WEBVTT 00:00:00.000 --> 00:00:02.279 When was the last time you woke up and actually 00:00:02.279 --> 00:00:05.320 felt rested? Not wired, not foggy, not running 00:00:05.320 --> 00:00:08.880 on caffeine and cortisol. The truth is, we don't 00:00:08.880 --> 00:00:13.800 sleep as well as we age. That deep sleep, it 00:00:13.800 --> 00:00:16.679 starts plummeting every decade that goes by. 00:00:16.820 --> 00:00:20.260 Women in their 40s, what tends to be the biggest 00:00:20.260 --> 00:00:23.199 thing that happens to them with regards to their 00:00:23.199 --> 00:00:25.420 sleep? As you start to hit that menopausal transition. 00:00:26.199 --> 00:00:28.879 You've got decreases in estrogen and progesterone. 00:00:29.039 --> 00:00:32.299 I'm very familiar with those. Nocturnal hot flashes, 00:00:32.679 --> 00:00:36.759 night sweats, which many women report wake them 00:00:36.759 --> 00:00:41.000 up. Are there surprising things that women are 00:00:41.000 --> 00:00:43.420 doing that keep them kind of stuck in these bad 00:00:43.420 --> 00:00:45.539 sleep cycles? This might surprise some people. 00:00:46.399 --> 00:00:50.700 We love our... A big cause of sleep problems. 00:00:50.820 --> 00:00:53.020 What is the solution that we're missing? Because 00:00:53.020 --> 00:00:55.579 I think we all are aware of sleeping pills, but 00:00:55.579 --> 00:00:57.719 like a lot of us don't want to take stuff for 00:00:57.719 --> 00:01:00.380 sleep. Cognitive behavioral therapy for insomnia. 00:01:00.600 --> 00:01:03.439 The women who were in the CBTI group had really 00:01:03.439 --> 00:01:07.000 very robust and impressive improvements in their 00:01:07.000 --> 00:01:10.840 sleep. We had no change in vasomotor symptoms 00:01:10.840 --> 00:01:13.659 in these women. Their insomnia got better. The 00:01:13.659 --> 00:01:16.040 hot flashes didn't bother them so much. Because 00:01:16.040 --> 00:01:24.769 they slept. If you've accepted being toxic, When 00:01:24.769 --> 00:01:27.489 was the last time you woke up and actually felt 00:01:27.489 --> 00:01:30.450 rested? Not wired, not foggy, not running on 00:01:30.450 --> 00:01:33.510 caffeine and cortisol. Rested and energized. 00:01:34.049 --> 00:01:37.030 Because here's the uncomfortable truth. For many 00:01:37.030 --> 00:01:39.930 women in midlife, deep restorative sleep quality 00:01:39.930 --> 00:01:43.250 disappears long before we realize it's even going. 00:01:43.409 --> 00:01:46.489 We blame stress. We blame hormones. We blame 00:01:46.489 --> 00:01:49.250 our kids, our screens, our schedules. But what 00:01:49.250 --> 00:01:51.629 if the problem isn't just life? What if it's 00:01:51.629 --> 00:01:54.189 the way we've unknowingly trained our brains 00:01:54.189 --> 00:01:57.209 to sleep? Alongside renowned sleep expert and 00:01:57.209 --> 00:02:00.590 CBTI researcher, Dr. Sue McCurry, we're unpacking 00:02:00.590 --> 00:02:04.430 her work on why insomnia explodes during perimenopause, 00:02:04.609 --> 00:02:07.909 how chronic sleep deprivation derails women's 00:02:07.909 --> 00:02:10.349 health, and the surprising behaviors that keep 00:02:10.349 --> 00:02:12.930 even the most disciplined women stuck in cycles 00:02:12.930 --> 00:02:15.669 of exhaustion. Make sure you stay tuned. to learn 00:02:15.669 --> 00:02:17.449 about a cutting -edge treatment that doesn't 00:02:17.449 --> 00:02:20.550 rely on pills, gadgets, or sleep hacks, and why 00:02:20.550 --> 00:02:23.449 it may be the most overlooked tool