06/17/2026
Yes, you read that right.. that’s not stress.
The perimenopausal sleep disturbance picture involves multiple mechanisms:
* Vasomotor symptoms (hot flashes & night sweats) (driven primarily by estrogen fluctuations/decline) cause night awakenings and are the single largest contributor to sleep disruption
* Declining progesterone reduces GABA-A–mediated sedative tone, can prevent the ability to return to sleep after waking
* hormonal swings in both estrogen and progesterone, appears to be more disruptive than steady low levels
* Increased sympathetic arousal from low estrogen states heightens pre-sleep arousal and negative thoughts about sleep.
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The 3am awakenings reflect the combined effects of hormonal instability, vasomotor-related arousals, and heightened sympathetic tone.
If this is your struggle right now, book a consult with me if you are in New York or Michigan. And if you to meet my community, you can come and join our 2nd anniversary celebration at my office in Chappqua on July 16th. Link in bio to register.