Female Hormones and Sleep Problems

Sleep plays a vital role in maintaining physical and mental well-being - of course we know that! But did you know that lack of sleep and the fallout from this can be worse for women? There's a few reasons (hello, parenthood), but many women struggle with sleep disturbances at various stages.

One significant factor contributing to these issues is the fluctuation of sex hormones, particularly estrogen and progesterone, throughout the reproductive years. Today, I explore how these hormones influence sleep quality, particularly in women, and why understanding this link is crucial for managing both sleep and overall health.

The Role of Estrogen and Progesterone in Sleep

Estrogen and progesterone, two primary sex hormones in women, affect numerous bodily functions, including the sleep-wake cycle. Let's pause for a moment to make sure we caught that. Female hormones massively influence sleep! That's important. Let's continue.

Estrogen is known to enhance the quality of sleep, especially by reducing sleep latency (the time it takes to fall asleep) and increasing the duration of deep sleep. This is because estrogen helps regulate the body's use of serotonin and other neurotransmitters involved in mood and sleep regulation. Higher estrogen levels are also linked to better sleep quality, particularly during certain phases of the menstrual cycle (here's an article about it).

Progesterone, on the other hand, is a bit less straightforward.

It has a sedative effect due to its interaction with GABA receptors in the brain, which are responsible for promoting relaxation and sleep. However, while progesterone can promote sleepiness, it is also associated with disruptions in sleep architecture, particularly by increasing the amount of time spent awake during the night (known as WASO, or wake after sleep onset)​. This can lead to women experiencing fragmented sleep during times of hormonal change, such as before menstruation or during pregnancy. Yay! Another PMS symptom! But I digress. Let's revisit the menstrual cycle, but relate it to sleep.

Hormonal Changes Across the Menstrual Cycle

The menstrual cycle brings about regular fluctuations in hormone levels, which can have a direct impact on sleep quality. The cycle is typically divided into two main phases: the follicular phase (from the start of menstruation until ovulation) and the luteal phase (after ovulation until the next period).

During the follicular phase, estrogen levels gradually increase, which tends to promote better sleep. However, as women enter the luteal phase, progesterone levels rise (and estrogen falls), and sleep quality often decreases. Research has shown that women tend to experience more sleep disturbances, such as difficulty falling asleep, waking up frequently during the night, and experiencing lighter sleep, in the luteal phase compared to the follicular phase​. This is particularly evident in women with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), where hormonal fluctuations exacerbate both mood and sleep issues.

Pregnancy and Sleep Disturbances

Pregnancy is another stage in a woman’s life where hormonal changes can significantly affect sleep. During pregnancy, especially in the first and third trimesters, progesterone levels are particularly high, contributing to increased sleepiness during the day but also to more frequent awakenings at night. The growing fetus, physical discomfort, and hormonal shifts make it harder for pregnant women to achieve uninterrupted sleep. Moreover, as pregnancy progresses, women may experience restless legs syndrome (RLS) and sleep apnoea, both of which further disrupt sleep quality​. When (kind meaning) people tell pregnant lasses to 'sleep well before baby comes' it's often already too late! Sleep has already become a bit of a shambles.

Menopause: The Impact of Declining Estrogen

As women approach menopause, their estrogen levels begin to decline. This hormonal shift is strongly associated with sleep problems, as estrogen plays a key role in maintaining healthy sleep patterns (as we saw above). Not just about the declining estrogen, but during menopause, women often experience symptoms such as hot flashes and night sweats, which can disrupt sleep cycles and cause frequent awakenings throughout the night.

Studies have shown that hormone replacement therapy (HRT) can alleviate some of these symptoms by supplementing estrogen, thus improving sleep quality in postmenopausal women. However, not all women are candidates for HRT, so it's best to speak to a trusted health professional about your options.

The Link Between Hormones, Sleep, and Depression

Sleep problems and depression are often closely intertwined, and sex hormones may be a common underlying factor. Women are twice as likely to suffer from depression compared to men, particularly during times of hormonal fluctuations, such as puberty, pregnancy, and menopause. The association between sleep disturbances and depression is also strong; poor sleep is both a symptom of depression and a risk factor for developing depressive episodes.

Changes in hormone levels, particularly estrogen and progesterone, are thought to influence this relationship. While higher estrogen levels are generally linked to better mood and sleep, sudden drops in estrogen, such as those experienced after childbirth, during PMS/PMDD or in menopause, are associated with increased depressive symptoms and sleep problems​. Conversely, women with chronic sleep issues, such as insomnia, may be more prone to hormonal imbalances, creating a feedback loop that exacerbates both mood and sleep disorders. It's a bit of a cycle.

Managing Hormone-Related Sleep Issues

Ok, so what can we do? Understanding the relationship between hormones and sleep can help women take proactive steps to manage sleep disturbances. Here are a few strategies that may help:

1. Track Hormonal Cycles: Keeping a sleep diary and noting how your sleep changes during different phases of your menstrual cycle can provide valuable insights into patterns and triggers. Apps designed for tracking both sleep and menstrual cycles can be particularly useful - most of them are free.

   
   

2. Mind Your Sleep Hygiene: Maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and limiting exposure to screens before bed can improve sleep quality, regardless of hormonal fluctuations.

   
   

3. Consult a Health Practitioner who Specialises in Female Hormones: If hormonal changes are significantly impacting sleep and mood, it may be worth discussing hormonal therapies, such hormone replacement therapy, herbal medicine, nutrition or other therpaies with your healthcare provider. These treatments can help stabilise hormone levels and alleviate sleep problems, especially during menopause.

   
   

4. Cognitive-Behavioural Therapy (CBT): CBT for insomnia (CBTi) has been shown to be an effective treatment for chronic sleep disturbances and may help break the cycle of poor sleep and depression, particularly when hormone-related sleep issues are involved. CBTi works really well along other therapies, including HRT.

The complex relationship between female hormones and sleep disturbances underscores the need for greater awareness of how hormonal fluctuations can affect sleep quality. Honestly, women and men can all benefit from knowing and understanding the female reproductive hormones and how they impact other areas of health. By understanding these links and implementing strategies to manage them, women can improve their sleep, mood, and overall well-being. You're not alone in this.