Who doesn’t have a love/hate relationship with sleep? We all need it, we all love it, and we certainly feel it when we don't get enough of it. One of the most common concerns I've heard from women since I started practicing in 2004 is difficulty sleeping.
And one of the most common complaints? Waking up in the middle of the night, hence, “The 3 AM Club.”
Why can we sleep so easily when we are younger and not so easily during perimenopause and menopause? Well, of course there are a lot of factors, but our changing hormones can have a lot to do with it.
Meet Laura
Meet Laura. Age 49. Wife, mother, successful professional, and until recently, a perfectly respectable sleeper.
But between 2 and 3 a.m., something happens.
Her eyes open.
Oh gosh, I have to go to the bathroom, but if I get up, I will be up forever. Okay, girl, try to hold it and go back to sleep.
The room is silent. The house is dark. Her husband sleeps peacefully beside her, blissfully unaware that Laura has entered a strange new world.
I’m awake!! Whatever you do, no matter what, do not, do not look at the clock!
A world where every unfinished task, forgotten conversation, and questionable decision suddenly demands her immediate attention.
Why did I say that stupid thing at dinner three years ago? I wonder if everyone remembers. And did I pay the electric bill?
Laura has unknowingly crossed into another dimension.
A dimension known only as...
The 3 A.M. Club.
Why 3 am? Your Brain’s Sleep Cycle:
- Sleep isn’t the same throughout your night. We cycle through different stages of sleep every 90-120 min.
- During the first half of the night, we spend more time in deep sleep. During this time, your brain is less responsive to disturbances, and you're harder to wake.
- The catch: As the night progresses, deep sleep decreases. You spend more time in lighter stages of sleep, and bouts of REM dream sleep increase.
Key note: Deep sleep is not REM sleep; they are different.
So by 3 am (depending on when you go to bed), it's easier to wake up.
Hello Adenosine! More Like Bye-Bye Adenosine:
- Adenosine is a brain chemical that builds sleep pressure.
- Sleep pressure is the need to sleep. The longer you are awake, the greater your sleep pressure becomes.
- While you are sleeping, that sleep pressure (and adorable adenosine) gradually decreases.
- At 3 am (depending on when you went to bed), you’ve less sleep pressure.
The catch: If something wakes you up (like dog claws going click-clack on your hardwood floors), it’s wakey-wakey.
You can still feel tired, but your brain has less sleep pressure, making it harder to fall back asleep.
Side note: Caffeine is the king of the masquerade, wearing a mask of wakefulness.
It blocks adenosine receptors in the brain, which is why the entire universe reaches for coffee in the morning.
Cock A Doodle Cortisol:
Cortisol naturally begins rising during the second half of the night to prepare us for morning.
- By early morning, your body may be gradually transitioning toward wakefulness, making it harder to fall back asleep if something disrupts your sleep.
Where’s The Melatonin?
Your sleep-promoting hormone generally remains elevated overnight, then declines as morning approaches. And sometimes that can be in the early hours of the morning. So come 3am, once you're woken, it's more difficult to fall back asleep.
Sugar Is Waking You Up! Blood Sugar That Is:
Eating high-sugar foods before bed can raise your blood glucose, triggering insulin release to bring it back down.
- If blood sugar drops too low, your body releases hormones like adrenaline and cortisol to help bring it back up.
- Adrenaline can increase your heart rate, cause sweating, and suddenly wake you up. Hello, 3 a.m.!
However, true nighttime hypoglycemia is uncommon in people. But blood sugar swings can still play a role in waking you up at night.
What’s Hormones Got To Do With It?
Estradiol:
- Helps regulate body temperature (hot flashes, heat flushes, night sweats).
- Helps with actual sleep quality.
- Estradiol receptors are found throughout the brain (areas for regulating sleep and wakefulness).
- Helps regulate neurotransmitters involved in sleep, mood, alertness, and relaxation, including serotonin, GABA, and norepinephrine.
- Affects the hypothalamus for temperature and sleep-wake cycles.
The catch: In perimenopause, when estrogen levels fluctuate and decline, or in menopause with low estradiol, these changes can contribute to disrupted sleep, so back to wakey-wakey and feeling like you didn’t get any restful sleep.
Progesterone:
- Converts to allopregnanolone, which makes GABA receptors more sensitive to GABA and enhances its effects. More GABA activity helps quiet an overactive brain.
When progesterone declines in perimenopause and menopause, you can lose that calming influence, hence being up at 3 am pondering every decision you’ve made, and the ones to come.
Waking Up To Pee All Night?
Waking up to use the bathroom several times a night is frustrating enough. But when you can't fall back asleep afterward, it can leave you feeling exhausted the next day.
Our bodies are designed to produce less urine at night so we can sleep without constantly getting up to pee. A hormone called vasopressin (ADH) signals our kidneys to conserve water and make less urine while we sleep. At the same time, our brains are less responsive to signals from the bladder, allowing us to sleep for longer stretches without needing to use the bathroom.
But when it comes to perimenopause and menopause, you might find yourself waking up to pee several times.
Is it because you drank more water before bedtime? Sure, that could be part of it, but it can be your hormones too.
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Estradiol:
- There are many estrogen receptors in the bladder and urethra.
- Bladder sensitivity: Estradiol helps regulate sensory nerves in the bladder. Declining levels may increase urgency, even when the bladder isn't full.
- Bladder muscle: Estradiol influences the detrusor muscle, which contracts to empty the bladder. Changes in estrogen signaling may contribute to urinary urgency.
- Urethral health: Estradiol maintains urethral tissue thickness, elasticity, and blood flow. Lower levels can contribute to urinary symptoms.
Sometimes your bladder wakes you up. Other times, you wake up for another reason and simply decide to pee.
Now that we understand why so many of us wake up at 3 a.m., the next question is: what can we do about it?
In my paid newsletter, I'll walk you through practical ways to improve your sleep, including how to assess your estradiol and progesterone, what supplements to consider if you're already taking HRT, and what else might be keeping you awake.
Ready to leave The 3 A.M. Club? Read the paid edition for solutions to help you sleep better.
