When was the last time you woke up and actually
felt rested? Not wired, not foggy, not running
on caffeine and cortisol. The truth is, we don't
sleep as well as we age. That deep sleep, it
starts plummeting every decade that goes by.
Women in their 40s, what tends to be the biggest
thing that happens to them with regards to their
sleep? As you start to hit that menopausal transition.
You've got decreases in estrogen and progesterone.
I'm very familiar with those. Nocturnal hot flashes,
night sweats, which many women report wake them
up. Are there surprising things that women are
doing that keep them kind of stuck in these bad
sleep cycles? This might surprise some people.
We love our... A big cause of sleep problems.
What is the solution that we're missing? Because
I think we all are aware of sleeping pills, but
like a lot of us don't want to take stuff for
sleep. Cognitive behavioral therapy for insomnia.
The women who were in the CBTI group had really
very robust and impressive improvements in their
sleep. We had no change in vasomotor symptoms
in these women. Their insomnia got better. The
hot flashes didn't bother them so much. Because
they slept. If you've accepted being toxic, When
was the last time you woke up and actually felt
rested? Not wired, not foggy, not running on
caffeine and cortisol. Rested and energized.
Because here's the uncomfortable truth. For many
women in midlife, deep restorative sleep quality
disappears long before we realize it's even going.
We blame stress. We blame hormones. We blame
our kids, our screens, our schedules. But what
if the problem isn't just life? What if it's
the way we've unknowingly trained our brains
to sleep? Alongside renowned sleep expert and
CBTI researcher, Dr. Sue McCurry, we're unpacking
her work on why insomnia explodes during perimenopause,
how chronic sleep deprivation derails women's
health, and the surprising behaviors that keep
even the most disciplined women stuck in cycles
of exhaustion. Make sure you stay tuned. to learn
about a cutting -edge treatment that doesn't
rely on pills, gadgets, or sleep hacks, and why
it may be the most overlooked tool in women's
health. If you've accepted being tired as your
new normal, this conversation is going to put
that to rest. Before we dive in, if conversations
like this help you take better care of your body,
your mind, and your future, make sure to follow
the show and hit subscribe. It's the simplest
way to support this work, connecting evidence
-based, life -changing conversations to women
who need to hear it the most. Welcome, Sue. Thank
you so much for being on the show. Thanks for
having me. We are so excited to have you all
the way from America, by the way. Welcome to
my fellow American. You have spent decades researching
sleep in midlife and beyond. What do you think?
When you think of like a healthy night's sleep
or a normal night's sleep versus the sleep you
hear women in midlife reporting, what is that
gap? Well, normal sleep is a little bit hard
to talk about. What I would say is ideally healthy
sleep is sleep that is regular. So you get about
the same amount of sleep every night. You go
to bed and get up at about the same time every
day. And when you get into bed, you're ready
to go to sleep. You're actually tired. You're
sleeping when you turn out that light. Of course,
there's lots of things in life that can impact
all of these things. There's vacations and there's
holidays and there's special events. So you may
not be able to follow the ideal of regularity
and readiness for sleep. But that's, I think,
what people should be aspiring to. And when you
say there's, you know, these little things that
come up, right? Vacations, holidays, whatever.
I feel like that's also a message that we give
in general health, right? So it's like, yeah,
you should be exercising. You should be eating
well. But there's wiggle room for special occasions.
But is there a way to know that you've gone too
far afield? This isn't just, oh, I got off track
for a holiday. Like, my sleep is really messed
up. Well, insomnia is defined as being a condition
where you have trouble sleeping. at least three
nights a week. It's been going on for at least
three months. It can be either trouble falling
asleep or staying asleep or waking up too early
in the morning. And it's interfering with your
daytime functioning in some way. So that's a
pretty big bar, right? If you have a couple of
nights that you're not sleeping well, but it
hasn't been going on for months and months, then
probably you're doing okay. Women in their 40s,
what tends to be sort of the biggest thing? that
happens to them with regards to their sleep?
Is it that they just don't get enough? Is it
that they can't fall asleep? What do you tend
to find? Well, so women in their 40s have a lot
of things going on that are going to impact their
sleep, right? The first is they're just getting
older. Girl, too real. Okay, too real. You know,
the truth is we don't sleep as well as we age.
That deep sleep you talked about in your intro.
It starts plummeting every decade that goes by.
And so because women are already starting to
spend less time in deep restorative sleep, they're
more likely to wake up more easily and then maybe
have trouble falling back asleep. So some of
it's just natural aging. Some of it is as you
start to hit that menopausal transition, you've
got changes in hormones going on. You've got
decreases in estrogen and progesterone. when
they're fully running, are helping with sleep
drive and quality of sleep. So the decrease is
going to increase propensity for some sleep troubles
anyway. But added to that is as those... hormones
decrease, we also start seeing these pesky vasomotor
symptoms showing up. I'm very familiar with those.
Right, nocturnal hot flashes, night sweats, which
many women report wake them up. Although interestingly,
the literature would suggest that sometimes The
woman wakes up and that triggers the hot flash
of night, which doesn't perceived that way, of
course, to the woman. It seems like it's a causal
thing, but it can go both ways. Wow. That is
interesting because my husband always complains.
