Sleep and Your Hormones: The Debt You Can’t Feel
Feeling fine is the least reliable reading in the building.
How would you know if you weren't sleeping enough? Most people assume they would feel tired. That is the first gauge short sleep breaks.
In a 2003 study, healthy adults spent two weeks on 6 hours in bed a night. By the end they were performing as badly as people kept awake all night, and they rated themselves only slightly sleepy. The part of you that would notice the shortage is the first thing the shortage damages.
What your body does only while you sleep
Sleep looks like the body switching off. Hormonally, it is one of the busiest stretches of your day. Melatonin rises as the light fades and tells every cell that it is night. Early deep sleep brings, in men especially, the day's most reliable growth hormone pulse, a repair signal for muscle and bone. In men, testosterone climbs as sleep begins, driven by sleep, not the clock. Toward dawn, cortisol climbs to hand you back to the day.
You can't feel your own sleep debt
We also guess our sleep high: in one study, sleep diaries said seven and a half hours while wrist monitors said a little under 6. When researchers let healthy young men sleep as long as their bodies wanted, the average need came out a little under eight and a half hours, nobody needed less than 7, and most had been running short at home without noticing.
My answer for most adults is about 8 hours of actual sleep, which usually means more than 8 hours in bed.
The weekend does not fix it. In a 2019 trial, a weekend of unlimited sleep paid back about one hour of a 12-hour debt. When people do recover, the feeling comes back before the brain does, which is why the feeling can't be trusted.
What short sleep costs
The bill arrives within a week. Six nights of 4 hours in bed left healthy young men clearing blood sugar nearly 40% more slowly than once caught up, with a lower thyroid signal and an evening cortisol that fell far more slowly. Knocking people out of deep sleep, with their total hours untouched, cut insulin sensitivity by about a quarter in three nights.
Sleep even decides what kind of weight you lose. On the same reduced-calorie diet, people given 8.5 hours in bed lost more than twice as much fat, while on 5.5 hours they lost about 60% more lean tissue. Same scale, different loss. In young men, short nights lowered leptin (fullness) and raised ghrelin (hunger).
Over years, population studies link short sleep to more type 2 diabetes and heart disease. That is why I won't interpret anyone's blood sugar or weight until I know how they sleep.
Melatonin opens the night
Melatonin is a hormone that doesn't knock you out: it calls the play, and the rest of the body runs it. Your supply falls with age: in one study, people around 60 made less than half the nightly melatonin of people around 30. No blood level defines a deficiency, so I dose to how you sleep, never to a lab number.
I start most adults at 1 to 3 milligrams and go up until they sleep through the night and wake up clear. Grogginess, headaches or nightmares that are more than vivid mean too much, so we step down. Most of my patients land between 3 and 30 milligrams, and some need up to 50. In trials of 10 to 25 milligrams nightly for up to six months, serious side effects were no more common than on placebo.
Store bottles are unreliable: in one lab test, the contents ran from 83% below the label to 478% above, and about a quarter contained serotonin. I prefer a compounded, micronized, sustained-release capsule, the same molecule let out across the night. And take it at bedtime, not with dinner. Taken right before sugar, melatonin made the blood sugar spike bigger, even in healthy young women.
Progesterone holds it
For women, the hormone that holds the night is progesterone. When you swallow it, your liver turns part of it into allopregnanolone, a calming molecule that presses the brain's brake. The synthetic progestins in most birth control and older hormone therapy don't make that conversion, so they lack the sleep effect. In sleep-lab studies, oral micronized progesterone cut time awake in the night with no next-day grogginess, and real progesterone beat the synthetic progestin head to head.
So the 3 a.m. wake-up in menopause is not just hot flashes. A 2022 review found that falling estradiol and progesterone track with worse sleep even after accounting for hot flashes, stress and weight, and that giving them back improved sleep in the better-quality studies.
Sedation is not sleep
The biggest family of sleeping pills, the benzodiazepines and the Z-drugs like zolpidem, presses that same brake. A woman who loses her progesterone, stops sleeping and is handed one of these gets a counterfeit of what she stopped making: the brake without the hormone.
The benefit is smaller than most people assume. In the trial data submitted to the FDA, the Z-drugs got people to sleep about 22 minutes faster than placebo. Past 60, for every 13 treated, one more slept better; for every 6, one more had a side effect. In 2013 the FDA cut the recommended zolpidem dose for women in half, warning that people can be impaired the next morning "even if they feel fully awake." Long-term benzodiazepine use has been linked again and again to a higher risk of dementia, and in the study that tracked it, the risk fell the longer people stayed off them.
If you take one, don't stop on your own overnight. Taper slowly with your prescriber; melatonin can make that easier.
The habits that belong to you
Sometimes the answer isn't a pill. Before any prescription, I look for the cause: the breathing (sleep apnea climbs in women after menopause, and you can't reliably feel it), the hormones, the clock. The habits are yours.
