Endometriosis Ruined My Sleep, but These 5 Coping Strategies Got My Shut-Eye Back on Track

Living with endometriosis is a special kind of torture I don’t wish on anyone. The disorder, in which uterine tissue grows in other places throughout the body, has affected every aspect of my life, down to how I deal with pain and even my ability to rest.

I waited 14 years for an official diagnosis, and during that time, I had to figure out ways to cope on my own—including how to sleep with endometriosis pain so unbearable that it kept me wide awake at night.

Here’s exactly how endometriosis has affected my sleep health, why chronic illnesses can lead to poor sleep, and ways to get better shut-eye if you’re dealing with an endo flare (or other chronic pain), according to experts.

Endometriosis wrecked my sleep for more than a decade

Sleep is an essential part of life. It’s a natural healer—helping you fight off minor illnesses like a cold or flu, repair muscle tissue, and even store important memories in your brain. But when you’re living with a chronic illness like endometriosis, quality, uninterrupted sleep is often an unattainable luxury. At least it was for me.

In my teens and early 20s, before my diagnosis, my endometriosis pain mostly flared during my period. But as I got older and went through my first (mostly unsuccessful but definitively diagnostic) endometriosis surgery in 2018, I faced new symptoms I had never anticipated: debilitating pelvic pain, what I thought were recurring UTIs (which turned out to be a painful bladder condition called interstitial cystitis, or IC), gut-wrenching bowel movements, chronic constipation, pain during sex, bloating so severe it made me look pregnant, and back pain that radiated to my legs (aka, sciatica), especially at night.

Many nights, I’d be curled up in a ball, either clutching my heating pad or lying on the shower floor until the hot water ran out. In bed, I’d stare at the ceiling, hoping the lightning bolts of pain that shot down my legs would subside long enough for me to drift to sleep, even if just for a few minutes.

On the nights I did manage to fall asleep, my urge to pee would wake me up repeatedly throughout the night (a common symptom of IC). My urologist prescribed me amitriptyline (an antidepressant) to help with my bladder issues, but it would make me so groggy in the mornings that I’d often show up late to work, so I stopped taking it. Crying myself to sleep became a ritual during endo flare-ups, especially if my IC was bothering me, too.

The sheer exhaustion of being in pain combined with my struggle to sleep slowly turned me into a barely functioning shadow of my former self, taking a toll on both my physical and mental health.

Since my last endometriosis excision surgery in 2022—a procedure that removes endometrial lesions and scar tissue that’s grown outside the uterus—my symptoms and overall quality of life have improved dramatically. But before then, I fell into a depression. Being awake was overwhelming, never mind having to function during the day at work or socialize with friends after a bad night’s sleep. My life was a cycle of pain, fatigue, and loneliness.

A broader look at the link between endo and sleep problems

Unfortunately, my experience is a common reality for many people with endometriosis. In fact, sleep problems are the biggest issue affecting quality of life for those with endo, according to a June 2024 study in BMC Women’s Health¹. An August 2020 study in the Journal of Clinical Sleep Medicine² also shows that insomnia and fatigue are twice as common among people with endometriosis as those without it.

Many people living with endometriosis “wake up throughout the night due to terrible pain that disrupts their sleep,” confirms Iris Kerin Orbuch, MD, a board-certified OB/GYN, director of the Advanced Gynecologic Laparoscopy Center in Los Angeles, and author of Beating Endo: How to Reclaim Your Life from Endometriosis.

What’s more, endometriosis sometimes co-occurs with other painful conditions like IC, low-back pain, vulvodynia (pain in the vulva), and TMJ dysfunction (which causes jaw pain), says Heather Jeffcoat, DPT, a pelvic floor therapist and owner of Femina Physical Therapy. These are referred to as “chronic overlapping pain conditions,” she notes.

People who deal with chronic pain as well as poor sleep often report “higher levels of pain, longer time spent in pain, higher levels of anxiety or depression, and more physical and psychosocial impairments,” Jeffcoat adds.

“Additionally, due to chronic pain, the central nervous system becomes over-activated and patients live in a ‘fight-or-flight’ state,” Dr. Orbuch says. “This subsequently affects multiple hormones as well as throws off cortisol levels, which also disrupt sleep.”

To make matters worse, poor sleep can increase inflammation, per Harvard Health Publishing, which can make endometriosis pain and symptoms more intense. It’s a vicious cycle: Pain leads to poor sleep, which causes inflammation, which amplifies pain, leading to more sleep problems.

How I get better sleep with endometriosis

Thankfully, the general recommendations for a good night’s sleep apply to people with endometriosis, too. This includes things like dimming the lights a couple hours before bed, staying off your phone or computer late at night, and having a relaxing before-bed routine, like taking a warm Epsom salt bath.

What’s made the biggest difference for me, though, has been working with an endometriosis specialist and finding the treatments and self-care habits that best address my specific symptoms.

Here’s what I’ve found helpful:

1. Address the root cause

Getting endometriosis surgery isn’t accessible or possible for everyone, but for me, it truly changed my life. Once I had excision surgery—the gold standard treatment for endo—my debilitating sciatica pain disappeared.

I had two top-notch surgeons who listened and prioritized my recovery: Tamer Seckin, MD, board-certified OB/GYN, endometriosis specialist, and founder of The Endometriosis Foundation of America; and Amanda Chu, MD, board-certified minimally invasive gynecologic surgeon at Seckin Endometriosis Center.

Ultimately, I thought it best to find a doctor who treats the disease, not just the symptoms. Once I addressed the root cause of my pain, I was able to get uninterrupted sleep for the first time in years.

