TL;DR
- Cortisol is not the villain. It follows a daily rhythm: lowest at night, climbing in the last hours of sleep, peaking around the time you wake.
- In menopause, stress, hot flashes and broken sleep feed each other. Flashes felt worse on higher-stress days in a 2026 study, and one bad night can leave stress hormones higher the next evening.
- New research points at night sweats, not daytime flashes, as the real sleep thief. Skin sensors clocked them at about an hour on average.
- Habits with evidence: a steady wake time, a five-minute to-do list at bedtime, slow breathing with long exhales, hard workouts finished four hours before bed, and big caffeine kept to the morning.
- At 3 a.m., skip the clock. If you are wide awake and wired, get up, keep the light low, and go back when you feel sleepy.
- Keep the bedroom around 65 to 68 F and sleep in something that moves sweat off your skin. If it is wearing you down, ask your doctor about CBT for insomnia or hot flashes and about medical options.
Jump to 7 ways to lower cortisol in menopause
It is 3 a.m. You are standing in the kitchen with a glass of water, and your brain has decided this is the perfect moment to replay a conversation from 2019, draft tomorrow's emails and wonder whether you locked the car. You are exhausted. You are also, somehow, wide awake.
If that sounds like your menopause, you have probably met the word cortisol online, usually next to a supplement, a "cortisol belly" or a promise to balance your hormones. The real story is more interesting, more hopeful and a lot cheaper.
This is what cortisol actually does at night, what research published in 2025 and 2026 found about stress, sleep and menopause, and the habits that have real evidence behind them. There is a plan for 3 a.m., a wind-down checklist you can tick off tonight, and answers to the questions we get asked most.
What does cortisol do at night?
Cortisol is best known as the stress hormone, and it does far more than stress: it has a hand in processes all over the body. It also runs on a clock.
Its daily rhythm goes like this. Levels start rising during the final hours of sleep, peak near the time you wake up, drift down through the day and reach their lowest point at night. That early climb is part of how your body gets ready for the morning. A little rise before dawn is normal physiology, not a malfunction.
The trouble is what a bad night does to the next one. In a classic sleep-lab study, cortisol in the evening after a night of lost sleep ran 37 to 45 percent higher than usual, and its quiet evening phase started at least an hour late. The volunteers were young men, not midlife women, but the lesson travels: a rough night can make the following evening harder to wind down from.
The brain side of the story is just as familiar. Researchers at UC Berkeley found that a sleepless night can raise anxiety by up to 30 percent the next day, with a region at the front of the brain that normally helps keep anxiety in check going quiet. Senior author Matthew Walker called deep sleep "a natural anxiolytic," an anxiety inhibitor, as long as you get it night after night.
Does menopause raise cortisol?
For some women, a little, mostly around the late menopause transition, and the research is smaller and messier than social media suggests. Here is what the studies actually show.
It can rise, then settle. The Seattle Midlife Women's Health Study tracked women through the transition with urine samples. Overnight cortisol averaged 45.3 in the early transition, 53.4 in the late transition and 46.4 in early postmenopause (in ng/mg creatinine, if you like units). In an earlier analysis by the same research team, women whose cortisol climbed during the late transition had more severe hot flashes, yet did not differ in stress, mood or sleep.
It travels with symptoms. In 85 women in early postmenopause, the overall burden of menopause symptoms explained about a third of the variation in 24-hour cortisol. A 2026 pilot study of 45 midlife Latinas found that having any hot flashes or night sweats in the previous two weeks went with higher cortisol stored in hair, a link that weakened once perceived stress was taken into account.
It is not a straight line. In 306 women with hot flashes, those with the most frequent flashes actually had slightly lower cortisol 30 minutes after waking, and the authors called the differences subtle. And in a three-night sleep lab study of 35 perimenopausal and postmenopausal women, measured sleep told a clearer story than questionnaires: less efficient sleep with more time awake in the night went with higher cortisol, while self-reported insomnia did not.
In short: cortisol, hot flashes and broken sleep travel together in menopause, but which one starts the chain varies from woman to woman. No home test or supplement untangles that for you. What you can change is the loop.
Does stress make hot flashes worse?
The evidence says stress makes them feel worse, and anxiety may even come first.
A 2026 diary study followed 130 women aged 42 to 60 for eight days. On days with more stress, hot flashes were more severe. Stress did not predict whether a flash happened at all, only how bad it felt when it did.
