Not getting enough sleep? The impact of this problem, which affects a large number of people, is often underestimated.
Women are twice as likely as men to have their sleep patterns affected, predominantly due to their monthly hormonal cycle as PMS can make the problem worse.
Aside from the expected tiredness after a restless night, other problems can occur. These include difficulty concentrating, greater susceptibility to colds and other infections, and the worsening of existing health conditions or their symptoms.
It is important to recognise the difference between insomnia and sleeping problems associated with PMS.
- Long-term insomnia is a medical, psychiatric or psychological condition often associated with mental health illnesses, such as schizophrenia and depression. However, the term is often used loosely by people to mean that they don’t sleep well
- Sleeping problems affect up to 25% of the population.
Women affected by PMS can find that, just before their period begins, they have difficulty falling and staying asleep, spending a few restless nights tossing and turning in bed. This problem quickly settles when menstrual bleeding starts and a regular sleeping pattern is again established.
Your hormones have a huge impact on your sleeping pattern. They help you to sleep at regular times and for the correct length of time. However, the fluctuation of female hormones each month can influence hormonal regulation in other body systems.
If there is a monthly pattern to your poor sleep, there are several reasons your monthly hormone cycle could be to blame:
- Your body temperature rises as progesterone levels rise, thus preventing REM sleep (this is when your brain processes and stores the day’s information, usually in the form of dreams). REM happens when your body temperature is low. Without REM sleep you tend to be more emotional about things.
- Progesterone is a soporific hormone – in other words, it makes you drowsy. If the rise in progesterone isn’t high enough then your need to sleep can be affected.
- Serotonin levels (which affect your mood) can be lowered as progesterone drops. This brings with it cravings for carbs and sugars, which in turn affect sleep, and the production of any extra serotonin. Low mood then triggers sleep problems.
- Melatonin is the hormone that helps you want to sleep, by preparing the body to feel tired; and you’ll never guess when it’s made – yes, you’re right, it’s made at night whilst sleeping.
Other symptoms of PMS such as period cramps or anxiety can cause you to feel uncomfortable at night and disturb sleep. Once you’re awake, these symptoms can make it difficult to get back to sleep.
Furthermore, cravings for sugar or caffeine can affect our sleep negatively, particularly if they are consumed in the evening or shortly before bedtime.
Make sure your evening meal is not too heavy or too late, and try to consume fewer refined carbs (e.g. white rice, white pasta or sugary foods like cakes and biscuits). When you’re pre-menstrual your body temperature rises, so if your body has to metabolise heavy food as well, it can increase your temperature further, which can cause you to become too hot to sleep.
Blood sugar levels can also drop in the lead up to menstruation due to fluctuating hormones. If you get hungry after dinner have a snack that isn’t too demanding on your system, but will gently balance your blood sugar levels, such as an oatcake or an unsweetened yoghurt.
Falling iron levels during your period can also take their toll on your quality of sleep. Iron helps to regulate serotonin, so a liquid iron supplement such as Feroglobin or Floradix may be effective.
Alcohol is another factor that can contribute to poor sleep. Remember, during your period your liver is already working hard trying to regulate your body’s temperature, without trying to process alcohol as well!
Poor sleep often worsens other symptoms of PMS, particularly the emotional symptoms. Feeling tired is not going to put you in the best frame of mind to tackle a mountain of work, or face a difficult situation. You may feel more anxious, irritable or low in mood.
Try to boost your serotonin levels: foods such as pineapple, eggs and bananas can help. Keep your sugary or fatty food cravings happy with fruit such as figs, mangoes and chickpeas. Exercise regularly - even just a short walk can help. Try a vitamin B complex and/or a magnesium supplement.
Melatonin production may be helped by adding bananas and porridge oats to your diet. (Another point to note is that serotonin helps your body make melatonin.)
Adjusting your sleep environment and lifestyle to coincide with your monthly cycle can help you sleep better during your period. Try these sleep tips, also known as good sleep hygiene:
- Make sure your room is dark and not too hot or cold. Remember that your increasing progesterone makes for a hotter you – try opening a window or turning down the radiator in your bedroom
- Try to keep your room as quiet as possible. If this is not possible, put on some gentle music to block out any background noise such as traffic
- Go to bed at the same time each night and not on too full a stomach
- Winding down before you go to bed means that you are more likely to drift off to sleep more quickly and easily. Dim the lights in your home, take a relaxing bath, read a book or do some yoga
- Keep away from computers, laptops, tablets, TVs or other similar devices around your bedtime, as often the glow from them affects the production of chemicals in your brain in a way that does not encourage sound and restful sleep.
Other things you can do:
- Reduce your intake of caffeine – try a coffee substitute or herbal teas instead
- Alcohol might help you by making you feel sleepy initially, but may disturb your sleep so if this is the case, watch the amount you consume
- Look at any medication that you may be taking. Do any contain things that can affect sleep or have any contraindications with sleep quality?
- Speak to your GP if the situation prevents from functioning in your normal daily life.
There are a number of herbs, which may be of help to you. Two of the most important are:
- Agnus castus: If your sleep problems are associated with other symptoms of PMS, start off with Agnus castus – a herb which works at the root of the problem and has a long history of use in treating general PMS symptoms
- Valerian and Hops: If poor sleep is your main or only PMS symptom, then a Valerian and Hops based product can help settle your mind and so help you drift off to sleep. These have the advantage of not leaving you feeling groggy the next morning.
Agnus castus and valerian may be used together. However, if you are already on prescribed hormonal treatment such as the contraceptive pill, speak to your doctor before using Agnus castus as it may not be suitable for you. Valerian products shouldn’t be used with other tranquilisers.
Doctors may suggest the use of sleeping pills, either available on prescription or from your pharmacist in the form of anti-histamines. However, some people find that the associated side effects may outweigh the benefits of the treatment. A number of conventional medicines can have contraindications such as drowsiness the next day, so it’s important to be careful which ones you choose, especially if driving or working with machinery.
If you have severe problems sleeping, or insomnia, as well as other pronounced symptoms of PMS, your doctor may suggest the use of hormonal medication such as the oral contraceptive pill. These work by interfering with your monthly menstrual cycle and ovulation and in this way, achieve control over your hormonal cycle.