Keep the same wake-up time seven days a week; irregular sleep is linked to higher death rates, even at the same total sleep. Keep caffeine to the morning: four coffees' worth six hours before bed cost more than an hour of measured sleep. Go easy on the nightcap, which delays dream sleep. Dim the lights in the evening and sleep in the dark.
Teenagers aren't lazy, either: puberty shifts the body clock later, and an early school start moves the alarm, not the bedtime.
If you have been told you're fine on 6 hours, or handed a sleeping pill without one question about your hormones or your breathing, you deserve a better question: what is your night missing?
The whole argument:
⚠️ Educational content, not individual medical advice or a treatment recommendation. Nobody should start, stop or change a prescription because of an article. Your labs and history belong in a one on one.
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Sources
Andersen, L. P., Gögenur, I., Rosenberg, J., & Reiter, R. J. (2016). The Safety of Melatonin in Humans. Clinical Drug Investigation, 36(3), 169-175. https://doi.org/10.1007/s40261-015-0368-5
Baker, F. C., Forouzanfar, M., Goldstone, A., et al. (2019). Changes in heart rate and blood pressure during nocturnal hot flashes associated with and without awakenings. Sleep, 42(11), zsz175. https://doi.org/10.1093/sleep/zsz175
Banks, S., Van Dongen, H. P., Maislin, G., & Dinges, D. F. (2010). Neurobehavioral dynamics following chronic sleep restriction: dose-response effects of one night for recovery. Sleep, 33(8), 1013-1026. https://doi.org/10.1093/sleep/33.8.1013
Belenky, G., Wesensten, N. J., Thorne, D. R., Thomas, M. L., Sing, H. C., Redmond, D. P., Russo, M. B., & Balkin, T. J. (2003). Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: A sleep dose-response study. Journal of Sleep Research, 12, 1-12. https://doi.org/10.1046/j.1365-2869.2003.00337.x
Billioti de Gage, S., Moride, Y., Ducruet, T., Kurth, T., Verdoux, H., Tournier, M., Pariente, A., & Bégaud, B. (2014). Benzodiazepine use and risk of Alzheimer's disease: case-control study. BMJ, 349, Article g5205. https://doi.org/10.1136/bmj.g5205
Billioti de Gage, S., Pariente, A., & Bégaud, B. (2015). Is there really a link between benzodiazepine use and the risk of dementia? Expert Opinion on Drug Safety, 14(5), 733-747. https://doi.org/10.1517/14740338.2015.1014796
Bixler, E. O., Vgontzas, A. N., Lin, H. M., Ten Have, T., Rein, J., Vela-Bueno, A., & Kales, A. (2001). Prevalence of sleep-disordered breathing in women: effects of gender. American Journal of Respiratory and Critical Care Medicine, 163(3 Pt 1), 608-613. https://doi.org/10.1164/ajrccm.163.3.9911064
Bougard, C., Gomez-Merino, D., Rabat, A., Arnal, P., Van Beers, P., Guillard, M., Léger, D., Sauvet, F., & Chennaoui, M. (2018). Daytime microsleeps during 7 days of sleep restriction followed by 13 days of sleep recovery in healthy young adults. Consciousness and Cognition, 61, 1-12. https://doi.org/10.1016/j.concog.2018.03.008
Broussard, J. L., Ehrmann, D. A., Van Cauter, E., Tasali, E., & Brady, M. J. (2012). Impaired insulin signaling in human adipocytes after experimental sleep restriction: A randomized, crossover study. Annals of Internal Medicine, 157, 549-557. https://doi.org/10.7326/0003-4819-157-8-201210160-00005
California Senate Bill 328, Pupil attendance: school start time. (2019). Codified at California Education Code § 46148.
