Still not sleeping during menopause? 7 things worth investigating

Key takeaways

• HRT doesn't resolve every sleep problem. It can improve sleep when hot flushes and night sweats are responsible, but other causes may still need attention.
• Waking at 3am isn't always hormonal. Anxiety, chronic insomnia, pain and sleep disorders can all contribute.
• Sleep apnoea can be overlooked in midlife women. It doesn't always present as obvious snoring.
• CBT-I is an evidence-based treatment for chronic insomnia, while menopause-specific CBT can help with sleep difficulties associated with hot flushes and night sweats [2].
• Specific nutrients and botanical extracts have been studied for sleep-related outcomes. Research into magnesium glycinate, KSM-66® ashwagandha and Affron® saffron is developing, although supplements are not a replacement for investigating persistent insomnia.

Why am I still not sleeping during menopause?

During perimenopause, fluctuating oestrogen and progesterone levels can influence temperature regulation, mood and sleep.

Night sweats may wake us repeatedly. Anxiety can make it harder to settle again. And after weeks or months of disturbed sleep, we may find ourselves anticipating another difficult night before we've even switched off the light.

But there's an important distinction between sleep disruption caused by menopause symptoms and chronic insomnia that continues even when those symptoms improve.

Understanding which we're experiencing can help us identify the next step.

Our earlier guide, Why Can't I Sleep During Perimenopause?, explores the hormonal changes involved. Here, we're looking at what else might be worth investigating when the usual solutions aren't working.

1. Still waking at 3am despite taking HRT?

HRT is an effective treatment for menopause-related hot flushes and night sweats. When those symptoms are disturbing our sleep, treating them can make a meaningful difference [2].

But HRT isn't a treatment for every possible cause of insomnia.

If we're still waking during the night, it's worth asking whether our menopause symptoms are adequately controlled, whether our treatment needs reviewing, or whether something else could be contributing.

For example, we might no longer experience night sweats but still find ourselves lying awake for hours. Or perhaps we fall asleep easily but wake feeling anxious and struggle to settle again.

These different patterns can point towards different approaches.

What to investigate: If we're taking HRT and sleep hasn't improved, a review with our prescriber can help assess symptom control, treatment suitability and other possible causes. We shouldn't adjust our dose without medical advice.

2. Could it be sleep apnoea rather than menopause?

Sleep apnoea is one of the conditions worth knowing about, particularly because it can be mistaken for ordinary menopause-related tiredness.

Obstructive sleep apnoea occurs when breathing repeatedly stops or becomes restricted during sleep, causing brief awakenings that we may not even remember. It becomes more common in women after menopause [3].

And while loud snoring is a familiar sign, not everyone experiences or recognises it.

Other symptoms can include:

• Waking frequently without knowing why.
• Gasping or choking during sleep.
• Morning headaches or a dry mouth.
• Feeling exhausted despite spending enough time in bed.
• Poor concentration and persistent daytime sleepiness.

It's easy to put fatigue and brain fog down to menopause, but sleep apnoea requires its own assessment and treatment.

What to investigate: If these symptoms sound familiar, speak to your GP about whether a sleep assessment is appropriate. Testing can often be arranged at home [3].

3. Restless legs and low iron: an overlooked connection

Ever settled into bed only to find your legs won't settle with you?

Restless legs syndrome causes an uncomfortable urge to move the legs, often accompanied by tingling, crawling or pulling sensations.

Symptoms typically become worse during rest and in the evening, making it difficult to fall asleep. Low iron stores can be one contributing factor, even without obvious anaemia [4].

What to investigate: If restless legs are regularly affecting sleep, a GP can review possible causes, medications and whether iron testing, including ferritin, is appropriate. Iron supplements shouldn't be started at high doses without advice.

4. Why does anxiety feel so much worse at night?

One of the more unsettling experiences during perimenopause can be waking suddenly with a racing heart or a mind that seems determined to revisit every worry we've ever had.

Hormonal fluctuations may influence anxiety and sleep, but the relationship works both ways. Anxiety can disturb our sleep, while poor sleep can make us more emotionally reactive and less able to manage stress the following day.

And once we begin worrying about how little sleep we're getting, that worry can become part of the problem.

