The menopause transition or menopause is not a single moment, but a period of years. Many women first notice that sleeping during menopause becomes more difficult: waking up more often, waking up sweating, or being wide awake at four in the morning. In this article, you will read about what happens in your body, what is and isn’t proven, and what you can do tonight and in the coming months.
First, the terms
Doctors use three terms interchangeably, which makes it unnecessarily confusing.
- Perimenopause: the years in which your hormone levels fluctuate significantly and your cycle becomes irregular. This is the phase in which most sleep complaints arise.
- Menopause: your last period. You only know in hindsight that it was the last one, after twelve months without.
- Postmenopause: everything after that.
The entire transition lasts an average of four to eight years, but hot flashes can persist much longer. In the American SWAN cohort, the median duration of hot flashes was 7.4 years (Avis, 2015).
How many women sleep worse?
Hot flashes and night sweats occur in approximately 75 to 80% of women during menopause (Thurston and Joffe, 2011). Sleep problems are slightly less common, but still frequent: about four out of ten women, rising to nearly half in late perimenopause (Kravitz, 2008; Baker, 2018).
Sleep complaints therefore do not peak after menopause, but in the years before, when hormones fluctuate the most.
What happens in your body
1. Your temperature regulation becomes more sensitive
To fall asleep, your core temperature must drop slightly, by about half to a full degree (Kräuchi and Wirz-Justice, 1994). Your body does this by releasing heat through your skin, especially through your hands and feet. Warm feet are therefore literally a signal to fall asleep (Kräuchi, 1999).
During menopause, the thermostat in your brain changes. Due to the loss of estrogen, certain nerve cells in the hypothalamus, known as KNDy neurons, become overactive (Rance, 2013). The result is that the zone in which your body considers the temperature “correct” becomes much narrower (Freedman, 2001). A small rise that you previously wouldn’t have felt now triggers a hot flash: your blood vessels open, you start to sweat, and your heart rate rises. That wakes you up.
2. Hot flashes don’t explain everything
This is an important nuance that is missing from many articles. Sleep laboratory research showed that hot flashes in the first half of the night are associated with waking up, but in the second half, with a lot of REM sleep, they hardly are (Freedman and Roehrs, 2006). Many women who sleep poorly during menopause therefore have other causes as well, and these deserve attention.
3. Sleep apnoea: often missed in women
After menopause, the risk of obstructive sleep apnoea—breathing stops during sleep—increases by a factor of 2.6 to 3.5 (Young, 2003). Estrogen and progesterone protect the muscle tone in the throat; when that protection disappears, the airway collapses more easily.
In women, sleep apnoea looks different from the classic image of the snoring man. It often presents as daytime fatigue, difficulty falling asleep, night sweats, and morning headaches. Exactly the complaints that are dismissed as “menopause.” Do you sleep poorly and are you exhausted during the day, even on nights without hot flashes? Then discuss with your GP whether a sleep study would be useful.
4. Mood and stress
In perimenopause, the risk of low mood and anxiety symptoms clearly increases, even in women who never had them before (Freeman, 2006; Bromberger, 2011). Sleep and mood reinforce each other in both directions: poor sleep makes you feel lower, and low mood makes it harder to fall asleep.
Regarding cortisol, the stress hormone, you often read that it “rises during menopause because the adrenal glands take over estrogen production.” That is incorrect. After menopause, the little estrogen you still produce comes mainly from fat tissue, and the evidence that cortisol rises structurally is mixed (Woods, 2009). What is certain: a short, interrupted night results in a higher cortisol level the next morning. That is a consequence of poor sleep, not a cause of menopause.
Why can sleeping during the transition be such a drama?
In order to fall asleep, your body temperature must drop a little, about 1 degree Celsius on average. This drop, by the way, is similar in men and women. In menopausal women, however, that ‘comfort zone’ is much narrower.
This leads to so-called“micro-wake-ups. Even a small rise in temperature can put your brain into ‘wake mode’ . This can eventually create a vicious circle cause: you wake up from a hot flash, the bed is soaking wet and blood hot, and because of the adrenaline and heat, it takes exactly ages before you sink back in. This is not without consequence as about 75% of women suffer from this, leading to less deep sleep, fatigue and a shorter fuse during the day.
What can you do about poor sleep during menopause?