Cappuccio, F. P., D'Elia, L., Strazzullo, P., & Miller, M. A. (2010a). Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 33(2), 414-420. https://doi.org/10.2337/dc09-1124
Cappuccio, F. P., D'Elia, L., Strazzullo, P., & Miller, M. A. (2010b). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep, 33(5), 585-592. https://doi.org/10.1093/sleep/33.5.585
Cappuccio, F. P., Cooper, D., D'Elia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. European Heart Journal, 32(12), 1484-1492. https://doi.org/10.1093/eurheartj/ehr007
Carskadon, M. A., Vieira, C., & Acebo, C. (1993). Association between puberty and delayed phase preference. Sleep, 16(3), 258-262. https://doi.org/10.1093/sleep/16.3.258
Carskadon, M. A., Wolfson, A. R., Acebo, C., Tzischinsky, O., & Seifer, R. (1998). Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep, 21(8), 871-881. https://doi.org/10.1093/sleep/21.8.871
Caufriez, A., Leproult, R., L'Hermite-Balériaux, M., Kerkhofs, M., & Copinschi, G. (2011). Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. The Journal of Clinical Endocrinology & Metabolism, 96(4), E614-E623. https://doi.org/10.1210/jc.2010-2558
Chang, A. M., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences, 112(4), 1232-1237. https://doi.org/10.1073/pnas.1418490112
Coccurello, R. (2026). Sleep-related Alzheimer's disease vulnerability in aging: A muscle-metabolic perspective. Neuroscience and Biobehavioral Reviews, 189, 106869. https://doi.org/10.1016/j.neubiorev.2026.106869
Curtis, B. J., McKinney, T. L., Euler, M., Anderson, J. S., Baron, K. G., Smith, T. W., & Williams, P. G. (2024). Sleepy without stimulation: Subjective and objective sleepiness in actigraphy-verified natural short sleepers. Journal of Sleep Research, 33(5), e14170. https://doi.org/10.1111/jsr.14170
Dahl, R. E., & Lewin, D. S. (2002). Pathways to adolescent health: Sleep regulation and behavior. Journal of Adolescent Health, 31, 175-184. https://doi.org/10.1016/s1054-139x(02)00506-2
Depner, C. M., Melanson, E. L., Eckel, R. H., Snell-Bergeon, J. K., Perreault, L., Bergman, B. C., Higgins, J. A., Guerin, M. K., Stothard, E. R., Morton, S. J., & Wright, K. P. (2019). Ad libitum weekend recovery sleep fails to prevent metabolic dysregulation during a repeating pattern of insufficient sleep and weekend recovery sleep. Current Biology, 29(6), 957-967.e4. https://doi.org/10.1016/j.cub.2019.01.069
Dong, Q., Gentry, N. W., McMahon, T., Yamazaki, M., Benitez-Rivera, L., Wang, T., Gan, L., Ptáček, L., & Fu, Y.-H. (2022). Familial natural short sleep mutations reduce Alzheimer pathology in mice. iScience, 25(4), 103964. https://doi.org/10.1016/j.isci.2022.103964
Drake, C., Roehrs, T., Shambroom, J., & Roth, T. (2013). Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine, 9(11), 1195-1200. https://doi.org/10.5664/jcsm.3170
Emet, M., Ozcan, H., Ozel, L., Yayla, M., Halici, Z., & Hacimuftuoglu, A. (2016). A Review of Melatonin, Its Receptors and Drugs. Eurasian J Med, 48, 135-141. https://doi.org/10.5152/eurasianjmed.2015.0267
Ensrud, K. E., Guthrie, K. A., Hohensee, C., et al. (2015). Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep, 38(1), 97-108. https://doi.org/10.5665/sleep.4332
Erland, L. A., & Saxena, P. K. (2017). Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. Journal of Clinical Sleep Medicine, 13(2), 275-281. https://doi.org/10.5664/jcsm.6462
Everitt, H., Baldwin, D. S., Stuart, B., Lipinska, G., Mayers, A., Malizia, A. L., Manson, C. C., & Wilson, S. (2018). Antidepressants for insomnia in adults. Cochrane Database of Systematic Reviews, 2018(5), Article CD010753. https://doi.org/10.1002/14651858.CD010753.pub2
Florida Senate Bill 296, School start times. (2025). As reported by News 6 ClickOrlando (2025, April 30) and Florida Politics (2025).
Foley, H. M., & Steel, A. E. (2019). Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence. Complementary Therapies in Medicine, 42, 65-81. https://doi.org/10.1016/j.ctim.2018.11.003
Garaulet, M., Gómez-Abellán, P., Rubio-Sastre, P., Madrid, J. A., Saxena, R., & Scheer, F. A. (2015). Common type 2 diabetes risk variant in MTNR1B worsens the deleterious effect of melatonin on glucose tolerance in humans. Metabolism, 64(12), 1650-1657. https://doi.org/10.1016/j.metabol.2015.08.003
Garaulet, M., Qian, J., Florez, J. C., Arendt, J., Saxena, R., & Scheer FAJL (2020). Melatonin Effects on Glucose Metabolism: Time To Unlock the Controversy. Trends Endocrinol Metab, 31(3), 192-204. https://doi.org/10.1016/j.tem.2019.11.011
