Help for Hormonal Sleep Problems

Can’t sleep? It could be your hormones.

Hormonal sleep problems are common during PMS, perimenopause, and menopause and are caused by a drop in progesterone, a histamine or mast cell reaction, or (in the case of menopause) a drop in estrogen.

Hormonal sleep problems

PMS and PMDD

Premenstrual sleep problems are caused by one or more of the following:

The solution is to support GABA with magnesium and vitamin B6 and take steps to reduce histamine. Read The Role of Histamine and Mast Cells in PMS and PMDD.

👉 Tip: Progesterone is good for sleep because it converts to a sedating neurosteroid called allopregnanolone or ALLO which soothes the GABA receptors in the brain. When progesterone is high (just after ovulation), sleep is deeper with more “sleep spindles” (brain waves that indicate the onset of deep sleep). When progesterone is low or non-existent (such as on hormonal birth control), sleep is shallower and less restorative with fewer sleep spindles.

Perimenopause

Perimenopausal sleep problems are caused by the great progesterone crash that happens in our forties. We lose progesterone years before we lose estrogen and that results in a recalibration of the brain and stress response (adrenal) system. Perimenopause can also be a time of mast cell activation or high histamine, which further worsens sleep.

The solution is to reduce alcohol (to lower histamine) and to take magnesium and progesterone (Prometrium) capsules (to stabilize the nervous system). Read Rescue Prescription for Perimenopause.

Menopause

Menopausal sleep problems are caused by the lack of both progesterone and estrogen. Estrogen deficiency causes sleep maintenance insomnia, which means waking at 2 or 3 am and is the single most distressing symptom of menopause.

The solution is to reduce or quit alcohol and to take magnesium, progesterone capsules, and possibly a transdermal estradiol patch like Estradot.

Menopausal insomnia usually occurs during the first twelve months after periods stop. After that, sleep tends to go back to normal.

👉 Tip: Hormonal sleep problems are also helped by the usual sleep-enhancing techniques of exercise, morning light, and sleeping in a dark room.

49 thoughts on “Help for Hormonal Sleep Problems”

  1. Does is matter when one takes the magnesium supplement? I’m currently on estradiol and progesterone but continue to wake up after 6 hours of sleep regardless.

    • magnesium seems to work better when taken in the afternoon. And I like magnesium glycinate with taurine. How many mg of “elemental magnesium” are you taking?

      Also, are you micronized progesterone? aka Prometrium or Utrogestan?

  2. I have had insomnia for many years and have tried many things. I just turned 70 and recently discovered information on progesterone. I tried it topically (forearms/40 mg) and it seems to help. Any downsides to continuing?

  3. Hi! I’m having horrible insomnia right before ovulation and right before my period. I’ve been taking DIM for several months to help with some cystic acne. Would this be making this problem worse?

  4. “Menopausal insomnia usually occurs during the first twelve months after periods stop. After that, sleep tends to go back to normal.”… Dr. Lara, is this true in your experiences you’ve seen as a specialist? I have not many resources/friends to know this and I am desperate. I am 10 months from my final period at 61 and am suffering many sleepless nights. I am trying to do this without any pharmaceuticals and OTC remedies don’t’ work so all I want to know is it possible to get back to normal sleep after this is over? Thank you please.

  5. I don’t know what Dr. Briden would think of this, but I have bad insomnia around ovulation and with PMS, and I find that Reactine (generic cetirizine, an antihistamine) helps a bit especially if I start taking it just before these situations arise. Either 5 or 10 mg a day seems to make my sleep easier and deeper. The downside is it makes me crabbier (a few people I’ve know who take it for allergies have found it makes them irritable too).

  6. Many thanks. I read the links and some other information about histamine and insomnia and I think this is what is happening with me.

  7. What causes insomnia around ovulation time? Every month around this time I have a couple of nights of almost no sleep. No matter how relaxed my mind is I don’t sleep. My body feels jittery.

  8. Lara, any idea why I get tender breasts every time I use melatonin (I have horrible insomnia) for a few days, even at a 1 mg dose? I seem to get this side effect with a few other supplements as well (spearmint and MSM). I took the latter to clear up my skin. They cleared me but the side effects were too much. Breast tenderness, and the MSM also made me go into a depression with constant panic attacks. Not sure if you’re familiar with that supplement. I’ve always wondered if this means I have an abnormal sensitivity with my hormones.

