Sleep Disorders And Their Link To Menstruation

Overview

Sleep is a critical physiological function that is essential to sustaining general health and well-being. Sleep patterns can be disturbed by a variety of causes, but one important feature that has drawn attention in recent studies is its relationship to the menstrual cycle. Due to the different hormonal changes that occur throughout the menstrual cycle because of the normal hormonal process of menstruation in women, sleep patterns and quality may be affected.¹ Menstrual irregularities have been associated with daytime tiredness, elevated psychological stress, and mood swings. Sleep disruption, especially when coupled with stress, may impact the hormonal changes involved in reproductive function that are controlled by sleep. This can also be referred to as premenstrual syndrome (PMS) while the more severe one is called premenstrual dysphoric disorder (PMDD).

The relationship between menstruation and sleep disorders

The association between sleep disorders and severe menstruation symptoms may be complicated. While the pain and stress of menstruation symptoms might make it difficult to fall asleep, sleep deprivation can affect hormones and the menstrual cycle. Both reproductive and sleep habits are impacted by hormonal changes that occur throughout the menstrual cycle. Therefore, imbalances in these hormones can cause both poor sleep and irregular menstruation. Both insomnia and menstruation issues can be influenced by risk factors such as physical inactivity, obesity, stress, and depression.²

Menstrual cycle and premarital syndrome

The uterus and ovary undergo changes each month that are crucial for sexual reproduction. Progesterone, luteinising hormone (LH), and follicle-stimulating hormone (FSH) are a few of the hormones that regulate these changes. The menstrual cycle is a cycle in which eggs are produced and the uterus is prepared for a potential pregnancy. The menstrual cycle lasts 28 days on average (although it can vary from 21 to 35 days) beginning at puberty, around the age of 12, and lasts until menopause, approximately at the age of 51. There is a link between PMS and the menstrual cycle, especially during the luteal phase (before menstruation). It usually improves once menstruation begins.³

The menstrual cycle is associated with premenstrual syndrome.

The menstrual cycle happens in four main stages:

• Menstruation: This is the first stage, which lasts about 1 to 5 days. It's when you have your period
• Follicular Phase: This second stage lasts about 13 days. During this time, the body gets ready to release an egg
• Ovulation: The third stage starts on day 14 of the cycle. This is when the egg is released
• Luteal Phase: The last stage goes from days 15 to 28. Premenstrual syndrome (PMS) shows up during this phase. When your period is over, PMS symptoms usually get better

Symptoms of sleep disorders during menstruation

Symptoms of sleep disorder in premenstrual syndrome include:

• Night-time insomnia, or difficulty falling asleep.
• Sleep disturbances.
• Sleep deprivation, which leaves you feeling tired or unrested the next morning.
• Feeling depressed or swinging in mood
• Fear or stress
• Inadequate focus
• Having no control over one's actions.
• A tendency to be sluggish or easily fatigued
• Body pains, soreness, or bloating in the breasts, and changes in appetite³

Causes of sleep disorders during menstruation

• Decrease in melatonin secretion: Premenstrual syndrome shows up during a phase called the "luteal phase," when its symptoms are strongest. When we compare this luteal phase to an earlier phase called the "follicular phase", women with PMDD have less melatonin response, which is a hormone affecting sleep. This change in the body's internal clock might be the reason why mood issues happen in the later part of the menstrual cycle
• Hormonal changes: having more progesterone and less of its derivative, allopregnanolone, during the luteal phase of the menstrual cycle might cause sleep disturbances. Gamma-aminobutyric acid (GABA) levels increase when allopregnanolone levels fall even more in women affected by premenstrual syndrome throughout this period. Due to the body's inability to appropriately regulate GABA's actions, higher GABA levels in women with premenstrual syndrome are linked to mood fluctuations, feelings of anxiety or sadness, and difficulty falling asleep⁴

Diagnosis of sleep disorders during menstruation

An examination of the patient's medical history and recording the symptoms for two possible menstrual cycles can be useful in diagnosing the condition.³ Certain diseases, such as chronic fatigue syndrome, thyroid issues, and mood disorders including sadness and anxiety, might resemble PMS. To get a precise diagnosis, your doctor may request tests like a thyroid function test or a test for mood disorders.

