The 3am Worry Club: A Toolkit for Perimenopausal Insomnia

This week I am bringing you a series on common concerns for neurodivergent, perimenopausal women and how to compassionately support yourself through them using Acceptance and Commitment Therapy (ACT) techniques.

Today, in article two, we continue our journey with worry-based insomnia, and how to soften the overthinking part of us that keeps us up at 3am.

Untangling the Mind

Perimenopause introduces a potent mix of hormonal fluctuations, anxiety, and disturbed sleep. This causes a complex shift as drops in oestrogen impact the accessibility of dopamine, serotonin, and GABA, and is further impacted by how our mast cells respond to cortisol and lowering oestrogen - not well, in fact.

• Dopamine - responsible for motivation. Drops in oestrogen make this neurotransmitter even less reliable and accessible.

• Serotonin - responsible for mood stabilisation. Changes in oestrogen and progesterone mean we are more likely to feel emotionally charged.

• GABA - responsible for relaxation. Drops in progesterone or oddities in how neurodivergent brains respond to progesterone mean that GABA isn’t doing its job of relaxing us anymore.

• Mast cells - responsible for producing histamine amongst other chemicals. They have receptors for oestrogen and cortisol, meaning that changes in these two hormones will impact mast cells, increasing inflammation and prolonging stress responses.

All of this has another challenge. For many women, especially neurodivergent women, changes in oestrogen and its impact on other hormones and neurotransmitters also has the double whammy of intensifying a network within the brain called the Default Mode Network (DMN). Causing it to get stuck in a loop.

This neural network, often called the brain’s auto-pilot or narrative (storytelling) network, because it kicks in when we’re in a relaxed state inducing a kind of day dreaming, can become hyperactive. This traps the mind in repetitive cycles of worry, guilt, and overthinking. And this is particularly prevalent during the vulnerable hours of the night when all else is quiet. The mind knows it is meant to be asleep, but when the DMN in hyperactive, it can end up switched on in unhelpful ways instead of lulling you back into rest.

If you find yourself wide awake at 3am with thoughts spiralling endlessly, know that you are not alone. This by itself might be slightly comforting. I also want to share with you that there are practical methods to gently step out of these loops using somatic techniques and ACT. More below.

The DMN and Perimenopausal Anxiety

The DMN is a cluster of brain regions active during rest and when our minds wander. Normally, it helps us daydream, reflect on the past, or plan for the future. But when overstimulated, like during sleep disruption exacerbated by perimenopausal anxiety, it can get stuck in cycles of repetitive negative thinking. This causes cortisol to be released as your anxiety rises, putting your nervous system on high alert.

Middle-of-the-night anxiety often becomes a catch-22. Your nervous system is hyper-alert, yet also fatigued, making it difficult to calm the mind or fall back asleep.

Traditional advice to ‘just stop thinking’ rarely works here. The harder we try to suppress thoughts, the stronger they become. That’s where ACT’s techniques of Defusion and Present Moment Contact can provide a fresh, kinder way to relate to your thoughts. And we can use some somatic approaches to calm the nervous system again.

The Somatic ACT Toolkit

The goal isn’t to battle or banish thoughts, but to learn to see them as just thoughts, not absolute facts or commands. Here are simple exercises you can try the next time your mind feels stuck:

1. Defusion Techniques: Unhooking from Thoughts

Leaves on a Stream

• Visualise your thoughts as leaves gently floating down a stream.

• As a thought arises, imagine placing it on a leaf and watching it drift away, without chasing it or pushing it away.

• Notice the sensation of detachment. Your thinking is happening, but you’re not dragged along with it into the vortex.

Silly Voice Technique

• Repeat a troublesome thought aloud using a funny, exaggerated voice, like a cartoon character or a chipmunk.

• This shifts the tone from distressing to absurd, reducing the thought’s power.

• You begin to see your thoughts as mental events rather than truths.

Name Your Story

• When a repetitive worry or guilty thought starts, label it: “That’s my ‘I should have done better’ story again.”

• Naming thoughts creates distance and diminishes their automatic impact.

2. Present Moment Contact: Sensory Grounding Practices

Body Scan

• Slowly focus on each part of your body, noticing sensations without judgment.

• Feel your feet on the floor, your back against the bed, the rise and fall of your breath.

• This reconnects you with your embodied present and soothes the nervous system.

EFT Tapping

• Gently tap each meridian point (see the graphic), repeating until you feel yourself yawn or sigh

• As you tap, you can also say words like ‘I am safe, I am sleepy, I am ready to go to sleep’.

Practising with Compassion and Patience

It’s so important to approach these exercises with kindness to yourself. Your mind getting stuck in a loop isn’t a failure, but a signal from your nervous system seeking help. Regular, gentle practice, even during the day, builds resilience to the DMN's looping.

If sleep disturbance and anxiety persist, combining these ACT strategies with somatic therapies like Internal Family Systems therapy or somatic healing can support profound healing, addressing both mind and body.

Remember, healing the mind through the body is a journey, especially in perimenopause. You are not alone in facing these loops, and with practical tools like Defusion and Present Moment Contact, you can learn to unhook gently, rest easier, and greet each day with more ease.