Why do I feel tired but wired?

What's actually going on

Being bone-tired and on high alert at the same time is a real thing, and perimenopause can add fuel to it. There isn't one neat answer, and researchers are still working parts of this out. But a few things tend to stack up.

Your hormones can drain your energy. The hormonal changes of perimenopause can make some women feel more tired than usual, and can turn up anxiety too. Things you'd normally take in your stride can suddenly feel like a lot.

Broken sleep keeps the cycle going. Sleep problems become more common in the lead-up to menopause, and night sweats can break up the night. Poor sleep leaves you running on empty, and running on empty makes the evenings harder.

Your brain can stay on high alert. Sleep researchers use the word hyperarousal for one pattern that can keep insomnia going: when bed starts to feel like the place you lie awake and worry, it gets harder to switch off. For some women it may be one part of the picture, not the whole story. A 2018 review describes a large US study that found signs of more alertness during sleep in women later in perimenopause than earlier on, partly linked to hot flushes. It can't tell us why any one woman feels tired but wired.

Life is genuinely full. Work, kids, ageing parents, money, relationships. Midlife tends to pile them on at once, and a stretched day doesn't hand you a calm brain at bedtime.

"Is it adrenal fatigue?" You may have seen this online. It isn't a recognised medical condition, and studies haven't backed it up. Treating it without a proper diagnosis can be risky, so if someone offers you a supplement for it, talk to your GP first. (There is a real, rare adrenal condition, and doctors can test for it.)

Other things worth ruling out. Ongoing tiredness can also come from iron deficiency (more likely if your periods are heavy), an underactive thyroid, sleep apnoea, depression, some medicines, or too much caffeine or alcohol. That's why it's worth getting checked rather than just pushing through.

What may help

If any of the signs in "When to talk to someone" below apply to you, follow that care advice first: urgent signs need urgent care straight away, and other concerns are worth a GP visit. Otherwise, you could try one or two of these for a few weeks and see what helps.

• A caffeine cut-off. Caffeine stays in your system for hours, so a good rule of thumb is no coffee, tea or energy drinks after about 2pm. Yes, that includes the "small one" at 3.
• Daylight in the morning, and movement during the day. Morning light helps set your body clock, and regular exercise is good for sleep. Just aim for earlier in the day rather than right before bed.
• A wind-down hour. In the hour before bed, put away the screens, emails and big conversations, and do something quiet instead: a warm shower, a book, some quiet music.
• Worry time, earlier in the evening. Set aside a little time well before bed to think through what's on your mind. Some people find writing it down, with what they'll do about it, helps it stay on the page instead of waiting for them at lights-out.
• Ask about CBT for insomnia or mindfulness. Both have been shown to improve sleep during the menopause transition, and there are online programs too. Ask your GP whether you're eligible for a mental health treatment plan and Medicare rebates for sessions with a psychologist.

When to talk to someone

See your GP if:

• you've felt tired for more than two weeks and it isn't getting better
• sooner if it's worrying you, it's stopping you doing things, or you've also lost weight without trying
• your periods are heavy or getting heavier, or you have bleeding between periods, after sex or after menopause. Ask about checking your iron.

Get urgent care if you have a heavy period along with dizziness or weakness, or bleeding that's suddenly much heavier than usual.

If you're feeling low or anxious most days, or having thoughts of harming yourself, please reach out now. Talk to your GP, or call Lifeline on 13 11 14 any time. In an emergency, call 000.

The bottom line

Tired but wired isn't a character flaw, and it isn't something you just have to put up with. There's usually more than one thing going on, and that means there's usually more than one thing that can help.

Now close a few of those tabs. The permission slip can wait until morning.

Next on the Learn hub: what does brain fog actually feel like? Join the early-access list and we'll let you know when it's ready.