Endometriosis and Sleep
What is Endometriosis?
Endometriosis is a medical condition, usually marked by pain, in which tissue that normally grows inside the uterus is found in other parts of the body. This misplaced endometrial tissue is usually shed during a woman’s period, but in the case of endometriosis, it ends up trapped and may form cysts. Usually, the misplaced tissue is found in the fallopian tubes, ovaries, and tissues surrounding the uterus and pelvis. More rarely, it ends up in the vagina, bladder, rectum, or cervix.
In many cases, endometriosis may lead to fertility problems, including difficulty conceiving and recurrent miscarriages. Endometriosis is one of the leading causes of female infertility in the U.S. Estimates suggest that around 30-50% of women who have endometriosis will be infertile.
Endometriosis is fairly common. In fact, it affects over 11% of American women between the ages of 15 and 44. Worldwide, over 176 million women (about 10% of the female population from the onset of menstruation to menopause) are affected by endometriosis during their reproductive years. It’s most common among women ages 25 to 29.
The primary symptom of endometriosis is pelvic pain, especially during periods. Because pain is often associated with menstrual cycles, endometriosis often goes undiagnosed. On average, women wait 8.6 years between the first onset of their endometriosis-related pain and an official diagnosis.
The symptoms of endometriosis are as follows:
- Pelvic pain/pain during menstruation
- Pain during sex
- Painful and frequent urination
- Diarrhea, constipation, or IBS.
- Heavy or irregular bleeding
- Overproduction of estrogen: Scientists agree that endometriosis is exacerbated by estrogen. Many of the existing treatments meant to curb some of the symptoms of endometriosis are aimed at decreasing estrogen production.
- Genetic predisposition: First-degree relatives of women who have endometriosis are likelier to develop the condition. This means that there is likely a genetic link when it comes to the onset of endometriosis.
- Retrograde menstruation: One of the proposed causes of endometriosis is “retrograde” menstruation, in which tissue flows backward through the fallopian tubes during the menstrual cycle.
- Immune system dysfunction: Because certain cancers and forms of immune system dysfunction are more common in women with endometriosis, some clinicians believe that faulty immune systems cause the disorder.
- Surgery/physical trauma: C-sections and hysterectomies can cause symptoms of endometriosis if uterine tissue is accidentally moved to another area of the body.
Why does Endometriosis make it Harder to Sleep?
How does endometriosis disrupt sleep? There are many factors relating to endometriosis and its associated symptoms and potential complications that cause it to affect sleep health.
Here are a few of the primary ways that endometriosis can disturb sleep patterns:
Pain and discomfort
Most women with endometriosis report moderate to severe pelvic pain that increases before and during their period, as well as during and after sex. This pain, associated with endometrial inflammation, goes far beyond “normal” menstrual cramping and can negatively affect your quality of life.
If you’ve ever tossed and turned with pain at night, you know how much a painful night can affect your sleep. Pain is the most debilitating symptom on a daily basis for many women with endometriosis, and the associated sleep loss can exacerbate that pain even further.
Women with endometriosis sometimes experience symptoms similar to the uncomfortable “hot flashes” often associated with menopause. Some anecdotal evidence suggests that this is because of hormone fluctuations, while others experience hot flashes as a side effect of medications commonly used to treat endometriosis.
Because hot flashes cause a corresponding surge in adrenaline, they’re not exactly conducive to sleep! Hot flashes are associated with chronic sleep loss and insomnia, and they’re one of the many reasons that women with endometriosis might struggle with sleep health.
Women with endometriosis experience higher rates of depression and anxiety than women with any other gynecological disorder. The negative effects of chronic pelvic pain and infertility or reduced fertility on mental health can exacerbate that anxiety even further.
Anxiety and sleep disturbances often go hand-in-hand. In fact, two-thirds of patients with sleep disorders have a psychiatric disorder as well. Anxiety activates our fight-or-flight response, ramping up the areas of our brain that helps with sleep regulation. This often contributes to a feedback loop, in which people struggling with anxiety and insomnia suffer from chronic worry about not being able to fall asleep, leading to a domino effect that creates a pattern of sleep loss.
