# Sleep: guides and answers · Unpaused

> Source: https://unpaused.cc/topics/sleep

## Sleep

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

Overview and common questions

* [Perimenopause](/topics/perimenopause)
* [Symptoms](/topics/symptoms)
* [Hormone therapy (HRT)](/topics/hrt)
* [Hot flashes](/topics/hot-flashes)
* [Weight and diet](/topics/weight-and-diet)

### 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](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595697/)). NICE also recommends menopause-specific CBT for sleep problems ([NICE NG23](https://www.nice.org.uk/guidance/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.

### Other topics

* [Perimenopause: Perimenopause symptoms and the first signs, how long the stage lasts, and hormone replacement therapy while periods continue.](/topics/perimenopause)
* [Symptoms: Brain fog, anxiety, aches and other changes, and what each symptom usually means.](/topics/symptoms)
* [Hormone therapy (HRT): What HRT is, the forms it comes in, who it suits and how the risks really stack up.](/topics/hrt)
* [Hot flashes: Why the heat comes on, and which treatments have trial evidence, with and without hormones.](/topics/hot-flashes)
* [Weight and diet: Why weight changes in midlife, and how to eat for energy, bone strength and heart health.](/topics/weight-and-diet)

[See all topics on one page](/topics)

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Plain, practical menopause advice

Plain, practical guides to perimenopause and menopause: symptoms, hormone therapy, sleep, hot flashes, weight and food, each checked against health services and medical societies.

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### Topics

* [Perimenopause](/topics/perimenopause)
* [Symptoms](/topics/symptoms)
* [Hormone therapy (HRT)](/topics/hrt)
* [Hot flashes](/topics/hot-flashes)
* [Sleep](/topics/sleep)
* [Weight and diet](/topics/weight-and-diet)
* [All guides](/articles)

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