Perimenopause & Sleep Anxiety: Why You’re Awake at 3 AM | Seanna Crosbie, LCSW-S Therapist in Austin, Texas & California
You wake up, gazing toward the ceiling. 3:14 AM. Again. You get restless—Did I not respond to that email? Is my to-do list expanding overnight? Why can’t I just sleep like I did before? You toss and you turn and check the clock again. 3:27 AM. Frustration rises.
If this rings a bell, you’re not alone. as a therapist in Austin, TX, and California, I work with many women in perimenopause who feel like their once-reliable sleep has suddenly turned against them. The culprit? Hormonal shifts and nervous system dysregulation—a combination that makes restful sleep feel impossible.
But here’s the good news: you can reset your sleep patterns. By understanding the link between perimenopause and sleep anxiety, you can take practical steps to calm your mind, balance your body, and finally get the rest you need.
How Perimenopause Disrupts Sleep | Seanna Crosbie, LCSW-S – Therapist in Austin, Texas & California
The Hormonal Link to Sleep Anxiety
During perimenopause—the years leading up to menopause—your body undergoes unpredictable hormonal shifts that can make sleep feel completely unreliable. You might find yourself lying awake, restless, or waking up multiple times a night, even when you're exhausted. A big part of this comes from changes in estrogen and progesterone, two hormones that help regulate stress, relaxation, and emotional stability. As estrogen drops, your body's stress hormone, cortisol, stays elevated longer, making it harder to wind down at night. Meanwhile, progesterone, a natural calming agent, also declines, making sleep feel lighter, more fragile, and easier to disrupt. Then there are the hot flashes and night sweats. Just as you start to drift off, your body suddenly overheats, leaving you kicking off the covers, then pulling them back on minutes later as a chill sets in. The result? A cycle of frustration, exhaustion, and anxiety about whether you’ll ever sleep normally again.
How to Stop the 3 AM Wake-Up Cycle
The key to breaking this cycle is calming your nervous system, creating a sense of safety in your body, and setting yourself up for deeper, more restorative sleep. Here’s how:
Keep Your Nervous System Calm Before Bed
Try magnesium glycinate – a natural relaxant that helps prevent nighttime wake-ups.
Reduce screen time – blue light disrupts melatonin, so swap scrolling for a book.
Create a wind-down ritual – a warm bath, deep breathing, or light stretching signals your body it’s time for rest.
Reset Your Body at 3 AM (Instead of Spiraling)
Practice 4-7-8 breathing: inhale for 4 seconds, hold for 7, exhale for 8—this slows the heart rate and reduces anxiety.
Shift your thoughts: instead of stressing, try "I trust my body to get the rest it needs."
Keep the lights dim: if you must get up, use warm lighting to avoid melatonin suppression.
Support Your Hormones for Better Sleep
Get morning sunlight – this helps regulate melatonin for deeper sleep later.
Move your body daily – physical activity lowers stress hormones and improves sleep quality.
Reframe Sleep Anxiety
Instead of panicking at 3 AM, try:
Reminding yourself it’s normal – "This is just my body adjusting. I will get the rest I need."
Avoiding the clock – checking the time fuels anxiety. Focus on breathing and relaxation instead.
Practicing self-compassion – "I’m doing my best. My body will regulate in time."
Final Thoughts: You Can Sleep Again
Perimenopause may be unpredictable, but you don’t have to accept sleepless nights as your new normal. By understanding the hormonal connection and making small adjustments, you can calm your nervous system, reduce anxiety, and finally get the deep rest your body craves.
About the Author:
Seanna Crosbie, LCSW-S, is a licensed therapist in Austin, TX, and California specializing in anxiety, perimenopause, and life transitions. With over 25 years of experience, she helps clients navigate hormonal changes, stress, and midlife shifts with a blend of insight-oriented therapy and practical coping strategies. Learn more or schedule a consultation here.
Seanna Crosbie, LCSW-S
