Insomnia is a typical symptom of perimenopause, and it plays an active cause-and-effect role in other perimenopausal conditions. Night sweats and panic attacks, for example, can contribute to insomnia. Long-term insomnia can contribute to heightened anxiety and feelings of fatigue, moodiness, and irritability. When women don't get enough rest, they can have difficulty with concentration, focus, and memory, and their overall physical and mental health can suffer.

Insomnia — a condition characterized by an inadequate amount or poor quality of sleep occurring three or more nights a week — isn't a concern just of menopausal women. As a nation, the United States appears to have entered a time of greater sleeplessness than ever before. The National Sleep Foundation (NSF) (an independent, nonprofit organization) released the results of its own national sleep survey in 2003, revealing that 71 percent of American adults between the ages of 55 and 74 report some sort of sleep problem, and most say they were able to get more sleep in the past (as little as five years earlier) than at the time of the survey.

Menopausal women are at particular risk for insomnia. In a 2006 Harris poll, women suffering from insomnia reported that this was the symptom of menopause that bothered them the most, with 72 percent of participants experiencing it frequently (at least once per week), and 59 percent losing on average three or more hours of sleep each night. The vast majority of these women, 88 percent, said they have more fatigue during the day, 62 percent said they are more irritable, and 44 percent said they cannot do their job as well.

Hormonal Imbalances and Sleeplessness

Remember when you were a teenager and could — if allowed — sleep past noon? For most women approaching menopause, that capacity for endless sleep is only a distant memory. Throughout her adult life, a woman's hormonal balance affects her ability to sleep. Many women experience sleep disturbances during menstruation, pregnancy, and in perimenopause and menopause.

Women who experience PMS often report sleeping difficulties during that same late phase of the menstrual cycle (days 22 through 28). The physical symptoms of PMS include bloating, headache, moodiness, and cramping — all of which can contribute to sleeplessness. But women with PMS report a range of sleep problems in addition to insomnia, including hypersomnia (sleeping too much) and daytime sleepiness. As women who have a history of PMS approach menopause, those symptoms can become even more severe.

Many sleep problems in perimenopause are caused by other symptoms of diminishing hormones, including hot flashes and night sweats. Though these problems may not diminish the length of a woman's sleep cycle, they can disrupt sleep frequently enough to cause fatigue and sleepiness throughout the following day. In the NSF poll, women reported that hot flashes contributed to their sleep disturbances at least five days a month.

Many doctors recommend hormone therapy or alternative treatments to combat many of the symptoms of perimenopause and menopause, including sleeplessness.