There isn't necessarily a special hormonal event happening at precisely 3am. Our normal sleep cycles, early-morning changes in alertness and the absence of daytime distractions can all make waking at that hour feel particularly difficult.

What to investigate: If anxiety is becoming frequent or affecting everyday life, speak to your GP. Persistent palpitations also deserve assessment rather than automatically being attributed to menopause. If palpitations occur with chest pain, fainting or significant breathlessness, seek urgent medical help.

5. Could chronic insomnia itself be keeping us awake?

Sometimes the original reason for our poor sleep improves, but the sleeplessness remains.

We might have started waking because of night sweats. Months later, those symptoms are better, yet we're still lying awake anticipating another bad night.

This can happen because our thoughts and behaviours around sleep have changed. We may start going to bed earlier to compensate, spending longer awake in bed, checking the clock or becoming increasingly anxious about how we'll function the next day.

Over time, these patterns can maintain insomnia.

Why CBT-I is worth knowing about

Cognitive behavioural therapy for insomnia (CBT-I) is a structured, evidence-based treatment that addresses the behaviours and thought patterns contributing to ongoing insomnia. It isn't simply another set of relaxation tips [5].

CBT-I can help us rebuild the relationship between bed and sleep, establish more consistent patterns and reduce the anxiety associated with sleeplessness.

NICE also recommends considering menopause-specific CBT for sleep difficulties associated with hot flushes and night sweats, either alongside other treatment or when HRT isn't suitable or preferred [2].

These approaches aren't identical. CBT-I specifically targets insomnia, while menopause-specific CBT addresses the impact of menopause symptoms.

What to investigate: If sleep problems have become persistent, ask your GP about CBT-I or suitable sleep-focused psychological therapies, including online programmes.

6. What does the research say about magnesium and sleep-supporting ingredients?

When sleep becomes difficult during menopause, it's understandable that many of us look for ways to support our evening routine.

And while supplements aren't a replacement for investigating persistent insomnia, there is a growing body of research exploring how certain nutrients and botanical extracts relate to sleep quality, relaxation and stress.

Importantly, not all forms of an ingredient are the same. The specific extract, formulation and dose used in clinical research can make a difference.

Magnesium glycinate: why the form matters

Magnesium is an essential mineral involved in hundreds of processes throughout the body, including normal nervous system and muscle function.

Magnesium glycinate, also known as magnesium bisglycinate, combines magnesium with the amino acid glycine.

Research into this particular form is developing. A 2025 randomised controlled trial involving 155 adults reporting poor sleep found that magnesium bisglycinate supplementation produced a modest but statistically significant improvement in insomnia symptom scores compared with placebo after four weeks [6].

The findings are encouraging, although larger and longer studies are needed to understand who benefits most.

This is one of the reasons we chose magnesium glycinate for our Better Night® formulation, rather than simply including magnesium without considering its form.

KSM-66® ashwagandha: a standardised extract with clinical research behind it

Ashwagandha has a long history of traditional use, but modern research has also investigated its effects on sleep and stress.

What matters here is the extract.

KSM-66®, the specific ashwagandha root extract used in Better Night, has been studied in randomised controlled trials.

In one 10-week study involving 60 adults with insomnia, participants receiving KSM-66 showed improvements in measures including sleep quality, sleep efficiency and the time taken to fall asleep compared with placebo [7].

A broader review of ashwagandha studies also found promising results for sleep, although the overall effects were relatively small and further research is needed [8].

These studies help explain why we selected a standardised, researched extract rather than a generic ashwagandha powder.

It's worth remembering that ashwagandha isn't suitable for everyone. It may interact with certain medications, including thyroid medication and sedatives, and may not be appropriate for people with certain medical conditions. If we're taking medication or managing an existing health condition, it's important to check with a healthcare professional before taking an ashwagandha-containing supplement.

Affron® saffron: more than a culinary ingredient

Saffron is perhaps better known for its use in cooking, but certain standardised saffron extracts have also been investigated for their effects on sleep and psychological wellbeing.

Affron®, the saffron extract included in Better Night, has been the subject of placebo-controlled clinical research.

A 2021 study involving 120 adults reporting poor sleep investigated Affron at two different doses over 28 days. Researchers observed improvements in self-reported sleep quality and some insomnia-related measures compared with placebo [9].

