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Although you're much more than your hormones, the cyclic rhythm of your chemical fluctuations does affect the rhythm of your slumber (as well as inflame syndromes you face more frequently than will a man, such as depression, anxiety, headache and migraine). So how do the female sex hormones, estrogen and progesterone, as well as male testosterone, affect your sleep patterns?
Nearly every woman has experienced premenstrual syndrome, or PMS, to some degree; its symptoms occur during the early luteal phase of your cycle, two weeks prior to menstruation. (If you don't become pregnant at ovulation, both estrogen and progesterone decrease and your body sheds its uterine lining as menstrual flow.) Indications include bloating, weight gain, fluid retention, insomnia, moodiness, irritability, anxiety, headaches, acne, breast tenderness, shifts in sex drive, cramps and cravings for carbohydrates and sweets. Studies indicate that these lowered levels of estrogen and progesterone increase nighttime awakenings and NREM, or nondream, sleep.
Recent studies also show women who suffer from
PMS have less slow-wave deep sleep -- stages 3 and 4 -- during the entire
month, not just during the premenstrual weeks. The most common PMS sleep
complaints include all three types of insomnia (sleep-onset, sleep-maintenance
and early morning-awakening insomnias), hypersomnia (sleeping too much),
unpleasant dreams and nightmares, and morning and daytime fatigue.
If you suffer from serious mood shifts during the two weeks prior to menstruation,
you may be diagnosed with premenstrual dysphoric disorder, or PMDD. While
you might experience other symptoms -- such as fluid retention, bloating
and cramping -- with PMDD, you'll also notice mood shifts that feel like
major depressions, accompanied with all the associated sleep difficulties.
The symptoms disappear until the next luteal phase, when your hormones
again interact to prepare your body for possible pregnancy.
Vitamins
Increase your calcium and magnesium intake. Your body always responds favorably to calcium and magnesium, both of which help calm the central nervous system. Some studies have shown a causal link between low magnesium blood levels and PMS symptoms.
Fluids
Increase your fluid intake. Water is a natural diuretic: The more you drink, the more you flush through your system. The rule of thumb is to drink approximately half your body weight, in ounces, daily. If you weigh 120 pounds, drink 60 ounces of water a day, or about 7 to 8 glasses.
Sodium
Watch your sodium intake. Fluid retention is heightened by excess sodium, so read labels carefully before you eat.
Diuretic herbs
Try using a natural herbal diuretic such as dandelion, either in tablet or as a tea. Ginger, chamomile and lemon balm teas also help with digestion and bloating.
Exercise
Keep up with and even increase your exercise during your premenstrual week. Sweating helps relieve bloating, and regular exercise helps you get a deeper night's rest.
Bodywork
Try some yoga and massage. The deep breathing, stretching and meditative centering of yoga calms the nervous system and relieves abdominal and back cramping. Massage helps with lymph, fluid and toxin drainage, and, best of all, feels wonderful. Acupuncture can also help relieve cramping.
Drinking
Eliminate caffeine, carbonated drinks and alcohol during this period. Too much caffeine and alcohol disrupt sleep patterns and exacerbate insomnia. And carbonated drinks can increase bloating and breast tenderness.
Eating
Lower your carbohydrate and sugar intake. Keep away from fast foods, high-carb desserts and snacks, and chocolate (which contains not only sugar but also caffeine). As a rule, avoid high-sugar foods, which can cause a blood sugar drop that awakens you during the night.
B vitamins
Take extra vitamin B6 (pyridoxine), about 100 milligrams daily. Take extra vitamin B complex during the few days before and during your period, but always check with your physician, as taking more than 200 to 300 mg daily of pyridoxine can be harmful.
Pain relief
Take ibuprofen for the aches. This non-aspirin pain reliever can help stave off cramps, as well as abdominal and lower back pain. Nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, suppress prostaglandins, chemicals that affect muscle tension, which help cause menstrual cramps. Take them at bedtime so you don't awaken during the night.
Fiber
To reduce constipation, use flaxseed oil or psyllium husks in juice or water. When you first get up, try a glass of hot or very warm water with a little lemon and honey; it helps flush out the system.
Bottle on the back
Employ the perennial PMS trick: A hot water bottle on the lower back does work wonders.
During Pregnancy
The hormonal and bodily changes you experience with pregnancy almost inevitably mean disrupted sleep. Researchers are beginning to collect sleep data on the three trimesters of a normal forty-week pregnancy to determine how these changes occur.
