Sleep is one of the great pleasures of life; the time when the body rejuvenates and repairs. It’s the foundation for your health and wellbeing alongside good nutrition.

After a good night’s sleep, you feel refreshed, clear-headed and noticeably good in your body.

But when sleep crashes, it affects everything else. You are then also more likely to reach for sugary foods and caffeine to keep going.

If you keep waking up at 3am, unable to fall back asleep – you know how exhausting this is.

This article is for you if you wonder why this is happening and what you may do to restore your sleep. 

In this article:

• Why progesterone is only part of the story
• Blood sugar and the 3am cortisol surge – and why fasting can make it worse
• The tired and wired state that keeps you awake
• Caffeine and your genetics
• How ancient Chinese medicine explains waking up at 3am, and 5am…
• How light affects your sleep
• Simple and effective solution for sleep, depending on root cause

How progesterone affects sleep – but it’s not the whole story

One of the most common reason women wake up at night is the drop in progesterone. Progesterone helps us fall asleep and stay asleep.

You may notice your sleep is more disrupted especially in the luteal phase, just before your period, when progesterone levels drop. Period insomnia as part of PMS or PMDD is incredibly common though rarely discussed.  In perimenopause, this can  intensify. 

This was my own experience of perimenopause – which incidentally helps me help others with sleep issues.

But progesterone may only be part of the reason for which you wake up at night. There are other potential reasons for waking up at 3am, and the good news is that all of these are modifiable.

Is your blood sugar low at night?

One of the most overlooked reasons for waking up at 3am is unstable blood sugar.

Your brain needs a constant supply of energy even during sleep. If blood sugar drops too low, the body releases cortisol and adrenaline to raise it again. The purpose is to wake you up so you can eat something and provide fuel for your brain. This is you if you wake up with anxiety and a racing heart.

If this is your pattern, you also tend to skip meals, undereat protein, or rely on caffeine to keep going. This is also why intermittent fasting and morning fasts are not the right approach for perimenopausal women. Fasting extends the overnight fuel gap which keeps cortisol high and disrupts sleep.

A protein-rich breakfast supports progesterone, lowers morning cortisol, and sets your blood sugar stable for the day.

I know this may land uncomfortably with women who fast hoping to maintain healthy weight but chances are that undereating keeps metabolism slow. There are other strategies for healthy body weight.

If your blood sugar is generally low, you may also benefit from a small protein-rich snack before bed to prevent overnight sugar dips that wake you up at 3am. A good and easy option is biltong, a protein ball, or a small handful of nuts.

Are you tired and wired?

This is almost all women I see, all juggling work and motherhood, and a relentless mental load keep the nervous system switched on even after the day has ended.

I wrote previously in my article on sleep deprivation in motherhood that after years of interrupted sleep many women become neurologically conditioned to remain alert at night. If this continues into perimenopause it can make sleep even more challenging. 

Many women override exhaustion with caffeine and sheer willpower. Then in the evening, the body produces a second wind which prevents deep sleep. You end up exhausted but unable to truly switch off.

In my practice the interventions that make the most difference are often the simplest:

• Reduce overstimulation in the evening – avoiding stressful films or emotionally charged conversations before bed
• Create a consistent wind-down routine, every night
• Ashwagandha before bed can help modulate the stress response; it quietens the mental chatter, nourishes an exhausted nervous system while increasing sleep quality. I prescribe it regularly. As always, check with your practitioner if you are on any medication or have a blood thinning disorder.

Why caffeine affects only some people?

We all know people who can drink coffee late at night and sleep perfectly.  

This is because we are all biologically unique.

Some people carry gene variants CYP1A2 and ADORA2A which determine how quickly caffeine is cleared from your body. Slow metabolisers take  even 12 hours to clear it so an expresso at 2pm may be still disrupting  your sleep. I often see these variants on genetic tests results.

Perimenopause makes this more intense. Oestrogen influences how the CYP1A2 enzyme is expressed, and as hormones fluctuate, many women suddenly become even more sensitive to caffeine and notice anxiety, palpitations, lighter sleep, and that 3am waking for the first time.

