Nighttime Awakening During Perimenopause: Get Ready for the Night as Early as Dinner Time

Waking up in the middle of the night and trouble falling asleep are often attributed to current worries, age, or a hectic lifestyle. The usual response boils down to advice on relaxation, or sometimes a sleeping pill.

These answers don’t take into account the changes that occur during this time. To fall asleep and stay asleep, the body needs three things: a clear signal that it’s nighttime, a stable body temperature, and a nervous system capable of winding down. Fluctuations in estrogen, a magnesium deficiency exacerbated by stress, and a dinner that interferes with melatonin production all disrupt these three conditions. And here’s the good news: two of them can be addressed right on your plate and in your living room, even before you go to bed.

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Three Ways to Sleep Poorly

Insomnia refers to reduced sleep, or sleep that is perceived as light and non-restorative. In France, according to Santé publique France, between 30 and 50 percent of adults report a sleep disorder, and true insomnia affects 15 to 20 percent of the population. One-third of adults report suffering from insomnia, with significantly higher rates among women. Perimenopause and premenstrual syndrome, with their relative deficiency in progesterone, increase the risk of insomnia.

There are several forms, each with different primary causes.

• Difficulty falling asleep, most often linked to high levels of internal tension characterized by impatience and impulsivity.
• Waking up during the night, most often due to stress, overwork, and anxiety.
• Waking up too early, without being able to fall back asleep, is more commonly associated with depression.

In addition to these factors, there are sleep disturbances caused by certain medications—such as diuretics, which force you to get up at night to urinate—as well as the poor-quality sleep that follows a heavy or alcohol-laden dinner, or a night spent in a poorly ventilated room.

Perimenopause can last from two to ten years and occurs in two stages. First, progesterone levels drop starting in one’s 40s, causing symptoms similar to premenstrual syndrome, including insomnia. Estrogen production then becomes irregular, and hot flashes begin to occur.

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How the Body Enters the Night

The body’s nighttime signal is called melatonin. It begins to be secreted as the light dims, two to three hours before bedtime, and its production continues mainly during the two to three hours after falling asleep. It signals to the cells that the rest phase is beginning: metabolism slows down and body temperature drops.

Light is the primary regulator of this signal. The retina contains cells that are particularly sensitive to blue light—the kind emitted by screens and many types of lighting. When stimulated in the evening, these cells suppress melatonin production and keep us awake. The effect is measurable and significant: exposure to light in the evening can delay the onset of melatonin by one and a half to three hours, which shifts the entire sleep-wake cycle forward.

Melatonin is produced from serotonin, a neurotransmitter in the brain. Serotonin itself is derived from tryptophan, an amino acid (one of the building blocks of proteins) obtained from food, and its production requires vitamin B6. Melatonin production remains stable until the age of thirty-five or forty, after which its nighttime peak gradually decreases with age.

The same mechanism is at work in the middle of the night. Turning on a bright light, checking your phone, or looking at the time on a bright screen when you wake up once again suppresses melatonin and makes it harder to fall back asleep. In practice, both in the evening and at night, lighting should remain dim and warm, and screens should be turned off.

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What disrupts sleep at this time of year

Serotonin Loses Support

Estrogens increase the availability of serotonin by stimulating its production and strengthening its receptors—the binding sites through which nerve cells receive its signal. Fluctuations in estrogen levels therefore affect serotonin and, consequently, melatonin, which is derived from it. Estrogens also act on GABA, the nervous system’s primary calming neurotransmitter. The decline in progesterone, which has a sedative effect, removes an additional source of support for sleep.

A lack of serotonin—or a failure to properly process its signals—can lead to difficulty falling asleep at night, anxiety, and a feeling of being on edge.

The thermostat is acting up

Body temperature is regulated by the hypothalamus, a small region of the brain that functions like a thermostat. A drop in estrogen levels makes it more sensitive: it mistakenly perceives the temperature as too high and dilates the blood vessels in the skin to release heat. This results in a hot flash—a period of intense heat lasting from thirty seconds to ten minutes, especially at night—followed by sweating.

The heat dissipates quickly, the skin stays wet, and a feeling of cold sets in. That explains those times when you wake up drenched, and then freezing.

