Sleep & Hormones Throughout the Menstrual Cycle

Did you know that women are more likely to suffer from sleep disturbances than men? According to a study published in the Journal of Clinical Sleep Medicine, 34.8% of women reported getting less than 7 hours of sleep per night, compared to 29.2% of men.

For women, sleep isn’t just about getting rest; it's an intricate ballet danced with hormones. The unique hormonal fluctuations that women experience throughout their menstrual cycle play a significant role in their sleep patterns. How exactly do women’s hormone changes effect sleep, and what strategies can be implemented to help address sleep challenges?

The Intimate Relationship Between Sleep and the Menstrual Cycle

1. Follicular Phase (Days 1-14):

This phase is marked by rising levels of estrogen, while progesterone levels drop. FSH (Follicle Stimulating Hormone) begins to increase, signaling the ovaries to prepare an egg for ovulation.

Elevated estrogen levels can enhance REM sleep, leading to a higher likelihood of vivid dreams. While the Follicular phase is characterized by the most REM sleep, it also exhibits more light or low-quality sleep. Beyond promoting REM sleep, estrogen also plays a role in managing the body’s energy resources, thermoregulation, and mood. It might even assist in countering the effects of cortisol, the body’s stress hormone. Overall, sleep tends to be more consistent during the Follicular phase, with fewer disturbances and greater sleep efficiency compared to the rest of the menstrual cycle (1).

2. Ovulation (Day 14)

A surge in Luteinizing Hormone triggers the release of a matured egg from the ovary, and Estrogen reaches its peak around this time as well. Some women report disrupted sleep around ovulation, potentially due to a slight increase in basal body temperature from the estrogen peak. There is also some evidence suggesting that women might feel more energetic or restless during ovulation, which could impact sleep onset (2).

3. Luteal Phase (Days 15-28):

After ovulation, an increased amount of progesterone is produced as the body prepares for potential pregnancy. Progesterone has sedative effects, often making women feel more tired. However, while progesterone can increase sleepiness, it can also cause disruptions in sleep, particularly in the latter half of the menstrual cycle. High progesterone can also lead to more frequent awakenings at night, shorter REM cycles, and increased sleep-disordered breathing events. This dichotomy – of feeling sleepy but also experiencing disrupted sleep – can be frustrating for many women (3).

During the luteal phase, elevated progesterone can also lead to higher core body temperatures – and body temperature is crucial for sleep. Falling core body temperature typically signals to the body that it's time to sleep, and a degree or two drop in body temperature is very beneficial for facilitating a fall into deep sleep. This means that sleep onset, sleep architecture, and the amount of REM sleep can be disrupted during the Luteal phase. Cool bedroom environments or cooling sleep products can be beneficial during this phase to offset these hormonal changes (4).

Overall, sleep disturbances throughout the night, insomnia, and daytime tiredness are typically more pronounced during the Luteal phase, especially as the body prepares to start a new cycle (5).

Premenstrual Syndrome (PMS) & Sleep Disturbances:

PMS isn’t merely about mood swings. It can involve a myriad of symptoms, from bloating and headaches to fatigue and sleep disturbances. This is due to the steep decline in both estrogen and progesterone levels just before menstruation begins. For some women, PMS symptoms can be severe enough to be classified as PMDD (Premenstrual Dysphoric Disorder), which can cause significant disruptions in sleep, mood, and daily functioning (6).

Holistic Approaches to Addressing Sleep Challenges

1. Track Your Cycle

Modern technology has blessed us with a range of apps and wearables that can help track menstrual cycles, predict ovulation, and even offer insights into how one might feel on any given day based on hormonal fluctuations. Our personal favorite wearable device for accuracy and functionality is the Oura ring, which provides this ability to track your cycle among a range of biomarkers that tell you more about your sleep quality, recovery status, and more.

2. Manage Temperature

Cooling sleep products, from mattresses with gel infusions to breathable bed linens and cooling pajamas, can help counteract the elevated body temperatures seen in the luteal phase. Taking a warm or hot shower before bed also helps because when you exit the warm environment, it forces your body to undergo a rapid cool down of body temperature that mimics the natural drop in temperature the body undergoes before sleep. This cooling process signals the brain to produce melatonin, the sleep hormone, which facilitates the onset of sleep (8).

3. Relaxation Techniques

Techniques such as guided meditation, progressive muscle relaxation, and deep-breathing exercises can combat the physiological stress and muscle tension brought on by hormonal fluctuations. These techniques also promote the release of melatonin, the sleep hormone, making them beneficial before bedtime.

