How does sleep impact my fertility?

A white person with dark hair and black shirt laying on their side, sleeping with their black dog nestled in their arms on a dark green couch.

Sleep can be a delicious respite from a long, busy, or stressful day. But make no mistake, regular, restorative sleep is not a luxury. Restorative sleep is necessary for overall health and provides a critical reprieve for the brain and body. It allows for tissue repair and growth. If you commonly wake in the middle of the night and find it hard to return to sleep, you might suffer from insomnia. Regular disruptions in sleep or insomnia are associated with stress on mental health, immunity, hormonal regulation, and cardiometabolism and may increase overall mortality risk. Sleep disruption may also impact reproductive health, increasing the time of pregnancy, and may specifically influence ovarian reserve.

A new study was published that further explored sleep quality with ovarian reserve. Chinese researchers reported that almost one-third of 1,070 reproductive-aged women reported poor sleep quality. Poor sleep was significantly associated with diminished ovarian reserve in this cohort. The women with the poorest sleep had fewer antral follicles, higher Follicle Stimulating Hormone (FSH) levels, and lower Anti-Müllerian Hormone (AMH) levels than those with better sleep.

A pilot prospective cohort study of 183 women found that the time to pregnancy over one year may be extended in individuals with changes in daily sleep onset and sleep duration. When the number of hours or the time of sleep onset significantly varied more than 1.8 hours from day to day, it was linked to a longer time to pregnancy, with approximately 20% achieving pregnancy within the year. In contrast, about 65% became pregnant within the year among those with the least variability in sleep onset. For individuals with a difference of 2.3 hours in sleep duration from night to night, around 30% became pregnant after 12 months, compared with approximately 65% for those who had more consistent sleep.

Sleep disruptions have already been identified as a possible contributor to infertility. In women and people with ovaries. luteinizing hormone (the ovulation that triggers ovulation) and FSH (the hormone that promotes an egg’s development in the ovary) are affected by shift work, which can lead to irregular menses or subfertility.

What is good sleep?

Good sleep is defined as restorative sleep. According to the CDC, people of reproductive age need anywhere from 7 to 9 hours of sleep nightly. Each person has 4 to 6 cycles of sleep, wherein each cycle has four stages of sleep:

Stage one is the dozing off stage, lasting approximately 5-10 minutes. The brain and body are beginning to relax.

Stage two is the pre-deep sleep stage, lasting up to 25 minutes. It helps with storing memories and reducing your senses to limit sleep interruptions. The brain and body further relax, and eye movement stops.

Stage three is deep sleep, which lasts 20 to 40 minutes. It is the key to restorative sleep, as the eyes and muscles are fully at rest.

Stage four is REM sleep, lasting about 10 minutes in the first sleep cycle. It occurs approximately 90 minutes into the initial sleep cycle. Each REM stage lengthens with each subsequent cycle of sleep. The eyes move rapidly while the body remains still, entering a temporary state of paralysis.  

Restorative sleep occurs in the last two stages of sleep. Non-restorative sleep is waking unrefreshed despite sleeping 7-9 hours.

What causes poor sleep?

 The causes of poor sleep are complex and range from internal health concerns to external influences. For example, some health conditions that can disrupt sleep include chronic pain, chronic fatigue syndrome, lung disease, restless leg syndrome, insomnia, sleep apnea, and narcolepsy. Sleep disruptions can also commonly present with perimenopause. External influences that affect sleep quality and duration are stress, poor sleep hygiene, having young children, shift work, jet lag, and certain medications like corticosteroids.

What can I do to get better sleep?

Here are some common habits that contribute to better sleep quality form the CDC: 

·     Try to keep a consistent sleep schedule. Significant shifts in sleep onset and sleep duration appear to affect fertility negatively.

·     Avoid screen time at least one hour before bed, and store electronic devices like computers, tablets, phones, and other screens outside of your bedroom.

·     Try to maintain an environment that promotes a good night’s sleep. A dark, cool room is ideal.

·     If eating closer to bedtime, stick to smaller meals or light snacks focused on protein and fruit or vegetables to reduce the risk of blood sugar dysregulation while sleeping.

·     Avoid coffee or other caffeinated drinks, alcohol, or nicotine in the hours before bedtime.

·     Get plenty of fresh water and fluids throughout the day to maintain hydration, and have your last beverage approximately 2 hours before bed.

·     Exercise regularly, such as brisk walking, swimming, bicycling, gardening, yoga, tai chi, and hiking.

How does Chinese medicine view sleep?

In Chinese medicine, sleep and restorative rest are also highly valued. Sleep occurs during the Yin period of the day (nighttime) when Blood returns to the Liver (Su Wen, Ch 10). The Wei Qi moves inward to the Yin, circulating 25 times (Ling Shu, Ch 18).

A sleep disruption can damage organs, affect the Shen, and consume Jing and Blood—all vital to supporting fertility, pregnancy, and birth. Supporting sleep is a significant component in the Chinese medicine approach to supporting one’s fertility.

Can acupuncture and Chinese medicine help insomnia?

If you continue to have sleep disruptions, reach out. Chinese medicine may help. Acupuncture is a drug-free, safe medical therapy that may support sleep, especially when provided for three or more weeks. Chinese herbal medicine is also a possible support strategy. Acupuncture and herbal therapies are tailored to your individual needs based on the cause and presentation of your insomnia. Do you have hot flashes that are waking you up? Is it hard to fall asleep? Do you have to wake up to go to the bathroom? Can you get back to sleep if you wake up? Do you get 8-9 hours of sleep but still are fatigued?

 Chinese medicine can help address most root causes of insomnia, with the ultimate goal of helping you fall asleep, stay asleep, and wake up refreshed and ready for your day.