Why is sleep so terrible during perimenopause (and what can we do about it)?

The most common demographic profile I see in my clinic is a woman in mid-life, between the ages of 35 and 50. Some of the reasons have to do with caregiving as a woman in the “sandwich generation” or anxiety and depression related to life stressors, but the most common throughline for these patients is perimenopause—the host of hormonal and other biological changes that happen to women for the ten or so years leading up to menopause. If you're in your 40’s (or even on the other side of menopause) and experiencing mysterious awakenings in the middle of the night, you're not alone—and you're not imagining things.