Gardiner, C., Weakley, J., Burke, L. M., Roach, G. D., Sargent, C., Maniar, N., Huynh, M., Miller, D. J., Townshend, A., & Halson, S. L. (2025). The effect of alcohol on subsequent sleep in healthy adults: A systematic review and meta-analysis. Sleep Medicine Reviews, 80, 102030. https://doi.org/10.1016/j.smrv.2024.102030
Garfinkel, D., Zisapel, N., Wainstein, J., & Laudon, M. (1999). Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Archives of Internal Medicine, 159(20), 2456-2460. https://doi.org/10.1001/archinte.159.20.2456
Glaser, R., York, A. E., & Dimitrakakis, C. (2011). Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas, 68(4), 355-361. https://doi.org/10.1016/j.maturitas.2010.12.001
Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331(7526), Article 1169. https://doi.org/10.1136/bmj.38623.768588.47
Gooley, J. J., Chamberlain, K., Smith, K. A., Khalsa, S. B., Rajaratnam, S. M., Van Reen, E., Zeitzer, J. M., Czeisler, C. A., & Lockley, S. W. (2011). Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. The Journal of Clinical Endocrinology & Metabolism, 96(3), E463-E472. https://doi.org/10.1210/jc.2010-2098
Gottlieb, D. J., Redline, S., Nieto, F. J., Baldwin, C. M., Newman, A. B., Resnick, H. E., & Punjabi, N. M. (2006). Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep, 29(8), 1009-1014. https://doi.org/10.1093/sleep/29.8.1009
Gottlieb, D. J., Ellenbogen, J. M., Bianchi, M. T., & Czeisler, C. A. (2018). Sleep deficiency and motor vehicle crash risk in the general population: a prospective cohort study. BMC Medicine, 16(1), 44. https://doi.org/10.1186/s12916-018-1025-7
Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Internal Medicine, 175(3), 401-407. https://doi.org/10.1001/jamainternmed.2014.7663
Greenblatt, D. J., Harmatz, J. S., Singh, N. N., Steinberg, F., Roth, T., Moline, M. L., Harris, S. C., & Kapil, R. P. (2014). Gender differences in pharmacokinetics and pharmacodynamics of zolpidem following sublingual administration. The Journal of Clinical Pharmacology, 54(3), 282-290. https://doi.org/10.1002/jcph.220
Gu, C., Brereton, N., Schweitzer, A., Cotter, M., Duan, D., Børsheim, E., Wolfe, R. R., Pham, L. V., Polotsky, V. Y., & Jun, J. C. (2020). Metabolic effects of late dinner in healthy volunteers: A randomized crossover clinical trial. The Journal of Clinical Endocrinology & Metabolism, 105(8), 2789-2802. https://doi.org/10.1210/clinem/dgaa354
Haufe, A., Baker, F. C., & Leeners, B. (2022). The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review. Sleep Med Rev, 66, 101710. https://doi.org/10.1016/j.smrv.2022.101710
Hauglund, N. L., Andersen, M., Tokarska, K., Radovanovic, T., Kjaerby, C., Sørensen, F. L., Bojarowska, Z., Untiet, V., Ballestero, S. B., Kolmos, M. G., Weikop, P., Hirase, H., & Nedergaard, M. (2025). Norepinephrine-mediated slow vasomotion drives glymphatic clearance during sleep. Cell, 188(3), 606-622.e17. https://doi.org/10.1016/j.cell.2024.11.027
He, Y., Jones, C. R., Fujiki, N., Xu, Y., Guo, B., Holder, J. L., Rossner, M. J., Nishino, S., & Fu, Y.-H. (2009). The transcriptional repressor DEC2 regulates sleep length in mammals. Science, 325(5942), 866-870. https://doi.org/10.1126/science.1174443
He, Q., Chen, X., Wu, T., Li, L., & Fei, X. (2019). Risk of dementia in long-term benzodiazepine users: Evidence from a meta-analysis of observational studies. Journal of Clinical Neurology, 15(1), 9-19. https://doi.org/10.3988/jcn.2019.15.1.9
Hirano, A., Hsu, P.-K., Zhang, L., Xing, L., McMahon, T., Yamazaki, M., Ptáček, L. J., & Fu, Y.-H. (2018). DEC2 modulates orexin expression and regulates sleep. Proceedings of the National Academy of Sciences, 115(13), 3434-3439. https://doi.org/10.1073/pnas.1801693115
Hitchcock, C. L., & Prior, J. C. (2012). Oral micronized progesterone for vasomotor symptoms--a placebo-controlled randomized trial in healthy postmenopausal women. Menopause, 19(8), 886-893. https://doi.org/10.1097/gme.0b013e318247f07a
Huedo-Medina, T. B., Kirsch, I., Middlemass, J., Klonizakis, M., & Siriwardena, A. N. (2012). Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ, 345, Article e8343. https://doi.org/10.1136/bmj.e8343
Iguchi, H., Kato, K.-I., & Ibayashi, H. (1982). Age-dependent reduction in serum melatonin concentrations in healthy human subjects. The Journal of Clinical Endocrinology & Metabolism, 55(1), 27-29. https://doi.org/10.1210/jcem-55-1-27
Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews. https://doi.org/10.1016/j.smrv.2014.10.001
