A couple of years ago, experts hypothesized that women need more sleep than men. As director of the Sleep Research Center Jim Horne explained, “Women’s brains are wired differently … so their sleep need will be slightly greater.”
He also outlined how women are more strongly affected by poor sleep or lack of sleep than men, with a higher likelihood of mood instability and psychological distress as a result. Horne went on to explain that women need an extra 20 minutes in the “recovery mode” provided by sleep compared to men. (Important note: his study shouldn’t be used by men to justify skimping on sleep! Sleep deprivation is a problem that affects all people, and everyone should take it seriously.)
It’s fun to see the research that acknowledges our hard-working brains. And it’s wonderful to have “expert permission” to sleep a little more...that is, if we can sleep more.
Sleep deprivation is tragically common in the United States. One in three people in the United States do not get enough sleep on a regular basis, according to the CDC, and many women with hormone imbalances encounter extra obstacles when it comes to healthy sleep. Hormone fluctuations after giving birth can interfere with sleep for many women (not to mention getting up often with baby), so can pregnancy itself. Hot flashes during perimenopause and menopause can also throw a wrench in good sleep.
But getting enough high-quality sleep helps women balance their hormones, erase period problems, and look and feel their best. Sleep matters. In this post, I outline why good sleep matters for your menstrual cycle and how you can get more of it.
The 4 Hormone-Related Causes of Insomnia
Getting enough healthy, high-quality sleep is important for so many reasons, from helping your brain detox to being able to perform your best at work the next day. Here are some key things get in the way of good sleep for women:
Cause #1: Adrenal Dysregulation
The adrenal glands control our stress response, and dysregulation in the adrenal system can mean an imbalance of the fight-or-flight hormone cortisol. You are supposed to get surges of cortisol during the day, but none at night. When the adrenal system is out of balance, the opposite happens: you have low cortisol in the morning, but then it peaks in the evening, leaving you with that wired-but-tired feeling when you’re trying to fall asleep — and feeling groggy and unable to get out of bed in the morning.
Cortisol is one of the body’s master hormones and when it is dysregulated, the body’s other master hormones, like insulin, estrogen, and progesterone, will be dysregulated, too. If you hope to heal your hormone imbalances and erase period problems like acne, bloating, heavy or irregular periods, and severe PMS, you need to address adrenal fatigue, and that means making sleep a priority.
How You Know If You Have Problems with Your Adrenal Glands
If you get a really good night’s sleep — say, you’re in bed by 10pm and sleep a full, uninterrupted 8 to 10 hours — but you still feel hungover in the morning, you might be experiencing the start of adrenal problems.
Other symptoms of early-stage adrenal dysfunction include:
- Low libido
- Inability to deal with stress
- Problems with concentrating and memory
- Getting sick often
- Feeling depressed
The Root Causes of Adrenal Dysfunction
Several common factors fuel adrenal problems. One of the main ones is not listening to the body’s internal clock when it tells us we’re tired (more on that below). Another contributing factor is imbalances in the gut microbiome. That’s because the gut microbiome is in conversation with the adrenal glands (which produce cortisol) and when the gut flora is imbalanced it can fuel problems with the adrenal system. In the case of leaky gut syndrome, for example, toxic substances leak from the gut to the rest of the body (where they shouldn’t be) and trigger inflammation — and that inflammation stresses the adrenal glands, which start to act erratically.
But one of the biggest root causes of an overtired (and poorly functioning) adrenal system is not listening to our bodies when they send us the signals that it is time to rest.
Culturally, we’re trained to think that we’re supposed to feel tired all of the time. We keep ourselves overbooked and overextended, we stay BUSY, in order to achieve everything we set out to achieve. For the most part, our brains can handle this. They can juggle work tasks, child care, meal planning, socializing, and studying and succeed. But our adrenals are more primitive than our brains and they cannot handle this. They get burnt out very quickly by the modern way of life.
This way of life also means that, all too often, we skimp on sleep, which makes adrenal imbalances —and all hormone imbalances — worse.
Cause #2: PMS-Related Insomnia
In order to improve the quality of your sleep, it’s critical to adopt lifestyle strategies that help balance your hormones. That’s because imbalanced hormones can affect the quality and quantity of your sleep.
Take PMS-related sleep problems, which is driven by hormone imbalances. When PMS strikes, you’re already feeling bloated, cranky, tired, and moody the week before your period. Now add insomnia to the list, which makes the PMS symptoms you’re experiencing even worse.
It’s a vicious cycle, one I know firsthand. When my period problems were at their worst in my early 20s, I was always tired but could never fall asleep.
But PMS-related insomnia doesn’t discriminate based on age. It can strike every menstruating woman, and it can be especially bad for women over age 35 when the hormonal shifts that happen during perimenopause start to kick in.
