Q: How does the menstrual cycle affect sleep?
A: The hormones estrogen and progesterone play a role in regulating the menstrual cycle and also, through their additional functions relating to the brain, influence other processes like sleep and circadian rhythms. Changes that occur in women’s bodies during the menstrual cycle can affect sleep. Many women report 2–3 days of disrupted sleep during each cycle. Some report more sleep in the premenstrual period, while others report insomnia. Factors like stress, mood, illness, medication, diet, and sleep environment can also affect sleep at this time. Menstrual cycles are usually 25–35 days long.
Q: What is sleep like before ovulation?
A: Day 1 of the menstrual cycle is identified as the first day of bleeding (menses). Bleeding usually continues for about 5 days. During this time, many women sleep less and feel less comfortable during their sleep time. Those who suffer from menstrual cramping and pain obviously spend more time awake due to pain than those who don–t, have greater movement activity during sleep, and experience more stage 1 (lighter) sleep and less REM sleep. When bleeding stops and estrogen levels start to rise, women may experience more REM sleep.
Q: Does sleep change at the time of ovulation?
A: Around day 14, ovulation (release of an egg from the ovary) occurs. Estrogen levels in the blood peak just before ovulation. During this time, there are no real changes in sleep quality or quantity, but there may be subtle differences in the amount of REM and slow wave sleep in women who have ovulated successfully.
Q: What happens to sleep after ovulation?
A: If the egg is fertilized after its release, pregnancy will ensue. Otherwise, this stage of the cycle is dominated by the hormone progesterone. If fertilization does not occur, hormone levels drop dramatically and menstruation occurs. Some women may find it difficult to sleep during this time. Others suffer from premenstrual syndrome (PMS), with bloating, irritability, headaches, moodiness, and abdominal cramps. All of these may affect the quality of sleep. Some women may experience drastic changes to their sleep including excessive sleep, insomnia for a couple of nights prior to their period, or significant daytime sleepiness. Depending on the severity and whether the problem is long– or short-term, this can be classified as a sleep disorder.
Q: What can I do to improve my sleep, especially premenstrually?
A: If you suffer from premenstrual syndrome or have severe mood changes (depression, anger, and irritability that affect normal functioning), you should seek medical advice. Apart from modifying lifestyle factors, there are some effective medications that can be very useful in controlling symptoms. Sometimes going on an oral contraceptive may help considerably.
Q: How do oral contraceptives affect ovulation?
A: Many women take oral contraceptives for long periods of time to regulate their menstrual cycles and to control fertility. Oral contraceptives are combined formulations of low-dose progestin and synthetic estrogen and suppress the body’s own production of these hormones. They, thus, prevent ovulation (production of an egg from the ovaries), interrupting the normal course of the cycle.
Q: Can oral contraceptives have an impact on sleep?
A: Oral contraceptives affect body temperature regulation and can affect sleep. Body temperatures are consistently raised throughout the cycle, unlike in women who are not on the pill. Secretion of melatonin may also be affected although the research evidence is currently still under review. Women on oral contraceptives have more stage 2 sleep and less slow wave sleep, the deep sleep that is thought to be restful and restorative. They are likely to have more REM sleep than women not on oral contraceptives.
Q: What is polycystic ovarian syndrome and how does it affect sleep?
A: Polycystic ovarian syndrome (PCOS) is a disorder in hormone production in which some of the ovarian cells produce too much androgen (male hormones). PCOS affects up to 4 in 100 women of child-bearing age and results in disrupted and irregular periods, weight gain, a tendency to develop diabetes, and excessive body hair. The risks for developing high blood pressure and heart problems are also increased. With regard to sleep, women with PCOS have a higher risk of developing sleep-disordered breathing and sleep apnea (probably due to weight gain) and are more likely to report symptoms of excessive daytime sleepiness. PCOS is usually treated by a specialist in hormones (endocrinologist).
Q: Does shift-work affect the menstrual cycle?
A: Shift-work can disrupt circadian rhythms in hormone production. The reproductive/sex hormones are also affected. Studies show that women shift-workers have more irregular menstrual cycles, painful menstruation, and longer menstrual cycles than women who are non-shift workers. Stress probably plays a large part in affecting the secretion of hormones from the pituitary gland that then regulate the production of sex hormones.

The menstrual cycle

By convention, the menstrual cycle is represented as lasting 28 days to show the changes that occur throughout the cycle. The first day of bleeding (menses) is day 1. Ovulation (release of the egg from the ovary) is day 14.

The cycle is thus divided into 2 phases. The first phase of the cycle (prior to ovulation) is the follicular phase. During this stage, as the egg starts to grow in the follicle, the levels of estrogen are high. The high estrogen levels cause a surge in luteinizing hormone (LH), which controls fertility and is the trigger for ovulation.

During the second half of the cycle (the luteal phase), the levels of progesterone are much higher than estrogen levels and resting body temperature may rise by as much as 1°F (1/2°C). If there is no fertilization and implantation of the egg during the luteal phase, the hormonal levels eventually drop drastically and bleeding commences.

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