-I is cognitive behavioral therapy for insomnia, a structured program that works on the thoughts and habits that keep you awake. A 2025 meta-analysis of 11 randomized trials in menopausal women found better sleep quality and lower insomnia scores, both face-to-face and remotely. Ask your vårdcentral or doctor what's available to you.
Does acupuncture help perimenopause insomnia?
The research is mixed. A Cochrane review from 2022 found the evidence too weak to support or rule out acupuncture for insomnia in general. A 2025 review of 12 small trials in perimenopausal women suggests possible benefit, but the authors call for larger, better-blinded studies. For me, acupuncture is one part of a plan, alongside sleep habits and food.
Want to know how I can help?
Book your first visit with me in Östermalm, or start with a free 15-minute call.