in women's 00:02:23.449 --> 00:02:26.349 health. If you've accepted being tired as your 00:02:26.349 --> 00:02:29.189 new normal, this conversation is going to put 00:02:29.189 --> 00:02:31.419 that to rest. Before we dive in, if conversations 00:02:31.419 --> 00:02:33.479 like this help you take better care of your body, 00:02:33.560 --> 00:02:35.860 your mind, and your future, make sure to follow 00:02:35.860 --> 00:02:37.900 the show and hit subscribe. It's the simplest 00:02:37.900 --> 00:02:39.759 way to support this work, connecting evidence 00:02:39.759 --> 00:02:42.500 -based, life -changing conversations to women 00:02:42.500 --> 00:02:44.780 who need to hear it the most. Welcome, Sue. Thank 00:02:44.780 --> 00:02:46.439 you so much for being on the show. Thanks for 00:02:46.439 --> 00:02:48.439 having me. We are so excited to have you all 00:02:48.439 --> 00:02:51.659 the way from America, by the way. Welcome to 00:02:51.659 --> 00:02:55.620 my fellow American. You have spent decades researching 00:02:55.620 --> 00:02:59.159 sleep in midlife and beyond. What do you think? 00:02:59.599 --> 00:03:01.319 When you think of like a healthy night's sleep 00:03:01.319 --> 00:03:04.379 or a normal night's sleep versus the sleep you 00:03:04.379 --> 00:03:06.580 hear women in midlife reporting, what is that 00:03:06.580 --> 00:03:09.659 gap? Well, normal sleep is a little bit hard 00:03:09.659 --> 00:03:13.979 to talk about. What I would say is ideally healthy 00:03:13.979 --> 00:03:18.639 sleep is sleep that is regular. So you get about 00:03:18.639 --> 00:03:21.180 the same amount of sleep every night. You go 00:03:21.180 --> 00:03:23.139 to bed and get up at about the same time every 00:03:23.139 --> 00:03:26.180 day. And when you get into bed, you're ready 00:03:26.180 --> 00:03:28.919 to go to sleep. You're actually tired. You're 00:03:28.919 --> 00:03:32.259 sleeping when you turn out that light. Of course, 00:03:32.280 --> 00:03:34.360 there's lots of things in life that can impact 00:03:34.360 --> 00:03:37.599 all of these things. There's vacations and there's 00:03:37.599 --> 00:03:40.039 holidays and there's special events. So you may 00:03:40.039 --> 00:03:44.319 not be able to follow the ideal of regularity 00:03:44.319 --> 00:03:47.240 and readiness for sleep. But that's, I think, 00:03:47.240 --> 00:03:49.379 what people should be aspiring to. And when you 00:03:49.379 --> 00:03:50.620 say there's, you know, these little things that 00:03:50.620 --> 00:03:52.520 come up, right? Vacations, holidays, whatever. 00:03:52.780 --> 00:03:55.180 I feel like that's also a message that we give 00:03:55.180 --> 00:03:57.099 in general health, right? So it's like, yeah, 00:03:57.139 --> 00:03:58.860 you should be exercising. You should be eating 00:03:58.860 --> 00:04:00.659 well. But there's wiggle room for special occasions. 00:04:00.900 --> 00:04:03.979 But is there a way to know that you've gone too 00:04:03.979 --> 00:04:06.360 far afield? This isn't just, oh, I got off track 00:04:06.360 --> 00:04:08.300 for a holiday. Like, my sleep is really messed 00:04:08.300 --> 00:04:12.599 up. Well, insomnia is defined as being a condition 00:04:12.599 --> 00:04:15.719 where you have trouble sleeping. at least three 00:04:15.719 --> 00:04:18.480 nights a week. It's been going on for at least 00:04:18.480 --> 00:04:22.040 three months. It can be either trouble falling 00:04:22.040 --> 00:04:24.560 asleep or staying asleep or waking up too