The Penn Ovarian Aging Study went further back in the chain. Compared with women in the normal anxiety range, women with moderate anxiety were nearly three times more likely to report hot flashes, and women with high anxiety nearly five times more likely. Anxiety at one visit also helped predict hot flashes at the next.
Work counts too. In a 2026 study of 648 working women, higher job strain and heavier workloads went with a greater chance of developing severe menopausal symptoms, while having more control over your own work was protective. So if Sunday night dread is a thing in your house, you are in good company.
And the pieces cluster. In SWAN, the long-running Study of Women's Health Across the Nation, hot flashes and sleep problems each doubled the odds of the other, and women with high anxiety had a 46 percent chance of juggling hot flashes, sleep problems and mood changes all at once, against 15 percent with low anxiety.
Now the hopeful part. A study that followed 4,619 Korean women for a median of 6.6 years found perceived stress rose during the late transition and fell again after menopause. In that study, at least, the most stressful stretch did not last forever. If stress seems to be showing up as sweat at night, our guide to stress, anxiety and night sweats explains the body's other kind of sweating.
New menopause sleep research worth knowing
A lot of useful work landed in 2025 and 2026. These are the findings we think are worth carrying around in your head.
Insomnia is common
42%
of postmenopausal women and 27% of perimenopausal women had insomnia symptoms at any one time, pooled from 102 studies of more than 1.1 million women.
General Hospital Psychiatry, 2026
Night sweats run long
60.5 min
was the average length of a night sweat measured by skin sensors, against 3.4 minutes for a hot flash. Night sweats also came earlier in the night.
Menopause, 2026 (274 women)
Sweats, not flashes, steal sleep
1.78x
the odds of trouble sleeping for women with night sweats only. Women with hot flashes but no night sweats were no different from women with neither.
Menopause, 2026 (841 women)
Workout timing
4 hours
Across more than 4 million nights of wearable data, exercise that ended at least four hours before sleep was not linked to changes in sleep. Late, hard sessions were.
Nature Communications, 2025
Regular beats long
33%
lower risk of developing anxiety over about seven and a half years for regular sleepers than irregular ones, and getting enough hours did not cancel out an irregular schedule.
Psychological Medicine, 2025 (79,666 adults)
Mindfulness and cortisol
39 studies
A structured mindfulness course called MBSR lowered cortisol more than comparison groups. The effect was real, and modest.
Health Psychology, September 2026
The second and third findings matter for anyone who reads the rest of this blog: if night sweats are what wake you, the problem is not a three-minute blip. It is a long, full-body event, which is why what you sleep in and under deserves as much attention as the stress. The mechanics are in what happens in your body during a night sweat.
Why stress feels louder at night
By day, worries have to compete with traffic, email and the dog. At night they have the stage to themselves.
Biology stacks the deck, too. Cortisol begins its climb in the last hours of sleep, and a flash that arrives in the evening can push sleep back: in a 2026 diary study of 99 women, more severe evening hot flashes went with taking longer to fall asleep that night. Add one short night and, as the Berkeley work showed, the anxious brain gets louder the next day.
None of that means something is wrong with you. It means the stress system and the sleep system share wiring, and in menopause the wires run a little hot. The picker below matches the most common patterns to something you can try tonight.
What does your stress look like at night? Tap the one that sounds most like you
One at a time. Each pattern has a different first move.
What is going on: your brain is doing tomorrow's admin at the one moment it has no distractions.
Try: a five-minute to-do list at bedtime, and make it specific. In a sleep lab, people who wrote a to-do list fell asleep in about 16 minutes, against about 25 minutes for people who wrote about what they had already done, and the more specific the list, the faster they fell asleep. It was a small, one-night study of young adults, but it only costs a pen.
What is going on: cortisol naturally starts climbing in the last hours of sleep, and in a silent house every worry sounds urgent.
Try: do not check the clock. If you are wide awake and wired, get up, keep the light low, do something calm and slightly dull, and go back when you feel sleepy. More in why you cannot stay asleep in menopause.
What is going on: The Menopause Society notes that a hot flash can come with sweating, chills and anxiety, so a pounding heart can arrive with the heat.
Try: cool down first (covers off, a dry top on), then breathe slowly with long exhales for a few minutes. The full routine is in what to do when you wake up sweating. If this feels different from your usual flashes, or it worries you, tell your doctor.
