Waking up at 4 a.m. every day may be caused by menopause. Menopause is a physiological phenomenon that occurs between the ages of 45 and 55. It is caused by endocrine dysfunction and can have a variety of symptoms, including palpitations, chest tightness, shortness of breath, excessive sweating, abnormal blood pressure, and menstrual disorders, including menopause and excessive menstrual flow. Patients may also experience sleep disorders, which may manifest as difficulty in falling asleep, easy to wake up early during sleep, and may also experience more dreams during sleep, affecting sleep quality. Patients may also develop menopausal anxiety disorder and menopausal depression. Patients with menopausal anxiety disorder mainly present with anxiety, irritability, panic and fear, which often force patients to have difficulty falling asleep and have nightmares during sleep. Patients with depression generally show a lack of interest in anything, low mood, and may also experience easy early awakening during sleep, as well as more dreaming.