early 00:04:24.560 --> 00:04:27.000 in the morning. And it's interfering with your 00:04:27.000 --> 00:04:30.339 daytime functioning in some way. So that's a 00:04:30.339 --> 00:04:32.660 pretty big bar, right? If you have a couple of 00:04:32.660 --> 00:04:34.620 nights that you're not sleeping well, but it 00:04:34.620 --> 00:04:36.819 hasn't been going on for months and months, then 00:04:36.819 --> 00:04:40.459 probably you're doing okay. Women in their 40s, 00:04:40.459 --> 00:04:43.949 what tends to be sort of the biggest thing? that 00:04:43.949 --> 00:04:45.629 happens to them with regards to their sleep? 00:04:45.750 --> 00:04:47.589 Is it that they just don't get enough? Is it 00:04:47.589 --> 00:04:49.670 that they can't fall asleep? What do you tend 00:04:49.670 --> 00:04:53.750 to find? Well, so women in their 40s have a lot 00:04:53.750 --> 00:04:55.949 of things going on that are going to impact their 00:04:55.949 --> 00:04:59.370 sleep, right? The first is they're just getting 00:04:59.370 --> 00:05:04.569 older. Girl, too real. Okay, too real. You know, 00:05:04.569 --> 00:05:07.889 the truth is we don't sleep as well as we age. 00:05:08.189 --> 00:05:10.870 That deep sleep you talked about in your intro. 00:05:11.560 --> 00:05:14.740 It starts plummeting every decade that goes by. 00:05:14.980 --> 00:05:19.759 And so because women are already starting to 00:05:19.759 --> 00:05:22.819 spend less time in deep restorative sleep, they're 00:05:22.819 --> 00:05:25.259 more likely to wake up more easily and then maybe 00:05:25.259 --> 00:05:26.899 have trouble falling back asleep. So some of 00:05:26.899 --> 00:05:31.019 it's just natural aging. Some of it is as you 00:05:31.019 --> 00:05:33.740 start to hit that menopausal transition, you've 00:05:33.740 --> 00:05:36.819 got changes in hormones going on. You've got 00:05:36.819 --> 00:05:41.730 decreases in estrogen and progesterone. when 00:05:41.730 --> 00:05:46.009 they're fully running, are helping with sleep 00:05:46.009 --> 00:05:50.310 drive and quality of sleep. So the decrease is 00:05:50.310 --> 00:05:53.810 going to increase propensity for some sleep troubles 00:05:53.810 --> 00:05:57.430 anyway. But added to that is as those... hormones 00:05:57.430 --> 00:06:01.069 decrease, we also start seeing these pesky vasomotor 00:06:01.069 --> 00:06:04.029 symptoms showing up. I'm very familiar with those. 00:06:04.509 --> 00:06:08.389 Right, nocturnal hot flashes, night sweats, which 00:06:08.389 --> 00:06:12.490 many women report wake them up. Although interestingly, 00:06:12.810 --> 00:06:17.660 the literature would suggest that sometimes The 00:06:17.660 --> 00:06:20.860 woman wakes up and that triggers the hot flash 00:06:20.860 --> 00:06:23.360 of night, which doesn't perceived that way, of 00:06:23.360 --> 00:06:25.720 course, to the woman. It seems like it's a causal 00:06:25.720 --> 00:06:28.779 thing, but it can go both ways. Wow. That is 00:06:28.779 --> 00:06:31.399 interesting because my husband always complains. 