We've had to change duvets. So I have my own
one, which is a nice lightweight one, which doesn't
feel like anything. He's got this really heavy,
thick one because our bedroom is sub -zero temperatures
because he can't sleep in the same room as me
because I need it. cold right and he's finding
it way too cold right because of the hot flashes
i was i was waking up in the middle of the night
just feel hot and the other night we were watching
tv and um we had the aircon on i had a blanket
i was like oh i'm really cold i'm i'm really
cool can we turn the aircon off he goes well
i don't know what's going on with you because
as soon as we go up one level Your body changes
and you're hot. That is interesting. My excuse
was hot air rises. It does. I mean, that's also
true in Singapore. I feel like the third floor
in our house is the hot one as well. The other
thing I do want to say about sleep and midlife
women too, though, is you think about the lifestyles
of many midlife women, right? So many women are
in high pressure, high intensity jobs. It's hard
to put that down at the end of the day. They
have family commitments. teenagers who have school
and sports activities or kids late into the night.
They may have partners who are on a different
sleep -wake schedule than they are that is disrupting
sleep. They may have financial responsibilities
that they're worried about. They may be caring
for an aging parent, that sandwich generation.
So women... in midlife, I think, have so many
stressors genuinely impacting them. They may
not be eating right. They may not be exercising.
They may not have time just for themselves. And
they're at greater risk for becoming depressed
or anxious, which are themselves risk factors
for sleep problems. So you see, it's complicated.
There's many things that are impinging upon women
impacting their sleep. So you mentioned exercise,
poor sleep, stress. Are there surprising things?
that women are doing that keep them kind of stuck
in these bad sleep cycles? One of the biggest
things is they're on their screens too much.
They're in bed, they've got their tablet, they're
checking their emails, they're watching a movie,
they're on the phone, they're surfing the net,
too many screens. And screens are problematic
for a couple of reasons. One is many of them
put out blue light, which goes through the eyes
and it turns off melatonin production, which
is our sleep hormone. So that's not good. Not
good. And even if people say, oh, well, I've
got the special glasses and I can turn my tablet
down, no blue light, it's still cognitively stimulating.
And what we want when we're getting ready to
go to sleep is we want to be ready to sleep.
We want our mind to be slowing down. We want
the light to be getting dimmer. We want to...
be telling our body and brain it's getting time
to sleep not you know running at high gear and
then hopping into bed and expecting to pass out
i mean it's funny that you mentioned that sue
because it really resonates with a slight shift
in my personal lifestyle in that i've been working
on a book with a u .s publisher and so i'm on
u .s hours with my book people right and they're
all all the calls are at night and so i'll come
off this call and it's not late necessarily so
it's like 9 30. But my brain is fully charged
because I just had an hour of like very high
level executive conversation with someone who's
very important for this process. And then it's
like, I can't just click it and go to bed. And
it's like I've noticed the difference, the subtle
shift in my ability to fall asleep. And then
in my in terms of my sleep tracker, which we'll
talk about later, my proportion of restorative
sleep. Right. I also want to mention this might
surprise some people is pets. We love our cats
and our dogs, and I suppose people have chickens
and other things too, but cats and dogs, they
need to go out. They need to come in. They're
on the floor throwing up next to the bed. They're
on top of the bed. They're on top of you. They're
making it impossible for you to roll over. Pets
are... A big cause of sleep problems in many
people. Code is my dog. We trained him not to
come upstairs. So partly because the kids get
a bit stuffy. So we don't want him to be in the
bedroom area. So he knows he's not allowed upstairs.
So we never actually sleep with Koda. But he
actually doesn't like because he obviously it's
quite hot here. He'll come and join us on the
sofa for, you know, a little moment for a stroke.
And then very quickly he's off again because
I think he's like, I can't handle it. Yeah, but
that on and off would be one if he was upstairs
would be one of those disruptions that you might
not even think about. And then kids. I've got
a lot of friends whose children come in in the
middle of the night. And she's recently just
started on progesterone because she told me her
sleep was very disruptive and she was having
issues staying asleep. And obviously one of the
big things is that, yes, her sleep has slightly
improved, but the thing that's not going to improve
is her child coming in at 2 a .m. Sure, sure.
And if you have a partner who snores. Or if you
have a partner who has to get up at 4 a .m. four
to get to work or comes home late at two after
you've already gone to bed. So there are all
of these circumstantial things. That's why a
guest room works beautifully for those moments.
It's like, guess what? Don't touch me at all.
But it works better for the husband than the
kids. I will say. But so I think we get a good
sense of what might be disrupting sleep. And
I think there's nothing you said that. some woman
in our audience will not resonate with, right?
It's pets, it's kids, it's stress. We all have
something there. But then what is the solution
that we're missing? Because I think we all are
aware of sleeping pills, right? And we're all
aware of melatonin supplements, but like a lot
of us don't want to take stuff for sleep. What
is the alternative? There's something called
cognitive behavioral therapy for insomnia or
CBTI. CBTI. And what CBTI is, it's a combination
of behavioral strategies that we teach people
and cognitive strategies, a way to think and
approach your sleep differently. And many organizations,
including the American College of Physicians,
the European Insomnia Network. the American Academy
of Sleep Medicine, say that CBTI should be the
first line of treatment if you have insomnia.
