The infamous 2 am wake-up call.
“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 predominantly with 40-65 year old women seeking hormone balance, the navigation of hormone imbalance is what I do best and chronic patterns of early morning insomnia tend to be one of the symptoms breeding the most angst. And 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 “2 am wake up call” has been linked to both the fluctuation and deficiency in the essential sex hormones estrogen and progesterone in multiple different ways since both estrogen and progesterone act directly on the sleep centers of the brain and influence the levels of important sleep neurotransmitters such as serotonin and GABA.
Progesterone in particular plays a critical role in sleep since 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 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. But let’s take a look at 3 different prominent life cycles targeting the most common imbalances leading to insomnia.
Hormonal sleep problems typically occur during PMS because both estrogen and progesterone plummet in the few days before bleeding begins, marking the beginning of the next cycle. Because progesterone guards the brain against cortisol and estrogen makes you more tolerant to cortisol, the reduction of both can be a recipe for a cyclical insomnia pattern.
In order to work with this natural pattern instead of fighting against it, 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” 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 which together make magnesium a miracle worker for putting you asleep and keeping you there.
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 enough magnesium through food since our topsoil has become relatively magnesium deficient. So my recommendation is to start with topical magnesium glycinate starting with 200-500 mg. This chelation of magnesium is multi-faceted and very impactful for targeting specifically sleep.
Vitamin B6, the other helper I mentioned earlier, not only supports the production of progesterone but also helps with GABA production. GABA is a neurotransmitter responsible for 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. If you don't eat these foods regularly, consider a b complex that includes at least 20 mg of B6.
Hormonal sleep problems typically occur during perimenopause because of a progesterone deficiency paired with relative estrogen dominance.While we adore estrogen for it's capacity to make us feel strong, creative and alive, too much in comparison to progesterone causes irritability, tension, and creates trouble falling asleep and in many cases staying asleep too.
Treatment strategies for perimenopausal sleep disturbance include magnesium + B6 [as discussed 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 which will not only keep estrogen in check but also guard the brain against the effect of cortisol which will work to keep you asleep.
It is important to note on the progesterone front that some women are so deficient in progesterone, due to declining levels of ovarian reserve and adrenal insufficiency, it is important to explore the repletion of progesterone orally or topically with a trusted functional medicine provider to sufficiently restore levels of progesterone necessary to thrive in peri-menopause.
On the estrogen front, cruciferous vegetables, broccoli sprouts / microgreens and the consumption of more fiber have been shown to be very supportive in the elimination of excess estrogen. You can either purchase broccoli sprouts or grow them yourself.
And finally, hormonal sleep problems typically occur during menopause because of both 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 2-4 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 production due to an estrogen deficiency.
On the lifestyle front, melatonin production can be increased by reducing exposure to the blue light of screens before bed as well as the maintenance of a more routine sleep schedule. Paired with the trifecta of sleep support [vitex, magnesium and l-tryptophan], you might just find your way back to some powerful zzzzz's.
Women with severe menopausal sleep disturbances need to also divert attention to their 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 passionflower.
When it comes to hormones remember there is no one size fits all. It’s also incredibly important to work with a functional medicine practitioner you trust to run labs targeting the exact hormone imbalance.
With this bespoke care, you’ll be an invincible sleep warrior.
To your beauty sleep.
Want more where this came from? Join The Table where we tackle hormonal issues at the ROOT.