00:06:31.579 --> 00:06:34.500 We've had to change duvets. So I have my own 00:06:34.500 --> 00:06:36.879 one, which is a nice lightweight one, which doesn't 00:06:36.879 --> 00:06:38.959 feel like anything. He's got this really heavy, 00:06:38.980 --> 00:06:42.439 thick one because our bedroom is sub -zero temperatures 00:06:42.439 --> 00:06:45.439 because he can't sleep in the same room as me 00:06:45.439 --> 00:06:48.050 because I need it. cold right and he's finding 00:06:48.050 --> 00:06:50.629 it way too cold right because of the hot flashes 00:06:50.629 --> 00:06:52.709 i was i was waking up in the middle of the night 00:06:52.709 --> 00:06:55.490 just feel hot and the other night we were watching 00:06:55.490 --> 00:06:58.110 tv and um we had the aircon on i had a blanket 00:06:58.110 --> 00:07:00.250 i was like oh i'm really cold i'm i'm really 00:07:00.250 --> 00:07:02.089 cool can we turn the aircon off he goes well 00:07:02.089 --> 00:07:03.509 i don't know what's going on with you because 00:07:03.509 --> 00:07:06.790 as soon as we go up one level Your body changes 00:07:06.790 --> 00:07:10.769 and you're hot. That is interesting. My excuse 00:07:10.769 --> 00:07:13.230 was hot air rises. It does. I mean, that's also 00:07:13.230 --> 00:07:14.689 true in Singapore. I feel like the third floor 00:07:14.689 --> 00:07:17.189 in our house is the hot one as well. The other 00:07:17.189 --> 00:07:19.910 thing I do want to say about sleep and midlife 00:07:19.910 --> 00:07:23.730 women too, though, is you think about the lifestyles 00:07:23.730 --> 00:07:26.410 of many midlife women, right? So many women are 00:07:26.410 --> 00:07:29.170 in high pressure, high intensity jobs. It's hard 00:07:29.170 --> 00:07:31.490 to put that down at the end of the day. They 00:07:31.490 --> 00:07:37.490 have family commitments. teenagers who have school 00:07:37.490 --> 00:07:40.610 and sports activities or kids late into the night. 00:07:40.709 --> 00:07:43.250 They may have partners who are on a different 00:07:43.250 --> 00:07:45.870 sleep -wake schedule than they are that is disrupting 00:07:45.870 --> 00:07:48.829 sleep. They may have financial responsibilities 00:07:48.829 --> 00:07:50.850 that they're worried about. They may be caring 00:07:50.850 --> 00:07:53.810 for an aging parent, that sandwich generation. 00:07:54.430 --> 00:07:59.779 So women... in midlife, I think, have so many 00:07:59.779 --> 00:08:03.199 stressors genuinely impacting them. They may 00:08:03.199 --> 00:08:05.699 not be eating right. They may not be exercising. 00:08:05.920 --> 00:08:08.300 They may not have time just for themselves. And 00:08:08.300 --> 00:08:10.379 they're at greater risk for becoming depressed 00:08:10.379 --> 00:08:13.139 or anxious, which are themselves risk factors 00:08:13.139 --> 00:08:15.720 for sleep problems. So you see, it's complicated. 00:08:16.199 --> 00:08:18.579 There's many things that are impinging upon women 00:08:18.579 --> 00:08:21.720 impacting their sleep. So you mentioned exercise, 00:08:22.040 --> 00:08:26.300 poor sleep, stress. Are there surprising things? 00:08:26.990 --> 00:08:29.589 that women are doing that keep them kind of stuck 00:08:29.589 --> 00:08:31.470 in these bad sleep cycles? One of the biggest 00:08:31.470 --> 00:08:33.470 things is they're on their screens too much. 00:08:34.370 --> 00:08:38.049 They're in bed, they've got their tablet, they're 00:08:38.049 --> 00:08:41.629 checking their emails, they're watching a movie, 00:08:42.009 --> 00:08:46.710 they're on the phone, they're surfing the net, 00:08:46.929 --> 00:08:49.750 too many screens. And screens are problematic 00:08:49.750 --> 00:08:52.230 for a couple of reasons. One is many of them 00:08:52.230 --> 00:08:55.710 put out blue light, which goes through the eyes 00:08:55.710 --> 00:08:58.750 and it turns off melatonin production, which 00:08:58.750 --> 00:09:00.889 is our sleep hormone. So that's not good. Not 00:09:00.889 --> 00:09:03.710 good. And even if people say, oh, well, I've 00:09:03.710 --> 00:09:05.909 got the special glasses and I can turn my tablet 00:09:05.909 --> 00:09:10.210 down, no blue light, it's still cognitively stimulating. 