Cognitive Behavioral Therapy for Insomnia (CBT-I)
This is the treatment with the strongest evidence, also specifically during menopause. In the MsFLASH studies, women with hot flashes and insomnia received six telephone sessions of CBT-I. Their insomnia decreased much more significantly than in the control group, and the effect was maintained after six months (McCurry, 2016). In a combined analysis of all MsFLASH studies, CBT-I had the greatest effect on insomnia, greater than estrogen, antidepressants, exercise, or yoga (Guthrie, 2018).
CBT-I does not work through your hormones, but through your sleep pressure and your biological clock: fixed wake-up times, bed only for sleeping, and breaking the cycle of worrying about sleep. A fixed worry time during the day, with pen and paper, is also part of it.
Alcohol, caffeine, and exercise
Alcohol helps you fall asleep but causes more awakenings and more sweating in the second half of the night (Ebrahim, 2013). Caffeine after midday prolongs the time it takes to fall asleep. Regular exercise improves sleep quality, although the effect on hot flashes themselves is limited (Guthrie, 2018). An evening walk also helps your body dissipate heat before bedtime.
When should you see your GP?
Sleep hygiene and CBT-I help most women, but not everyone. See your GP if:
- hot flashes and night sweats interrupt your night several times a week;
- you are exhausted during the day, even after nights without hot flashes (consider sleep apnoea);
- your mood is low or anxious for an extended period;
- you have night sweats without hot flashes, combined with fever or weight loss. This is not a menopausal symptom and requires investigation.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy replenishes the estrogen deficiency, usually combined with progesterone. It is the most effective treatment for hot flashes. The effect on sleep is more modest and works primarily by reducing those hot flashes (meta-analysis by Cintron, 2017). Micronised progesterone, the form usually prescribed in the Netherlands, also has its own mild sleep-promoting effect (Caufriez, 2011).
The Dutch GP guideline (NHG-standard The Menopause, 2022) and the international guideline from the Menopause Society (2022) agree on the timing: starting within ten years of menopause and preferably before age sixty provides the most favorable balance between benefits and risks. Your GP or gynecologist will weigh your personal situation, such as a history of breast cancer or thrombosis.
New: medications that act on the thermostat
Recently, non-hormonal agents have been developed that specifically target the overactive KNDy neurons. Fezolinetant has been registered in the EU since late 2023 and reduces hot flashes and the associated sleep disruption (Lederman, 2023). With this medication, your liver function is monitored. Elinzanetant, a second drug from the same group, showed a measurable improvement in sleep in addition to fewer hot flashes in the OASIS studies (Pinkerton, 2025) and received a positive opinion from the European Medicines Agency in September 2025.
These medications are particularly relevant for women who cannot or do not want to use hormones, for example after breast cancer. Discuss the options with your doctor.
You cannot change your thermostat, but you can ensure it is challenged less often. The more stable your temperature under the duvet, the less often a hot flash is triggered.
You cannot change your thermostat, but you can ensure it is challenged less often. The more stable your temperature under the duvet, the less frequently a hot flash is triggered.
To be honest: there is no independent randomized research that has tested cooling mattresses or duvets specifically in menopausal women. What does exist are laboratory studies on sleep climate and temperature (review in Okamoto-Mizuno, 2012) and the physiology mentioned above. From these follow plausible principles, not guarantees.
Can a mattress save you?
Fortunately, there are certainly solutions to be found when it comes to sleep comfort. There are many ways to optimize your sleeping environment. Here is a summary:
High Heat Capacity Materials (HHCM) distribute body heat .. This leads to much better thermoregulation. Many mattresses (especially made of (memory) foam) act as an insulator: they retain your body heat. Mattresses equipped with HHCM do not do this. They diffuse heat.
A prominent example of an HHCM mattress is Technogel®. This unique polymer gel has a high thermal conductivity, allowing heat to quickly move away from the body and diffuse horizontally. Instead of retaining heat, this gel absorbs heat and spreads it horizontally across the surface. Studies show that mattresses with Technogel® (thickness min. 1.7 cm) can help you fall asleep up to 33% faster and give you up to 45% more time in deep sleep (NREM-3). Other research, specifically focusing on women during menopause, also shows very powerful results regarding individual sleep experience.