Having to go to the bathroom at night
Endometriosis is associated with a range of bladder and bowel symptoms, including frequent urination. This is because, in women with endometriosis, cells that should be in the womb end up elsewhere–like in the bladder or bowels. The body sometimes responds with negative symptoms like an overactive bladder.
It’s easy to see why urgent, frequent urination could lead to sleep problems. Women with endometriosis are likelier to have to get up in the middle of the night to use the bathroom, and they may have trouble falling back asleep due to pain or other troubling symptoms. Anxiety over potential bed-wetting could exacerbate the problem.
Women with endometriosis are likelier to experience migraines, and vice versa. Researchers aren’t sure of the reasons for the link, but there’s plenty of evidence to suggest that migraines and endometriosis often go hand-in-hand.
Unfortunately, migraine sufferers are also 2 to 8 times likelier to experience sleep problems, according to the American Migraine Association.
The link between migraines and poor sleep health is a complex problem: Migraines often make people have a harder time falling asleep. In turn, chronic sleep deprivation or oversleeping to make up for the lack of sleep that often accompanies a migraine can trigger–you guessed it–more migraines.
Longer and heavier periods
Endometriosis causes longer periods, shorter and more frequent cycles, and heavier menstrual flows for many women. It can also worsen PMS symptoms, from cramps and psychiatric symptoms to headaches and bowel-related issues, all of which can disturb sleep.
Because the hormone fluctuations associated with monthly cycles sometimes lead to sleep disturbances, including both hypersomnia and insomnia, it makes sense that women with atypically long periods would experience particularly severe sleep disruption.
Women with heavier flows may also experience anxiety around excessive bleeding. They might also wake up more frequently than normal in order to replace tampons or pads.
Distinguishing Between Fatigue and Sleepiness
Besides pain, one of the main complaints that women with endometriosis have is fatigue. When the body struggles to rid itself of unwanted tissue, it can lead to inflammation and exhaustion. Think about the last time you were really sick: No matter how much you slept, you probably still felt tired to the bone. That’s fatigue.
It’s important to distinguish between fatigue and sleepiness. Sleepiness and fatigue might go hand-in-hand in some cases, but they have distinct symptoms and effects on sleep health.
Fatigue can include both physical and mental exhaustion. If you have endometriosis and you’re feeling tired regularly, better sleep will help, but it might not be enough. Make sure that you’re seeking help from a medical professional to determine whether your exhaustion is due to chronic sleep deprivation or other symptoms associated with endometriosis.
Strategies for Sleeping with Endometriosis
Below we’ll look at three different areas to explore when figuring out how to achieve quality sleep with endometriosis.
Make sure You’re Getting the Best Treatment for You
Endometriosis often comes with a host of symptoms that can lead to sleep disruption. The good news is that there are many kinds of medical treatments available to ease your endometriosis symptoms–and get a better night’s sleep in the process.
Here are a few treatments that you can ask a qualified medical professional about if you hope to improve your sleep health while managing endometriosis.
Pain medication: Pain is the chief complaint of many women with endometriosis, and it’s also one of the primary reasons that sleep is often disturbed. Pain management is key to achieving a better quality of life with endometriosis. Particularly if you’re not experiencing other symptoms like infertility or problematic menstrual cycles, easing your pain is the first step to a better night of sleep with endometriosis.
Over-the-counter treatments for pain and inflammation, such as ibuprofen, might be enough. But if you find that your pain is persistent and severe, ask your doctor about other options.
Hormone therapy: The natural thickening, breakdown, and bleeding of endometrial tissues that happens before and during your menstrual cycle is also what causes many endometriosis symptoms to flare up. Managing the hormonal variations that regulate this cycle can significantly ease your endometriosis symptoms.
Options for hormone therapy that your doctor might recommend include progestin therapies, hormonal contraceptives, and other drugs that lower your estrogen levels. All of these therapies, when used for endometriosis, are designed to lighten, shorten, or stop your menstrual cycles in order to curb abnormal tissue growth and relieve your associated symptoms.
Surgery: The bothersome endometrial tissues can be surgically removed by a doctor, whether laparoscopically (more commonly) or, in very severe cases, via hysterectomy. While the tissue might grow back, many women do experience improved symptoms and a great deal of relief after surgery. And laparoscopic surgery in particular is minimally invasive, so your recovery time should be manageable.
