ADHD Insomnia in Perimenopause: “Wired but Tired” and the 3AM Brain

Last reviewed: 02/12/2026

Reviewed by: Dr. Kiesa Kelly

If you are in perimenopause and dealing with adhd insomnia, you may recognize the same nightly script: you are exhausted at 9PM, wide awake at 11PM, and then your brain turns on like a searchlight at 3AM. This “wired but tired” pattern is not a character flaw. It is often a predictable interaction between hormonal transition, stress physiology, and an ADHD brain that has a harder time downshifting.

💡 Key takeaway: When sleep becomes fragmented, the brain gets more opportunities to “reboot” into problem-solving mode, especially in ADHD.

In this article, you’ll learn:

• Why sleep can get lighter and more fragmented in perimenopause (even without ADHD)

• Why ADHD can amplify racing thoughts at night and 3AM waking

• What “wired but tired” actually reflects in the nervous system

• What patterns to track so you and your clinician can target the right fix

• What evidence-based help looks like, including CBT-I and sleep therapy via telehealth

Why Sleep Gets Harder in Perimenopause (Even Without ADHD)

Perimenopause is the transition phase leading up to menopause, when estrogen and progesterone fluctuate and gradually decline. Sleep complaints rise during this transition, with nighttime awakenings among the most common concerns.[1]

Night sweats/hot flashes and fragmented sleep

Vasomotor symptoms (hot flashes and night sweats) can trigger sudden awakenings and make it harder to return to sleep. Even brief awakenings can “invite” the mind to start scanning for problems, especially if you have been juggling stress, caregiving, or an overfull mental load.[1]

If your 3AM wake-ups often follow a heat surge, sweating, or chills, that points to a hot-flash-linked pattern. Perimenopause-related sleep disturbance is commonly characterized by difficulty staying asleep.[2]

🔥 Key takeaway: A hot flash is not just discomfort. It is a physiological arousal event that can fragment sleep and raise the odds of a full wake-up.

Anxiety and stress reactivity changes

Hormonal shifts can influence mood and stress sensitivity, and stress itself is a reliable sleep disruptor. In midlife, sleep disturbance and mood symptoms often travel together.[1] When the brain is primed to detect threat, it becomes harder to interpret “wakefulness” as harmless, which can accelerate a spiral of frustration.

One common misconception is that anxiety-driven insomnia only happens when you feel anxious. In reality, your body can be in a higher-alert state even if your mind does not feel panicky at bedtime.

Circadian shifts and early waking

Some people notice a shift toward earlier waking during the menopausal transition, possibly related to changes in circadian regulation and melatonin patterns.[2] If you consistently wake at the same early hour (for example, 3–5AM) and feel “done sleeping,” your internal clock may be running earlier than it used to.

Harvard Health has also noted that menopausal hormone changes and vasomotor symptoms can contribute to early-morning awakenings in older women.[3]

🌙 Key takeaway: Not all 3AM waking is “stress.” For some people, the clock itself has shifted earlier.

Why ADHD Makes the Night Brain Louder

ADHD is not only about attention during the day. Many adults with ADHD experience sleep timing and insomnia symptoms, and circadian rhythm delay is common in a substantial subgroup.[4]

Hyperfocus, rumination, and “can’t turn it off”

If your brain tends to lock onto problems, ideas, or unfinished tasks, nighttime can become a magnet for rumination. At 3AM, there are fewer external cues and fewer distractions, which can actually make the internal noise louder.

A second misconception: “If I was truly tired, I would fall asleep.” In insomnia, tired and sleepy are not always the same. You can have heavy sleep debt and still feel wired, especially after repeated awakenings.

Time blindness at night (revenge bedtime procrastination)

Many adults describe a pattern of staying up later than intended to reclaim personal time, then paying for it with lighter sleep and earlier waking. Researchers describe bedtime procrastination as going to bed later than intended when no external barrier prevents sleep.[5]

In ADHD, time blindness and task switching challenges can make “one more episode” turn into two hours, and the brain may interpret bedtime as a hard stop to stimulation.

📱 Key takeaway: Bedtime procrastination is not laziness. It is often a self-regulation and reward issue that gets worse when you are depleted.

Sensory sensitivity and comfort issues

Small discomforts can become big awakeners: a warm room, scratchy fabric, a noisy fan, dry mouth, or a partner’s snoring. ADHD sensory sensitivity can make it harder to “tune out” body sensations once you are awake.

Practical example: If you wake at 3AM and immediately notice the seam of your pajamas, the pillow texture, and the hum of the refrigerator, you are not being dramatic. Your nervous system is simply registering more input.

“Wired but Tired”: What It Actually Means

“Wired but tired” is the experience of fatigue plus arousal: your body wants rest, but your system is acting like it needs to stay alert.