What is going on: tired but wired can be the hangover of a short night. After lost sleep, evening cortisol ran 37 to 45 percent higher in the lab, and its quiet phase started an hour late.
Try: hold your usual wake time even after a rough night, finish hard workouts at least four hours before bed, and keep big caffeine doses to the morning.
What is going on: anticipation. Heavier workloads and job strain went with a higher chance of severe menopausal symptoms in a 2026 study of working women, while control over your own work was protective.
Try: move the planning out of the bedroom. Write Monday's specific to-do list after Sunday dinner, lay out what you need, then start the wind-down below.
How to lower cortisol in menopause (what has evidence)
There is no pill, patch or pajama that lowers cortisol on command. What has evidence is a handful of habits that calm the stress system over weeks and protect sleep, which feeds straight back into how stressed you feel. Two of them, exercise and mindfulness, have been measured against cortisol directly; the rest calm the stress response and protect sleep.
One honest note before the list: The Menopause Society says relaxation techniques, yoga and exercise have not been shown to reduce hot flashes themselves. Think of these habits as turning down the stress, not switching off the flashes.
1
Keep your wake time steady, even after a bad night
Regularity is quietly powerful. In a UK Biobank study of 79,666 adults, regular sleepers had a 33 percent lower risk of developing anxiety, and sleeping enough hours did not make up for an irregular schedule. The classic instructions for insomnia therapy include setting an alarm for the same time every morning, too.
Shown: the NightCool Scoop T-Shirt and NightCool Pants in Violet.
2
Move, and mind the timing
A 2022 review of 10 studies found physical activity programs lowered cortisol and improved sleep quality, though most participants were people with breast cancer. A 2025 analysis of 44 trials in adults under psychological strain found yoga lowered cortisol the most, while high-intensity interval training tended to nudge it up, though not significantly. And since workouts that ended at least four hours before sleep were not linked to changes in sleep across more than 4 million nights of wearable data, save the hard sessions for earlier in the day.
Shown: the NightCool Gathered Tank Nightgown in Merlot.
3
Learn a mindfulness practice properly
Across 39 studies, MBSR, a structured mindfulness course, lowered cortisol more than comparison groups, with a modest effect. In menopause specifically, a 2025 review of randomized trials found mindfulness programs improved sleep quality, anxiety and stress, though the authors rated the evidence low to moderate. A 2021 review found meditation's effect on saliva cortisol was small and not significant overall, so expect a gentle slope, not a switch.
Shown: the NightCool Long Scoop Neck Nightgown with 3/4 Sleeves in Black.
4
Breathe out for longer than you breathe in
In a month-long Stanford-led trial, five minutes a day of cyclic sighing, a breathing pattern built around long exhales, lifted mood more than the same time spent in mindfulness meditation. A 2026 review of slow breathing before bed found people reported better sleep, though sleep measured by devices was inconclusive.
Shown: the NightCool Scoop Neck Nightshirt in Island-Leaf.
5
Keep big caffeine doses early
In a controlled trial, 100 mg of caffeine had no measurable effect on sleep even four hours before bed, but 400 mg delayed sleep when taken within 12 hours of bedtime. The volunteers were young men, and your mileage may vary, but a very strong afternoon coffee is a fair suspect.
Shown: the NightCool Long Scoop Neck Nightgown with 3/4 Sleeves in Merlot.
6
Go easy on the nightcap
A 2025 meta-analysis of 27 studies found that even a low dose of alcohol, up to about two standard drinks, disrupted REM sleep, and the disruption grew with higher doses.
Shown: the NightCool Long Tank Gown in Merlot, with the men's NightCool Crew Neck T-Shirt and NightCool Pants in Navy.
7
Laugh on purpose
Yes, really. In a small 2026 trial of 64 postmenopausal women, a self-care education program combined with laughter yoga lowered perceived stress and saliva cortisol compared with a control group. Small study, low cost, zero side effects we know of.
Shown: the NightCool Scoop Neck Short Tank Nightgown in Island-Leaf.
A wind-down for a busy brain
Think of the last stretch of the evening as a runway. The goal is not a perfect routine. It is a predictable one, so your body learns that this sequence ends in sleep.
Change out of the day. Swapping into sleepwear is a small signal with a big job. Some women change straight after dinner into soft, comfortable pajamas for women that work on the sofa and in bed; others like a little support while they lounge, which is what built-in bra sleepwear is for.
