# Sleep and mood in perimenopause

> When 3am becomes your new wake-up time

Category: Perimenopause · 4 min read · Written by the Splash team · Sources checked October 2026
URL: https://splash.care/learn/perimenopause/sleep-mood

## Quick answer

- Sleep problems, low mood and anxiety are common in perimenopause.
- Regular routines, cool rooms and exercise help.
- CBT made for menopause and HRT are both options NICE recommends considering; talk to a GP.

Disrupted [sleep](https://splash.care/learn/movement-sleep/sleep-cycle), [low mood](https://splash.care/learn/mind-mood/why-mood-shifts) and [anxiety](https://splash.care/learn/mind-mood/luteal-anxiety) are some of the most common, and least talked about, [perimenopause](https://splash.care/learn/glossary/perimenopause) symptoms. They also feed each other: poor sleep makes mood worse, and worry makes sleep worse.

## Helping your sleep

- Keep a regular bedtime and wake time, even at weekends
- Keep your bedroom cool, dark and quiet, especially if you get night sweats
- Try to avoid [alcohol](https://splash.care/learn/nutrition/caffeine-alcohol) and nicotine for 1 to 2 hours before bed. Caffeine can keep you awake, so try a warm milky drink or herbal tea instead later in the day.
- Try to avoid screens for an hour before bed
- If you are awake after around 20 minutes, get up, do something calm, and go back to bed when sleepy
- Get daylight and be active during the day

## Looking after your mood

- Talk to people you trust about how you are feeling
- Regular [exercise](https://splash.care/learn/period-care/exercise-on-period) can help mood
- Try relaxation, [mindfulness](https://splash.care/learn/glossary/mindfulness) or yoga
- NICE says to consider [CBT](https://splash.care/learn/glossary/cbt) designed for [menopause](https://splash.care/learn/glossary/menopause), for low mood and anxiety linked to hot flushes, and for sleep problems that go with them
- NICE also says to consider [HRT](https://splash.care/learn/glossary/hrt) for low mood that starts around the same time as other menopause symptoms
- If you have depression, treatment follows the usual depression guidance and can be given alongside menopause care. You can refer yourself to NHS talking therapies in England.

**Myth:** Feeling anxious or low in your 40s is “just stress”.

**Fact:** Hormone changes can genuinely affect mood. That does not mean it is “all hormones” either, so it is worth an open conversation with a doctor. Both can be true at the same time.

> **Splash says:** if you wake at 3am, do not clock-watch. Get up, do something calm in dim light, and go back to bed when sleepy.

### When to see a doctor

See a GP if low mood, anxiety or poor sleep are affecting your life. If you are having thoughts of harming yourself, get help now: call 999, go to A&E, or call Samaritans on 116 123 (free, any time).

## Sources

1. [NHS: Things you can do to help with menopause symptoms](https://www.nhs.uk/conditions/menopause-and-perimenopause/things-you-can-do/)
2. [NICE NG23: Menopause: identification and management](https://www.nice.org.uk/guidance/ng23)
3. [NHS Every Mind Matters: How to fall asleep faster and sleep better](https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/how-to-fall-asleep-faster-and-sleep-better/)
4. [NHS: Symptoms of menopause and perimenopause](https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/)

This is general information, not medical advice. Splash can’t diagnose. If you’re worried, talk to a GP, pharmacist or sexual health clinic. In an emergency call 999 (UK) or 911 (US).