PCOS Fatigue: Understanding and Addressing It
Does PCOS make you tired?
Are you experiencing PCOS fatigue or PCOS insomnia?
Know that you are not alone. PCOS fatigue, PCOS insomnia, and sleep disturbances are all common. There are days when my PCOS fatigue makes me incapable of getting out of bed when my alarm sounds, probably because I was dealing with insomnia the entire night before. I swear I write movies in my dreams and solve the world’s most complex issues when I should be asleep. That’s how active my “sleep” is. But why? Why do so many of us with PCOS struggle with feeling tired, extreme fatigue, and insomnia? Like everything with PCOS, it’s complicated…so let’s dive in.
Note: This post begins with an overview of why PCOS can cause fatigue across three categories: 1. Hormonal Imbalance; 2. Nutrient Deficiencies; 3. Sleep Disturbances. The final section of the post “Addressing PCOS Fatigue” discusses recommendations for remedying PCOS fatigue
Hormonal Imbalance
PCOS is an endocrine disorder. Given that, hormonal imbalance can cause “PCOS insomnia” and “PCOS fatigue”
High Cortisol:
A meta-analysis of 41 studies was conducted to compare cortisol levels in people with PCOS against people without PCOS. What they found was significantly higher cortisol levels in those with PCOS. When in balance, cortisol regulates our use of carbohydrates, fats and proteins. It helps with keeping down inflammation, regulates blood pressure and blood sugar. Cortisol also assists with control of our sleep and wake cycle, or our circadian rhythm. Chronically heightened cortisol levels disrupt our body’s ability to increase this hormone to give us energy to wake up, and decrease the hormone in favor of naturally occurring melatonin when it’s time to sleep. This can lead to daytime sleepiness and nighttime restlessness.
Low Progesterone:
According to Yale Medicine, progesterone is a “relaxing hormone” that can have a mildly sedative effect. In people with PCOS, progesterone levels are often lower than in those without PCOS. Chronically low progesterone levels can contribute to sleep difficulties, resulting in “PCOS fatigue”.
Vitamin D Deficiency:
Contrary to its name, Vitamin D is a hormone produced by the kidneys, and, spoiler alert: when it’s deficient, it can cause major fatigue. We can also get it from sunlight and our diet. Vitamin D controls blood calcium concentration, impacts the endocrine, cardiovascular and immune systems, and helps our cells to generate energy through use of oxygen. A study conducted in China compared Vitamin D levels in those with PCOS against levels in those without PCOS, revealing significantly lower levels of Vitamin D in those with PCOS. Vitamin D deficiency was also significantly higher in those with PCOS versus those without PCOS. So, if you’re scratching your head wondering why you are so tired even after a full night’s sleep, Vitamin D deficiency may be the culprit.
Hormonal Imbalance Driving PCOS Fatigue:
What To Do
Get a blood test to investigate your hormone levels and discuss next steps with your doctor. Developing practices to manage stress are key to managing cortisol levels. Sunlight, salmon, and egg yolks are great natural sources of Vitamin D if you are deficient.
Nutrient Deficiencies:
Many individuals with PCOS may feel tired or experience fatigue because of certain nutrient deficiencies. A few of the main culprits are listed below
Iron:
Iron deficiency anemia can leave you feeling fatigued because your body effectively is not getting enough oxygen. Without proper iron, we can’t produce hemoglobin, something in our red blood cells that carries oxygen to all parts of the body. You may not be getting enough iron if you lose a lot of blood during your periods or have slow chronic blood loss. Not consuming enough iron through meat, eggs, and leafy greens can also contribute. Pregnancy or an inability to absorb iron are also causes of iron deficiency anemia.
B12, B6, Folate (B-complex vitamins):
Common medications used to treat symptoms of PCOS can contribute to B-complex vitamin deficiencies. Similar to iron deficiency anemia, B12 deficiency means a lack of healthy red blood cells, again contributing to the body not receiving the proper levels of oxygen. Metformin, used to treat insulin resistance, blocks the absorption of vitamin B12. Oral contraceptives, often used to treat PCOS acne, PCOS irregular menstruation cycles and more, are also associated with lower levels of vitamins B6, B12 and folate. Natural sources of B-complex vitamins include oranges, leafy greens, broccoli, lentils, eggs, meat, poultry and shellfish.
Magnesium:
Type II diabetes can cause a magnesium deficiency. According to the CDC, more than half of people with PCOS will develop either diabetes or pre-diabetes before age 40. Additionally, digestive problems, which are fairly common in people with PCOS can contribute to any nutrient deficiencies. Spironolactone, a medication often used for its anti-androgen effects in PCOS, is a diuretic. Long-term use of diuretics can also contribute to a magnesium deficiency. Natural sources of magnesium include almonds, pumpkin seeds, dark chocolate, peanuts and popcorn.
Nutrient Deficiencies Driving PCOS Fatigue:
What To Do
Getting a blood test can reveal whether you have nutrient deficiencies. Discuss next steps with your doctor. Incorporating a diverse source of nutrient-dense foods into your diet can help, and in some cases, your doctor may recommend a daily supplement.