Time the warm shower. A warm shower or bath one to two hours before bed, for as little as ten minutes, helped people fall asleep faster in a 2019 meta-analysis. The warmth draws blood to your hands and feet, which then shed heat, helping your core cool down on schedule.
Cool the room. The Sleep Foundation suggests a bedroom around 65 to 68 degrees Fahrenheit, and your core temperature is meant to drop by about 1.8 degrees overnight. For a broader habits plan, see our non-hormonal guide to sleeping better in menopause.
Tonight's wind-down checklist
Tap each one as you do it. Six small moves, no gadgets required.
Awake at 3 a.m.? Try this instead of scrolling
Skip the clock, cool down if you are hot, and if you are wide awake and wired, get up and do something calm in low light until you feel sleepy. That is the short version. Here is why it works.
A 3 a.m. wake-up is not proof of a "cortisol spike." Cortisol's pre-dawn climb is normal physiology. Plenty of things wake people in the small hours, and in menopause night sweats are a common one: skin sensors show they can last around an hour.
The famous 15-minute rule was never really a rule. Here is a tidbit from a 2025 best-practice paper on insomnia therapy: when Richard Bootzin first applied the get-out-of-bed method to insomnia in 1972, he left the timing intentionally vague "to prevent clock-watching behavior." Clinicians now describe two ways to use it: get up after a set time, or get up when you notice you are awake and cannot sleep. Clock-watching is often part of the problem in insomnia, so the second version suits a racing mind.
Cool first, calm second. If you wake damp, a dry top and a cooler layer come before any breathing exercise, because it is hard to relax while you are clammy. Then try the long-exhale breathing from the list above.
Keep the out-of-bed activity boring. A paperback, folding laundry, a dim lamp. Not your phone, not your inbox, and definitely not the news.
Set up a cooler, calmer bed
Your bed will not lower your cortisol, and no honest brand should tell you it will. What it can do is stop a warm night from becoming a wide-awake one.
Be realistic about what cooling does. The Menopause Society lists cooling techniques, such as adjusting clothing or room temperature, among measures without solid data for reducing hot flashes. That is exactly how we think about it: sleepwear does not stop a flash. What it can change is the aftermath, whether a sweat leaves you lying damp and chilled, fully awake and irritated, or lets you settle back down.
Choose fabric for the hour after a sweat. A fabric that holds sweat keeps you damp; one that moves it and dries fast shortens the clammy stretch. Our NightCool line is made with Kottinu fabric, which wicks sweat away from the skin and dries fast, so a long night sweat is less likely to leave you clammy at 3 a.m. Every piece in our menopause pajamas collection is NightCool. How the fabric does it is explained in what moisture-wicking fabric actually does.
Which night is yours? Pick your coverage
Tap one. Every option is the same NightCool knit, so this is about coverage, not fabric.
Least fabric, most air. The NightCool Gathered Tank Nightgown is sleeveless and knee-length, with a softly gathered front that skims rather than clings. More styles are in our women's nightgowns.
Sleeves for the chill, without the heat. The NightCool Long Sleeve Scoop Neck Nightshirt gives you full-arm coverage in a knee-skimming length, in a knit that dries fast, so the cold spell after a sweat has less to work with.
The middle ground. The NightCool Long Scoop Neck Nightgown with 3/4 Sleeves falls below the knee, and its three-quarter sleeves stop clear of the wrist, so you are not pushing fabric up all night.
Separates you can mix. Pair the short-sleeve NightCool Scoop T-Shirt with full-length NightCool Pants, with an elastic or drawstring waist, your choice. The pants pair with any NightCool top.
Each style has its own size chart on its product page, so check the piece you pick rather than assuming your usual size.
When habits are not enough
Habits are the foundation, not the whole house. If stress or sleep is wearing you down day after day, there are proven next steps, and asking for them is a strength.
Ask about CBT for insomnia by name. The American Academy of Sleep Medicine strongly recommends cognitive behavioral therapy for insomnia (CBT-I) for chronic insomnia. In a trial of perimenopausal and postmenopausal women with hot flashes, 70 percent of those who did CBT-I by telephone were out of the insomnia range at eight weeks, against 24 percent in the comparison group. Their hot flashes were no less frequent, but they got in the way less. A 2026 pilot of CBT adapted for menopausal insomnia with night-time hot flashes also cut insomnia severity more than menopause education alone.
