PCOS and Sleep: Why Better Rest Could Be the Missing Link in Your Symptom Management
- Jodie Relf
- May 26
- 5 min read
Polycystic ovary syndrome (PCOS) is known for its effects on periods, hormones, and metabolism—but one area that often gets overlooked? Sleep.
If you regularly struggle to fall asleep, wake up feeling exhausted, or can’t make it through the day without a nap, it might be more than “just a bad night.” PCOS and poor sleep are closely connected, and research shows that the relationship goes both ways.
In this blog, we’ll break down how PCOS affects sleep, how sleep problems can make PCOS symptoms worse, and—most importantly—what you can do to improve your sleep and feel more in control of your body again.
How PCOS Disrupts Sleep
Sleep issues are much more common in women with PCOS. Here’s why:
Hormonal disruption: High androgens and insulin resistance—hallmarks of PCOS—can interfere with the body’s internal clock, melatonin rhythms, and sleep quality.
Circadian rhythm issues: Many women with PCOS experience a “delayed body clock,” meaning melatonin (the sleep hormone) stays high into the morning, making it harder to wake and feel refreshed.
Lower sleep efficiency: Studies show women with PCOS take longer to fall asleep and spend less time in restorative deep sleep.
Sleep apnoea risk: PCOS increases the risk of obstructive sleep apnoea (OSA), even in women who aren’t overweight. OSA causes disrupted breathing during sleep, leading to daytime fatigue, poor blood sugar control, and elevated blood pressure.
Insomnia and restlessness: Poor sleep quality, frequent waking, and even restless legs syndrome are more common in PCOS—especially if anxiety or depression are also present.
How Poor Sleep Makes PCOS Worse

Not getting enough sleep—or enough quality sleep—can make PCOS symptoms more difficult to manage:
Worsens insulin resistance: Sleep deprivation is a known driver of insulin resistance. If you’re not sleeping well, your blood sugar regulation and energy levels are likely to suffer.
Increases androgens: Irregular sleep or stress-related insomnia can trigger hormonal changes that lead to higher testosterone levels—worsening symptoms like acne, facial hair, and cycle irregularity.
Affects your menstrual cycle: Sleep and stress hormones interact with the reproductive system. Disrupted sleep can throw off your ovulation patterns and make cycles more irregular.
Makes weight loss harder: Lack of sleep increases appetite (especially for high-carb foods), decreases satiety hormones, and reduces motivation to exercise. This can make weight management even harder.
The result? A vicious cycle where poor sleep worsens PCOS, and PCOS symptoms (like stress, cravings, fatigue) make it harder to sleep well.
Practical Tips to Improve Sleep with PCOS
The good news? Sleep is one of the most powerful and underused tools in managing PCOS. Here are some strategies to help improve it:
1. Create a wind-down routine
Your body needs cues that it’s time to rest. Try to:
Turn off screens 1–2 hours before bed
Dim the lights and avoid intense tasks in the evening
Use a calming herbal tea, warm shower, or journaling to unwind
2. Keep a consistent sleep schedule
Go to bed and wake up at the same time—even on weekends—to reset your circadian rhythm. This helps regulate melatonin and cortisol levels.
3. Time your exercise and meals
Try to exercise earlier in the day (morning or early afternoon). Exercising too late in the evening can elevate cortisol and body temperature, which may delay your ability to fall asleep.
Avoid large meals and caffeine too close to bedtime (aim for at least 3 hours before sleep).
4. Evaluate your sleep environment
Keep your bedroom cool, dark, and quiet.
Remove distractions like phones or TVs.
Try a white noise machine or blackout curtains if needed.
5. Check for underlying issues
If you snore, wake frequently, or feel excessively tired despite enough sleep, speak to your GP. Around 35% of women with PCOS meet the criteria for obstructive sleep apnoea (OSA), which is significantly higher than the general population. PCOS increases the risk of both OSA and restless legs syndrome—both of which are treatable.
6. Prioritise magnesium-rich foods
Magnesium supports relaxation and sleep quality. Include foods like pumpkin seeds, almonds, leafy greens, and whole grains.
Final Thoughts
Sleep isn’t just “nice to have”—it’s essential for hormone balance, mood, metabolism, and menstrual health. If you’ve been focusing on food and exercise for your PCOS but still feel stuck, poor sleep might be the missing piece.
Remember: small changes add up. Even going to bed 30 minutes earlier or swapping your phone for a book in the evening can make a meaningful difference.
References:
Simon SL, et al. J Clin Endocrinol Metab. 2019 – Study in obese adolescent girls: PCOS group had delayed melatonin offset and longer melatonin secretion; morning melatonin misalignment correlated with higher free testosterone and insulin resistancepubmed.ncbi.nlm.nih.gov.
de Sousa G, et al. Sleep Breath. 2012 – Polysomnography in obese adolescents: hyperandrogenemic PCOS had less deep sleep and lower sleep efficiency vs controls; insulin-resistant PCOS had reduced REM sleeppubmed.ncbi.nlm.nih.gov.
Kahal H, et al. Sleep Breath. 2020 – Systematic review/meta-analysis: ~35% of women with PCOS have OSA; PCOS patients have ~3.8-fold higher odds of OSA vs controlspubmed.ncbi.nlm.nih.gov. Obesity exacerbates OSA in PCOS, but PCOS itself is an independent risk factorpubmed.ncbi.nlm.nih.gov.
Kumarendran B, et al. Eur J Endocrinol. 2019 – UK cohort study (76,978 PCOS vs 143,077 controls): PCOS associated with >2× risk of incident OSA independent of BMI (HR 2.26)pubmed.ncbi.nlm.nih.gov. Authors urge clinicians to screen for OSA in PCOSpubmed.ncbi.nlm.nih.gov.
Zangeneh FZ, et al. Front Endocrinol. 2022 – Meta-analysis of 18 studies (16,152 participants): PCOS patients have higher prevalence of overall sleep disturbances (OR 6.22) and worse sleep quality (PSQI scores) than controlsfrontiersin.org. Those with sleep disturbance had higher BMI, blood pressure, LDL, and glucose, and lower HDLfrontiersin.org.
Evsen MS, et al. Turk J Sleep Med. 2021 – Cross-sectional study: 61.6% of PCOS patients had poor sleep quality vs 34.9% of controlsjtsm.org; PCOS had significantly higher PSQI, insomnia, and daytime sleepiness scoresjtsm.orgjtsm.org. RLS was ~4 times more common in PCOS (23.3% vs 6.3%)jtsm.orgjtsm.org, and 31.5% of PCOS were high-risk for OSA by screening vs 4.8% of controlsjtsm.org.
Tasali E, et al. J Clin Endocrinol Metab. 2011 – Interventional trial: 8 weeks of CPAP in obese women with PCOS + OSA improved insulin sensitivity (IVGTT-derived) and reduced daytime blood pressure and sympathetic activitypmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov, without significant weight change. Demonstrates treating sleep apnea yields metabolic benefits in PCOS.
Evans A, et al. Biomedicines. 2023 – PCOS vs controls pilot: no difference in average sleep duration or melatonin output, but PCOS showed lower weekend sleep efficiency and a misalignment between melatonin levels and sleep timingmdpi.commdpi.com. Authors highlight the importance of counseling on sleep hygiene in PCOS caremdpi.com.
Li L, et al. Front Endocrinol. 2022 – Systematic review: Emphasizes that hyperandrogenemia and hyperinsulinemia in PCOS may disrupt circadian clock genes, linking PCOS to altered sleep-wake patternsfrontiersin.org. Recommends incorporating sleep management into PCOS treatment plansfrontiersin.org.