Mattress covers with PCMs (Phase Change Materials) have microcapsules inside the mattress cover. These microscopic capsules contain materials that change phase when it gets too hot (solid to liquid or vice versa). In this way, heat is temporarily stored. When the temperature drops, the heat is released again. Many brands use this technology and often give it their own name. The technology itself is being developed by major textile players such as HEIQ(Smart Temp, Cool) and Devan Thermoregulation (Thermic, Cool).
Highly breathable materials or fibers such as wool (sheep, camel, alpaca), linen, cotton, coconut, flax or horse hair incorporated into the mattress cover or mattress may also offer a solution. This can also be a synthetic material, such as Labyrinth(ENKEV) which is up to 97% breathable. These materials allow heat to disperse very quickly.
An active cooling system may also be a solution. In this case, a ventilation system is incorporated into the bed. So electricity is used to ventilate or to let cool water flow through the mattress. Dutch company Fresh Bed thus developed an active ventilation system that also purifies the air around the body at the same time. The American Eight Sleep uses water to cool, through its Pod technology. Be careful, because these systems consume energy and can make noise. Passive cooling technologies do not have these drawbacks.
Duvet and bedding
Know that 80% of your sleep environment is controlled by the duvet and your bedding! Invest in duvets that are strong in both thermal insulation, moisture control and ventilation!
For most women, this means that natural duvets in wool (sheep, camel, alpaca …) , linen, kapok or natural hair are the best choice, as they score very strongly on these three characteristics!
Real down is a dime on its side. The thermal insulation is top notch! But the success rate is highly dependent on the down cover used and the fill weight – meaning also the fill power – of the duvet. When these factors are properly matched, this can be a godsend.
Synthetic hollow fibers are generally less recommended for women during menopause. That is, unless they truly align with your personal temperature regulation. These duvets are often effective in one or two areas of climate control, but they rarely perform exceptionally well in all three. Advansa is a manufacturer of fibers for synthetic duvets and, much like its competitor 3M, has developed specific fibers that go the extra mile. Certain duvet brands incorporate this technology into their products, so it is worth keeping an eye out for their logos.
5 Tips & tricks: this may be how to hack menopausal nights!
Want to survive the night without waking up like an ice cube or steamed noodles? Combine technology with these habits:
- Keep the bedroom stable at around 18 degrees. Niet kouder: je lichaam moet dan harder werken, en koude voeten remmen juist het inslapen.
- Warm feet, cool head. Sokken of een warm voetenbad vóór het slapen versnellen de warmteafgifte (Kräuchi, 1999).
- Layers. Ademend nachtgoed en een dekbed dat je half kunt wegleggen, zodat je bij een opvlieger niet helemaal bloot ligt en daarna weer afkoelt.
- No alcohol in the three hours before bed and no caffeine after lunch.
- A fixed wake-up time, even after a bad night. This is the core of CBT-I and the fastest way to build up your sleep pressure again.
In conclusion
Sleeping poorly during menopause is not a matter of just “toughing it out.” The mechanism is known, the treatments have been researched, and most women can do something about it. Start with what is in your own hands: your sleep behavior and your sleep climate. If problems persist, the GP is the next step, especially if you suspect there is more going on than just hot flashes.
Next step: if you want to work on your sleep behavior step by step, you will find a CBT-I based program in SleepGrip that you can follow at home. If you have doubts about your mattress or duvet, seek advice in a specialty store that asks about your sleep climate, not just your sleeping comfort.
Good to know: this article provides general information and is not a substitute for medical advice. Have you been sleeping poorly for a while or are you concerned about your health? Talk to your doctor. Read our disclaimer
Resources
- Avis, N.E. et al. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531-539.
- Baker, F.C. et al. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and Science of Sleep, 10, 73-95.
- Bromberger, J.T. et al. (2011). Major depression during and after the menopausal transition (SWAN). Psychological Medicine, 41(9), 1879-1888.
- Caufriez, A. et al. (2011). Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. Journal of Clinical Endocrinology and Metabolism, 96(4), E614-E623.
- Cintron, D. et al. (2017). Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. Endocrine, 55(3), 702-711.
- Ebrahim, I.O. et al. (2013). Alcohol and sleep I: effects on normal sleep. Alcoholism: Clinical and Experimental Research, 37(4), 539-549.
- Freedman, R.R. (2001). Physiology of hot flashes. American Journal of Human Biology, 13(4), 453-464.