Can birth control cause insomnia? The experts explain

WWhen it comes to hormonal contraception, two somewhat contradictory things are true. This type of medication allows millions of people with a uterus to safely plan their families, treat acne, and manage painful hormonal health conditions (and maintain autonomy over their reproductive futures). Yet at the same time, many people aren’t always enthusiastic about the side effects that often come with hormonal birth control—side effects that rarely get the attention they deserve in medical research.

This is incredibly true when it comes to how birth control affects sleep. Peruse social media and you’ll find plenty of videos of people talking about how they battled insomnia after starting the pill or other form of birth control. Yet other people swear by the same medication that helps them pass out like a baby every night. What gives?

The short answer: we’re not sure. Even the experts wish there were more definitive answers about how birth control affects our sleep. “The data on birth control and sleep is mixed,” says Stephanie Hack, MD, a board-certified obstetrician-gynecologist and founder of Lady Parts Doctor. “While there are studies that suggest that sleep quality/efficiency improves or worsens, there are others that do not suggest any change.”

That said, years of working with patients and an in-depth understanding of hormones have given hormone health experts first-hand information about how birth control might affect a person’s sleep.

The sleep x hormone connection

According to Dr. Hack, the inconsistent way that hormonal birth control affects sleep from person to person is due in part to additional factors that complicate the picture. “Many different things can affect your sleep, such as medical conditions, mental health, your environment, technology use (i.e. blue light), substance use, your diet, and more,” she says. “It’s hard to control for all of these things when trying to determine if birth control is to blame for reduced sleep efficiency (or) quality.”

This is probably why previous research on the subject has had such mixed results. For example, a 2020 study published in the sleep research journal concluded that hormonal contraceptives can interfere with the quality/quantity of sleep and may be associated with insomnia. But that contradicted the results of an earlier 2012 study published in the International Journal of Gynecology and Obstetrics, who found that birth control could actually improve sleep efficiency. Cue the confusion.

“(Sex) hormones play a crucial role in regulating sleep patterns, and any change in their levels can impact the quality and quantity of sleep,” —Jasmine Pedroso, MD MPH, FACOG, OB/GYN at Kindbody.

But what do your sex hormones have to do with sleep? It turns out that estrogen and progesterone, which regulate your menstrual cycle, also help control your body’s thermostat and therefore play a big role in your sleep, says Aimee Eyvazzadeh, MD, MPH, a California-based reproductive endocrinologist.

In the simplest terms possible: Your body lowers your core temperature before it’s time to go to sleep. This helps prepare you for sleep and ensures you get the most restful sleep possible; it is a normal part of your circadian rhythm. And both estrogen and progesterone play a role in this process. “Estrogen lowers body temperature, while progesterone increases body temperature,” says Dr. Eyvazzadeh.

Progesterone has other unique influences on sleep besides temperature regulation, adds Dr. Eyvazzadeh. “Progesterone also has a naturally calming and sedative effect,” she says. “Imbalances in these hormones can cause changes in the sleep cycle.” Low progesterone levels have been linked to sleep problems.

Can birth control cause insomnia or ruin your sleep?

For some people, adding hormonal birth control (whether it’s combination birth control pills, an intrauterine device, also known as an IUD, or a progestin-only pill) to the mix can affect their sleep patterns.

“(Sex) hormones play a crucial role in regulating sleep patterns, and any change in their levels can have an impact on sleep quality and quantity,” says Jasmine Pedroso, MD MPH, FACOG, OB/GYN at Kindbody. “With hormonal birth control (like the pill), the introduction of synthetic hormones can create fluctuations in estrogen and progesterone levels. These changes can affect your body’s natural sleep-wake cycle and potentially lead to disruptions in your sleep patterns.” In short, the new hormone levels may cause you to have trouble falling asleep or staying asleep. (Hello, insomnia!)

Dr. Pedroso says the extent of these effects can vary between individuals. While one person may experience a drastic change in their sleep schedule, another person may not even notice the difference. According to Alisa Vitti, HHC, founder of FLO Living, this could be due to his hormonal status prior to taking the pill.

“Some women who have low progesterone levels due to hormonal imbalances before taking a progestin-containing pill might find improved sleep, possibly due to a higher daily dose of progestin,” says Vitti. “Those whose progesterone levels drop after taking the pill from a normal level before starting the drug could experience common progesterone insomnia insomnia, as their daily dose would drop.”

Some of the variable effects on sleep could also have to do with the type of contraception. “The (Mini-Pill) contains only progesterone, which can have sedative effects and promote drowsiness,” Dr. Pedroso says as an example. (In comparison, combined birth control pills have estrogen and progesterone.) “However, (progestin-only birth control pills) can also cause fragmented sleep with more awakenings during the night.” Then there’s the hormonal IUD, which she says releases a small amount of progesterone directly into the uterus. “While systemic absorption is very low, some people may still experience sleep pattern changes similar to progesterone-only pills,” she says.

If you’re on a birth control pill (regardless of whether it’s both progesterone and estrogen or just the former), the timing of your dose could also affect your sleep cycle. Birth control pills reach their highest concentration in the blood within an hour or two of taking them, says Dr. Hack. Each pill then lasts for around 24 hours. “The best time to take them depends on two factors: when you’ll remember to take them, and how/if you feel your sleep is being affected,” he says. If you feel that your pill is negatively affecting your sleep, try taking it in the morning. That way, “the peak concentration (of hormones) is reached while you’re awake,” he says. If you feel that your birth control method helps you sleep, continue taking the pill at night.

How to catch up on sleep

Of course, there are also other factors that have nothing to do with birth control that make people with a uterus more prone to sleep problems. “Women and people with a uterus are twice as likely to be diagnosed with depression than their male/non-uterus counterparts,” says Dr. Hack. “Many mental health conditions are linked to lack of sleep, such as depression, anxiety, and psychological stress.”

There’s also sleep apnea, a sleep disorder in which a person’s breathing starts and stops throughout the night, “resulting in lack of sleep and fatigue during the day,” adds Dr. Hack. Anyone can have sleep apnea, but the symptoms are different for people with a uterus and don’t always involve snoring (think anxiety, depression, morning headaches, waking up frequently during sleep).

Our bodies are unique, including how they respond to medications. That’s why Dr. Pedroso says it’s important to keep track of any changes you notice and report any concerns to your trusted healthcare provider. That way, he will receive “one-on-one guidance to find the right balance between contraception and maintaining healthy sleep patterns.”

In the meantime, taking steps to support healthy sleep is a win-win, and there are plenty of expert-approved ways to get started. Dr. Hack is a big believer in “creating a bedroom environment that supports healthy sleep and a bedtime routine that signals your body that it’s the right time and place to fall asleep.” She recommends limiting screen use (and blue light exposure) at night, as well as avoiding caffeine or late-night eating, all of which can disrupt her sleep.

Dr. Pedroso also says that mastering stress management techniques is key to getting a better night’s sleep. “Manage stress through relaxation techniques, mindfulness, or activities that help you unwind before bed,” she says. With these tips up your sleeve, you’ll be sleeping like a baby in no time.

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