And remember, insomnia isn't just you're having
trouble sleeping for a few nights or even weeks,
as I described. It has to be an ongoing chronic
problem. But these major organizations are saying
you should try these behavioral strategies first
before you ever take a sleeping medication. And
then see, that is such a huge paradigm shift.
But I don't think people are hearing the message
because I think if you took 100 women with sleep
problems that have seen somebody about it, a
physician, let's say, have they been recommended
CBTI first? I can't imagine more than five of
the handful, and maybe if they came to our clinic
or another lifestyle medicine clinic, but have
even been exposed to that. So how do we change
the paradigm so that women are aware of what
CBTI is and what its power is? Well, part of
the problem, I think, is there aren't a plethora
of sleep medicine specialists. So not every physician
knows where they would even send someone. Correct.
There are online courses that you can take. There
are ways that virtually you can get access to
this information. And there are many, many, many
books that have been written that are very good
quality to talk women or anyone through the steps
involved in going through this. But one thing
is just access. Another thing is... Most women
will first report sleep problems if they do report
them. They don't always talk about them. But
if they do, they'll report them to an MD. And
what MDs do is they prescribe medicine. There
you go. And medicines are readily available.
And so I think it's partially just a culture
in treatment. And hey, behavior change is hard.
medicine is easy. And I mean, we see that with
all sorts of different types of medications.
But you mentioned CBTI is first line or should
be for everyone, men and women alike. But I really
want to hammer down on why women in particular
should consider this. And you've done some compelling
work about CBTI and vasomotor symptoms. Can you
talk about that? Right. So I was involved with
a study. It was called MS Flash. It was a National
Institute of Health study that was funded to
fund multiple large grants looking at how to
treat vasomotor symptoms. So one of those studies
looked at the use of yoga. One of them looked
at estrogen supplements. One of them looked at
aerobic exercise. My particular MS Flash grant
was looking at the use of CBTI for women who
had both insomnia and severe vasomotor symptoms.
And so what we did, it was a six -week trial.
It was telephone delivered. It was for women
between the ages of 40 and 60 who were experiencing
a certain level of insomnia and a certain level
of these phasomotor symptoms, including night.
And we put them through the program. And at the
end of that, at two months, and then again at
six -month follow -up, the women who had... been
in the CBTI group compared to a placebo educational
contact control. So those women also got phone
calls for six weeks from our coaches who gave
them lots of really interesting and useful information
about menopause and health. But the women who
were in the CBTI group had really very robust
and impressive improvements in their sleep, both
at post -test and at six -month follow -up compared
to the placebo control. And I should say that
both groups, women in both groups, their insomnia
symptoms reduced. So some of that is just contact,
right? You're talking to somebody who's nice
about your sleep problems. But the improvements
between the CBTI group and the placebo were quite
impressive and were sustained. Wow. I have to
admit, I did not realize that specificity of
the study whereby the placebo got education.
So I figured it was just placebo, placebo. Like
they didn't, you know, they just were out living
their lives. And then the other group was getting
this amazing targeted resource of CBTI. But no,
they were getting some educational calls. Yeah,
because we wanted to control for that impact
that can come just from talking to somebody.
That is powerful. And that really answers one
of the questions I wanted to ask you is like,
how, when you hear that, A cognitive behavioral
intervention that is not medical, meaning it
does not contain medicine or pharmaceuticals,
that is delivered over the phone could possibly
be the solution to our problems. It almost sounds
impossible to me. Yeah, it's pretty amazing.
It's a beautiful thing because, like I said earlier,
not every community has sleep medicine specialists
that people can go to. nor do they necessarily
have the insurance that they could pay for it
if they were going to such a provider. Not everybody
has access to good internet wireless service
that they could even do it virtually, but almost
everybody in the world has a telephone. And what
was great about our study, if I do say so myself,
is... The women who we had delivering the intervention
had, before the study, no experience with sleep
medicine at all. They were trained to be CBTI
coaches for this study. They were following a
protocol, so it was a manualized intervention.
But the fact that it was over the phone and it
was offered by women, by master's level clinicians,
who had not previously been sleep specialists,
suggests that in principle this model of delivery
that could reach many, many women is a possibility.
It hasn't ever been tested in trials, so we don't
know that for a fact. But we do know that historically
they did something similar with smoking cessation,
where they trained people to... talked to folks
over the telephone who would call a hotline number
and they would get coaching on cutting back on
smoking. And 20 years ago, that was a very big
deal. And so it's a model that has been used
with other health promotion concerns. Yeah, Alcoholics
Anonymous uses a component of that model, right?
Where you can access your sponsor via phone call
or text. It's not the first time you've heard,
hey, coaching works or partnership works, accountability
works. But really interesting that, again, two
pieces of information I want our listeners to...
acknowledge here one is that the first line recommendation
from is it the american oh it's it's the american
college of physicians the european insomnia network
the american academy of sleep medicine it's everyone
is saying try this first we have now work that
you are you know an author on that says this
works women need to have this tool in their toolbox
And here's something kind of fun that you might
enjoy. So in our study, the MS Floss study, we
got these really beautiful improvements in sleep,
right? We had no change in vasomotor symptoms
in these women. So we didn't have to get rid
of the vasomotor symptoms to get the improvements
in sleep. But what we did see was on a measure
that asked women how... disturbing how much interference
in your day do you have from your vasomotor symptoms
that dropped in the cbti group compared to so
women had insomnia their insomnia got better
their hot flashes stayed exactly the same but
the hot flashes didn't bother them so much because
they slept yes they because they slept or because
something about the process of cbti which um
does look at people's attitudes and perspective
about sleep also generalized perhaps to their
attitudes and perspectives about their hot flashes.
