Period Problems: Sleepless Nights And Uncomfortable Days

Sleep quality can be affected by the menstrual cycle. Many women experience sleep disturbances during their periods, with 30% reporting disturbed sleep during menstruation. This can be caused by various factors, including hormonal changes, physical discomfort, and emotional fluctuations. Understanding the relationship between sleep and the menstrual cycle is essential for managing sleep disturbances and maintaining overall well-being.

Hormonal changes

Fluctuating levels of estrogen and progesterone during the menstrual cycle can affect sleep quality. Estrogen tends to make you feel more awake, while progesterone tends to make you sleepier. Both of these hormones drop sharply right before your period starts. As the shedding of the uterine lining tapers off, your estrogen starts to increase, which can coincide with increased energy, until you ovulate. At that point, progesterone begins to increase as well, signalling rest mode. Then, both drop off suddenly, and your cycle begins anew.

Progesterone has a hypnotic function that helps people sleep. When the amount of progesterone dips, it could affect sleep quality. Estrogen also affects your sleep-wake cycle. It keeps your body temperature low at night, helping you sleep better. This hormone can also have an antidepressant effect, stimulating better sleep quality. The drop in estrogen levels during the luteal phase could cause sleep problems.

During the luteal phase, the amount of progesterone produced by your body increases to build the uterine lining for a possible pregnancy. Once the body realises that pregnancy didn't occur, progesterone levels start decreasing. The luteal phase is associated with increased waking during the night and decreased slow-wave sleep. Generally, sleep quality appears to be lowest during the mid-to-late luteal phase.

Falling levels of estrogen and progesterone in the days before your period are linked to reduced sleep quality. In addition, menstrual cramps and heavy bleeding can also make sleep more challenging during this time.

Anxiety and depression

Periods can cause a range of uncomfortable symptoms, including emotional distress and symptoms of anxiety and depression. These symptoms are often part of premenstrual syndrome (PMS), which is a combination of physical, emotional, and behavioural symptoms that occur during the premenstrual phase of the cycle and typically go away after the period begins.

Causes of Anxiety and Depression During Periods

The exact cause of depression due to PMS is unknown, but it may be connected to several factors, including:

• Hormonal fluctuations during the second half of the menstrual cycle, particularly changes in estrogen and progesterone levels.
• Sensitivity of the central nervous system to reproductive hormones.
• Genetic factors, such as a family history of PMS, PMDD, or mood disorders.
• Psychosocial factors, such as stress.

Premenstrual Dysphoric Disorder (PMDD)

If you experience severe anxiety and depression before or during your period, it may be due to premenstrual dysphoric disorder (PMDD). PMDD is a more severe form of PMS that affects up to 10% of people who menstruate. It is characterised by extreme irritability, anxiety, or depression, and these symptoms can be severe enough to interfere with daily life, relationships, and work. People with PMDD may also experience suicidal thoughts.

Premenstrual Exacerbation (PME)

PME occurs when hormonal changes before a period intensify the symptoms of an existing mental health condition, such as depression or generalised anxiety disorder. PME is similar to PMDD, but the key difference is that PME heightens existing depression, while PMDD causes depression-like symptoms not related to major depressive disorders.

Coping with Anxiety and Depression During Periods

If you are experiencing anxiety and depression during your period, there are several strategies that may help:

• Track your symptoms: Keeping a journal or using a period-tracking app can help you identify patterns and determine if your symptoms are connected to your menstrual cycle. This information can also be useful when discussing your symptoms with a healthcare professional.
• Lifestyle changes: Making healthy lifestyle choices, such as regular exercise, a balanced diet, adequate sleep, and stress management techniques, can help improve mood and reduce symptoms of anxiety and depression.
• Medical treatment: If lifestyle changes are not enough, you may want to consult a healthcare professional. They may recommend over-the-counter or prescription pain medication, hormonal birth control, or antidepressants, depending on your specific symptoms and needs.

Physical discomfort

The physical discomfort caused by periods can significantly impact sleep quality. Cramps, abdominal pain, and gastrointestinal issues are common complaints during menstruation, disrupting sleep patterns and making it challenging to find a comfortable sleeping position.

Hormonal changes during the menstrual cycle, particularly the drop in estrogen and progesterone levels before the period, can contribute to increased sensory awareness. This heightened sensitivity can make noises seem louder, smells stronger, and itchy sensations more intense, further hindering a good night's rest.

