Sleep can be tricky in midlife—one night you’re out like a light, the next you’re tossing and turning for hours. Hormonal changes, stress and lifestyle shifts all play a role in why so many women in their 40s, 50s and beyond struggle with getting quality rest.
The good news? Science is uncovering new insights into how sleep changes during this phase of life and, more importantly, what you can do to improve it.
From understanding the impact of perimenopause on sleep cycles to discovering the best evidence-backed habits for better rest, we spoke with sleep experts about ways to optimize your sleep, what the latest science shows and how to reclaim your nights.
Why Women in Midlife Struggle With Sleep
Women often struggle with insomnia during menopause due to a combination of hormonal changes, lifestyle factors and aging-related shifts in sleep patterns.
“Sleep is essential to our health,” Dr. Neha Pathak, chief physician editor of health and lifestyle medicine for WebMD, tells Flow Space. “During sleep, the brain and body reset, allowing your body to recover during this restful time. During menopause, the body produces less estrogen, and this estrogen withdrawal causes the brain to become more reactive to temperature shifts, leading to hot flashes and night sweats.”
Here’s why sleep becomes more elusive during this time according to Pathak:
Hormonal Fluctuations
- Estrogen plays a role in regulating sleep and maintaining body temperature. As levels begin to fluctuate and then decline during perimenopause and menopause, women may experience hot flashes and night sweats, which disrupt sleep.
- Progesterone has a calming effect on the brain, promoting relaxation. Just like estrogen, production of progesterone declines as we age, and lower levels can contribute to anxiety and difficulty falling or staying asleep.
- Menopause can lead to increased stress hormone (cortisol) levels, and this cortisol imbalance making it harder to wind down at night.
Night Sweats and Temperature Regulation
- Many women experience vasomotor symptoms (VMS) like hot flashes, which can cause sudden awakenings and difficulty getting back to sleep.
Increased Anxiety and Mood Changes
- The hormonal shifts of menopause can contribute to anxiety and depression, both of which are linked to insomnia.
- Worrying about sleep itself can lead to sleep anxiety, making the problem worse.
Sleep Apnea and Other Disorders
- Postmenopausal women have a higher risk of sleep apnea, which can cause fragmented sleep and daytime fatigue.
- Restless legs syndrome (RLS) and increased joint pain due to aging can also disrupt rest.
Lifestyle and Environmental Factors
- Stress from work, caregiving or life changes can contribute to racing thoughts at bedtime.
- Poor sleep hygiene—like too much screen time, caffeine or irregular sleep schedules—can make things worse.
Circadian Rhythm and Melatonin Decline
- Melatonin, the sleep hormone, decreases with age, leading to lighter, more fragmented sleep.
- Many women find they wake up earlier than they used to—even when they still feel tired.
What the Latest Science Says
Recent scientific advancements have shed light on effective strategies to improve sleep quality for women in midlife, and addressing challenges such as hormonal fluctuations lifestyle factors and age-related changes are some of the best ways to optimize sleep hygiene, Dr. Amy Divaraniya, founder and CEO of Oova, tells Flow Space.
“There are a number of sleep metrics that can be helpful, but one metric that many people don’t consider is estrogen levels,” she said. “We recently conducted a study that looked at the correlation between estrogen levels and sleep. We found a decline in estrogen (E3G) levels in women who report fewer hours of sleep compared to those with longer sleep duration. By tracking their hormones and sleep together, women can understand how hormone fluctuations throughout perimenopause are impacting their sleep and adjust accordingly.“
Other notable advances include:
Gut Health and Diet
Emerging research emphasizes the significant role of gut health in sleep regulation.
Case studies have highlighted that dietary modifications—specifically, reducing alcohol and processed foods, while increasing intake of greens, nuts, oily fish and sleep-promoting foods like chicken and bananas—can lead to substantial improvements in mood and sleep quality for perimenopausal women. Incorporating probiotics can further enhance these benefits.
Nutritional Supplements
The use of supplements such as melatonin and magnesium has been explored for sleep enhancement. Melatonin, a hormone regulating the sleep-wake cycle, is beneficial for short-term sleep issues like jet lag but lacks sufficient evidence for chronic insomnia treatment.
Magnesium supports nerve and muscle function and promotes relaxation by activating the neurotransmitter GABA, indirectly aiding sleep. However, more research is needed to fully understand its efficacy. Consulting a healthcare provider before starting any supplement is advisable.
Sleep Patterns and Cardiovascular Health
Long-term studies have found that persistent insomnia symptoms and short sleep duration during midlife are associated with an increased risk of cardiovascular events, such as heart attacks and strokes, later in life. These findings underscore the importance of addressing sleep disturbances to maintain overall health.
Technological Interventions
Innovations in sleep technology, such as devices providing personalized real-time acoustic stimulation, have shown promise in promoting faster sleep onset. A large-scale study demonstrated that such a device could reduce the time taken to fall asleep by approximately 24 minutes, offering a non-pharmacological alternative for sleep improvement.
These findings offer promise for enhancing sleep quality in midlife women, however Divaraniya says individual responses may vary, and it is essential to consult with your healthcare professional before implementing any new supplements or practices.
Practical Ways to Improve Sleep in Midlife
While sleep disturbances can be frustrating, there are science-backed strategies that can help.
Pathak recommends:
- Put yourself on a sleep schedule—go to sleep and wake up at the same time. It is suggested that adults get seven to nine hours of sleep a night.
- Avoid naps during the day, which can prevent you from sleeping well at night.
- Avoid drinking caffeine, alcohol or eating a big meal at least two hours before bedtime.
- Exercise regularly but not right before sleep.
- Avoid using electronics that emit blue light at least an hour before you sleep.
- Make your bedroom a sleepy slumber den by controlling temperature to keep it cool and reduce noise factors.
- Wear loose clothing made of natural fibers (cotton) to bed to reduce being too hot and waking up from night sweats.