The Big Sleep

Your guide to getting a good night’s sleep

by Christiane Northrup, M.D.


If you haven’t enjoyed a good night’s sleep in awhile, the first step is to believe that it’s possible.

A couple weeks ago, a good friend called and said, “Help. I have night sweats and hot flashes. And I haven’t had a good night’s sleep in months. I watched you talk about bioidentical hormones on television. What do you think?”

My friend, age 54, had stopped her periods about one year before. And it was obvious to me that she was experiencing the neurological effects of hormone withdrawal on her brain (hence the sleep problems). I already knew that her diet (low glycemic) and exercise patterns were optimal, that her alcohol and caffeine intake were minimal and that she didn’t smoke. She was also on an excellent supplementation program and had optimal vitamin D levels.

In addition to that, she and her husband have a thriving business that they both enjoy doing. So job and economic stress wasn’t a factor either. In addition, she had had blood levels of her hormones drawn a year before, and they were all very low. For reasons that are not clear, however, she didn’t start to have symptoms until recently.

She was eager to try some hormone therapy and wasn’t worried a bit about possible safety issues, especially with really low doses of bioidentical hormones. So I suggested a small dose of bioidentical estrogen (0.5 mg estradiol) balanced with some progesterone (100 mg) and a little DHEA (10 mg), a precursor to testosterone. These were all mixed together by a formulary pharmacist.

Within two weeks my friend’s hot flashes and night sweats were gone and she was getting a full night’s sleep again. She also noticed beneficial changes in her vaginal tissue and her sex life. An easy and effective solution. Case closed.

Why You Need a Good Night’s Sleep

More and more studies have shown conclusively that getting a solid night’s sleep is essential to good cardiovascular health, weight control, upbeat mood, and overall health. In fact, deep sleep is the single most effective modality known for metabolizing excess stress hormones. REM sleep, the kind you have when you are dreaming, is essential for the healthy functioning of your brain. When we say, “let me sleep on it,” we’re really talking about the amazing ability of the brain to process information and come up with solutions while our bodies are asleep.

I’ve read that Napoleon had a useful bedtime ritual that demonstrates this principle: He imagined a cabinet with multiple drawers in it. He’d place any current problem he was having in one of the drawers, fully expecting that in the morning he’d have the solution. This is a kind of “turning it over to a Higher Power” ritual that, once mastered, is very effective for inducing restful sleep.

How to Get the Sleep You Need

My friend’s situation reminded me of how easy it is to deal with the problem of insomnia when someone is already following a healthy lifestyle and is happy with their life situation. Her situation is fairly rare. And that’s why the hormone solution worked so well and so quickly. And that might be your solution too. If not, there are lots of options to consider, including the following ten easy-to-adopt solutions.

1. Stop all caffeine. As women get older, many of us become very sensitive to the neurological effects of caffeine. So even one cup of coffee in the morning will keep us awake at night. To see if this is the case for you, you need to experiment. It takes three days for caffeine to clear from your body. So go decaf for a full week. See what happens with your sleep.

Note: Caffeine is also a bladder irritant and many women find that they don’t have to get up at night to urinate if they eliminate caffeine.

2. Turn out the lights and pull the drapes. Light is a nutrient. And we’re designed by nature to take light into our eyes during the day when melatonin levels are at their lowest. At night, darkness increases the amount of melatonin that is secreted by the pineal gland. Melatonin induces sleep and also has health-giving antioxidant properties. When you sleep in the dark, your melatonin levels rise and your sleep quality increases.

Of course you can also try melatonin as a supplement. The usual dose is 1–3 mg about 30 minutes before bedtime.

Hint: I always sleep with a flaxseed stuffed eye pillow over my eyes. It’s a handy solution to the light problem and also very relaxing.

3. Eat a low glycemic diet—one that doesn’t spike your blood sugar and insulin levels. A diet high in refined carbohydrates (white potatoes, processed foods, white flour, and white sugar products) raises blood sugar quickly. Insulin follows. This sends your blood vessels into spasms called glycemic stress. Your body pours out the stress hormones cortisol and epinephrine as a result. And your cells, including those in your brain, develop inflammation! Hence, you find yourself unable to sleep. Many people find that they sleep like a baby when they switch to a low glycemic diet. It’s also best to eat 3–4 hours before going to sleep. A full stomach and a good night’s sleep don’t mix well!

4. Exercise. Regular exercise (in the first half of the day) actually results in more relaxing sleep at night. Notice how children run around during the day and then fall asleep quickly and easily at night—sometimes on the stairs going up to their rooms. This is because they’ve fully exercised their bodies!

5. Get enough magnesium. Magnesium is a mineral that is absolutely essential for normal nerve function. It helps relax all the muscles and nerves in the body. Try an Epsom salts bath before bed (about 1 cup poured into warm water). Soak for 20 minutes. Epsom salts is magnesium sulfate. And it will be absorbed into your bloodstream through your skin. That combined with the warm bath will often be all it takes to lull you to sleep.

6. Feng shui for rest. Your bedroom should be arranged for intimacy and sleep. Soft, flesh tones are best. Also fabrics that feel good on the skin. Cover all mirrors and television screens before going to sleep. These shiny surfaces, believe it or not, actually activate chi in a room—and can keep you awake.

Hint: I don’t recommend having a television in your bedroom—or a computer. But I know this isn’t going to happen for many of you.