Surgery to treat endometriosis has two primary goals: to ease pain and inflammation and to improve fertility. Surgery might also improve your sleep or any chronic insomnia you experience, especially if pain or anxiety related to infertility is keeping you up at night.
Fertility treatment: If endometriosis is causing you to have trouble getting pregnant, your doctor may recommend fertility treatments to help you conceive. Fertility treatments might include medication to stimulate ovulation, or more complex procedures such as in vitro fertilization.
Fertility treatments most likely won’t have a direct effect on your endometriosis symptoms or related sleep issues. Instead, managing your fertility alongside a medical professional might ease the anxiety and depression that often accompany infertility, thus improving any chronic sleep problems you might have.
Create the Ideal Environment for Sleep
Regulate the Temperature of Your Sleep Space and Body
The effects of painful menstruation, the possibility of hot flashes from prescribed medications, and the general rules of sleep hygiene all indicate that keeping a cool temperature is crucial to getting good sleep with endometriosis.
Keeping your body temperature well-regulated (“thermoregulation”) is key to achieving a good night’s sleep. With endometriosis symptoms, temperature regulation becomes all the more important for quality rest. There are a few ways to achieve thermoregulation while you sleep:
- Keep your bedroom cool. The best temperature for falling asleep is between 60 and 67 degrees Fahrenheit. You shouldn’t be falling asleep shivering or waking up sweating.
- Use lightweight, breathable bedding and a softer mattress. Firmer mattresses and body contouring mattresses will increase your body temperature at night, so opt for an airbed or innerspring mattress if you can.
- Keep cool refreshments, such as water, near the bed at night. If you wake up unexpectedly, you can cool yourself down right away.
Practice Excellent Sleep Hygiene
It’s always important to practice good sleep hygiene. It’s especially crucial if you want to ease any disruption in your nightly rest that your endometriosis symptoms may be causing.
There are a few key principles that will maximize your chances of achieving better sleep health with endometriosis:
- Know how much sleep you need: The average adult needs 7 to 7.5 hours of sleep a night. In general, you should aim to get at least 7 hours of sleep a night.
- Go to bed at the same time every night and follow a bedtime routine: Try to go to sleep at the same time every night and wake around the same time every morning. Use a sleep diary or sleep tracker if you’re struggling to keep track.
- Find a dark, cool, quiet place to sleep: A dark, quiet room that’s kept between 60 and 67 degrees Fahrenheit and as free of noise pollution as possible will give you the best possible night’s sleep.
- Dedicate your bed only to sleep and sex: Treat your bedroom as a haven for rest. Don’t use your bed for work, texting, talking on the phone, or anything else that might distract you.
- Limit screen time: It’s tempting, but try to stop using phones, computers, tablets, televisions, e-readers, or any other electronics that use blue light at least one full hour before bed.
- Eat well, exercise, and get sunshine during the day: A healthy day makes for healthier rest. Getting sunshine during the day will regulate your circadian rhythm, while eating nutritiously and exercising strenuously will help you sleep better when it’s time.
- Avoid substances like caffeine and alcohol before bed: Caffeine can jump-start your adrenaline, while alcohol disrupts essential REM sleep. Avoid both substances close to bedtime.
Use Relaxation Techniques while Trying to Sleep
Relaxation techniques such as meditation exercises can prove to be a fundamental part of your nightly sleep routine.
In terms of endometriosis, relaxation techniques can have a dual benefit: both in terms of aiding sleep and in easing related symptoms of anxiety and even chronic pain. Here are a few mindfulness meditation techniques you can use to help you drift off to a restful night of sleep.
Progressive Muscle Relaxation: Begin a progressive muscle relaxation practice by turning out the lights and doing some deep breathing. Focus on any areas of tension in your body. Then, tense and contract each muscle in your body for five seconds, followed by at least 30 seconds of full relaxation of that muscle. Do this with every part of your body, from the top of your head to your toes. Slowly, you’ll drift into a deep state of relaxation and let go of any remaining tension.