Wow. Did these women have sleep trackers on like
a watch or something like that? Because I am
wondering whether they saw an improvement in
a sleep tracker or was it just that they felt
better? Like when you think you're feeling better
because it's saying you slept better? Or it was
just like, no, I genuinely feel better, but I
have no idea what my sleep tracker was saying.
That's a super good question. I'm glad you brought
it up. So no, they did not have trackers on them.
And if they had had trackers on them, we would
have asked them not to use them. Good. You have
to understand that insomnia isn't like a liver,
right? It's not a thing. It's not pneumonia.
It is in part based upon... subjective experience
perspective there are people who are shorter
sleepers and some people who are longer sleepers
and so really to successfully treat insomnia
you want people's feelings about their sleep
to change that's not that's not made up it's
a real part of the syndrome right the thing about
trackers too is trackers aren't really measuring
sleep What they're measuring is movement, and
they're measuring pulse rate, maybe in some cases
sweat. They tell you, oh, you spent this much
time in deep sleep and this much time in REM,
and that's actually bogus. That's an algorithm
that's taking some combination of how much you're
moving and how much your heart rate or respiration
has dropped, and they're saying, we deem this
to be sleep versus wake. And the algorithms are
proprietary, so you will never know, nor can
I as a researcher know, what's behind the scenes
with research grade. accelerometers you can get
that information but you can't with like the
popular trackers so the the trackers are great
if you're wearing one and you're trying to systematically
make changes and see how your sleep's getting
better or worse over time your tracker you you
can monitor within person change but you shouldn't
take the data too seriously I've got people that
get up in the middle of the night and they're
checking their tracker data to see how much have
I slept, how much deep sleep have I gotten already.
I think that's a mistake because the information
isn't, the data aren't that good, really. And
it also is creating a preoccupation with sleep
that is unhealthy. You know, we sleep to live.
live to sleep and we shouldn't be obsessed with
getting a perfect amount of sleep every night
it doesn't help yeah yeah or feel less than because
we didn't right you know it's like oh if that's
if the goal is a perfect eight hours right with
you know what upwards of one hour of restorative
sleep then it's like i failed right it's a and
again i feel like for women it's it's another
metric by which we can see that we failed. Right.
And add that to the list of many failings. Not
effective. The other day I woke up and I was
like, oh, I feel so tired. I don't feel like
I slept very well, but my sleep score said I
slept fine. I'm like, no, this is not right.
I don't feel like I don't feel rested. So that's
a good example of how the subjective piece of
sleep. Yeah. Well, so you're telling us that
sleep trackers might not be the most objective
way to even quantify sleep, but let's talk about,
let's break down CBTI into what it actually is,
because I think Anyone familiar with CBT as a
therapy approach is like, okay, I know what this
is. It's therapy, right? It's talk therapy. I'm
going to sit in a room with somebody. But there
are tools within CBTI, correct? Like there's
certain kind of protocols. Do you mind sharing
a few of those? Oh, sure. So CBTI is, of all
the CBT protocols, I think one of the best because...
It is grounded in an understanding of what are
the physiological mechanisms within us that help
with sleep, which are largely our homeostatic
drive. Our need to sleep works in partnership
with our circadian sleep -wake cycles. And so
CBTI is trying to, and it works upon a process
of something that's called conditioned insomnia.
We, you remember Pavlov? Yes. Pavlov's dog got
conditioned that when the bell rang, food was
coming, so the dog would salivate even in the
absence of food. We can be conditioned to think
of bed and bedroom as being a place where we're
awake and anxious about being awake. And so cognitive
behavioral therapy is going to be addressing
both these processes from a behavioral point
of view and also this conditioned insomnia. So
some of the main tools that people are probably
aware of is one is called stimulus control. Behavior
comes under control of certain stimuli. So what
we're trying to do is impact that conditioned
insomnia by telling people bed is for sleep.
When you're in bed, you can sleep, you can be
intimate with your partner or even cuddle with
your kids, but you don't read, you don't surf
the nets, you don't watch television, you don't
do work, you don't eat, you don't nest there.
You have a wind down time before bed to get at
what you were talking about earlier. you are
going to not nap during the day. Because if you're
napping during the day, you're pulling out of
the bank that need to sleep that's been building
up all day. Now you don't have as much need when
you go to bed. I'm definitely not a napper. I
can't nap. And it really encourages having a
consistent rise time in the morning. Because
if there's one thing our bio rhythms like more
than anything, it's consistency. And it's much
easier to maintain a consistent rise time than
a consistent bedtime. Because there's so many
things at night that can impact your ability
to go to bed at a certain time. But if there's
one... cbti recommendation i would make for everybody
it would be to get up at the same time every
day no matter how you slept the night before
i love that no matter if it's your birthday or
it's christmas so for me my usual wake time is
6 30 a .m just because the boy i'm helping the
boys get ready for school but the weekend i do
want to sleep in but annoyingly i can't because
my body will actually wake up between 6 30 and
7 a .m It's a good thing. It's a good thing.
