Period And Sleep: Exploring The Connection

Fluctuating hormone levels can cause sleep disturbances during the menstrual cycle, with many women reporting sleep issues in the lead-up to their period. This phenomenon is known as period insomnia and is often associated with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). While the exact cause is still unknown, it is believed that changes in hormone levels, particularly estrogen and progesterone, can impact sleep quality by activating certain brain areas that inhibit sleep. Additionally, symptoms such as bloating, breast tenderness, and pelvic or muscle pain may also contribute to sleep disturbances. Addressing sleep hygiene, making lifestyle changes, and seeking medical advice are recommended to improve sleep during this time.

Hormonal changes and their impact on sleep

Fluctuating hormone levels can significantly impact sleep quality. The hormones oestrogen and progesterone, which play a role in regulating the menstrual cycle, can also influence sleep. Research shows that sleep quality is worse in the days leading up to a person's period, with people reporting waking up more frequently and taking longer to fall asleep.

Hormone shifts during the menstrual cycle can affect sleep. In women with normal menstrual cycles, oestrogen and progesterone rise and fall at predictable times. During the luteal phase, the amount of progesterone produced by the body increases to build the uterine lining for a possible pregnancy. Progesterone is a calming and soothing hormone with a hypnotic function that helps people sleep. When the amount of progesterone dips, it could affect sleep quality.

Estrogen also affects the 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.

Women with premenstrual dysphoric disorder (PMDD) have the worst luck with sleep as they near their period. As many as 70% of women with PMDD have insomnia symptoms before their period. They also produce less melatonin, a hormone that promotes sleep. Their bodies also have a blunted response to melatonin during this time.

Additionally, unpleasant symptoms such as bloating, pelvic pain, headaches, and muscle aches could keep you awake.

The link between PMS and insomnia

PMS, or premenstrual syndrome, is a condition that affects up to 90% of people who menstruate. It involves a range of physical and emotional symptoms, including tender breasts, bloating, headaches, irritability, tension, and, you guessed it, sleep problems. For many, insomnia is a telltale sign that their period is approaching.

Research shows that twice as many people experience insomnia in the days leading up to their period. This can manifest as difficulty falling or staying asleep, or feeling fatigued during the day, even after a full night's rest. Those with more severe PMS, known as premenstrual dysphoric disorder (PMDD), experience an even greater disruption to their sleep. As many as 70% of women with PMDD have insomnia symptoms before their period.

So, what's the connection between PMS and insomnia? The exact cause is still not fully understood, but it is believed to be related to hormonal fluctuations. During the luteal phase of the menstrual cycle, the body produces more progesterone, a calming and soothing hormone that aids sleep. However, as the body realises that pregnancy hasn't occurred, progesterone levels start to decrease, which may impact sleep quality.

Additionally, estrogen affects the sleep-wake cycle by keeping body temperature low at night, promoting better sleep. A drop in estrogen levels during the luteal phase could, therefore, cause sleep problems.

Melatonin, a hormone that regulates the sleep-wake cycle, may also play a role. Women with PMDD and insomnia during the luteal phase have been found to have decreased melatonin secretion. This could be a significant factor in period insomnia, but more research is needed to confirm the link.

Anxiety, depression, and mood swings, which are common symptoms of PMS and PMDD, can also directly impact sleep quality. The physical discomfort associated with PMS, such as bloating, pelvic pain, and muscle aches, can further contribute to sleep disturbances.

While the exact mechanisms are not yet fully understood, it is clear that PMS and insomnia are closely linked. If you struggle with period insomnia, there are strategies you can implement to improve your sleep quality, such as improving sleep hygiene, making dietary changes, and seeking medical advice for personalised recommendations.

Lifestyle changes to improve sleep

Lifestyle changes can be very effective in improving sleep quality during your period. Here are some strategies you can try:

Exercise regularly: Aim for at least 30 minutes of exercise daily, preferably outdoors and earlier in the day. However, avoid strenuous exercise close to bedtime as it may energize you when you should be winding down.

Maintain a consistent sleep schedule: Go to bed and wake up at the same time every day, even on weekends. This helps to set your body's internal clock and improve your overall sleep quality.

Optimize your sleep environment: Ensure your bedroom is dark, cool, quiet, and comfortable. Remove distractions such as televisions and mobile devices, and consider using earplugs or eye masks if needed.

Avoid stimulants: Limit your intake of caffeine and alcohol, especially close to bedtime. Caffeine is a stimulant that can disrupt your sleep, while alcohol can interfere with your sleep quality.

Practice relaxation techniques: Incorporate relaxation techniques such as deep breathing, meditation, or yoga into your daily routine. This can help you unwind and de-stress before bedtime, improving your overall sleep quality.

Improve your sleep hygiene: Sleep hygiene refers to habits that improve your sleep quality. This includes avoiding daytime naps, limiting screen time before bed, and establishing a relaxing bedtime routine.

Manage your diet: Avoid foods high in salt, sugar, and spicy foods, as they can contribute to bloating and discomfort. Instead, opt for protein and complex carbohydrates. Additionally, eat smaller meals in the evening to avoid feeling too full or uncomfortable at bedtime.

