Sleep

Why sleep breaks down around menopause, and the approaches with evidence for getting it back.

Overview and common questions

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Sleep: the overview

Trouble sleeping is one of the most common complaints of the menopause years. Some of it is night sweats waking you up. Some of it is classic insomnia: lying awake at 3am with a busy mind even on nights without a flush. Anxiety and a need to pee in the night add to it.

What helps

Treating the sweats often fixes a large part of the problem, which is why HRT can improve sleep for women whose nights are broken by flushes. For insomnia itself, the treatment with the strongest evidence is cognitive behavioural therapy for insomnia (CBT-I). A 2024 review found it improves sleep quality and reduces insomnia severity in menopausal women, with gains lasting months after treatment ended (scoping review in PMC). NICE also recommends menopause-specific CBT for sleep problems (NICE NG23).

What the guides here cover

The articles in this topic look at sweating at night, insomnia, what over-the-counter sleep aids can and cannot do, and how to set up a bedroom that stays cool.

Ines Kovac's view: work out which kind of waking you have first. If you wake hot and damp, treat the sweats. If you wake dry and wide awake, CBT-I is the better first step.

Written by the Unpaused editors. Updated 2026-10-17.

Questions readers ask

Why do I wake at 3am in menopause?

Sweating, a busy mind and needing the toilet are the usual causes. Each points to a different fix.

Does HRT help sleep?

It can, mainly when overheating is what wakes you. For insomnia on its own, CBT-I has better evidence.

What is CBT-I?

A structured course of cognitive behavioural therapy for insomnia, usually four to eight sessions, available in person, online or by app.