Islam, M. M., Iqbal, U., Walther, B., Atique, S., Dubey, N. K., Nguyen, P.-A., Poly, T. N., Masud, J. H. B., Li, Y.-C., & Shabbir, S.-A. (2016). Benzodiazepine use and risk of dementia in the elderly population: A systematic review and meta-analysis. Neuroepidemiology, 47(3-4), 181-191. https://doi.org/10.1159/000454881
Kalkanis, A., Lenkens, D., Steiropoulos, P., & Testelmans, D. (2025). Sleep regularity as an important component of sleep hygiene: a systematic review. Sleep Medicine Reviews, 84, 102203. https://doi.org/10.1016/j.smrv.2025.102203
Kansagra, S. (2020). Sleep disorders in adolescents. Pediatrics, 145(Suppl 2), e20192056I. https://doi.org/10.1542/peds.2019-2056I
Kitamura, S., Katayose, Y., Nakazaki, K., Motomura, Y., Oba, K., Katsunuma, R., Terasawa, Y., Enomoto, M., Moriguchi, Y., Hida, A., & Mishima, K. (2016). Estimating individual optimal sleep duration and potential sleep debt. Scientific Reports, 6(1), Article 35812. https://doi.org/10.1038/srep35812
Koren, D., & Taveras, E. M. (2018). Association of sleep disturbances with obesity, insulin resistance and the metabolic syndrome. Metabolism: Clinical and Experimental, 84, 67-75. https://doi.org/10.1016/j.metabol.2018.04.001
Kripke, D. F., Langer, R. D., & Kline, L. E. (2012). Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open, 2(1), Article e000850. https://doi.org/10.1136/bmjopen-2012-000850
Kunz, D., Schmitz, S., Mahlberg, R., Mohr, A., Stöter, C., Wolf, K. J., & Herrmann, W. M. (1999). A new concept for melatonin deficit: On pineal calcification and melatonin excretion. Neuropsychopharmacology, 21(6), 765-772. https://doi.org/10.1016/S0893-133X(99)00069-X
Lader, M. (2014). Benzodiazepine harm: how can it be reduced? British Journal of Clinical Pharmacology, 77(2), 295-301. https://doi.org/10.1111/j.1365-2125.2012.04418.x
Lancel, M., Faulhaber, J., Holsboer, F., & Rupprecht, R. (1996). Progesterone induces changes in sleep comparable to those of agonistic GABAA receptor modulators. Am J Physiol, 271(4 Pt 1), E763-E772. https://doi.org/10.1152/ajpendo.1996.271.4.E763
Lelak, K., Vohra, V., Neuman, M. I., Toce, M. S., & Sethuraman, U. (2022). Pediatric melatonin ingestions: United States, 2012-2021. MMWR. Morbidity and Mortality Weekly Report, 71(22), 725-729. https://doi.org/10.15585/mmwr.mm7122a1
Leproult, R., & Van Cauter, E. (2010). Role of sleep and sleep loss in hormonal release and metabolism. In S. Loche et al. (Eds.), Pediatric neuroendocrinology (Endocrine Development, Vol. 17, pp. 11-21). Karger. https://doi.org/10.1159/000262524
Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173-2174. https://doi.org/10.1001/jama.2011.710
Li, Y., Li, Z., Lei, F., Du, L., & Tang, X. (2013). Persistent insomnia despite long-term nightly use of sleeping pills. J Clin Sleep Med, 9(8), 834-836. https://doi.org/10.5664/jcsm.2936
Lindberg, E., Bonsignore, M. R., & Polo-Kantola, P. (2020). Role of menopause and hormone replacement therapy in sleep-disordered breathing. Sleep Med Rev, 49, 101225. https://doi.org/10.1016/j.smrv.2019.101225
Liu, P. Y., Yee, B., Wishart, S. M., Jimenez, M., Jung, D. G., Grunstein, R. R., & Handelsman, D. J. (2003). The short-term effects of high-dose testosterone on sleep, breathing, and function in older men. The Journal of Clinical Endocrinology & Metabolism, 88(8), 3605-3613. https://doi.org/10.1210/jc.2003-030236
Martínez-Cerón, E., Barquiel, B., Bezos, A. M., Casitas, R., Galera, R., García-Benito, C., Hernanz, A., Alonso-Fernández, A., & Garcia-Rio, F. (2016). Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial. American Journal of Respiratory and Critical Care Medicine, 194(4), 476-485. https://doi.org/10.1164/rccm.201510-1942OC
Matricciani, L., Paquet, C., Galland, B., Short, M., & Olds, T. (2019). Children's sleep and health: a meta-review. Sleep Med Rev, 46, 136-150. https://doi.org/10.1016/j.smrv.2019.04.011
Matsumoto, M., Sack, R. L., Blood, M. L., & Lewy, A. J. (1997). The amplitude of endogenous melatonin production is not affected by melatonin treatment in humans. Journal of Pineal Research, 22(1), 42-44. https://doi.org/10.1111/j.1600-079x.1997.tb00301.x
McAlpine, T., Mullan, B., & Clarke, P. J. F. (2024). Re-considering the role of sleep hygiene behaviours in sleep: associations between sleep hygiene, perceptions and sleep. Int J Behav Med, 31, 705-717. https://doi.org/10.1007/s12529-023-10212-y
McEvoy, R. D., Antic, N. A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., Mediano, O., Chen, R., Drager, L. F., Liu, Z., Chen, G., Du, B., McArdle, N., Mukherjee, S., Tripathi, M., Billot, L., Li, Q., Lorenzi-Filho, G., Barbe, F., . . . Anderson, C. S. (2016). CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. New England Journal of Medicine, 375(10), 919-931. https://doi.org/10.1056/NEJMoa1606599
