Period-Related Insomnia: Why Sleep Evades Before Menstruation

Sleep disturbances during the menstrual cycle are common, with about 70% of women experiencing changes in their sleep before their period. This is often attributed to hormonal changes, such as a drop in progesterone, which can lead to increased body temperature, making it harder to fall asleep. Other factors include pain and discomfort from menstrual cramps, bloating, breast tenderness, gastrointestinal issues, and frequent urination. Additionally, hormonal changes can impact mood, causing anxiety, irritability, or sadness, which can also disrupt sleep. Understanding these factors is essential for managing sleep disturbances and improving sleep quality during the menstrual cycle.

Hormonal changes

The two primary hormones controlling the menstrual cycle are oestrogen and progesterone. In the week before the period, progesterone levels increase as the body prepares for 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 may be why premenstrual syndrome (PMS) can cause insomnia.

Experts believe that it is the change in hormone levels, rather than the levels themselves, that has the greatest potential to disrupt sleep. The drop in progesterone levels can lead to an increased body temperature, making it harder to fall asleep or stay asleep comfortably. This is supported by the fact that body temperature naturally dips before and during sleep, aiding the transition to deeper sleep stages.

Additionally, during the premenstrual phase, people with premenstrual dysphoric disorder (PMDD) produce less melatonin, a hormone that promotes sleep. Their bodies also show a blunted response to melatonin during this time. This reduction in melatonin may also be linked to increased deep sleep in women with PMDD.

Pain and discomfort

Sleep disturbances during the menstrual cycle are common, and pain and discomfort are significant factors that can disrupt sleep. Here are some ways in which pain and discomfort can affect sleep the day before a period:

Menstrual Cramps

Menstrual cramps, known as dysmenorrhea, are throbbing or cramping pains in the lower abdomen that many women experience before and during their periods. These cramps can range from being merely annoying to severe enough to interfere with daily activities. The pain can start 1-3 days before the period, peaking 24 hours after the period begins and usually subsiding within 2-3 days. Prostaglandins, compounds that behave like hormones, cause inflammation and pain as the uterus contracts.

Physical Discomfort

In addition to menstrual cramps, women may experience physical discomfort in the form of bloating, breast tenderness, and gastrointestinal issues such as diarrhoea or constipation. These symptoms can make it challenging to find a comfortable sleeping position and disrupt sleep.

Pelvic Pain

Pelvic pain associated with periods can be intense and radiate to the lower back and thighs. This pain can be caused by conditions such as endometriosis, uterine fibroids, or adenomyosis. Endometriosis involves the growth of womb tissue in other places, such as the ovaries, bowels, or abdomen, causing pain and inflammation. Uterine fibroids are non-cancerous growths in the wall of the uterus, which can cause pain and irregular or heavy bleeding. Adenomyosis occurs when the tissue that lines the uterus grows into the muscular walls of the uterus.

Treatment Options

To alleviate pain and discomfort before and during a period, there are several treatment options available:

• Over-the-counter pain relievers like ibuprofen, or medications specifically designed for menstrual cramps, can help reduce pain and inflammation.
• Heat therapy, such as using a heating pad or a hot water bottle, can provide comfort and relaxation to the lower abdomen or back.
• Relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation can help calm anxiety and reduce stress, improving sleep quality.
• Staying hydrated is important, but limiting fluid intake in the evening can reduce the frequency of nighttime bathroom trips, which can disrupt sleep.
• Creating a comfortable sleep environment by keeping the room cool, dark, and quiet can promote better sleep.

Increased anxiety and mood swings

Hormonal changes during the menstrual cycle can have a significant impact on mood and anxiety levels. Fluctuations in hormone levels, particularly a drop in progesterone, can cause a range of emotional changes, including increased anxiety, irritability, sadness, anger, and mood swings. These emotional states can keep your mind racing and make it difficult to relax and fall asleep.

The luteal phase, which begins after ovulation and ends when menstruation starts, is characterised by significant changes in estrogen and progesterone levels. These hormonal shifts can affect neurotransmitters in the brain, such as serotonin and dopamine, which play a crucial role in mood regulation. As a result, many individuals experience mild to moderate mood changes during this phase.

