What causes insomnia prior to the menstrual cycle (menstruation)?

From the Guidelines

Insomnia before your menstrual cycle can be effectively managed with cognitive behavioral therapy for insomnia (CBT-I) and relaxation strategies, as recommended by the American College of Physicians guideline 1. To address insomnia before your menstrual cycle, consider the following approaches:

• Establish a consistent sleep schedule by going to bed and waking up at the same time daily, even on weekends, to help regulate your body's internal clock.
• Practice relaxation techniques like deep breathing, meditation, or gentle yoga before bedtime to reduce stress and anxiety, which can contribute to insomnia.
• Limit caffeine and alcohol consumption, particularly in the week before your period, as these substances can disrupt sleep patterns.
• Consider taking magnesium supplements (300-400mg daily), especially magnesium glycinate, which may help improve sleep quality and reduce premenstrual syndrome (PMS) symptoms.
• Over-the-counter options like melatonin (1-3mg taken 1-2 hours before bedtime) may help regulate your sleep cycle, but it is essential to consult with a healthcare provider before starting any new supplements. The American College of Physicians guideline 1 emphasizes the importance of psychological therapy, including CBT-I, as a first-line treatment for insomnia, and it is crucial to consult with a healthcare provider to determine the best course of treatment for your specific needs.

From the Research

Insomnia Before Menstrual Cycle

• Insomnia is a highly prevalent disease among women, directly affecting performance and quality of life 2.
• The female organism has its peculiarities due to hormonal changes, which can lead to an overload of work and stress, making women more vulnerable to insomnia 2.
• Progesterone has an important effect on sleep, acting both as a hypnogenic and as a respiratory stimulant, and hormonal contraceptives may be a new therapeutic element for the treatment of insomnia 2.

Hormonal Changes and Sleep

• The menstrual cycle influences stage 2 and REM sleep in women, irrespective of premenstrual dysphoric disorder (PMDD) 3.
• Women with PMDD showed a decreased response to melatonin in their luteal phase as compared to the follicular phase of the menstrual cycle 3.
• Sleep disturbance and decreased melatonin secretions due to hormonal fluctuations during the luteal phase of the menstrual cycle could explain the sleep complaints of PMDD 3.

Menstrual Cycle-Related Variation in Sleep

• Sleep homeostasis and continuity remain stable across the menstrual cycle in young women, but the influence of the menstrual cycle on physiological sleep in midlife women is unknown 4.
• Midlife women have more awakenings and arousals per hour of sleep and less percentage slow wave sleep when progesterone is raised during the luteal compared with the follicular phase 4.
• Sleep is more disrupted in the luteal phase compared with the follicular phase in midlife women, whether or not they have an insomnia disorder 4.

Treatment of Insomnia

• Trazodone has been shown to be effective in the treatment of insomnia, with evidence demonstrating its efficacy for primary insomnia, as well as secondary insomnia 5.
• The use of hormonal contraceptives, mainly those based on progestagens, could be a new therapeutic element for the treatment of insomnia and improvement of women's sleep pattern and quality of life 2.