Memi, E., et al. (2024). Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord, 25, 751-772. https://doi.org/10.1007/s11154-024-09882-0
Menczel Schrire, Z., Phillips, C. L., Chapman, J. L., Duffy, S. L., Wong, G., D'Rozario, A. L., Comas, M., Raisin, I., Saini, B., Gordon, C. J., McKinnon, A. C., Naismith, S. L., Marshall, N. S., Grunstein, R. R., & Hoyos, C. M. (2022). Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. Journal of Pineal Research, 72(2), Article e12782. https://doi.org/10.1111/jpi.12782
Meyer, E. J., & Wittert, G. A. (2024). Approach the Patient With Obstructive Sleep Apnea and Obesity. J Clin Endocrinol Metab, 109(3), e1267-e1279. https://doi.org/10.1210/clinem/dgad572
Miller, M. A., Kruisbrink, M., Wallace, J., Ji, C., & Cappuccio, F. P. (2018). Sleep duration and incidence of obesity in infants, children, and adolescents: A systematic review and meta-analysis of prospective studies. Sleep, 41(4). https://doi.org/10.1093/sleep/zsy018
Minges, K. E., & Redeker, N. S. (2016). Delayed school start times and adolescent sleep: A systematic review of the experimental evidence. Sleep Medicine Reviews, 28, 86-95. https://doi.org/10.1016/j.smrv.2015.06.002
Mong, J. A., Baker, F. C., Mahoney, M. M., Paul, K. N., Schwartz, M. D., Semba, K., & Silver, R. (2011). Sleep, rhythms, and the endocrine brain: influence of sex and gonadal hormones. J Neurosci, 31(45), 16107-16116. https://doi.org/10.1523/JNEUROSCI.4175-11.2011
Montplaisir, J., Lorrain, J., Denesle, R., & Petit, D. (2001). Sleep in menopause: differential effects of two forms of hormone replacement therapy. Menopause, 8(1), 10-16. https://doi.org/10.1097/00042192-200101000-00004
Nedeltcheva, A. V., Kilkus, J. M., Imperial, J., Schoeller, D. A., & Penev, P. D. (2010). Insufficient sleep undermines dietary efforts to reduce adiposity. Annals of Internal Medicine, 153(7), 435-441. https://doi.org/10.7326/0003-4819-153-7-201010050-00006
O'Brien, L. M. (2011). The neurocognitive effects of sleep disruption in children and adolescents. Sleep Med Clin, 6(1), 109-116. https://doi.org/10.1016/j.jsmc.2010.12.007
Ochab, J. K., Szwed, J., Oleś, K., Bereś, A., Chialvo, D. R., Domagalik, A., Fąfrowicz, M., Ogińska, H., Gudowska-Nowak, E., Marek, T., & Nowak, M. A. (2021). Observing changes in human functioning during induced sleep deficiency and recovery periods. PLOS ONE, 16(9), Article e0255771. https://doi.org/10.1371/journal.pone.0255771
Paruthi, S., Brooks, L. J., D'Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., Maski, K., Nichols, C., Quan, S. F., Rosen, C. L., Troester, M. M., & Wise, M. S. (2016). Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6), 785-786. https://doi.org/10.5664/jcsm.5866
Pejovic, S., Basta, M., Vgontzas, A. N., Kritikou, I., Shaffer, M. L., Tsaoussoglou, M., Stiffler, D., Stefanakis, Z., Bixler, E. O., & Chrousos, G. P. (2013). Effects of recovery sleep after one work week of mild sleep restriction on interleukin-6 and cortisol secretion and daytime sleepiness and performance. American Journal of Physiology-Endocrinology and Metabolism, 305(7), E890-E896. https://doi.org/10.1152/ajpendo.00301.2013
Pellegrino, R., Kavakli, I. H., Goel, N., Cardinale, C. J., Dinges, D. F., Kuna, S. T., Maislin, G., Van Dongen, H. P. A., Tufik, S., Hogenesch, J. B., Hakonarson, H., & Pack, A. I. (2014). A novel BHLHE41 variant is associated with short sleep and resistance to sleep deprivation in humans. Sleep, 37(8), 1327-1336. https://doi.org/10.5665/sleep.3924
Penninkilampi, R., & Eslick, G. D. (2018). A systematic review and meta-analysis of the risk of dementia associated with benzodiazepine use, after controlling for protopathic bias. CNS Drugs, 32(6), 485-497. https://doi.org/10.1007/s40263-018-0535-3
Pinheiro, M. C., Costa, H. E., Mariana, M., & Cairrao, E. (2025). Sleep deprivation and its impact on insulin resistance. Endocrines, 6(4), 49. https://doi.org/10.3390/endocrines6040049
Popovic, R. M., & White, D. P. (1998). Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol, 84(3), 1055-1062. https://doi.org/10.1152/jappl.1998.84.3.1055
Prather, A. A., Janicki-Deverts, D., Hall, M. H., & Cohen, S. (2015). Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep, 38(9), 1353-1359. https://doi.org/10.5665/sleep.4968
Prior, J. C., & Hitchcock, C. L. (2012). Progesterone for hot flush and night sweat treatment: effectiveness for severe vasomotor symptoms and lack of withdrawal rebound. Gynecol Endocrinol, 28(Suppl 2), 7-11. https://doi.org/10.3109/09513590.2012.705390
