Does DHEA help with sleep disruption during perimenopause?

DHEA may have some influence on sleep quality during perimenopause, primarily through its neurosteroid effects on GABA receptors in the brain rather than through direct sedation. DHEAS levels naturally decline with age and are often lower in midlife women experiencing sleep disruption. DHEA converts to allopregnanolone, a neurosteroid that acts on GABA-A receptors and has calming properties similar to those of progesterone. Since perimenopausal sleep disruption is partly tied to falling progesterone and reduced GABAergic tone, this is a plausible biological mechanism worth understanding.

The direct evidence for DHEA improving sleep is limited. A small 2004 study found that DHEA administration improved rapid eye movement (REM) sleep in younger men, but comparable high-quality trials in perimenopausal women are lacking. Observational research has found that women with higher DHEAS levels tend to report better sleep quality and fewer nighttime awakenings, but this association does not prove that supplementing DHEA causes better sleep. A 2011 review in Sleep Medicine Reviews noted that DHEAS is involved in sleep architecture regulation, particularly in supporting REM and non-REM transitions, but called for more rigorous trials. The sleep benefit, if present, is likely indirect for most women, coming through reduced anxiety, improved mood, or partial vasomotor relief rather than a direct sleep-inducing effect.

Perimenopause disrupts sleep through several overlapping mechanisms. Night sweats and hot flashes wake women from sleep directly. Falling progesterone, which would normally support GABA receptor activity, reduces the sleep-promoting signal in the brain. Elevated cortisol from the stress of hormonal transition keeps the nervous system in a lighter, more alert state. DHEA may nudge some of these factors in a helpful direction. Its conversion to allopregnanolone could partially compensate for falling progesterone's GABA effect, and its anti-cortisol properties (DHEA and cortisol are produced from the same adrenal precursor and often move inversely) could reduce nighttime arousal.

For oral DHEA in the context of sleep, studies have used doses from 25 to 50 mg per day. Studies have used 25 mg as a starting reference point. Talk to your healthcare provider about the right dose for your situation. Timing may matter: some practitioners suggest taking DHEA in the morning to align with the body's natural DHEA peak (which occurs in the morning) and to avoid any stimulating effects interfering with sleep onset. Taking it at night is sometimes recommended for sleep support, but this is not well-studied. Start with morning dosing and adjust only under provider guidance. Getting a DHEAS blood level tested before starting is also important, since supplementing when your levels are already adequate is unlikely to help and adds unnecessary risk.

For sleep disruption, DHEA is not your best first option. Magnesium glycinate has solid evidence for improving sleep quality. Improving sleep hygiene, addressing night sweats, and reducing evening cortisol through relaxation practices all have stronger behavioral evidence. Do not add DHEA to an existing hormone therapy regimen without your provider's knowledge. If you have or have had breast cancer, ovarian cancer, uterine cancer, endometriosis, PCOS, or uterine fibroids, do not use DHEA without discussing it with your healthcare provider first. Androgenic side effects including acne, oily skin, facial hair growth, scalp hair thinning, and voice changes can occur. OTC availability does not make DHEA safe to self-dose.

If DHEA is going to improve sleep, you would likely notice changes over 8 to 12 weeks. Changes might be subtle: fewer nighttime awakenings, slightly faster sleep onset, or feeling more rested on the same hours of sleep. These gradual improvements are hard to notice without tracking. Rate your sleep quality on a simple scale each morning so you have objective data rather than a vague sense of whether things are better.

See a doctor if sleep disruption is severe or persistent, if you are averaging fewer than 5 hours per night regularly, if you have symptoms of sleep apnea (gasping, witnessed apnea, extreme daytime fatigue), or if your sleep deprivation is affecting your ability to function safely. A sleep study may be warranted. Sleep apnea, which often goes undiagnosed in women and can worsen during perimenopause, requires specific treatment and is not addressed by supplements.

Tracking sleep patterns alongside other symptoms helps you see what is driving the disruption. The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log sleep quality, night sweats, and mood together each day so you can identify your specific pattern and share meaningful data with your healthcare provider.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.