  9. I have severe insomnia generally, but it definitely gets worse right before ovulation. I notice you don’t mention this. According to the chart in the book Taking Charge of Your Fertility, this is when progesterone is the lowest in the cycle. Do you agree, Dr. Briden? Why do you not mention ovulation insomnia? It’s very uncommon?

    I also have extreme insomnia right before my period, normally the night before I start.

    • I have the same problem and it’s getting worse, instead of 2—3 days before period, it’s 7 days, and the time before ovulation also lengthened to several days. I am trying a supplement which should increase progesterone. It looks like my sleep is worse.
      Either the supplement doesn’t work or it’s the wrong supplement. I can’t understand what is out of balance. I also tried magnesium with no effect at all.
      The next step is to try estrogen supplement. I still have my period but I don’t think my cycle is ovulatory now, it feels difffeent and something is definitely off balance. My sleep worsened ten times since I’ve had this change in my cycle. Has anyone found a solution?

  10. I’m perimenopausal and suddenly having a hellish time with sleep maintenance insomnia (no problems falling asleep) which is the opposite of what you predict above. I’ve seen a psychiatrist who doesn’t think I’m clinically depressed and suspects its hormonal. Gynecologist says I still have periods so it can’t be. I tried vitex and the insomnia got worse. I’m lost in a sick haze of fatigue.

    • Same thing happened to me (sleep maintenance insomnia), turned out I have mild sleep apnea! I’m not overweight and I don’t have a thick neck. Turns out your airway can lose some muscle tone with menopause – who knew? I now have a CPAP machine and I feel I have a whole new life! No more drowsy driving or sleeping under my desk at lunchtime, woo!

      If you have any sleep clinics or sleep neurologists available to you, I’d encourage you to check them out. I’m in Canada and went to a MedSleep clinic in my town, they were excellent. Any good sleep clinic will test for about 80+ possible sleep conditions, not just sleep apnea.

      I’m blogging about the whole experience — 2 posts on sleep completed, and working on the 3rd one right now. See https://kickassaging.ca/2018/01/17/fixing-my-sleep-part-1-the-problem/ and https://kickassaging.ca/2018/02/22/fixing-my-sleep-part-2-first-visit-to-the-sleep-clinic/ .

      BTW I do continue to follow Dr. Briden’s excellent advice — I take bioidentical progesterone and estrogen — but if you’re stopping breathing 50 times a night, as I was, the hormones can’t fix that.

      Good luck!

  11. Hello Lara..

    I had my total hysterectomy on Dec 6 th 2017. Since than I am not able to sleep at all. I am taking 5 mg progestrone and 1 mg estrogen everyday. I also take sleep aid for sleep but it Does not help at all. What should I Do? WHAT FUTHER TEST i NEED TO DO TO ADJUST MY HORMOME . Plz Help.

    THANK YOU.

  12. Hello,

    Firstly I’d just like to thank you for all the work you put in with the blog etc. I’ve gone off dairy and my eczema just disappeared and after two periods I’m already having less pain! I’ve ordered your book but while I wait for it to arrive I just have a quick question:

    I’m 34 and have a 6 year old and a 2 year old. For the last few years (honestly I can’t remember how long, my memory has gotten so bad) I’ve had issues with insomnia for the week and a half/2 weeks leading up to my period. It usually starts right after ovulation (I have a 31 day cycle where I ovulate on the 17th day). I have no trouble falling asleep but I wake up at progressively earlier as the week goes on, usually 2am, then 1:30am, then 1am etc. and cannot fall back asleep. I am taking magnesium glycinate, B6 and turmeric. What would be my next step? I had my thyroid tested, which came out fine, but have been totally shrugged off by doctors.

  13. Hello Lara.
    I write you from Washington State in the US.
    I have been suffering from chronic insomnia for the last 6 months. I need advice. I have been working w 3 different ND’s, a therapist and a neurologist all to help w the insomnia.
    here is my story.
    I gave birth 15 months ago. My pregnancy was fine and easy but I was riddled w anxiety about losing it. Had baby at home, Cried for about 3 months straight, I didn’t realize I had PPD, I just chalked it up to overtiredness and stress, I also had PPA. Neither was severe, yet I think I am still dealing w them 15 m post partum.
    I nurse now only 2 per day.
    Due to night nursing and my inability to fall asleep or relax while nursing I had very erratic sleep.
    My cycle returned 9 months pp and that is when the insomnia struck hard.( I’ve had insomnia since my 20’s but only during high stress situations. )
    I enter the insomnia phase usually when I enter my fertile time, around day 14.
    Usually I fall asleep super easy but its staying asleep and falling back to sleep that I struggle w. Sometimes whne its really bad (around day 17 of cycle) I cant fall asleep either, which looks like 2 hours of sleep…Its miserable.