Sleep debt + adrenaline cycle

Fragmented sleep builds sleep debt. Then, each difficult night can teach the brain to anticipate struggle at bedtime. Over time, that anticipation can activate stress physiology (racing thoughts, faster heart rate, muscle tension), which increases the chance of another disrupted night.

A third misconception: “I just need perfect sleep hygiene.” Hygiene helps, but chronic insomnia often persists because of conditioned arousal and unhelpful sleep behaviors that developed for survival, not because you are doing bedtime “wrong.”[6]

⚡ Key takeaway: Insomnia is often a learned pattern in the brain-body system, not a willpower problem.

Overstimulation and recovery mismatch

Many people with ADHD spend the day compensating: masking symptoms, pushing through fatigue, and juggling executive demands. If the day is overstimulating and the evening is packed, the nervous system may not get enough gentle downshift time to transition into sleep.

This is where supportive skill-building can matter. For some clients, combining insomnia treatment with practical supports (like routines, planning, and time management) makes the sleep plan more sustainable. For ADHD-specific skills support, executive function coaching can complement therapy by turning concepts into daily systems.

Why naps/caffeine can become complicated

When you are running on broken sleep, it is natural to reach for naps or caffeine. The complication is timing: late naps can reduce sleep drive at night, and afternoon caffeine can linger longer than expected.

Rather than labeling naps or caffeine as “bad,” it helps to observe what happens next. If your insomnia is primarily early waking, a late-day nap might worsen the pattern. If your insomnia is sleep-onset, caffeine after lunch may keep the mind louder than usual.

Patterns to Track (So You Can Get the Right Help)

Sleep is not one problem. It is a set of patterns. Tracking helps you and your clinician target the correct lever.

3AM waking vs sleep-onset insomnia

Ask yourself:

• Do you struggle to fall asleep initially, or do you fall asleep fine and then wake in the early morning?

• When you wake, do you feel hot, anxious, alert, or physically uncomfortable?

• Do you fall back asleep within 20–30 minutes, or does wakefulness last longer?

Practical example: If you fall asleep easily at 10:30PM, wake at 3:05AM after a heat surge, and then start mentally organizing tomorrow’s tasks, you may be dealing with a vasomotor trigger plus a rumination loop.

Hot flash nights vs stress nights

A simple note can help:

• Hot flash nights: heat surge, sweating, chills, tossing, multiple brief awakenings

• Stress nights: mind racing, muscle tension, doom-scrolling, chest tightness (without medical emergency signs)

• Mixed nights: a hot flash wakes you, then the brain takes over

If hot flashes are prominent, a medical conversation about perimenopause symptoms can be important. The North American Menopause Society provides evidence-based guidance on nonhormone options for vasomotor symptoms, which can indirectly improve sleep by reducing night disruptions.[7]

Medication timing questions to discuss with a prescriber

Medication changes are not DIY. Still, pattern tracking helps you bring clear questions to your prescriber, such as:

• Did insomnia worsen after a dosage change or timing change?

• Do stimulant effects or “wear-off” overlap with bedtime?

• Are any evening medications activating, or are morning meds causing afternoon crashes that lead to late naps?

If you are also considering hormone-related treatment, it may help to coordinate care so sleep, mood, and perimenopause symptoms are addressed together.

🧭 Key takeaway: Better data leads to better care. A two-week pattern log often beats a vague “I never sleep.”

Evidence-Based Help for ADHD Insomnia (High-Level, Not DIY Medical Advice)

What CBT-I focuses on

CBT-I (Cognitive Behavioral Therapy for Insomnia) is considered a first-line treatment for chronic insomnia, with strong evidence behind multicomponent CBT-I approaches.[6] It targets the patterns that keep insomnia going, such as conditioned arousal, irregular sleep schedules, and unhelpful behaviors used to cope with bad nights.

At ScienceWorks, insomnia care is offered through a specialized insomnia program, and CBT-I can also be coordinated alongside therapy for anxiety, trauma, or neurodivergence.

Sleep hygiene vs sleep rules that create shame

Sleep hygiene is the set of general habits that support sleep (light, caffeine timing, wind-down routines). It is helpful, but it is rarely sufficient for chronic insomnia on its own, and clinical guidelines caution against using sleep hygiene as the only treatment.[6]

A shame-free reframe:

• Hygiene is supportive.

• CBT-I is targeted.

• Your job is not to “be perfect.” Your job is to run small experiments and learn what your nervous system responds to.

Nervous-system downshifting strategies that are safe and gentle

These are not medical treatments, and they do not replace clinical care. They are low-risk ways to signal safety to the body when you are awake at night:

• A short “body scan”: slowly notice points of contact (feet, calves, hips, shoulders) without trying to change anything.

