Why The Pill May Impair Sleep

SEATTLE, WA—Use of a combined oral contraceptive has shown to increase cortisol and adrenocorticotropic hormone concentrations, which are closely related with sleep, according to data presented at SLEEP 2015.

Combined oral contraceptives and topical azelaic acid are commonly prescribed to treat adult female patients with acne, a population that frequently experiences higher stress levels. Sleep deprivation is known to activate the stress axis, leading to higher concentrations of cortisol. However, the influence of azelaic acid on sleep quality or cortisol concentrations has not been studied.

In a randomized, comparative, single-blind trial, researchers from Universidade Federal de São Paulo, São Paulo, Brazil, examined the sleep quality and stress hormone concentrations on adult female acne patients before and after treatment with the combined oral contraceptive ethinyl estradiol plus drospirenone vs. azelaic acid topical gel at baseline and after 6 months of treatment. Patients completed the Pittsburgh Sleep Quality Index, and had their cortisol and adrenocorticotropic hormone levels measured.

The study found that after 6 months, the combined oral contraceptive group had higher cortisol concentrations compared to baseline than the azelaic acid group, and also had reduced subjective sleep duration, without overall changes in sleep quality.

“Although combined oral contraceptive, consisting of ethinyl estradiol plus drospirenone, is a very effective treatment for adult female acne, it can also increase cortisol concentrations and even impair sleep,” noted Rachel G. Albuquerque, the study’s lead author. “These factors impact welfare and quality of life.”