Women have more trouble sleeping than men, and it’s largely due to fluctuation or deficiency of female hormones.
Both estrogen and progesterone act directly on the sleep centers of the brain. The also influence the levels of important sleep neurotransmitters such as serotonin and GABA.
For example, progesterone promotes sleep because it makes a metabolite called allopregnanolone (ALLO) which interacts with GABA receptors, and is very soothing. (That’s why progesterone is our “Valium-hormone”.)
The sleep-enhancing effect of progesterone can be seen in EEG or brain-wave studies. When progesterone is high (just after ovulation), women’s brains have more “sleep spindles” (brain-waves that indicate the onset of deep sleep). Conversely, when there is no progesterone (such as women on hormonal birth control), women’s brains show fewer sleep spindles and fewer restorative sleep cycles.
Hormonal sleep problems
Hormonal sleep problems occur during PMS because both estrogen and progesterone drop in the few days before the period. The best PMS sleep remedies are magnesium (see below) and vitamin B6 because it supports progesterone (discussed in my PMS post). Vitamin B6 also helps with GABA production. The herbal medicine Vitex agnus-castus boosts progesterone, and further benefits sleep by interacting with opiate receptors and enhancing melatonin. For more information about progesterone, please read Road Map to Progesterone.
Hormonal sleep problems occur during perimenopause because of progesterone deficiency and estrogen excess. Estrogen excess causes irritability, tension, and trouble falling asleep. It also worsens histamine intolerance, which can cause insomnia. Treatment strategies for perimenopausal sleep disturbance include magnesium (see below), B6 and Vitex to enhance progesterone (discussed above), as well as progesterone cream or FDA-approved natural progesterone capsules. (Progesterone in capsule form gives more of the beneficial sedating progesterone metabolite allopregnanolone).
Hormonal sleep problems occur during menopause because of progesterone and estrogen deficiency. Estrogen deficiency causes difficulty in staying asleep, and many women report sleep maintenance insomnia (waking at 2am) as the single most distressing symptom of menopause. Menopausal sleep can be helped by magnesium (see below), melatonin, and herbal medicines such as Black Cohosh, St John’s wort, and Kava. But sometimes that’s not enough. Women with severe menopausal sleep disturbance can consider taking progesterone capsules (which relieve estrogen deficiency) and possibly estrogen. A small dose of bio-identical estradiol can dramatically improve sleep. Fortunately, sleep usually improves on its own two to three years after menopause.
Natural sleep treatment
Magnesium is the great sleep-promoter. No other sleep treatment will work until magnesium is also in place. Magnesium calms the brain by shielding the NDMA receptor from the stimulating neurotransmitter glutamate. It also regulates the production of cortisol, and prevents the uptake of cortisol into the brain. All of my insomnia patients get magnesium on the first visit. Sometimes it’s all that’s needed.
Cortisol and the HPA Axis. Healthy sleep requires a stable HPA (hypothalamic-pituitary-adrenal) axis, and a reduction of night-time cortisol. That means stress reduction such as yoga, massage, and the inclusion of Gentle Carbs in the diet. Anxiety reducing “adaptogen” herbs such as withania and rhodiola can also help.
Melatonin is our master sleep hormone. We can enhance natural production of melatonin by reducing exposure to the blue-light of screens, and by taking vitamin B12. Melatonin supplements are also a safe and effective sleep strategy.
Yours in health and good sleep,