    Other issues I deal w:
    Innability to drop ANY weight after initial baby belly.
    dry eyes diagnosed by eye dr
    Overactive histamine response to …? Constantly itchy nose (dust Im allergic to, tree pollen too) allergies (I usually get these once per year, but this year its been almost constant)
    I get ONE hive, every few days, never connected it to any food or enviro allergen
    Super light sleeper (this began at about 30) ear plugs, dark room and sound machine
    easlily startled
    horrific nightmares if I don’t eat a decent snack before bed
    My cycle is typically every 28 days and usually medium flow, but I have had a couple scant two day bleeds and a couple super heavy long ones
    low libido except when fertile but so exhausted during fertile time I have no energy for sex.
    brain fog,
    poor memory
    forgetful
    irritable (when I don’t sleep well)
    I tend toward anxiety in response to stress

    WHat I do already:
    SUper clean balanced healthy diet. Approved by two ND”s and nutritional therapist/personal trainer. Good fat, protein and carbs.
    little to NO sugar (gave it up for a full month) now use a small bit of maple syrup once in a while
    No caffeine or alcohol
    Little cow/sheep/goat dairy
    only sprouted grains
    workout 3-5 times per week. HIIT, yoga, walk daily. I took aobut a month off and just walked just to see if it would help.
    I use marijuana once a day to help me sleep. (I also didn’t use this for most of PP, only when sleep began to become unattainable)
    NO contraception for 12 years
    I currently take Cod liver oil or Vit A, 300 mg of Mag prescribed by ND and B vitamins, cortisol manager, Hcl
    Iron (dessicated liver formula) due to extremely low but not anemic levels of ferritin.
    I have tried every natural sleep aide literally on the market, from tinctures to homeopathics
    Have healthy sleep hygiene. Though I coddle my sleep due to present challenges

    So, there it is. I am so desperate for relief. I feel like I am drowning. If you have any insight I would so appreciate it.
    Ps. My thyroid levels were checked and fine and my blood work was great except for ferritin.

    Thank you so very much
    Blessings on your day-

    • Hi, Leah! I went through something like this too some years back. I sympathize with you – I know it’s absolute hell. I’ll be interested to see what Dr. Briden says about your situation.

      For me, what really helped was bioidentical progesterone (brand name prometrium) at bedtime. I know you may not be able to do this yet because you’re still nursing, though. Also, it’s a bit pricey. It’s covered by my health care up here in Canada, though.

      My sleep is still light and fragmented many days but much better than before.

      I know you’ve already tried a lot of these supplements, but I’ll share what works for me (again, if you’re still nursing, you may have to wait on some of these):

      — Morning: Rhodiola (helps with stress/anxiety, but can cause insomnia if taken at night)
      — Evening: Ashwagandha, magnesium glycinate (I see you are already taking magnesium), valerian tea with 2 or 3 drops of California poppy extract in it; PLUS the prometrium (2 little 100 mg capsules, total 200 mg), plus a GABA capsule, plus 2 or 3 Natural Factors Stress-Relax Tranquil Sleep.
      — Middle of the night when I inevitably wake up: 1 more capsule of prometrium — I put it in a little dish in the bathroom so I don’t have to turn on the light to take it
      — If I have restless legs at bedtime: 2 Tylenol (arghg)

      I also avoid blue lights and screens for several hours before bed, and I find I sleep significantly better if I don’t watch ANY TV at all in the evening.

      I wonder if you’re sensitive to the grains you eat (even though sprouted), and dairy?

      I find I sleep less well if eating grains or too many carbs, and dairy makes me feel antsy. Some sites list insomnia as an autoimmune condition — have you looked into the Paleo Autoimmune diet? (e.g., https://www.thepaleomom.com/ )

      Also, I’ve fought against this for years (I don’t have time!), but meditation (even 10 min a day) really does help. It sort of reminds your body what it’s like to feel relaxed.

