PCOS and Sleep: Why You’re Always So Tired

When you have polycystic ovary syndrome (PCOS), it can seem like you have no respite at all. Despite your efforts to overhaul your lifestyle and meet the challenges of PCOS, there’s always one more health concern that needs to be addressed. Sleep is one such critical concern, as poor-quality sleep is known to exacerbate symptoms and increase the risk of complications. Both PCOS and sleep disorders have been linked to poor cardiometabolic health and a high risk of type 2 diabetes. Sleep problems can also make it harder to follow a healthy diet and lifestyle, significantly affecting your mood and quality of life. Considering these implications, it’s important to understand how PCOS affects sleep and what you can do about it. 

Does PCOS cause insomnia?

It’s a question that doctors hear all too often, and the answer is yes, it can. Insomnia is just one of many sleep disorders associated with PCOS. Several studies have shown that 10% of all women with PCOS suffer from insomnia, while nearly a third of all patients have some form of sleep impairment. Some studies also show that there is a 50% higher risk of some kind of sleep disturbance developing in women with PCOS, as compared to in healthy women, over a 10-year period. In a large-scale study of Indian women with PCOS, 53% reported sleeping fewer than 7 hours per night, while 21% reported experiencing chronic insomnia.

Moreover, these sleep problems are not just linked to excess weight or obesity, which is a common concern in PCOS, as the same rates of sleep disorders have been observed in women with PCOS who have a healthy body weight. This points to physiological, metabolic, and psychological changes in PCOS as likely causes of PCOS insomnia and other sleep disorders.

Common sleep problems faced by women with PCOS

Women with PCOS often experience disturbed or poor-quality sleep on account of a wide range of sleep problems. These can include:

• Sleep insufficiency: This refers to short or inadequate duration of sleep at night on a regular basis. More than half of all women with PCOS in India are reported to have sleep insufficiency, getting less than the recommended seven hours of nightly sleep, with some getting even less than six. 

• Insomnia: This includes any disordered sleep in which you have trouble going to sleep even when lying in bed at night, or if you wake up earlier than you should and then can’t go back to sleep. 

• Obstructive sleep apnoea (OSA): This is the most pervasive condition in women with PCOS, occurring two to three times more frequently in women with PCOS, as compared to other women of the same age and weight.

• Hypersomnia: Hypersomnia or excessive daytime sleepiness is a common symptom of sleep impairment that is frequently reported in women with PCOS. It results from inadequate or poor-quality sleep, which means that you could wake up feeling fatigued despite going to bed on time. 

Hormonal triggers behind sleep problems in PCOS

Hormonal imbalances are a defining feature of PCOS, so it’s no surprise that they also play a role in PCOS-related sleep disorders. The role of hormones here is bidirectional — they can give rise to sleep disorders in PCOS, and sleep disorders can also worsen hormonal imbalances. 

The rise in androgens or male hormones that is seen in PCOS can interfere with normal sleep signalling. These changes also contribute to insulin resistance, which often changes patterns of cortisol and melatonin secretion, which regulate stress response and sleep.

Lifestyle factors that make PCOS sleep worse

PCOS has a huge psychological and emotional burden, as women have to deal with a variety of unpredictable and discomforting symptoms, often with little social support. This, along with hormonal changes, significantly increases the risk of anxiety and depression. This, in turn, changes brain activity patterns and neurotransmitters that regulate the sleep-wake cycle. 

Mood swings, stress, anxiety, and depression can also make it harder to maintain healthy dietary and lifestyle habits, making it more likely for you to consume alcohol or skip exercise. These behaviours can worsen sleep problems and make it harder to manage PCOS, creating a vicious cycle. Women with PCOS who engage in a structured exercise routine (at least 150 minutes of moderate activity per week) experience a 30%-50% improvement in sleep quality along with a marked reduction in daytime fatigue.

Tips to improve sleep with PCOS

Lifestyle changes, such as daily exercise, that are recommended for PCOS and sleep problems, can lower the risk of chronic sleep disorders and will also help with their management. Some additional tips to improve your PCOS sleep routine include:

• Maintain a disciplined sleep and wake schedule with regular bedtime and morning alarms.

• Prepare yourself for the night with sleep hygiene practices, wherein you limit screen time and stimulating activity for a few hours before bedtime.

• You can also use blackout curtains and white noise machines to improve sleep quality. 

• Adopt stress reduction and relaxation techniques such as meditation, deep breathing, or massages shortly before bedtime. 

• Avoid consuming heavy meals or caffeinated beverages shortly before bedtime.

• Get help from a therapist, as behavioural therapy is proven to help manage sleep disorders. 

Learning to manage PCOS

It can be tough to cope with the occasional sleepless night, so dealing with inadequate or disturbed sleep on a regular basis can feel overwhelming. Fortunately, PCOS and sleep impairments can be managed with many of the same approaches involving healthy lifestyle choices. Just talk to your healthcare providers, as they can provide you with more personalised guidance for better long-term outcomes. 

Frequently Asked Questions

1. Does PCOS cause sleep problems or worsen them?

Hormonal imbalances and symptoms of PCOS can contribute to sleep disorders and may even worsen pre-existing sleep problems. 

2. How do sleep problems affect PCOS?

Inadequate or poor-quality sleep is known to exacerbate PCOS symptoms, increasing hormonal dysregulation and insulin resistance. 

3. Does exercise help with PCOS and sleep disorders?

Yes, exercise is proven to improve PCOS outcomes and sleep quality. It also lowers the risk of complications associated with both problems, including cardiovascular disease and diabetes.