Period Insomnia: Why Can't I Sleep The First Night?

Many women experience insomnia in the days leading up to their period. This is often referred to as period insomnia or menstrual insomnia. Research suggests that hormonal changes, particularly a drop in progesterone levels, are responsible for this phenomenon. Progesterone has a sleep-inducing effect, so a sharp drop in progesterone levels before a period may cause insomnia. Additionally, body temperature changes during the menstrual cycle can also impact sleep. Other factors such as caffeine intake, stress, and pre-existing conditions like polycystic ovary syndrome (PCOS) or premenstrual dysphoric disorder (PMDD) can further contribute to sleep disturbances. While menstrual insomnia is a common issue, there are various strategies to improve sleep quality during this time, including lifestyle changes, relaxation techniques, and medical treatments.

Hormonal changes, including a drop in progesterone, can cause insomnia

Progesterone is one of the two main hormones that control the menstrual cycle. In the week before a period, progesterone levels increase as the body prepares itself for a potential pregnancy. However, if pregnancy does not occur, progesterone levels drop dramatically, triggering the start of the period.

Progesterone has a sleep-inducing effect, so this sharp drop in levels just before a period may be why many people experience insomnia during this time. Experts believe that it is the change in hormone levels, rather than the levels themselves, that has the greatest potential to disrupt sleep.

During the follicular phase, which is the first half of the menstrual cycle, the brain signals the pituitary gland to make follicle-stimulating hormones, which trigger a rise in estrogen. This can make people feel overstimulated and lead to insomnia. During this phase, people tend to have more light or poor-quality sleep and an increase in REM sleep, often at the end of the night, which can make it difficult to wake up in the morning.

Additionally, body temperature changes can also impact sleep. Sleep and body temperature are linked. Throughout the menstrual cycle, the core body temperature changes, and it is about 0.3 degrees Celsius to 0.7 degrees Celsius higher after ovulation and remains high until the period begins. The body temperature then drops back down to its regular temperature. As the body temperature is higher just before a period, it may impact sleep.

Body temperature changes can disrupt sleep

Your body temperature can also impact your circadian rhythm (or body clock). Research has shown that women with premenstrual dysphoric disorder (PMDD) produce less melatonin, a hormone that helps tell your body it's time to rest.

To improve your sleep during this time, try cooling your room's temperature to around 65°F (18°C). This may mean keeping the window open at night or using fans.

Polycystic ovary syndrome (PCOS) can worsen sleep disturbances

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects the reproductive, metabolic, and psychological health of women. Women with PCOS may have irregular menstrual periods, lower progesterone levels, and high testosterone levels. PCOS is associated with a higher risk of sleep apnea, a condition where breathing stops for short periods during sleep. This can disturb sleep, leading to daytime sleepiness, reduced sex drive, and other symptoms.

PCOS is also linked to insulin resistance, which can cause hyperinsulinemia and further contribute to sleep disturbances. Additionally, PCOS patients have been found to have higher levels of fasting insulin and lower glucose-to-insulin ratios, which are associated with a higher risk of sleep apnea.

Obesity is common in women with PCOS and can exacerbate sleep disturbances. However, sleep problems also occur in women with PCOS who have a normal weight, suggesting that PCOS itself plays a role in sleep disturbances.

The relationship between PCOS and sleep disturbances is complex and may be bidirectional. Addressing PCOS through prevention and treatment may help reduce the risk of sleep disturbances.

Premenstrual dysphoric disorder (PMDD) can cause insomnia

Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). It is a chronic health condition that affects people of childbearing age and can cause insomnia. PMDD affects up to 10% of women or people assigned female at birth (AFAB) of reproductive age.

PMDD causes physical and emotional symptoms in the week or two before menstruation, including severe anxiety, depression, and mood changes, anger, irritability, feelings of being overwhelmed, and fatigue. These symptoms can interfere with daily life, work, and relationships.

Changes in sleep patterns are common in PMDD, with excessive sleeping or difficulty sleeping. Studies have shown that people with PMDD experience more severe insomnia than those without the disorder. As many as 70% of women with PMDD have insomnia symptoms before their period.

The exact cause of PMDD is unknown, but it may be due to an abnormal reaction to normal hormone changes during the menstrual cycle. Hormonal changes can cause a decrease in serotonin, a brain chemical that regulates mood, hunger, and sleep. Additionally, body temperature changes during the menstrual cycle can affect sleep, as sleep is linked to body temperature.

Treating PMDD can include lifestyle changes, such as increasing rest and sunlight exposure, maintaining a healthy diet, and reducing alcohol and caffeine intake. Relaxation techniques, antidepressants, hormonal birth control, and vitamin supplements may also be recommended.

Lifestyle changes can improve sleep during periods

• Exercise: Regular exercise can help reduce the severity of PMS symptoms. Try yoga, swimming, or aerobic exercise.
• Diet: Eat more whole grains, fruits, and vegetables to reduce PMS symptoms. Stay hydrated by drinking more water, and reduce caffeine, salt, and sugar intake to prevent bloating.
• Sleep position: Depending on your symptoms, you may need to adjust your sleep position. For example, if you feel bloated, you may not want to sleep on your stomach. If you have back cramps, try side sleeping with a pillow between your thighs or sleeping on your back with a thin pillow under your knees.
• Temperature: Keep your bedroom cool. Hormones can elevate your body temperature during your cycle, so a cooler bedroom may help you sleep better.
• Relaxation: Try yoga, deep breathing, meditation, or muscle relaxation techniques to help you relax before bed.
• Sleep hygiene: Keep a regular bedtime, maintain a cool, dark, and quiet bedroom, and avoid blue light before bed.
• Bedtime routine: Establish a nighttime routine and stick to it. This can include reading, listening to music, or doing yoga.
• Avoid stimulants: Avoid caffeine, alcohol, and cigarettes close to bedtime, as these can disrupt your sleep.
• Supplements: Talk to your doctor about taking melatonin supplements or other nutritional supplements to help with your sleep and PMS symptoms.

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