Once upon a time, humans spent a third of our lives getting some shuteye, but the average number of hours of sleep has plummeted since — even though getting proper sleep is one of the most important things you can do for your overall health. Your body repairs and rejuvenates itself while you’re getting a good night's sleep, and hormones help the body accomplish these tasks. Because of this interdependent relationship between hormones and sleep, too low or too high hormone levels can have an impact on your sleep (and vice versa).
"The two most common time periods/life events where sleep is an issue in my practice is the third trimester of pregnancy (when it's difficult to find a comfortable position to sleep) and menopause," explains OB-GYN and Modern Fertility medical advisor Dr. Eva Luo, MD, MBA. "The hormonal changes of menopause can lead to sleep disturbance in a few ways: hot flashes, mood changes, and isolated sleep changes."
So, if poor sleep can be triggered by menopause, when estrogen levels are low, would addressing out-of-range estrogen or other hormone levels help you get better sleep? Yes and no. If the cause of sleep disturbance is purely hormonal, addressing out-of-range hormone levels may improve sleep — but in the case of reproductive hormones specifically, hormone replacement therapy won't be the first recommended treatment option.
In this article, we'll give you an overview of the hormones involved in sleep and where reproductive hormones fit in. And because there's always value in improving your sleep, we're including a few pointers.
Sleep cycles 101
Like music that's underscored by the beat of a drum, your body has its own rhythm (a circadian rhythm) that uses light cues to regulate your sleep patterns. There's also a rhythm within sleep itself: While you sleep, you cycle through different stages of sleep with varying levels of intensity.
To help you better understand where hormones fit into the picture, here's a brief explainer on the stages of sleep:
1. Non-rapid eye movement (NREM):
- Stage 1: This is when you initially drift off and still may have some level of consciousness. This stage typically only lasts about 5-10 minutes.
- Stage 2: Your sleep deepens during this second stage. Your body temperature and awareness drop. Your breathing slows. This is the stage you return to most while sleeping.
- Stage 3: This is when you experience your deepest (slow wave) sleep. When you reach this stage, your muscles relax, your breathing slows even more, and your blood pressure drops.
2. Rapid eye movement (REM): During this time, brain activity increases and you dream. Eyes tend to move back and forth quickly, hence the name REM — and even though your brain activity picks up, you won’t be able to move. REM typically happens about 90 minutes after you fall asleep.
Throughout any given night of sleep, you cycle through non-REM and REM several times. As you get closer to waking up, you'll have longer and deeper REM periods.
What's the relationship between sleep and hormones?
Like with many other aspects of our health and wellness, there are specific hormones that are involved in sleep and affect different parts of the sleep cycle. Here are which ones and how:
- Cortisol: Famously known as “the stress hormone,” cortisol plays an important role in sleep. In normal situations, cortisol levels drop during stage 3 sleep, but they surge in the middle of the night and peak during the wee hours of the morning.
- Melatonin: Released by the pineal gland, melatonin (which you may be more familiar with as a sleep supplement) is a hormone that helps regulate sleep. "Normal" melatonin levels, which lead to "healthy" sleep-wake-cycles, are high at night and low during the day.
- Ghrelin: Ghrelin is a hormone that promotes hunger. Animal studies show that higher levels of ghrelin tend to increase stage 3 sleep and decrease REM, but researchers believe that poor sleep quality can disrupt ghrelin levels.
- Leptin: Leptin is a hormone that suppresses hunger and tells your body when it's full. Leptin may increase overnight and peak in the morning, though some research has found no changes related to the sleep cycle.
- Growth hormone: Once you fall asleep, your body pumps up the amount of growth hormone it produces in continued spurts while you sleep. Levels skyrocket during stage 3 sleep.
- Thyroid-stimulating hormone (TSH): Thyroid-stimulating hormone (TSH), which is released by the pituitary gland in the brain to regulate the thyroid gland, is highest in the middle of the night and lowest in the afternoon. (P.S. This is one of the hormones Modern Fertility measures!)
How do reproductive hormones play a role in sleep?
We know that testosterone levels affect sleep in people with sperm, but the role of sex hormones in the sleep of people with ovaries is not quite clear. Hormonal birth control has given us some clues: People who take hormonal contraceptives have improved sleep in some areas (e.g., REM sleep), while other areas may suffer. Scientists aren’t sure if estrogen is the factor here — but the fact that sleep can be disturbed during menopause means estrogen is very likely the culprit.
While we need more research to fully understand the connection, hormone fluctuations throughout the menstrual cycle also impact sleep and can lead to more sleep disruption. There’s evidence that sleep may be the most affected during the luteal phase — when elevated hormone levels begin to decline.
Sleep and menopause
More than 45% of people with ovaries experience sleep disturbance during menopause — and this is where the topic of sleep comes up the most in Dr. Luo's practice. There are a few different ways menopause can impact your sleep:
- Low estrogen levels: Menopause is marked by lower estrogen levels, which can interfere with getting a good night’s rest.
- Hot flashes: Hot flashes, a common symptom of menopause driven by decreased levels of estrogen, tend to be more common at night and can also lead to sleep disturbance.
- Sleep apnea: Lower estrogen levels may also play a major role in sleep apnea, a sleep-related breathing disorder.
- Depression: When estrogen levels drop, there's an increased risk of having mood changes or becoming depressed, which can cause you to sleep more or not enough. "Depression/anxiety as a new-onset condition is more common during the menopause transition and can certainly affect sleep," adds Dr. Luo.