Address your stress: Stress can significantly impact your sleep. Try stress management techniques such as exercise, meditation, or deep breathing exercises.

Consider supplements and medication: Speak to your doctor about supplements such as melatonin or chasteberry, or medication such as hormonal contraceptives or antidepressants, which may help improve your sleep and manage PMS or PMDD symptoms.

Seek professional help: If lifestyle changes alone do not improve your sleep, consider consulting a healthcare professional. They can provide personalized advice and treatment options to help you get a better night's rest during your period.

Medication and supplements to aid sleep

Sleep issues are among the most common symptoms attributed to premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). While the exact cause of "period insomnia" is still unknown, it is thought to be related to hormonal fluctuations. Progesterone, for instance, is a calming and soothing hormone that helps people sleep. When its levels dip, it could affect sleep quality.

If you are experiencing period insomnia, there are several medications and supplements you can take to aid sleep.

Medication

If you are experiencing severe PMS or PMDD, your doctor may prescribe medication to control your symptoms, including insomnia. These may include hormonal contraceptives or antidepressants.

Supplements

• Melatonin: Melatonin is a hormone that signals to your brain that it's time to sleep. Melatonin supplements have become a popular sleep aid, especially when dealing with jet lag or shift work. Melatonin supplements appear to be safe for adults when used for short periods, although more research is needed on their long-term effects. It is not recommended for pregnant or nursing people.
• Valerian: Valerian is an herb that is commonly used as a natural treatment for symptoms of anxiety, depression, and menopause. It is also one of the most commonly used sleep-promoting herbal supplements in the US and Europe. Valerian root supplements may improve sleep quality and sleep disorder symptoms when taken in doses of 300-600 mg. However, the safety of long-term use is uncertain.
• Magnesium: Magnesium is a mineral that is involved in hundreds of processes in the human body, including brain function and heart health. It may help quiet the mind and body, making it easier to fall asleep. Magnesium supplements may help optimize the quality and quantity of your sleep.
• Lavender: The soothing fragrance of lavender is believed to enhance sleep. Lavender aromatherapy may help improve sleep and reduce anxiety. However, more studies are needed on the effects of lavender supplements on sleep.
• Passionflower: Passionflower is a popular herbal remedy for insomnia. Passionflower tea or extract may help slightly improve sleep quality, although the evidence is mixed.
• Glycine: Glycine is an amino acid that plays an important role in the nervous system and may help improve sleep. Consuming glycine immediately before bedtime may help you fall asleep faster and improve overall sleep quality.
• Cannabidiol (CBD): CBD is a compound derived from hemp that has been found to relieve anxiety and act as a natural sleep aid. However, more high-quality research is needed before CBD can be routinely recommended for the treatment of sleep disorders.
• Tryptophan: Taking at least 1 g of tryptophan per day could help improve sleep quality and reduce the amount of time spent awake in the middle of the night.
• Ginkgo biloba: Consuming around 240 mg of ginkgo biloba 30-60 minutes before bed may help reduce stress, enhance relaxation, and promote sleep.
• L-theanine: Consuming a daily supplement containing up to 200 mg of L-theanine may help improve sleep and relaxation, especially when combined with GABA or magnesium.

How to build a healthy sleep routine

Set up a healthy sleep environment

Make sure your bedroom is comfortable and relaxing. Keep the noise level low, the room dark and cool, and add white noise (e.g. from a fan, humidifier, or noise machine) if it's too quiet or noisy. Remove anything that will get in the way of your sleep, such as TVs and computers, and keep your bed an area just for sleeping.

Maintain a consistent sleep schedule

Keep the same bedtime and wake-up schedule every day, even on weekends. This will help keep your circadian rhythm in check and train your brain to naturally feel tired at bedtime.

Establish an electronic curfew

The blue light from screens (TV, tablet, phone, or laptop) disrupts the release of melatonin in your body, making it harder to fall asleep. Set a curfew, turning off all screens at least one to two hours before bedtime. If you enjoy reading, opt for printed books rather than electronic devices.

Reduce caffeine and other substances

Caffeine, alcohol, over-the-counter medication, and heavy meals may make it more difficult to fall asleep, so avoid these before bed. Caffeine can be found in coffee, tea, hot cocoa, lattes, espresso, chai, iced tea, soda, energy drinks, and chocolate. Try to avoid eating large meals two to three hours before bed, and if you're hungry, opt for a light snack of protein and complex carbohydrates.

Avoid physical activity right before bed

Physical activity can energise the body and raise your body temperature, making it harder to sleep. Being physically active earlier in the day will help you sleep better.

Choose calming activities before bed

Pick something soothing and relaxing, such as reading, listening to music, doing gentle yoga or stretching, reflecting on the day, or thinking about something positive you will do tomorrow.

Improve sleep hygiene

Sleep hygiene is a set of tactics aimed at improving your sleep quality. This includes going to sleep and waking up at the same time every day, avoiding daytime naps, not staying awake in bed for more than 15 minutes, avoiding TV, reading, or using mobile devices in bed, and ensuring your bedroom is comfortable and well-ventilated.

Frequently asked questions