It is a good thing from a circadian point of
view. For sure. But, you know, sometimes I just
want to stay in bed. I would love to sleep a
little bit longer. And then it also means I can't
do things on a Friday night or a Saturday night
because then I need to be in bed by 9 p .m. Otherwise,
I'm not going to get my full sleep and then it's
going to affect me. So I've become boring as
I've gone older. So this is a diatribe on life
in your 40s. But is there any added benefit?
This is literally just a personal question to
getting up with the sun. So like in Singapore,
right, we are 12 months a year the same schedule.
We don't have daylight saving. We're on the equator.
I love it. I love the fact that it's 12 hours.
Oh, me too. It suits me so well. But is there
any added benefit to waking up with the sunrise
in your given location, knowing that in a lot
of locations, it isn't the same time every day?
Right. Early morning light is very good for,
again, anchoring your circadian clock. Get up
at the same time, and if you can get early morning
light exposure, it just sort of helps, like I
said, anchor the day, and the rest of the day
will unfold. That's great, since you have the
sun coming up at the same time every day. As
you mentioned, most people do not in other parts
of the world. Some people use bright light boxes
for that purpose. They'll get up in the morning,
and they'll have a box sitting on the kitchen
table where they're having their morning coffee
and reading the paper or the news on their phone,
and it'll be shining in their eyes, and it provides
kind of a simulation of morning light to do that
anchoring effect. Have you heard of that? I have
not, but when we were in Norway over Christmas,
there was pretty much no light. So I guess like
those locations definitely need something like
that. Well, and that early morning bright light
exposure can also help for people who have seasonal
affective disorder, who get depressed in the
dark, you know, times of the year. So that's
incredible. Cause I was thinking, I was like,
we are actually really lucky that our wake time
could coincide with our sunrise every single
day. Pretty much. Cause you know, we get it right
before seven o 'clock or around seven o 'clock.
So that, you know, it kind of works for a lot
of schedules in Singapore. That's so interesting.
So how should we think about planning for sleep?
So waking at the same time is one way to do it,
but how do we kind of reverse engineer from the
wake time into the night before? Like, what are
we doing to make that sleep as restful as possible?
Okay. So one of the things I didn't mention a
moment ago when I was talking about those stimulus
control recommendations, another big... and CBTI
is something that's commonly called sleep restriction,
which I don't like the name of that because we're
not actually trying to restrict how much sleep
people get. It's really more bed restriction
because a lot of people who have insomnia are
spending too much time in bed. They're spending
too much time in bed because they think, I didn't
get enough sleep last night, so if I go to bed
earlier, I sleep in later, then I'm going to
have time to get all this extra sleep. And they
wind up spending way more time in bed than they
need, which actually is bad. for making those
underlying processes work. So it's time in bed
awake rather than time in bed. Right, because
if you only need seven and a half hours sleep
at night, you biologically only need that much
and you're in bed for 10 hours a night, then
two and a half hours, you're just lying awake.
And that is not psychologically a good thing
for supporting. That's an example of a thing
that can go into planning. A person can come
up with a plan. They can say, I'm going to spend
no more than eight and a half hours in bed at
night. And I'm going to get up at this same time,
which means I'm going to aim to go to bed at
that time. Maybe I'll not be able to do that
every night, but that's what I'm going to aim
for. So here's your sleep plan. The trouble with
sleep plans, in my experience, is people get
sloppy pretty easy. They don't want to get up
at 7 if they had a bad night's sleep or a short
night's sleep. They don't want to give up their
reading on their phones in bed. They don't want
to do it. But that's really no difference than
going to the gym, right? People set up a gym
plan for New Year's every year, and then they
wind up, I don't want to go to the gym. So I
have a colleague, my husband and I know someone
who... Later in his life, he became rather strict
about his sleep schedule. And so we'll be at
a conference together and they'll have some late
night event. He'll look at his watch and say,
nope, it's nine o 'clock, it's my bedtime, I'll
see you tomorrow. It's just a priority for him.
That's just what he does. Well, not everybody's
willing to do that. Yeah, it's true. I was speaking
to a client yesterday and she was saying that,
oh, I think I'm going to change my doctor because
this HRT isn't working for me. And I said, what
are the issues? So she named what her issues
were. One of them was, I'm not sleeping great.
I don't feel well. Then my question to her was,
are you doing the right things to help you sleep
well? Because if your sleep hygiene isn't optimal,
then you can't blame it on the hormones yeah
do you find that that's what people tend to do
they think that it's Just my hormones are affecting
it. Yeah, but when you sort of dig in, then you
realize actually maybe it's because, like you
said, you're scrolling at nighttime or you're
exercising late into the evening. Or you're drinking
too much coffee. Some people become, maybe when
they were in their 20s, they could drink six
cups of coffee a day. But now if they're drinking
more than two after like 11 a .m., it can impact
their sleep. Some people are enjoying half a
bottle of wine at dinner and overnight, which
works great in helping you fall asleep, but then
as it burns off, it wakes you up. It's like we
said earlier in our research study where we got
very beautiful improvements in sleep. We didn't
change the vasomotor symptoms at all. HRT is
going to be working on... the vasomotor symptoms
and some of those things it's not a sedative
yeah so and i think sue you know you said it
first thing on this podcast and it broke my heart
but then i you know i i have resilience aging
i mean you just got to be realistic about the
eight cups of coffee you drank in your 20s and
not working for you in your 40s this is a similar
you know kind of mantra that we're using with
clients all the time in terms of nutrition and
fitness you know just because you could go to
back -to -back HIT classes six times a week in
your 20s and be no problem doesn't mean that's
the approach for your 40s and I think acknowledging
the refinement in approach especially if you're
able to acknowledge that hormones are changing.