7. Supplements to help you sleep. There are a number of herbs that have been well-studied for their ability to help you sleep. Valerian is one of them. This herb goes to the GABA receptors in the brain like the benzodiazepine drugs (like Valium or Ativan). Substances that bind to GABA receptors help the body relax and are considered anxiolytics (having anti-anxiety affects). Valerian doesn’t have the side effects of drugs such as Ativan and Valium.

The usual dose is 800 mg, 60 minutes before bedtime. Look for a brand with guaranteed potency. You can also drink valerian tea. Passionflower also helps many people.

Note: Valerian has recently been shown to be effective in the 11 percent of the population who suffer from restless leg syndrome. Cueller¹

8. Interrupt the gerbil wheel. If you’re anything like me, you probably have a little gerbil wheel in your brain that runs problems over and over again until you finally come up with a solution. (I’ve been known to go through all my papers and files at 2:00 a.m. looking for a medical study I need to present the next day—knowing that it’s there somewhere.) The end result of this is exhaustion the next day—and high cortisol levels that night! It’s far more effective to write down what you need to do the next day—and then set that paper aside.

August Gold, the spiritual head of the Sacred Center in New York City says, “If it doesn’t come out in your journal, it will come out in your body.” So true. It’s so much easier to deal with a challenge when it’s all out on paper. I’ve found that what I really need when I can’t find a solution is a break from the problem.

There are a number of audio programs available to entrain your brain to sleep. The most effective one I’ve found is from Holosync.

9. Become media savvy. Do not. I repeat. Do not watch the news before going to sleep. If you do, you will be seeding your subconscious with all the carefully selected, background-music-enhanced bad news from around the entire planet. Your central nervous system was not designed by God to handle this. And worrying about things over which you have no control renders you far less capable of dealing with the things over which you do have control.

10. Try hormones. During the years leading up to the final menstrual period (perimenopause), progesterone levels are the first thing to fall, as you start skipping ovulations. During this time, estrogen levels may actually rise for several years. A little 2% progesterone cream (1/4–1/2 tsp) rubbed on the skin is readily absorbed and, like Valerian, goes to the GABA centers in the brain and acts as an anxiolytic. 2% progesterone cream is still available over the counter.

Hint: I like the Progest or Emerita brands, but others are available that are good, too.

If you are having hot flashes and night sweats, chances are good that you need some estrogen. (Lack of sleep has always been the number one reason I’ve prescribed estrogen!) Use bioidentical estrogen (17 beta-estradiol), which is widely available in conventional pharmacies in the form of Evamist (a spray), Vagifem (a vaginal tablet), or one of the patches, such as Vivelle or Estraderm. A transdermal route of hormone administration is safer and more effective that taking pills. Estrogen should be balanced with natural progesterone—which, in and of itself, has been shown to have a beneficial effect on hot flashes.

Avoid products containing pregnant horse urine (Premarin and Prempro), and also avoid synthetic progestins such as Provera and Prempro. Synthetic progestins are downright dangerous. In my opinion, and those of many other researchers, they are the culprit behind all the adverse effects of hormone therapy. For more information, see my hormone primer, The ABCs of HRT, and the article It’s Time to Learn the Difference for more information on this topic.

Note: Of course it’s also possible to have your healthcare practitioner put a personalized combo together for you—like the one I recommended for my friend. Any good formulary pharmacist can help your healthcare provider get started with this. Or, if your healthcare provider wants to learn more, I recommend that he or she take a course on bioidentical hormones through the Institute for Functional Medicine.

If you haven’t enjoyed a good night’s sleep in a while, the first step is to believe that it’s possible. Now that you’ve read through my suggestions, choose the one that makes the most sense for your situation and try it for a week or so. All of these tips will help your entire body, so add more if that feels right. Before you know it, you’ll be enjoying nights of restful, restorative slumber.


  1. Cueller, N., Ratcliffe, S., 2009. Does valerian improve sleepiness and symptom severity in restless leg syndrome, Alternative Ther. Health and Medicine, Mar/April (15)2: 22-28.

Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Catherine
    2 months ago

    I have been on Prempo lowest dose for a month. I never had hot flashes or night sweats just anxiety and insomina. I want to go off this and go on thee Emerita Projest Cream. I tried not taking my schedule dose and felt fine until 10pm. I got weird sensations and anxiety like crazy so I took the pill. Took ativan and benadryl. Finally went to sleep at 2am and slept 5 straight hours…haven’t slept that long in years. Can I half the prempro and take the projest cream or stop prempro all together and just use the cream? I have only been on the prempro for 4 weeks.

  2. Gina
    6 months ago

    I found, that I needed to adjust my progesterone and topical estrogen on my own with my providers permission. You may need 200mg of progesterone at bedtime and a littke less estrogen, or maybe having something compounded by a compounding pharmacy. Early menopausal symptoms can be tricky. There is no, one size fits all, fix. Talk to your doctor or find a provider that prescribes compounded hormones. Hang in there. It will get better

  3. Lisa
    7 months ago

    I’m 49 years old and have been taking 100 mg progesterone since October 2016, with estrogel cream since December ., last last week I’ve slept 4 hours, my doctor tells me that my hormones are well balanced but last week I’ ve had hot flashes, very sensitive breast and vaginal mucus like I was ovulating, m sleep has been a living hell since last august, I’m desperate to find sleep again, I’m going for blood test again tomorrow morning. I basically went from sleeping well to not sleeping at all. Can you offer any insight on my situation, this insomnia Is going to kill me.

    1. Morgan
      4 months ago

      Possibly you would need a less estrogen, because progesterone makes you tired, (it’s ideal to take your largest amount at bedtime.) And I’m deducing that since your wired and restless at noon night, that is the effect of estrogen.

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