• Gentle paced breathing: slightly longer exhale than inhale, staying comfortable.

• “Worry parking lot” earlier in the evening: 5 minutes to write down tomorrow’s tasks, then close the notebook.

• Low-stimulation reset: dim light, quiet activity (paper book, simple puzzle) until sleepiness returns.

A randomized clinical trial found that telephone-delivered CBT-I improved sleep in perimenopausal and postmenopausal women with insomnia and hot flashes, supporting accessible formats like telehealth.[8]

🫶 Key takeaway: The goal at 3AM is not to “force sleep.” It is to reduce arousal so sleep can return.

When to Talk to a Clinician

Red flags (apnea symptoms, severe insomnia, mood shifts)

Consider a clinical evaluation if you notice:

• Loud snoring, gasping, or witnessed breathing pauses during sleep[9]

• Excessive daytime sleepiness even after adequate time in bed[9]

• Morning headaches, dry mouth, or attention problems that feel dramatically worse[10]

• Insomnia that lasts more than a few weeks and is impairing work, relationships, or safety

• New or worsening depression, irritability, panic symptoms, or significant mood swings during perimenopause[1]

Coordinating care: medical + behavioral

Many people do best with coordinated care:

• Medical evaluation for hot flashes, sleep-disordered breathing, medication effects, or thyroid concerns

• Behavioral treatment for insomnia patterns and nighttime anxiety

• ADHD-informed supports for routines, wind-down, and time boundaries

If you are unsure whether what you are experiencing is ADHD, insomnia, or both, targeted assessment can help clarify the picture. ScienceWorks offers psychological assessments to support accurate diagnosis and a more tailored plan.

Tennessee telehealth options

If you live in Tennessee, you can access insomnia treatment and CBT-I via telehealth with a clinician trained in behavioral sleep approaches. If you are looking for a neurodiversity-affirming, whole-person approach, you can explore our team and reach out through our contact page to discuss next steps.

Summary and next steps

Perimenopause can fragment sleep through vasomotor symptoms, stress sensitivity, and circadian shifts.[1][2] ADHD can add a louder night brain through rumination, time blindness, and sensory sensitivity.[4][5] Together, they can create the “wired but tired” cycle: you feel depleted, but your system stays on high alert.

If you are stuck in 3AM waking, consider tracking patterns for two weeks, then bring that data to a clinician. The most effective next step is often evidence-based insomnia treatment (like CBT-I) paired with ADHD-informed support, so your plan is realistic for your brain and your life.[6][8]

About the Author

Dr. Kiesa Kelly earned her PhD in Clinical Psychology, with a concentration in Neuropsychology, from Rosalind Franklin University of Medicine and Science. She completed practica, internship, and an NIH-funded postdoctoral fellowship at the University of Chicago, the University of Wisconsin, the University of Florida, and Vanderbilt University, and brings 20+ years of experience in psychological assessment.

At ScienceWorks Behavioral Healthcare, Dr. Kelly provides neurodiversity-affirming care and evidence-based therapy, including CBT-I for insomnia and specialized treatment for OCD, trauma, ADHD, and autism. She is available via telehealth in Tennessee and additional participating states.

References

1. Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and sleep disorders in the menopausal transition. Sleep Med Clin. 2018;13(3):443-456. doi:10.1016/j.jsmc.2018.04.011

2. Park KM. Sleep disturbance in perimenopausal women. Chronobiol Med. 2024;6(3):109-115. doi:10.33069/cim.2024.0027

3. The 3 a.m. wake-up: Why it happens to women more often after 55. Harvard Health Publishing. Accessed 12/02/2026. Harvard Health article

4. Luu B, Fabiano N. ADHD as a circadian rhythm disorder: evidence and implications for chronotherapy. Front Psychiatry. 2025;16:1697900. doi:10.3389/fpsyt.2025.1697900

5. Kroese FM, de Ridder DTD, Evers C, Adriaanse MA. Bedtime procrastination: introducing a new area of procrastination. Front Psychol. 2014;5:611. doi:10.3389/fpsyg.2014.00611

6. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262. doi:10.5664/jcsm.8986

7. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200

8. McCurry SM, Guthrie KA, Morin CM, et al. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a randomized clinical trial. JAMA Intern Med. 2016;176(7):913-920. doi:10.1001/jamainternmed.2016.1795

9. 4 Signs You Might Have Sleep Apnea. Johns Hopkins Medicine. Accessed 12/02/2026. Johns Hopkins overview

10. Sleep apnea: Symptoms and causes. Mayo Clinic. Accessed 12/02/2026. Mayo Clinic overview

Disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. If you are experiencing persistent insomnia, significant mood changes, symptoms of sleep apnea, or any medical concerns, please consult a qualified healthcare professional or seek urgent care when appropriate.