I had to cut coffee entirely for two years at one point in  perimenopause to restore sleep and also a sense of calm. As my hormones stabilised, I could introduce coffee again.

If you have these genetic variants and suspect that coffee may be a factor, stop drinking any caffeinated drinks at noon for several weeks and see how you feel. Other than coffee, you may also be reacting to other sources of caffeine: matcha, green tea, and hot chocolate.

How light and modern life affect sleep

Women today spend most of their days under artificial light, disconnected from the natural light rhythms and natural light.

Natural light is essential – morning sunlight and darkness at night are biological instructions for our brain, hormones and sleep.

Blue light from phones, laptops and LED bulbs suppresses melatonin, and makes it harder not only to fall asleep but also to stay asleep.

Morning light is one of the most powerful tools for sleep. Getting outside within 30 mins of awakening, even on cloudy days, helps regulate your hormones including melatonin for the night ahead. Start your day by opening your blinds and face the morning light.

In the evening: dim lights after sunset, wear blue-light blocking glasses if screens are unavoidable, and switch to warmer or red-spectrum lighting where possible.

To read more about light and your health, read my article on light and metabolism here.

What Chinese medicine says about waking at 3am

In Chinese medicine, the body has it’s own rhythm divided into two-hour intervals, when the life force Qi passes through each organ at specific times.

Between 1 and 3 am, Qi moves through the liver.

In Western medicine, we think of the liver primarily as a detoxification organ. But in Chinese medicine, the liver is additionally deeply connected to emotional processing. It is  the seat of unresolved frustration, resentment and suppressed anger.

Between 3 and 5am is Lung time. The lungs in TCM are associated with unexpressed grief and sadness.

Perimenopause has the tendency to bring our buried, unexpressed emotions to the surface. As women often spend decades suppressing their needs and feelings, caring for everybody else, perimenopause is usually the first time women are confronted with the emotional material, no longer able to continue as they were.

If you wake up in these early hours, this is worth sitting with and exploring.

Easy and effective solutions to sleep well

Every woman struggling with sleep and waking up at 3am is doing it for reasons that are unique to her. One woman’s primary driver is blood sugar. Another’s is cortisol and coffee at the wrong time.  This is why a one-size-fits-all approach to sleep – take magnesium, try melatonin, avoid caffeine – often produces only partial results. Finding what is actually driving your specific picture is what changes things properly.

That said, here is what I find most consistently helpful:

Protein before bed – for low blood sugar pattern – just a small snack rather than a meal to stabilise blood sugar overnight.

Magnesium glycinate in the evening meal or Epsom salts baths. This supports GABA receptors that progesterone used to activate, and improves sleep depth.

Ashwagandha – for the tired and wired pattern specifically. Modulates cortisol, quietens the mind and improves sleep quality over time.

Caffeine cut-off at noon – or earlier if you suspect SNPs on your caffeine metabolism.

Morning light and evening darkness – essential for circadian rhythm. Dim lights and reduce screens in the last two hours of your evening.

If your partner snores, sleeping separately may sometimes be the healthiest solution.

The 3am waking is a signal that something needs to change.

Magda Jenkins is a registered Nutritional Therapist and Naturopath specialising in women’s health, based in Petersfield, Hampshire. She works with clients locally and globally via Zoom.

If this resonates, book a free discovery call at magdajenkins.com

References

Jeffery, G. (2026) Light, Mitochondria and Health: 2 Billion Years of Evolution Under Sunlight Until Recently. BNFM conference, London, 30 April. [Personal notes.]

Chang, A.M. et al. (2015) ‘Evening use of light-emitting eReaders negatively affects sleep’, PNAS, 112(4), pp. 1232–1237.

Mosconi, L. (2024) The Menopause Brain. Avery/Penguin.

248-scientist consensus statement on light and circadian biology (2023) Frontiers in Photonics.

Holst, S.C. et al. (2014) ‘Caffeine effects on sleep and cognition’, Progress in Brain Research, 190, pp. 105–130.