Menopause Dreams: Why Your Sleep Is Getting Strange

If you’ve spent time scrolling perimenopause forums, you’ve likely seen the question pop up again and again: “What’s up with all these weird dreams?!” A woman who used to dream rarely is now having vivid nighttime escapades with George Clooney. Or worse—waking up from anxiety-fueled nightmares.

It’s tempting to dismiss these nocturnal visions as a harmless quirk of mid-life. But if they’re regularly disrupting your sleep, they could take a toll on your health. Chronic sleep disruption is linked to cognitive and mood issues, as well as a higher risk of heart disease, stroke, kidney disease, high blood pressure, diabetes, and obesity.

There’s no definitive study linking vivid dreams to menopause—but experts say that doesn’t mean the connection isn’t real. Here’s why your dreams might be getting stranger in perimenopause or menopause, and what you can do to sleep more soundly.

About the Experts:

Fiona Baker, Ph.D., is director of the Human Sleep Research Program at SRI International.

Deirdre Barrett, Ph.D., is an assistant professor of psychology at Harvard Medical School, editor of the journal Dreaming, and author of The Committee of Sleep.

Why Might Menopause Change Dreams?

As estrogen and progesterone levels fluctuate and decline in perimenopause, sleep quality tends to take a hit, and wake-ups increase, which can lead to better dream recall. Some 40 percent of women report sleep disturbances during the transition leading up to menopause, according to a 2024 study.¹ Other sleep issues that are common during menopause—including sleep apnea and anxiety—have been linked to nightmares.²

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Interrupted sleep and dream recall

Harvard researchers have noted that the more you wake up at night—or the more slowly you fall asleep—the more likely you are to remember your dreams.³ And since many women in perimenopause and menopause wake up more often—and take longer to fall asleep—it makes sense that they’re remembering more dreams, says Fiona Baker, PhD, director of the Human Sleep Research Program at SRI International.

REM (rapid eye movement) sleep is the stage where most dreaming happens—and more wakeups mean less REM overall. ⁴ So why are menopause dreams more vivid? 

One explanation is that during REM sleep, areas of the brain associated with short-term memory are fairly active, says Deirdre Barrett, PhD, an assistant professor of psychology at Harvard Medical School.

“We’re essentially recording our dreams onto a short-term notepad,” says Barrett. “But if we don’t wake up, that short-term memory decays in a matter of minutes,” she explains.

Anxiety and menopause dreams

Heightened anxiety is another trigger for vivid menopause dreams, including nightmares. Hormonal changes during menopause can alter neurotransmitter activity in the brain, increasing the risk of anxiety. ⁵ Add in life stress—college-bound kids, aging parents, and work pressure—and you’ve got fertile ground for anxious dreams.

“Daytime anxiety correlates pretty strongly with anxiety dreams and nightmares,” Barrett says. And when you wake up in a state of heightened stress, you’re also more likely to remember those dreams, she adds.

Sleep apnea and dreams

Menopause increases the risk of obstructive sleep apnea (OSA)—a disorder that causes people to stop breathing and wake up several times during the night. ⁶

Not only does sleep apnea increase dream recall, but it may also affect the content of your dreams. When the body is deprived of oxygen, it panics so you wake up, Barrett explains. “And that emotion is transferring into dream content.” One review even linked sleep apnea with more violent or hostile dreams.⁷

According to Baker, declining estrogen and progesterone during perimenopause may be to blame for sleep apnea. Progesterone, in particular, supports the brain’s respiratory drive and helps maintain muscle tone in the upper airway. Without enough of it, the airway can sag or collapse, increasing OSA risk—especially in women who’ve gained weight around the midsection, another common midlife shift.⁸, ⁹

Insomnia and nightmares

Women might experience more nightmares in menopause due to a higher likelihood of insomnia, which affects up to 47 percent of perimenopausal women and 60 percent of post-menopausal women.¹⁰ And like OSA, it’s been linked to an increased risk of nightmares.

A perfect storm of interacting factors come together to cause insomnia during menopause, according to Baker. Hormonal imbalances, particularly the decline in progesterone, make it difficult to fall and stay asleep. Stress, depression, and anxiety, often heightened during menopause, also contribute, she says.