Management and treatment of sleep disorders in menstruation

Pharmacological therapy is required for severe mood instability. Selective serotonin reuptake inhibitors (SSRIs) are the best therapy for severe mood disorders. The initial course of therapy is with these antidepressants. Due to the close connection between gonadal hormones and the serotonergic system, SSRIs offer the most effective treatment. As a first-line treatment for premenstrual syndrome, SSRIs are employed. PMS can also be treated with tricyclic antidepressants (TCAs). An SSRI may also be taken in combination with a benzodiazepine when anxiety and sleeplessness are the main symptoms.

The use of bright light therapy has proved effective in treating premenstrual syndrome during the late luteal phase of the menstrual cycle, lowering stress, despair, and premenstrual tension in women. PMDD can be effectively treated with whole or partial sleep deprivation, and both early and late sleep deprivation work to improve sleep quality.

Communicating openly with close friends and family about the issue, as well as learning stress-reduction techniques and better communication skills, can help. The use of group counselling, especially for severe symptoms, may also be beneficial. In addition, while many "PMS diets" lack scientific backing, certain dietary adjustments can help. Having a low-salt diet and eating fewer refined carbohydrates might prevent oedema. Those suffering from tension, anxiety, and insomnia can benefit from reducing their caffeine intake. Avoiding excessive alcohol consumption is critical for relationship strain. Some people find relief from mood swings by consuming small, frequent meals. Also, aerobic exercise, even in moderate amounts, can temporarily alleviate premenstrual symptoms for many women. It can also act as a stress-relief outlet, offering relaxation.⁵

Before turning to surgery, it's important to try medications for severe PMDD. If standard treatments don't work due to ineffectiveness, side effects, or cost, women with strong symptoms that disrupt their relationships and lives might consider a temporary pause in ovarian activity. For those sure about not having children, discussing the possibility of removing the ovaries for lasting relief from premenstrual symptoms is an option. This should only be considered if temporary ovarian suppression has been effective as an alternative to other treatments. Studies show that ovarian removal and hormone replacement therapy can effectively treat PMDD. If a hysterectomy is also done, certain hormone medications may not be needed, avoiding issues like irregular bleeding and symptoms returning.

Certain hormonal contraception drugs can help prevent ovulation, which can ease PMS symptoms. You should speak with your physician if this is an option for you.

Medical ovarian suppression, which involves inhibiting the ovaries' normal function, can be extremely helpful for women who are experiencing severe and long-lasting symptoms. To prevent menopausal symptoms and adverse effects, the typical activity of the ovaries must be stopped while still maintaining a low level of oestrogen.⁵

FAQs

How common is sleep disorder during menstruation?

Up to 7 out of 10 women have different sleep patterns before menstruation. In most cases, this occurs three to six days before menstruation.

How can I avoid sleep problems during my period?

When you know that your sleep problems happen because of your period, you can guess when they might come again next month. Before those days, be sure to rest and sleep well. It's a good plan to have less coffee and alcohol during this time. Stay active and eat a healthy diet. Eat less salty and sugary stuff and eat more foods with calcium. Spend time outside and soak in some sunlight before and during PMS. Keep in mind that after this tough time is over, your sleep and feelings will go back to normal. This means you'll feel less upset and worried about your sleep.

What are the risk factors of sleep disorders during my period?

• Menstruation
• If you or a family member have premenstrual syndrome
• Having issues with mood
• Smoking cigarettes
• Consuming alcohol
• Being stressed
• Gaining weight

When should I see a doctor?

Speak with your physician if your PMS issues are significantly affecting your quality of life. You may talk about remedies for PMS symptoms. If you carry out this, your sleep will often improve as well.

Summary

Sleep is crucial for overall health and its connection to the menstrual cycle is significant. Menstrual changes due to hormones can impact sleep quality. Irregular menstruation can lead to tiredness, stress, and mood swings. Sleep disorders during menstruation include insomnia, mood swings, and fatigue. The causes include changes in melatonin and hormone imbalances. Tracking symptoms for two cycles can help rule out possible causes that are affecting sleep quality. Treatment includes medication, light therapy, lifestyle changes, and surgery to improve sleep quality. Ovarian suppression can help with severe symptoms. About 7 out of 10 women face sleep problems before menstruation. Lifestyle adjustments and seeing a doctor when needed can improve sleep during this time.