Sleep and Hormones with Rob Hobson

Hormones play a significant role in women’s health, influencing and characterising different stages of the lifespan. Research has shown that women are more likely to get poor sleep compared to men which is in part a result of hormones. The effect that hormones have on a women can make sleep troublesome which may be the result of PMS or menopause.

Does the menstrual cycle affect sleep?

A significant number of women state that their quality of sleep differs during their monthly cycle and especially just before their period. According to research the most common time for this to occur is 3 to 6 days before their period occurs.

Sleep issues appear to be a common occurrence when women talk about their menstrual cycle and especially with respect to PMS. This condition has many symptoms that can vary in severity but one that often gets forgotten about is sleep which can occur on its own or alongside other symptoms such as mood changes, cramps and food cravings. Research shows that women with PMS are twice as likely to experience insomnia before and during their period.

The link between sleep and PMS is not fully understood but a number of reasons have been suggested. Some women say that they are sleepier during the day in the lead up to their period. In some cases, women may sleep for longer than usual or sleep too much which is called hypersomnia. This may happen even if they have had enough sleep as we know that the REM stage (rapid eye movement) is lessened in the day leading up to a women’s period. This stage of sleep is restorative and when we dream and not getting enough can leave you feeling un-refreshed.

Hormone changes during this stage of your cycle (such as a drop in progesterone) can also make impact on body temperature which can also affect sleep quality. Research has also found that during the menstrual cycle melatonin levels change and this hormone is responsible for the regulation of your circadian rhythms.

Mood changes are another consideration especially as PMS can encourage anxiety and depression which are both associated with difficulty sleeping.

Does menopause affect sleep?

During menopause women can experience many different symptoms. Sleep issues are common during this time and it has been shown that disordered sleeping affects 39-47% of perimenopausal women and 35-60% of postmenopausal women. Hot flushes, insomnia and breathing issues are some of the more common sleep related problems reported by women during menopause.

Menopause is characterised hormonally by a drop in oestrogen. This hormone plays a role in the production of serotonin which is converted into melatonin in the brain which helps to control the sleep-wake cycle. Oestrogen is also helps to keep body temperature low during the night which helps with sleep. With less oestrogen women may experience higher body temperature, low mood and overall poorer quality sleep.

Hot flushes

Hot flushes can happen throughout the night and in this case are referred to as night sweats. The rise in body temperature and blood flow to the face and body creates heat which causes the individual to wake up. The heat and adrenaline involved in night sweats makes it difficult to fall back to sleep. Even if a woman does fall back to sleep the quality of that sleep is affected by frequent wakening’s and discomfort which results in daytime fatigue.

Breathing issues

Snoring and apnoea are more common and sever in postmenopausal women. Obstructive sleep apnoea is a condition that leads to intermittent pauses in breathing which leads to snoring, gasping and poor sleep quality.

Progesterone may affect breathing drive and research suggests that this hormone may prevent the relaxation of airways causing lapses in breathing. However, falling progesterone levels will prevent this type of protection.

Interestingly, women on HRT are less likely to suffer breathing issues. So, lower levels may contribute to sleep apnoea and associated sleep issues.

What can you do?

It is first worth trying to identify if it is PMS is keeping you awake at night. Try and keep a sleep diary for a couple of months. Jot down your symptoms daily and list when your period starts and stops. This will help you to see of your symptoms are linked to PMS. If there is a link then you can start to tackle the issue with good sleep hygiene and possible intervention from a psychologist specialising in sleep.

During menopause it is worth adopting health diet and lifestyle habits while also trying some useful sleep hygiene methods related to the symptoms of menopause such as keeping cool at night.

What are the best ways to get a good night’s sleep when tackling your hormones?

Whether you are struggling with PMS or menopause there are some useful tips that can be used in either situation to help you get a good night’s sleep.

1. Maintain a healthy body weight as being overweight is associated with breathing difficulties during the night.
2. Avoid spicy or acidic foods before bed as they can trigger hot flushes.
3. Cut out caffeine after midday and keep alcohol to a minimum especially before bed as both can lead to disrupted sleep.
4. Avoid drinking too much before you go to bed to avoid waking up during the night to use the bathroom.
5. Find ways to manage your stress and anxiety. This might involve jotting down your thoughts before bed, doing some simple stretching exercises or performing simple breathing exercises to help relax your body and mind. If stress and anxiety is getting out of control then go and speak to a registered health professional for help.
6. Create your own personal sleep ritual which may include taking a bath, reading a book, supplementing with magnesium, drinking a hot chocolate before bed, performing breathing exercises or whatever it is that works for you.
7. Dress in light cotton pyjamas to stay cool at night. Moisture-wicking exercise clothes are another good option when suffering with night sweats. You should also invest in cotton bedding to help keep you cool. Keep the windows open at night and curtains drawn during the day to try and keep your room nice and cool.
8. Train yourself to follow a regular sleep schedule which means going to bed and waking up at the same time every day.
9. Avoid napping during the day unless you are really struggling with fatigue. Avoid sleeping for more than around 20 minutes as any longer your body will fall into deep sleep. Waking from this can be difficult and is often referred to as sleep inertia. Napping can also disrupt sleep later in the evening.