My doctor recommended continuous hrt because the (oral) micronized progesterone helps with sleep. My understanding is that both estrogen and the (oral) micronized progesterone can help, and micronized progesterone affects GABA -- when I started taking 200 mg micronized progesterone a night, within two days I went from waking up at 2 or 3 am to sleeping until 6 am. Taking a higher dose of progesterone every night did eventually cause other (less serious) problems for me, but everyone is different, and my doctor said she does have success putting some people who still have periods who have sleep problems on continuous hrt. It's also possible to take 100 mg micronized progesterone for the first couple of weeks, and 200 mg the second couple weeks, so it is in effect a sequential regime, and this may be more typical. My doctor also told me higher doses of estrogen in peri are often necessary to repair broken sleep. For some women, taking sequential hrt with the progesterone only in the second half of the cycle may be enough to help with sleep.
Sounds like you already are on hrt, but for others who decide to try hrt, my experience was that the micronized progesterone helped with sleep within a couple nights. The estrogen effects on sleep seemed to take more time to cohere, and it does take some time to arrive at the right dose. For me, HRT treated many symptoms I didn't even know were being caused by hormones, and it helped more than anything else with sleep. My doctor thought doing anything but hrt for hormone related sleep issues was not addressing the real underlying problem, and she said this was the place to start.
I went through the threads on this forum and saw others mentioned trying melatonin, CBD, and antidepressants with some success. I do think antidepressants are often prescribed for this issue. Some antidepressants are particularly good for sleep, although many of them may help. Mirtazapine is one that is often mentioned (Remeron). Trazadone is also often mentioned.
For those who don't want to take hrt or anti-depressants, there are herbal preparations that help with hormones that may help with sleep. I have heard of people taking vitex berry and black cohosh, as well as other formulations, but I haven't tried any of this as my doctor said hrt would likely be more effective for my level of problems.
Others also mentioned sleep hygiene issues, including getting plenty of exercise; getting lots of exercise does help me with sleep. The sleep hygiene conversations can feel a bit invalidating if your sleep hygiene is already good because hormones are definitely involved, but trying all the tips was helpful to me to see the other factors that influence sleep, even though hormones began the problems. There is a lot on the web about sleep hygiene and there are even some CBT sleep hygiene programs / apps on the web that could be useful, although this isn't addressing the hormone component, which for me was important. It is worth thinking about, especially if you go on hrt and this isn't enough.
Drinking coffee was something I had to take a new look at in the sleep hygiene department that some may not know influences hormones. Coffee (and even green tea) don't just influence wakefulness, there is research suggesting they also affect our hormone levels (and these effects might be helpful or harmful and may be different for different women). I used to drink fully caffeinated coffee and at times during my work on sleep I had to eliminate caffeine entirely. More recently, I've been able to have smaller amounts of caffeine than I used to drink -- less than 1 cup of coffee a day -- but I have to be careful to monitor how late in the day it works to have caffeine and still get a good night's sleep. The rate of eliminating caffeine from the body is different for different people. I noticed that at different points in my cycle, and different hrt doses, caffeine was affecting me differently. Sometimes I could tell it wasn't a good idea because I already felt wired.
I can't take antidepressants, but got in the habit of taking a tryptophan supplement at night, which was helpful for me. I recommend being careful to get tryptophan and not 5-htp, as 5-htp can keep some people awake. Both are helpful with serotonin and might be an alternative to antidepressants, although their effects are much less pronounced.
I also tried a lot of other supplements, in addition to the tryptophan. I have been taking magnesium at night, which is really helpful for me. There are lots of different forms of magnesium, so it's worth reading and experimenting and seeing which form is best for you.
I also tried GABA supplements, and lavender sleep supplements, which didn't particularly help me, but seem to have been helpful to some others. I tried L-theanine and Relora, which might have helped me some?
I tried gabapentin (this is a drug not a supplement), which I don't like to take every night as I find it sedating/depressing the next day, but it is excellent for me to be sure I will sleep after a night of poor sleep, and I have minimal side effects if I don't take it 2 days in a row. I only take 100 mg, but it comes in larger doses for people who tolerate more. Some people take it regularly for sleep (not intermittently like me), and some have found it helpful for hot flashes.
Some people on the forum have commented on the risks of benzodiazepines, which I agree with in terms of taking regularly, but right before my period my sleep is absolutely horrendous, and if I have a night where I don't sleep at all, the next night I take .5 or 1 mg of ativan, being careful never to take it 2 nights in a row. This has worked for me in terms of not developing dependence on it, but putting a cap on how horrible sleep problems can get. Its effects on sleep wear off if you take it regularly, and as others stated, it is possible to develop dependence and have a hard time getting off, so it takes a measure of discipline and is probably only justified for occasional use if there are serious problems and you feel you can be responsible with it. Doctors often don't want to prescribe it if there is any kind of addiction history, and it is probably a last resort only for occasional use for most people.
Maybe others can add if there are things I missed; when I searched the forum for "insomnia" and "sleep" I found lots of threads, but it was hard to find a good summary in one place, and I want to help the sleep deprived!
Best of luck with it; the sleep problems are hard.
Warmly,
karab
. After my periods disappeared I didn't stop carrying protection for 5 years ....... on an in case basis!