Sleep and other key reproductive hormones
Just how much sleep truly impacts our health remains somewhat of a mystery, but more information continues to unfold that links sleep quality to a variety of hormonal changes and health conditions.
As we mentioned earlier, TSH is one of the hormones most impacted by sleep. When you’re dealing with sleep deprivation, TSH may drop — and too high or too low TSH levels can interrupt your menstrual cycles and make it harder to time sex or insemination around your most fertile days when trying to get pregnant.
While insulin — a hormone produced by the pancreas that helps control the amount of glucose (sugar) in your blood — isn't exactly a reproductive hormone, insulin resistance is linked to challenges with fertility. When you're resistant to insulin, your body has a harder time managing your blood sugar levels — and a lack of sleep can be a risk factor for insulin resistance. Night shift workers, who often report sleep issues (possibly due to lower melatonin levels), also tend to have reduced insulin sensitivity (which can be a precursor to insulin resistance).
When is it time to talk to your doctor about sleep challenges?
According to Dr. Luo, it's important to talk to your healthcare provider about sleep if you're experiencing daytime fatigue or sleepiness, drowsiness while driving, or cognitive difficulties. Your healthcare provider will ask about your typical sleep onset and wake-up times (even on weekends), total sleep time on average, whether or not you work in shifts, and your quality of sleep. There's also something called the Epworth Sleepiness Scale that can help doctors evaluate your sleep issues.
"The doctor's initial goals are to assess for medical, neurological, or mental disorders that can affect sleep — including the effects of medications or recreational drugs," says Dr. Luo. "And to rule out any specific sleep disorders, like obstructive sleep apnea and restless leg syndrome."
You and your healthcare provider can work together to find the best treatment for extending and improving your sleep duration — whether or not issues are caused by your hormones.
What treatment options are available for sleep problems during menopause?
"If [sleep issues] are hot flash-related, the easiest fixes are environmental: wearing layers to bed, using a light comforter/blanket, leaving windows open or turning the air-conditioning colder, having a cold glass of water nearby, wearing sweat-wicking clothing to bed (silk is a common recommendation), etc.," explains Dr. Luo. "If mood-related, [patients] can consider starting an antidepressant that can make one drowsy (like Gabapentin)."
If hot flashes are the primary concern and environmental changes don't help, Dr. Luo says that hormone therapy may be a good option (more on this later).
What are some steps you can take on your own to get better sleep?
Regardless of your hormone levels and their role in your sleep patterns, the following tips can help you make some improvements to your ability to catch enough shuteye each night:
- Go to bed and wake up the same time each day — even on the weekends.
- Use your bedroom for sleeping and sleep preparation only.
- Limit your exposure to blue light (which many electronics give off and can disturb sleep) and turn off electronics at least an hour before bedtime.
- Establish a bedtime routine, like taking a warm bath with Epsom salts (which contain magnesium), doing restorative yoga or light stretching, or reading a book.
- Try not to consume any caffeine after 2pm.
- Get regular exercise
Can treating out-of-range hormone levels help you get better sleep?
Given the link between hormones and sleep, it stands to reason that treating out-of-range hormones would reduce sleep-related symptoms. This may be true — but only for those whose sleep issues are directly impacted by their hormone levels:
- Estrogen replacement therapy and sleep: It's possible that estrogen replacement therapy may improve sleep for menopausal women and people with ovaries, but Dr. Luo says that she's never prescribed estrogen therapy if sleep disturbance is the only symptom of menopause. Talk to your doctor about your symptoms. Depending on what those symptoms are — sleep and hot flashes, sleep and mood changes — they can help guide you and your provider on what treatment options would work best for you. This may or may not include hormone therapy.
- Thyroid treatment and sleep apnea: If you're experiencing sleep apnea because of hypothyroidism, which is diagnosed when TSH levels are low due to an underactive thyroid gland, medication management may be effective. The standard treatment of hypothyroidism is daily usage of a synthetic thyroid hormone, like levothyroxine (Synthroid is a common one).
- Other possible hormone-related treatment options for sleep problems: Taking a melatonin supplement for short periods of time can help with insomnia or difficulty falling asleep (but the findings are mixed on whether or not melatonin supplements can specifically help people who work the night shift). Researchers are also investigating the role of hormonal contraceptives in managing sleep problems.
Want to better understand your hormones? Modern Fertility can help
Because we’re hormone nerds at Modern Fertility — and proud of it — we offer a few different ways to measure and understand the hormones most important to fertility. First, the Modern Fertility Ovulation Test tracks your luteinizing hormone (LH) at low, high, and peak levels to help you predict ovulation and your fertile window. The Modern Fertility App makes that even easier by letting you scan and log your Ovulation Test results ~like magic~ with your phone’s camera — as well as track your periods and sex or insemination. (The app also makes predictions and testing recommendations for future cycles.)
If you’re trying to conceive, the Modern Fertility Pregnancy Test lets you test for pregnancy and trust the result. You can use our app to log your results and know when to test for pregnancy.
Finally, you can use the Modern Fertility Hormone Test to understand how your fertility is changing over time. Our fertility hormone test gives you insight into the number of eggs you have and can help you identify "red-flag" issues — like polycystic ovary syndrome (PCOS) or thyroid conditions — that could affect your reproductive health down the line.
This article was medically reviewed by Dr. Eva Marie Luo, MD, MBA, OB-GYN at Beth Israel Deaconess Medical Center and Clinical Lead for Value at the Center for Healthcare Delivery Science at Beth Israel Deaconess Medical Center.