Sleep and Menopause: A TCM Guide for Restful Nights Part 1

Sleep becomes elusive for many women during the menopausal years, where more than half of menopausal women (a reported 40-70% of females) struggle to get adequate sleep during this transition. Night sweats, hot flashes, and early morning waking are recurrent complaints during this stage, resulting in feelings of fatigue, brain fog, and emotional taxation. 

Menopausal changes are commonly linked to shifting hormones (like estrogen and progesterone), which influence circadian rhythm, cortisol levels, and temperature regulation. Consequently, these physiological changes during menopause make it harder to fall asleep, stay asleep, and maintain a cool evening body temperature. However, TCM offers a deeper perspective — one that sees menopause not as loss, but as a natural and anticipated transition. 

Rather than view menopause as the end of a chapter, Traditional Chinese Medicine (TCM) understands menopause to be the beginning of a new and beautiful cycle, often called the “Second Spring.” While it may be the end of fertility and reproduction, this next phase reflects a return inward— a rebirth, if you will. Instead of focusing on creating new life, women are encouraged to nurture their own bodies and redirect their energy back to self. In doing so, we’re better able to support the shifting balance of Yin and Yang, ease menopausal symptoms, and guide the body back toward harmony for sound sleep. 

The takeaway? Restful nights are possible — even during menopausal years. By listening to the body’s wisdom and responding with care, women can find balance during this season of change. Through Yang Sheng rituals — from mindful eating to calming evening practices — we can harmonize body and spirit, ease sleep troubles, and bring more vitality into this phase of life. 

Sleep Problems During Menopause: A Fresh Perspective 

If you’re wondering why menopausal women wake up at 3 a.m., or why falling asleep suddenly feels impossible, you’re not alone. Sleep disruptions are among the most common — and frustrating — changes during the menopausal transition. And while it’s completely normal to feel discouraged by the exhaustion, know that you still have the power to feel at home in your body. In fact, our bodies naturally desire a state of equilibrium, and by listening to our symptoms rather than trying to “rid” them, we can better understand where healing is needed. 

To help you identify areas of imbalance, here are some of the most common sleep-related menopausal symptoms to look out for:

Common symptoms of menopause-related sleep problems: 

● Hot flashes and night sweats 

● Waking frequently during the night 

● Early morning waking without feeling restored 

● Difficulty falling asleep, even when tired 

● Anxiety or a racing mind at night 

● Restless, light, or dream-disturbed sleep 

● Fatigue, brain fog, or low energy during the day 

A TCM Perspective on Menopause & Sleep 

In Chinese Medicine, menopause doesn’t carry the same negative connotation that it often does in modern views. This chapter of life is about renewal, not loss. Your body is capable of finding its rhythm again, the natural harmony of Yin and Yang is simply adjusting. This is where TCM offers clarity — identifying distinct patterns that help explain your sleep-related menopausal symptoms and revealing practical, time-tested ways to restore balance. By working with these patterns (instead of against them), you can move through this transition with a greater sense of ease and grace. 

The 7-Year Life Cycles: The Impact on Menopausal Sleep 

To understand why Chinese Medicine considers menopause a “second spring”, it’s important to understand the 7-year life cycles of women, and its influence on Jing and Essence. According to TCM, a woman moves through a new growth cycle every seven years — and with each cycle, the body’s energy naturally evolves. Keep in mind, we are not meant to feel the same at every stage — the body is continuously reshaping itself, guided by the rise and gradual decline of Kidney Jing. 

● Ages 0–7: Qi and Blood are forming, laying the foundation for growth and vitality. ● Ages 7–14: Kidney Qi strengthens, setting the stage for puberty and deeper development. 

● Ages 14–21: The Ren and Chong meridians awaken, and menstruation begins, marking the body’s readiness for reproduction. 

● Ages 21–28: Qi and Blood reach their most abundant state, supporting peak fertility and vitality. 

After this period of fullness, a gentle decline begins: 

● Ages 28–35: The first signs of Jing depletion emerge (with symptoms such as fertility issues or changes in skin and digestion), as the body begins to shift toward balance rather than growth. 

● Ages 35–42: Subtle changes in cycles, complexion, hair, and energy, reflect the gradual waning of Essence, often accompanied by more restless nights or lighter sleep.

● Ages 42–49: Kidney Jing continues to decline, guiding the body toward menopause, when menstruation naturally ceases and sleep-related issues readily appear. This shift can make it harder to regulate temperature and calm the mind at night, leading to more frequent waking, vivid dreams, or early-morning restlessness. 

Seen through this lens, the sleep challenges that accompany menopause are not random disruptions, but part of the natural rhythm the body has been following all along. This stage is simply the next chapter in a continuum that begins at birth — a chapter that calls us to honor the body’s wisdom, slow down, and nourish ourselves more deeply. By understanding these changes, we can approach this transition not with frustration, but with compassion, creating the opportunity for truly restorative rest. 

The 7-Year Jing Cycle: Its Role in Menopause & Sleep 

In Traditional Chinese Medicine, a woman’s life unfolds in cycles of seven years. From ages 0–28, Qi and Blood develop and reach their peak, supporting fertility and vitality. After 28, Jing (our vital Essence, stored in the Kidneys) begins a gradual, natural decline. At around age 49 (the seventh cycle), this decline leads to menopause, marking a natural transition into the body’s “second spring.” If not in tune with the body’s signals, sleep issues begin to arise. 