CBT and clinical hypnosis help with hot flashes too. The Menopause Society lists both, alongside weight loss, as low-risk strategies that can help manage hot flashes and night sweats. In the UK, NICE guidance suggests menopause-specific CBT as an option for sleep problems such as night-time awakening that come with hot flashes.
Talk about medical options. There are hormonal and non-hormonal treatments for hot flashes, and the list is growing: the FDA approved elinzanetant, a non-hormone prescription medicine for moderate to severe hot flashes, in October 2025, and its trials also tracked sleep disturbance. Which option fits you is a conversation for you and your doctor. Do not start, stop or change any medication on your own.
Know when to get checked. Cleveland Clinic's advice is simple: see a healthcare provider if night sweats disrupt your sleep. Talk to your doctor, too, if anxiety or low mood is affecting your days, and if you are ever in crisis in the US, you can call or text 988 to reach the 988 Suicide and Crisis Lifeline, free and confidential, 24/7. Poor sleep matters beyond tomorrow's mood, as we explain in what poor sleep does to your health in menopause.
Your questions about cortisol, stress and sleep
These are the questions people ask in search and in our inbox, in the words they use. Tap any of them.
Does menopause cause high cortisol?
Not in a simple way. In the Seattle Midlife Women's Health Study, overnight cortisol was highest on average in the late menopause transition and lower again in early postmenopause, and women whose cortisol rose had more severe hot flashes. But in that same research, day-to-day stress, mood and sleep were not what separated women with rising cortisol from the rest. Menopause can nudge cortisol, and so can symptoms, sleep loss and life. It is rarely one cause.
What are the signs of high cortisol?
Cortisol is the body's main stress hormone, so it rises and falls with daily life. A medical condition of too much cortisol over a long period, Cushing's syndrome, is something else. The NIH describes it as rare when the body makes the excess itself, about 40 to 70 people per million, and it affects about three times as many women as men. Signs include weight gain, a round face, a fatty hump between the shoulders, thin arms and legs, easy bruising, wide purple stretch marks and weak muscles. The most common cause is long-term, high-dose use of cortisol-like steroid medicines. If several of these signs are new for you, see your doctor, not the supplement aisle.
How can I lower cortisol in menopause naturally?
Protect your sleep first, because lost sleep pushed evening cortisol 37 to 45 percent higher in the lab. The habits with the best evidence for cortisol itself are regular exercise (with hard sessions finished four hours before bed) and a structured mindfulness course such as MBSR. For stress and sleep, add a steady wake time, slow breathing with long exhales, strong caffeine kept to the morning and less alcohol. Expect gradual, modest change over weeks, not a switch.
Why do I wake up at 3 a.m. in menopause? Is it a cortisol spike?
Cortisol does start climbing in the last hours of sleep, but that is its normal daily rhythm, and it is not evidence of a spike that wakes you. In menopause, night sweats are a more common culprit: skin sensors show they last around an hour on average, and they nearly doubled the odds of trouble sleeping in a 2026 study. Stress plays a part too, since constant stress can trigger sweating in your sleep. If you wake up and cannot settle, skip the clock and use the 3 a.m. plan above.
Can high cortisol cause hot flashes?
Researchers have found links, not proof of cause. Women whose cortisol rose in the late transition had more severe hot flashes, symptoms explained about a third of the variation in cortisol in another study, and hot flashes went with higher hair cortisol in a 2026 pilot. But women with the most frequent flashes had slightly lower cortisol after waking in a study of 306 women. The honest answer: cortisol and hot flashes travel together, and scientists are still working out which leads.
Can stress cause night sweats?
It can. Cleveland Clinic notes that anxiety and panic disorders can trigger sweating in your sleep and that even constant stress can lead to sweating. In menopause, stress also seems to make hot flashes feel more severe. We cover the stress kind of sweating in detail in stress, anxiety and night sweats.
Is perimenopause anxiety worse at night?
It often feels that way, and there are reasons. At night worries have no competition, evening hot flashes can delay sleep, and a short night makes the next day's anxiety louder: one sleepless night raised anxiety by up to 30 percent in the Berkeley research. If anxiety is showing up most days, not just at night, talk to your doctor. There is effective help for sleep, such as CBT for insomnia, and your doctor can talk you through support for anxiety too.
Is adrenal fatigue real?
