Attention Allies psychotherapist Claire Wirsig explores what happens when ADHD and perimenopause collide – and sleep takes the hit. Forget fairytale slumber; this is the frazzled, middle -of-the-night edition, starring hormones, hyperfocus and too much thinking. In this article Claire unpacks why rest becomes elusive and how a dose of understanding and self-compassion can help you to find your way back to it.
(6 minute read)
In a popular fairy tale, Sleeping Beauty pricks her finger on a spinning wheel and falls into a deep sleep. Well, lucky her! When ADHDers prick their fingers on the perimenopause, they fall into restlessness and wakefulness. Instead of a 100-year nap, we get 3:17 a.m. wide-awake brain cinema featuring our never-ending to-do list, the perfect comeback for a conversation from last week and our latest ear worm (mine is ‘Oops Upside Your Head’ by The Gap Band). Here we explore the relationship between ADHD, perimenopause and sleep.
ADHD and sleep
Many ADHDers will have had the experience of struggling with sleep throughout our lifetimes. Not wanting to go to bed or take naps as children, then, when falling asleep, having vivid dreams or nightmares and waking up in the night. As teenagers, our time optimism and impulsivity can lead us to staying up late working, studying or partying, then crashing for 12 hours when we go to bed. Throughout adulthood, many ADHDers experience erratic sleep: being natural night owls, working hard and playing hard, or as parents surviving the early child-rearing years.
The connection between sleep deprivation and ADHD is a vicious cycle. Poor sleep heightens ADHD symptoms, making it even harder to concentrate, manage impulses and regulate emotions during the day. Adults with ADHD who don’t get enough restful sleep often experience increased irritability, forgetfulness and impulsiveness. Research suggests that roughly 60% of adults with ADHD screen positive for a sleep disorder (Wynchank, 2025).
It isn’t just medical conditions that affect sleep. ADHD traits themselves can be disruptive. Night-time presents the perfect opportunity to hyperfocus on a project – fewer distractions and interruptions (Pacheco, 2025). The quiet of the night can feel like the perfect environment to finally write that email, finish that spreadsheet or reorganise the entire digital photo archive from 2009. When we’re younger, we often have the energy to push through the next day on minimal sleep. As we get older, burning the candle at both ends becomes far less forgiving.
Perimenopause and sleep
In midlife, many of us become less physically active due to competing responsibilities. Even when we ramp up exercise, get fresh air and practise impeccable sleep hygiene (regular bedtimes, fewer screens and lavender-scented everything), ADHDers can still struggle to switch off. Adult hyperactivity is often internal – a restless, looping mind that never quite settles (thinkADHD, n.d.).
During perimenopause, the transition into periods stopping, many women and people who have periods experience increased difficulty with sleep. Symptoms include trouble falling asleep, staying asleep or feeling restored. One common experience is waking regularly between 3 and 4 a.m., then lying awake until the alarm goes off. The result? Grogginess all day, afternoon energy crashes and an internal debate about whether coffee is a lifeline or a betrayal of the next night’s sleep.
Poor sleep quality is an extremely common feature of perimenopause and has a ripple-on effect to other processes in the mind and body (Johns Hopkins Medicine, 2025). For example, when poor sleep impairs executive function, we can forget to take our magnesium tablet or to order our repeat HRT prescription in time. Even when we try ‘doing the right things’, sleeping issues can get in the way. We can feel frustration and shame of knowing what the right things are, yet still struggle to do them in the exhaustion of chronic sleep debt.
Changes in oestrogen and progesterone affect body temperature regulation, mood and circadian rhythms – all of which are closely linked to sleep (Newson, 2025). It’s not just the sleep disruption itself, but the anxiety around it. As sleep becomes unreliable, trust in one’s ability to sleep erodes. “What if I don’t sleep again tonight?” activates the stress response, making relaxation even harder. This creates a self-perpetuating loop of wakefulness, frustration and exhaustion (Johns Hopkins Medicine, 2025).
ADHD + perimenopause + poor sleep: The triple whammy
So, what happens when ADHD and perimenopause collide? For many, it feels like the coping strategies that once worked suddenly stop working. Hormonal fluctuations can intensify ADHD symptoms such as emotional dysregulation, brain fog and restlessness – especially at night. Sleep deprivation then amplifies everything further.
Many who have periods report that perimenopause is the time when their ADHD symptoms worsen, sometimes prompting a first diagnosis. Sleep disruption plays a central role in this experience. When sleep is poor, executive functioning suffers, resilience drops and daily life feels disproportionately hard.
It can be deeply disheartening to be doing all the “right things” but still struggle to sleep. What matters is finding the right approach for you. Support may include a combination of approaches: exercise, meditation, mindfulness, ADHD-aware counselling or psychotherapy, hormonal support, medication reviews and – perhaps most importantly – being kind of ourselves.
In fairy tale, the curse is broken by a kiss. In real life, Sleepless Beauty may need HRT and some lifestyle adjustments. Because if you’re awake at 3 a.m. anyway, even though you might feel like you’re cursed, you’re not. You’re just navigating a natural process alongside an active brain. We might all be seeking that fairy tale ending when it comes to sleep, but we’ll settle for doing our best along with a good dose of self-compassion.
References
Johns Hopkins Medicine (2025). How Does Menopause Affect My Sleep?
www.hopkinsmedicine.org/health/wellness-and-prevention/how-does-menopause-affect-my-sleep (accessed 28 February 2026).
Newson, L. (2025). Sleep and hormones. www.drlouisenewson.co.uk/knowledge/sleep-and-hormones (accessed 28 February 2026).
Pacheco, Danielle (2025). ADHD and sleep problems. www.sleepfoundation.org/mental-health/adhd-and-sleep (accessed 28 February 2026).
thinkADHD (n.d.). ADHD and sleep disorders. https://thinkadhd.co.uk/adhd-and/adhd-and-sleep-disorders/ (accessed 28 February 2026).
Wynchank, D. (2025). How to manage sleep in women with ADHD during (peri)menopause? National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC12438809/ (accessed 28 February 2026).
Click the links if you'd like to visit Claire's therapy website or her directory entry on Attention Allies.
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Published 2 March 2026
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