Sleep and energy
Perimenopause tiredness and insomnia: why you are exhausted, and what helps
Perimenopause tiredness is very common, and broken sleep is usually at the heart of it. Night sweats, hot flushes, early waking and a busier mind all chip away at your sleep in the years around menopause, and poor sleep makes mood, appetite and energy harder to manage. Cognitive behavioural therapy for insomnia (CBT-I) has strong evidence, and a few steady habits help too. If you are tired for weeks for no clear reason, see your GP.
Key facts
In a survey of 12,603 women aged 40 to 55, difficulty sleeping was most common in late perimenopause (45.4%), and menopausal stage was linked to poor sleep independent of age and other factors. About 26% of women in the menopausal transition have sleep symptoms severe enough to affect daytime functioning. In a randomised trial, 70% of women who had 6 phone sessions of CBT for insomnia were in the no-insomnia range after 8 weeks, against 24% given menopause education.
Why perimenopause makes you so tired
The main reason is sleep. In a large US survey of women aged 40 to 55, about 4 in 10 had had trouble sleeping in the previous 2 weeks, and the rate was highest in late perimenopause. Menopausal stage mattered even after age, health and other factors were taken into account, so this is about more than getting older.
Hot flushes and night sweats are a big part of it. A review of the research found that many, though not all, hot flushes are linked with waking during the night, and that time awake adds up. The NHS also notes that sleep problems can leave you irritable, stressed and anxious, and that mood, memory and concentration feel worse when you are very tired.
Turtle members see the same pattern. In Turtle's data, 52% of women in perimenopause or menopause typically slept under 7 hours, against 38% of women under 45 (how women sleep in perimenopause), and 57% of women aged 45 to 54 averaged under 7 hours (sleep hours by age).
Perimenopause insomnia and menopause sleep problems
Insomnia means trouble falling asleep, staying asleep or waking too early, often enough that it affects your day. A review estimated that 26% of women around menopause have symptoms severe enough to qualify for a diagnosis of insomnia. The same review noted that some sleep problems go hand in hand with depression, and that sleep-related breathing and movement disorders become more common, especially after menopause.
How much sleep is enough? An expert panel for the US National Sleep Foundation recommends 7 to 9 hours for adults, and 7 to 8 for older adults. If you are regularly well under that, it is worth treating as a health issue in its own right, not something to push through.
What helps perimenopause tiredness
None of these is a cure on its own, but together they make good sleep more likely. Pick one to start with.
Small changes that help menopause sleep problems
- Keep the same sleep and wake times, including at weekends. The NHS recommends regular sleep routines.
- Keep your bedroom cool and have light layers you can throw off. The NHS suggests a cool bedroom and lightweight clothing for night sweats.
- Put screens away before bed. 82% of women keeping Turtle's sleep diary used a phone or watched TV before sleep on most nights (phones before bed).
- Watch caffeine and alcohol later in the day. The NHS lists caffeine and alcohol among possible hot flush triggers, and advises keeping alcohol within the recommended limits.
- Move every day. Regular exercise is on the NHS list of things that help menopause symptoms.
- Get out of bed if you can't sleep. Lying awake for long stretches can make bed feel like the place you worry. Getting up and going back when you feel sleepy is one of the core parts of CBT for insomnia.
Based on the NHS menopause and tiredness pages and the CBT-I trial below. If hot flushes are waking you most nights, talk to your GP about treatment options.
CBT for insomnia: the best-studied fix
Cognitive behavioural therapy for insomnia (CBT-I) is a short course that changes the habits and thoughts that keep insomnia going. It usually includes setting a consistent sleep window, getting up when you can't sleep, and working on the worry that builds around bedtime.
In a randomised trial of 106 women aged 40 to 65 with insomnia and hot flushes, 6 telephone sessions of CBT-I over 8 weeks cut insomnia scores roughly twice as much as menopause education. After 8 weeks, 70% of the CBT-I group were in the no-insomnia range, against 24% of the comparison group, and the benefit lasted to 24 weeks. Their hot flushes didn't become less frequent, but they bothered them less.
NICE, which sets guidance for the NHS in England, recommends considering menopause-specific CBT for sleep problems linked to hot flushes and night sweats, alongside other options. Ask your GP what is available near you.
Built for midlife
A coach for perimenopause and menopause
Turtle is built for women in perimenopause and menopause: strength sessions, protein, sleep and a weekly check-in that reads your trend, not one weigh-in.
4.6★ on the App Store · 100,000+ members · Free to download
Tiredness, hunger and weight
Poor sleep makes weight harder to manage. In a small lab study, people on a calorie deficit who slept 5.5 hours instead of 8.5 lost less fat and more lean mass, and felt hungrier. It was only 10 people over 2 weeks, but it fits what many women notice: tired days are hungry days. If the scale has been creeping up as your sleep has got worse, see perimenopause weight gain and menopause weight gain.
