The link between sleep and PMS
Over 90% of women get Premenstrual Syndrome (PMS) symptoms such as bloating, cramps, irritability, anger, stress, fatigue and mood swings in the second half of their menstrual cycle, roughly a week prior to menses onset.
And more than 70% of women experiencing Delayed Sleep Phase Syndrome (DSPS) – a condition where sleep is delayed by two or more hours beyond what is considered an acceptable bedtime – were found to experience PMS.
DSPS is a circadian misalignment that is not only linked to PMS but also to irregular menstrual cycles and dysmenorrhea.
Symptoms of DSPS include inability to fall asleep until very late at night, often much past midnight, due to the internal clock sending waking signals to the brain and the body; and difficulty waking up at “normal” time as the internal body clock fails to send alert signals. Those affected by DSPS may sleep well in terms of duration and quality, but the timing at which these people sleep disrupts hormones causing reproductive difficulties as well as impacts daily life. It may develop in early childhood and last into adult life due to the underlying circadian rhythm abnormalities, yet it may also occur due to the social reasons.
Although, the exact mechanisms to which late sleep onset disrupts the hormonal profile are not yet established, it is expected that melatonin disruption affects serotonin levels (responsible for mood) and reproductive hormones as well as raises inflammatory mediators, which in combination cause mood swings, fatigue, irritability and irregular and painful menstrual cycle.
It is fair to conclude that maintaining a healthy sleep regime will provide relief to a lot of women struggling with monthly discomfort and may assist in establishing a regular cycle.
However, women with PMS symptoms often also experience insomnia, which may prevent them from establishing healthy sleeping patterns.
Hormones like melatonin, cortisol, thyroid stimulating hormone, and prolactin, vary across the 24-hour day and are highly regulated by the circadian and sleep-wake cycles. Evidence suggests that these hormones alongside physiological events play a role in sleeping patterns and visa versa. These relationships are further regulated by the menstrual cycle as the sex hormones fluctuations occur throughout the menstrual cycle.
Healthy women are twice as likely to experience sleep disturbances as men. Insomnia in women of childbearing age often occurs in the luteal phase of the cycle, 1-2 weeks before the start of menstruation. It appears that the sleep-regulating role of the female hormones is greater in women with PMS, PMDD (premenstrual dysphoric disorder - a more sever version of PMS), in postmenopausal and postpartum phases of the reproductive cycle.
It has been noted that healthy menstruating women undergo a reduction in REM sleep (dream phase) during the luteal phase of the monthly cycle. REM sleep occurs when the body temperature is at its lowest point. A rise in progesterone at ovulation and its continuous growth as the body prepares for pregnancy tends to increase body temperature, and also acts similarly to that of valium at the GABA-a receptor. This means that increased progesterone makes women fall asleep easier but dream less during the second half of the menstrual cycle.
Melatonin is most commonly known as the “sleep hormone” and is intricately involved with the female hormonal axis. Unexpectedly, receptors for melatonin and female hormones both occur at the same areas of the brain, and melatonin is even found in the ovarian fluid. The relationship between the “sleep hormone” and female hormones is crucial, yet is complex and still understudied. Some scientific studies report that progesterone and melatonin oppose each other, while other studies claim these hormones support each other’s actions. There is a little more clarity on oestrogen - it seems to reduce melatonin activity.
Cortisol is another reliable marker of circadian phase and peaks in the early mornings, when melatonin secretion is declining to reach undetectable levels during the day. Both melatonin and cortisol are sensitive to the environmental factors like retinal light exposure (which reduces melatonin production) and stress (which stimulates cortisol secretion).
Just like in healthy menstruating women, disturbances of sleep in women with PMS are very common in the second half of the menstrual cycle and are accompanied by a reduction in dream phase. Studies have established that women with PMS have lower levels of progesterone towards the end of the cycle and lower GABA receptor activity levels than healthy women. This reduction causes lesser calming and anxiety-reducing effects. Studies establish that a reduction in REM sleep greatly contributes to the symptoms in women with PMDD and an increase in the REM phase improves their symptoms.
During the studies abnormal melatonin secretions and lesser body response to this hormone were noted in women with PMS in comparison to their healthy comparative group. Reduced melatonin production can be linked to the reduced availability of serotonin during the second half of the menstrual cycle, which contributes to greater inflammatory mediators in the body. In turn, inflammation blocks serotonin production in the brain and digestive system.
And as we know, inflammatory mediators also contribute to the follicular development, pain levels, digestive processes and mood, thus play a critical role in PMS symptoms and insomnia. Disturbed sleep and circadian rhythms are associated with increased incidence of obesity and diabetes, cardiovascular disease, and depression.
