The Menstrual Cycle And Sleep: How Periods Affect Sleep
Quick Summary
Hormonal fluctuations, particularly the rise in progesterone during the luteal phase (the week before your period), can lead to significant, though sometimes subtle, changes in sleep patterns and body temperature.
Objective sleep lab studies show consistent changes across the cycle, such as an increase in light sleep (N2), a decrease in REM sleep, and a notable increase in sleep spindles - bursts of brain activity thought to protect sleep.
Women with conditions like Polycystic Ovary Syndrome (PCOS) are at a higher risk for sleep-disordered breathing, while those with severe PMS or PMDD often perceive poor sleep even when lab studies show minimal disruption.
The relationship is a two-way street; research shows that insufficient sleep duration and poor sleep quality can also contribute to menstrual cycle irregularity.
Ever found yourself tossing and turning more than usual, or perhaps feeling utterly exhausted, and wondered if it’s “that time of the month”?
It’s a common experience for many women, and it turns out there’s a solid scientific basis for these monthly fluctuations in sleep. From the first period to the onset of menopause, a woman's body undergoes a series of complex hormonal shifts each month.
These hormones don't just orchestrate reproduction; they have a wide-reaching impact on mood, body temperature, breathing, and yes, even our sleep (Baker & Lee, 2018).
So, how exactly do these hormone changes affect a woman’s nightly sleep? And what happens when conditions like Polycystic Ovary Syndrome (PCOS) or severe Premenstrual Syndrome (PMS) enter the picture?
We take a comprehensive look below, but first, let’s revisit the basics regarding the menstrual cycle.
What Are the Phases of the Menstrual Cycle?
The menstrual cycle is divided into two main phases: the follicular phase and the luteal phase.
Most women experience cycles lasting between 21 and 30 days, with menstruation (your period) typically lasting less than 7 days (Wood et al., 1979).
The Follicular Phase: This phase starts on day 1 of your period. During this time, the pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones act on the ovaries, prompting the development of follicles, which produce estrogens, primarily estradiol. Estrogen levels rise, peaking just before ovulation.
Ovulation: Triggered by the LH peak, ovulation, the release of an egg, usually occurs around day 14 of a typical 28-day cycle.
The Luteal Phase: Following ovulation, a structure called the corpus luteum forms and starts producing progesterone, along with estrogen. These hormone levels peak about 5 to 7 days after ovulation. If pregnancy doesn't occur, these hormone levels then decline, leading to the breakdown of the uterine lining and the start of menstruation, beginning a new cycle (Baker & Lee, 2018).
Why is this hormonal fluctuation important for sleep? Receptors for estrogen and progesterone are found in many areas of the brain involved in sleep regulation, such as the hypothalamus and brainstem (Shughrue et al., 1997; Curran-Rauhut & Petersen, 2002).
This means that as these hormone levels ebb and flow, they can directly or indirectly modulate our sleep patterns and even our internal body clock, or circadian rhythms.
How Does the Menstrual Cycle Actually Affect Sleep?
The effects of this hormonal rollercoaster on sleep can be quite varied, and what one woman experiences can be different for another. Research has looked at this from two angles: what women report feeling and what objective lab studies measure.
What Do Women Report About Sleep and Their Menstrual Cycle?
Many women report more sleep disturbances around the time of menstruation. This typically includes the last few days before their period (the late luteal phase) and the first few days of bleeding (the early follicular phase) (Baker & Driver, 2004; Kravitz et al., 2005; Manber et al., 2006; National Sleep Foundation, 2008).
However, it's not a universal experience. Some studies don't find a strong link between the menstrual cycle and sleep quality, or they find only small effects (Li et al., 2015; Romans et al., 2015).
This variability is interesting. Research by Van Reen and Kiesner (2016) identified three distinct patterns:
Some women show no relationship between their cycle and sleep difficulties.
Others report increased difficulty sleeping around mid-cycle (ovulation).
A third group experiences more sleep problems premenstrually.
It's not entirely clear if these perceived sleep disturbances are solely due to the direct action of ovarian hormones. It could be that changes in progesterone and estrogen levels in the late luteal phase, rather than their absolute levels, are more critical for sleep quality (Baker & Lee, 2018).
Furthermore, other symptoms that can fluctuate with the menstrual cycle, like anxiety, depression, headaches, cramps, and breast tenderness are also known to make sleeping difficult (Van Reen & Kiesner, 2016).