Quan, S. F., Wright, R., Baldwin, C. M., Kaemingk, K. L., Goodwin, J. L., Kuo, T. F., Kaszniak, A., Boland, L. L., Caccappolo, E., & Bootzin, R. R. (2006). Obstructive sleep apnea-hypopnea and neurocognitive functioning in the Sleep Heart Health Study. Sleep Med, 7(6), 498-507. https://doi.org/10.1016/j.sleep.2006.02.005
Resnick, H. E., Redline, S., Shahar, E., Gilpin, A., Newman, A., Walter, R., Ewy, G. A., Howard, B. V., & Punjabi, N. M. (2003). Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care, 26(3), 702-709. https://doi.org/10.2337/diacare.26.3.702
Roberts, R. E., & Duong, H. T. (2014). The prospective association between sleep deprivation and depression among adolescents. Sleep, 37(2), 239-244. https://doi.org/10.5665/sleep.3388
Rubio-Sastre, P., Scheer, F. A., Gómez-Abellán, P., Madrid, J. A., & Garaulet, M. (2014). Acute melatonin administration in humans impairs glucose tolerance in both the morning and evening. Sleep, 37(10), 1715-1719. https://doi.org/10.5665/sleep.4088
Ruddick-Collins, L. C., et al. (2022). Timing of daily calorie loading affects appetite and hunger responses without changes in energy metabolism in healthy subjects with obesity. Cell Metabolism. https://doi.org/10.1016/j.cmet.2022.08.001
Scheer, F. A., Hilton, M. F., Mantzoros, C. S., & Shea, S. A. (2009). Adverse metabolic and cardiovascular consequences of circadian misalignment. Proceedings of the National Academy of Sciences, 106(11), 4453-4458. https://doi.org/10.1073/pnas.0808180106
Scheer FAJL, Van Montfrans, G. A., van Someren, E. J. W., Mairuhu, G., & Buijs, R. M. (2004). Daily nighttime melatonin reduces blood pressure in male patients with essential hypertension. Hypertension, 43, 192-197. https://doi.org/10.1161/01.HYP.0000113293.15186.3b
Schüssler, P., Kluge, M., Yassouridis, A., Dresler, M., Held, K., Zihl, J., & Steiger, A. (2008). Progesterone reduces wakefulness in sleep EEG and has no effect on cognition in healthy postmenopausal women. Psychoneuroendocrinology, 33(8), 1124-1131. https://doi.org/10.1016/j.psyneuen.2008.05.013
Seabra, M. L., Bignotto, M., Pinto, L. R., & Tufik, S. (2000). Randomized, double-blind clinical trial, controlled with placebo, of the toxicology of chronic melatonin treatment. Journal of Pineal Research, 29(4), 193-200. https://doi.org/10.1034/j.1600-0633.2002.290401.x
Shah, N., & Roux, F. (2009). The relationship of obesity and obstructive sleep apnea. Clin Chest Med, 30, 455-465. https://doi.org/10.1016/j.ccm.2009.05.012
Silva, G. E., Goodwin, J. L., Sherrill, D. L., Arnold, J. L., Bootzin, R. R., Smith, T., Walsleben, J. A., Baldwin, C. M., & Quan, S. F. (2007). Relationship between reported and measured sleep times: the Sleep Heart Health Study (SHHS). J Clin Sleep Med, 3(6), 622-630. https://doi.org/10.5664/jcsm.26974
Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. The Lancet, 354, 1435-1439. https://doi.org/10.1016/S0140-6736(99)01376-8
Spiegel, K., Tasali, E., Penev, P., & Van Cauter, E. (2004). Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine, 141(11), 846-850. https://doi.org/10.7326/0003-4819-141-11-200412070-00008
Tasali, E., Leproult, R., Ehrmann, D. A., & Van Cauter, E. (2008). Slow-wave sleep and the risk of type 2 diabetes in humans. Proceedings of the National Academy of Sciences, 105(3), 1044-1049. https://doi.org/10.1073/pnas.0706446105
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 163(3), 191-204. https://doi.org/10.7326/M14-2841
Uccella, S., Cordani, R., Salfi, F., Gorgoni, M., Scarpelli, S., Gemignani, A., Geoffroy, P. A., De Gennaro, L., Palagini, L., Ferrara, M., et al. (2023). Sleep deprivation and insomnia in adolescence: implications for mental health. Brain Sci, 13(4), 569. https://doi.org/10.3390/brainsci13040569
Unruh, M. L., Redline, S., An, M.-W., Buysse, D. J., Nieto, F. J., Yeh, J.-L., & Newman, A. B. (2008). Subjective and objective sleep quality and aging in the Sleep Heart Health Study. J Am Geriatr Soc, 56(7), 1218-1227. https://doi.org/10.1111/j.1532-5415.2008.01755.x
U.S. Food and Drug Administration. (2013, January 10). Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist) [Drug Safety Communication].
U.S. Food and Drug Administration. (2019, April 30). FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines [Drug Safety Communication].
U.S. Food and Drug Administration. (2024, December 20). FDA approves first medication for obstructive sleep apnea [Press release].