Despite the complex relationships between the hormones, sleep and PMS symptoms there are great behavioural, nutritional and herbal tools that can help alleviate insomnia and premenstrual syndrome symptoms
Here are some tips to improve sleep and PMS symptoms:
Develop rituals around bedtime to help you relax. It can be a soothing bath with Epsom salts and drops of lavender essential oil
Eat two or more hours before bed and avoid eating heavy meals rich with protein, spices and fat during that time. A small snack prior to bed is encouraged in those with low blood sugar issues
Go to bed and wake up at the same time every day, the body responds well to routine
If you must, nap for 20 minutes, and always before 3pm
If you must, only drink caffeine (coffee, tea, chocolate) in the morning
Avoid stimulating activities at least one hour before bedtime (computer use, television and mobile phone – the blue light that they release has a strong impact on the hypothalamus, reducing melatonin and increasing cortisol)
Adjust the internal clock by going to bed 15 minutes earlier each night (e.g., go to bed at 11:45pm, wake up at 7:45am, the next day go to bed at 11:30pm and wake up at 7:30am) until the desired sleeping pattern is achieved (10pm sleep and 6am wake-up)
Bright light therapy requires a bright light exposure (light box must be purchased) for half an hour each morning to help reset the internal body clock. This is best followed by the reduced light exposure as it gets closer to bedtime
Set a comfortable and dark bedroom, do not spend time on your phone, computer, do not eat or watch TV in the bedroom – only relaxing sleep-related activities are allowed
Breathing exercises and meditation assist with relaxation prior to bed
Herbs and nutrients for sleep and PMS
Chamomile is an anti-inflammatory herb with mild sedative and analgesic actions. It improves the digestive upsets, lowers pain and inflammation levels and relaxes the body making it easier to fall asleep. An excellent remedy in young adults and sensitive individuals
Lavender reduces anxiety and acts as a mild antidepressant. It also improves tense muscles and under-active digestive system, and increases the production of the relaxing neurotransmitter GABA. When drinking it in a tea one may experience relaxed and uplifted mood and fall asleep with greater ease
Passionflower, when accumulated in the body, increases REM phase of sleep, is a potent anxiolytic and sedative herb. It is known to relax the muscles and reduce heart palpitations associated with anxiety. It stimulates GABA production and restores calming sensations
Ashwaganda is a relaxing adaptogen that works to restore the function of the adrenal glands. It is anti-inflammatory in nature and is a herb of choice for wired yet tired individuals who tend to stay up until 3-4am
Lemon balm is a good choice for the anxious and impulsive people with poor focus. It lifts the mood and calms the mind
Valerian lowers anxiety levels and restores the nervous system. It alleviates muscular spasms and nervous tension, improves quality of sleep, and contributes to greater sleep as it increases GABA production
Vitamin E shows strong neuroprotective effects on the brain and can decrease inflammation levels associated with poor sleep patterns. Studies report that vitamin E can counteract the short and long-term memory reduction in chronically sleep-deprived individuals. Care must be taken in selecting the vitamin E supplementation as during the manufacturing it may have been oxidised and will bring more harm than good. Dietary sources of vitamin E are encouraged and include sunflower and sesame seeds
Magnesium is essential for melatonin production and also releases muscle tension and improves sleep by increasing GABA production. Not every magnesium form is the same. Magnesium rich foods are green leafy vegetables, almonds and Brazil nuts
B vitamins work on restoring the nervous system providing adequate body endurance during the day and greater nervous system relaxation at night. Niacin (B3) works to increase serotonin production thus improving one’s mood. B vitamins can be found in lentils and chickpeas, brown rice and oats, green leafy vegetables, chia seeds, Spirulina, insects, fish, dairy and animal products
L-Tryptophan is an essential amino acid necessary to make niacin that contributes to the production of serotonin, which in turn enhances the production of melatonin thus providing a better sleep and relaxation. It can be found in sweet potatoes, bananas, chia seeds. Eating these a few hours prior to bedtime will enhance sleep. It is a common misconception that consuming turkey meat increases tryptophan levels in the body. Study shows that the same amount of this amino acid is consumed with chicken as with turkey or eggs
In cases where the above suggestions did not have an effect a natural medicine practitioner will be able to establish personal treatment plan for you to obtain good quality sleep and PMS symptoms alleviation using herbal and nutritional medication.
Consult your healthcare provider if you have any pre-existing health issues such as heart arrhythmia, kidney insufficiency, or other heath implications prior to changing your health care regime.