Cuando se trata de PMS, the laundry list of symptoms can be a nightmare: headaches, frequent urination, acne, constipation, bloating, gas, weight gain, abdominal cramping, etc. Yet, one symptom is rarely listed or discussed–sleep. Whether you’re sleeping too much or unable to sleep (insomnia), this symptom may be more connected to your menstrual cycle than you think. Today, let’s dive into how insomnia may be linked to your “time of the month.”
What is PMS (and PMDD)?
Unfortunately, most women are well acquainted with one or more of the common premenstrual symptoms, but what es PMS? Premenstrual syndrome, most commonly referred to as “PMS” is a condition that spans approximately 6 days before a woman’s period, until her period begins at the end of the fase lútea (which officially starts a new cycle).
Eighty percent of women experience at least one physical or emotional PMS symptom; only about 20-30% of women are affected severely enough that it negatively impacts their daily activities or relationships during that time. About 2% of women [myself included] are unlucky enough to have trastorno disfórico premenstrual (TDPM)[1]. PMDD occurs at the same time in a woman’s cycle as PMS, but affects a much smaller portion of women and is classified as a depressive disorder in the DMS-5 (the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).
What causes PMS?
Según la Clínica Mayo, the cause of PMS is unknown, though there are several valid theories. Changing hormones throughout the cycle, specifically after ovulation, seem to be clearly related. Just before and immediately after ovulation occurs, the hormones estrógeno, FSH, and LH drop drastically while progesterona slowly increases.
Un estudiar published in 2019 found a strong correlation between the severity of PMS symptoms with progesterone levels throughout the cycle. Women who had lower overall progesterone levels, especially when progesterone levels drop right before menstruation, had worse PMS symptoms [2].
PMS and insomnia
While also casually called “period insomnia,” the Sleep Foundation defines this PMS symptom as “insomnia that consistently occurs the week before one’s period then resolves shortly after” and posits that it “likely stems from hormonal changes.”
Insomnia itself is a sleep disorder that makes it difficult to fall asleep, stay asleep, or experience good quality rapid eye movement (REM) sleep. There are two different types of insomnia: primary insomnia is a chronic condition that is not the result of another condition; secondary insomnia is a result of a “medical condition, medication, lifestyle change, or environmental factor, including the menstrual cycle” according to Noticias médicas de hoy.
The different sleep stages and how the phases of the menstrual cycle impact them
Stage 2 sleep is characterized by moderately-light sleep, slowed brain waves with bursts of high activity, and is considered to be the transition stage between light sleep and deep sleep. This stage is where much of the memory consolidation and emotional regulation occur, and makes up about 45% of total sleep time.
REM sleep, on the other hand, is when the most vivid dreams occur due to increased brain activity (almost as much brain activity as when you’re awake in fact!), rapid eye movements, and temporary muscle paralysis (to prevent you from acting out your dreams). REM is needed to process new information, consolidate memories, and regulate emotions.
The menstrual (i.e., bleeding) phase of the cycle has been shown to affect both stage 2 sleep as well as REM sleep. Women in their mid-luteal phase (between ovulation and menstruation) experience an increase in stage 2 sleep and a decrease in REM sleep compared to their early follicular phase (which starts when menstruation begins).
What period insomnia looks like
Period insomnia symptoms resemble the symptoms of a lack of REM sleep. Both include decreased sleep satisfaction and alertness while awake, impaired memory and concentration, and mood changes. Period insomnia also decreases sleep efficiency (time in bed compared to time actually asleep) as well as duration of time spent asleep. Interestingly, women with PMDD are more likely to experience an increase in deep sleep (or stage 3 sleep) with a reduction of REM sleep [3].
Un estudiar publicado en la revista Naturaleza found that “the absence of REM sleep [exacerbates] the incidence and pathogenesis of psychiatric disorders,” making an interesting connection between the mood disorders associated with PMS and PMDD, and the sleep changes the brain is experiencing at that same time [4].
How to combat period insomnia
While experiencing a sleepless night can be extremely frustrating, there are some good habits that are easy to engrain into your day to increase your likelihood of a restful sleep.
Generally, the best way to combat insomnia leading up to menstruation is to develop good overall sleep hygiene habits. Sleep hygiene consists of healthy habits and environmental factors that lead to longer duration and better quality of sleep. Some habits recommended by the Sleep Foundation to implement when PMS starts kicking in may include:
- Exercise at least 30 minutes a day (but not within ~5 hours of your bed time)
- Exposure to sunlight at least 30 minutes per day
- Consistent wakeup and sleep time every day
- Avoiding long naps, especially in the late afternoon and evening
- Avoiding caffeine (including chocolate!) at least 6 hours before bed
- Avoiding alcohol at least 3 hours before bed
- Destressing before bed by reading, listening to calming music, or stretching
- A dark, cool, quiet bedroom during sleep and while getting ready for bed
- Natural sleep aids like magnolia, rosemary, or ginseng, or look into taking a small amount of melatonina to help fall asleep [5]
Lo esencial
Sleepless nights are rough, especially when combined with other symptoms of PMS or PMDD. Know that this too shall pass, and in the meantime, try improving sleep hygiene habits in order to make the most of the time you are able to rest!
You can also keep track of when you experience sleeplessness on your cycle tracking charts to determine if there’s a correlation with different cycle phases (and if you don’t know how to track your cycle, you’re in the right place! Natural Womanhood has hundreds of articles to get you acquainted with your cycle and how to track it, like this one aquí.). In the hands of a restorative reproductive medicine-trained healthcare practitioner, your sleep patterns could be valuable information for getting to the bottom of various hormonal- or cycle-related issues.
Referencias
- Yonkers, K. A., & Casper, R. F. (2024, April 30). Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder?sectionName=DIAGNOSTIC+CRITERIA&topicRef=7380&anchor=H287511&source=see_link#references
- Roomruangwong, C., Carvalho, A. F., Comhaire, F., & Maes, M. (2019). Lowered Plasma Steady-State Levels of Progesterone Combined With Declining Progesterone Levels During the Luteal Phase Predict Peri-Menstrual Syndrome and Its Major Subdomains. Frontiers in psychology, 10, 2446. https://doi.org/10.3389/fpsyg.2019.02446
- Jehan, S., Auguste, E., Hussain, M., Pandi-Perumal, S. R., Brzezinski, A., Gupta, R., Attarian, H., Jean-Louis, G., & McFarlane, S. I. (2016). Sleep and Premenstrual Syndrome. Journal of sleep medicine and disorders, 3(5), 1061.
- Di, T., Zhang, L., Meng, S. et al. The impact of REM sleep loss on human brain connectivity. Transl Psychiatry 14, 270 (2024). https://doi.org/10.1038/s41398-024-02985-x
- Hu Z, Oh S, Ha TW, Hong JT, Oh KW. Sleep-Aids Derived from Natural Products. Biomol Ther (Seoul). 2018 Jul 1;26(4):343-349. doi: 10.4062/biomolther.2018.099. PMID: 29929351; PMCID: PMC6029681.
