Mastering Menstrual Sleep Issues: Strategies for Better Rest During Your Cycle

For many people who menstruate, the days leading up to our period often bring a familiar struggle: sleep becomes elusive and fragmented. Our minds race with thoughts we can’t quiet, our bodies feel hot and uncomfortable, and no position feels right for our limbs. If we share our bed, our partner’s breathing can seem unusually loud, and touch can be unbearable. Even when we manage to fall asleep, it’s light and restless, punctuated by frequent awakenings and strange dreams.

It took me a while to connect the dots between my disrupted sleep and my impending period. Conversations about menstruation have been taboo until fairly recently, and information about how hormonal fluctuations impact us at different stages of our cycle was hard to come by. Thankfully, this is changing, and we now have a much better understanding of what’s happening and how we can improve our chances of getting better sleep.

Let’s first take a closer look at the two main hormones, estrogen and progesterone, and how they contribute to sleep. With this understanding, we can create an action plan for when we need to manage without them.

Estrogen is the dominant hormone in the first phase of the cycle leading up to ovulation. It helps produce melatonin, the sleep hormone, by aiding the conversion of tryptophan, an essential amino acid, into serotonin, which in turn is the precursor to melatonin. Estrogen also increases vasodilation, the expansion of blood vessels, which helps dissipate excess body heat. Additionally, it modulates neurotransmitters like serotonin and norepinephrine, influencing temperature regulation via the hypothalamus, the brain’s main regulatory center. This lowers the hypothalamic temperature set point, meaning the body cools off faster and easier. To fall asleep, our body temperature usually drops by 0.5 to 1 degree Celsius, so without sufficient estrogen, this cooling process is hindered, making it harder to fall asleep.

Estrogen also affects our sleep architecture, leading to longer REM sleep, which is crucial for memory formation and emotional regulation.

Next is progesterone, which I like to call my zen hormone because it feels like a hug from the inside. Progesterone dominates during the second half of the cycle, known as the luteal phase. It acts on a neurotransmitter called GABA, the main inhibitory neurotransmitter in our brain, reducing overactivity and promoting calmness, making it a natural anxiolytic. Fun fact, alcohol acts on the same neurotransmitter, which is why cocktails reduce inhibition. But unlike progesterone, it will definitely not help you get quality sleep.

Progesterone also influences key enzymes in the melatonin production pathway, increasing the amount of this important sleep hormone we can make. Progesterone’s sedative effect facilitates the initiation of sleep and it is known to increase non-REM sleep, the deep, restorative sleep when the body performs most of its repair and regeneration processes, including tissue growth, muscle repair, protein synthesis, and the release of growth hormones.

While these hormones dominate at different stages of the menstrual cycle, it isn’t until about five days before menstruation that they both drop significantly. This hormonal drop is when sleep issues typically arise. Let’s summarize what we can expect during this time based on what we now understand of these hormones.

The production of melatonin will decrease, making it harder to initiate sleep. Without progesterone, it becomes more difficult to quiet the mind, ignore external influences like light or noise, and calm anxiety. We don’t have estrogen to help us regulate body temperature. Consequently, falling and staying asleep becomes more difficult, and even the sleep that is achieved lacks crucial aspects necessary for optimal functioning the next day.

Armed with this information, let’s reverse-engineer our action plan:

A robust bedtime routine is of even greater importance during this time. The first step is to reduce factors that can further blunt melatonin production: lights out, no alcohol, nicotine, or big meals close to bedtime, and cutting back on coffee.

Beyond these general tips, there are specific dietary and lifestyle steps one can take. Let’s start with diet.

To address the lack of estrogen, incorporate foods containing phytoestrogens (plant compounds that mimic estrogen). These compounds can bind to estrogen receptors, slightly reducing the impact of withdrawal. Soy products are high in isoflavones, a type of phytoestrogen that has been shown to reduce sleep issues commonly associated with perimenopause, similar to the days leading up to menstruation. Lignans, another type of phytoestrogen, are found in flaxseeds and sesame seeds. Legumes, almonds, and walnuts also contain phytoestrogens.

Melatonin can also be found in certain plants. Tart cherries are the best source, but plain cherries, walnuts, almonds, certain grape varieties, tomatoes, oats, bananas, corn, and some types of rice like jasmine or basmati are also good sources of this essential hormone. Most health-food shops will sell tart cherry juice which is just as effective.

Ensuring adequate protein and starchy carbohydrate intake helps convert more tryptophan into serotonin, increasing your sense of calm. Including fatty fish rich in omega-3 can mitigate some of the added oxidative stress on your brain when sleep is less than optimal. Higher levels of DHA in omega-3 have also been linked to increased sleep quality, which is especially important given how the lack of estrogen and progesterone impacts sleep architecture.

Magnesium also shows promise in promoting sleep, particularly during hormonally challenging times. Prioritizing food sources of magnesium is relatively easy as it is found in plenty of fresh fruits and vegetables, such as dark leafy greens, legumes, grains, nuts, and avocados.

Your basal metabolic rate is also higher during this time as is the need for quality complex and starchy carbohydrates. So take this into account to avoid hunger being an additional thing keeping you awake.

I recommend eating most of the protein-heavy meals early in the day as protein metabolism increases the thermal effect of food, meaning it raises body temperature, and having your starchy carbohydrates in the evening.

Now let’s move on to exercise. As always, movement is king. But this is not the time to go for your personal best. Workouts that are too strenuous, especially later in the day, can elevate your cortisol levels too much making it even harder to fall asleep. High-intensity workouts (such as interval training or heavy weightlifting) also tend to induce greater excess post-exercise oxygen consumption or EPOC for short, which is the famous after-burn. The more intense the exercise, the more significant the recovery process and the higher the metabolic rate during EPOC. A higher metabolic rate means more body heat. Not ideal when you are already struggling with cooling down. As that would even further compromise the sleep you need to repair and build tissue, the positive effect of the workout would be blunted anyway.

But more gentle forms of exercise such as yoga, going for a swim or a light run, or even just walking can do wonders for your sleep by tapping into the parasympathetic nervous system, often referred to as the rest and digest system, and for good reason. You can engage in resistance training, just keep it light and focus on maintaining rather than building. Being physically active during this time also reduces other discomforts such as cramps, common for many. One less thing keeping you awake.

On a by note: there are still too many yoga teachers instructing anyone menstruating not to do inversions such as headstands. There is no scientific basis for that. It is simply a relic from a time when men who knew nothing about female internal anatomy invented their own rules for biology.

Sauna use, especially in the evening, has also been proven effective by reducing core body temperature. It may sound counterintuitive, but when we expose our body to heat, it response by initiating cooling processes like vasodilation. Around 20 minutes is a good time to spend sweating it out, just be sure not to stay beyond 30 minutes. If you do not have access to a sauna, a hot bath can do the trick. Have the water as hot as you can bare without scolding yourself and again stay for about 20 minutes. Failing that, a hot shower will still provide some benefits, although not as effective as the first two options.

Mental housekeeping like writing down everything that is occupying your mind such as to-do lists and ideas can further reduce the cognitive strain keeping you awake during times when the lack of progesterone makes it especially difficult to switch off. Research shows that writing things down helps our brain shelve things, at least for the time being.

Guided meditations such as yoga nidra, also called non-sleep deep rest, and breathing techniques such as box breathing can help you calm an over-active mind and reduce anxiety, making it a bit easier to find your way to satisfying shut eye.

Failing all of the above, there are supplements that can help. I will explore those in a separate post.

Those are just some ideas I have researched and been able to confirm with evidence. If you know of anything else that helps, please do share!

Sybille Hazward