Ana Reisdorf, a 41-year-old registered dietitian for Wellness Verge, was always a pretty good sleeper, other than the occasional restless night after drinking too much. But a few years ago, she suddenly began waking up at 3 a.m. for no reason.
“It was just awful,” she recalls. Her life was chaotic at the time — she had just started a business, had two small kids, and had recently moved across the country — so she wasn’t surprised when she took an at-home cortisol test and discovered that the hormone was spiking. The problem is stress, she thought.
Throughout 2020, she tried to balance her cortisol levels by taking adaptogens, magnesium, and CBD, as well as managing her stress and reducing her workout intensity. “Some of it sort of helped, but nothing really made a huge dent all the time,” she says. Reisdorf’s doctor even prescribed her the antidepressant Trazadone, which she only took for a month. “I wasn’t comfortable taking a medication like that because I am not depressed,” she says.
A colleague eventually referred Reisdorf to a local physician who deals with women's hormones. “She immediately said, ‘It’s not your cortisol, it’s your progesterone because you are perimenopausal and your progesterone is the first hormone to start dropping,’” Reisdorf says. Along with being a key player during pregnancy, progesterone is a calming hormone that helps alleviate anxiety and promote balanced sleep, so it would make sense that low levels were at the root of Reisdorf’s issues.
She began taking prescription progesterone in July and has since noticed that her sleep is significantly better. Today, she says, “I very rarely wake up in the middle of the night, except when a child wakes me up, and I feel rested.”
Poor Sleep Can Have a Major Impact on Your Hormones
Many women struggle to get a good night’s sleep. While this is often written off as a symptom of our busy lives, the truth is that insufficient sleep causes problems that go far beyond exhaustion and not functioning at our best. Poor sleep can cause a myriad of health issues, many of which stem from its disruption to our hormones.
Sleep is not merely the absence of being awake. “It’s a very dynamic state in which melatonin rises, cortisol declines, growth hormone peaks, and many other physiological states are distinctly different from their daytime counterparts,” explains ob-gyn Dr. Felice Gersh. Sleep is the critical time when your body goes into cleaning and restoration mode. Without this rebuilding period, your ability to stave off illness, heal both internally and externally (think acne scars), and fight free radicals that can cause cancer and other diseases suffers. These ripple effects can extend through all areas of your hormones and health.
Melatonin, which is made from serotonin, is the hormone most commonly associated with sleep. But it’s role in the body goes far beyond regulating your sleep cycle. According to Gersh, this hormone is instrumental in about 700 reactions in the body, including being a catalyst in the production of protective antioxidants and playing a critical role in regulating glucose. “Melatonin is very key to the control of glucose transport and can help to prevent pre-diabetes,” Gersh says.
During a good night of sleep, cortisol production dramatically drops. This, however, may not be the case when stress is involved, as Reisdorf initially suspected. When your cortisol doesn’t settle down for the night, your body can’t produce enough melatonin, which in turn affects your ability to get both adequate quality and quantity of sleep.
In women, unbalanced melatonin and cortisol aren’t just a problem for your energy level. Gersh explains that these two hormones also have distinct effects on ovarian function. Melatonin, for instance, has receptors on your ovaries, and when sleep problems lead to a reduction in melatonin production, it can change your menstrual cycle.
While Gersh says irregular cycles are the most common caused by poor sleep in women, it’s by no means the only one. “Sleep deprivation leads to alterations of digestion, which then leads to leaky gut and the evolution of systemic inflammation due to the passage of toxic bacteria into the body proper,” she says. A 2015 study also found that people who got less than six hours of sleep a night were several times more likely to get sick. In addition to these problems, sleepless nights can also lead to weight gain, mood dysregulation, headaches, constipation, and gastroesophageal reflux disease.
And Your Hormones Can Have a Major Impact on Your Sleep
So, it’s clear that sleep is important for more than just preventing us from snapping at our loved ones. But it’s also important to note that, if you suffer from sleep disruptions, your late bedtimes or lifestyle choices aren’t the only issues that could be to blame. In something of a catch-22, poor sleep causes hormonal issues, but hormonal issues can also cause poor sleep, as Reinsdorf discovered.