A word about alcohol, because what is said about it deserves clarification. Its link to hot flashes is not as well-established as is often claimed: only heavy drinking is associated with more frequent hot flashes, while moderate drinking is not. On the other hand, its effect on sleep itself is beyond doubt: it helps you fall asleep faster but then disrupts the second half of the night—precisely when your body is supposed to be recovering. That’s the real reason to avoid it in the evening. Caffeine, meanwhile, stimulates norepinephrine—a neurotransmitter associated with wakefulness—and raises the body’s core temperature.

The Magnesium Cycle and Stress

Magnesium inhibits the neurotransmitters associated with wakefulness and enhances the action of GABA. It also plays a role in the production of serotonin and melatonin, and helps regulate cortisol, the stress hormone. A magnesium deficiency leads to more restless sleep, and waking up during the night is one of its symptoms.

Stress causes the body to lose magnesium through urine, and this deficiency, in turn, makes you more sensitive to stress. The cycle feeds on itself, and it gets even worse when you worry about your own sleep.

Perimenopause adds to this effect, as estrogen levels fluctuate and still experience spikes. When estrogen levels rise, blood magnesium levels drop, and vitamin B6—which the liver uses to eliminate estrogen—is consumed at a higher rate. However, vitamin B6—which is activated by magnesium—is also essential for the production of GABA. Coffee reduces magnesium absorption, and alcohol increases magnesium loss.

A useful clarification about supplements. The most frequently cited study, conducted among 100 people over the age of 51 who had trouble sleeping, clearly showed that magnesium improved their magnesium status and inflammation markers. However, sleep quality improved in both groups, including the placebo group. Magnesium should therefore be obtained through your diet—where average intake remains just below recommended levels—without expecting it to act as a sleep aid. The form and dose of any supplementation should be determined by your healthcare provider or pharmacist.

The dinner that's in the competition

Tryptophan is the rarest amino acid in the diet. To enter the brain, it shares a pathway with other amino acids, which are abundant in meat. A meat-heavy dinner therefore significantly slows the passage of tryptophan to the brain—and with it, the production of serotonin and melatonin. Meat also raises the body’s temperature at a time when it needs to drop.

Slow-release carbohydrates have the opposite effect. They cause a moderate rise in insulin, the hormone that transports sugar into cells. Insulin also transports competing amino acids into the muscles, allowing tryptophan to pass through unimpeded. Fast-release carbohydrates, on the other hand, cause blood sugar levels to fluctuate wildly, which produces the opposite effect.

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Prepare for the Night While You're Still Awake

A light, plant-based dinner

• A hearty lunch and a light dinner, consisting mainly of slow-release carbohydrates and no alcohol.
• Animal protein for lunch, and possibly for breakfast, and no meat for dinner.
• Slow-release carbohydrates starting at 5:00 p.m., which should make up the bulk of your dinner: sweet potatoes, pumpkin, squash, or celeriac—in soup or mashed—as well as legumes, buckwheat, quinoa, rice, or chestnuts. Cooking grains until al dente and including fiber in your meal slow down their absorption.
• A handful of nuts a day—thirty grams of walnuts, almonds, and Brazil nuts. Eating nuts has been linked to higher levels of serotonin derivatives in the body.
• Whole foods, with plenty of vegetables and whole grains. Ultra-processed foods, saturated fats, and added sugars make night sweats worse.

Magnesium on Your Plate

• Mineral water rich in magnesium, whole grains, legumes, tofu, and nuts.
• Green vegetables, sweet potatoes, chestnuts, and a banana.

Stimulants, before midday

• No more than two to three cups of black coffee a day, and no coffee, black tea, soda, or energy drinks in the afternoon. An organic decaf can be a good alternative.
• Alcohol should be limited and avoided during dinner in particular. If you do drink, it's best to do so earlier in the evening.

For Nighttime Hot Flashes

• Soy. The isoflavones in soy modestly reduce the frequency and intensity of hot flashes, and it takes several weeks for their effects to become apparent. You can include 100 grams of tofu in your lunch. The response varies greatly from one woman to another.
• Flaxseed, on the other hand, has not been shown to have an effect on hot flashes: the largest trial, conducted among 188 women, found no difference compared to a placebo. It remains beneficial for its omega-3 fatty acids, but not for this purpose.
• Omega-3 fatty acids from small, fatty fish, which can help relieve night sweats.
• If you are overweight, weight loss makes a difference. Overweight women report more frequent and more intense hot flashes, and weight-loss programs reduce these symptoms.