4. Consultation & Therapy

Beyond general sleep hygiene practices, Cognitive Behavioral Therapy for Insomnia (CBT-I) provides structured and evidence-based strategies for combatting sleep disturbances. For women experiencing severe PMS or PMDD, a combination of therapy and lifestyle changes can be very beneficial. CBT-I has been shown to be one of the most effective techniques for significantly improving sleep efficiency, reducing the time it takes to fall asleep, and decreasing nocturnal awakenings by addressing the underlying cognitive and behavioral factors contributing to insomnia (8).

5. Supplementation

Magnesium Glycinate or L-Threonate - promotes relaxation and muscle ease, aiding in physical calmness while maintaining healthy levels of GABA, a neurotransmitter that promotes sleep and regulate mood.
L-Theanine – an amino acid that promotes relaxation, calmness, and reduced stress or anxiety.
Melatonin – a natural hormone that assists in regulating the sleep-wake cycle, making the onset of sleep smoother.
Glycine - acts as an inhibitory neurotransmitter and enhances GABA activity for greater relaxation. and has a cooling effect on the body. P romotes deep, restorative sleep, has a cooling effect on the body, and improves cognitive function.
Taurine - regulates calcium signaling and acts as a potent antioxidant. It has GABAergic activity and works synergistically with Glycine and Magnesium to support calming effects.
Passionflower - primarily acts by increasing levels of GABA in the brain, which helps reduce neuronal activity and induce relaxation. It may also contain flavonoids that have sedative properties.
Chamomile - contains apigenin, an antioxidant that binds to certain receptors in the brain and may promote sleepiness and reduce insomnia.

6. Other General Sleep Promoting Tips:

Keep a Regular Bedtime:

Maintaining a regular sleep schedule by going to bed and waking up at the same time daily reinforces our body's internal clock, known as the circadian rhythm. Consistency allows for more regular sleep patterns and improves the quality of nighttime rest. Optimizing the body's circadian rhythm also facilitates the peak release of growth hormone that occurs within the first hour of sleep. Growth Hormone plays a vital role in cellular repair, muscle growth, and metabolism regulation within the body, and if you miss your normal bedtime, you also miss the best opportunity to get it.

Limit Screen time Before Bed:

The blue light emitted from screens such as smartphones, tablets, and computers can interfere with the production of melatonin, a hormone responsible for regulating sleep. Exposure to electronic devices before bedtime prolongs the time it takes to fall asleep, delays the circadian clock, and reduces the amount and delay of REM sleep, which can be especially disruptive for women who already experience sleep disturbances due to menstrual cycle fluctuations (9). Eliminate or reduce screen time at least one hour before bed.

Maintain Mindful Eating Habits Before Bed:

Consuming hefty meals, spicy food, or cured meats close to bedtime can induce discomfort, indigestion, or increased metabolic activity which may interrupt sleep or decrease sleep quality. Similarly, the intake of caffeine or alcohol later in the day can meddle with the natural sleep rhythm. Ensure a gap of at least two hours between eating and bedtime while avoiding caffeine or alcohol during the later part of the day can facilitate a more restful and uninterrupted night's sleep.

Understanding the intimate relationship between hormones and sleep in women can provide a foundation for crafting individualized sleep-enhancing strategies throughout the menstrual cycle. Remember, this is a general overview and might not address specific individual needs or unique physiological responses. Always consult with a healthcare professional for personalized advice.

References:

Baker F.C., Driver H.S. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med. 2007;8(6):613-622.
Parry B.L., Mostofi N., LeVeau B., et al. Sleep EEG studies during early and late partial sleep deprivation in premenstrual dysphoric disorder and normal control subjects. Psychiatry Res. 1999;85(2):127-143.
Lee K..A, Shaver J.F., Giblin E.C., Woods N.F.. Sleep patterns related to menstrual cycle phase and premenstrual affective symptoms. Sleep. 1990;13(5):403-409.
Baker F.C., Waner J.I., Vieira E.F., Taylor S.R., Driver H.S., Mitchell D. Sleep and 24 hour body temperatures: a comparison in young men, naturally cycling women and women taking hormonal contraceptives. J Physiol. 2001;530(Pt 3):565-574.
Shechter A., Varin F., Boivin D.B. Circadian variation of sleep during the follicular and luteal phases of the menstrual cycle. Sleep. 2010;33(5):647-656.
Nowakowski S., Meers J., Heimbach E. Sleep and Women's Health. Sleep Med Res. 2013;4(1):1-22.
Haghayegh, S., Khoshnevis, S., Smolensky, M. H., Diller, K. R., & Castriotta, R. J. (2019). Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis. Sleep Medicine Reviews, 46, 124-135.
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 163(3), 191-204.
Chang, A. M., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Journal of Applied Physiology, 118(2), 229-235.