For some, these mood changes can be more severe, indicating a more serious disorder such as premenstrual dysphoric disorder (PMDD). PMDD affects up to 10% of people who menstruate and causes severe anxiety, depression, and mood swings. It is often associated with pre-existing mental health disorders, and individuals with a personal or family history of anxiety or depression may be at a higher risk for developing PMDD.

The exact cause of PMDD is not fully understood, but it is believed to be linked to decreasing levels of estrogen and progesterone after ovulation and before menstruation. Additionally, serotonin, a brain chemical that regulates mood, hunger, and sleep, may also play a significant role in PMDD.

To manage increased anxiety and mood swings before your period, there are several strategies you can try:

• Relaxation techniques: Practising deep breathing, meditation, or progressive muscle relaxation can help calm your mind and reduce anxiety.
• Exercise: Regular exercise throughout the month can help reduce the severity of PMS symptoms, including mood changes and anxiety.
• Sleep: Maintaining a consistent sleep schedule and improving your sleep environment can be beneficial. Aim for 8 hours of sleep per night.
• Diet: Consuming a diet rich in complex carbohydrates and calcium can help reduce moodiness and anxiety-inducing food cravings during PMS.
• Vitamins: Studies have shown that calcium and vitamin B-6 can help reduce the psychological symptoms of PMS, including anxiety.
• Avoid triggers: In the week or two before your period, limit your intake of caffeine, alcohol, and salt, as these can exacerbate anxiety and disrupt sleep.

Frequent urination

It is important to note that frequent urination may also be a sign of an underlying issue, such as a urinary tract infection (UTI) or an overactive bladder. A UTI is a bacterial infection of the urinary tract, which includes the kidneys, ureters, urethra, and bladder. An overactive bladder affects bladder function and can cause symptoms such as a sudden urge to urinate, urinary incontinence, and nocturia (waking up at night more than once to urinate).

If you are experiencing frequent urination before your period, here are some tips to help manage it:

• Stay hydrated, but monitor your fluid intake. Drinking small amounts of water throughout the day can help maintain bladder health and prevent irritation, while also reducing the frequency of nighttime bathroom trips.
• Practice bladder training. This involves scheduling bathroom breaks at regular intervals and gradually extending the time between trips. This can help you gain better control over your bladder and reduce frequent urination.
• Reduce your intake of salty foods and caffeinated or alcoholic beverages. These can contribute to water retention and bladder irritation, increasing the urge to urinate.
• Strengthen your pelvic floor muscles through exercises like Kegels. This can improve bladder control and reduce the urgency to urinate frequently.
• Apply a heating pad to your lower abdomen to relax the muscles, reduce cramping, and ease the pressure on your bladder.

If frequent urination persists or significantly disrupts your life, consult a healthcare provider. They can assess underlying conditions such as bladder infections, hormonal imbalances, or other issues and recommend appropriate treatment options.

Heavy or irregular bleeding

There are several potential causes of heavy or irregular bleeding. One cause is hormonal imbalances, which are most common among those who have recently started menstruating or are close to menopause. Excess levels of the hormones estrogen and progesterone can cause heavy bleeding, as they regulate the buildup of the uterine lining. Other hormonal changes, such as those caused by certain medications, can also affect menstrual bleeding.

Another cause of heavy or irregular bleeding is intrauterine devices (IUDs) used for birth control. Heavy bleeding can be a side effect of IUDs, and certain types of birth control can also cause irregular bleeding.

Pelvic inflammatory disease (PID) and other infections can also cause irregular periods. Endometriosis, a condition in which the tissue that lines the inside of the uterus begins to grow elsewhere in the body, can cause heavy bleeding and pain.

Benign (noncancerous) growths in the uterus, such as polyps or fibroids, can also cause heavy or irregular bleeding. In rare cases, certain cancers, such as cervical, ovarian, or uterine cancer, can cause heavy bleeding.

If you are experiencing heavy or irregular bleeding, it is important to see a doctor, as it may indicate an underlying medical condition. Your doctor may recommend medications such as progestin, nonsteroidal anti-inflammatory drugs (NSAIDs), or antibiotics if an infection is present. In some cases, surgery may be necessary to remove growths or treat cancer.

Frequently asked questions