During the first trimester, the placenta produces high levels of hormones, including estrogen and progesterone. Progesterone (which has a sedating effect on the brain) levels rise rapidly during those first twelve weeks, and most women feel exceptionally drowsy. Many feel sufficiently sleepy during the day that they take naps; they also tend to sleep more hours at night.
Insomnia symptoms appear toward the end of the first trimester, as the expanding uterus starts to press on the bladder and bathroom trips become more frequent. Morning sickness, or nausea, is hormone-induced and can strike at any time, either day or night. You may suffer with backaches and tender, swollen breasts, other factors that cause sleeplessness.
Sleep improves during the second trimester as your body finally adjusts to increased hormone levels. The fetus also presses less on the bladder, necessitating fewer nighttime trips to the bathroom. But restless legs and leg cramping may appear in this part of the pregnancy, and the medication used to treat the syndrome may harm your fetus. Speak with your health-care provider about perhaps increasing iron levels to counteract painful limb sensations. The good news is that this restless legs activity almost always subsides after pregnancy. Heartburn and gastric reflux -- in which stomach acid is pushed back up from the stomach into the esophagus -- can also disrupt sleep. Elevate your head slightly at night, and eat several smaller meals throughout the day.
In the third trimester, sleep deprivation and fatigue are major issues. Meanwhile, your body is still expanding, with possible frequent urination, leg cramps, heartburn, backaches and the inability to find a comfortable sleeping position. Snoring and sleep apnea can appear; if you start to snore, have someone watch to see if you gasp for breath during the night, which lowers the oxygen not only to your brain but also to the fetus. If you live alone, you can tape-record yourself. If you indeed gasp during the night, check with your doctor about wearing a continuous airway pressure mask (CPAP) until delivery. You'll sleep better, feel less fatigued and protect your growing baby.
As your anxiety increases over the pending delivery and new motherhood, so may instances of insomnia. It's important to do as much as you can to ease your fears. Talk to friends who have been through labor, read and gather as much information as you can, and practice some of the relaxation techniques described in this book. (A journal is particularly helpful during pregnancy and interesting to read again months and years later!) Nightmares, particularly those dealing with fears about delivery, are frequent during this last trimester, and talking through them does help.
Postpartum
After delivery, both your hormones and the neurotransmitters that control mood and sleep quickly return to normal. Though the structure of your sleep changes little throughout your pregnancy and post delivery months, sleep disruption and sleep deprivation are still big players, particularly now that you're on an extended sleep-interruption schedule for nighttime feedings. Unless you have round-the-clock help, you 're going to learn firsthand all about sleep disruption once you bring your infant home. And if you already suffered with sleep disorders, you'll find them exacerbated now.
The quick drop in hormonal levels -- the result of the expulsion of the hormone-secreting placenta just after birth -- is thought to be a main culprit of postpartum distress, or the baby blues, about three to five or six days after birth. Most women ride out this brief period, feeling wide mood swings that usually subside and disappear after a week or so.
However, for about 10-15 percent of new mothers -- particularly, those who have a history of mood disorder -- these blues develop into full-blown postpartum depression, with greatly disturbed sleep. If you have a history of depression, mood disorder or severe PMS symptoms, it's important to work with your physician and health-care providers throughout your pregnancy and during the postpartum period and beyond. You're at a much higher risk of developing serious postpartum depression, and should discuss medication and treatment with your physician.
The specific cause of postpartum depression is still unknown, though the combination of sleep deprivation, hormonal shifts and possible labor and delivery difficulties appear to conspire to deregulate mood function.
Sleep on your left side
The National Sleep Foundation recommends sleeping on your left side during pregnancy to allow the best blood flow to the uterus and kidneys. Most women find putting a pillow between their legs -- special pregnancy pillows are available -- helps reduce backaches, which can wake you up.
Take naps
Make use of naps to offset your sleep fragmentation, both during pregnancy and postpartum. The advice "Sleep when your baby sleeps" holds true; and if you can bring in someone to help during your naptime, all the better. Don't feel guilty about your sleep needs. Take advantage of any social and family support you can.
Eat well
Obviously, make sure you're eating good, nutritious food that has a positive effect on your quality of sleep. Avoid high-sugar and spicy foods, particularly late in the evening, drink plenty of water up until dinner and eat smaller meals more often.