      Good luck!

      • Did you get a prescription for bio progesterone from your family doctor? I am in Canada too but my doctor never suggested progesterone for my insomnia. She is totally unhelpful with that. Please tell me how this prescription was covered, where did you get bio progesterone ?

        • Yes it’s called prometrium and take 300mg at bedtime makes you drowsy so you can fall asleep. It’s actually good in preventing breast cancer and is very helpfull. Don’t expect a miracle but it does bring relief. I suffered immensely and this worked. If I get four hours I’m good as opposed to 0. Take 600mg of magnesium as well and melatonin 3 mg doesn’t hurt as well. All good for you no worries. Educate yourself and take charge of your health. Drs sometimes dismiss these issues. Find yourself a female dr they tend to be more willing as they have also experienced these issues as women. Good luck happy zzzz’s

    • Hi Leah, check in your area for Functional Medicine doctors. They are MD’s or DO’s that get additional training. They do a lot of testing to find and treat the root cause of the problem rather than symptoms. Some are better than others. I had very good luck at the Cleveland Clinic Functional Medicine.

  14. I have acne, and PMS. I’ve taken magnesium glycinate, but on my bloodtest is showed high levels of magnesium (0,96). Is this dangerous? And can high levels of magnesium contribute to acne?

    • High magnesium on blood test can be caused by not by magnesium supplements, but rather by dehydration or under-active thyroid.
      No, magnesium does not cause acne.

        • Over the a week I stopped taking all my supptlements (b6, b-complex,DIM? Berberine), and just kept on with magnesium, probiotic and zinc. My acne is gone!! But I still suffer from insomnia, and wake up a lot during the night. I’m exhausted. Been going on like this for months. I also have an ache in my lower back, and run to the bathroom to pee 4-5 times a night. My eyes are also very dry. What could help me sleep, Lara? This is realy awfull. I’m so tired:(

          • Hi Susan. I am so sorry you are struggling with sleep. I know how horrible this can be from personal experience. I am an Ayurvedic Practitioner and have worked with many clients to restore restful sleep. Ayurveda takes a comprehensive whole life approach, looking at diet, lifestyle and stress. Based on the few symptoms of dry eyes, low back ache and frequent urination I would say your insomnia is driven by a Vata imbalance due to the dry, light, mobile qualities and over-stimulation due to increased Air/movement in your system and mind. Ayurveda applies the opposite qualities to create balance. For example, eating warm soupy food with healthy oils, staying well hydrated through sipping warm water throughout the day, bringing yourself to a state of calm twice daily through breath and meditation. For more information go to my website: http://www.ayurvedaseattle.com. Read the information on Vata Dosha and let me know if you would like to schedule a consultation for further help to reclaim your sleep and energy. Wishing you healing and deep sleep. Blessings, Kael

          • Hi Susan, How are you now? Did you find out what was going on for you? I am asking because I had the same symptoms for a period of about 6 months earlier this year. Neck and back pain, dry skin, nasal passage and mouth (bleeding gums), feeling dehydrated, but water just going through me so needing to urinate all the time, also very stressed, and of course barely sleeping. I got lots of tests done, which didn’t really help. I was also taking magnesium at the time and had similar test results to you. I did some research and now think that I had HPA Axis dysregulation/adrenal fatigue, so had elevated cortisol. I think this has been a problem since my teens as have always had issues with sleep, but became very chronic earlier this year. Symptoms have now subsided for me, mainly through stress management, but I also went on lexapro for a few months, which is something I never thought I would do, but I was desperately stress/depressed. It has helped and I am now preparing to go off it. Anyway, I hope you are feeling better, but if not have a look into HPA Axis dysregulation and cortisol stuff – it affects water/salt in the body. There are natural ways to address this, but it takes time.

  15. Hi, I have read in your book I think that Melatonin isnt good for fertility. But have read new studies stating the opposite. What is correct? I fall asleep quicky but wake up ifte. During the night, maybe I have too light sleep. My Doctor has me trying 2 mg of Circadin/Melatonin, slow release 1-2 hours before sleep. I am trying to get pregnant. How does this affect fertility?