Additionally, the body's ability to regulate temperature can be affected by hormonal fluctuations, making it challenging to maintain an ideal sleeping environment.

Menstruation can also lead to iron deficiency, resulting in tiredness and fatigue. This, coupled with the busy lives many people lead, can leave them feeling rundown and exhausted.

To alleviate physical discomfort and improve sleep during periods, it is recommended to focus on soothing the pain. This can be achieved through various means, such as pain relief medications, hot water bottles, or herbal remedies like peppermint tea.

Switching to soft, breathable period care products, such as organic cotton pads, can also enhance comfort and reduce the risk of itching and irritation in the vaginal area, promoting a more restful night's sleep.

Sleep environment

Sleep is heavily influenced by the menstrual cycle, and vice versa. As such, it's important to create a soothing sleep environment to help you rest better during your period. Here are some tips to improve your sleep environment:

Keep Your Bedroom Quiet, Dark, and Cool

A quiet, dark, and cool environment is ideal for sleeping. Consider using earplugs, eye masks, blackout curtains, or a white noise machine to create a peaceful and relaxing space.

Put Away Mobile Devices at Least an Hour Before Bedtime

The blue light emitted by electronic devices can disrupt your sleep cycles. Give your eyes a break and avoid the temptation to stay online by retiring your phone or tablet at least an hour before bedtime.

Establish a Bedtime Routine

A bedtime routine can signal to your body that it's time to relax and prepare for sleep. Try to incorporate activities that help you unwind, such as reading a light-hearted book, meditating, or practising deep breathing exercises.

Exercise Regularly, but Not Too Close to Bedtime

Regular physical activity can improve your sleep quality. However, strenuous exercise within an hour of bedtime can negatively impact sleep. Aim to finish your workouts a few hours before you plan to sleep to give your body time to relax.

Avoid Heavy Meals Close to Bedtime

Eating a large, high-calorie meal close to bedtime can disrupt your sleep. If you're hungry, opt for a light snack like a banana with almond butter or a cup of Greek yoghurt.

By making these adjustments to your sleep environment and routine, you can hopefully improve your sleep quality during your period.

Diet and exercise

Diet

• Increase your intake of complex carbohydrates: Whole grains, beans, barley, fruits, and vegetables are great sources of complex carbs, which can help curb cravings and stabilise your mood by regulating your insulin levels.
• Consume more calcium and vitamin D: Calcium and vitamin D-rich foods like reduced-fat milk, yoghurt, and cheese may help alleviate PMS symptoms. Non-dairy alternatives include nuts, low-fat dairy products, fish with bones (such as salmon and sardines), tofu, broccoli, and bok choy.
• Reduce salt intake: Sodium contributes to fluid retention, abdominal bloating, breast swelling, and pain. Avoid processed and packaged foods, as salt is often hidden in these.
• Limit caffeine and alcohol: Caffeine and alcohol can disrupt your sleep and aggravate PMS symptoms. Caffeine can be found in coffee, tea, chocolate, and some soft drinks.
• Eat more iron-rich foods: You lose a lot of iron during menstruation, so eating iron-rich foods can help prevent anaemia. Good sources include lean red meat, lentils, beans, and seafood like greenshell mussels.
• Eat smaller meals more frequently: Instead of three large meals, try having six smaller meals throughout the day to keep your blood sugar stable and improve your symptoms.
• Stay hydrated: Drinking plenty of water is always important, but especially during your period. Herbal teas, such as chamomile, are also good options.

Exercise

• Engage in regular exercise: Research suggests that women who exercise regularly are less likely to suffer from menstrual pain, cramps, and mood disturbances. Aim for at least 30 minutes of exercise most days of the week.
• Aerobic exercise is beneficial: Activities that get your heart rate up, such as running, swimming, or group fitness classes, can help improve PMS symptoms like depression and fatigue by releasing endorphins.
• Try yoga: Yoga can help reduce stress and menstrual pain, cramps, and bloating. Certain poses, like "cobra," "cat," and "fish," may be especially beneficial in easing painful cramping.
• Add strengthening and balancing exercises: These exercises can lower your chances of injury, as your muscles may move differently during your period, making you more susceptible to injury.
• Listen to your body: Match the intensity of your workouts to your energy levels. During your period, when energy levels are lower, opt for low-intensity activities like walking, stretching, or Pilates. As your energy increases throughout your cycle, incorporate more cardio and strength training.

Frequently asked questions