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.
Last Updated: March 17, 2009

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. Gloria McGraw
    1 year ago

    May I have a link to the pillow for night sleep that Dr Northrup rec last year ?

  2. Anita Ellison
    5 years ago

    But didn’t your friend taking the combined low dose therapy with DHEA as a compounded cream work for us with uterus still .. without causing our uterine walls to thicken .. I thought the progesterone had to be by pill form to keep this from happening

  3. monique webber
    5 years ago

    I feel everyone’s pain.I can’t sleep no matter what I take and I’m so exausted that i can’t function properly.i’ve spent so much money trying different things from meds to changing my bed,covers,gowns you name it.i’ve read every book pertaining to the subject and no further to finding a solution to this,I’m really at my wits end…..

  4. Nancy
    6 years ago

    I feel your pain. I have also been to many drs. Neurologists who specialize in sleep, a “Sleep Psychiatrist, who put me on .5mg Klonopin and 7.5 mg of Remeron. He told me that I would probably be on them the rest of my life. Hate taking them. Sometimes they work and sometimes not. But, I have noticed an increased amount of forgetfulness. Cut back on the Klonopin by 25% and stopped sleeping at all. I’ve been to chiropractors, natural paths, general practitioners, an Endrocrinologist, as well. Nothing seems to work. I just turned 70 and have had this problem now for 5 months now. Tomorrow I have my first appointment with a hormone specialist. But, I understand if I have a B pathway, progesterone won’t work. This has substantially changed my life. It is miserable not being able to sleep. Have tried so many herbs and so called sleep nutrients that the hormone Dr. is my last hope.

    1. Cynthia
      5 years ago

      Nancy, did you find anything to help you sleep? I’m 55 and post menopausal. I haven’t had a full night sleep in 12 years. My integrative nurse has tried every supplement on me. I hope you write back.

  5. Kara
    6 years ago

    Hi, I’m 53 and have numerous daily hotflashes and nightsweats. Mostly every 26 minutes although sometimes less often. My bloodwork is great but indicated my estradiol is low at 15 and progesterone .8. My ND prescribed 1.6 mg of estriol and .4 mg of estradiol in the morning and 100 mg of progesterone in the evening. They are bio identical and in Troche form. I feel since starting progesterone, my nightweats are worse. Is this normal?

    1. Cynthia
      6 years ago

      Kara, progesterone is known to be thermogenic. It overall heats up the body, I noticed that too with myself.

  6. Aspengal
    6 years ago

    Hi Ladies,

    While it’s a bummer to hear about this pervasive problem called insomnia, I am glad I am not alone. I am
    actually taking a leave of absence from my work because the sleep deprivation is getting in the way of my competency.
    I have very good sleep hygiene/diet/exercise and still, there are nights where I don’t sleep and it’s traumatic. I broke down and tried medication, trazadone, which hasn’t helped me sleep and I just started 200mg of progesterone. So far I feel exhausted from the progesterone, like walking through quicksand. Does anyone know if this will pass? Desperate for answers and to feel like I am back int he land of the living.

    1. Cynthia
      6 years ago

      Aspengal, I know your post is from six months ago. I am post menopausal and am still having broken sleep. It’s been 11 years since I’ve had a solid night of sleep. It’s very frustrating. I feel your pain.

  7. Lori
    6 years ago

    Tonight I took my first 200mg of progrestrone. It’s been 2 hours since I first took it and I’m still not sleepy. My Dr told me that it would make me sleepy with in an hour. I read that it’s equivalent to drinking two glasses of wine. Nope not feeling it.

    1. gisela
      6 years ago

      I had to take 300mg of the progesterone (Prometrium) and I do fall asleep withi the hour.

      1. Mona
        4 years ago

        Is that Justi for sleep

    2. donna
      5 years ago

      Progesterone is known to wire some people…try taking it in the morning.

  8. Jerri Schroeder
    6 years ago

    Hi, I recently had a stroke caused by high cholesterol & stress. I am on Lipitor 40 mg., aspirin 325 mg., Norvasc 5 mg., Coreg 12.5, & Losartan 100 mg. When i was in the hospital they took me off of Estrace .5 mg , now I can’t sleep & flashing alot. Any ideas on what I could take that would help. Thanks so much


  9. Angela Wright
    7 years ago

    I am 63 and have been waking up at 2 am and can not go back to sleep. I have an apt. to see my doctor Jan. 29. I tried 1 mill tablet of melatonin…at 2 but I do not go back to sleep heavy…I tried cherry juice. I am healthy…problem with this year’s blood test and other tests..last year I slept longer. I eat a peanut butter jelly sandwich that puts me to sleep. I recently had dental work done to help my tmj….my dentist is great just finished the process …last year he gave me a device to see if I have sleep apnea because of the tmj..
    I was fine last year. I have no night sweats. I swim 10 laps a day. I changes my magnesium to magnesium malate the slow mag..was upsetting my stomach…that was better. I am still working but walking up at 2 has not helped..I go to bed at 9 set my alarm at 12…and eat the sandwich and sleep longer. I am at my wits end because my sleep was better last year…I tired of eating at night. Nuts help too to go back to sleep.

