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Women, Hormones, and Sleep Problems

WebMD Feature By Gina Shaw Reviewed By Louise Chang, MD Women are much more likely to report sleep problems like not getting enough sleep or being sleepy during the day, according to the National Sleep Foundation. One possible culprit? Our hormones. Hormonal changes can wreak havoc on sleep. In turn, sleep deprivation can affect hormone levels in a sleepless vicious cycle. So when hormone levels spike or drop -- such as during the menstrual cycle, during and after pregnancy, and especially around menopause -- women may be more vulnerable to sleep problems.

How Menopause Messes With Sleep


As menopause approaches, hormonal changes can affect sleep more than during any other period in a womans life. There is a big impact from the loss of hormones, particularly estrogen, and our sleep quality is affected, says Tristi Muir, MD, director of the Pelvic Health and Continence Center and an associate professor of obstetrics and gynecology at the University of Texas Medical Branch at Galveston. There are declining levels of estrogen long before you are in actual menopause." Hot flashes and irritability can happen off and on throughout the decade before menopause hits, she adds. Researchers have found that women who have hot flashes during perimenopause (the years preceding menopause, when hormone levels are declining) are also more likely to have sleep disturbances. About 2/3 of perimenopausal women have hot flashes, according to Muir, and many of these women will also have associated sleep problems. Sleep studies have shown that women are more prone to having their sleep disturbed in the first half of the night by having a hot flash, says Sharon Wong, MD, FACOG, chairman of the perinatal department at Adventist Medical Center in Portland. During REM sleep, in the latter half of the night, women seemed to be more able to suppress their sleep disturbances. Once youve actually made it into menopause, which doctors usually define as at least a year without a menstrual cycle, your sleep will probably settle down, along with your hot flashes. But perimenopausal women may struggle with sleep disturbances for years.

How to Deal With Sleep Problems During Menopause


What can you do? First, talk to your doctor to try to pinpoint the source of your sleep problems. Lack of sleep and night wakings can be caused by many factors, and hormones are only one of

them. If you cant get to sleep at all, says Ricki Pollycove, MD, FACOG, former chief of the Division of Gynecology at the California Pacific Medical Center and the author of The Complete Idiots Guide to Bioidentical Hormones, your sleep problem may not be due to menopause. One option is to try hormonal support. This type of sleep disorder is often very well treated with a low dose of estrogen, says Pollycove. In fact, a large study, presented at the annual meeting of the American College of Obstetricians and Gynecologists in May 2010, found that menopausal women with sleep problems due to hot flashes got significant relief from estrogen therapy. Pollycove also recommends mind-body techniques, such as guided imagery, breathing control, and yoga. These are very effective, with no side effects, and are good for your brain, she says. Also, you can take steps to reduce the effect of hot flashes. Studies have found that by having room temperatures lower, and by wearing layers to bed that you can take off or put on, women are less disturbed by hot flashes and have more restful sleep patterns, says Wong.

Pregnant Pauses in Sleep


Women often joke that the sleep problems they have during pregnancy are just preparing them for motherhood, when theyll be waking up countless times in the night. But sleepless nights during pregnancy, and in the postpartum period, can be very serious. Getting too little sleep can be bad for both mother and baby, leaving you irritable and vulnerable to illness. Its hard to tease out exactly how much of pregnancy-related sleep problems are directly due to hormonal changes. Many other things can keep you from a good nights rest: the constant need to urinate, tender breasts, and a growing belly. But one thing we do know, says Pollycove, is that women with a lot of sleep disturbances during pregnancy are more vulnerable to postpartum depression. Here are some tips for a good nights sleep during pregnancy:

Dont exercise within an hour or two before going to bed. Drink something soothing in the evening, like warm milk or a calming tea. Keep the bedroom temperature comfortable, perhaps a bit lower than usual (like menopausal women, pregnant women often feel overheated). If youre congested, which often happens in pregnancy because women produce more mucus, try clearing your nose with a neti pot or nasal rinse to make yourself more comfortable.

Postpartum Sleep and Mental Health


Another huge shift in hormones happens after the baby is born -- so this is another time when you may find yourself struggling with sleep.

Postpartum sleep disorders, combined with caring for a newborn and learning new things like breastfeeding, can be a killer, says Pollycove. Its the most demanding job a woman has ever done. Because lack of sleep puts you at greater risk for postpartum depression, antidepressant medications can help. Low-dose estrogen may also help, and the hormone doesnt interfere with lactation and breastfeeding, Pollycove says. The low estrogen levels that create sleep disorders in postpartum women are also very much associated with depression. It sometimes takes a very small dose to help with that. Its an infrequent problem, but one were really good at fixing, says Pollycove.

Menstrual Cycles and Sleep


What about your menstrual cycle itself? Can you have trouble sleeping at that time of the month? Its much less common than in menopause and pregnancy, but it does happen. Menstrual cycles for the vast majority of us are regular, in terms of a predictable hormonal sequence of events, says Pollycove. In young women, its pretty rare that the regular rise and fall of estrogen and progesterone disrupts sleep. But there are women with premenstrual syndrome for whom sleep disruption can be a symptom. If youre one of them, and if sleep issues are really wreaking havoc in your life every 28 days or so, then one possible solution is hormonal birth control. If youre not trying to conceive a baby, birth control pills can put your hormones in more of a steady state, says Wong. Most patients arent going to want to go on the pill because of a couple of nights of lost sleep, but thats one way of doing it. You can also try the mind-body therapies such as yoga, guided imagery, and breathing techniques, as well as the good sleep hygiene strategies recommended for women having sleep problems at other life stages. If menstrual pain is keeping you up at night, you can try one of the available medications that combines a pain reliever with a sleep aid.