10/20/2026
Awake at 3 a.m. for hours, but no hot flashes? Hormones may still be involved.
In perimenopause, lower estrogen and higher FSH are linked to more nighttime awakenings, even in women who never get hot flashes or night sweats.
The timing makes sense too. Early in the night, sleep drive is strong and most of your deep sleep happens then, so a disruption may not fully wake you. Toward morning, sleep gets lighter. Wake up at 2 or 3 a.m. and your stress response kicks in, cortisol rises, and you stay up.
As Dr. Byrne explains, the thing that woke you isn’t always the thing keeping you awake.
From Dr. Nicki Byrne's conversation on sleep at the Livelong Media NYC Women's Health Summit