Naps and sleep before your period

In the lead up to a period, I love a good afternoon nap. It turns out this is more common than I thought. People with periods report poorer sleep quality, sleep duration and more disrupted sleep during the week before their period and whilst menstruating than at any other time during their menstrual cycle.

Sleep efficiency generally declines through the menstrual cycle, until right before your period, in the late luteal phase, where sleep quality, sleep time and ability to remain asleep all take a dive. Exactly how the menstrual cycle messes with sleep is still up for debate, but we have good evidence of the impact the menstrual cycle has on sleep.

During the luteal phase, people who menstruate may experience sleep changes like unpleasant dreams, more awakenings during the night, failure to wake at expected times, tiredness, poorer sleep quality and longer time to fall asleep (1, 2).

Sleep during the luteal phase

Once an egg is released from the ovary, the ovarian follicle that contained the egg forms a corpus luteum. The corpus luteum secretes hormones, including progesterone for 14 days (as long as the egg is not fertilised) (3). Progesterone rises during the luteal phase, peaking mid luteal phase and then declines during the late luteal phase.

Progesterone causes the body to rise 0.3-0.6*C during this phase (4, 5, 6, 7). Even though this rise in body temperature seems small, the change has been shown to interrupt sleep during the luteal phase (8, 9). REM sleep and NonREM sleep occur in cycles throughout the night. REM sleep is when you process information, experience dreams, but also when your body cools down. If your body’s temperature rises in the luteal phase, you will generally experience less Rapid Eye Movement (REM) sleep (4, 6, 10, 11). This is most likely due to the system that maintains the body’s core temperature being inhibited during REM sleep (4, 6). It’s important to note that not everyone who menstruates has the same rise of progesterone, meaning that not all people who menstruate will experience the same sleep interruptions during this time (8).

The luteal phase is also home to Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). People who experience PMS or PMDD report more disturbing dreams, fatigue, frequent awakenings during sleep and poor sleep quality during the luteal phase (1). They show higher nighttime temperatures during their period and less short wave sleep throughout their cycle (4, 10, 11). People with PMS or PMDD also have increased NonREM sleep than those without PMS or PMDD (10, 11, 12). Sleep complaints, sleep disturbance, insomnia and being excessively sleepy are some of the symptoms of PMDD, and comprise one of the eleven groups of symptoms to be diagnosed (12, 13, 14). It is thought that Melatonin, which plays a role in getting you ready to sleep, may not have the same sleepy response for those with PMDD during the luteal phase, which may contribute to this poor sleep quality (4, 12).

Menstrual cramps also contribute to poor sleep, with increased physical tension, more awakenings during the night and increased body movements (11). Period pain disturbing sleep is commonly reported, and contributes to fatigue, decreased awareness and concentration during the day (3, 4). Primary dysmenorrhea, or VERY painful period cramps, further impacts sleep quality, sleep efficiency and REM sleep in part due to higher uterine contractility during the night (4, 11, 12). People who menstruate report poorer sleep quality in the late luteal phase and during menstruation, compared to other phases of their cycle, even when they did not experience severe menstrual pain (1, 9, 13, 15).

Other physical and psychological factors may also influence sleep during the menstrual cycle, including iron deficiency, irregular periods, headaches, menstrual migraines, depression and anxiety to name a few (13, 16).

What you can do

If you’ve been feeling tired around your period, it might be a good idea to track your cycle and symptoms for a few months. You can do this in a diary or calendar, or in a period-tracking app like Clue. This will also help you to next predict your luteal phase, and schedule in some extra rest.

Lifestyle changes may also help improve your sleep during this time. For me, I schedule less on my calendar and plan some nap time during my late luteal phase. You could also implement changes like limiting alcohol and caffeine intake during this time, or address physical symptoms with anti-inflammatories (17). If you’re not napping and you have some time, yoga has also been found to reduce disturbances of sleep during this phase of your cycle (18).

References

1. Nowakowski, S., Meers, J., Heimbach, E. 2013, ‘Sleep and Women’s Health’, Sleep Med Res 4, 1. pp1-22
2. Zheng H, Harlow SD, Kravitz HM, et al. Actigraphy-defined measures of sleep and movement across the menstrual cycle in midlife menstruating women: Study of Women’s Health Across the Nation Sleep Study. Menopause. 2015;22(1):66-74. doi:10.1097/GME.0000000000000249
3. Speroff L, Fritz MA, editors. Clinical gynecologic endocrinology and infertility. lippincott Williams & wilkins; 2005.
4. Baker, F., C., ‘High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea’, 1999 (110.142.025.058) Am. J. Physiol. 277 (Endocrinol. Metab. 40): E1013–E1021, 1999
5. Farage MA, Neill S, MacLean AB. Physiological changes associated with the menstrual cycle: a review. Obstet Gynecol Surv. 2009;64(1):58-72. doi:10.1097/OGX.0b013e3181932a37
6. Baker FC, Driver HS, Paiker J, Rogers GG, Mitchell D. Acetaminophen does not affect 24-h body temperature or sleep in the luteal phase of the menstrual cycle. Journal of applied physiology. 2002 Apr 1;92(4):1684-91. DOI:10.1152/japplphysiol.00919.2001
7. Cagnacci A, Arangino S, Tuveri F, Paoletti AM, Volpe A. Regulation of the 24h body temperature rhythm of women in luteal phase: role of gonadal steroids and prostaglandins. Chronobiology international. 2002 Jan 1;19(4):721-30. DOI:10.1081/CBI-120005394
8. Sharkey, K, Objective Sleep Interruption and Reproductive Hormone Dynamics in the Menstrual Cycle, Sleep Med. 2014
9. Baker FC, Driver HS. Self-reported sleep across the menstrual cycle in young, healthy women. Journal of psychosomatic research. 2004 Feb 1;56(2):239-43.
10. H S Driver, D J Dijk, E Werth, K Biedermann, A A Borbély, Sleep and the sleep electroencephalogram across the menstrual cycle in young healthy women, The Journal of Clinical Endocrinology & Metabolism, Volume 81, Issue 2, 1 February 1996, Pages 728–735, https://doi.org/10.1210/jcem.81.2.8636295
11. Driver, H. S. 1998, ‘Menstrual factors in sleep’, Sleep Medicine Reviews. 2, 4. 213-229
12. Jehan S, Auguste E, Hussain M, Pandi-Perumal SR, Brzezinski A, Gupta R, Attarian H, Jean-Louis G, McFarlane SI. Sleep and premenstrual syndrome. Journal of sleep medicine and disorders. 2016;3(5).
13. Van Reen, E. Individual differences in self-reported difficulty sleeping across the menstrual cycle, Arch Womens Mental Health 2016.
14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc. 2013.
15. Romans, S. Sleep quality and the menstrual cycle, Sleep Medicine. 2015
16. Meers, J 2019 Sleep, premenstrual mood disorder and women’s health. Current opinion in psychology.
17. Moline M, Broch L, Zak R. Sleep problems across the life cycle in women. Curr Treat Options Neurol 2004;6:319–330.
18. Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern Ther Health Med. 2019 Sep 1;25(5):40-7.
19. Karaman, H., Tanriverdi, G. (2012), ‘Subjective sleep quality in premenstrual syndrome’, Gynaecological Endocrinology. 28.8. 661-664