According to the Endocrine Society, "no scientific proof exists to support adrenal fatigue as a true medical condition." Their concern is practical: if you are told you have it, the real cause of your symptoms may be missed. Tiredness, poor sleep and craving caffeine are common and have many possible causes, so they are worth checking with a doctor.
Do cortisol or adrenal supplements work?
Be careful. The Endocrine Society warns that supplements sold as a treatment for adrenal fatigue could hurt you, and that many have not been tested for safety. Adrenal hormone supplements are a particular worry: taken when you do not need them, they can stop your adrenal glands working properly, and after stopping, the glands can stay "asleep" for months, with a risk of a life-threatening adrenal crisis. Talk to your doctor before taking anything marketed to balance cortisol.
Does exercising in the evening ruin sleep?
Not if you time it. In a 2025 study of more than 4 million nights of wearable data, exercise that ended at least four hours before sleep was not linked to changes in sleep, whatever the intensity. Later and harder sessions went with falling asleep later, sleeping less and a higher heart rate overnight. A gentle evening walk is a different animal from a late spin class.
How late can I have caffeine if I have trouble sleeping?
It depends on the dose. In a controlled trial, 100 mg of caffeine did not measurably affect sleep even four hours before bed, but a big 400 mg dose delayed sleep when taken within 12 hours of bedtime and broke sleep up when taken within eight. The volunteers were young men, so treat it as a guide: keep strong coffee to the morning, especially on nights that follow a bad one.
Can pajamas lower cortisol?
No, and you should be skeptical of anyone who says so. Sleepwear cannot lower cortisol or stop a hot flash. What the right fabric can do is keep you drier and more comfortable when a sweat rolls through, so it is less likely to leave you clammy, chilled and wide awake. That protects the sleep that the rest of this article is working to build.
What should I wear to bed if stress and hot flashes make me sweat?
Something light and loose that moves sweat off your skin and dries fast, with a dry top within reach. Then pick coverage by how you feel after a sweat: sleeveless if you run hot all night, long sleeves if the chill afterward is the problem, three-quarter sleeves or a tee and pants in between. Our menopause sleepwear is all NightCool, in nightgowns, nightshirts and separates.
When should I see a doctor about stress and sleep?
When night sweats disrupt your sleep, which is Cleveland Clinic's rule of thumb, and when stress, anxiety, low mood or exhaustion is affecting your days. Ask about CBT for insomnia, CBT or clinical hypnosis for hot flashes, and hormonal and non-hormonal medical options. If you are ever in crisis in the US, call or text 988.
Read next
- Menopause and sleep: why rest is the health lever no one talks about
- Menopause insomnia: why you cannot stay asleep and what helps
- How to sleep better in menopause: evidence-based, non-hormonal strategies
- Stress, anxiety, and night sweats: when your nervous system runs hot at night
- Sleeping hot in perimenopause, even when the room is cold
This article is for general information and is not medical advice. Please talk to your doctor about your own symptoms and treatment options.
Sources
- Kaur J, Gandhi J, Sharma S. "Physiology, Cortisol." StatPearls, NCBI Bookshelf. Updated December 1, 2025. ncbi.nlm.nih.gov. (Daily rhythm: rising in the final hours of sleep, peaking near waking, lowest at night.)
- Leproult R et al. "Sleep loss results in an elevation of cortisol levels the next evening." Sleep, 1997. pubmed.ncbi.nlm.nih.gov. (Evening cortisol 37 and 45 percent higher after partial and total sleep loss; quiet phase delayed by at least an hour; young men.)
- UC Berkeley News. "Stressed to the max? Deep sleep can rewire the anxious brain." November 4, 2019, on Ben Simon E et al., Nature Human Behaviour. news.berkeley.edu. (Up to a 30 percent rise in anxiety after a sleepless night.)
- Woods NF et al. "Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study." Menopause, 2009. pmc.ncbi.nlm.nih.gov. (Overnight urinary cortisol 45.3, 53.4 and 46.4 ng/mg creatinine by stage.)
- Woods NF et al. "Increased urinary cortisol levels during the menopausal transition." Menopause, 2006. pubmed.ncbi.nlm.nih.gov. (Women whose cortisol rose in the late transition had more severe vasomotor symptoms, with no difference in stress, mood or sleep.)
- Cagnacci A et al. "Increased cortisol level: a possible link between climacteric symptoms and cardiovascular risk factors." Menopause, 2011. pubmed.ncbi.nlm.nih.gov. (Symptom score explained 32.5 percent of the variance in 24-hour urinary cortisol; 85 women.)