Van Cauter, E., Leproult, R., & Plat, L. (2000). Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA, 284(7), 861-868. https://doi.org/10.1001/jama.284.7.861
Van Cauter, E., Holmbäck, U., Knutson, K., Leproult, R., Miller, A., Nedeltcheva, A., Pannain, S., Penev, P., Tasali, E., & Spiegel, K. (2007). Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res, 67(suppl 1), 2-9. https://doi.org/10.1159/000097543
Van Dongen, H. P. A., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26(2), 117-126. https://doi.org/10.1093/sleep/26.2.117
Vujovic, N., Piron, M. J., Qian, J., Chellappa, S. L., Nedeltcheva, A., Barr, D., Heng, S. W., Kerlin, K., Srivastav, S., Wang, W., Shoji, B., Garaulet, M., Brady, M. J., & Scheer, F. A. J. L. (2022). Late isocaloric eating increases hunger, decreases energy expenditure, and modifies metabolic pathways in adults with overweight and obesity. Cell Metabolism, 34, 1486-1498. https://doi.org/10.1016/j.cmet.2022.09.007
Weedon, M. N., Jones, S. E., Lane, J. M., Lee, J., Ollila, H. M., Dawes, A., Tyrrell, J., Beaumont, R. N., Partonen, T., Merikanto, I., Rich, S. S., Rotter, J. I., Frayling, T. M., Rutter, M. K., Redline, S., Sofer, T., Saxena, R., & Wood, A. R. (2022). The impact of Mendelian sleep and circadian genetic variants in a population setting. PLoS Genetics, 18(9), e1010356. https://doi.org/10.1371/journal.pgen.1010356
Wesstrom, J., Ulfberg, J., & Nilsson, S. (2005). Sleep apnea and hormone replacement therapy: a pilot study and a literature review. Acta Obstet Gynecol Scand, 84, 54-57. https://doi.org/10.1111/j.0001-6349.2005.00575.x
Widome, R., Berger, A. T., Iber, C., Wahlstrom, K., Laska, M. N., Kilian, G., Redline, S., & Erickson, D. J. (2020). Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents. JAMA Pediatrics, 174(7), 697-704. https://doi.org/10.1001/jamapediatrics.2020.0344
Williamson, A. M., & Feyer, A. M. (2000). Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and Environmental Medicine, 57(10), 649-655. https://doi.org/10.1136/oem.57.10.649
Wittert, G. (2014a). The relationship between sleep disorders and testosterone in men. Asian J Androl, 16, 262-265. https://doi.org/10.4103/1008-682X.122586
Wittert, G. (2014b). The relationship between sleep disorders and testosterone. Curr Opin Endocrinol Diabetes Obes, 21(3), 239-243. https://doi.org/10.1097/MED.0000000000000069
Worley, S. L. (2018). The extraordinary importance of sleep: the detrimental effects of inadequate sleep on health and public safety drive an explosion of sleep research. P T, 43(12), 758-763.
Wright, K. P., Jr., Drake, A. L., Frey, D. J., Fleshner, M., Desouza, C. A., Gronfier, C., & Czeisler, C. A. (2015). Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance. Brain, Behavior, and Immunity, 47, 24-34. https://doi.org/10.1016/j.bbi.2015.01.004
Wu, C.-S., Ting, T.-T., Wang, S.-C., Chang, I.-S., & Lin, K.-M. (2011). Effect of benzodiazepine discontinuation on dementia risk. The American Journal of Geriatric Psychiatry, 19(2), 151-159. https://doi.org/10.1097/JGP.0b013e3181e049ca
Xie, L., Kang, H., Xu, Q., Chen, M. J., Liao, Y., Thiyagarajan, M., O'Donnell, J., Christensen, D. J., Nicholson, C., Iliff, J. J., Takano, T., Deane, R., & Nedergaard, M. (2013). Sleep drives metabolite clearance from the adult brain. Science, 342(6156), 373-377. https://doi.org/10.1126/science.1241224
Yamazaki, E. M., Antler, C. A., Lasek, C. R., & Goel, N. (2021). Residual, differential neurobehavioral deficits linger after multiple recovery nights following chronic sleep restriction or acute total sleep deprivation. Sleep, 44(4). https://doi.org/10.1093/sleep/zsaa224
Young, T., Finn, L., Austin, D., & Peterson, A. (2003). Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. American Journal of Respiratory and Critical Care Medicine, 167(9), 1181-1185. https://doi.org/10.1164/rccm.200209-1055OC
Zhdanova, I. V., Wurtman, R. J., Balcioglu, A., Kartashov, A. I., & Lynch, H. J. (1998). Endogenous melatonin levels and the fate of exogenous melatonin: Age effects. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 53(4), B293-B298. https://doi.org/10.1093/gerona/53a.4.b293
Zhong, G., Wang, Y., Zhang, Y., & Zhao, Y. (2015). Association between benzodiazepine use and dementia: A meta-analysis. PLoS ONE, 10(5), e0127836. https://doi.org/10.1371/journal.pone.0127836
