PCOS and Sleep: How to Take Charge of Your Night!
Information collected from LIVE discussion on IG with Courtney!
Alright, buckle up, PCOS warriors! We're about to embark on a wild ride through the wondrous world of sleep and its peculiar relationship with Polycystic Ovary Syndrome (PCOS). Spoiler alert: it's a rollercoaster of sleep disorders and sneaky bedtime bandits!
First off, let’s talk about the sleep troubles that cozy up to PCOS like it’s the best slumber party in town. There is a bidirectional pathway between sleep challenges and PCOS symptoms. Learning to set yourself up for sleep success is a great way to give that unwanted guest out the door.
Now cue the drumroll for our unwanted guest, obstructive sleep apnea (OSA). If you have experienced OSA you know the feeling. If not here is a visualization to help you understand the experience some people go through. Imagine your airway deciding to play peek-a-boo during sleep, causing blockages, possible gasping for air, waking up your partner, loud breathing, etc. This all resulting in possible weight gain and a slow dance towards diabetes and chronic diseases. And guess what? In women with PCOS, the chances of this happening are 5-10 times higher than in those without PCOS. Addressing sleep issues through direct support from professionals trained in supporting OSA is extremely important. One of my favourite instagram accounts to check out are @SleepBetterNYC and @SleepApneaStories.
Now wait! There is more! Chronic daytime fatigue and sleepiness sneak in like those unexpected houseguests that just won’t leave. Again, think bidirectional, hormone imbalances may be causing these symptoms, as well as poor quality sleep making this even worse.
Then there's the circus of circadian rhythm dysregulation – cue the cortisol and melatonin rollercoaster! It’s like your body's internal clock throwing a party at the wrong hour, leaving you feeling like a time-traveling insomniac.
From a sleep perspective, what is commonly reported as the most common difficulties for PCOS clients are difficulty falling asleep and maintaining sleep. BOTH requiring optimal melatonin levels and low cortisol, and many other hormones to be balanced and timed correctly to allow for quick sleep onset and maintaining quality sleep across the night.
Now, why's sleep such a big deal for PCOS, you ask? Poor sleep interferes with the insulin signaling pathways, leading to impaired glucose regulation. The body becomes more resistant to insulin causing higher blood sugar levels.
Poor sleep can also disrupt hormone balance and lead to irregular cycles and periods, resulting in irregular ovulation and disruption of other reproductive hormones (LH and FSH levels).
Poor sleep can make it difficult for someone with PCOS to lose weight and cause possible weight gain. The reason for this is it disrupts appetite-controlling hormones. Ghrelin, the hunger hormone, decides to throw a tantrum and increase with sleep deprivation screaming for more snacks and less than ideal cravings, while Leptin, the supposed fullness hero, takes a nap on the job and decreases with inadequate sleep leaving you feeling unsatisfied and craving more.
Now that we have a good understanding of PCOS and the hormone rollercoaster and many unwanted guests that come along for the ride, let’s dive into sleep.
The real question is… what is good quality sleep?
It’s those nights where you hit the pillow, drift off into dreamland, and wake up feeling like you've been upgraded to a new and improved version of yourself. This feeling is different for everyone and to be completely transparent may not be 100% of the time. And that is okay! We are looking for high quality sleep over sleep quantity.
Some things to consider are the total duration. The Sleep Foundation suggests that the average length of sleep for adults is 7-9 hours. This is a normative sample, so some may feel rested and alert, with no physiological side effects after 6-6.5 hours sleep and some may need more. All humans are different so taking note of your ideal sleep length will be important.
Let’s talk sleep hygiene and evening routines. Everyone’s is going to be different and if you are anything like me, I need to have flexibility within the structure. No one wants to go to a party where they feel like they HAVE to behave a certain way. If you are engaging in behaviours because that is what you think you SHOULD do but it does not bring you joy or peace, then scrap it and find something else that will work.
The main goal of an evening routine is to help wind-down your nervous system, quiet your mind and allow the hormones to do their thing. You want to start making wise sleep choices around 2 hours before bed. This may include dimming the lights, putting phones and work away, connecting with others, having that last meal. Keeping stress to an absolute minimum at this time. Cortisol spikes are not what we need to help initiate sleep.
