Why Women in Their 40s Can’t Sleep Through the Night with Dr. Deborah Matthew

 In Health, Sleep

Hormonal changes during perimenopause significantly impact sleep quality in women. Progesterone, testosterone, cortisol, and thyroid function play interconnected roles in regulating mood, energy levels, and the sleep-wake cycle. Understanding the dynamics of these hormones can help us navigate the twists and turns of sleep disruption and finally get that quality sleep that we are all looking for. 

And nobody understands that better than one of my recent guests on the Sleep Like a Boss podcast, Dr. Deb Matthew. 

Dr. Deb Matthew MD, also known as the Happy Hormones Doctor, is a best-selling author, international speaker, educator, wife and mom of four boys. After suffering for years with fatigue and irritability due to hormone imbalances, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and FOX.

The Changes That Happen in Perimenopause 

Perimenopause, or as Dr. Deb calls it "puberty in reverse," marks the transition period preceding menopause, during which hormonal changes, including fluctuations in progesterone, estrogen, testosterone, cortisol, and thyroid function, can significantly impact sleep quality. 


Progesterone, known for its calming effects, experiences a decline during perimenopause, contributing to increased feelings of anxiety, irritability, and impatience among women. This decline in progesterone levels correlates with disrupted sleep patterns, characterized by frequent awakenings and difficulty falling back asleep, often accompanied by night sweats. The relationship between progesterone and sleep underscores the importance of hormonal balance in promoting restorative sleep.


Similarly, testosterone, typically associated with male physiology, plays a crucial role in women's mood regulation, motivation, and energy levels. As testosterone levels fluctuate during perimenopause, women may experience a sense of apathy, decreased motivation, and diminished zest for life, all of which can impact sleep quality. Addressing testosterone imbalances is essential for restoring vitality and improving sleep outcomes in women.


Cortisol, the body's primary stress hormone, exhibits a circadian rhythm that influences the sleep-wake cycle. Dysregulation of cortisol levels, characterized by elevated or diminished secretion at inappropriate times, can lead to insomnia, nocturnal awakenings, and difficulty maintaining sleep. Chronic stress, a common feature of modern lifestyles, exacerbates cortisol dysregulation, further compromising sleep quality and overall well-being.


Moreover, thyroid dysfunction, often intertwined with hormonal imbalances, presents another contributing factor to sleep disturbances in women. Hypothyroidism, characterized by an underactive thyroid gland, is associated with excessive daytime sleepiness and prolonged sleep duration, while cortisol dysregulation further exacerbates thyroid function, perpetuating sleep disruptions. So, if you're taking your thyroid medications but still having the same symptoms, you might have a cortisol imbalance. 

How Do You Know if It's Your Hormones? 

Hormone disbalances bring a lot of different symptoms First up, progesterone, your calming companion. 

  • Progesterone, known as the calming hormone, declines during perimenopause, leading to increased anxiety, night sweats, and difficulty falling asleep. 
  • Testosterone, often associated with men, also influences mood, memory, and motivation in women. Fluctuations in testosterone levels can result in feeling stuck, lacking drive, and struggling to find joy in daily activities, all of which contribute to sleep disturbances.
  • Cortisol, the stress hormone, disrupts sleep schedules with its erratic patterns, causing issues like experiencing a second wind at night or persistent anxiety. Coping with stress becomes challenging, leading to feelings of overwhelm and exhaustion.

The symptoms don't stop there. From food cravings to blood pressure fluctuations, hormonal imbalances can manifest in various ways, making it challenging to pinpoint the root cause of sleep disturbances. For women in their forties and beyond, the struggle to cope with life's stressors becomes all too real, often leading to emotional exhaustion and physical fatigue.

But by recognizing the patterns of hormonal imbalance and seeking solutions tailored to your needs, you can take proactive steps toward reclaiming restful sleep and revitalizing your well-being. From lifestyle modifications to hormone testing, there are avenues to explore on the journey to balancing your hormones and getting your sleep back on track.

How to Get Your Hormones in Balance

According to Dr. Deb addressing hormonal imbalances, prioritizing a healthy diet is paramount. Focusing on whole foods rich in healthy fats, such as olive oil, avocados, and nuts, is crucial. These fats are integral for hormone production, including cholesterol-based hormones like estrogen, progesterone, testosterone, and cortisol. Ensuring an adequate intake of protein from sources like wild-caught fish and grass-fed beef supports overall hormonal health.

Furthermore, reducing sugar intake is essential, as it can exacerbate symptoms like night sweats and disrupt sleep by promoting inflammation, which throws hormones off balance. Dr. Deb shares that some of her patients report huge improvement in their symptoms by simply managing their diet, even before hormone testing results are available.

In addition to dietary adjustments, incorporating physical activity is beneficial, as it helps regulate cortisol levels and supports hormonal balance. While intense exercise isn't necessary, activities like walking or stretching are sufficient.

Prioritizing quality sleep is another cornerstone of hormone balance. Practicing good sleep hygiene, such as maintaining a consistent bedtime and minimizing exposure to artificial light before bed, can enhance sleep quality.

Managing stress is another crucial factor for hormonal health. While eliminating stress entirely may be impossible, adopting stress management techniques like meditation, mindfulness, or gratitude journaling can help mitigate its effects. Because these practices influence biochemical pathways, reducing the negative impact of stress on hormone balance.

Also, supplementation with key nutrients like a high-quality multivitamin, fish oil, and vitamin D can further support hormone health. Magnesium supplementation may also aid in regular bowel movements, facilitating the elimination of excess hormones from the body.

Dr. Deb also shares that in cases where lifestyle modifications aren't sufficient to address hormonal imbalances, hormone replacement therapy (HRT) may be considered. While cortisol is typically managed through lifestyle changes and supplements, estrogen, progesterone, and testosterone replacement may be warranted, especially as we approach menopause.

Dr. Deb points out that concerns about HRT and breast cancer risk are based on misconceptions. Research suggests that estrogen replacement alone does not increase breast cancer risk. It's the combination of estrogen with a specific kind of synthetic progestins that may slightly elevate risk. Women who undergo hysterectomy and receive estrogen alone may even experience a decrease in breast cancer risk.

If you’d like to connect with Dr. Deb or learn more about her work, head over to her Instagram, Facebook and LinkedIn. Also, make sure you take a look at Dr. Deb’s book This Is NOT Normal!: A Busy Woman's Guide to Symptoms of Hormone Imbalance.

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