“Insomnia is associated with hyperarousal across multiple systems, like cardiovascular and stress systems,” says Baker. “This state of hyperarousal could influence the tone of dreams and how dreams are recalled.”

Barrett adds that most people with insomnia report anxiety and depression as they’re lying awake. “Psychologically, it’s a vicious cycle,” she says. “Losing sleep causes you to be more anxious, and then anxiety causes you to lose sleep and contributes to nightmares.”

Do Changes in the Brain During Menopause Affect Dreams?

Dream science is still evolving, but we know menopause impacts how the brain functions—and those changes may contribute to weird or vivid dreams.¹¹

• Falling estrogen reduces the ability of the brain to use glucose—its main energy source—leading to decreased activity in key areas involved in cognition, emotion, and dreaming.¹²
• Estrogen loss also impacts the hypothalamus, the brain’s thermostat, leading to hot flashes and spikes in cortisol, says neuroscientist Lisa Mosconi, PhD, a renowned expert on brain changes in menopause and author of The Menopause Brain.¹³ And high cortisol levels can contribute to vivid, bizarre dreams. ¹⁴
• Estrogen affects the amygdala, the brain’s emotional center. When the hormone declines mood swings become more likely—and so do emotionally intense dreams. ¹⁵

Strategies for Managing Menopause Dreams

There’s no magic pill to stop weird menopause dreams, but hormone replacement therapy (HRT, also called menopause hormone therapy or MHT) can minimize forces that wake you during sleep, including relief for anxiety, hot flashes, and insomnia. Besides HRT, plenty of options exist to improve sleep quality—and reduce the chances you’ll wake up remembering every wild detail.

Try a CPAP

Some research estimates that 90 percent of people with sleep apnea are undiagnosed, and many of them are likely women over 45.¹⁶ Studies show that menopausal women are three times more likely to have OSA than pre-menopausal women, even if they don’t have classic symptoms like heavy snoring.¹⁷ 

Instead, women often report frequent waking, early-morning headaches, daytime fatigue—or even acid reflux.¹⁸,¹⁹

Modern CPAP (continuous positive airway pressure) machines are quieter, sleeker, and more effective than you might expect.
 

Review Your Supplements and Medications

Several medications commonly taken by women in menopause can interfere with sleep or dreaming, including:

• Antidepressants. Often prescribed for anxiety and hot flashes, antidepressants can cause insomnia in some 17 percent of people.²⁰, ²¹ 
• Blood pressure medications. Beta-blockers can suppress melatonin; diuretics can lead to frequent urination at night.²²
• ADHD medications. Stimulants like Ritalin and Adderall intended to treat ADHD  symptoms can cause insomnia.²³
• Drug interactions. Women in this age group may be taking more medications and supplements than they used to, so talk to your doctor about whether any drug interactions could be behind your strange dreams or sleep problems.

Never stop a medication without consulting your doctor. But if you suspect a sleep-related side effect, your provider may be able to adjust the dose, timing, or medication.

Avoid alcohol

“Alcohol suppresses REM sleep in the short term, but then there’s a rebound where it makes REM periods more intense,” Barrett says. That can trigger vivid or unpleasant dreams. Consuming alcohol in the menopause years may also worsen hot flashes, which are associated with more night wakings and nightmares. ²⁴

Exercise

Regular exercise improves sleep quality and reduces insomnia for menopausal women with sleep problems, according to a 2023 research review.²⁵ The study authors believe exercise enhances sleep by using up energy, releasing endorphins, and regulating core body temperature.

Try Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard for managing chronic insomnia—and it works for menopause-related sleep issues.²⁶ It targets negative thought patterns and behaviors that interfere with sleep.²⁷ A version called CBT-N (CBT for nightmares)focuses specifically on reducing the intensity and frequency of nightmares.²⁸

Calm Your Brain and Body 

If you wake up from a disturbing menopause dream, Barrett suggests:

1. Deep abdominal breathing. Focus on your stomach rising and try to slow your breath further to release tension.
2. Positive imagery. Remind yourself where you are: “I’m safe at home, the doors are locked, my cat is at the foot of the bed.” Or picture a calming memory or place. 
3. Incubation. Think about your favorite dream and tell yourself, “When I fall back asleep, I want to dream like that.” It may help steer your next dream in a more pleasant direction.