By Tye Johnson-Mason, DNP, PMHNP-BC
You jolt awake and stare at the dimly glowing digits on your clock: 3:13 a.m. Your heart taps a jittery rhythm against your ribs, the room silent except for your own restless thoughts.
If you often find yourself waking up around 3 a.m. and aren’t sure why, I want you to know this:
You’re not being dramatic.
You’re not “just overthinking.”
And you’re not alone.
Many women going through perimenopause mention this as a common problem, and it can leave you feeling drained. You might fall asleep easily, but then suddenly wake up in the middle of the night with your mind racing.
Before we go further, take a moment to check in with yourself: On a scale of 1 to 10, how would you rate your sleep quality over the last week? (1 being very poor sleep, 10 being restful and restorative every night.) Noticing this number can help make sense of what comes next and see how these issues may be affecting you personally.
Why waking up at 3 a.m. feels so intense
Many women describe the 3 a.m. wake-up like this:
- Heart racing
- Mind spinning
- Feeling hot, restless, or panicky
- Worrying about everything all at once
- Unable to fall back asleep
This usually isn’t about willpower. It’s actually related to how your nervous system works.
A quick overview: the body’s stress response system
Think of your body’s stress system like a home thermostat. The HPA axis acts as the control panel, sensing stress and adjusting the “temperature” through the release of cortisol, your main stress hormone. When it works well, the thermostat keeps you comfortable: the right amount of energy to get up in the morning and wind down for rest at night.
Cortisol isn’t a bad thing. In fact, you need it to wake up in the morning, stay focused during the day, and feel normal.
But the timing matters.
Cortisol levels are supposed to be higher in the morning and lower at night, which helps your body rest.
What perimenopause changes
During perimenopause, hormonal changes can make your nervous system more sensitive and reactive. Your body might not handle stress as easily as it used to.
This means that stress, trouble sleeping, changes in blood sugar, and shifting hormones can all combine to make you feel both wired and tired at the same time.
So instead of staying asleep, your body switches into alert mode.
The cortisol-sleep-anxiety cycle
Here’s what can happen:
- You wake up in the middle of the night.
- Your brain senses “something is wrong.”
- Stress hormones rise
- Your thoughts start racing.
- You feel anxious, hot, restless, or wide awake.
- You start worrying about not sleeping.
- The cycle repeats
Now you’re not just awake. You’re activated.
Why this matters
Chronic sleep disruption affects:
- mood stability
- memory
- energy
- appetite
- anxiety levels
- resilience to stress
When women share that they feel more emotional, overwhelmed, or foggy, I always ask about their sleep. Sleep is the foundation for everything else.
Next time, in Part 3, we’ll discuss brain fog during perimenopause and share a few simple ways to support your nervous system without adding stress to your life.
Disclaimer: This article is for educational purposes and does not replace medical or mental health care. Always consult a licensed provider for individualized support.
About the Author
Dr. Tye Johnson-Mason, DNP, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner at JMS Behavioral Health, where she provides outpatient psychiatric care in New Jersey. She is dedicated to helping women in midlife feel informed, supported, and empowered as they go through perimenopause and menopause.