Even the regularity of your cycle matters: women with irregular cycles tend to report more sleep difficulties than those with regular cycles, even after accounting for factors like age, BMI, and premenstrual symptoms (Hachul et al., 2010).
What Do Objective Sleep Studies Reveal About Sleep Changes During The Menstrual Cycle?
To get a more objective picture of sleep changes during the menstrual cycle, scientists have used tools like actigraphy, wrist-worn devices that track sleep-wake patterns, and polysomnography (PSG), the gold-standard overnight sleep study.
What Does Actigraphy Show Regarding Menstrual Cycle Sleep Changes?
Actigraphy studies have found some evidence supporting self-reports. One study of 163 women found a significant decrease in sleep efficiency, the percentage of time in bed actually spent asleep, and total sleep time during the premenstrual week. This effect was more pronounced in women who were obese, under financial strain, smoked, or had signs of sleep-disordered breathing (Zheng et al., 2014). However, another smaller study found only weak associations, suggesting self-reported sleep wasn't linked to hormone levels at all (Li et al., 2015).
What Do PSG Studies Reveal About Sleep During The Menstrual Cycle?
Polysomnography (PSG) studies, which measure brain waves, eye movements, and breathing, have provided more detailed insights. A key study by Driver and colleagues (1996), though small (9 women), carefully recorded sleep every second night across an entire menstrual cycle. They found:
Sleep continuity was generally stable, though results are not entirely consistent across all research. While most studies show no major changes in how long it takes to fall asleep or the amount of time spent awake after falling asleep (WASO), a couple did find more wakefulness in the late luteal phase (Baker & Driver, 2007; Parry et al., 1989). One noted that a steeper increase in progesterone was associated with more WASO (Sharkey et al., 2014).
There was an increase in N2 sleep, a lighter stage of non-REM sleep.
REM (Rapid Eye Movement) sleep tended to decline in the luteal phase compared to the follicular phase.
The amount of slow-wave sleep (SWS), or deep sleep, did not change when averaged across the whole night.
The stability of deep sleep suggests that the body's fundamental drive for sleep doesn't change much across the cycle. However, a more detailed analysis showed subtle changes: deep sleep activity was higher in the first part of the night and lower in the second part during the mid-luteal phase (Driver et al., 2008). The reduction in REM sleep during the luteal phase is a more common finding across studies and may be related to the rise in body temperature that occurs during this phase (Baker et al., 2012; Baker & Lee, 2018).
Why Do Sleep Spindles Increase During the Luteal Phase, and What Might This Mean?
Perhaps the most striking change seen in brain activity is in sleep spindles. These are short bursts of brain activity in the 14.25 to 15.0 Hz range, and they are significantly increased in the luteal phase compared to the follicular phase (Driver et al., 1996; Baker et al., 2012). The exact mechanism isn't known, but it might involve progesterone byproducts affecting certain brain receptors (Driver et al., 1996).
Since sleep spindles are thought to help protect sleep from outside noises (Steriade et al., 1993), an increase in spindles during the luteal phase could be the brain's way of maintaining sleep quality despite hormonal changes (Shechter & Boivin, 2010). Because sleep spindles are also thought to play a role in strengthening memories overnight, this finding has led researchers to investigate whether memory consolidation during sleep also changes across the menstrual cycle (Genzel et al., 2012; Sattari et al., 2017).
Does the Menstrual Cycle Affect Breathing and Sleep Apnea Risk?
Upper airway resistance is lower during the luteal phase in healthy women (Driver et al., 2005). This could mean that the severity of sleep-disordered breathing might vary by menstrual phase, potentially impacting sleep apnea diagnosis.
One study found that women evaluated for sleep apnea during their follicular phase had a lower apnea-hypopnea index, a measure of breathing disruptions, than those evaluated in their luteal phase (Spector et al., 2016).
It's also worth noting that age may play a role, as some research suggests that women in midlife might be more vulnerable to these luteal phase-related sleep changes compared to younger women (de Zambotti et al., 2015).
How Does the Menstrual Cycle Affect Your Internal Body Clock?
The hormonal shifts across the menstrual cycle also influence our circadian rhythms, the 24-hour internal cycles that regulate sleep and other bodily functions.
