Chapter 8 234 urinary progesterone metabolites correlated with worse sleep efficiency, and Baker et al. (2012) found that higher progesterone levels correlated with more time being awake during the night. In contrast, Lee et al. (2000) found that their low luteal progesterone group (non-ovulating women) had more time spent awake during the night (WASO), longer REM latency and more REM sleep in the luteal phase compared to the high luteal progesterone group (ovulating women). Kravitz et al. (2005) also found that participants reported the best sleep during the mid-menstrual cycle phase, when estrogen levels are highest. Li et al. (2015) found that estrogen metabolite level was positively associated with sleep efficiency, also indicating better sleep when estrogen levels were higher. De Zambotti et al. (2015) found higher estrogen levels to be associated with fewer arousals during sleep. Lowered estrogen levels were associated with poorer sleep over time in Hollander et al. (2001), but this was only significant in the older (45+) age group. Kische et al. (2016) found that higher estrogen levels were associated with more daytime sleepiness and more sleeping problems. A higher ratio of estradiol to testosterone (E2/TT ratio) was associated with more daytime sleepiness and fewer sleeping problems. Baker et al. (2012) found that both higher progesterone and estrogen levels were correlated with lower percentage REM sleep, an increase in WASO, and an increase in delta power, but only in control participants and not in women with PMS. In summary, both higher and lower endogenous progesterone levels (through absence of ovulation, or after suppression progesterone levels) seem to worsen sleep quality. Higher endogenous estrogen levels might have a positive effect on sleep quality, although the results vary strongly. 3.8. Link sex hormones and depression No significant sex hormone differences were found in the depressed group compared to healthy controls in the study of Antonijevic et al. (2003). Baker et al. (2012) and Shechter et al. (2012) found no significant differences in sex hormone levels (estrogen and progesterone) between women with PMDD and controls.
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