Mindful Breathing: Breathing meditation involves being mindful of your inhales and exhales in a relaxed state. Turn off your bedroom lights and get comfortable. Notice any tension in your body, and don’t try to breathe differently than you normally would. Follow the path of your breath, breathing in through your nose and out through your mouth. As you meditate, try to gradually make your exhales longer than your inhales. If you get distracted, don’t judge yourself: Simply refocus your attention (gently) back on your breath.
Counting Meditation: Thoughts invade our brain constantly, whether we want them to or not. Counting meditation is designed to get you to refocus your attention to something simple and straightforward: counting. After you get your room dark, cool, and comfortable, start to count slowly. You can count out loud or silently in your head. Either way, redirect your attention to the numbers anytime your mind starts to wander (but don’t be hard on yourself if it does!). Count until you reach a certain number, or until you fall asleep.
Guided Meditation: Guided meditations can include all of the above, in addition to repetitive mantras or chanting, music, or storytelling. There are plenty of guided meditations available on YouTube and platforms like iTunes for you to follow along with. Using headphones or simply your phone, set your device to the right volume and follow along. As with the other forms of meditation, make sure that you’ve practiced good sleep hygiene by resting comfortably in a dark, cool room, and redirect your attention gently to the meditation leader’s voice anytime your mind wanders.
Use of Sleep Aids
If relaxation methods and sleep hygiene practices still don’t get you the rest you need with endometriosis, there are many sleep aids you can try. Here are a few of the most popular sleep aids on the market, as well as some of their potential side effects.
|SLEEP AID||DESCRIPTION||AVAILABILITY||SIDE EFFECTS|
|Antihistamines||Antihistamines are typically used to treat allergic reactions, but can also cause drowsiness. Medications such as Unisom or Benadryl are most often used.||Over-the-counter||Side effects include dry mouth, dizziness, nausea, drowsiness, and difficulty concentrating.|
|Melatonin||Melatonin is a hormone that regulates and spurs the onset of sleep. While naturally occurring, it’s available in supplement forms.||Over-the-counter in the U.S.||Melatonin can disrupt hormonal regulation. There are some cases showing it lowers sperm count in men. In higher dosages, melatonin can cause hypersomnia.|
|Sleep Teas||“Sleep teas” are caffeine-free herbal teas that claim to improve sleep. Chamomile tea and valerian tea are the most popular.||Health food stores, online||Chamomile tea can cause allergic reactions and is a blood thinner. Valerian root can be addictive.|
|CBD||CBD oil, or cannabidiol, is one of the chemical compounds found in cannabis. It helps with pain relief, relaxation, and sleep.||Check your local laws to ensure legality.||Side effects can include fatigue, dizziness, changes in appetite, diarrhea, and dry mouth.|
|Prescription Sleep Medicines||Most prescription sleep medications act on the benzodiazepine receptors in the brain to cause sleepiness. “Z-drugs” include medications like zaleplon (Sonata), while benzodiazepine medications, such as temazepam (Restoril) are used to treat anxiety disorders and also have sleep-inducing effects.||Prescription only||Both non-benzodiazepine and benzodiazepine drugs can be habit-forming. They also may cause central nervous system depression, which can result in coma and death. No prescription sleep medications should be combined with alcohol.|
Endometriosis is a common medical condition among women in their reproductive years. The pain and other symptoms that often result can lead to disrupted sleep and chronic sleep deprivation.
Still, ample resources are available. Hormonal treatments, surgery, fertility treatments, and pain management from qualified medical professionals can all help to ease the troubling endometriosis symptoms that often lead to sleep disturbances.
To manage sleep problems, women with endometriosis can practice good sleep hygiene and use sleep aids for a good night’s rest. With endometriosis, symptoms can be difficult, but relief is possible.
Resources for Endometriosis Treatment
If you or someone you know is experiencing sleep disruption associated with endometriosis, here are some helpful resources:
- For general information on endometriosis, check out the resources at Planned Parenthood, the U.S. Department of Health and Human Services, and the Endometriosis Research Center.
- If you’re wondering where to find the best endometriosis specialist for you, read about what factors to consider at the Endometriosis Foundation of America.
- Wondering what to ask your doctor when considering surgery for endometriosis? This resource from the Endometriosis Association will help.
- If you’re struggling with infertility, the National Infertility Association has plenty of helpful resources to guide you.