Sleep in midlife often feels unpredictable. Some nights pass quickly, while others involve hours of staring at the ceiling. Hormonal shifts, rising stress levels, and changes in daily routines all contribute to why restful sleep becomes harder to achieve in the 40s, 50s, and beyond.
Recent research provides a clearer picture of what happens during this stage. Experts such as Lauryn Higgins, Helen Carefoot, Dr. Neha Pathak, and Dr. Amy Divaraniya have studied how fluctuating hormones, lifestyle habits, and age-related changes influence sleep during perimenopause and menopause. Their findings reveal why sleep becomes lighter, why nighttime awakenings increase, and which practical strategies can support better rest.
By understanding these factors, women can take steps to improve their sleep patterns and overall wellbeing.
Why Sleep Becomes Challenging in Midlife
Freepik | Insomnia in women commonly rises with menopause due to hormone and clock changes.
Women often notice a rise in insomnia symptoms during menopause due to hormonal shifts, mood changes, and changes in the body’s internal clock.
Dr. Neha Pathak, chief physician editor of health and lifestyle medicine for WebMD, explains that “sleep is essential to health. During sleep, the brain and body reset, allowing the body to recover during this restful time.” She notes that declining estrogen during menopause makes the brain more reactive to temperature changes, and as a result, hot flashes and night sweats often interrupt rest.
Key reasons sleep feels disrupted during this stage include:
1. Hormonal Shifts
- Estrogen plays a role in body-temperature regulation and steady sleep cycles. As it fluctuates, sudden heat surges and nighttime sweating become common.
- Progesterone promotes calmness and relaxation. Declines in progesterone can contribute to anxiety and trouble falling asleep.
- Cortisol, the body’s stress hormone, may increase during menopause, making nighttime wind-down harder.
2. Temperature Spikes and Vasomotor Symptoms
Hot flashes frequently trigger abrupt awakenings, and the lingering warmth can make it hard to fall back asleep.
3. Anxiety and Mood Changes
Hormonal changes may heighten anxiety or low mood, both of which are strongly associated with insomnia. Worrying about not sleeping can create a cycle known as sleep anxiety.
4. Sleep Apnea and Other Disorders
Risk of sleep apnea rises after menopause, leading to fragmented sleep. Restless legs syndrome and age-related joint pain also interfere with uninterrupted rest.
5. Lifestyle and Environmental Pressures
Daily stress from work, caregiving, or major life transitions often leads to racing thoughts at night. Irregular sleep routines, caffeine intake, and excessive screen time contribute as well.
6. Changes in Melatonin
Melatonin naturally declines with age, creating lighter sleep and earlier wake times, even when fatigue lingers.
What New Research Reveals
Recent studies point to meaningful strategies that support better rest by addressing hormonal patterns, gut health, sleep behaviors, and environmental triggers.
Dr. Amy Divaraniya, founder and CEO of Oova, highlights the importance of understanding hormone patterns. “We saw a decline in estrogen (E3G) levels in women reporting fewer hours of sleep. Tracking hormones alongside sleep helps women see how perimenopause affects their rest and adjust accordingly,” she explains.
Several scientific findings stand out:
1. Gut Health and Diet
Freepik | balanced diet that supports the gut can stabilize sleep and improve mood in perimenopausal women.
Growing evidence suggests that a balanced gut supports stable sleep. Case reports show that reducing alcohol and processed foods while increasing greens, nuts, oily fish, and foods like chicken and bananas can boost mood and sleep quality in perimenopausal women. Probiotics may add additional support.
2. Supplements and Nutrients
Melatonin may help with short-term sleep issues such as jet lag, though data is limited for chronic insomnia.
Magnesium supports nerve and muscle relaxation by interacting with GABA, a calming neurotransmitter. Research is ongoing, so checking with a healthcare provider is recommended before starting supplements.
3. Sleep Patterns and Heart Health
Long-term data links persistent insomnia and short sleep duration during midlife to a higher risk of cardiovascular events, including strokes and heart attacks. These findings highlight the value of addressing sleep disruptions early.
4. Light Exposure and Cardiovascular Impact
A 2025 study published in JAMA Network Open analyzed nearly 88,900 adults over 40 using wrist sensors to measure nighttime light exposure. Adults exposed to higher levels of bright light at night showed increased risks of coronary artery disease, stroke, and heart failure. These effects were more pronounced in women. The study strengthens guidance on dimming lights at night to protect both sleep quality and long-term heart health.
5. Technological Tools
Sleep devices that use real-time acoustic stimulation show promise. A large study reported that one such device shortened sleep-onset time by roughly 24 minutes, offering a non-medication option for those struggling to fall asleep.
Divaraniya notes that individual responses vary, so new approaches should be discussed with a healthcare professional.
Tips to Improve Sleep During Midlife
Freepik | Minimize blue light exposure by turning off screens an hour before sleep.
The good news is that several expert-backed habits can help restore a consistent rhythm. Dr. Pathak recommends approaches that support both body and mind:
1. Keep a steady sleep schedule. Going to bed and waking up at the same time every day strengthens the body’s internal clock. Adults generally benefit from seven to nine hours of sleep.
2. Skip daytime naps to prevent nighttime disruptions.
3. Limit caffeine, alcohol, and heavier meals for at least two hours before bed.
4. Stay active, but avoid intense exercise close to bedtime.
5. Reduce bright light exposure at night, and try to get natural morning light within the first hour of waking.
6. Avoid screens for at least an hour before bed to minimize blue light.
7. Shape the bedroom into a calm environment, keeping it cool and quiet.
8. Choose breathable sleepwear, such as loose cotton clothing, to help reduce overheating.
These steps help regulate internal rhythms and reduce common triggers for nighttime awakenings.
Midlife often brings noticeable changes in sleep, yet research continues to offer clarity and meaningful solutions. By understanding hormonal patterns, adjusting daily habits, and paying attention to environmental influences, restful sleep becomes more achievable.
A thoughtful approach to lifestyle factors and personalized strategies can help restore steadier nights during this stage of life.