- Long CA et al. "Are psychosocial factors and menopause symptoms related to hair cortisol concentrations among midlife Latinas? Results from the Menopausia, Salud, Corazón pilot study." Comprehensive Psychoneuroendocrinology, 2026. pubmed.ncbi.nlm.nih.gov. (Pilot study, 45 women.)
- Reed SD et al. "Daily salivary cortisol patterns in midlife women with hot flashes." Clinical Endocrinology, 2016. pubmed.ncbi.nlm.nih.gov. (306 women; lower cortisol 30 minutes after waking with the most frequent hot flashes; subtle differences.)
- Sahola N et al. "Worse sleep architecture but not self-reported insomnia and sleepiness is associated with higher cortisol levels in menopausal women." Maturitas, 2024. pubmed.ncbi.nlm.nih.gov. (35 women, three-night sleep study.)
- Fan YA et al. "The relationship between daily stress and hot flashes in women of menopausal age." Journal of Clinical Psychology, 2026. pubmed.ncbi.nlm.nih.gov. (130 women, eight-day diaries.)
- Freeman EW et al. "The role of anxiety and hormonal changes in menopausal hot flashes." Menopause, 2005. pubmed.ncbi.nlm.nih.gov. (Moderate anxiety nearly three times, high anxiety nearly five times more likely to report hot flashes.)
- Iida M et al. "Associations of employment characteristics and psychosocial work factors with severe menopausal symptoms among working women: a longitudinal study." Occupational and Environmental Medicine, 2026. pubmed.ncbi.nlm.nih.gov. (648 working women followed for about 5.3 years.)
- Maki PM et al. "Associations between vasomotor symptoms, sleep disturbances, and frequent mood changes individually and within symptom groups across the menopausal transition and early postmenopause: observations from the Study of Women's Health Across the Nation." Menopause, 2026. pubmed.ncbi.nlm.nih.gov. (2,066 women.)
- Jang Y et al. "Menopausal stage transitions and associations with overall and domain-specific perceived stress in middle-aged Korean women." Maturitas, 2025. pubmed.ncbi.nlm.nih.gov. (4,619 women, median follow-up 6.6 years.)
- Balasubramanian I et al. "Prevalence and incidence of depressive, anxiety, and insomnia symptoms in perimenopausal and postmenopausal women: systematic review and meta-analysis." General Hospital Psychiatry, 2026. pubmed.ncbi.nlm.nih.gov. (102 studies, 1,141,955 women.)
- Shreyer S et al. "Distinguishing hot flashes and night sweats: a mixed-method analysis." Menopause, 2026. pubmed.ncbi.nlm.nih.gov. (Night sweats 60.5 minutes versus 3.4 minutes for hot flashes; 274 women.)
- Sievert LL et al. "Hot flashes and night sweats in relation to trouble sleeping and daytime sleepiness." Menopause, 2026. pubmed.ncbi.nlm.nih.gov. (841 women; adjusted odds ratio 1.78 for trouble sleeping with night sweats only.)
- Law C, Gunthert K, Sokolovsky A. "Subjective menopausal hot flashes in sleep disturbance: does the timing of hot flashes matter?" Menopause, 2026. pmc.ncbi.nlm.nih.gov. (99 women, seven-day diaries.)
- Leota J et al. "Dose-response relationship between evening exercise and sleep." Nature Communications, 2025. pubmed.ncbi.nlm.nih.gov. (14,689 people, 4,084,354 nights.)
- Li DR et al. "Regular sleep patterns, not just duration, critical for mental health: association of accelerometer-derived sleep regularity with incident depression and anxiety." Psychological Medicine, 2025. pubmed.ncbi.nlm.nih.gov. (79,666 UK Biobank participants, median follow-up 7.5 years.)
- Johnson BT et al. "Mindfulness-based stress reduction interventions and cortisol regulation: a systematic review and meta-analysis." Health Psychology, 2026. pubmed.ncbi.nlm.nih.gov. (39 studies.)
- Wang H et al. "The effectiveness of mindfulness-based interventions on menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials." Journal of Affective Disorders, 2025. pubmed.ncbi.nlm.nih.gov.
- Koncz A et al. "Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis." Health Psychology Review, 2021. pubmed.ncbi.nlm.nih.gov.
