Insomnia

author

Medically Reviewed by

Dr. Nilong Vyas

Written by

Eric Suni

Sleeping problems are common in America, with up to 35% of adults reporting symptoms consistent with insomnia. Women are more likely to experience poor sleep than men, and one likely cause is hormonal changes related to the menstrual cycle.

In the days leading up to their period, women frequently note physical and emotional changes that occur alongside shifts in the body’s hormone production. For many women, these changes are mild, but for others, they are disruptive and lead to premenstrual syndrome (PMS). When severe, they can cause premenstrual dysphoric disorder (PMDD).

Women with PMS and PMDD often sleep too little or too much, and even women with mild symptoms may be tired or experience insomnia before and during their period.

The exact cause of these sleeping problems is not fully understood, but given how central sleep is to physical and mental health, it’s important to know about the menstrual cycle and sleep and how to best sleep on your period.

Basics of the Menstrual Cycle

While the length of the menstrual cycle can vary for every woman, the average cycle is 28 days, during which changes are induced by rising and falling levels of hormones including estrogen, progesterone, follicle-stimulating hormone, and luteinizing hormone.

What are the Stages of the Menstrual Cycle?

The menstrual cycle has four stages:

  1. Menstrual phase: This phase starts on the first day of monthly bleeding, often known as your period. During this time, the body discards the extra lining of the uterus that was formed in preparation for pregnancy. On average, it lasts for about five days.
  2. Follicular phase: This involves the development of an egg cell inside a follicle within the ovaries, and it starts on the first day of your period and typically lasts for 13 days.
  3. Ovulation phase: In the ovulation phase, a mature egg is released by the ovary. In a 28-day cycle, this normally happens on day 14.
  4. Luteal phase: This phase lasts for around two weeks after ovulation. If a woman does not become pregnant, the luteal phase ends with menstruation and the start of a new cycle.

Some resources classify the menstrual cycle as having only three phases and consider the days of menstruation to be a component of the follicular phase.

How Do Hormones Change During the Menstrual Cycle?

Each stage of the menstrual cycle occurs in response to changes in the production of hormones. Hormones like estrogen and progesterone rise during the follicular phase and after ovulation, but if pregnancy does not occur, these hormones decrease substantially during the concluding days of the luteal phase.

These hormones don’t just affect the ovaries and uterus; they influence multiple systems in the body with far-reaching effects. The decline in estrogen and progesterone in the days before your period can affect how you feel both physically and emotionally.

Physical and Emotional Changes Before Your Period

Around 90% of women report that they notice at least some physical or emotional changes in the lead-up to their period. Examples of changes that can occur include:

  • Bloating or gassiness
  • Tender or swollen breasts
  • Constipation or diarrhea
  • Cramps
  • Headache
  • Clumsiness
  • Sensitivity to noise and light
  • Reduced concentration and memory
  • Fatigue
  • Sadness, anxiety, irritability, and mood swings
  • Changes in sex drive
  • Sleeping too much or not enough
  • Appetite changes

When these symptoms appear, they range from 10 days to only a few hours before your period. They may go away shortly after menstruation begins or can last for several days after your period starts.

Though almost all women detect some changes before their period, they are usually limited and mild. The type and severity of changes can fluctuate over time and across different menstrual cycles.

What is PMS?

Premenstrual Syndrome is a condition defined by extensive and bothersome symptoms that arise in the days preceding your period and can continue with menstruation. The severity of PMS varies, but some women with PMS find that the symptoms disrupt their daily life and activities.

What is PMDD?

Premenstrual dysphoric disorder is a more severe condition involving at least five symptoms including significant changes to mood or emotional health. PMDD can result in greater problems at work, in school, or in social and family life.

How Common are PMS and PMDD?

PMS is estimated to affect up to 12% of women, and in most of those cases, the symptoms are moderate. It is believed that about 1% to 5% of women have PMDD.

The likelihood of having PMS or PMDD changes over the course of a woman’s life. They are more common from the late 20s to the 40s with the most intense symptoms often arising in the late 30s into the 40s.

Women may have PMS during some menstrual cycles and not others. Some sources estimate that, at some point during their life, nearly 75% of women will experience PMS-like symptoms.

What Causes PMS?

The exact mechanisms of PMS are unknown. While widely considered to be related to changing hormone levels, experts don’t know for sure why some women have more significant symptoms.