So she can acknowledge, his friend, that HRT
was part of her treatment plan because her hormones
needed it. Then perhaps she could also acknowledge
that it's time to evolve her sleep quality, her
sleep schedule, her workouts, whatever it may
be. And everybody is different. They're different
in how much sleep they need, and they're different
in how strict they need to be with these different
kinds of behavioral strategies. It's not unusual
for, so I put people through a CBTI program and
we have a pretty rigid plan for the six weeks
that I'm working with them. But then at the end,
they're going to go off and live their life.
And so we talk about how do you modify this plan
over time? And I have an approach to encouraging
people to do that. But some people can go immediately
back to the most sloppy sleep habits and they
continue to sleep fine. Interesting. Some people...
cannot. And the people who cannot are kind of
mad about it. They'll say, well, it's just not
fair. My husband, as soon as he puts his head
on the pillow, he passes out and he sleeps all
night. You know, if you have a gluten allergy,
it's not fair, but you still can't eat wheat.
And it's sort of the same way. If you at this
stage in your life are a person who can't use
your screens in bed, who can't spend too much
time in bed, who have to get, it's not fair,
but It's just how you are. And to realize that
it's somewhat under your control. If you decide
to go on vacation and throw all of these things
out the window and your sleep, you know, is terrible,
you don't feel so scared and alarmed because
you understand that. I'm not following my own
plan, which works best for me. That's a choice
I'm making for this point in time. And I can
always get back on the plan when I get back home.
So that's exactly what we say. You know, it's
like I will have every now and then a beer. knowing
full well it is not going to go well for my sleep
and it never does so it's like i know it and
i show it and that's fine but i don't feel victimized
by right right you know i feel actually empowered
by that knowledge because i can then choose to
to have a better night's sleep with the tools
that i do have yeah i think that's part of the
reason also why we decided to make the change
of like giving up the not like totally giving
up alcohol but not drinking yeah so You know,
like Amanda said, that when we make that conscious
decision, we know exactly what we're doing. And
I think that is, like you said, that's empowerment.
Very much so. Yeah, very much so. So let's talk
about things a little bit less in our control.
I am a mom of little littles, right? So I'm a
later in life mom who has little tiny kids, five,
four, and one, almost two. Oh no, I can't believe
it. And I do find that obviously kind of the
sleep rhetoric in this community of moms with
little kids is basically like, can't fix it,
don't try, struggle through the first five years,
hope for the best. And definitely it's something
that I reject personally in my own life because
we did some pretty, you know, you mentioned people
who are strict about sleep. I always say if zero
or one is like co -sleeping in a big bed with
no bedtimes and 10 is like a military prison.
My house is a nine. So that's kind of how we
run it. But realistically, do you have maybe
some softer tips or some more introductory tips
for families like mine with little kids to get
a little bit more sleep, better sleep? You know,
my feeling about kids, when I was raised, my
son was born when I was in my 40s. So I was a
late mom. And, you know. At that time, there
was a book by a man named Richard Ferber. I don't
know if Ferber is still out there. Ferbering.
Again, you don't touch sleep training without
talking about Ferber. Yeah, so everybody was
about Ferbering when I was raising my son. And
perhaps because I was an older mom and he was
my only, perhaps just because of the way we run
our household, the strictness of that plan didn't
work for me. And so for a number of years, my
kid would, in the middle of the night, call,
Mom! And I'd get up and I'd go in there and sit
next to the bed and I'd put my hand on him and
he'd go right back to sleep and then I'd go to
bed and I'd go back to sleep. And it worked fine
for both of us. So I think each family has to
figure out what strategies are best for them.
And to remember, this doesn't last forever. You
know, kids grow up. Their bodies and brains are
still... changing learning how to sleep for one
thing and learning the societal expectations
that they're going to sleep in their own bed
for this period of time and not going to but
you've got so many things going on with kids
right you've got siblings bothering one another
oh yeah that's in my house my um i've got 10
year old and eight year old twins three boys
they all sleep in the same room And 100%, the
eldest, I know it's Kyan. Sorry, Kyan, I know
it's you. He will disturb his brothers. But then
yesterday he had tennis in the evening. And when
we got back, I opened the door very quietly.
And I think the twins thought it was Kyan because
they were waiting up for him. I'm like, I'm here.
I'm going to sleep. So, you know, I know that
they will wait for each other. They will always
mess around with each other. And that's just,
that's just what they do. Yeah. They do that
or they get sick or they have a nightmare or
they develop anxiety about the dark or, you know,
there's all sorts of things that, and kids are
also under a lot of stress and strain these days,
right? Pressures at school. And so I think. There
is some truth to this. This is a hard stage and
it will pass. And each family gets to decide.
What seems to work best for them, given the realities
of their situation? I very well would have been
likely to be less enthusiastic about getting
up if I'd had three kids that are all little
ones as opposed to one. I do feel like I got
more stringent as they came, rather than less.