00:09:10.610 --> 00:09:13.350 And what we want when we're getting ready to 00:09:13.350 --> 00:09:15.990 go to sleep is we want to be ready to sleep. 00:09:16.509 --> 00:09:19.529 We want our mind to be slowing down. We want 00:09:19.529 --> 00:09:22.330 the light to be getting dimmer. We want to... 00:09:23.389 --> 00:09:26.149 be telling our body and brain it's getting time 00:09:26.149 --> 00:09:29.909 to sleep not you know running at high gear and 00:09:29.909 --> 00:09:32.450 then hopping into bed and expecting to pass out 00:09:32.450 --> 00:09:34.970 i mean it's funny that you mentioned that sue 00:09:34.970 --> 00:09:38.009 because it really resonates with a slight shift 00:09:38.009 --> 00:09:40.590 in my personal lifestyle in that i've been working 00:09:40.590 --> 00:09:42.830 on a book with a u .s publisher and so i'm on 00:09:42.830 --> 00:09:45.629 u .s hours with my book people right and they're 00:09:45.629 --> 00:09:47.730 all all the calls are at night and so i'll come 00:09:47.730 --> 00:09:50.110 off this call and it's not late necessarily so 00:09:50.110 --> 00:09:54.110 it's like 9 30. But my brain is fully charged 00:09:54.110 --> 00:09:56.690 because I just had an hour of like very high 00:09:56.690 --> 00:09:58.750 level executive conversation with someone who's 00:09:58.750 --> 00:10:00.769 very important for this process. And then it's 00:10:00.769 --> 00:10:03.250 like, I can't just click it and go to bed. And 00:10:03.250 --> 00:10:05.549 it's like I've noticed the difference, the subtle 00:10:05.549 --> 00:10:08.289 shift in my ability to fall asleep. And then 00:10:08.289 --> 00:10:09.929 in my in terms of my sleep tracker, which we'll 00:10:09.929 --> 00:10:12.309 talk about later, my proportion of restorative 00:10:12.309 --> 00:10:15.389 sleep. Right. I also want to mention this might 00:10:15.389 --> 00:10:19.129 surprise some people is pets. We love our cats 00:10:19.129 --> 00:10:21.110 and our dogs, and I suppose people have chickens 00:10:21.110 --> 00:10:23.789 and other things too, but cats and dogs, they 00:10:23.789 --> 00:10:26.269 need to go out. They need to come in. They're 00:10:26.269 --> 00:10:30.009 on the floor throwing up next to the bed. They're 00:10:30.009 --> 00:10:32.269 on top of the bed. They're on top of you. They're 00:10:32.269 --> 00:10:36.789 making it impossible for you to roll over. Pets 00:10:36.789 --> 00:10:40.360 are... A big cause of sleep problems in many 00:10:40.360 --> 00:10:43.159 people. Code is my dog. We trained him not to 00:10:43.159 --> 00:10:46.960 come upstairs. So partly because the kids get 00:10:46.960 --> 00:10:50.500 a bit stuffy. So we don't want him to be in the 00:10:50.500 --> 00:10:53.019 bedroom area. So he knows he's not allowed upstairs. 00:10:53.080 --> 00:10:54.960 So we never actually sleep with Koda. But he 00:10:54.960 --> 00:10:57.120 actually doesn't like because he obviously it's 00:10:57.120 --> 00:10:58.799 quite hot here. He'll come and join us on the 00:10:58.799 --> 00:11:01.700 sofa for, you know, a little moment for a stroke. 