By Elaina Hundley
How fluctuations in hormone levels can impact your sleep.
Hormones impact and direct so many of our biological processes—including sleep. Fluctuations in hormone levels often lead to disrupted sleep patterns, either temporarily or long-term. People assigned female at birth (AFAB) in particular often experience more frequent periods of hormonal fluctuations due to menstruation, pregnancy and menopause, all of which can disrupt sleep. However, some hormonal fluctuations have more to do with the amount of estrogen or testosterone a person’s body consistently produces (among other factors, of course). For example, men with less testosterone are more susceptible to obstructive sleep apnea (OSA), while studies show that estrogen treatment in women undergoing menopause can help improve sleep quality. Oftentimes, there are physical side-effects caused by changing hormone levels that can also contribute to how well we sleep. We recently explored a little bit about how melatonin impacts sleep, but we also thought it might be interesting to look into how estrogen, testosterone and other fluctuating hormones impact sleep and the varying circumstances under which people may experience disordered sleep due to shifts in their hormones.
When Do Our Hormones Fluctuate?
When it comes to sleep, studies have shown that AFAB women tend to go to sleep earlier and wake up earlier than assigned male at birth (AMAB) men and are, in general, said to achieve higher quality sleep. At the same time, women are also more prone to insomnia than men. But, there are also numerous factors throughout our lives that lead to hormone shifts—many of which can and will impact sleep quality. Transgender individuals undergoing gender affirming surgery and/or hormonal therapy, individuals that are menstruating or pregnant as well as aging populations all experience hormonal shifts during adulthood that can adversely impact sleep. So how do each of these phases or factors contribute to hormonal shifts and sleep changes?
Transitioning – Hormone Replacement Therapy (HRT)
While there are few studies that look specifically at hormone replacement treatment and its impact on sleep, this study presents three cases in which testosterone levels correlate with changes in each patient’s experience of obstructive sleep apnea (OSA). In the first case, a transgender woman (assigned male at birth) with severe OSA ceased experiencing breathing difficulty during sleep once their female sexual hormone therapy commenced. In the additional two cases, the initiation of male sexual hormones in transgender male patients seemingly prompted the onset of OSA.
While there is still much to be learned about the impact of HRT on sleep, this study in particular does reflect some larger trends having to do with how estrogen and testosterone impact sleep. There are additional physical and emotional changes that HRT can cause that may also interfere with sleep—shifting moods, achiness, painful acne and other largely temporary side-effects may also disrupt sleep.
Most people are familiar with premenstrual syndrome (PMS) symptoms, particularly those that are dramatized in popular culture—mood swings, cravings, cramps and crying—but you may not know that PMS can also lead to trouble focusing, insomnia, increased anxiety and depressive feelings.
While there is also little in-depth research on the impact of menstruation on sleep, the shifts in estrogen, progesterone, follicle stimulating hormone and luteinizing hormone experienced during menstruation are the factors that bring on premenstrual symptoms. Many people with periods experience bouts of insomnia leading up to and during their menstrual cycle. The connection is not totally known, though falling estrogen levels could be to blame. Several studies show that insomnia normally occurs at the beginning of the cycle (the late-luteal cycle when PMS first begins). Additionally, the hormone shifts can impact melatonin production. Finally, progesterone can impact body temperature—so much so that it can disrupt sleep.
There are significant paradoxes when it comes to pregnancy and sleep. The work of being pregnant and having a little person growing inside your body leads to an increased need for sleep, as do high levels of human chorionic gonadotropin and progesterone. But on top of those hormones, pregnancy often brings about a whole plethora of other physical symptoms that can cause sleep disturbances. And, disordered sleep during pregnancy can be detrimental to the success of the pregnancy. Increases in progesterone cause daytime naps and nighttime sleep fragmentation, while oxytocin can cause uterine contractions that disturb sleep later on in a pregnancy. The physiological and psychological strains of pregnancy can also lead to disordered sleeping—including issues like snoring, OSA, restless leg syndrome and insomnia—a worried mom may lay awake at night stressing about the health of the baby and future delivery.
Menopause & General Aging
We’ve previously written about aging and sleep, but here we wanted to focus more specifically on menopause because menopause can cause sleep disruption for a number of reasons largely related to hormones. The onset of menopause is caused by a woman’s ovaries gradually decreasing production of the estrogen and progesterone during what is called perimenopause. Perimenopause can last 7-10 years before menopause fully sets in. The hormonal changes one experiences during perimenopause contribute to an increase in sleep disorders before, during and after menopause. Physiological and psychological symptoms like hot flashes and mood swings can cause sleep disruption that can lead to chronic insomnia symptoms. Additionally, decreases in progesterone production can increase the risk of OSA overtime. HRT can sometimes provide a solution to some of the side-effects of perimenopause and menopause, but the treatment can also pose risks.
Sleep Loss Can Feel Like An Endless Cycle
The biggest issue with any health problem or physical change that can prompt insomnia is that lack of sleep begets less and less sleep and leads to more adverse physical and psychological symptoms. As we know more about how important sleep is and how much it can impact our ability to function, losing sleep can also feel even more stressful—leading to insomnia-exacerbating anxiety and the like. However, habits like developing consistent nighttime routine, avoiding blue light before bed and cutting off caffeine intake earlier on in the day that are recommended to anyone trying to have a consistent sleep cycle can make a difference.
Simply being aware of the impact shifting hormones can have on your sleep patterns and preparing accordingly can help curb some of those side effects. Keeping sleep supplements on hand that work for you (and are doctor-approved) can be beneficial for when you expect your period. Or as you age, keeping a full schedule as well as exercising during the day to tire yourself out at night can offset some of the hormonal fluctuations. If you are pregnant, try to allow your body the extra sleep it needs and treat some of the physical side-effects that might keep you up at night. Regardless of why your hormones are fluctuating, if insomnia or other sleep disorders are plaguing you don’t hesitate to talk to your doctor about greater interventions like HRT, sleep aids, CPAP devices and more to resolve the issue.