    1. Cynthia
      6 years ago

      Have a four point cortisol saliva test done. You measure your cortisol four times throughout the day. It’s supposed to be high in the morning and goes lower as the day goes on. You might be having a cortisol surge at 2 AM. If you find that it’s off, adaptogens like ashwaghanda can be helpful. Check out the Canary Club online for a home kit. I used them for my cortisol testing.

      1. Jeanette
        6 years ago

        I have been on bio identical hormones for 2 months now. It really helps me to get to sleep, but I do find myself waking at 3:15 occasionally. Is it safe to try Cortisol manager while on bioidenticals?

        1. Cynthia
          6 years ago

          Jeanette, I’m seeing this three months later. I’m not really sure. My guess is it would be okay to take together, but I’m not a doctor.

  10. Linda O'Sullivan
    7 years ago

    Hi Dr.

    Ive be feeling terrible last 15 years.had bad panic. Was put on antidepressants until 2&1/2 years ago. Had cortisol test done through salvia and it came back with 3 highs and low dhea but yet the hospital tested me snyachen test with acth injection. I cannot get into a deep sleep. havnt got hospital results yet.i was diagnosed with periodic leg movement but i had it right last year and doctor sent me for 2 seperate blood tests(8 viles).i dont know if its that but i had drop nature throid down an awful fatigue ever since. Im finding it v hard to tolerate dhea supplements but some one told me to crush little bit up and rub it in with olive oil.

    1. Car
      6 years ago

      Magnesium citrate 400mg at night. Spoonful of GABA into chammomile tea before bed. Low gi, dairy free and gluten/grain free diet. S-acetyl-glutathione, cucurmin and resveratrol for anti-inflammatory and chelating toxins which can indyce your issue. See Dr Datis Kharrazian book, why isnt my brain working. Xx

  11. Catherine
    7 years ago

    Turning 51 in Dec. Still have a monthly period. Was having 2 a month, but went on Emerita Projest Cream and now back to one. Some nights I sleep great but wake up every hour or two which is least I am sleeping. Other nights an hour or two. I try not taking the Ativan. I have had anxiety most of my life. I went on the Estrogen patch this past week to see if that would help improve my sleep. I notice after 4 days I was cranky and had more anxiety than before. Sleep is the same. Took the patch off and the anxiety is better…I just ordered Dhea 5mg starting it tomorrow am. Just wondering if I can take the patch a week before my period to see if that will help aid sleep and remove after my period. All my bloodwork says I am in the normal range. I have just recently found out I have Narrow-Angle Glaucoma and I can not take sleep aids until I have both eyes Lasered. One eye is done and the other is set for next week. So ready to sleep like before and have energy and live life. Not able to plan anything due to not know what each night brings me. Had these sysmptoms when I was 48, but after 8 months I started sleeping again. Then this past March overnight it all came back. I do feel its mainly due to years of high stress and go go. I know that through Christ I can do all things. I will beat this and get me back to a place so I can be a blessing to others and enjoy this life that God has giving me.

  12. Catherine
    7 years 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.

  13. Gina
    7 years 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

  14. Lisa
    7 years 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
      7 years 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.

    2. Bren
      6 years ago

      Oh I hear you. I went through menopause at 46 I’m now 56. My biggest problem has been insomnia and it is truly messing with my life. I sleep for about 1hour then spend the next 2hours trying to get back to sleep. I have hrt patches (10 years) , they have at least helped me to get the sleep I do. It’s because of the serious lack of sleep that then causes anxiety forgetfulness etc. I would take any medication no matter what the health risk just to sleep normally again.

      1. gisela
        6 years ago

        I have chronic insomnia and tried diffrent hormone creams, pills ect and nothing has really helped me stay asleep but Kavinace Ultra PM. It really works but it is expensive and has phenabit as an ingredient which is adicting and causes withdrawal, which is insomnia, go figure? I would love to stop using it, but also want to sleep. I have 2 sisters that sleep like a rock and dont take any hormones, but for some reason I have been plagued with chronic unrelenting insomnia since 40 and noe am 57. I have gone to so many “specialists and bio hormone docs” and none have helped me. Im so tired of spending money on tests that they really cannot interpret correctly and finally give my body what it needs, to sleep soundly throughout the entire night!!!

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