People With PCOS Tend to Struggle With Sleep. Here’s Why, and How to Get Better Rest

PCOS creates an overproduction of androgens—or sex hormones like testosterone—and an underproduction of hormones created by the ovaries, like progesterone. This hormonal imbalance causes several small cysts to grow on your ovaries, along with other symptoms like irregular periods, infertility, obesity, acne, and heavy hair growth on your chest, face, and arms, per the Mayo Clinic.

But many people don't realize that PCOS and sleep are also connected. There is evidence suggesting that people with PCOS are at an increased risk for sleep issues like sleep apnea, insomnia, and fatigue.

“It’s estimated¹ that women with PCOS have a 30-fold higher prevalence of sleep disturbances than women in the general population,” says Chester Wu, MD, a medical reviewer for Rise Science who's double board-certified in psychiatry and sleep medicine. “PCOS is also associated with other health conditions that can affect sleep, like obesity and depression, as well as sleep disorders like obstructive sleep apnea (OSA).”

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Below, learn more about PCOS and sleep issues, plus how to treat PCOS fatigue and how to get better sleep overall.

Why does PCOS affect sleep?

PCOS doesn’t just play a role in your fertility and sexual health. The condition can touch nearly every aspect of life, including how you sleep. As we've learned, PCOS increases androgen hormones while reducing the amount of progesterone circulating in your body—a hormone that plays a role in how your brain regulates sleep, according to Yale Medicine.

“Low levels of circulating ovarian hormones affect the brain's ability to produce and use hormones GABA and serotonin, which directly act on the areas of the brain that control sleep,” says Chelsie Rohrscheib, PhD, head sleep expert and neuroscientist at Wesper.

According to Dr. Rohrscheib, low estrogen and progesterone can affect sleep quality in three main ways—prolonged sleep latency (or the time it takes you to fall asleep), frequent awakenings during the night, and a lowered arousal threshold, which means your brain is much easier to wake up than usual. As a result, people with PCOS can feel the hallmark symptoms of insomnia.

Additionally, Dr. Rohrscheib says that low estrogen and progesterone raise a women's risk of developing obstructive sleep apnea, a type of breathing disorder that causes long pauses in breathing as you sleep, due to airway blockages. “PCOS increases body-wide adipose tissue [body fat], including on your neck, abdomen, and chest, which makes airway obstruction more common. Plus, low ovarian hormones cause a weakening of the muscles that help to keep your airways open,” says Dr. Rohrscheib.

These sleep disturbances—including insomnia and sleep apnea—can affect your daytime hours, too. It’s not uncommon for people who have PCOS-related sleep disturbances to also have excessive daytime sleepiness, cognitive issues like brain fog or poor concentration, fatigue, and morning headaches.

Finally, it’s important to understand that poor sleep quality can worsen your PCOS. Sleep is essential for hormone control and without enough rest, hormone function can suffer. In a March 2020 study in the Journal of Circadian Rhythms, researchers found that sleep deprivation lowered sex hormones in both men and women, thereby affecting overall health.

How to get better sleep with PCOS

You don’t have to just “grin and bear it” when it comes to PCOS and sleep issues. Below, our experts break down some strategies to try to help you get a good night's rest.

Manage stress and cortisol levels

A chronic lack of sleep can put the body under unnecessary stress, which can further mess with your hormones. “Chronically poor sleep keeps your nervous system in a constant state of fight-or-flight mode,” says Dr. Rohrscheib, “which results in an overabundance of cortisol production, which itself, is a very wake-promoting [hormone] and can make insomnia worse.”

To help lower your cortisol levels, avoid stress-inducing activities right before bed like scrolling on your phone and last-minute emails. You may also think about seeing a therapist to learn some stress-management techniques. Dr. Wu says cognitive behavioral therapy for insomnia (CBT-I) is typically the gold-standard treatment for these issues.