“Often, due to the 10-year diagnostic delay from symptom onset to [endometriosis] diagnosis, patients have multiple other pain generators (e.g., pelvic floor dysfunction, small intestinal bacterial overgrowth, IC, etc.) in addition to their endometriosis,” says Dr. Orbuch. “I identify and treat every etiology of their pain.”

2. Try an anti-inflammatory diet

In the months leading up to my surgery, I did everything I could to reduce inflammation in my body, which included following an anti-inflammatory diet. This meant avoiding anything that could trigger more flares—including things like gluten, dairy, processed meats, alcohol, caffeine, and high-sugar foods, per Johns Hopkins Medicine. (While not everyone has to or even should go gluten- and dairy-free, it’s what worked for me.)

I also tried to eat a lot of anti-inflammatory foods, like those high in omega-3s (i.e., fish, chia, and flaxseeds), green leafy veggies, berries, ginger, and turmeric. I even tried out a lot of turmeric-rich golden milk recipes, which I found to be a great drink to help me relax before bed.

To be clear, there’s limited research around anti-inflammatory foods and endometriosis. But we do know inflammation plays a role in the condition, so for me, these nutrition tweaks felt worthwhile. And once I was consistent, I did notice a small improvement in my pain levels and, therefore, my sleep.

Still, an anti-inflammatory diet alone cannot heal endometriosis (in my case, I needed surgery), and it’s always best to talk to your doctor or a registered dietitian before starting a new eating style.

3. Consider CBD suppositories

One thing that really helped my back pain was CBD—specifically, Foria’s Relief Melts with CBD, which are meant to target pain from menstrual cycles and pelvic floor conditions. These little suppositories, which come in packs of eight, can be inserted vaginally or anally and are made with all-natural cocoa butter and hemp. I’d pop one in 30 minutes before bed, and it would make a noticeable difference. I’d find myself drifting off a little easier. I also love the brand’s Intimacy Melts with CBD to help whenever I’m dealing with painful sex.

Dr. Orbuch says she recommends CBD to her patients with endometriosis because it helps relax the pelvic floor muscles. And an August 2024 study in Immunity, Inflammation and Disease³ notes that CBD may indeed be effective in managing endometriosis because of its anti-inflammatory properties. CBD is also antiangiogenic, meaning it reduces the growth of new blood vessels, which may also be helpful in managing endometriosis, according to the study, although it notes that more research needs to be done to confirm these benefits.

4. Do meditation or breathwork

Jeffcoat says one key step to alleviating pain and getting better sleep is to calm the nervous system through mindfulness practices such as meditation or breathwork. These practices are well known for helping with sleep, but research also connects these practices to pain relief. For example, one recent review, published October 2024 in Pain Management Nursing⁴, found that mindful breathing was effective for reducing pain and improving quality of life for people with chronic low back pain.

While I didn’t take any formal meditation classes or download any apps, I did incorporate breathing exercises into my nighttime routine.

“A couple of breathing exercises that work great for calming the nervous system and reducing pain and anxiety include alternate nostril breathing and 5-7-3 breathing,” Jeffcoat says.

Alternate nostril breathing involves closing one nostril with your thumb and taking slow, deep breaths through the other for five to six seconds, alternating between nostrils as many times as you’d like before bed, per the Cleveland Clinic.

For the 5-7-3 breathing technique, try inhaling for five seconds, exhaling for seven seconds, and pausing for three seconds, repeating about seven or so times, per Jeffcoat. She mentions it’s not as important to adhere to the exact number of seconds as it is to focus on breathing out longer than in.

“For both types, you don’t have to wait until you are lying down and ready to go to bed,” says Jeffcoat. “You can start it earlier in the evening and do them every hour until you go to bed, including when you are lying down. You can also use these breathing techniques throughout the day if you feel your heart is racing, mouth is dry, or [you’re showing] other signs of stress or distress.”

5. Do some stretching before bed

According to Jeffcoat, gently moving your body can help with both pain management and sleep. Indeed, the Endometriosis Foundation of America recommends gentle, relaxing yoga poses combined with deep breathing to help ease the pain of endometriosis.

Jeffcoat recommends two yoga poses—which you can do in bed—to specifically relieve abdominal and pelvic pain: child’s pose (aka, prayer stretch) and happy baby pose.

Here are Jeffcoat’s tips for doing child’s pose:

1. 1.
   Get on your hands and knees and slowly rock back until your buttocks touch your heels, while keeping your hands in place.
2. 2.
   Do 5-7-3 breathing and hold this pose for seven breath cycles.

“If it hurts too much in your back or abdomen to do the full position, you can also place a pillow over your thighs and stretch over the pillow,” she says.

And for happy baby pose, Jeffcoat says to:

1. 1.
   Lie on your back with or without your head supported on a pillow.
2. 2.
   Lift your legs towards your head and grab the inside part of the soles of your feet.
3. 3.
   Hold this position for four to seven cycles of 5-7-3 breathing.

“If your hips and back feel like they’re too tight to lift from the floor, start with your legs supported on a chair or couch and just stretch one side at a time,” she says.

The bottom line

Ultimately, excision surgery had the biggest effect on my endometriosis symptoms and my sleep health. But the coping strategies I’ve learned throughout my journey with this painful condition have been invaluable, and I’ll continue to lean on them to help me get the quality shut-eye I so desperately need.

What works for me might not work for everyone with endometriosis or chronic pain, but I hope my experience serves as a jumping off point for others searching for what might work best for their body.

In the end, it’s crucial to assemble an endometriosis care team you trust, who can help guide you on your quest for better sleep with the condition.

—reviewed by Angela Holliday-Bell, MD