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Please note – this post contains descriptions of PMDD that some may find distressing. Please read with caution.
Introduction
It’s well known that PMDD symptoms can include insomnia (difficulty sleeping) or hypersomnia (difficulty staying awake).
For a select few, however, sleep may remain unaffected — and if that’s the case, what a blessing that must be.
For the rest of us, poor-quality sleep is simply another challenge to add to the long list of problems associated with premenstrual dysphoric disorder.
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It’s something I know all too well which is why I want to explore the connection I’ve noticed between my sleeping patterns and my symptoms.
The things I share will include an observation I’ve rarely seen discussed at the time of writing.
In turn, it’s made me wonder whether it’s unique to my own experience.
Given the complexities of PMDD, I felt it was a topic worth addressing in case other women have noticed the same.
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The anomaly I speak of is specifically the onset of distressing nightmares during PMDD episodes.
On my ‘good’ days, I rarely dream at all, or perhaps I simply don’t remember my dreams when I do.
Either way, they are generally uneventful and never a cause for concern.
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During PMDD however, although the usual symptoms no longer cause as much disturbance as they once did, the nightmares remain a persistent feature.
How badly they affect me, seems to depend on the quality of sleep I’ve had, with insufficient sleep making them more disruptive.
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It’s a pattern I began to notice because such nightmares only ever occur during PMDD — strange, right?
So, before I get into this bizarre phenomenon, I first want to discuss sleeping patterns as they relate to the condition generally.
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Sleep & Symptom Severity
In the past, I would experience insomnia during my more difficult weeks.
Thankfully, my sleeping patterns have improved considerably, largely due to factors such as regular exercise and other lifestyle changes, which I’ll discuss later.
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Even without PMDD, struggling to sleep, or struggling to stay awake over prolonged periods can see our mental health impacted.
This article examines the effects of sleep deprivation in otherwise healthy individuals.
When viewed through that lens, the implications for those of us already living with a condition become even more apparent.
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So, what does life look like when you’re already struggling mentally, and you add in a disruptive sleeping pattern?
Whether you’re not sleeping enough, or sleeping too much, it’s a combination that can leave you feeling depleted — and that was my experience.
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I’d struggle to concentrate, my fatigue would intensify as though it wasn’t difficult enough, and I’d find myself trying to hold my life together on what felt like a thread and a prayer.
Ultimately, poor wellbeing combined with poor-quality sleep is a recipe for disaster.
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When PMDD & Sleep Collide
For readers who don’t have PMDD, I hope the above helps explain why suicidal ideation can feature with this condition.
To provide further context, we’re often battling depression, anxiety, exhaustion, and severe fatigue — all at the same time.
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Our patience runs excessively thin, we become easily and unusually agitated, we’re unsettled by loud noise, and socialising becomes particularly uncomfortable.
We crave and eat foods for short-term comfort, and we may become upset by our appearance, causing our confidence to sink even when nothing has actually changed.
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We feel hopeless, sad, exhausted, and traumatised by this monthly fiasco.
At the height of our symptoms, we hate the condition, we despise ourselves, and we can find it difficult to see the value in life.
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The added disruption of poor sleep only intensifies the struggle, pushing us to wits end as the desperation for an escape continues to mount.
As extreme as it may sound, to a woman in the depths of PMDD, death may feel like a rational escape from the weight of such suffering.
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Although the above statements won’t accurately reflect every woman’s experience with PMDD, I suspect many will recognise elements of their own journey within it.
The torment I’ve described was exactly how my own life looked — for many, many years.
This specific video diary entry serves as a testament to that.
It’s difficult to watch but equally reminds me of how far I’ve come and is why I care so deeply for the welfare of others.
Especially those who know what it is to be at war with themselves.
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So how does sleep play into all this?
The impact of both insomnia and hypersomnia on PMDD can be detrimental.
What differs, however, is the way in which they each influence certain symptoms — or at least that has been my observation.
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The Cost of Sleepless Nights
For me, insomnia specifically fuels and intensifies anxiety.
That constant sense of being on edge becomes so heightened that I can barely sit still, leaving me restless, fidgety, and frantic about everything.
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I would begin to exhibit OCD-like behaviours driven by a fear that the way I was feeling might cause me to drop the ball in some way.
To compensate, I became obsessively meticulous.
I’d over-plan, then plan some more — checking, rewriting, and re-reading everything.
Although it felt helpful at the time, these behaviours only exhausted me further, compounding an already difficult situation.
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To give a real-life example, I’ll use something as familiar as driving.
At times, my anxiety became so overwhelming that I had to pull over and park.