Body Temperature: The most consistent finding is a change in body temperature. A woman’s core body temperature is slightly higher - by about 0.4°C - during the luteal phase due to the heat-producing effect of progesterone (de Mouzon et al., 1984). The normal nighttime drop in temperature is also blunted, meaning the overall range, or amplitude, of your body temperature rhythm is smaller during this phase (Baker & Driver, 2007).
Melatonin: This well-known sleep-promoting hormone doesn't seem to be as affected. Studies using highly controlled conditions have generally found no difference in the timing or amount of melatonin secretion between cycle phases (Shechter et al., 2010; Shibui et al., 2000; Wright & Badia, 1999).
Other Rhythms: There are also reports of a slightly higher heart rate (about 4 beats per minute), especially at night, during the luteal phase (Driver et al., 2008; de Zambotti et al., 2013).
How Does Polycystic Ovary Syndrome (PCOS) Impact Sleep?
Women with Polycystic Ovary Syndrome (PCOS) often report a higher prevalence of insomnia and are at an increased risk for sleep-disordered breathing. PCOS is the most common endocrine disorder in reproductive-age women, with prevalence rates between 5% and 20% (Baker & Lee, 2018). It is characterized by high testosterone levels, irregular menstrual cycles, and sometimes polycystic ovaries.
Perceived Sleep Quality: One study found that 12.6% of women with PCOS had scores indicating insomnia, compared to just 3% of controls. Furthermore, 25% of the PCOS group reported sleeping less than 6 hours per night, whereas all controls slept more than 6 hours (Franik et al., 2016).
Daytime Sleepiness: Findings on daytime sleepiness are mixed. While the previous study found no difference, another reported significantly higher sleepiness scores in women with PCOS (Suri et al., 2016). An earlier study found that a remarkable 80.4% of women with PCOS experienced daytime sleepiness compared to 27% of controls (Vgontzas et al., 2001).
Objective Sleep Findings: Two key PSG studies yielded different results. One found that women with PCOS had significantly more time awake during the night (WASO), averaging 55 minutes versus 38 minutes for controls (Suri et al., 2016). In contrast, another study found that after adjusting for BMI, the PCOS group had a longer time to fall asleep (44 minutes vs. 30 minutes) but similar REM sleep (Vgontzas et al., 2001).
Sleep Disordered Breathing (SDB): A major concern for women with PCOS is the high risk for obstructive sleep apnea (OSA). Researchers are still exploring why women with PCOS have such a high risk of sleep apnea. The debate centers on whether it is a direct effect of the syndrome itself - perhaps related to elevated testosterone levels, or if it is primarily an indirect effect of the central obesity and insulin resistance that often accompany the condition (Vgontzas et al., 2001; Suri et al., 2016). A long-term study in Taiwan noted that women with PCOS had a higher incidence of developing OSA over time than healthy controls, even after adjusting for age and other health issues (Lin et al., 2017).
How Do PMS and PMDD Affect Sleep?
Women with severe Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) frequently report sleep problems like insomnia, disturbing dreams, poor sleep quality, and daytime sleepiness in the late-luteal phase.
PMDD is a severe form of PMS affecting 3% to 8% of women, and sleep disturbance is one of its potential diagnostic symptoms (American Psychiatric Association, 2013).
Perceived Sleep Quality: In one study, 80.5% of students with PMS/PMDD were classified as poor sleepers based on the Pittsburgh Sleep Quality Index (PSQI), compared to 56.4% of controls (Khazaie et al., 2016). They reported more sleep disturbances and daytime dysfunction. This has led researchers to suggest that women with PMS/PMDD may have both 'trait' differences (sleep issues that are present across the entire cycle compared to controls) and 'state' differences (sleep issues that worsen specifically in the late-luteal phase when other symptoms are present) (Baker et al., 2008).
Objective Sleep Findings: Despite these strong perceptions, objective lab studies show surprisingly little evidence of disrupted PSG sleep specifically in the late-luteal phase for these women (Shechter & Boivin, 2010; Baker et al., 2012). This suggests the feeling of poor sleep quality might be linked to other PMS symptoms, such as anxiety, rather than a fundamental disruption of sleep architecture (Baker et al., 2012).
Daytime Sleepiness: Regarding hypersomnia (excessive sleepiness), another PMDD diagnostic criterion, women with PMS symptoms felt sleepier and less alert in the late-luteal phase (Lamarche et al., 2007). This feeling of fatigue is supported by objective data; one study found that women with PMS experienced measurable psychomotor slowing, including more lapses in attention and slower reaction times, during their late-luteal phase (Baker & Colrain, 2010).
