Sleep is one of the great pleasures of life, and the time when the body rejuvenates and repairs. We also say “I’ll sleep on it” because sleep is when we receive clarity about our lives. 

So when sleep crashes, it affects everything else. You’re also more likely to reach for unhealthy foods and much more caffeine just to keep going, worsening it all a bit more.

Insomnia is one of the most common symptoms of perimenopause. Many women, like me, slept well until their mid-40s, when suddenly their sleep plummeted. Through my own experience and my work with clients, I’ve learned what really helps. Now I can help you too.

And night-time waking often brings racing, catastrophic thoughts that keep you awake even longer. This is because at night, the amygdala, the emotional centre of your brain, is more active, while the logical part that usually keeps it in check is quieter. The good news is that there are effective strategies to deal with it.

This article is for you if you’ve been wondering why you’re not sleeping, and what you can do to sleep well again. 

In this article:

• How hormones affect sleep
• 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 sleep
• Practical ways to improve sleep
• CBT for insomnia and the night’s mind

How hormones affect sleep 

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

This can actually happen at any age, not just in perimenopause when hormones start shifting. For instance, sleep can get more disrupted in the luteal phase, just before your period, as that is when progesterone levels drop. This is called period insomnia. As part of PMS or PMDD, it’s incredibly common, though rarely discussed.

But progesterone may be only one of the reasons you wake up at night. There are other potential reasons for waking up at 3am, and the good news is that most of these are modifiable. Good sleep is possible at any age.

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 may be your case if you wake up in the middle of the night with anxiety and a racing heart.

Skipping breakfast or long fasts can make this worse by extending the overnight fuel gap. A protein-rich breakfast supports progesterone, lowers morning cortisol, and keeps your blood sugar stable for the day.

Some of my clients with low blood sugar 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 describes almost every woman I see: juggling work and motherhood, with the nervous system still switched on 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 wind-down routine, and go to bed at the same time 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. As always, check with your practitioner if you are on any medication or have a blood thinning disorder.

What about coffee?

We all know people who can drink coffee late at night and still sleep well. This is because we are all biologically unique.

Some people carry variants in the CYP1A2 and ADORA2A genes, which affect how quickly caffeine is cleared from the body. Slow metabolisers can take up to 12 hours to clear it, so if this is you, a 2pm espresso may still be in your system as you’re trying to sleep. I often see these variants on genetic tests.

Perimenopause can make this more intense. Oestrogen affects how quickly the CYP1A2 enzyme clears caffeine, and in perimenopause it often swings up, sometimes to levels higher than in your 30s! When it does, caffeine lingers longer. This is why so many women suddenly become more sensitive to caffeine, with anxiety, palpitations and broken sleep.

If you suspect caffeine may be a factor, you could stop all caffeinated drinks by noon for several weeks and see how you feel. 

How light affects sleep

We spend so much time these days under artificial lights, disconnected from the natural light  and its rhythms.

Natural light is essential for our sleep cycle – 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 waking, even on cloudy days, helps regulate your hormones including melatonin for the night ahead. Start your day by opening your blinds and facing the morning sunlight.

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 its own rhythm divided into two-hour intervals, when the life force Qi passes through each organ at specific times.

Between 1am and 3am, 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 3am 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. 

Interestingly, this ancient view echoes what neuroscience tells us about the emotional brain being more active at night.

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

Practical ways to improve your sleep

Every woman struggling with sleep and waking up at night is doing so for reasons that are unique to her. One woman’s primary driver is blood sugar. Another’s is cortisol or coffee at the wrong time. I get to the bottom of this in consultations with my clients so I can offer the best approach to restore their sleep.

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

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

Magnesium glycinate with 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 you’re a slow caffeine metaboliser.

Morning light and evening darkness – to regulate circadian rhythm. Dim lights and reduce screens in the evening.

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

CBT for insomnia

For some women, even once the root causes are addressed, waking at night has become a habit of its own and sets in as insomnia. This is where CBTi (Cognitive Behavioural Therapy for Insomnia) can help. It’s the gold-standard treatment for insomnia, and I now offer it alongside my nutritional and naturopathic work, using coaching techniques to help you build changes that fit your real life.

CBTi also helps with the dark thoughts that so often arrive at 3am. Because your emotional brain is more active at night and your logical brain is quieter, worries feel bigger and more urgent than they would in daylight. Simply knowing “this is my 3am brain” can take some of the power out of them.

In perimenopause, changing hormones can make our emotional brain even more reactive. Whether you see it through neuroscience or through Chinese medicine, with the liver and lungs holding anger and grief, the message is similar: what surfaces at night is often what we’ve pushed aside for years. I see this as an invitation as well as a challenge. This is what Jung called shadow work, and perimenopause can be a powerful time to finally face it and heal. But 3am isn’t the best time to do all of that work. Notice what comes up, then return to it in daylight, with a clearer mind, through journaling, talking it through, or working with a health practitioner.

One technique I use is worry time. In the early evening, set aside 15 minutes to write down everything on your mind, and for each worry, one small next step. This gives your brain permission to let go at night, because it’s already been dealt with. 

Magda Jenkins is a registered Nutritional Therapist and Naturopath specialising in women’s health, based in Petersfield, Hampshire, and working with clients worldwide via Zoom. If insomnia is part of your life right now, 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.