Another study involving 63 adults also reported improvements in sleep-related questionnaire scores after four weeks of Affron supplementation [10].

These findings are particularly interesting because they relate to the specific branded extract used in our formulation.

Why we brought these ingredients together in Better Night®

When developing Better Night, we wanted to be thoughtful about the ingredients we selected and the research behind them.

Our formulation combines magnesium glycinate, KSM-66® ashwagandha and Affron® saffron with other carefully selected ingredients, including lemon balm, chamomile, Montmorency cherry and vitamins D3, B6, B12 and K2.

Each has its own nutritional or research background, and together they reflect our approach to supporting midlife wellbeing.

EXPLORE BETTER NIGHT®

If sleep problems are persistent, particularly when accompanied by symptoms such as snoring, palpitations or significant daytime fatigue, it's important to investigate the underlying cause rather than relying on supplements alone.

7. When should we ask our GP for further investigation?

If poor sleep is affecting our concentration, mood, relationships or ability to function during the day, it's worth asking for help. We don't have to wait until we're completely exhausted.

Before an appointment, keeping a sleep diary for one or two weeks can make it easier to identify patterns.

Record when we're going to bed, how often we're waking, whether night sweats or anxiety are involved, and how we feel the following morning. It can also help to note symptoms such as snoring, gasping, uncomfortable legs or persistent pain.

What might our symptoms be telling us?

These symptoms aren't enough to make a diagnosis, and more than one cause may be involved. But they can help us have a more informed conversation.

The bottom line: we deserve more than another list of sleep tips

Sleep difficulties are common during menopause, but that doesn't mean every disrupted night should automatically be dismissed as hormonal.

For some of us, improving hot flushes and night sweats will make a significant difference. For others, it may mean investigating sleep apnoea, addressing anxiety or accessing a more targeted treatment for chronic insomnia.

And sometimes several things need attention at once.

Our evening routines, nutrition and wider wellbeing habits still matter. A supplement such as Better Night may be something we choose to include in that routine, provided it's suitable for us.

But if we've tried the usual advice and we're still not sleeping, the next step isn't necessarily to try harder. It's to look a little deeper.

Because a good night's sleep shouldn't feel like something we've simply aged out of.

Frequently asked questions about menopause insomnia

Why do I keep waking at 3am during menopause?

Hormonal fluctuations, night sweats, anxiety and disrupted sleep patterns can all contribute to early-morning waking. But waking at 3am doesn't indicate one specific hormonal cause. Persistent waking may also be associated with chronic insomnia or another sleep disorder.

Why am I still not sleeping even though I'm taking HRT?

HRT can improve sleep when hot flushes and night sweats are responsible, but it doesn't treat every cause of insomnia. If sleep problems continue, speak to your prescriber about treatment effectiveness and whether another condition needs investigating.

What is the best treatment for menopause insomnia?

Treatment depends on the cause. HRT may help when vasomotor symptoms are disrupting sleep. CBT-I is an established treatment for chronic insomnia, and menopause-specific CBT may help with sleep problems associated with hot flushes and night sweats.

Can menopause cause sleep apnoea?

Obstructive sleep apnoea becomes more common in women after menopause, although age, anatomy and other factors also influence risk. Snoring, gasping, morning headaches and excessive daytime sleepiness are reasons to seek assessment.

References and further reading

1. British Menopause Society (2025). New BMS tool for clinicians managing sleep disturbance during the menopause transition.
2. National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23), recommendations.
3. NHS. Sleep apnoea.
4. NHS. Restless legs syndrome.
5. NHS. Insomnia.
6. Schuster J, et al. (2025). Magnesium Bisglycinate Supplementation in Healthy Adults Reporting Poor Sleep: A Randomized, Placebo-Controlled Trial. View study.
7. Langade D, et al. (2019). Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. View study.
8. NIH Office of Dietary Supplements. Ashwagandha: Is it helpful for stress, anxiety, or sleep? View evidence review.
9. Lopresti AL, et al. (2021). An investigation into an evening intake of a saffron extract (affron®) on sleep quality, cortisol, and melatonin concentrations in adults with poor sleep. View study.
10. Lopresti AL, et al. (2020). Effects of saffron on sleep quality in healthy adults with self-reported poor sleep: a randomized, double-blind, placebo-controlled trial. View study.