“Insomnia is more common in women than men,” says sleep expert Dr. Jyoti Matta. Some of this has to do with the hormonal shifts that occur during your menstrual cycle that influence sleep. “Many women who suffer from premenstrual dysphoric disorder [a more severe form of PMS] tend to have sleep disruption about a week or 10 days prior to the onset of their menstrual cycle,” Matta explains. In fact, during sleep studies, Matta and her colleagues have found a “significant sleep disruption and phase shift between the various stages of sleep in the pre-menstrual days.”
These problems don’t necessarily end with the end of your cycle. As menopause nears, your body begins to produce less estrogen, a hormone that helps to regulate sleep. Because of this, women with low levels of estrogen—as well as those with declining progesterone—can experience sleep deprivation. Matta has observed that perimenopausal women who suffer from severe hot flashes often have fluctuations in estrogen levels that are more dramatic than in women with less severe symptoms. “The former tend to suffer from significant sleep disruption and this also tends to continue for much longer after perimenopausal symptoms have resolved,” she says.
The good news is that there are things you can do about this. Your physician can often help you get your sleep back on track with some lifestyle changes, stress management techniques, or hormone replacement therapy, like the progesterone that Reisdorf is now taking. “There are receptors in the brain for both estrogen and bioidentical progesterone, and together they work to lower job stress and insomnia,” says Gersh. She explains that estradiol and progesterone work as well on the endocannabinoid receptors, which are also key to sleep.
Reclaim Control by Optimizing Your Sleep Habits
“We’re all sleeping a couple of hours less per night than we did in the past,” Dr. Charles Czeisler, a Professor of Sleep Medicine at Harvard, said during a 2011 TEDXCambridge talk. He attributed this change to modern lifestyle factors including constant exposure to artificial light, caffeine intake, and technology. The good news is that with a few small tweaks, you can improve your sleep quality.
Sleep medicine specialist Dr. Steven Feinsilver says the average person requires 7.25 hours of sleep. You may need more, you may need less, but he tells his patients to aim for “however much sleep you need to keep you from being sleepy during the day.” To get the best quality sleep, plan your sleep according to your body’s natural rhythms.
Beyond developing a better sleep routine, you can also embrace healthier sleep hygiene. It can be annoying to hear the same sleep habit tips offered over and over again, but we have to admit they’re everywhere for a reason: they work! As you have surely heard before, try to keep your room cool and dark, avoid eating at least two hours before your bedtime, and keep your daytime naps to a minimum. And, of course, you should ditch the electronics (or, more specifically, the blue light they emit) ideally one hour before bedtime. If your life allows, ban electronics from your room (alarm clocks are back in fashion) or program your phone to automatically go into “do not disturb” mode at a certain time each night.
It’s also important to limit your time lounging in bed. Regardless of how you slept, don’t stay in bed longer than you need to. “Beds are for sleeping,” says Dr. Feinstein, though he adds one big, sexy asterisk. “There's one exception reasonably…and it’s not chasing your emails or logging onto computers."
Finally, if you wake up in the middle of the night, don’t panic. “Nobody sleeps through the night,” says Dr. Feinstein. “The biggest misconception of sleep is that it comes seven or eight hours at a time; it doesn't. It’s about a two, two-and-a-half-hour cycle,” he explains. At the end of most cycles, you’ll be awake for a few minutes before falling back to sleep. If it’s longer than that, it’s still okay. As Feinstein says, “You don't need seven hours in a row; you need seven hours, more or less, total.”
After those seven hours, you will not only wake up feeling refreshed and energized, but your hormones will reestablish balance. Once things like melatonin and cortisol are humming along like they’re supposed to, you will experience the effects in every aspect of your health, including in your skin that will heal more quickly, have fewer flare-ups, and overall look more bright, youthful, and — dare we say — well rested.