Menstruation has a lot to answer for. From flooding to cramping to dizziness , the monthly cycle can come with a helping of very unwelcome side effects for some women, with sleep issues being a less obvious offshoot of getting your period. If you’re tossing and turning prior to your time of the month, there’s a biological explanation, and thankfully ways to mitigate the insomnia , broken sleep and restless legs that can sometimes accompany your menstrual cycle, because frankly we’ve got enough going on without walking around zombified for a week every month. Here’s how to make bedtime better around your bleed.
How your cycle affects your sleep
You may find that you sleep soundly all month long, or don’t notice any kind of nocturnal disruption that can be put down to your period, but if you are experiencing monthly insomnia, consultant in Sleep Medicine and Anaesthesia at the Sleep and Health Clinic Dr Sara McNeillis assures you that it’s “normal”:
“Women who have menstrual cycles will also have corresponding alterations to sleep patterns. Sleep patterns differ between the pre-ovulation time of the month (or follicular phase) and the post-ovulation (or luteal) phase. Some women are more sensitive to these changes in sleep patterns than others.
“The most common sleep changes occur after ovulation. Women may feel increasingly sleepy and fatigued in this period, despite having clocked up a proper night’s sleep. You may also find that your sleep is more broken or fragmented.
“The reasons for sleepiness in the post-ovulation phase are down to the effects of the hormone progesterone. Progesterone prepares and maintains the lining of the womb, but also increases sleepiness by its soporific actions directly on the brain’s sleep centre.
“Once a period starts, levels of the progesterone reduce rapidly, however the sleepiness associated with high levels of progesterone may take a few days to improve. As such, most of hormone related sleep problems will start to improve from the beginning of your period.”
This is of course good news from that point forward, but if you’re in the throes of menstrual insomnia or extreme fatigue, you may recognise some of the following symptoms…
If you’re enduring sodden sheets thanks to night sweats or are quite simply sweltering for no obvious reason, post-ovulation overheating could be to blame, as Dr McNeillis explains:
“It is known that core body temperature is increased over the two weeks following ovulation, again due to the impact of progesterone. In addition, core body temperature increases to its maximum each day between approximately 9pm and 10pm. You should begin to feel sleepy when your core body temperature starts to drop shortly after 10pm, but in women the reduction in core body temperature in the post-ovulation phase is blunted, which may cause the feeling of overheating at night. This can subsequently lead to an alteration of your sleeping pattern during these nights.”
How to cope:
It seems obvious, but taking steps to keep your cool after ovulation and before and in the first few days of your period can take the edge off of oven-like nights. Dr McNeillis suggests some simple sleep-inducing tweaks:
“It is important to ensure that your home environment allows the core body temperature to drop sufficiently to allow the body to feel sleepy. Keep your sleep environment well ventilated in the hours before bed and avoid activity that will make you feel too warm.”
Sleep consultant and in-house sleep expert at period subscription box service The Pink Parcel Maryanne Taylor advises “keeping your bedroom at a temperature between 15-19 ºC and using a fan or air con if you have it to create a cross breeze and pull hot air away from you.”
Maryanne also prescribes a few other pre-bed rituals to help you to cool off during the premenstrual phase:
“Take a warm bath. It sounds counterintuitive but having a warm bath or shower can help you to cool down. Staying hydrated is also vital- keep a glass of water next to your bed to help to reduce your body temperature if it spikes at night.”
If your sleeplessness is causing you to feel stressed, don’t pile on the pressure to bed down if your body isn’t playing ball pre-period. Clinical Director for Bupa Dr Petra Simic underlines that rushing to bed when you’re not ready to sleep can cause more insomnia-causing anxiety:
“If you suddenly realise that it’s ‘time for bed’ and rush to prepare, your body begins to pump out adrenaline, which is overly stimulating, can cause overheating and makes it harder to drop off.
“I encourage people to lose this race to bed and instead do all of the necessary bed-preparation before they sit down to relax. Get your PJs on and teeth brushed before chilling out (literally). Avoid screens, dim the lights and let yourself relax. Once you feel sleepy, just take yourself straight to bed.”
Don’t feel guilty about having an early night or an extra lie in when your body is telling you to
Some symptoms of period related insomnia can be more tricky to deal with than cracking open a window or instilling a cooling off ritual, however…
If you have a nocturnal urge to move your legs or an unpleasant ‘creeping’ sensation in your feet, calves or thighs, you could be suffering from restless leg syndrome, and there’s an explanation as to why shaky legs strike around your period according to Dr McNeillis:
“Restless leg syndrome affects some women during their period, and it’s most common for these symptoms to occur in the evening, around bedtime and during the night. As you’d imagine, these involuntary movements can disturb sleep.”