Sleep Disturbances
Individuals with PCOS often report insomnia, trouble falling asleep and trouble staying asleep. This can contribute to daytime fatigue, and there are various potential causes:
Reactive Hypoglycemia:
The choice of meal we make can influence both our energy levels after eating, as well as whether we have restful sleep. High glycemic load meals or snacks too close to bed can cause reactive hypoglycemia while we sleep. What this means is that if we eat too many carbohydrates at once, or if we do not balance our carbohydrates with protein, fiber and healthy fats, our bodies have to produce a lot of insulin quickly. The goal is to bring blood sugar back down, and get glucose out of our bloodstream and into our cells. This brings down blood sugar too rapidly for the complement, glucagon, to keep up. Glucagon is responsible for restoring blood sugar levels, but when it’s not yet in adequate supply, we experience a “sugar crash”. Sugar crashes have been associated with energy crashes during the day, and disrupted sleep and vivid dreams at night, which can lead to daytime fatigue.
Low GABA:
GABA is an amino acid that serves as a chemical messenger, or neurotransmitter, in the brain. Thus far, researchers have discovered GABA’s primary role is to calm the brain by blocking certain signals in the central nervous system. One study of PCOS patients in Egypt showed significantly lower GABA levels versus individuals without PCOS. Since activation of GABA receptors promotes restful sleep by slowing down the brain to reduce stress and lower anxiety, low levels may make it difficult to get restful sleep. Natural sources of GABA included fermented foods like kefir, yogurt and kimchi, as well as certain teas, almonds, walnuts, fish, citrus, tomatoes, berries and leafy greens.
Daytime Stress and Anxiety or Depression:
Dreaming helps us consolidate memories, process events, rehearse for future situations, and more. If we experience daytime stress and anxiety, or are worried about a future event, that can disrupt our sleep either through inability to fall asleep because of active minds, or overactive thoughts inhabiting our dreams. Additionally, anxiety and clinical depression can interfere with our sleep patterns, energy levels and overall motivation.
Obstructive Sleep Apnea
Obstructive sleep apnea is common in PCOS, and it causes a physical blockage in our airways. When we are low on oxygen, we likely have more fragmented sleep. Lack of oxygen also means our bodies can experience stress, which can manifest in vivid dreams, contributing to poor sleep.
Addressing PCOS Fatigue
Get a blood test to investigate your hormone and nutrient levels
Discuss next steps with your doctor. Consider lifestyle changes to help with imbalances shown in your test results:
Cortisol: Adopt practices to manage stress
Vitamin D: Get proper sunlight, or use UV therapy; eat Vitamin D rich foods like salmon and egg yolks. In some cases, a supplement may be recommended
Iron: Consume iron rich foods such as meat, eggs and dark leafy greens. In some cases, a supplement may be recommended
B-Complex Vitamins: Natural sources of B-complex vitamins include oranges, leafy greens, broccoli, lentils, eggs, meat, poultry and shellfish. In some cases, a supplement may be recommended
Magnesium: Natural sources of magnesium include almonds, pumpkin seeds, dark chocolate, peanuts and popcorn. In some cases, a supplement may be recommended
GABA: Natural sources of GABA included fermented foods like kefir, yogurt and kimchi, as well as certain teas, almonds, walnuts, fish, citrus, tomatoes, berries and leafy greens. In some cases, a supplement may be recommended
Avoid meals that have a high glycemic load
This will help prevent reactive hypoglycemia while you sleep, especially by avoiding these meals close to bedtime. If you want a bedtime snack, opt for something high in protein. Balance meals throughout the day to avoid reactive hypoglycemia that can induce fatigue during the day.
Explore mindfulness practices that work for you to manage stress
These may include physical exercise, yoga, dancing, caring for a pet, trying talk therapy, journaling, art therapy, music therapy, etc. The possibilities are endless!
If anxiety or depression symptoms persist, talk with your doctor about medication
Anxiety and depression can interfere with our sleep patterns, energy levels and overall motivation. Exploring your medication options could help your fatigue or insomnia. And, you can still try out lifestyle changes while incorporating new medications.
Get a sleep test if needed
Obstructive sleep apnea is common in PCOS and often can be treated with a CPAP machine to help you optimize your sleep.
Practice a sleep hygiene routine:
Limit screen time before bed
Wear blue light blockers when watching screens or working on a phone/laptop
Avoid caffeine after 2 PM
Sleep in a cool, dark room
Move your body daily
Avoid intensive exercise within 2 hours of bed
Create a sleep schedule with consistent rise and sleep times
Avoid eating less than 3 hours before bedtime. If you want a snack, go for something high protein
Try caffeine free teas before bed that promote restful sleep like chamomile or spearmint tea
Supplement, but only where necessary
There are many supplements out there that may promote restful sleep, including melatonin, GABA, and magnesium to name a few. However, these supplements will only work if you are truly deficient in whatever may be causing issues with your sleep, or driving your fatigue. Always chat with your provider before starting a new supplement.
The Bottom Line
PCOS can literally be exhausting, but rest assured that even though the process may take some investigation, you can make choices every day to better optimize your sleep and energy levels.
Happy Healing!
Sources:
https://pubmed.ncbi.nlm.nih.gov/33818258/
https://www.frontiersin.org/articles/10.3389/fendo.2020.00171/full
https://link.springer.com/article/10.1007/s00421-019-04104-x
https://pubmed.ncbi.nlm.nih.gov/33549285/
https://www.goodrx.com/conditions/birth-control/birth-control-and-vitamin-deficiency