Exercise
Keep on a regular exercise routine to improve circulation and help you sleep deeply. Don't push too hard, make sure you warm up and cool down, and use good breathing techniques.
Avoid stimulants
Avoid caffeine, nicotine and alcohol. These can harm your fetus and nursing baby, as well as disrupt your sleep. If you absolutely must have some kind of caffeinated drink, ask your doctor or health-care provider how much caffeine you can safely consume.
Explore bodywork and movement
With the enormous changes your body has undergone, massage and acupuncture can help restore balance to your system. Movement class, dance and yoga -- sometimes geared for pregnancy or post pregnancy needs -- also smoothes out major body transformation and transition.
Get your sleep
Practice good sleep habits, and make consistent use of relaxation routines. These are important healthy lifestyle choices, particularly during pregnancy and early motherhood. Make sleep a priority, and learn to share nighttime duties with a partner, if possible (you can breast-pump milk for night feedings).
Ask for help
If serious sleep deprivation persists, consider asking someone to come in one night a week or bimonthly (perhaps different friends and/or relatives) so you can get at least several good, solid sleep nights each month.
As your body did with the onset of your menstruation, it will decide when you experience menopause, technically the cessation of menstrual periods for a full year. Perimenopause, or the years leading up to the menopausal marker, can begin anywhere from four to ten years earlier than your last menstrual cycle. During these years, you'll notice physical changes as your ovaries start to decrease production of estrogen and progesterone.
The most common menopausal symptom -- hot flashes (along with night sweats) -- occurs for about 80 percent of the 50 million women moving through menopause and is the one symptom most associated with insomnia. Studies clearly show that perimenopausal and menopausal women have a much higher incidence of sleep disturbance and insomnia than do premenopausal women. These sleep disruptions are often associated with hot flashes' quick rise in body temperature (which can occur up to hundreds nightly), since a lowered body temperature promotes sleep.
When estrogen (along with progesterone) is replaced through traditional hormone replacement therapy (HRT) or through more natural plant extracts, menopausal symptoms often decrease. Estrogen replacement is particularly effective for hot flashes and insomnia.
However, HRT is not recommended for women who have a personal or family history of breast cancer, uterine cancer, blood clots and/or liver disease. Many other women choose to forgo estrogen replacement because of the documented increase in risk for breast cancer. Still, there are menopausal hormone supplements and treatments available that will help with sleep, some traditional, some alternative; most notably, Chinese herbs and acupuncture.
Editor's note: Recent findings in large-scale research studies suggest that HRT may increase a woman's risk of breast cancer, heart disease and stroke. In addition, when estrogen is prescribed alone, it may increase the risk of ovarian cancer. Consult a physician before starting any medication regimen.
Herbs like fennel, dong quai, red clover and black cohosh are phytoestrogens and can help reduce hot flashes, insomnia and other symptoms. Health food stores often carry the herbs in preformulated supplements, or you can take them through teas. Always check with your physician before taking any herbal supplement; women who are on HRT are cautioned against using phytoestrogens.
Soy
Increase your soy protein intake. Research shows that an increase of soy to the diet lessens the frequency and intensity of hot flashes and thus helps reduce nighttime awakenings.
Vitamins
Many gynecologists suggest taking an extra 200 mg of time-released vitamin B6 (pyridoxine) to reduce the side effects of hormone replacement therapy. Extra vitamin E, as well as extra calcium and magnesium, may also help with symptoms. Again, make sure you consult with your physician first.
Nightclothes
If you suffer from hot flashes, breathable cotton pajamas and sheets are better than synthetic fabrics. Use loose, light bed clothing, and keep an extra pair of pajamas or a nightshirt by the bed so you can quickly change clothes after a nighttime drenching.
Good sleep hygiene
Excellent sleep hygiene accentuates the positive during these sometimes negative sleep years: eat properly; exercise regularly; use relaxation techniques to reduce stress and discomfort; go to bed and rise at the same time; avoid late-night eating and stimulants such as caffeine, nicotine and sugar, as well as alcohol.
Bodywork
Acupuncture and regular massage help many women sleep better throughout midlife hormonal shifts. Shiatsu massage and reflexology are two good choices. Daily yoga and stretching exercise, morning and evening, help relieve tension and calm the nervous system.
© 2003 Powered
by Mugaes Kumar (J10129) & Mun Poh Yuet (J10136). All rights reserved.