One explanation is that there are different ways that a woman’s body can react to fluctuations in hormones like progesterone and estrogen. This may be related to the interaction of these hormones with other hormone-regulating systems like metabolism. Deficiency in serotonin, a chemical involved that carries signals through the brain and nervous system, is one suspected cause. Some evidence points to deficiencies in calcium or magnesium as contributing factors as well.

How Does PMS Affect Sleep?

PMS often causes sleeping problems. Women with PMS are at least twice as likely to experience insomnia before and during their period. Poor sleep may cause excessive daytime sleepiness and feeling tired or drowsy around their period.

PMS can cause some women to sleep much more than normal. Fatigue and tiredness around their period, as well as mood changes like depression, may lead to sleeping too much (hypersomnia).

These problems can be even worse for women with PMDD as around 70% of women with this condition have insomnia-like problems before their period and over 80% describe feeling tired.

Why Does PMS Affect Sleep?

Researchers are uncertain about exactly why PMS negatively affects sleep; however, studies have identified potential reasons for this symptom.

Changing hormone levels may provoke difficulty falling asleep as well as more sleep interruptions in women with PMS. Multiple studies have found that sleep worsens during the late-luteal phase (when PMS arises) in comparison with other parts of the menstrual cycle.

Hormonal changes before and during menstruation may harm sleep through effects on body temperature and melatonin production. Progesterone, which increases after ovulation until the late-luteal phase, increases body temperature to an extent that can cause fragmented sleep. Some research has found altered levels of melatonin during the menstrual cycle, and melatonin is a hormone essential to the regulation of circadian rhythm and regular sleep patterns.

Though results have been inconsistent, some studies have found that women with PMS have altered sleep architecture, which means that they progress abnormally through stages of the sleep cycle. For example, some women have been found to have less rapid eye movement (REM) sleep during the late-luteal phase. REM sleep involves heightened levels of brain activity and is associated with vivid dreaming. These changes to sleep architecture may occur even in women who do not have PMS.

Some women experience more rapid fluctuations in hormones before their period, and research has connected those faster shifts to more fragmented sleep. The concept of sleep difficulties being driven not just by the changing hormones themselves but by the rate of change may explain why different women can have such distinct sleep experiences before their period.

Mood changes are another important consideration in pre-period sleep issues. PMS can foster anxiety and depression, both of which are associated with sleeping problems. In addition, these mood changes could cause women to perceive that they have a harder time falling asleep or are waking up less well-rested.

As many as 14% of women have heavy periods that involve significant menstrual bleeding. They may have to get up from bed to change pads or tampons and may have greater anxiety about sleep and possible nighttime accidents that could stain sheets or their mattress.

Better Sleep Before, During, and After Your Period

While it’s common to confront insomnia around your period, there are steps that can help get better sleep during any phase of the menstrual cycle.

Sleep Hygiene

A common tactic for improving sleep is healthy sleep hygiene. This means optimizing your habits, routines, and environment to make them more conducive to getting the sleep you need.

Having a consistent sleep schedule, avoiding excess caffeine, getting exposure to daylight, reducing noise and light in your bedroom, and developing a relaxing bedtime routine are all examples of strategies that can strengthen sleep hygiene.

It can be beneficial to focus on sleep hygiene as a preventive measure well before your period starts. While sleep hygiene won’t eliminate all PMS-related sleeping problems, it can bring stability to your sleep and provide tools to fall asleep quickly and fend off insomnia.

Before Your Period

The days before your period starts are the most common time to have sleeping problems. Steps to manage PMS, such as regular exercise, a healthy diet, relaxation techniques, and drinking plenty of water, may reduce overall symptoms and make PMS easier to cope with.

Some medications and nutritional supplements may also be prescribed for more severe symptoms of PMS and PMDD, and these may contribute to improved sleep. Light therapy, which uses a bright lamp to affect circadian rhythm, may be beneficial for some women with PDD.

For any woman experiencing bothersome PMS symptoms, including sleeping problems, it is important to talk with a doctor who can describe the pros and cons of different treatments to help make an informed choice about the best option in their situation.

During and After Your Period

Treatment for PMS may be continued during menstruation if the symptoms continue, but many women find that their symptoms decrease or go away within a day or two after their period starts.

For women with heavy periods or who worry about bleeding at night, absorbent pads designed for nighttime use may be helpful. A mattress pad or protector can offer peace of mind for women concerned about staining their mattress.

Once PMS symptoms have reduced, it provides an opportunity to refocus on healthy sleep habits that can contribute to regular, restorative sleep with the goal of reducing disruptions before and during your period.