Why am I waking at 3am?

What's actually going on

Researchers are still piecing it together, and for most women it's a few things overlapping rather than one neat cause.

Your hormones are shifting, not just dropping. In perimenopause, oestrogen and progesterone can rise and fall quite unpredictably. It's less like a dimmer slowly turning down and more like someone in the next room fiddling with the switch. Those changing levels can affect your body clock and make it harder to stay asleep, even if you don't have hot flushes.

Night sweats and hot flushes. These are closely linked with waking in the night. Interestingly, women often wake just before a hot flush starts, so you might surface with the doona kicked off and no idea why.

The 3am spiral. Once you're awake, it's easy to start stressing about being awake. Unfortunately, that stress releases cortisol, which makes it harder to drift off again. It's not you being dramatic. It's chemistry.

Life, frankly. Midlife often comes with teenagers, ageing parents, work pressure and a mental to-do list that never quite ends. A 3am brain is excellent at worrying and hopeless at solving anything.

Things worth ruling out. Not every 3am wake-up is perimenopause. Needing the toilet, a glass or two of wine in the evening, pain, snoring or sleep apnoea (which becomes more common around menopause), low mood and anxiety can all play a part. That's exactly why a GP is worth seeing if it's ongoing.

What may help

These are options, not homework. Pick one or two that feel doable.

• Keep your wake-up time steady, even after a rough night. It sounds harsh, but a regular wake time helps keep your body clock on track.
• Get up if you're wide awake. If you've been lying there for 15 to 20 minutes, get up, keep the lights low and do something boring (folding washing counts) until you feel sleepy again. It's also worth turning the clock to face the wall, so you're not doing 3am maths about how much sleep you've got left.
• Look at the evening wine. Alcohol can make you feel sleepy, but it disrupts your sleep later in the night. Try keeping it to more than four hours before bed, or have a few alcohol-free nights and see what changes.
• Ask about CBT for insomnia (CBT-I). It's a structured, drug-free program and a recommended first treatment for ongoing insomnia, including during the menopause transition. You can do it with a psychologist, by telehealth or online, and your GP can tell you whether you're eligible for a mental health treatment plan and Medicare rebates.
• Take the heat out of night sweats. A cool room, a fan, light cotton sheets and layers you can throw off won't stop night sweats, but they can make them easier to sleep through. If hot flushes seem to be what's waking you, your GP can also explain treatment options, including menopausal hormone therapy (MHT) and non-hormonal choices, and whether they suit you.

When to talk to someone

It's worth booking a GP appointment if:

• you're sleeping badly most nights for a few weeks and it's affecting your days
• you snore loudly, wake up gasping, or someone has noticed you stop breathing in your sleep (your GP can arrange a sleep study)
• you can't work out what's waking you, or you've tried the basics and nothing's shifted

If low mood is part of the picture, or you're having thoughts of harming yourself, please don't wait. Talk to your GP soon, or call Lifeline on 13 11 14 any time. In an emergency, call 000.

The bottom line

Waking at 3am is common, it's real, and for many women it's something that can be improved. You don't have to just put up with it, and you don't have to work it out on your own.

As for the thing you said at that dinner in 2011? You're almost certainly the only one still thinking about it.

Read next: Why do I feel tired but wired? Or join the early-access list and we'll let you know when new articles go up.