The Role of Jing and Essence in Menopause & Sleep 

Jing, also known as Essence, plays a foundational role in menopause-related sleep issues. This deeply yin substance is stored in the Kidneys, and is considered our vital energy source. Jing is what gives us vitality, drives growth and reproduction, supports longevity, regulates restorative sleep, and sustains life through every stage. 

TCM recognizes two forms of Jing: 

● Prenatal Jing (Inherited Essence): This is the Essence inherited from our parents at birth — our constitutional foundation, much like DNA. It determines the strength of your Qi, the timing of your life cycles, and your genetic predisposition. Prenatal Jing is finite — you’re only born with a certain amount — and while it can be conserved, it cannot be replenished. 

● Postnatal Jing (Acquired Essence): This Essence is cultivated after birth, from the food you eat, the air you breathe, and the way you live. Unlike prenatal Jing, postnatal Jing can be nourished and replenished through healthy lifestyle practices like mindful eating, adequate sleep, and stress management. 

When Jing is strong, it’s apparent in the way we age. It manifests as strong hair, bones, and teeth, healthy skin and complexion, physical and mental resilience, a robust immune system, strong reproductive health, and deep, restorative sleep.  However, during the menopausal years, there is a natural decline of prenatal Jing. This decline can disturb our sleep and lead to menopausal symptoms.  And if we over-tax our body (with chronic stress, poor nutrition, inadequate sleep, or overwork), we can deplete our Essence even sooner. This results in not only premature aging, hormone imbalance, infertility, and cognitive decline, but also restless nights, difficulty falling or staying asleep, and vivid or disturbing dreams. 

The good news is that we can nourish our post-natal Jing through a healthy lifestyle, helping to slow the aging process and smoothe the natural decline of pre-natal Jing, which helps to support our sleep. 

RELATED: TCM For Women's Health 

Kidney Yin Deficiency and Menopausal Sleep 

In TCM, nighttime belongs to Yin — the quiet, cooling, restorative energy that allows the body and mind to rest. Yin governs stillness and inward movement, supporting deeply restorative sleep. If Yin becomes deficient, as it does when Kidneys naturally decline, this natural evening calm is disrupted. 

Therefore, the body’s grounding Yin energy is no longer able to fully balance the warming, active energy of Yang. As a result, exuberant Yang rises up to create sensations of heat, restlessness, and a racing mind. This makes it harder to drift into sleep or stay asleep through the night. This is known as Kidney Yin deficiency, one of the most common TCM patterns seen during menopause. It explains why symptoms like night sweats, hot flashes, or vivid dreams often feel most intense in the evening or during the early hours of the morning (when Yin should be at its peak). 

TCM Insight: 

Yin cools, anchors, and restores; Yang warms, activates, and moves. When Yin is insufficient during menopause, Yang becomes relatively excessive, disrupting the quiet harmony of night and leaving the mind and body unable to fully rest. 

The Heart-Kidney Connection and Its Link To Poor Sleep 

In TCM, the Heart and Kidneys share a dynamic relationship, both playing an essential role in restful sleep. The Kidneys, a water element, are responsible for cooling and anchoring the body, while the Heart, a fire element, governs the Shen (the spirit or consciousness) which needs grounding from the Kidneys to rest at night. As the Kidneys decline during menopause, it may fail to anchor the Heart’s fire. This allows heat to rise unchecked, leaving the Shen restless. This disharmony, known as the “Heart and Kidney not communicating,” may show up as: 

● Difficulty falling asleep or staying asleep 

● Night sweats and sensations of heat 

● Palpitations or a racing heart at night 

● Restlessness or anxiety when the mind should be quiet 

● Vivid or dream-disturbed sleep

By nourishing the Kidneys and calming the Heart, through practices like mindful rest, Yin-nourishing foods, evening rituals, acupuncture, and herbal therapy, you can restore harmony and create the conditions for deeper, more peaceful sleep. 

What the Research Says: A Modern Look at Sleep & Menopause 

While TCM offers a long-recognized framework for understanding sleep changes during menopause, modern research provides a complementary lens, helping us better understand the biological shifts that affect rest. Together, these perspectives offer a more complete, integrative approach to supporting the body during this transition. 

The Hormonal Connection 

As estrogen and progesterone decline during menopause, so does their calming influence on the nervous system. Both hormones play a key role in regulating serotonin and GABA, neurotransmitters that help to regulate sleep and mood. Without their stabilizing effect, 56% of menopausal women experience a rise in insomnia, lighter sleep, or more frequent waking. 

The Stress Response 

Menopause is also associated with changes in cortisol, our primary stress hormone. When balanced, cortisol should peak in the morning and slowly taper throughout the day, allowing the body to feel energized in the morning and restful at night. However, during menopause, shifting hormones and increased stress can disrupt this rhythm, commonly leading to heightened evening cortisol levels. This can make it harder to fall asleep, stay asleep, and leave you feeling wired when you should be tired. And if your sleep-wake cycle remains disrupted over time, it can further tax the body, leading to daytime fatigue, brain fog, mood swings, and increased inflammation. 

Thermoregulation and Night Sweats 

One of the most disruptive sleep challenges during menopause is the body’s shifting ability to regulate temperature. As estrogen levels decline, the hypothalamus (the part of the brain that controls temperature) becomes increasingly sensitive to even minor changes in heat. This heightened sensitivity causes a rise in core body temperature, triggering hot flashes and night sweats, often at the very times you’re trying to rest. 

The good news is that identifying these underlying patterns allows for targeted, supportive solutions — from optimizing nutrition and balancing blood sugar, to practicing stress reduction and improving sleep hygiene — all of which complement a restorative Yang Sheng practice from the view of TCM.