Sleep is one of the pillars of good health, and during the menopausal transition, it might be deeply affected. The hormonal shifts we experience during this life stage often make it hard to fall asleep or stay asleep all night. If you’re feeling tired, oscillating between low motivation and anxiety because it is hard to keep pushing through it, you aren’t alone. You might be stuck trying to understand whether you’re suffering from anxiety or insomnia.  The reality is that this might be like asking who came first, the egg or the chicken because sleep problems often cause anxiety or depression and mood challenges also can cause insomnia.

 I know too well how life can become much harder when one experiences insomnia, which is only one of various forms of sleep disruption. After learning more about sleep, I understood I have always suffered from different forms of insomnia, and how my sleep is highly sensitive to my environment and stress in general. Having that paired with chronic pain, hormonal fluctuation, and other menopause transition symptoms is… well… let’s just say not a fun combo.

With the exhaustion comes difficulty thriving in all areas of your life. How can you expect to take care of yourself, maintain healthy relationships or do well at work when you feel so tired? This is a good moment to pause and consider your support network and daily routine. Try reaching out to a friend or loved one, even just to let them know how you are feeling. You might consider joining a support group related to menopause or sleep challenges, either in your local community or online. Finding a group can help you gain encouragement, learn practical tips, and remind you that you are not facing this alone. If you notice you are feeling isolated, think about one small action you can take today to connect with someone, whether it's messaging someone you trust or seeking out a community event. Strengthening your circle, even in small ways, can make this period feel more manageable.

 

I often work with my clients to help them identify and lean into their resources. Each person has a unique context, and your resources might include your loved ones, your community, your passions, your work, and the professionals helping you take care of your health. You don’t need to be alone during this phase of your life, and having professional guidance makes a difference. 

Knowing that you are not broken and that your experience is quite common can be helpful. During midlife, you might be juggling several roles, and just the thought of seeking connection might make you cringe. I understand you. At the same time, I must say that we all need others. Good friendships (or acquaintances) can be a powerful medicine.

 

When I realized I couldn’t solve my sleep problems by myself, I found a professional certified by the Menopause Society who introduced me to Cognitive Behavioural Therapy for Insomnia (CBT-I). It was incredibly helpful.

CBT-I is a structured, evidence-based therapy that teaches you practical ways to change unhelpful thoughts and habits around sleep. For example, sleep restriction helps you regulate your sleep window by limiting the time you spend in bed to match your actual sleep time, making your body more ready for sleep when you do lie down. Stimulus control focuses on strengthening the connection between your bed and restful sleep, encouraging you to only go to bed when you are truly sleepy and to get up if you’re unable to fall asleep after a certain period. These techniques can make the path to better sleep feel less mysterious and more actionable.

CBT-I is the first line of treatment for insomnia. Here it is important to mention that, if you suffer from sleep apnea and restless syndrome, CBT-I can be an additional support, after you address your main problem with a sleep specialist.

One of the many positive aspects of using CBT-I is that it is a flexible and collaborative protocol, which feels aligned with how I work as a therapist. This approach also combines practical strategies within a structured framework with reflective moments to address anxious thoughts about your sleep experience.

 

First, we need to assess and confirm that insomnia is your main problem. Tip: If you are having trouble falling asleep or waking during the night, and this is happening ≥ 3 nights per week or ≥ 3 months, you may be suffering from chronic insomnia.

Next, we will gather data. You will track your sleep patterns for a week so we can understand your experience, develop a treatment plan that fits your needs, and make the best use of your resources.

Then, I will help you use tools such as restriction and stimulus control to help your nervous system feel safe and comfortable enough to fall asleep.

Throughout this process, we will explore mood patterns and learn strategies to help you ride the waves of the menopausal transition.

I recommend we have at least eight sessions to address insomnia exclusively. Each session is structured to help you progressively understand and improve your sleep. In the first session, we will assess your sleep difficulties and clarify your specific challenges and goals.

Sessions two and three focus on sleep education, exploring how sleep works during menopause, and building awareness of factors that contribute to insomnia. In sessions four and five, we introduce tools such as sleep restriction and stimulus control and start practicing them. We might introduce those steps earlier depending on your level of awareness. 

Sessions six and seven are dedicated to troubleshooting challenges, refining strategies, and addressing any obstacles you encounter. Session eight will focus on reviewing progress, consolidating what you have learned, and creating a practical plan for maintaining improvements. 

Once you move beyond the exhaustion, we can continue therapy to address the broader impact of menopause and midlife, including mood, identity, relationships, and personal growth, tailored to your evolving needs.