Sleep disturbances in midlife women are common, under‑recognized, and highly treatable. Sleep problems in this phase include short, fragmented, or poor‑quality sleep, as well as insomnia symptoms like difficulty falling asleep, staying asleep, or waking too early and not being able to return to sleep.


"An estimated 40% to 69% of midlife women report sleep disturbances across the menopause transition, with increased wake‑after‑sleep onset (WASO) as a hallmark feature often linked to vasomotor symptoms such as hot flashes and night sweats."


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Sleep issues in this life stage rarely occur in isolation. They frequently coincide with hot flashes/night sweats (vasomotor symptoms), mood changes (e.g. depression and anxiety), trauma history, substance use (including alcohol and cannabis), and major psychosocial stressors related to work, caregiving, and relationships. Urinary symptoms can also increase waking at night and strategies such as reducing sodium intake in the day and reducing water or liquid intake the 3 hours prior to bedtime can make a difference. If urinary symptoms persist it is also important to rule out other conditions such as genitourinary syndrome of menopause (GSM) or urinary tract infections (UTIs).


Chronic sleep disturbance is associated with higher ASCVD (cardiovascular and stroke risk), impaired cognition/brain fog and alertness, poorer mental health, reduced quality of life, and even increased risk of unemployment and lost productivity in midlife women.


The good news is that effective treatments do exist.


Nonpharmacologic strategies for Insomnia


  1. Cognitive‑behavioural therapy for insomnia (CBT‑I) are first‑line and also app‑based CBT‑I tools. CBT-I are as effective as sleep medications for insomnia, including in midlife women and even when vasomotor symptoms are present.
  2. Brief behavioural treatment for insomnia (BBTI)
  3. Mindfulness‑based therapies


Pharmacologic options for Insomnia


  1. Targeted hormone replacement therapy, and emerging agents for vasomotor‑linked sleep disruption may also play a role for selected women.

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If you are experiencing persistent sleep problems in midlife, talk with your primary care provider about a thorough sleep assessment and evidence‑based behavioural treatments to protect your long‑term health and daily functioning.


To your best health,


Dr. Amy J. Tung, ND

Naturopathic Doctor & Menopause Society Certified Practitioner

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References:


Jakubowski K. Sleep Disturbances in Midlife Women: Prevalence, Correlates, and Treatments. Practice Pearl, The Menopause Society, 2026.


​Lancel M, Faulhaber J, Holsboer F, Rupprecht R. Progesterone induces changes in sleep comparable to those of agonistic GABAA receptor modulators. Am J Physiol. 1996 Oct;271(4 Pt 1):E763-72. doi: 10.1152/ajpendo.1996.271.4.E763. PMID: 8897866.


Maki PM, Panay N, Simon JA. Sleep disturbance associated with the menopause. Menopause. 2024;31:724‑733.


Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018;10:73‑95.