I think you feel like you have to, don't you,
when you've got more. It's because otherwise
they'll just run riot. But my kids still bring
up a time. This would have been a couple of years
ago, so they were much younger. But they're like,
mommy, do you remember that time when you cried
when you didn't sleep? Because they kept coming
into my room and I was just tired. And it just,
it really took a toll on me. And they still remember
that. I'm like, oh yes, I remember. I remember
when I was exhausted and it was just too much
for me. But I do always say to my clients, because
I've had this question before, and I say to them,
look, it's your choice. If you are happy with
your child coming into your room, sleeping in
your bed, that's fine that's you know something
that you are again deciding to do but for me
it wasn't fine and I was really struggling and
I really needed the sleep um and so again part
of why I also ran a military operation with with
the boys you see why we get along I caught your
semantics there I caught you earlier using three
words very differently tired sleepy exhausted
yeah Do you is that intentional that you kind
of like you said tired and then you said sleepy
when you're talking about going to the bedroom?
And I feel like when I think of those three words,
for some reason, I think sleepy means it's time
to go to sleep. Like it's time for me to get
into bed and sleep. Tired means I've done enough
for today. Like I've used enough physical energy
that I am now tired. It doesn't it's not a negative.
It's just that is the end of my day. I am tired.
Exhausted signals to me. And again, maybe I'm
reading too deep into semantics that I am beyond.
what I can handle in this day. Like I'm not just
tired. I'm now in excess of what I had to spend
energy wise. Right. And for me, the connotation
there is exhausted doesn't necessarily mean sleep
deprived. It means it's a stretch beyond tired,
you know, that you have overdone. It's just piling
up. Everything is piling up. It's too much. I
can't carry it all this anymore. That just sounds
like a 40 -year -old woman to me. Resonance,
deep, right? Exhaustion is where, yeah, sometimes
where we kind of, it's almost like our happy
place. Yeah. Something we can probably scale
back. Well, speaking of happy places, our happy
place on the show is our fun little segment called
Hot or Hype. So we take experts like yourself,
we give you some kind of hot button issues in
your field, and you give us your reflections.
So hot. means you agree. You're like, yeah, this
is a good thing, helpful, whatever. Hype means
not so much, wouldn't recommend it. Is there
something in the middle? Ooh, great question.
Liquid? Maybe something with an H. Hyper halfway?
Powerful, powerful language. But you can definitely
qualify. Okay. So this is not a one word. You
can say your thing and then explain your piece.
All right. So quote we hear all the time in kind
of high achieving, high performer circles. You
can sleep when you're dead. I would have to say
yes. Meaning? Meaning? You can't outsmart it
forever. You can't. Well, meaning that says I
can put off sleeping. I don't have to sleep.
deserve to be able to stay up after my kids are
in bed and do my own thing. I can sleep when
I'm dead. I'll do that later. Which really, I
mean, we're supposed to sleep every day. We need
to sleep every day. So denying yourself sleep
is fine. It's a choice you can make, but it will
come at a cost if you do it consistently for
a long time. Is it true that you said individual
sleep needs differ? But when someone says, because
I've had clients say this to me, like, I'm fine
on four or five hours. Is there such a person
that is fine on four or five hours? Yes. However,
fine on four or five hours in the sense that
they don't feel like they need any more sleep
like that and they continue to be productive
or active with all the rest of the hours. There
are people like that. Whether that's actually
good for you or not, I mean, They've done studies.
Now, these are people who wouldn't necessarily
consider themselves short sleepers, but they've
done studies with people who are getting consistently
less than five hours of sleep at night for prolonged
periods of time. And those individuals are like
three times the increased risk for car accidents.
For some of them, it's almost like driving slightly
drunk because your reaction time and your attention
concentration are slowed. whether a natural short
sleeper who lives that way for a long time suffers
any of these kinds of sequelae. I'm not sure
from the literature, but I think what we do,
we don't know that there's the number eight hours
of sleep at night. That's just completely made
up. There's no hype. That's hype. Absolutely.
What the right amount is, it does vary from people
to people, but it's probably somewhere in the
range from six to nine. And then you start dropping
off. And when you start getting people who are
either sleeping like less than five every night
or more than 10, that's not. Good for you. I
said 12 -hour night sleep for an adult is not
recommended. Well, now and then it's okay. But
if you're doing it every night, there's something
not right. And I got to be a little snarky, like
show me somebody sleeping five hours that's like
jacked, meaning like muscular and has great muscle
density because your muscles ain't growing in
four or five hours. I had a genetic test done,
which actually showed that I'm a long sleeper.
I don't know how accurate it is, but it says
I need to have... Nine hours plus sleep. And
I do feel that I do need more sleep. Sleep is
always one of my big sore, well, it's a sore
point for me. Like if I don't get enough sleep
or if I'm, you know, go to sleep too late. Yeah,
mommy's crying. Mommy, I'm definitely crying.
Mommy, mommy needs her sleep for real. All right.
Hot or hype soup? Melatonin supplements. That's
a middle H. So there are people who are melatonin
deficient. As an actual disorder? Actual disorder.
A blood test can tell you whether you're melatonin
deficient. And those individuals definitely benefit
from melatonin. There's good evidence that melatonin
is very useful for jet lag when you're going
across all these time zones. And I know people
in Singapore travel a lot. That's so relevant.
