A sleep routine for menopause: habits, CBT-I and what works

Name: A sleep routine for menopause: habits, CBT-I and what works
Creator: MenoWoman

Good sleep habits are a sensible base, but the best-proven treatment for ongoing insomnia, including in menopause, is cognitive behavioral therapy for insomnia (CBT-I). It can help even when hot flashes continue.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

Woman stretching happily in bed in the morning sun

See a doctor if you often sleep badly, if you snore loudly or stop breathing in sleep, have restless legs, or feel very sleepy during the day. Night sweats with fever or weight loss also need checking.

Why sleep changes in menopause

About 40 to 69% of midlife women report sleep problems during the menopause transition.¹ Hot flashes and night sweats can wake you.¹ They are also linked to more time awake at night, even when women do not notice the hot flashes.¹

Other causes include anxiety and low mood, restless legs and sleep apnea. Sleep apnea becomes more common around menopause and is easy to miss in women, because symptoms are often subtle.¹ For more on causes, see sleep problems and night sweats.

Everyday sleep habits

These "sleep hygiene" habits are widely recommended and low-risk. They form one part of CBT-I, the recommended treatment for chronic insomnia.² On their own, they are less well proven.

Keep a regular schedule. Get up at the same time every day, including weekends.⁴
Do not lie awake for long. If you cannot sleep after about 20 minutes, get up, do something calm, and return when sleepy.⁴
Make the bedroom cool, dark and quiet. A fan, layered bedding and breathable nightwear can help with night sweats.⁴
Watch caffeine, alcohol and nicotine. Stimulants last for hours, and alcohol can disturb sleep later in the night.⁴
Keep naps short and early, under an hour and not late in the day.⁴
Move during the day and get outdoors, but avoid hard exercise close to bedtime.⁴
Park your worries. Write them down earlier in the evening and set them aside for tomorrow.⁴

Special cooling devices have not been shown to reduce night sweats in small controlled trials, though some women find them more comfortable.⁸

Try changing one or two habits at a time, and give each a couple of weeks. A short sleep diary can show what helps and is useful to bring to a doctor.

CBT for insomnia (CBT-I)

The American College of Physicians recommends CBT-I as the first treatment for chronic insomnia in adults.² A Menopause Society practice guide also calls it first-line for insomnia in midlife women.¹ It says CBT-I works as well as sleep medicines in adults generally.¹

CBT-I usually runs over several weeks. It includes setting a fixed sleep window, using the bed only for sleep, changing unhelpful thoughts about sleep, and sleep education.² It can be done one-to-one, in groups, by phone, online or with a self-help book.²

Some parts, such as limiting time in bed, can make you sleepier during the day at first. It is best followed with a trained therapist or a structured program. Ask your doctor first if you drive for work, or have epilepsy, bipolar disorder or another health condition.

A US trial included women aged 40 to 65 with insomnia and at least two hot flashes a day.³ Six short phone sessions of CBT-I gave lasting sleep improvements compared with menopause education.³ Hot flashes did not become less frequent, but women said they interfered less with daily life.³

Ask your doctor about local CBT-I services, as access varies by country. Online programs are available in many places. See also CBT for menopause.

Other things that may help

In menopausal women, exercise programs, most often walking, reduced insomnia severity in a review of trials.⁵ Mindfulness meditation improved sleep quality in adults about as well as other proven treatments.⁶ Relaxation techniques alone have not been shown to treat insomnia, but they are often part of CBT-I.⁷

If night sweats are the main cause of waking, treating them may help. Talk to your doctor about options such as hormone therapy or non-hormonal treatments.

What it is used for: evidence rated

Option	Evidence	What the research shows
CBT for insomnia (CBT-I)	Strong evidence	First-line treatment for chronic insomnia in major guidance, with trial evidence in midlife women with hot flashes.^2,1,3
Sleep hygiene habits	Some evidence	Widely recommended and low-risk, but included as one part of CBT-I rather than proven as a treatment on its own.^4,2
Regular exercise	Some evidence	Exercise reduced insomnia severity in menopausal women, though overall sleep quality scores did not change significantly.⁵
Mindfulness meditation	Some evidence	Improved sleep quality in adults compared with education alone.⁶
Hot flashes disturbing daily life	Some evidence	In one trial, CBT-I did not reduce hot flash frequency but women felt hot flashes interfered less with daily life.³
Relaxation techniques alone	Weak evidence	Not shown to treat chronic insomnia on their own.⁷
Cooling devices for night sweats	Weak evidence	Small studies found no objective reduction in night-time hot flashes.⁸

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.