What Causes Insomnia the Week Before Your Period?
The week before your period (when PMS strikes) is called the luteal phase. During the luteal phase, you have a big surge and then a rapid decline in estrogen and progesterone. When your estrogen and progesterone are balanced in relation to each other, this rise and fall shouldn’t trigger any symptoms.
But when you have too much estrogen relative to progesterone—a condition called estrogen dominance—you can experience PMS symptoms, including insomnia. Estrogen dominance is triggered by a long list of common factors, including stress, lack of self-care, poor diet, sedentary lifestyle, and exposure to environmental toxins.
This hormone imbalance is made worse if your progesterone levels are low overall—which can affect women of every age, but which happens more often to women over age 35. That’s because overall progesterone levels start trending downward during perimenopause, and lower progesterone negatively impacts the production of melatonin, which is required to fall asleep and stay asleep. Progesterone also promotes relaxation, and without enough of it, you will have trouble falling asleep easily. Progesterone is good for sleep.
Some common environmental factors make the situation even worse. Drinking caffeine is one, using alcohol to unwind is another. If you have adrenal fatigue, you may experience PMS-related insomnia as feeling “tired-but-wired,” where you lay in bed exhausted but can’t fall asleep. Micronutrient deficiencies, including low levels of magnesium, zinc, and/or selenium can also fuel the problem. Magnesium helps promote relaxation; selenium may help boost progesterone and bring your reproductive hormones back into balance; studies show that zinc can help improve sleep quantity and quality.
Cause #3: Perimenopause
The hormonal fluctuations that accompany perimenopause, the years preceding menopause, can cause sleepless nights.
Perimenopause is when a woman’s ovaries begin to move from ovulating like clockwork to not ovulating anymore. This is accomplished by the slow and steady rise of follicle-stimulating hormone (FSH) and fluctuating estrogen levels. Over time, these fluctuating hormone levels become waning hormone levels and they stop signaling the process of ovulation all together (menopause). Think of this as a kind of reverse-puberty.
Levels of melatonin, the sleep-promoting hormone, also drop as we get older. Experts suspect that it is the decreases in both estrogen and melatonin (and the complex interactions between these and other hormones) that give rise to perimenopausal (and menopausal) sleep complaints.
I recommend three top strategies for having symptom-free perimenopause. First, you’ll want to practice phase-based eating, which means changing what you eat in each phase of your cycle to support optimal hormone balance and metabolism. This approach to eating provides the most variety of micronutrients to support overall hormonal balance. It also ensures that you’re getting key foods at critical times to break down the excess levels of estrogen that can cause breakouts and PMS. Not to mention that this approach will improve the quality of your bleed, support fertility, and boost sex drive, energy, and mood. Phase-based eating is the true differentiator for the FLO protocol. Everything about your diet and lifestyle should be relevant to your female biochemistry, and the FLO protocol ensures that.
Second, you’ll want to engage in phase-based exercise. The cyclical nature of your 28-day menstrual cycle provides the perfect architecture for planning how to work out and when to work out. During each phase of your menstrual cycle, your body is primed for different kinds of exercise. At certain times—during the luteal phase and during menstruation, for example—the nutrients and hormones in your body are directed toward building up the lining of your uterus, so you won’t have all the internal resources you need to work out at full capacity. During the other phases, however, your body can channel all its resources into a really strong workout. By engaging in phase-based exercise, you will save yourself from exhaustion, burn-out, and unpleasant perimenopause symptoms.
Third, you’ll want to maximize your micronutrients. Supplements are non-negotiable for keeping hormones balanced and stable as you enter perimenopause. Supplementing with specific micronutrients gives the body the extra support it needs during times of hormonal transition. For women in perimenopause, I specifically recommend a B-complex to help with energy and fatigue; magnesium for regular ovulation and thyroid function and healthy, high-quality sleep; probiotics to help metabolize estrogen; and a vitamin D3-Omega-3 blend to support overall hormone balance and fertility.
Cause #4: Postpartum
Your hormones are on a roller coaster after giving birth, so this can throw off your sleep. So, of course, does having a baby to take care of! One of my key pieces of advice, in the first months after giving birth, is to try to sleep when your baby sleeps. In addition, you’ll want to engage in phase-based eating when your period returns. Supplement with a prenatal vitamin, probiotic, and fish oil, if you are breastfeeding and take Balance Supplements when you are done breastfeeding. Focus more on sleeping than on making time for exercise in the first months after pregnancy. When your period returns, start to return to exercising in sync with your cycle.
Not Paying Attention to Sleep Cues
One of the biggest issues we face in getting to sleep is ignoring the signs that we are tired. We’re trained from an early age to push right past them, and we do. We might start yawning around 8:30 or 9:00pm, but in our push to be productive or sneak in one more episode of our favorite streaming show, we dismiss the signs that we’re tired and stay awake — often until much later than 9:00!