When to see your GP about tiredness
When to see your GP: Perimenopause is not the only cause of tiredness. The NHS advises seeing a GP if you have felt tired for a few weeks and are not sure why, if it affects your daily life, or if it comes with other symptoms such as weight loss or mood changes, or you have been told you gasp, snort or choke in your sleep. Your GP can check for other causes, and may suggest blood tests for things like anaemia, diabetes or an overactive thyroid. They can also talk you through treatment for menopause symptoms.
What the research says
Each study below was checked against its PubMed record, or read at source for NHS, NICE and government pages, on 7 October 2026.
In 12,603 women aged 40 to 55, 38% reported difficulty sleeping; age-adjusted rates were highest in late perimenopause (45.4%) and after surgical menopause (47.6%), and menopausal stage was linked to poor sleep independent of other factors.
Kravitz HM, Ganz PA, Bromberger J, et al. (2003). Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause (New York, N.Y.). 10(1):19-28 doi.org/10.1097/00042192-200310010-00005
A review found 26% of women around menopause have sleep symptoms severe enough to affect daytime functioning and qualify for an insomnia diagnosis, with hot flushes a major contributor to night-time waking.
Baker FC, de Zambotti M, Colrain IM, et al. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and science of sleep. 10:73-95 doi.org/10.2147/NSS.S125807
In a randomised trial of 106 women aged 40 to 65 with insomnia and hot flushes, 6 telephone CBT-I sessions over 8 weeks put 70% in the no-insomnia range at 8 weeks (vs 24% with menopause education), with benefits sustained at 24 weeks.
McCurry SM, Guthrie KA, Morin CM, et al. (2016). Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial. JAMA internal medicine. 176(7):913-20 doi.org/10.1001/jamainternmed.2016.1795
NICE recommends considering menopause-specific CBT for sleep problems, such as night-time waking, associated with hot flushes and night sweats, alongside other options including HRT.
National Institute for Health and Care Excellence (2015). Menopause: identification and management (NG23), last updated April 2026. NICE guideline. www.nice.org.uk/guidance/ng23
A National Sleep Foundation expert panel recommended 7 to 9 hours of sleep for adults and 7 to 8 hours for older adults.
Hirshkowitz M, Whiton K, Albert SM, et al. (2015). National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep health. 1(1):40-43 doi.org/10.1016/j.sleh.2014.12.010
In a crossover study of 10 adults on a calorie deficit, 5.5 hours of sleep opportunity instead of 8.5 cut the share of weight lost as fat by 55%, increased lean mass loss by 60% and increased hunger.
Nedeltcheva AV, Kilkus JM, Imperial J, et al. (2010). Insufficient sleep undermines dietary efforts to reduce adiposity. Annals of internal medicine. 153(7):435-41 doi.org/10.7326/0003-4819-153-7-201010050-00006
Questions women ask
Why am I so tired in perimenopause?
Mostly because sleep gets harder: night sweats, hot flushes and early waking are common, and difficulty sleeping peaks in late perimenopause. Mood changes and a busy midlife add to it. If you are tired for weeks for no clear reason, see your GP, as there can be other causes.
What helps perimenopause insomnia?
CBT for insomnia has the strongest evidence: in one trial, 70% of women were in the no-insomnia range after 8 weeks. Regular sleep times, a cool bedroom, less caffeine and alcohol later in the day and getting up when you can't sleep also help. Your GP can talk you through treatment for night sweats.
Can perimenopause cause extreme fatigue?
Tiredness is common in perimenopause, but extreme or lasting fatigue can have other causes, such as anaemia or thyroid problems. See your GP if tiredness lasts a few weeks without a clear reason or affects your daily life.
How much sleep do women need in menopause?
Expert panels recommend 7 to 9 hours for adults. Many women in perimenopause get less: in Turtle's data, 52% of women in perimenopause or menopause typically slept under 7 hours.
Does poor sleep cause weight gain in menopause?
It makes weight harder to manage. In a small study, people on a calorie deficit who slept 5.5 hours lost less fat and more lean mass, and were hungrier, than when they slept 8.5 hours.
Does menopause insomnia go away?
Hot flushes and night sweats, a common cause of broken sleep, often last for several years, but insomnia itself can be treated at any stage. CBT for insomnia works for many women, so you don't have to wait it out.
This guide is general information, not medical advice. It isn't tailored to you and doesn't replace advice from your GP or another qualified professional. If something's worrying you, speak to your GP. LeanShield™ is a trademark of ParrotPal Ltd: it rates the habits linked to protecting muscle, is not a medical device and doesn't measure muscle.