Sleep is foundational for aspects of health, including hormonal health. There are many connections between hormones and sleep that I’ll discuss today. To learn more about this topic, be sure to check out Part 1 of this sleep series: How Sleep Affects Health – Importance of Quality Sleep.

“Sleep is foundational for all aspects of health, including hormonal health.” 

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Now, let’s explore how hormones and sleep impact each other, including:

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● Progesterone and sleep 

● The sleep insulin resistance connection 

● Thyroid hormones and the circadian rhythm 

● Melatonin, the sleep hormone 

● Cortisol and sleep 

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Let’s get started! 

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Progesterone and Sleep 

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Progesterone and sleep problems have a fascinating link. You might remember from previous articles that progesterone rises during the second half of the menstrual cycle after ovulation, making you feel calm and relaxed. 

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Because of the hormonal changes during the cycle (or in perimenopause), it’s not surprising that changes in sleep occur because of hormonal changes. If you notice that your sleep declines during the luteal phase of your cycle before your period or in perimenopause, you might want to pay attention to what progesterone is doing. 

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On the one hand, poor sleep could relate to low progesterone levels. Progesterone might be low if you didn’t ovulate during a cycle or if levels are low relative to estrogen, as we see in estrogen dominance. In either case, without adequate progesterone, you might feel more anxious, irritated, and have more interrupted sleep. In cases of low progesterone, especially in perimenopause and menopause, progesterone replacement therapy is an option for improving sleep. 

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On the other hand, poor sleep may relate to how progesterone is metabolized. One of the progesterone metabolites, called allopregnanolone, is a GABA receptor agonist, meaning that it blocks GABA function. GABA is the primary inhibitory neurotransmitter that calms the nervous system and promotes sleep.

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So, if you increase progesterone when the high allopregnanolone pattern is present, you may make sleep issues worse! This is an example of why I always recommend testing first. The DUTCH test that we offer at The Fork gives us so much insight into progesterone and the root causes behind sleep issues. 

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Insulin, Insulin Resistance, and Sleep 

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Lack of sleep and insulin resistance is another hormonal connection with sleep. Insulin’s main role is to move blood sugar into cells where it can be used as energy, but this signal is muddy in insulin resistance. 

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Chronic poor sleep contributes to insulin resistance. If you’ve ever had a poor night of sleep, you might have felt more hungry, more dependent upon quick calories, and with less energy for cooking, exercise, and making healthy choices. 

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When we don’t get enough sleep, the body interprets this as stress. Blood sugar rises, and high blood sugar leads to insulin resistance over time. Therefore, it’s not surprising that poor sleep is associated with an increased risk for the diseases related to insulin resistance, including metabolic syndrome, obesity, Type 2 diabetes, cardiovascular disease, and other chronic health conditions. 

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Then, insulin resistance sleep problems might ensue. Carrying excess weight and changes in metabolic health worsen sleep problems. 

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Thyroid Hormones and Sleep 

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Thyroid levels aren’t the first hormone for sleep we consider, but thyroid health also connects with the circadian rhythm and sleep. You might hear this referred to as thyroxine sleep problems. 

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TSH, or thyroid stimulating hormone, is released by the brain to signal the thyroid gland to make thyroid hormone (T4 or thyroxine). Both TSH and T3 (active thyroid hormone) affect sleep quality, circadian rhythm, and the stages of sleep. 

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Therefore, hypothyroidism (low thyroid hormone) or hyperthyroidism (high thyroid hormone) alter sleep quality and duration. 

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If new sleep problems appear, it might be time to get a full thyroid panel done, in addition to testing other hormones.

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Melatonin to Sleep 

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Does melatonin help you sleep? Absolutely. Melatonin may be the most well-known hormone that regulates sleep; it’s known as the sleep hormone, after all. That said, it’s not appropriate for everyone and the dose makes the poison. More isn’t always better and consistent usage of melatonin is also not advised, as your body can become unresponsive to it after a while.

Melatonin is mainly made by the pineal gland in the brain. Its levels are low during the day but rise in the evening to promote drowsiness and sleep. Many people use supplemental melatonin to sleep at night. 

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You might also be curious about the connection between melatonin, serotonin, and sleep. Here’s the link: melatonin is made from serotonin. Without enough serotonin, you might not have enough sleep hormones. This may be one of the connections between sleep and mood that I discussed in Part 1. (Add link). Ensure your diet is balanced with healthy plant rich foods like non-starchy vegetables, plant protein such as lentils and chickpeas as well as nuts and seeds for optimal neurotransmitter production and function. 

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Cortisol and Sleep 

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Finally, I want to discuss one other hormone: cortisol. Cortisol is the main stress hormone made by the adrenal glands and has an opposite circadian pattern to melatonin. Cortisol is low at night and then increases upon waking to promote alertness during the day. 

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The daily cortisol pattern may become dysregulated because of stress, inflammation, toxins, and other factors. High cortisol at night is a common pattern that I see in my practice that makes it hard to fall asleep and impacts sleep quality. Even a single high-stress day can influence cortisol levels and sleep. 

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Again, I suggest testing instead of guessing since so many hormones influence sleep. When considering how to lower cortisol for sleep, if this is your pattern, phosphatidylserine and certain botanicals like magnolia are effective ways to improve sleep quality. 

“As you can see, there are so many connections between sleep and hormones, but what I want to uncover are your personal connections. This is where functional medicine shines.” 

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As you can see, there are so many connections between sleep and hormones, but what I want to uncover are your personal connections. This is where functional medicine shines. I can talk all day about the science, but when we are face to face, we can take all of this knowledge and make it incredibly applicable to you, your life, and your health goals. 

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References 

1. Baker, F. C., & Lee, K. A. (2018). Menstrual Cycle Effects on Sleep. Sleep medicine clinics, 13(3), 283–294. 

2. Nolan, B. J., Liang, B., & Cheung, A. S. (2021). Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data. The Journal of clinical endocrinology and metabolism, 106(4), 942–951.

3. Gottesmann C. (2002). GABA mechanisms and sleep. Neuroscience, 111(2), 231–239. 4. Reutrakul, S., & Van Cauter, E. (2018). Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism: clinical and experimental, 84, 56–66. 5. Shekhar, S., Hall, J. E., & Klubo-Gwiezdzinska, J. (2021). The Hypothalamic Pituitary Thyroid Axis and Sleep. Current opinion in endocrine and metabolic research, 17, 8–14. 6. Hardeland, R., Pandi-Perumal, S. R., & Cardinali, D. P. (2006). Melatonin. The international journal of biochemistry & cell biology, 38(3), 313–316. 

7. Sladek, M. R., Doane, L. D., & Breitenstein, R. S. (2020). Daily rumination about stress, sleep, and diurnal cortisol activity. Cognition & emotion, 34(2), 188–200.