Does PCOS make you sleep badly? #99
PCOS and Sleep: an interesting relationship
Women with PCOS are twice as likely to be impacted by sleep issues.
The question is: does PCOS make us sleep badly, or does sleeping badly make our PCOS worse?
Does PCOS make us sleep badly?
Technically, yes. Here are three things that impact how well we can sleep:
Excess weight
One of the most foundational explanations is obesity. Through the pressure weight puts on the upper airways, a 10% increase in body weight predicts a 6x increase in the risk of developing sleep-disordered breathing.
However, PCOS patients with normal BMI also experience sleep problems, so it’s not just down to excess weight.
Insulin resistance
When we eat, insulin is released to help glucose get into the cell. Women with PCOS, if they have insulin resistance, tend to have excess insulin hanging around the blood. This excess insulin signals to the brain that food is coming, which needs to be digested. This means we need to be awake for it.
This is why eating very close to bedtime is also not a great idea. In addition to insulin making you alert, active digestion increases body temperature, and good sleep requires a slight drop in body temperature. Especially if you have PCOS, I recommend keeping your last meal at least 3 hours before bedtime.
This is a simplistic view of how insulin resistance affects sleep. More complex and unknown mechanisms of action are at play.
HPA Axis
Women with PCOS often have an overactive HPA axis, which is closely linked to sleep regulation. Elevated HPA axis activity can increase cortisol production, disrupting normal sleep patterns. The circadian rhythm, which regulates sleep-wake cycles, is influenced by other neuromodulators, including melatonin and cytokines. Alterations in these regulatory substances due to PCOS can further disrupt sleep patterns. The reason why these are altered is not fully known. I would guess that it sits in genetics.
How does poor sleep affect PCOS?
However, not sleeping well pushes our PCOS symptoms even further. Poor sleep sends us into an inflamed, non-restorative body state that will worsen our PCOS.
Our hormones
Disturbed sleep is associated with a 46% increased chance of irregular periods. But why?
This is because poor sleep affects the hormones that help us ovulate. Routinely sleeping less than 6 hours/night has been associated with a 20% drop in FSH (Follicle-stimulating hormone). In addition, LH seems to be higher in the evening when we have not slept well.
For women with PCOS, our LH: FSH ratio is already disturbed due to our condition. Poor sleep will continue exacerbating this imbalance, making it hard for us to ovulate.
Of course, this has implications for fertility. This will impact our ability to get pregnant but also maintain a pregnancy, as women who sleep less than then needed during the first trimester have an increased risk of miscarriage 😔.
Poor sleep quality has also been associated with increased testosterone levels in women with PCOS, which we know is not great news for us.
Insulin resistance
Poor sleep increases insulin resistance, a key feature of PCOS.
Inflammatory markers such as C-reactive protein (CRP) and serum amyloid A (SAA) have been raised in people who don’t sleep, which interferes with insulin's effectiveness.
In addition, the hormone glucagon-like peptide-1 (GLP-1) seems to have a lower response to glucose. GLP1 is the active hormone that weight loss injections mimic. It is released after we eat and stimulates insulin secretion from pancreatic cells in response to elevated blood glucose levels. Poor sleep disturbs this hormone, leading to higher insulin levels.
Lastly, it makes us much hungrier the next day. We discussed how that happens in last week’s article → How lack of sleep makes us gain weight.
It is essentially a vicious cycle.
How can I sleep better?
Track it - it’s essential to understand how much sleep you are getting and use technology to help you optimise it. Products such as FitBit or Whoop can help you optimise the hours you go to sleep to maximise the chance of getting a good night's sleep.
Keep the last meal of the day 3 hours before bed so the body has enough time to clear out the excess insulin it used to digest your dinner. I think this is key for us, who might already suffer from some insulin resistance.
Temperature—Our body needs a slight drop in temperature before bed so it can fall asleep, so ensure you are not too hot.
Light - I am sure this is not shocking news, but trying not to be on your phone till late at night will help. Our circadian rhythm works based on light-darkness stimuli. Your brain needs to know what is happening based on what your eyes can see. If they see light, they will take it as a cue to stay awake.
Accepting your sleep type—are you a night owl or an early bird? Your genetics determine that. I will discuss this in our next newsletter.
See you next Sunday.
Francesca
Francesca is a Nutritional Therapist with years of experience managing PCOS symptoms. If you are interested in one-to-one consultations, you can book a free discovery call here.
References
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Vgontzas, A. N., Legro, R. S., Bixler, E. O., Grayev, A., Kales, A., & Chrousos, G. P. (2001). Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: Role of insulin resistance. Obstetrical & Gynecological Survey, 56(7), 418–419. https://doi.org/10.1097/00006254-200107000-00017
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Disclaimer: We are all unique in our ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please consult your healthcare provider further about your health needs.