[by Tamara Sellman RPSGT CCSH for Advanced Cardiovascular Sleep Disorders Center]
Ever wonder why women are said to be twice as likely to complain of poor sleep than men?
It might be as simple as having a menstrual cycle.
Research suggests that during the menstrual cycle, women tend to have restless sleep directly related to the cyclical hormonal changes in a woman’s body throughout her mature life.
These problems with sleep accompany the variations in estrogen and progesterone that begin with the arrival of menses (the onset of menstrual cycles).
Hormonal swings, from high to low, play a role in regulating these cycles, but also have additional functions related to circadian rhythms.
The Women and Sleep Poll
The National Sleep Foundation’s Women and Sleep Poll 1998 showed that between one quarter and one half of the women surveyed reported their sleep had been disrupted by symptoms of the menstrual cycle (such as breast tenderness, bloating, backache, cramping, and headache).
Disturbances included frequent awakenings, taking too long to fall asleep, feeling unrefreshed in the morning, awakening too early and not being able to fall back asleep, and struggling to get out of bed in the morning.
When were the symptoms most troublesome? More than two thirds of the women surveyed said they experienced sleep problems and daytime fatigue during the week prior to or during the first few days of their periods.
This may not be the full picture for many women, however. Some women don’t have trouble sleeping, but instead experience something known as premenstrual hypersomnia, a menstruation-related disorder that leads to excessive daytime fatigue in the days leading up to their periods.
Increasing and decreasing hormone levels are to blame for these sleep problems. While the onset of one’s period usually marks the time when the lining of the uterus is shed in a stream of blood, there are actually several stages to a period.
The menstrual cycle and its influence on sleep
Stage 1: The menstrual phase (days 1 through 5)
This is classically known as “having your period.” Blood loss (the shedding of the lining of the uterus, known as the endometrium) marks this time, as does cramping related to the muscular process of releasing these fluids and tissues.
Discomfort is the most likely cause for lost sleep during the menstrual phase.
Stage 2: The follicular phase (days 1 through 13)
This shift in hormones also happens during the menstrual phase but continues for much longer. It’s the time when hormones are secreted to stimulate the growth of cells to form eggs known as follicles. It takes 13 days for follicles to arrive at maturity. Most women do not experience sleep disturbances at this time.
Stage 3: The ovulation phase (day 14)
During ovulation, the ovaries receive a hormonal signal to release these follicles where they travel from the ovaries to the fallopian tubes. A rise in core body temperature by as much as half a degree can lead to troubles falling asleep.
Stage 4: The luteal (or premenstrual) phase (days 15 to 28)
This is the final stage of a menstrual cycle. The follicles that were released during ovulation remain in the fallopian tubes for 24 hours; if they aren’t fertilized, they disintegrate.
Progesterone levels continuously dip to finally signal the uterus to release the lining (the endometrium) to begin the very next cycle.
Women report struggles with falling asleep, getting good sleep, and struggling with daytime fatigue during the latter part of the luteal phase, which can be traced back to these falling hormonal levels. Progesterone spikes right after ovulation occurs, then drops precipitously during the short transition to the menstrual phase.
They also tend to experience more “hot flashes,” mood swings, and other unpleasant symptoms related to hormone changes, including mornings when they experience a problem known as sleep inertia, or an extended pattern of grogginess that makes it difficult to get out of bed in the morning.
A 2010 study in the journal SLEEP also showed changes in sleep stages and structure during the premenstrual phase. Fewer stages of restorative REM sleep can result in particular, leaving women feeling groggy at this time.
Sleep disorders related to menstruation
Shift work disorder
Women who work night or overnight shifts can’t avoid disrupted circadian rhythms as a side effect. These disruptions also influence hormone production, leading to problems with irregular cycles, more painful periods, and longer menstrual cycles when compared to women who do not work at night. It is thought that the stress caused by circadian disruption plays a large part in the dysregulation of reproductive hormones in women, as well.
Insomnia
One result of menstruation-related apnea can be periods of sleeplessness following frequent awakenings at night. But apneas aren’t the only reason why you might not sleep during your menstrual cycle. Discomfort alone can make it hard to sleep, and sudden swings in hormones will create periods of wakefulness when racing thoughts, mood swings, and irritability can gain access, preventing you from falling asleep.
Restless Legs
Women who have heavy periods are prone to experiencing restless legs syndrome (RLS), an irritating condition in which the legs experience unusual tingling or other unpleasant sensations. It could occur because of deficiencies in iron and other minerals caused by excess bleeding. While it won’t interrupt sleep, RLS can significantly delay sleep for those who suffer.
How to survive sleep problems during your period
- Give yourself enough time to get a full night’s sleep. Going to bed early allows you the chance to get enough sleep even if you awaken frequently at night. If you get adequate sleep over the rest of the month, a few nights of disrupted sleep may be a nuisance but won’t lead you to a lifetime of sleep deprivation if you make sleep a priority every night of every part of your cycle.
- Practice good self care. Regular exercise, healthy eating habits, hydration, and avoiding substances like caffeine, alcohol, nicotine, and illicit drugs really does make for easier menstrual cycles.
- Keep your room cool to help you fall asleep. Your body’s core temperature naturally falls as part of the circadian transition from wake to sleep. However, when you hit the premenstrual phase, your core temperature can rise by as much as half a degree, making it harder to make this transition. A glass of cold water at bedtime, or a warm (not hot) bath or shower before bed, followed by sleep in a cool room (60 to 67 degrees) can help alleviate this problem.
- If tenderness and pain are problems, consider using pillows to support more comfortable positions to minimize pressure on the areas where you’re most sore.
- If you use a birth control pill, consider whether some of your sleep problems might stem from the use of artificial hormones. For some women, an oral contraceptive can help alleviate problems, while for others, it can worsen them.
- If you have excessive bleeding or pain during your periods, consult a doctor. Conditions such as PMS (Premenstrual Syndrome), PMDD (Premenstrual Dysphoric Dysfunction), dysmenorrheal, and polycystic ovary syndrome (PCOS) are measurable, legitimate health conditions related to menstruation. Treating them will likely help you get better sleep at night and feel more energized during the day.