If you are falling asleep within 15-30 minutes of settling into bed and turning the lights out then your evening routine is likely working for you.
Now, if you find yourself waking up in the middle of the night this is where the hormonal issues may be coming into play, ESPECIALLY for PCOS clients. Using nutrition and movement to help keep the hormones balanced during the day and accepting that this is your current experience until it is resolved will be helpful. Try not to beat yourself up, this is not something you can control.
If you do wake up, you have a couple of choices. One would be to stay in bed and do some mindfulness activities, or engage in a low stress activity (e.g., reading a book). Saying to yourself “this is my hormones, and I am doing all that I can to support balance” may be a helpful mantra. Take the opportunity to rest. Resting is still important if sleep does not quite come.
Another option, if you find yourself very alert and starting to get agitated. Changing the environment up may be helpful. For me, when I experience hormone imbalances I usually get discomfort in my legs. So going out for a stretch, quick walk around my tiny kitchen or legs up the wall is helpful. I may bring my portable low blue light lamp out and read a book or watch a quick show until I am tired again.
Remember we cannot control our hormones but through lifestyle changes and support from professionals who deeply understand how to balance them will be important. The answers won’t come over night so giving yourself grace and self compassion when the night wakings occur will be highly supportive.
Sleep loves a schedule. Sleep loves a routine. Our bodies need routine to help regulate all of the hormonal functions in our system. One of my TOP tips is to keep your wake time and sleep time as consistent as possible. If you have had a rough night sleeps, trying to avoid naps and engaging in behaviours that will support sleep will be helpful. You will need lots of willpower and a plan to help you through this phase. Usually lasting a few weeks, but I know you can do it!
Some other wise sleep choices I suggest when coming up with your daily routines to support healthy sleep are:
Develop strategies to support overall stress responding. If you experience severe panic attacks or are easily triggered, finding ways to catch the escalation before it peaks will be helpful. As well as adding in regulation breaks for yourself throughout your day. This may be a off-the-grid hour reading a book, having a bath, puttering around your hours. Whatever serves you. This acts as a preventative strategy and will expand your capacity to navigate the stress in your day.
Manage your blue light intake. Research is mixed on this, and some individuals are impacted more than others. Ensuring 2 hours before bed, dim the lights in your home (candle light is the best!) turning on night shift mode, decreasing active screen use and allowing for slowness will be helpful in setting up that natural melatonin increase before bed. Some brains need more clear cues than others so can’t hurt to try to decrease your light intake at night.
Eat a balanced diet. Through support of a nutritionist like Courtney, you can get an idea if you have any nutritional deficiencies that could be impacting the quality of sleep you are getting (e.g., magnesium, Vitamin D, Iron, etc.).
Look at your relationship with caffeine. Caffiene can wreak havoc on your nervous system as well as your sleep drive. Caffiene has a half life of 5-6 hours, and we want it as low as possible before bed. Keep your caffiene to the morning and try different alternatives to get that same fix in the afternoon. Also - be prepared, it is common to experience some fatigue at around 2pm as our circadian rhythm dips. Scheduling an outside walk/movement break is a great way to keep you going through your day instead of reaching for the cup of joe!
Understand your choices around alcohol. Alcohol can lead to hormone disruption, as well as interfere with the quality of sleep that you receive. Reflecting on why alcohol may be a choice in your daily routine is a good place to start. Is it out of boredom. Are you avoiding something? Is it regulating? Receiving support in changing this behaviour may be needed. Best case scenario, avoid alcohol as much as possible. Keep drinks limited and about 2-3 hours before bed to allow for processing and stay hydrated with water.
So, there you have it, the curious case of PCOS and sleep! The answers is not simple, but through putting all the puzzle pieces together, giving yourself patience as things stabilize through your behavioral changes around nutrition and wise sleep choices, you will one day sleep well again!
For more information about the nutrition side of PCOS follow Courtney Minors on Instagram. If you need support with sleep, sign up for my newsletter or contact me directly and I am happy to chat with you about next steps!
xoxo, Nicole
This article does not constitute medical advice. Consult your health care provider or certified medical practitioner before taking any supplement or medication.