Perimenopause

Sleep disruption — perimenopause

Perimenopausal sleep issues come from multiple angles: night sweats waking you, progesterone decline (progesterone is itself sleep-promoting), anxiety, and age-related changes in sleep architecture.

Key points

✓Ashwagandha 300-600 mg evenings addresses both sleep and cortisol
✓Valerian has moderate evidence; takes 2-4 weeks to build benefit
✓If night sweats are waking you, treat those first (sage, black cohosh) — sleep often follows
✓Bioidentical progesterone (micronized, with a clinician) is hormonally targeted and sedating
✓Consistent sleep-wake schedule matters more than any supplement

Supportive herbs

Ashwagandha
Valerian
Magnolia Bark
Lemon Balm

Lifestyle & diet

Cool room, moisture-wicking pajamas, magnesium glycinate 300-400 mg before bed, 4-7-8 breathing if waking at 3 am, no alcohol within 3 hours of bed.

When to see a clinician

Insomnia >4 weeks with daytime dysfunction, suspected sleep apnea (more common in post-menopause), severe mood changes with sleep loss.