The trouble with melatonin use, and it's quite
prominent in the States, is for one thing in
the States, But melatonin is not FDA regulated.
Mostly people are buying it over the counter.
And you don't know when you get a bottle of melatonin,
it says it's five milligrams. If there's actually
five milligram pills in there or if some of them
are 10 or if some of them had no melatonin at
all. You have no way of knowing that because
it's not regulated. But the other thing is melatonin
is designed to rise and fall naturally in the
body. and at its peak it's at maybe 0 .8 0 .9
milligrams so when someone's taken 10 milligrams
of melatonin every single day they're running
the risk even though melatonin leaves your body
fairly quickly they're running the risk that
basically they've got more melatonin in their
body all the time than it naturally would be
as it rises and falls. And the rising and falling
is part of the activating, telling your brain
it's time to go to sleep or it's time to wake
up. So you're running the risk that you're, and
melatonin isn't a sedative. It's a hormone that,
again, is supposed to just signal your brain
it's time to sleep. So I think it is way overused,
in the States at least. And I think for many
people, it's actually more of a placebo, makes
them feel better than does any good to their
sleep at all. I heard that if you take exogenous
melatonin, it will reduce or stop the production
of endogenous melatonin. So then you become reliant
on it. So if you start taking it regularly enough
that... You will then need to keep on taking
it. Is that true or am I just making this up?
You know, I'm not 100 % sure that that's true
or not, but it makes sense to me that it might
be. I remember I had a client once who came to
me and she was taking 20 milligrams of melatonin
every day. And I said, hmm, that's rather a lot.
I don't think I've ever seen anybody take that
much. She says, oh, I've been doing it for years.
I said, does your doctor know you're taking this
much melatonin? So I really was leaning on her
to go to her physician because. She seemed to
have no side effects that she was reporting,
but I just can't believe it was good for her
if she was getting that much melatonin, which
we don't know. It sounds like a heavy hand and
good for years. I also wonder that because it's
not FDA approved and it's not. technically a
medication that people are like, oh, this is
fine. I'll just take this and it will help me
sleep. And it's not like I'm popping sleeping
pills or something. Well, and they think it's
going to put them to sleep, but it's not supposed
to put them to sleep. It's not Ambien. It's a
hormone. Do you have a strategy for deploying
melatonin for jet lag? I do have a strategy.
And what it involves is about three days before
you travel, you start taking melatonin at the
time of day where you are. when it would be bedtime
where you're going. So it's not a sedative. It
won't make you sleepy, but it's starting to put
in there for a few days in advance the signal
that at that time you're going to then want to
be going to sleep when you arrive where you're
going. And then you could do the same thing in
reverse when you're coming back home. I'm doing
it. I have terrible jet lag going to the U .S.
worse jet lag when I'm coming back from the UK
back to Singapore like I really really struggle
and purely because we tend to go for a longer
period of time when we're there for four to six
weeks by the time I'm like all fully settled
in with UK timing and I come back and then I'm
like oh I can't see this is just too much but
I'm gonna try that yeah and about five milligrams
that was my next question okay five milligrams
three days before you travel, at what would be
the bedtime in the destination. That's correct.
So interesting. See, that's the hard -hitting
news we need, Sue. All right, a couple more hotter
hypes. Midnight snacks. So I wake up, I'm hungry.
Do I eat? No, it's a hype. Should not do that.
Your body can become habituated to doing that.
So then you naturally wake up. And then you're
going to wake up whether you need to be eating
or not. And then you're going to have strikes
again. All right. And last one, nightcaps. I'm
just going to do a little glass of wine, take
the edge off, help me get to bed. Well. As we
talked earlier, the trouble with alcohol is as
it starts to burn out of your system. Now, if
it's a little nightcap, it probably won't make
a difference. And it may take the edge off and
help you fall asleep. But it's, again, something
you can become habituated to. And, of course,
it's very easy with alcohol for the little bit
to become a little bit more and become a little
bit more. And the more and more, then the more
it increases your risk for sleep problems. Absolutely.
Well, Sue, I say this with love. You have successfully
completed your 40s. We ask every guest on the
show to share some wisdom for women in their
40s. And we ask the question, what is your 40s
formula? So with the advantage of having lived
them, what is your 40s formula for our listeners?
Well, since we've been talking about sleep, what
I will say is, you know, there's a lot of things
that can impact sleep negatively, adversely for
women in their 40s. I would encourage all women
in their 40s to aim to have a regular sleep schedule.
And if they have any conditions that are impacting
their sleep, medical, psychological, emotional,
or situational, that can be treated to not hesitate
to go ahead and seek help. And panic about your
sleep will not be useful. So remember that just
like we have many things that cause sleep problems,
we have many strategies to help treat these problems.
And if you're obsessing about your sleep, it's
only going to make it worse. You can't fall asleep
when you're upset and anxious. Love that. Remove
the obstacles. Stay calm. Stay calm. This is
going to get better. Thank you so much for being
on the show today, Sue. We've really learned
a lot. You're welcome. Thank you. So Sue, as
you can see, if there's little stumbles like
that, you can just restate and then we'll tighten
that up in the editing. So let's see if this
lives up to your pitch. Yeah, I know. It's like,
you better say all this stuff. No, I'm just kidding.
I know you will.