00:11:01.919 --> 00:11:03.659 And then very quickly he's off again because 00:11:03.659 --> 00:11:06.379 I think he's like, I can't handle it. Yeah, but 00:11:06.379 --> 00:11:08.620 that on and off would be one if he was upstairs 00:11:08.620 --> 00:11:10.519 would be one of those disruptions that you might 00:11:10.519 --> 00:11:12.980 not even think about. And then kids. I've got 00:11:12.980 --> 00:11:15.360 a lot of friends whose children come in in the 00:11:15.360 --> 00:11:17.919 middle of the night. And she's recently just 00:11:17.919 --> 00:11:21.840 started on progesterone because she told me her 00:11:21.840 --> 00:11:24.299 sleep was very disruptive and she was having 00:11:24.299 --> 00:11:27.940 issues staying asleep. And obviously one of the 00:11:27.940 --> 00:11:30.320 big things is that, yes, her sleep has slightly 00:11:30.320 --> 00:11:32.259 improved, but the thing that's not going to improve 00:11:32.259 --> 00:11:35.419 is her child coming in at 2 a .m. Sure, sure. 00:11:35.500 --> 00:11:38.279 And if you have a partner who snores. Or if you 00:11:38.279 --> 00:11:41.000 have a partner who has to get up at 4 a .m. four 00:11:41.000 --> 00:11:45.340 to get to work or comes home late at two after 00:11:45.340 --> 00:11:46.840 you've already gone to bed. So there are all 00:11:46.840 --> 00:11:49.840 of these circumstantial things. That's why a 00:11:49.840 --> 00:11:52.559 guest room works beautifully for those moments. 00:11:53.639 --> 00:11:55.519 It's like, guess what? Don't touch me at all. 00:11:55.980 --> 00:11:58.100 But it works better for the husband than the 00:11:58.100 --> 00:12:02.799 kids. I will say. But so I think we get a good 00:12:02.799 --> 00:12:05.179 sense of what might be disrupting sleep. And 00:12:05.179 --> 00:12:07.919 I think there's nothing you said that. some woman 00:12:07.919 --> 00:12:09.620 in our audience will not resonate with, right? 00:12:09.740 --> 00:12:12.440 It's pets, it's kids, it's stress. We all have 00:12:12.440 --> 00:12:16.600 something there. But then what is the solution 00:12:16.600 --> 00:12:19.000 that we're missing? Because I think we all are 00:12:19.000 --> 00:12:21.120 aware of sleeping pills, right? And we're all 00:12:21.120 --> 00:12:24.080 aware of melatonin supplements, but like a lot 00:12:24.080 --> 00:12:26.820 of us don't want to take stuff for sleep. What 00:12:26.820 --> 00:12:29.710 is the alternative? There's something called 00:12:29.710 --> 00:12:32.710 cognitive behavioral therapy for insomnia or 00:12:32.710 --> 00:12:37.470 CBTI. CBTI. And what CBTI is, it's a combination 00:12:37.470 --> 00:12:40.429 of behavioral strategies that we teach people 00:12:40.429 --> 00:12:43.590 and cognitive strategies, a way to think and 00:12:43.590 --> 00:12:47.870 approach your sleep differently. And many organizations, 00:12:47.889 --> 00:12:50.529 including the American College of Physicians, 00:12:51.029 --> 00:12:56.059 the European Insomnia Network. the American Academy 00:12:56.059 --> 00:12:59.980 of Sleep Medicine, say that CBTI should be the 00:12:59.980 --> 00:13:03.779 first line of treatment if you have insomnia. 00:13:03.919 --> 00:13:05.799 And remember, insomnia isn't just you're having 00:13:05.799 --> 00:13:08.340 trouble sleeping for a few nights or even weeks, 00:13:08.419 --> 00:13:10.919 as I described. It has to be an ongoing chronic 00:13:10.919 --> 00:13:15.360 problem. But these major organizations are saying 00:13:15.360 --> 00:13:18.779 you should try these behavioral strategies first 00:13:18.779 --> 00:13:22.149 before you ever take a sleeping medication. And 00:13:22.149 --> 00:13:25.090 then see, that is such a huge paradigm shift. 