Insomnia or Trouble Sleeping During Period? Here's Why

If you have trouble sleeping before, during, or a bit after your period, you are not alone.

Acute (temporary) insomnia is one of the different types of insomnia that is incredibly common for women around their periods.

I’m going to summarize all the current research about why you might have trouble sleeping near your period, and what you can do about it.

Sleep Problems Before or During Periods Are Very Individual

Why do some women have the most trouble sleeping just before their periods, while others have trouble sleeping during them?

The best answer that research currently suggests is that there are many individual factors that can contribute to insomnia (1).

SummarySo just because you might not experience the exact same sleep issues at a particular time as other women, doesn’t mean your sleep troubles are any less valid.

Are You Just a Poor Sleeper? Or Do You Have Insomnia?

While this is optional, it’s nice to be able to quantify just how bad your sleep is during your period.

The Pittsburgh Sleep Quality Index (PSQI) is the most common index used in research, and is a valid predictor in women with premenstrual syndrome (PMS). In other words, the higher your score, the more likely you are to be an insomniac (2).

It only takes a minute or two to take, here’s a free online PSQI quiz calculator if you’d like to get your score.

SummaryThe typical threshold for insomnia is any score above 8, while poor sleep is a score of 5-8. The higher you score, the more important it is to seek help before it causes long-term health effects.

Causes of Insomnia Before, During, or After Period

In general, insomnia is caused by one or more of:

• Hormonal changes
• Stress and anxiety
• Physical discomfort and pain
• Poor sleeping habits

For most women, the biggest issue is the hormonal changes that occur before, during, or after their periods.

However, sleep issues in your past during your period can also cause you to have anxiety about having future sleep issues (a vicious cycle).

And finally, some women unfortunately experience intense physical pain and discomfort during their period. Without relief from medication in those cases, it’s of course going to cause sleep issues.

SummaryFor most women with trouble sleeping around the time of their period, it’s caused by hormonal changes. However, it’s important to be aware that other issues like stress or physical symptoms could contribute to sleep issues as well.

How Hormones Change Over A Menstrual Cycle

There are 4 main phases of a menstrual cycle. The main hormones that fluctuate during this time are estrogen and progesterone.

Again, those are general patterns that they follow, but levels will vary between individual women.

Here’s how they affect sleep:

• Estrogen - High estrogen levels actually makes it easier to get to sleep and increases total sleep time, which is why ovulation typically doesn't cause insomnia. However, when estrogen gets low, it usually causes a rise in body temperature (i.e. hot flashes), and can make sleep more difficult (3).
• Progesterone - High levels of progesterone are associated with more frequent waking up during sleep, as well as other sleep difficulties (3). As a side note, it makes breathing easier, which explains why sleep apnea isn’t that common in pregnant women, even as they gain weight.

SummaryBased on the above information and chart, it’s clear that hormonal changes (primarily progesterone) are likely responsible for sleep troubles during the luteal phase of the menstrual cycle (the time leading up to the period/menstruation).

PMS and Insomnia

About 90% of women get PMS, which comes with both physical and mood symptoms that are usually present in the luteal phase.

Insomnia is deeply linked to several mental health issues (most notably depression), and the mood swings themselves may be the cause of sleep issues.

The International Classification of Sleep Disorders (ICSD) has a specific designation for sleep issues related to PMS in premenstrual insomnia and premenstrual hypersomnia (4).

Side Effects of Sleep Trouble During Periods

One question that you might have is: “is it that big of a deal to have a few days or weeks with bad sleep?”

Yes, yes it is.

On top of annoying symptoms like daytime sleepiness and irritability, long term insomnia side effects of insomnia can include mental health conditions like depression (5).

And since the menstrual cycle happens regularly, there’s a risk of developing those side effects over time. Even though you can’t necessarily “fix” your insomnia, depending on your specific situation, you can try to get help to manage your sleep quality.

How To Deal With and Treat Period Insomnia

Here are the main ways that doctors typically try to treat insomnia in patients who have trouble sleeping on their period.

You should see your doctor before pursuing any of these treatment methods in order to manage any potential risks.

Antidepressants

It turns out that antidepressants, particularly serotonin reuptake inhibitors (SSRIs) like Trazodone, often have the side effect of making it easier to get to sleep.

If a patient has depressive symptoms in addition to sleep issues, it’s common for physicians to prescribe an antidepressant to cover both issues.

However, different medications have different risks, and while newer ones are generally safer, they can still have side effects like causing drowsiness during the day.

Other Sleep Medication

There are other medications that are specifically made to try and treat insomnia in patients with depression concerns.

The most common hypnotic drugs are benzodiazepine and nonbenzodiazepine drugs, like Zalplon and Zolpidem. However, while they are safe for short-term use, there is concern over long term abuse, reliance, and other safety concerns (6).

That’s why these are prescribed drugs and your doctor will have to decide what’s right for you.

Over the Counter Sleep Aid Options

There are two main types of over the counter sleep aids:

• Certain first generation histamine blockers that cause sedation as a side effect. Note they can cause “hangover” effects the following day. It’s also possible to develop a tolerance to these medications and they will lose effectiveness.
• Melatonin is the hormone that makes you feel “sleepy.” You can buy melatonin supplements, which may help you fall asleep. Most people have lower melatonin levels as they get older, which is why older people with insomnia typically get the most benefit from melatonin supplementation (3).

Finally, many people turn to alcohol. For some, alcohol helps them sleep, while it makes it harder to sleep for others. But there are obvious side effects of drinking alcohol, particularly on a regular basis.

Cognitive Behavioral Therapy (CBT)

For many insomnia patients, CBT is a safe and effective way of learning to decrease the stress and anxiety that causes insomnia.

For women with insomnia because of their periods, CBT may help if the patient has some stress issues that are significantly contributing to the sleep troubles.

Period Insomnia vs. Pregnancy Insomnia

Hormones fluctuate during periods, but also during pregnancy (5).

It’s no surprise that insomnia is common in pregnant women.

It is possible for sudden insomnia to be an early sign of pregnancy. However, if you’ve had sleep issues in the past because of your period, that’s much more likely. Insomnia typically develops over the course of pregnancy and peaks in late pregnancy before labor.

Frequently Asked Questions About Period Insomnia

Here are a few questions that I’ve often seen asked about insomnia and periods.

Is Insomnia a Sign of PMS?

PMS can cause many symptoms, including mood disorders that can cause insomnia. Sleep troubles during PMS may or may not be related, it depends on the root cause of the insomnia.

Is Insomnia an Early Sign of Pregnancy?

Some women experience insomnia in the early stages of pregnancy, so it is possible that it is an early sign of pregnancy.

How Do You Treat Hormonal Insomnia?

Insomnia caused by hormonal changes during periods can’t be “cured” because a woman’s body needs those hormones for good reasons. Instead, symptoms are managed as best as possible.

How Do You Beat PMS Insomnia?

In most cases, PMS insomnia can’t be beat, but it can be managed. A physician can prescribe a course of treatment using one or more of: sleep medication, over the counter sleep aids, and cognitive behavioral therapy.

Is Hormone Therapy a Treatment Option for Postmenopausal Women?

Hormone therapy is sometimes prescribed for postmenopausal women with insomnia. Research suggests that it may come with a higher risk of having a stroke, so while it can be effective, it’s a situational treatment.

References

1. Sleep and the menstrual cycle
2. Subjective sleep quality in premenstrual syndrome
3. Evaluation and Management of Sleep Disturbance During the Menopause Transition
4. International Classification of Sleep Disorders
5. Women and insomnia
6. Eight weeks of non-nightly use of zolpidem for primary insomnia