What should you know about premenstrual insomnia?

You may lie awake, wake repeatedly, wake earlier than planned or sleep but feel unrefreshed. Daytime sleepiness and difficulty concentrating can follow. Record bedtime, wake time, awakenings, caffeine, medicines, mood and the first day of bleeding for several cycles. Improvement after menstruation begins supports a cyclical pattern, while sleep trouble through the whole month may point to insomnia, anxiety, depression, burnout, jet lag or another cause.

Keep a steady wake time, use a dim and quiet wind-down routine, and reserve the bed for sleep. Limit late caffeine, nicotine, alcohol and heavy meals; keep the bedroom cool and dark. If you are awake for a prolonged period, move briefly to a calm activity in low light and return when sleepy. Bring your sleep record to a clinician, who can review mental health, medicines and possible sleep disorders and discuss structured insomnia treatment.

Seek an appointment when poor sleep affects driving, work, mood or safety, lasts beyond the premenstrual phase, or keeps returning. Get urgent help for suicidal thoughts, severe confusion, unusual periods of little need for sleep with racing thoughts, or any situation in which you cannot stay safe.

Does my sleep diary suggest premenstrual insomnia? Could a medicine, anxiety or depression be contributing? Which sleep treatment fits my health and pregnancy plans? When should I seek urgent help?