00:13:25.590 --> 00:13:27.409 But I don't think people are hearing the message 00:13:27.409 --> 00:13:29.309 because I think if you took 100 women with sleep 00:13:29.309 --> 00:13:31.850 problems that have seen somebody about it, a 00:13:31.850 --> 00:13:34.429 physician, let's say, have they been recommended 00:13:34.429 --> 00:13:37.889 CBTI first? I can't imagine more than five of 00:13:37.889 --> 00:13:39.990 the handful, and maybe if they came to our clinic 00:13:39.990 --> 00:13:42.450 or another lifestyle medicine clinic, but have 00:13:42.450 --> 00:13:45.090 even been exposed to that. So how do we change 00:13:45.090 --> 00:13:47.289 the paradigm so that women are aware of what 00:13:47.289 --> 00:13:50.330 CBTI is and what its power is? Well, part of 00:13:50.330 --> 00:13:53.309 the problem, I think, is there aren't a plethora 00:13:53.309 --> 00:13:57.970 of sleep medicine specialists. So not every physician 00:13:57.970 --> 00:14:00.269 knows where they would even send someone. Correct. 00:14:00.679 --> 00:14:03.659 There are online courses that you can take. There 00:14:03.659 --> 00:14:06.700 are ways that virtually you can get access to 00:14:06.700 --> 00:14:08.960 this information. And there are many, many, many 00:14:08.960 --> 00:14:11.399 books that have been written that are very good 00:14:11.399 --> 00:14:15.620 quality to talk women or anyone through the steps 00:14:15.620 --> 00:14:17.879 involved in going through this. But one thing 00:14:17.879 --> 00:14:23.120 is just access. Another thing is... Most women 00:14:23.120 --> 00:14:26.139 will first report sleep problems if they do report 00:14:26.139 --> 00:14:28.080 them. They don't always talk about them. But 00:14:28.080 --> 00:14:31.480 if they do, they'll report them to an MD. And 00:14:31.480 --> 00:14:35.539 what MDs do is they prescribe medicine. There 00:14:35.539 --> 00:14:38.360 you go. And medicines are readily available. 00:14:38.440 --> 00:14:44.059 And so I think it's partially just a culture 00:14:44.059 --> 00:14:49.220 in treatment. And hey, behavior change is hard. 00:14:49.720 --> 00:14:52.120 medicine is easy. And I mean, we see that with 00:14:52.120 --> 00:14:53.580 all sorts of different types of medications. 00:14:54.019 --> 00:14:58.080 But you mentioned CBTI is first line or should 00:14:58.080 --> 00:15:01.220 be for everyone, men and women alike. But I really 00:15:01.220 --> 00:15:03.539 want to hammer down on why women in particular 00:15:03.539 --> 00:15:05.740 should consider this. And you've done some compelling 00:15:05.740 --> 00:15:08.899 work about CBTI and vasomotor symptoms. Can you 00:15:08.899 --> 00:15:12.000 talk about that? Right. So I was involved with 00:15:12.000 --> 00:15:16.379 a study. It was called MS Flash. It was a National 00:15:16.379 --> 00:15:19.799 Institute of Health study that was funded to 00:15:19.799 --> 00:15:24.899 fund multiple large grants looking at how to 00:15:24.899 --> 00:15:27.940 treat vasomotor symptoms. So one of those studies 00:15:27.940 --> 00:15:30.500 looked at the use of yoga. One of them looked 00:15:30.500 --> 00:15:33.100 at estrogen supplements. One of them looked at 00:15:33.100 --> 00:15:38.340 aerobic exercise. My particular MS Flash grant 00:15:38.340 --> 00:15:42.080 was looking at the use of CBTI for women who 00:15:42.080 --> 00:15:45.539 had both insomnia and severe vasomotor symptoms. 