What To Do If You Can’t Fall Back Asleep (and Why Insomnia Happens)

It’s 3am. You’ve woken suddenly, your mind racing, and no matter how many times you flip your pillow over, sleep refuses to return. If this sounds familiar, you’re not alone. Women are more likely than men to experience insomnia, particularly during times of hormonal change such as pregnancy, perimenopause and menopause. But why does this happen — and what can you do when sleep simply won’t come?

Why Insomnia Happens

Sleep disturbances have many possible causes, but for women, biology and life stage play a significant role:

• Hormonal changes: Fluctuations in oestrogen and progesterone during the menstrual cycle, pregnancy or menopause can disrupt normal sleep patterns. Hot flushes and night sweats in menopause are well-known culprits.

• Stress and anxiety: Cortisol, the “stress hormone”, keeps the brain alert and makes it difficult to drift back off once you’re awake.

• Health conditions: Thyroid issues, chronic pain, and conditions such as restless legs syndrome are more common in women and can interfere with sleep.

• Caring responsibilities: Being woken by children, caring for family, or simply carrying the “mental load” can fragment rest.

Insomnia Affects Women Disproportionately

Research consistently shows that women are between 30–50% more likely to experience insomnia than men. Studies from the National Sleep Foundation and the Journal of Clinical Sleep Medicine suggest that hormonal changes are only part of the picture.

Women are also more likely to report co-occurring conditions such as depression, anxiety, chronic pain, and autoimmune disorders, all of which can worsen sleep. Social factors — including caregiving roles, workplace stress, and the impact of gendered expectations — also contribute to the disparity.

These overlapping biological and social pressures mean that insomnia is not just more common in women, but often more persistent and complex to treat.

What To Do If You Wake in the Night

The good news is there are evidence-based strategies that can help you return to sleep:

1. Don’t Stay in Bed Tossing and Turning

If you’ve been awake for more than 20 minutes, get up. Staying in bed frustrated conditions the brain to link your bed with wakefulness. Instead, move to another room, keep the lights dim, and do something calming such as gentle stretching or reading.

2. Keep the Lights Low

Avoid bright light and especially phone or tablet screens, which emit blue light that signals your brain to wake up. If you must use your phone, enable a night mode filter.

3. Try a Breathing Exercise

Techniques such as “box breathing” (in for 4 counts, hold for 4, out for 4, hold for 4) or progressive muscle relaxation can lower heart rate and ease anxious thoughts.

4. Don't Watch the Clock

Clock-watching only increases pressure and stress. Turn your alarm clock around or place your phone out of reach.

5. Create a Cool, Comfortable Environment

Temperature is crucial. A slightly cool room (around 18°C) with breathable bedding can reduce awakenings, particularly if you’re dealing with night sweats.

6. Consider Hormonal or Medical Support

If insomnia is linked to menopause, hormone replacement therapy (HRT) may help. Speak with your GP if sleep disruption is persistent or linked to other symptoms.

Longer-Term Tips to Prevent Night-Time Wakefulness

• Keep a consistent sleep schedule — waking and sleeping at the same times helps regulate your body clock.

• Limit caffeine and alcohol — both can interfere with restorative sleep.

• Exercise regularly — activity in the day promotes better rest at night, though avoid vigorous workouts close to bedtime.

• Prioritise winding down — rituals such as herbal tea, journalling, or a warm bath cue your body for rest.
  

When to Seek Help

Occasional sleepless nights are normal. But if you’re regularly awake for hours in the night, or daytime fatigue is affecting your work, mood, or relationships, it’s worth seeking medical advice. Persistent insomnia may point to an underlying condition such as sleep apnoea, anxiety, or thyroid dysfunction — all treatable with the right care.