Plants: On a Case-by-Case Basis

Several plants are traditionally used: hops for hot flashes, sage for both daytime and nighttime sweats, eschscholtzia (California poppy) for waking up at night, as well as valerian—which is enhanced by lemon balm—passionflower, linden, and hawthorn for sleep in general. Valerian is the most extensively studied herb in postmenopausal women, with an improvement in sleep quality demonstrated in a placebo-controlled trial.

Their effects vary from person to person: a plant that soothes some women may have the opposite effect on others, which is precisely the case with valerian. Hops are contraindicated in cases of a history of hormone-dependent cancer, breast tenderness, or pregnancy, and they enhance the effects of sleeping pills and sedatives. Sage is contraindicated in cases of a history of hormone-dependent cancer, excess estrogen, or epilepsy, and its essential oil should be strictly avoided. The choice of which herbs to use is up to your therapist and should be based on medical advice if you are undergoing treatment.

The light, the room, and the bed

• An evening screen-time curfew, and filters or orange-tinted glasses if screen use is still necessary.
• Don't miss the boat. When you start yawning, it's time to go to bed: sleep cycles last about ninety minutes, and the next one will come an hour and a half later.
• Don't stay awake in bed for too long, and opt for a short nap—15 to 20 minutes—rather than a long one: spending too much time in bed can lead to insomnia.
• A well-ventilated, quiet, and cool room, around 17 degrees, neither too dry nor too humid, with warm feet.
• Staying active during the day. The more active you are during the day, the better you'll sleep at night.

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Other Possible Causes

Sleep can also be disrupted by other factors, which often occur in addition to these. Each is discussed in detail in a separate article:

• Sleep that remains light and waking up feeling unrested: see “Morning Fatigue.”
• Breathing pauses during the night: see “Sleepiness at Rest.”
• Prolonged stress and cortisol: see “Hypersensitivity to Stress and Noise.”
• Iron deficiency, which can contribute to restless legs: see “Energy Slumps.”

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When to Seek Medical Attention

Seek immediate help if you experience nighttime breathing pauses noticed by those around you, restless legs that prevent you from sleeping, or waking up very early in the morning accompanied by deep sadness, a loss of interest, or dark thoughts.

Remotely, if you continue to wake up frequently despite the measures described here; if you are taking sleeping pills or sedatives (which should always be discontinued under medical supervision); a diuretic or a beta-blocker (a heart or blood pressure medication that inhibits melatonin); if you are considering herbal remedies or phytoestrogens (plant compounds similar to estrogen, such as those found in soy) and have a history of hormone-dependent cancer, or if you wish to take melatonin long-term. This is something you should discuss with your doctor.

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Key takeaways

Sleep depends on a clear signal—melatonin—a stable internal clock, and a nervous system capable of winding down. During this time, fluctuations in estrogen levels destabilize serotonin—from which melatonin is derived—and disrupt the internal clock. Stress depletes magnesium, and estrogen spikes lower its levels in the blood. A meat-heavy dinner slows the uptake of tryptophan into the brain.

These mechanisms explain why people are waking up more frequently. But they don’t mean you can skip taking action: a light dinner consisting of slow-releasing carbohydrates and no meat, foods rich in magnesium, stimulants reserved for the first part of the day, little or no alcohol in the evening, and a night free from screen light.

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Frequently Asked Questions

I wake up soaked, and then I feel cold. Why?

A hot flash dilates the blood vessels in the skin to release heat that the brain’s thermostat perceives as excessive. The sweat evaporates, the skin cools down, and a chill follows. A cool room helps you fall back asleep.

What should I do when I wake up in the middle of the night?

Avoid any bright light and screens, even when checking the time: they once again suppress melatonin production. Stay in dim light, and don’t spend too much time awake in bed, as this can lead to insomnia.

Why should you avoid eating meat in the evening?

Its amino acids compete with tryptophan for access to the brain, which reduces the production of serotonin and melatonin. It also warms the body at a time when its temperature should be dropping.

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