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Why you wake up at 3AM in menopause (and how to fall back asleep) | Felice Gersh, MD

Felice Gersh

13,751 views

In this talk, I explain why so many women wake up in the middle of the night, often around 2–3AM, and have trouble falling back asleep.

Hormonal changes in perimenopause and menopause play a major role. Declining estradiol affects serotonin and melatonin production, which disrupts normal sleep cycles. At the same time, cortisol can rise during the night, making it harder to fall back asleep. Night sweats and hot flashes are also a common cause, but they are not the only reason.

I review other key contributors, including light exposure, circadian rhythm disruption, exercise timing, alcohol, late meals, medications, sleep apnea, and environmental factors like noise and temperature. I also share practical strategies to improve sleep, including light exposure, sleep hygiene, cognitive behavioral techniques, and when to consider hormone therapy or a sleep study.

Waking up occasionally is normal. Not being able to fall back asleep is not—and it is something that can be improved.

Watch for my latest Instagram lives at
Instagram: dr.felicegersh

I am a full time practicing doctor. I see patients in my office in Irvine, CA and worldwide via telemedicine. If you need more healthcare assistance than I can provide in a video series, please contact my office:
https://integrativemgi.com/

#SleepProblems #MenopauseHealth #SleepHealth #HormoneHealth #Insomnia #Perimenopause #HealthyAging #CircadianRhythm #DrFeliceGersh

~~---- Contents of this video --------------------------~~

00:00 why waking up at 3AM matters
01:00 night sweats, hot flashes, and sleep disruption
03:00 estradiol, serotonin, and melatonin
05:00 cortisol and why you can’t fall back asleep
06:00 light exposure and circadian rhythm problems
08:00 hormones, progesterone, and sleep quality
10:00 lifestyle triggers: alcohol, food, and exercise timing
12:30 sleep apnea, medications, and underlying health issues
15:30 environmental factors: light, noise, and temperature
18:00 practical tools to fall back asleep (CBT techniques)

20 Comments

@GlobalMenopauseCollective 5 months ago

So many women wake at 3 AM in menopause and think it’s just stress, but hormones often play a big role too. Understanding the reason behind broken sleep can make it feel less frustrating and easier to manage. At the Global Menopause Collective, we’re helping women make sense of these changes so they feel more supported through midlife.

@marypoppings12 8 days ago

Thank you so much for not hoarding this information for your paid clients only and thank you for sharing it with us. I cannot even begin to explain how grateful I am. Everything I have suspected but NO doctors but you have been able to explain it like you do.

@ewelinakozlowska3639 5 months ago

Mine was histamine intolerance, but so little is talked about it in perimenopausal women. I was told by several doctors that is stress or anxiety and all of them wanted to put me on antidepressants. I tried everything to stop waking up in the middle of the night. Sleep hygiene, medication, herbal remedies to regulate cortisol, sleeping tablets etc, nothing worked. Until I came across one video linking histamine intolerance with drop in progesterone level. So that night I took anti histamine and slept all night. I strongly believe that most of issues are linked to gut microbes that change massively during perimenopause and your digestive track. Im working on it now and i see big improvements. Soon as i touch high histamine food i flare up in hives and my sleep is disrupted that night.

@minatohid7855 5 months ago

Estradiol manages our thermostat as well beside everything else that it does!!!

@beautifulmess2023 1 month ago

Anyone watching this in the middle of the night 👋

@Olga-rd3gg 5 months ago

I did notice light in the am helps. I use a light box (northern lights is the brand I believe). I turn it on when I drink my coffee and it wakes me right up.

@silverST-u7m 5 months ago

We love you!

@janereinhardt4715 5 months ago

I just realized about 1 year ago that many people sleep all night! I thought that everyone woke up every half hour or every 1 hour like i do! I have been tired my whole life, i know that! I slept until about 4 p.m today, off & on, as always.

@CleanEatingKitchen 5 months ago (edited)

I pop an oral progesterone when I wake up and I’m good to go! Asleep the rest of the night. Please stop demonizing oral progesterone! The research shows it is so helpful for women!!!!!!

@Olga-rd3gg 5 months ago

A combo of a patch and injections was the key to me. The patch provides a “floor” but it’s not enough on its own. So injections supplement it.

@heidixxx2454 3 months ago

I've been awake for 2+ hours since my mid 30s. 1:30, 2:30 until 5am ish. I'm 61 now. Although I'm naturally hot, I never have had night sweats. Melatonin not a big help. I've done as much as 6 mg immediate release + 6 mg delayed release. I've tried many things. Started BHRT 8 months ago. Still slowing titrating up on E2, some DHEA. I do 96mg topical Pg. Still take some melatonin. Sleep involves so many factors--I'm pretty diligent--but it's difficult to control all, or be good at all at the same time. I take 1/4 tab of benadryl some times when I must be able to function for something important and when I do I feel so much better the next day. For an item that is said to be bad for our memory, I sure feel so much better. I never had children, been a housewife with part time simple work. I can't imagine how other women function having kids and careers with the same sleep disturbance.

@gingermonroe4153 3 months ago

Great info, thx so much ❤🎉

@Jennifer-jf7nx 5 months ago

Estrogen definitively helps me sleep I had chronic insomnia for 14 years nothing put me to sleep like hormones.. but one thing I find interesting is testosterone keeps me sound asleep all night and gives me long dreams

@onewomansjourney760 5 months ago (edited)

Taking the Micronized oral capsule Progesterone INSERTING VAGINALLY at bedtime along with Estradiol patch works wonders for me, great sleep! Removed ALL anxiety, removed racing thoughts! Removed hot flashes. Cortisol spikes at night too keeping us awake. Eat something, drink some juice, then go back to sleep. Also, when outside....your Eyes NEED sunlight! Not looking at the sun but remove those sunglasses people. 😎 My husband & I started sleeping in separate rooms and it's worked wonders & NO, it hasn't negatively impacted our marriage. It's improved our mood, health, marriage. We always spend alot of time together anyway. Don't call it sleep divorce though. Sounds so negative.

@Duc-ef7bb 5 months ago

Sleep issues were brutal for me 😩 I’d wake up at weird hours and feel heavyy the next day. My stomach always felt bloaated too. Then a girl in a womens group told me about Eat.Like.a.Woman.Protocol by -L. Green. I tried it and somehow dropped 30 lbs, belly finally flat again. Crazy more ppl dont know this.

@honifit 5 months ago

A room too dark stops me going to sleep. Been like this since childhood.

@Icewing10 3 months ago

Very detailed video! I had no idea Nocturia existed. I've been dealing with this for years.

@angelinaperfumes 4 months ago

Thank you!! ❤❤❤

@Inat____1010 3 weeks ago

Hallo from Indonesia. Ive been trying to to book a consultation with your clinic - but with no luck 🥲written many mails. No answer. I really wish to arill get one. Think everything you say majes so much sense.