My legs would be trembling profusely so to avoid a potential collision, I’d sit and allow myself time to calm down.
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For a new driver on the road, a certain level of anxiety is understandable.
However, when you’re practically a driving veteran, that level of fear can be difficult to comprehend.
I make this point to demonstrate that although anxiety is problematic enough on its own, when combined with insomnia, it becomes debilitating.
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The Exhaustion Paradox
My experience with hypersomnia has been just as severe, albeit in a different way — particularly, when it comes to PMDD-related depression.
The more I slept, the more intense the fatigue seemed.
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Sleep never felt restorative, and I was often left with a lingering sense of guilt.
At the same time, the depression worsened, leaving me unable to keep up with my daily responsibilities as self-deprecating thoughts continued to circulate.
I felt as though I was letting myself down, yet I lacked the energy to do much about it.
And so I kept sleeping because in a strange twist, sleep had become an escape from reality.
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Understanding PMDD Nightmares
I’ll shortly share some of the practices I use to improve my sleep.
Before I do, let’s return to the main topic at hand — PMDD nightmares.
The reason why I’ve chosen to draw attention to them stems from a previous experience.
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What I dreamt is difficult to describe, largely because it was so bizarre and fragmented it barely made sense.
The part I do remember most vividly, however, involved three women I had never met who were exceptionally cruel towards me.
I’ll spare you the details, but it was deeply frightening.
Within the nightmare, I was already in tears, and when I awoke, the same flood of emotion followed me in real life.
My hysterical crying pulled me out from sleep, leaving me shaken and distressed.
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The nightmare caught me off guard, but what concerned me most was how it spilled into my waking reality.
The unsettling part wasn’t just the emotion it stirred, but the realisation that this wasn’t an isolated incident.
It was one of many and the severity helped me recognise the pattern more clearly.
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Each month, such nightmares plague my sleep for several nights, triggering many of the very symptoms I work so hard to fight.
Once my bleed appears, however, the nightmares vanish along with all the rest of my symptoms.
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One contributing factor has particularly caught my attention.
The severity and impact of these nightmares seems to increase whenever my quality of sleep is compromised.
Good sleep doesn’t guarantee I’ll be nightmare-free.
However, I’ve noticed that when I’m sleeping well, even unpleasant dreams have less of a lasting effect on my wellbeing.
Which brings us unto the final, and perhaps most important part of this post.
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The Power of Rest
What does good sleep look like, and how can it benefit a condition like PMDD?
This answer will differ from one woman to the next, but to start, adults are generally advised to get between seven and nine hours of sleep per night.
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For those of us living with PMDD, adhering to this recommendation is crucial.
Our mental wellbeing is already under greater strain than those without such conditions.
For that reason, we must be vigilant and proactive in our self-care.
So no matter how enticing it may be to stay up and watch another episode on Netflix, your wellbeing matters more.
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We experience PMDD because of our brain’s sensitivity to hormonal changes.
That led me to wonder whether my brain might also be more sensitive to sleep disruption than that of the average person.
If that is the case, it would help explain why certain symptoms intensify whenever my sleep is affected.
To give our minds the best chance of functioning well, we must play an active role in ensuring we get adequate rest.
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Following three years of a more disciplined sleep pattern at the point of this post, I have noticed a distinct difference in how the condition affects me when I’m sleeping well compared to when I’m not.
I equally encourage you to adopt healthy sleeping habits, especially during PMDD episodes.
See what difference it can make to your overall wellbeing.
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Movement as a Sleep Aid
Committing to a routine of morning workouts eventually helped resolve my insomnia.
Not only did the exercise boost my energy levels and release endorphins, but it also meant that when bedtime approached, I was desperate for rest.
The adjustment can feel difficult at first.
However, with consistency, our bodies adapt, and over time the routine becomes part of everyday life.
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The nightmare I described, which left me waking in a state of distress, came after several consecutive nights of inadequate sleep.
For a brief period, I had slipped back into an old pattern of sleeplessness.
However, the way that dream affected my mood, and the growing intensity of my PMDD symptoms, was enough to quickly get me back on track.
In doing so, the spiked symptoms began to ease.
I immediately felt a great deal of emotional relief, becoming more like my usual self again.
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Summary
How you sleep may not seem like a big deal.
It’s possible that up until today, you haven’t given it much thought in relation to PMDD, but it matters.
If anything I’ve described is reflective of your own experience, then please believe me when I say that sleep is not something you should take for granted.
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Making sleep a priority is a method of self-care for the brain, and when it comes to PMDD, brain health is everything.
If you’d like to hear more about what I discovered regarding the relationship between sleep and mood, I previously published a YouTube miniseries that you can watch here.