How to cope:
“One of the reasons why you can experience restless leg symptoms during your period is due to the drop in iron stores in the body. You can ask your GP to check your iron (ferritin) levels , and if they are low then you’ll likely need to take some iron supplements, which should reduce both the symptoms of restless legs and fatigue. Patients who have painful restless legs symptoms are often advised to take a the painkiller codeine to ease discomfort (and thereby improve sleep in this case).”
If you do find that restless legs cause problems during your period, the NHS also recommends lifestyle adjustments such as avoiding stimulants in the evening, quitting smoking and exercising regularly (but not late in the day).
Sleeplessness and PMS
More familiar but no less sleep-limiting PMS can also be a source of monthly nighttime hell, as Maryanne relates:
“As well as headaches and and cramps, digestive issues such as indigestion, nausea or diarrhoea can be brought on during a period, all of which can clearly have a significant impact on sleep.”
How to cope:
If you’re experiencing severe PMS , visit your GP to discuss treatment and pain management options, explaining that your menstrual symptoms are causing you sleep problems- no one should suffer in silence, and symptoms are likely to get worse if you’re not sleeping well. Dr McNeillis also puts forward a few ideas to help you to maximise rest when PMS is making nights miserable:
“Some women who experience significant mood swings in their premenstrual period have been shown to have sleep timings that are not synchronised with their body’s circadian rhythms (in short, the body clock is out of whack). Studies suggest that being exposed to bright light in the evening or undergoing sleep restriction therapy can help to realign the body clock for women experiencing premenstrual sleep issues. Taking melatonin has also been shown to improve sleep quality during this period, but this will need to be taken on the advice of your doctor.”
As far as sleep restriction therapy goes, this should only be planned, embarked upon and monitored by a sleep psychologist.
Pink Parcel’s resident therapist Pat Duckworth also advocates investigating what could be making PMS worse as a means to improve your sleep:
“Keep a journal for a month to assess if there’s a pattern to your disrupted sleep. Include your diet, exercise habits and whether you were under stress at the time. If PMS symptoms are the obvious cause, drinking peppermint tea can help to lessen the pain of cramping and keep you hydrated if you’re experiencing headaches, while a hot water bottle or hot compress can soothe pain around the abdomen. A magnesium rich Epsom salt bath can help to both relieve aching and cramping and help you to feel more sleepy. Try adding an aromatherapy oil to the water to destress too.”
Dr McNeillis also promotes exercise early in the day “to reduce the pain associated with your period and improve sleep quality later on.” If shuteye is still eluding you despite introducing a PMS vs. sleep plan, Dr Simic urges you not to panic:
“Yes, a full night’s sleep every night is the ultimate goal, but for most people this is an unrealistic expectation, for a variety of reasons. So, when you do get the opportunity for a good, long sleep- take it.
“Recharging your batteries with an extra-long slumber at the weekend or during a holiday is something we should embrace and enjoy. Regular sleep binges will help your body to do all the repairing it needs to do, so don’t feel guilty about having an early night, or an extra lie in when your body is telling you to.”
Basically, schedule some non-negotiable R&R when you really need it, whether it’s by way of a duvet day, asking a partner, husband or babysitter to take care of kids or cancelling party plans to catch up on sleep, because PMS is bad enough already without the added insomnia.
If you’re wearing the highest level of protection possible and blood is still leaking onto bedding, you’re likely experiencing flooding (medically termed menorrhagia), which can in turn lead to iron deficiency anaemia. This can affect your sleep patterns in itself, so see your doctor to get tested and rule out other conditions associated with heavy bleeding such as PCOS , fibroids, endometriosis or thyroid dysfunction.
If you do leak, remember that it’s not the end of the world and we’ve pretty much all been there
How to cope:
If you’re not experiencing heavy bleeding, but worried about nightly leaking, Maryanne reckons that changing your protection can help to resolve the issue:
“Pads can be bulky and have a high risk of leakage- not just due to the strength of flow at night, but also your sleeping position. Gravity is also a factor when wearing pads as lying down may cause the flow to seep beyond the area that a pad covers.
“Tampons or a menstrual cup on the other hand can be worn for up to eight hours and aren’t affected by a change of gravity, so if you’re concerned about leakage, you may feel more comfortable and relaxed changing from a pad to a different form of sanitary protection, but of course that choice is very personal.”
If you do leak, remember that it’s not the end of the world and we’ve pretty much all been there. Vanish will do the job nicely, and anyone who judges you doesn’t deserve to be anywhere near your bed anyway.