- De Nys L et al. "The effects of physical activity on cortisol and sleep: a systematic review and meta-analysis." Psychoneuroendocrinology, 2022. pubmed.ncbi.nlm.nih.gov. (10 studies, mostly in people with breast cancer.)
- Li X et al. "The optimal exercise modality and dose for cortisol reduction in psychological distress: a systematic review and network meta-analysis." Sports, 2025. pubmed.ncbi.nlm.nih.gov. (44 studies.)
- Balban MY et al. "Brief structured respiration practices enhance mood and reduce physiological arousal." Cell Reports Medicine, 2023. pmc.ncbi.nlm.nih.gov.
- Eide EM et al. "Slow breathing techniques before bedtime and the effects on sleep: a systematic review." Sleep Medicine Reviews, 2026. pubmed.ncbi.nlm.nih.gov.
- Gardiner CL et al. "Dose and timing effects of caffeine on subsequent sleep: a randomized clinical crossover trial." Sleep, 2025. pubmed.ncbi.nlm.nih.gov. (23 young men.)
- Gardiner C et al. "The effect of alcohol on subsequent sleep in healthy adults: a systematic review and meta-analysis." Sleep Medicine Reviews, 2025. pubmed.ncbi.nlm.nih.gov. (27 studies.)
- Gülevi DK et al. "Effects of a self-care-based education and laughter yoga on chronic stress, menopausal symptoms, and salivary cortisol: a randomized controlled trial." African Journal of Reproductive Health, 2026. pubmed.ncbi.nlm.nih.gov. (64 postmenopausal women.)
- Scullin MK et al. "The effects of bedtime writing on difficulty falling asleep: a polysomnographic study comparing to-do lists and completed activity lists." Journal of Experimental Psychology: General, 2018. pmc.ncbi.nlm.nih.gov. (57 healthy adults aged 18 to 30.)
- Haghayegh S et al. "Before-bedtime passive body heating by warm shower or bath to improve sleep: a systematic review and meta-analysis." Sleep Medicine Reviews, 2019. pubmed.ncbi.nlm.nih.gov.
- Cuddihy LJ, Grandner MA, Nowakowski S. "Implementation of stimulus control and sleep restriction therapy for insomnia: standard definitions and best practices." Journal of Behavioral and Cognitive Therapy, 2025. pmc.ncbi.nlm.nih.gov.
- Sleep Foundation. "Why Do I Get So Hot When I Sleep?" Medically reviewed by Abhinav Singh, MD. Updated September 9, 2026. sleepfoundation.org. (Bedroom around 65 to 68 degrees Fahrenheit; core temperature drops about 1.8 degrees at night.)
- The Menopause Society. "Hot Flashes." menopause.org. (Weight loss, CBT and clinical hypnosis can help manage hot flashes and night sweats; cooling techniques, exercise and yoga, relaxation techniques and trigger avoidance have limited data.)
- Edinger JD et al. "Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline." Journal of Clinical Sleep Medicine, 2021. pubmed.ncbi.nlm.nih.gov.
- McCurry SM et al. "Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a MsFLASH randomized clinical trial." JAMA Internal Medicine, 2016. pubmed.ncbi.nlm.nih.gov. (106 women.)
- Arentson-Lantz EJ et al. "Cognitive behavioral therapy for menopausal insomnia in perimenopausal and postmenopausal women with insomnia and nocturnal hot flashes: a randomized-controlled pilot trial." Menopause, 2026. pubmed.ncbi.nlm.nih.gov. (43 women.)
- NICE. "Menopause: identification and management" (NG23), recommendation 1.5.24. Last updated April 15, 2026. nice.org.uk.
- U.S. Food and Drug Administration. Drugs@FDA, NDA 219469 (elinzanetant), approved October 24, 2025. accessdata.fda.gov.
- Baker FC et al. "Elinzanetant in postmenopausal women with sleep disturbance: results from the randomized, phase II NIRVANA study." Sleep, 2026. pubmed.ncbi.nlm.nih.gov.
- Endocrine Society. "Adrenal Fatigue." Last updated January 25, 2022. endocrine.org.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). "Cushing's Syndrome." niddk.nih.gov.
- Cleveland Clinic. "Night Sweats." Last reviewed April 28, 2026. my.clevelandclinic.org.
- 988 Suicide and Crisis Lifeline. 988lifeline.org.
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