Sleeping problems during the menstrual cycle is very common. In fact, women have more sleeping problems than men, and that's partly due to the constant fluctuation of hormones that happen throughout the month. In the days leading up to a woman's period, she may experience something called premenstrual syndrome (PMS), or something more severe called premenstrual dysphoric disorder (PMDD). In this article, we will talk about how PMS can lead to insomnia, and what are some ways to improve one's sleep while traversing through a menstrual cycle. 

What is Premenstrual Syndrome? 

The menstrual cycle takes place every ~28  days (this varies widely between women) and is a constant flow of hormones from the brain that control different parts of the menstrual cycle. There are four phases, the menstrual (when bleeding starts), follicular (the development of an egg cell), ovulation (the release of the egg) and the luteal (takes place after ovulation and lasts until the first day of bleeding). 

The luteal phase is when a majority of women experience PMS due to the hormone fluctuations. During the luteal phase, a woman's body is getting ready for a potential implantation of a fertilized egg. The uterine lining is thickening and there is a higher level of progesterone, a hormone responsible for maintaining pregnancy if the egg was fertilized.  

If pregnancy doesn't happen, then progesterone, and other hormones like estrogen, fall rapidly, triggering the shedding of the lining, or menses. These hormones doesn't just affect the reproductive system, but many other parts of the body as well - affecting women both physically and emotionally. 

Physical and Emotional Changes Before Your Period 

Around 90% of women have at least some change before their periods. Some of these changes can include bloating, tender or swollen breasts, constipation or diarrhea, cramps, headache, fatigue, moodiness, changes, in sex drive, and more. These changes can have a profound effect on normal functioning.

What is PMS and PMDD? 

PMMS is a condition of extensive and bothersome symptoms that arise the days preceding your period and continue with menstruation. The severity of PMS varies, but some women find that it disrupts their daily life and activities. 

PMDD is much more severe and includes at least five symptoms related to significant changes in mood or emotional health. PMDD can cause even bigger disruptions in school, work, and social or family life. 

How Common are PMS and PMDD? 

PMS affects up to 12% of women, and about 1-5% have PMDD. The likelihood of having these disorders changes throughout a woman's life. They are more common from 20-40, with more intense symptoms arising in the late 30s and 40s. Some women have them every menstrual cycle, and throughout the cycle, while others do not. 

The causes of PMS are not well understood. They may be related to hormones, but it's unclear why women experience them at varying levels. One explanation is that there are different ways that women's bodies can react to fluctuations in hormones like progesterone and estrogen. This may be related to the interaction of these hormones, and a deficiency in serotonin (a neurotransmitter responsible for happy emotions) could be a cause. There is also speculation about deficiencies in nutrients and other issues. 

PMS and Sleep 

PMS causes sleeping problems, and women with PMS are more likely to experience insomnia before and during their period. Poor sleep can lead to excessive daytime sleepiness which further exacerbates the mood and energy issues during menstrual cycles.

PMS can also cause some when to sleep way more than normal. Fatigue and tiredness, as well as mood disorders like depression, can lead to sleeping too much.

Women with PMDD may have it even worse, as 70% of women with this condition have insomnia-like problems, before their period and over 80% describe feeling tired. 

Researchers are unsure about why PMS negatively impacts sleep, however, there are potential reasons. One is the changing hormone levels may create difficulty falling asleep, as well as more sleep interruptions. Women with PMS have worse sleep around late-luteal phase in comparison with other parts of the menstrual cycle.

Hormonal changes can also impact temperature and melatonin production - two key factors in getting decent sleep. Progesterone increases body temperature to a point of causing fragmented sleep. Melatonin can fall during the menstrual cycle, which is the primary hormone responsible for sleep. 

These results have been inconsistent, however, women with PMS have altered sleep architecture. This means that the time spent in each phase of sleep and the progression through an entire sleep cycle is abnormal. Women have been found to have less rapid eye movement (REM) sleep during the late-luteal phase. REM sleep involved heightened levels of brain activity and is associated with vivid dreaming.  

Another factor may be mood fluctuations as women with PMS have anxiety and depression - both of which contribute to and are caused by sleep disturbances. These mood changes may make women perceive that they have a hard time falling asleep during those periods of time. 

Abou 15% of women have really heavy flows - so heavy that they have to get up in the middle of the night to change their pad or tampons. They also may have more generalized anxiety about having an accident in the bed which may cause them to be hyper aware of any bleeding or feelings of liquid throughout the night. 

Better Sleep Before, During and After Period 

There are steps that one can take to overcome the insomnia associated with the menstrual cycle. 

One way is to improve one's sleep hygiene. Sleep hygiene are your habits, routines and environment, and improving it involves making all of these things more optimal for sleep. Having a consistent sleep schedule, avoiding excess caffeine and getting exposure to daylight can help with improving sleep and overcoming some difficulties. 

Before PMS begins, management techniques like regular exercise, a healthy diet, relaxation techniques, and drink plenty of water can reduce overall symptoms and make PMS easier to deal with. Nutritional supplements can be prescribed for severe PMS and PMDD symptoms. Light therapy can also help women with PDD create a stable circadian rhythm. 

Throughout and after menstruation, there are some steps to take to help individuals get better rest. A mattress pad or protector can offer peace of mind for those concerned with staining their mattress. Once PMS has resolved, it's important to go back to focusing on positive habits so future PMS and PMDD symptoms maybe aren't so disruptive. 

If you are continuing to have sleeping issues,and you think you may need more than behavioral interventions, then please click the orange button to take a free online sleep test and get in touch with one of our professionals. 

https://www.sleepfoundation.org/insomnia/pms-and-insomnia#:~:text=PMS%20often%20causes%20sleeping%20problems,sleep%20much%20more%20than%20normal.