Altered Circadian Rhythms: There is clearer evidence for disturbances in circadian rhythms in women with PMDD. Research has found altered melatonin rhythms, suggesting that issues with the body's internal clock might be a factor (Shechter et al., 2012; Parry et al., 2006). One pilot study found that women with PMDD had lower nocturnal melatonin levels during both menstrual phases compared to controls. They also seem to have a blunted response to morning bright light in the luteal phase, suggesting a reduced ability to adjust their internal rhythms (Parry et al., 2011).
Can Painful Periods Disrupt Sleep?
Yes, painful menstrual cramps, a condition known as dysmenorrhea, are a common and direct cause of sleep disruption. Severe dysmenorrhea is known to negatively impact sleep, daytime function, and mood (Davis & Mirick, 2006; Woosley & Lichstein, 2014). PSG studies confirm this, showing sleep disturbances like lower sleep efficiency when menses are painful (Baker et al., 1999; Iacovides et al., 2009).
This can create a difficult cycle: pain disrupts sleep, and poor sleep can, in turn, worsen pain perception (Iacovides et al., 2017). One study showed that a nonsteroidal anti-inflammatory drug helped alleviate nighttime pain and restored sleep quality in women with primary dysmenorrhea, highlighting the importance of managing pain to protect sleep (Iacovides et al., 2009).
What Is the Impact of Hormonal Contraceptives on Sleep?
The few studies on sleep in women taking combined oral contraceptives (OCs) have not found increased sleep disruption or poorer sleep quality. However, they do show that OCs alter sleep architecture.
Women on active pills had about 12% more light N2 sleep and less deep N3 sleep compared to naturally cycling women in their luteal phase (Baker et al., 2001a; Baker et al., 2001b). They also have more sleep spindles, similar to what's seen in the natural luteal phase (Plante & Goldstein, 2013).
In fact, one study found that women using oral contraceptives experienced less snoring, a lower apnea-hypopnea index, and fewer arousals, suggesting a potentially protective effect on sleep-disordered breathing (Hachul et al., 2010).
Women on OCs also have an increased 24-hour body temperature profile, likely due to the synthetic progestin in the pill (Baker et al., 2001b). So, while OCs change certain sleep stages and body temperature, their impact on overall sleep quality appears to be minimal.
Can Poor Sleep Affect Your Menstrual Cycle?
Yes, the relationship between sleep and reproductive health is a two-way street. Research has found links between short sleep duration and altered menstrual cycles.
During puberty, a key reproductive hormone called luteinizing hormone (LH) is released in pulses during deep sleep (N3), playing an important role in reproductive regulation (Boyar et al., 1972).
In adulthood, this relationship shifts, and sleep in the early follicular phase actually inhibits LH secretion, which is thought to be important for developing ovarian follicles (Hall et al., 2005).
More directly, women reporting less than 6 hours of sleep were more likely to have abnormal (short or long) menstrual cycle lengths (Lim et al., 2016). In a survey of adolescents, short sleep duration (5 hours or less) was significantly associated with an increased likelihood of menstrual cycle irregularity (Nam et al., 2017).
What Are the Key Takeaways?
Women are complex. It's clear that sleep and circadian rhythms can change in connection with the hormonal fluctuations of the menstrual cycle and in the presence of menstrual-associated disorders.
Variability is Key: The extent of these effects varies, especially for self-reported sleep quality, which worsens for some, but not all, women when premenstrual symptoms appear.
Objective Changes: Objectively, we see changes like increased light sleep, potential alterations in REM sleep, and notably, an increase in sleep spindles during the luteal phase. Body temperature rhythms are also consistently altered.
PCOS and SDB: Women with PCOS have an increased risk for sleep-disordered breathing, which is an important health concern that needs attention.
PMS/PMDD and Perception: Women with severe PMS/PMDD often perceive their sleep to be poor, particularly premenstrually, even if objective measures don't always show significant disruption. Disturbances in melatonin rhythms are a notable finding in PMDD.
Pain Matters: Painful periods can significantly disrupt sleep.
Sleep Impacts Hormones Too: Don't forget that sleep duration and quality can also influence your reproductive hormones and cycle regularity.