When we’re young, we follow the cues our bodies give us that tell us we’re tired. I see this with my daughter now. She gets tired, rubs her eyes, wants a bit to eat, a cuddle, and then she’s out. There’s no fighting it, it’s a routine and she sleeps often!
As we get older, we often ignore the cues our bodies send us that tell us we’re tired. We may start yawning, but we ignore it to keep on working or reading or binging Netflix. Our eyes start to feel heavy but we push through, intent on playing one more round of cards with friends or finishing the chapter we’re on in our book (we’re so close, after all!).
So your first step in the quest to get more sleep is to simply start tuning into your body, paying attention to signs that you’re tired, and then following those signs to bed!
Your next step is to uncover your sleep story and make specific, targeted changes to address your unique sleep dysregulation.
What’s your sleep story?
Which of these situations do you experience?
- You can’t fall asleep until super late. This could mean you’re getting a surge of cortisol late in the evening and it’s keeping you awake. FLO Fix: Use adaptogens to help soothe adrenal fatigue and regulate cortisol. When you have the choice, prioritize sleep over other activities, e.g. if your choice is between a very early morning workout and getting more sleep, choose the sleep!
- You wake up around 3am. This could be a sign that your liver is working overtime during the night. FLO Fix: Don’t drink alcohol before bed. Support your liver with supplements, like curcumin, n-acetyl-cysteine (NAC), or silymarin (milk thistle) and engage in liver-supportive lifestyle habits like infrared sauna bathing, Epsom salt baths, and eating a lot of cruciferous vegetables.
- You wake up super groggy. This may be a sign of hypoglycemia. FLO Fix: Work to balance blood sugar by eating plenty of healthy fats, clean proteins and complex carbs. Avoid simple carbs and processed sugars.
- You have to wake up to pee. This could be a magnesium deficiency or adrenal dysregulation. FLO Fix: Supplement with magnesium.
How to Put PMS Insomnia to Bed For Good — and To Get More High Quality Sleep in General
Here are your long-term strategies for better sleep and for saying goodbye to insomnia the week before your period:
Ditch the coffee
You know this one already, but it is worth repeating: coffee is bad for a good night’s sleep—no matter when during the day you drink it. Coffee is also really bad for hormone balance. So skip the java and caffeinated tea. Your hormones will thank you.
Eat specific foods right after you ovulate
As you enter the second half of your 28-day menstrual cycle, you have much more estrogen circulating in your body—and what you eat can help your body metabolize that extra estrogen more efficiently. Cruciferous vegetables are especially important for estrogen detox during this phase. Think broccoli, cauliflower, Brussels sprouts, cabbage, bok choy, and watercress. The more effectively your body handles estrogen during the second half of your cycle, the easier it will be to fall asleep.
Boost progesterone production
Taking a high-quality vitamin B6 supplement can help boost your progesterone levels. Another helpful supplement for boosting progesterone is chasteberry, or Vitex. This herb has been used for centuries to support hormone health.
Tackle your stress
The adaptogenic herb ashwagandha supports your adrenal glands and helps modulate your stress response. This can help you fall asleep more easily. Yoga nidra is a calming yoga practice that helps ease stress and promote sleep.
It’s relaxing! It helps balance hormones! And it helps you drift off into a relaxing sleep.
Avoid blue light at night
The light emitted by computer, tablet, and phone screens inhibits the body’s production of melatonin and interferes with sleep. Invest in a pair of blue light-blocking glasses or, better yet, skip screens all together at least an hour before bed.
Adopt a nighttime routine
When it comes to young children, we know instinctively that they need a nighttime routine to calm their bodies and brains and get them ready for bed. A bath, a story in bed, soothing music, maybe a foot or backrub. The need for comfort and calm before bed is no different for adults, but we often expect to work or do chores up until the last minute and then fall into bed and drift pleasantly to sleep. But we need the same mental and physical preparation. Carve out at least 20 minutes to half an hour to transition to bedtime. A relaxing ritual before you climb into bed can really make a difference.
Always remember that once you have the right information about how your body really works, you can start making health choices that finally start to work for you! You can do this – the science of your body is on your side!