    • Yes, the research is conflicting. I suspect at low dose, melatonin is neutral or beneficial for fertility. But at higher dose, it might be a problem. If you’re ovulating regularly, then you’re probably ok at the lost dose of 2 mg. But best to speak to your doctor.

  16. 56yr old had hysterectomy I am in bad menopause vaginal anothpy trying bioidentical harmone treatment but it’s bad for my sleep what can I take to sleep along with these medication

    • Usually, bioidentical hormone treatment is good for sleep. You might want to talk to your doctor about the formula and the dose.

  17. Hi Lara,

    I have been using melatonin for two months most of the days since I found it recommended in your book.
    Recently I have read that it might effect the production of your hormones.
    The one I use is 5mg by Natrol. Before I had severe problems with my sleep.
    However, I am working on beating my PCOS and worried that progress is not coming fast enough.

    The article about melatonin effecting other hormones:
    https://www.psychologytoday.com/blog/sleep-newzzz/201102/melatonin-not-magic-bullet-sleep

    Lin

  18. In my opinion,the symptoms of menopause hot flashes causes excessive sweating,night sweat is not a separate symptom of menopause. It is only a night-time manifestation of hot flashes, while sweating is experienced during daytime. Since night sweats occur while you are asleep, and not able to take evasive actions, it becomes all the more noticeable.There are herbal treatments for reducing the pain of menopause: https://goo.gl/Y1DBUA

  19. Hi Lara,

    In your book you recommend valerian for sleep medicine. I am wondering if this is safe to take while trying to get pregnant. I have also been suffering from hair loss for the past 6 months. Will valerian impact hair loss? I am taking 300 mg of magnesium citrate currently and a pre-natal vitamin.

    Thank you in advance,
    Tammy

  20. Hello Lara I came across your website I wanted to know I’ve been suffering from chronic insomnia, fatigue and depression. I had a saliva test that showed I have high cortisol and candida. I don’t know what to do? How would I know my hormones are low?

    • Have you been tested for estradiol (estrogen) and progesterone? The best time to do the blood test is one week before your period.

  21. I’m 39 and confirmed through my ND to be in perimenopause – very low progesterone on day 21 and elevated FSH on day 3. While I’m working on cleaning up my diet she has me on a progesterone cream and 3mg of melatonin and she suggested I try 500mg of Inositol an hour before bed. I’m falling asleep much faster and waking up less times per night. The progesterone cream has also regulated my period for the last 2 months. I still get some PMS symptoms but not nearly as bad.

  22. Hi, I’m late to the party but just discovered your blog. . . . I was taking 10mg of melatonin daily for a few weeks. That month, I ovulated fourteen days later than usual, after years of pretty regular cycles. Also–surprise!–I got pregnant on day 34 of my cycle. . . . I did some research after the fact and it seems like there’s some data showing melatonin delays ovulation. Wondering if you have any info on this? It’s water under the bridge for me at this point, but I do feel like other women of childbearing age should know about the potential side effects of melatonin!

    • Thanks for sharing your story Laura. The ovary has melatonin receptors, so Yes, melatonin supplements can potentially impact ovulation and fertility. It doesn’t surprise me at all that it shifted the timing of your ovulation. My understanding is that it can also reduce FSH and estrogen.
      That said, it appears to improve egg quality, so shows promise as a fertility enhancer. Here is a review paper from 2009.
      Melatonin and the ovary: physiological and pathophysiological implications.

  23. Just discovered your blog – love it! So wise and sensible – added to my favourites. WIll reintroduce magnesium for my insomnia, didn’t realize how crucial it is.

    Wish I could come and consult you in person, but I’m in northern Canada 🙁 (“the clear, true air of the Canadian Rockies”….yes!)

  24. Try topical magnesiusm! I do and you cannot overdose with that NOR will it cause loose stools. Then you can take LESS internal magnesium.

  25. Hi Dr Lara,

    Great article.However for anyone suffering IBS type symptoms be careful with magnesium. After great deal of elimination diets etc I discovered magnesium is a major gut inflamitory for me.

    Thank you for your great information for women.

    • yes, magnesium is an osmotic laxative, which means that it draws water into the bowel and can cause loose bowel in some people. Magnesium chelate (glycinate) is usually better, especially if you’re careful with dose. I try to find a way for patients to tolerate itself because it’s so good for hormone balance, and has natural anti-inflammatory properties.

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