If you notice significant sleep disturbances that seem linked to your menstrual cycle, or if you have a condition like PCOS, PMS/PMDD, or dysmenorrhea, discussing these concerns with a healthcare professional is a good idea.
You can also talk to a NZ sleep clinic like The Better Sleep Clinic for sleep help. Whether it’s an Auckland sleep clinic, Wellington sleep clinic, Christchurch sleep clinic, Hamilton sleep clinic or anywhere in NZ, we can help. We specialise in the recommended insomnia treatment - CBT for insomnia as well as treatments for other
Ask for a free chat below or book an assessment (no referral required) and get started addressing your sleep problems today.
Frequently Asked Questions: The Menstrual Cycle And Sleep
Q1: Why do I sleep so badly right before my period?
A1: You may sleep more poorly before your period due to hormonal shifts, particularly the rise and fall of progesterone in the late luteal phase, the week before you menstruate. While some women don't notice a change, many report more sleep disturbances during this time (Baker & Driver, 2004). Objective lab studies show that this phase is associated with an increase in lighter sleep, a decrease in REM (dream) sleep, and more arousals from sleep, even if you don't fully wake up (Baker & Lee, 2018).
Q2: Why do I feel hotter at night during certain times of the month?
A2: You feel hotter at night during the second half of your cycle because of the hormone progesterone, which has a heat-producing effect on the body. This causes your core body temperature to rise by about 0.4°C during the luteal phase (the time after ovulation and before your period). This hormonal shift also blunts the natural drop in body temperature that helps you fall and stay asleep, which can contribute to feelings of restlessness (de Mouzon et al., 1984; Baker & Driver, 2007).
Q3: Does my menstrual cycle affect my dreams?
A3: Yes, your menstrual cycle can affect your dreams, primarily by reducing the amount of time you spend in the stage of sleep where most vivid dreaming occurs. Studies using polysomnography, a method for measuring brain waves during sleep, consistently find a decrease in REM (Rapid Eye Movement) sleep during the luteal phase compared to the follicular phase (Baker & Lee, 2018). This reduction in REM sleep may be linked to the increase in core body temperature that also happens during this time.
Q4: Is there a link between PCOS and sleep problems like sleep apnea?
A4: Yes, there is a strong link between Polycystic Ovary Syndrome (PCOS) and an increased risk for sleep-disordered breathing, including obstructive sleep apnea (OSA). Women with PCOS, an endocrine disorder characterized by high testosterone levels and irregular cycles, are much more likely to develop OSA than women without the condition (Lin et al., 2017). Researchers believe this high risk may be due to a combination of the hormonal imbalances of PCOS itself and the central obesity that often accompanies the condition (Vgontzas et al., 2001).
Q5: Does PMS and PMDD disrupt sleep?
A5: While you may feel exhausted, lab studies show surprisingly little disruption to the actual stages of sleep in women with PMS and Premenstrual Dysphoric Disorder (PMDD). Despite strong feelings of poor sleep quality and daytime sleepiness, objective tests often don't find significant changes in sleep architecture during the premenstrual phase (Shechter & Boivin, 2010; Baker et al., 2012). This suggests the perception of poor sleep may be more closely related to other PMS symptoms like anxiety and mood changes, or potentially to subtle disruptions in your body's internal clock, or circadian rhythms (Shechter et al., 2012).
Q6: Can a lack of sleep make my period irregular?
A6: Yes, a lack of sleep can contribute to menstrual cycle irregularity. The relationship between sleep and reproductive hormones is a two-way street. The hormones that regulate your cycle are closely tied to your sleep-wake schedule, and disrupting your sleep can disrupt this delicate balance (Hall et al., 2005). Studies have shown that women who consistently sleep for short durations (less than 6 hours) are more likely to have irregular, short, or long menstrual cycles (Lim et al., 2016; Nam et al., 2017).
Q7: Can a lack of sleep make my period irregular?
A7: Hormonal contraceptives can change your sleep patterns, but they don't necessarily worsen sleep quality. Studies show that women taking combined oral contraceptives tend to have more light sleep and less deep sleep compared to naturally cycling women (Baker et al., 2001a). However, some research suggests that oral contraceptives may have a protective effect, with users experiencing less snoring and fewer breathing disruptions during sleep (Hachul et al., 2010).
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Written By The Better Sleep Clinic
Reviewed By Dan Ford, Sleep Psychologist