Women need more sleep than men. https://www.sleepfoundation.org/articles/do-women-need-more-sleep-men
Sleep Deprivation in the United States https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html
J Clin Sleep Med. 2015 Jun 15; 11(6): 593–594. Sleeping for Two: The Great Paradox of Sleep in Pregnancy Christine H.J. Won, MD, MS https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442217/
The Neuroprotective Aspects of Sleep. Andy R. Eugene1,* and Jolanta Masiak2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651462/
Neurotherapeutics. 2018 Jan; 15(1): 5–22. Gut Microbiota and the Neuroendocrine System
Aitak Farzi,corresponding author1 Esther E. Fröhlich, and Peter Holzer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794709/
PLoS One. 2016; 11(11): e0166077. Association between Higher Serum Cortisol Levels and Decreased Insulin Secretion in a General Population. Aya Kamba,1 Makoto Daimon,1,* Hiroshi Murakami,1 Hideyuki Otaka,1 Kota Matsuki,1 Eri Sato,1 Jutaro Tanabe,1 Shinobu Takayasu,1 Yuki Matsuhashi,1 Miyuki Yanagimachi,1 Ken Terui,1 Kazunori Kageyama,1 Itoyo Tokuda,2 Ippei Takahashi,2 and Shigeyuki Nakaji2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115704/
Epidemiology. Author manuscript; available in PMC 2016 Mar 1.Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Karen C. Schliep,a Sunni L. Mumford,a Catherine J. Vladutiu,b Katherine A. Ahrens,a Neil J. Perkins,a Lindsey A. Sjaarda,a Kerri A. Kissell,a,c Ankita Prasad,a Jean Wactawski-Wende,d and Enrique F. Schistermana https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315337/
Stress and infertility. National Institutes for Health. https://www.nih.gov/news-events/news-releases/nih-study-indicates-stress-may-delay-women-getting-pregnant
Published in final edited form as: J Sleep Med Disord. 2016; 3(5): 1061. Sleep and Premenstrual Syndrome. Shazia Jehan,1 Evan Auguste,1 Mahjabeen Hussain,1 Seithikurippu R. Pandi-Perumal,3 Amon Brzezinski,4 Ravi Gupta,5 Hrayr Attarian,6 Giradin Jean-Louis,1 and Samy I. McFarlane2,* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323065/
J Med. 1990;21(5):225-50. Caffeine and the development of normal, benign and carcinomatous human breast tissues: a relationship? Wolfrom D1, Welsch CW. https://www.ncbi.nlm.nih.gov/pubmed/2079614
DOI: 10.1373/clinchem.2008.103465 Published August 2008
Coffee Consumption and Circulating B-Vitamins in Healthy Middle-Aged Men and Women
Arve Ulvik, Stein Emil Vollset, Geir Hoff, Per Magne Ueland http://clinchem.aaccjnls.org/content/54/9/1489
J Clin Endocrinol Metab. 2011 Apr; 96(4):E614-23. Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. Caufriez A1, Leproult R, L'Hermite-Balériaux M, Kerkhofs M, Copinschi G. https://www.ncbi.nlm.nih.gov/pubmed/21289261
Scientifica (Cairo). 2017; 2017: 4179326. The Importance of Magnesium in Clinical Healthcare. Gerry K. Schwalfenbergcorresponding author 1 and Stephen J. Genuis 2 , 3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637834/
Curr Opin Obstet Gynecol. 2014 Jun;26(3):145-50. Vitamin D and female fertility. Lerchbaum E1, Rabe T. https://www.ncbi.nlm.nih.gov/pubmed/24717915
Hepat Mon. 2010 Winter; 10(1): 12–16.N-Acetylcysteine Improves Liver Function in Patients with Non-Alcoholic Fatty Liver Disease. Manouchehr Khoshbaten,1 Akbar Aliasgarzadeh,2 Koorosh Masnadi,1 Mohammad K Tarzamani,3 Sara Farhang,4,* Hosain Babaei,5 Javad Kiani,6 Maryam Zaare,6 and Farzad Najafipoor6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270338/
Int J Mol Sci. 2015 Dec; 16(12): 30269–30308. Oxidative Stress and Inflammation in Hepatic Diseases: Therapeutic Possibilities of N-Acetylcysteine. Kívia Queiroz de Andrade,1 Fabiana Andréa Moura,1,2 John Marques dos Santos,3 Orlando Roberto Pimentel de Araújo,3 Juliana Célia de Farias Santos,2 and Marília Oliveira Fonseca Goulart3,* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691167/
J Psychiatr Res. 2018 Jan; 96: 196–202. Blocking nocturnal blue light for insomnia: A randomized controlled trial. Ari Shechter, PhD,1 Elijah Wookhyun Kim, MS,2 Marie-Pierre St-Onge, PhD,2,3 and Andrew J. Westwood, MD4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703049/
Sleep Sci. 2017 Jan-Mar; 10(1): 11–18. Sleep, Melatonin, and the Menopausal Transition: What Are the Links? Shazia Jehan,1 Giardin Jean-Louis,1 Ferdinand Zizi,1 Evan Auguste,1 Seitikurippu R. Pandi-Perumal,2 Ravi Gupta,3 Hrayr Attarian,4 Samy I. McFarlane,5 Rüdiger Hardeland,6 and Amnon Brzezinski7,* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/