Insomnia and birth control pills

Women need more sleep than men and can have a more difficult time getting it due to hormonal shifts across the menstrual cycle. Does this mean by using hormonal contraception you can smooth out the hormonal bumps and get fantastic sleep?1 Well, not so fast.

The oral contraceptive pill (OCP) was released to the market in the 1960s and is used by millions of women worldwide to prevent pregnancy. It does this by blocking the release of the gonadotrophic releasing hormone in your brain. This prevents follicle stimulating hormone and luteinising hormone from working.2 In a non-hormonal speak, this means you don’t ovulate; hence, why it is 99.8% effective for preventing pregnancy.

Your natural hormones are shut down in a kind of temporary, chemical menopause.

 

How do oral contraceptive pills contribute to insomnia?

 

Altered sleep architecture

It appears the changes between the sleep of naturally cycling women and those using the OCP relate to alterations in sleep architecture. Sleep architecture is broken up into non- rapid eye movement (N-REM) of which the deep, slow-wave sleep is a component and rapid eye movement sleep (REM) which is a lighter sleep where dreaming occurs.

Women on the OCP get less slow wave sleep and have more REM sleep.

Slow wave sleep is essential for:

  • Repair and regeneration of cells
  • Memory
  • Immune regulation
  • Hormone production including glucose regulation

REM sleep is lighter, and you can be more easily awakened from it.3

What this may mean is an increased risk of immune, inflammatory and blood sugar issues, which in themselves can disrupt sleep. Also, if you are spending more time in lighter REM sleep, you have more opportunity to be woken by environment noise or snoring partner noise!

 

Anxiety

If you don’t ovulate, you don’t make progesterone. To be clear, most OCPs contain progestin, which is similar, but not the same as natural progesterone.

Progesterone converts to the neurosteroid, Allopregnanolone (Allo), progestins don’t.

Allo interacts with the GABA receptors in your brain to decrease the stress response and calm the mind and adrenals4. It’s one of the reasons the perimenopausal decline in progesterone may cause increased anxiety.

 

Depression

Both progesterone and progestins increase monoamine oxidase (MAO), an enzyme which breaks down neurotransmitters – serotonin, dopamine and noradrenaline. But, the progestins in the OCP may have a more significant impact. Higher MAO levels equal less serotonin – a hormone vital in both mood and sleep.

Serotonin is also a building block to melatonin – the sleep hormone.

What does this mean?

Naturally cycling women may notice a slight dip in mood in the week before menstruation (this is when progesterone is highest in the cycle). Because many OCPs deliver the same amount of progestin all cycle, this depressive effect on mood may be amplified for those on hormonal contraception.

 A depressed mood in itself can lead to poor sleep as it can reduce the desire for physical activity and to eat healthy foods creating a vicious sleep-disrupting cycle.

 

Increase in nocturnal body temperature

At night your core body temperature drops slightly, and this makes you feel sleepy. The OCP can cause a continuous elevation in body temperature if the progestin dosage is the same throughout the cycle1.

 

Nutrient deficiencies

It is well known that the OCP use of >1 year causes depletion of nutrients including B group vitamins, zinc and magnesium. These nutrients are essential in the production of neurotransmitters and hormones which support sleep and relax the nervous system5.

 

Obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a sleep disorder where you have momentary pauses of breathing throughout the night. The effects of these repeated hypoxic episodes can have serious health implications. The OCP may contribute to this by causing weight gain as a result of insulin resistance.

Natural progesterone is also a respiratory stimulant6. This is why the incidence of females with OSA rises sharply after menopause.

 

(Read more about Obstructive Sleep Apnoea)

 

Hormones are not just for reproduction

 

The side effects of OCP and the impact on the broader area of women’s health are sparsely researched. Will all women on the OCP have poor sleep? No, but many will.

 

My clinical experience does suggest it is a player for many women when it comes to their sleep health. If you choose to use hormonal contraception (and, don’t get me wrong, it is a valid choice), I recommend being diligent with other aspects of your sleep health. Optimise your circadian rhythm, maintain solid sleep hygiene practices, keep in a healthy weight range, manage stress and eat nutritious food.

 

Have you experienced sleep issues while taking hormonal contraception?

 

Leave me a comment below.

 

References:

  1. Bezerra AG, Andersen ML, Pires GN, Tufik S, Hachul H. Effects of hormonal contraceptives on sleep – A possible treatment for insomnia in premenopausal women. Sleep Sci. 2018;11(3):129-136. doi:10.5935/1984-0063.20180025
  2. Welling L. Psychobehavioral Effects of Hormonal Contraceptive Use. Evol Pschology. 2013;11(3):718-742. doi:10.1177/147470491301100315
  3. Shine R, Ba B, Hoffmann R, Armitage R. Short Note : Oral Contraceptives and Sleep in Depressed and Healthy Women. Sleep. 2002;25(3):2001-2003.
  4. Liang JJ, Rasmusson AM. Overview of the Molecular Steps in Steroidogenesis of the GABAergic Neurosteroids Allopregnanolone and Pregnanolone. Chronic Stress. 2018;2:1-17. doi:10.1177/2470547018818555
  5. Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013;17:1804-1813.
  6. Popovic RM, White DP, Rainer M, White DP. Upper airway muscle activity in normal women : influence of hormonal status. J Appl Physiol. 1998;84(3):1055-1062.

Need help with your sleep?

Norelle Hentschel is an experienced naturopath with a clinic in Crows Nest, Sydney who enjoys supporting her clients to reach their health goals.

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