By Ellie Kempton
“I fall asleep just fine. But I seem to wake up between 2-4 am and I’m WIDE awake.”
Does this sound familiar? You are not alone. This is one of the most common complaints I receive from my clients. In working predominately with 40-65 year old women, seeking hormone balance, the navigation of hormone imbalance is what I do on the best and chronic patterns of early morning insomnia tend to be the symptom breeding the most angst. As it should! Sleep IS a form of medicine. Without it- there is a missing link to our vitality.
You’ll be delighted to know there is a root cause to this... and a cure. The "3 am wake up call" has been linked to both fluctuation and deficiency in the essential sex hormones estrogen and progesterone in multiple different ways. Both estrogen and progesterone act directly on the sleep centers of the brain. They also influence the levels of important sleep neurotransmitters such as serotonin and GABA.
Progesterone in particular plays a critical role in sleep as it makes a metabolite called allopregnanolone (ALLO) which interacts with GABA receptors, and is very soothing. 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 is the case when women are on hormonal birth control or are post menopausal], women’s brains show fewer sleep spindles which equates to fewer restorative sleep cycles. Not all insomnia can be traced to the same hormone imbalance because each different life cycle stage tends to drive different hormonal fluctuations Let’s take a look at 3 different life cycles targeting the most common imbalance leading to insomnia.
Hormonal sleep problems typically occur during PMS because both estrogen and progesterone plummet in the few days before the period.
In this case, the best PMS sleep remedies are magnesium and vitamin B6 because they both support progesterone production inducing the calming impact progesterone has on the body both asleep and awake.
Magnesium is nothing less than a “miracle drug” when it comes to sleep, if you are deficient. Upwards of 80% of us are. In fact, I find it to be difficult to gain any traction on a case of insomnia if a client is magnesium deficient. 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 clients suffering from insomnia [linked to hormone imbalance or not] get magnesium on the first visit. There are multiple types of magnesium. And while I wish I could promise you could get what you need from magnesium rich foods, it is unfortunately very difficult to obtain much magnesium through food as the topsoil has become relatively magnesium deficient. So my recommendation is to start with topical magnesium gel and if you are ready to increase therapy talk to a practitioner about the best source + form + dosage.
Vitamin B6, the other helper I mentioned earlier, not only supports the production of progesterone but it also also helps with GABA production. GABA is a neurotransmitter promoting feelings of peace and is essential for sound sleep. Unlike magnesium you CAN get B6 easily through food. Food sources of B6 include: turkey, beef, pistachios, tuna, pinto beans, and avocado.
Hormonal sleep problems typically occur during perimenopause because of progesterone deficiency and estrogen excess.
Estrogen excess causes irritability, tension, and trouble falling asleep.
Treatment strategies for perimenopausal sleep disturbance include magnesium, B6 [as indicated above] along with an herbal superstar- Vitex Agnus Castus. Vitex also referred to as Chaste Berry has been shown to enhance mid-luteal production of progesterone.
On the estrogen front- both broccoli sprouts and milk thistle have been shown as very supportive in the elimination of excess estrogen. You can either purchase broccoli sprouts or grow them yourself. Haven’t heard of milk thistle either? You’ll find a wonderful breakdown of why it might be your new best friend for both liver health and estrogen dominance here.
And finally, hormonal sleep problems typically occur during menopause because of progesterone and estrogen deficiency.
Estrogen and progesterone deficiencies combined can lead to difficulty in staying asleep, and many women report sleep maintenance insomnia [waking at 3 am] as the single most distressing symptom of menopause.
Menopausal sleep can be improved with magnesium and vitex [see above], but the addition of L-tryptophan [the precursor to both the neurotransmitter serotonin and the hormone melatonin] rounds out the perfect trifecta . Serotonin is our “happy hormone” and melatonin is the master sleep hormone, making both critical for a sound night of peaceful sleep. Because estrogen is required for optimal production of both serotonin and melatonin, L- tryptophan offers a gentle but targeted way to support decreased serotonin and melatonin product due to an estrogen deficiency. On the lifestyle front, melatonin production can be boosted by reducing exposure to the blue light of screens before bed.
But sometimes the combination of these treatments is not enough.
Women with severe menopausal sleep disturbance need to divert attention to the cortisol and HPA Axis. Healthy sleep requires a stable HPA [hypothalamic-pituitary-adrenal] axis and a reduction of night-time cortisol. Some tangible stress reduction strategies include yoga, massage, and the inclusion of calming “adaptogenic” herbs such as ashwagandha, tulsi and rhodiola.
At the end of the day, it’s also highly beneficial to work with a practitioner you trust to run labs targeting the exact hormone imbalance. With this information you’ll be an invincible sleep warrior.
In good sleep,