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Why PMS Gives You Insomnia

Can't sleep before you get your period? Here's why -- and what you can do about it.
By Christina Boufis
WebMD Magazine - Feature
Reviewed by Louise Chang, MD

Most nights, Karin Wacaser, 48, a public relations consultant in Dallas, sleeps soundly for about 10 hours. But three days before her period, like clockwork, Wacaser has intense insomnia, waking up every hour or two. "It's crazy," she says. "And frustrating. Sometimes I'll toss and turn for an hour until I can go back to sleep."At other times, Wacaser lies awake all night, finally falling asleep around 7 a.m.

What is going on? "Each phase of the menstrual cycle has different effects on sleep," says Michael Breus, PhD, ABSM, WebMD's sleep expert and author of the "Sleep Well" blog on WebMD.com. Rising and falling levels of the hormones estrogen and progesterone, which regulate the menstrual cycle, can affect a woman's ability to fall and stay asleep -- as well as influence the quality of her sleep.

Insomnia and PMS: The Estrogen Connection

According to a 2007 National Sleep Foundation poll, 33% of women say their sleep is disturbed during their menstrual cycles. Another 16% report missing one or more days of work in the past month because of sleep problems. (Altogether, 67% of women report having a sleep problem a few nights a week.)

The menstrual cycle is divided into two main phases: follicular (day one of menstruation to ovulation) and luteal (after ovulation). Kathryn Lee, RN, PhD, associate dean of research at the University of California, San Francisco School of Nursing and women's sleep expert, explains that during the follicular phase, estrogen builds up until ovulation. "Estrogen is almost like an energy supplement," Breus says. Then at ovulation, around day 14, "estrogen is suddenly kicked up another notch, and we see a tremendous number of sleep disturbances for women."

After ovulation, your progesterone rises. Lee calls this "the soporific hormone” -- in other words, one that can make you drowsy. Then, just a few days before the start of your next period, estrogen and progesterone levels drop. And this is when many women have trouble sleeping. "The thinking is women who have a more abrupt withdrawal of progesterone -- or maybe had a higher amount and it fell faster -- have insomnia," Lee says.

And how does Wacaser cope? "Now I know what it is and when so I can plan for it. I don't plan any early morning meetings or calls [just before my period] because I know more than likely I'm not going to get any sleep."

Getting More Sleep -- Despite PMS

To combat menstrual-related sleep problems, Lee, who has been studying women and sleep patterns for more than a decade, recommends:

Exercise more. "Exercise helps to promote deep-sleep stages," says Lee, the kind of restorative sleep where growth hormone, necessary for cell repair and regeneration, is secreted.  

Avoid alcohol. Progesterone is highest around ovulation and during the luteal phase, which can exacerbate the effects of alcohol (or any other central-nervous system depressant). Though having a glass of wine in the evening may induce sleepiness, drinking alcohol at night can cause wakefulness and fragmented sleep.

Keep a sleep diary. Record the days of the month you have trouble falling or staying asleep, as well as when you wake early or have daytime sleepiness and fatigue.

Reviewed on March 14, 2011

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