"Chronically poor sleep keeps your nervous system in a constant state of fight-or-flight mode, which results in an overabundance of cortisol, making insomnia worse." —Chelsie Rohrscheib, PhD, neuroscientist

Set yourself up for success with sleep hygiene

Because people with PCOS are already prone to insomnia, Dr. Rohrscheib recommends being extra proactive about your sleep hygiene. Try to stick to a sleep schedule by going to bed and waking up at around the same time every day—including weekends. Ideally, you should allot for 7 to 9 hours of sleep every night.

It's also helpful to avoid caffeine late in the day, and heavy meals right before bed, which could keep you awake. And doing things like reducing your alcohol intake and quitting smoking can improve your sleep quality, too, says Dr. Wu.

If your PCOS leaves you prone to hot flashes or night sweats, Dr. Rohrscheib also recommends investing in a cooling mattress topper, cooling sheet sets, or breathable bedding. Finally, take stock of other environmental factors in your life that could be disturbing your sleep—like the temperature in your room (ideal is between 60 and 67 degrees Fahrenheit), the amount of light, etc.

Get tested for sleep apnea

If you have any symptoms of sleep apnea—like snoring, waking up at night gasping or choking, or morning headaches—you may want to get tested for the condition. “Sleep apnea not only reduces sleep quality, but it also carries a large risk for many chronic health conditions,” says Dr. Rohrscheib. If you are diagnosed with sleep apnea, your doctor will work with you to determine the best treatment, like a C-PAP machine to help you breathe at night. Sleep apnea, PCOS, and menopause can have overlapping symptoms, so it’s important to be tested by your doctor or a sleep specialist.

Consider diet, weight, and metabolic factors

Many people with PCOS also have metabolic disease—a cluster of conditions like high blood pressure, high blood sugar, and cholesterol issues that increase the risk of heart disease, stroke, and diabetes, per the National Institute of Health. Just like PCOS, metabolic issues can lead to sleep disturbances, says Ana Maria Kausel, MD, board-certified endocrinologist and co-founder of Anzara Health.

“Fixing metabolic issues is key,” says Dr. Kausel. For her patients, Dr. Kausel says this is often achieved through slight weight loss—at least 5 percent of your body weight. But of course, talk to your doctor about what's appropriate for your body size and overall health.

Along with weight management, Dr. Kausel says medication may be needed, but she also recommends lifestyle changes like eating fewer refined carbohydrates and getting more exercise. To fully address metabolic factors, though, it's best to talk with your doctor about your options. (More on this below.)

Talk to your doctor about treatment and medications

If you're still finding it difficult to manage your PCOS and sleep issues,  there are viable treatment options for both. Dr. Rohrscheib says most treatments will look at ways to help regulate hormones at night and prevent night sweating and hot flashes.

Hormonal therapies can help stabilize your hormone levels, and potentially benefit sleep. But the time of day you take these medications will especially matter when it comes to sleep. “If you're taking progesterone as part of your PCOS treatment, try to take it at bedtime,” says Dr. Rohrscheib. “Progesterone supports serotonin, which promotes relaxation and sleep, so taking it at bedtime is like taking a gentle sleeping pill.”

Other options include short-term medications, insomnia therapy programs, and treating any other conditions you may have that affect sleep, like depression.

When to see a doctor

While sleep issues are considered chronic if they last more than three months, you don't have to wait that long to talk to your doctor, especially if your sleep problems are from your PCOS. Dr. Wu recommends seeing your doctor if you have consistent sleep disturbances that last more than a few days.

Additionally, because people with PCOS are so disposed to sleep apnea, Dr. Rohrscheib says to look out symptoms like excessive daytime sleepiness, snoring, choking or gasping for air, frequent nighttime urination, or dry mouth, and talk to your doctor as soon as possible.

Early intervention can prevent complications and improve overall well-being, says Dr. Wu, so it’s important to talk to your doctor before your sleep issues start affecting your day-to-day life.

—medically reviewed by Angela Holliday-Bell, MD