00:15:46.409 --> 00:15:49.950 And so what we did, it was a six -week trial. 00:15:50.230 --> 00:15:54.129 It was telephone delivered. It was for women 00:15:54.129 --> 00:15:59.149 between the ages of 40 and 60 who were experiencing 00:15:59.149 --> 00:16:03.450 a certain level of insomnia and a certain level 00:16:03.450 --> 00:16:05.970 of these phasomotor symptoms, including night. 00:16:06.970 --> 00:16:09.710 And we put them through the program. And at the 00:16:09.710 --> 00:16:12.029 end of that, at two months, and then again at 00:16:12.029 --> 00:16:14.679 six -month follow -up, the women who had... been 00:16:14.679 --> 00:16:19.039 in the CBTI group compared to a placebo educational 00:16:19.039 --> 00:16:22.179 contact control. So those women also got phone 00:16:22.179 --> 00:16:25.039 calls for six weeks from our coaches who gave 00:16:25.039 --> 00:16:27.539 them lots of really interesting and useful information 00:16:27.539 --> 00:16:30.580 about menopause and health. But the women who 00:16:30.580 --> 00:16:34.409 were in the CBTI group had really very robust 00:16:34.409 --> 00:16:38.029 and impressive improvements in their sleep, both 00:16:38.029 --> 00:16:40.590 at post -test and at six -month follow -up compared 00:16:40.590 --> 00:16:43.470 to the placebo control. And I should say that 00:16:43.470 --> 00:16:46.129 both groups, women in both groups, their insomnia 00:16:46.129 --> 00:16:49.870 symptoms reduced. So some of that is just contact, 00:16:50.049 --> 00:16:51.929 right? You're talking to somebody who's nice 00:16:51.929 --> 00:16:54.629 about your sleep problems. But the improvements 00:16:54.629 --> 00:16:58.029 between the CBTI group and the placebo were quite 00:16:58.029 --> 00:17:01.139 impressive and were sustained. Wow. I have to 00:17:01.139 --> 00:17:03.259 admit, I did not realize that specificity of 00:17:03.259 --> 00:17:05.839 the study whereby the placebo got education. 00:17:06.400 --> 00:17:08.220 So I figured it was just placebo, placebo. Like 00:17:08.220 --> 00:17:09.579 they didn't, you know, they just were out living 00:17:09.579 --> 00:17:11.059 their lives. And then the other group was getting 00:17:11.059 --> 00:17:13.519 this amazing targeted resource of CBTI. But no, 00:17:13.599 --> 00:17:15.859 they were getting some educational calls. Yeah, 00:17:15.859 --> 00:17:19.279 because we wanted to control for that impact 00:17:19.279 --> 00:17:21.819 that can come just from talking to somebody. 00:17:21.960 --> 00:17:24.819 That is powerful. And that really answers one 00:17:24.819 --> 00:17:26.299 of the questions I wanted to ask you is like, 00:17:26.339 --> 00:17:31.390 how, when you hear that, A cognitive behavioral 00:17:31.390 --> 00:17:36.569 intervention that is not medical, meaning it 00:17:36.569 --> 00:17:38.390 does not contain medicine or pharmaceuticals, 00:17:38.390 --> 00:17:41.869 that is delivered over the phone could possibly 00:17:41.869 --> 00:17:44.369 be the solution to our problems. It almost sounds 00:17:44.369 --> 00:17:46.210 impossible to me. Yeah, it's pretty amazing. 00:17:46.369 --> 00:17:49.009 It's a beautiful thing because, like I said earlier, 00:17:49.109 --> 00:17:51.009 not every community has sleep medicine specialists 00:17:51.009 --> 00:17:54.170 that people can go to. nor do they necessarily 00:17:54.170 --> 00:17:55.950 have the insurance that they could pay for it 00:17:55.950 --> 00:17:58.130 if they were going to such a provider. Not everybody 00:17:58.130 --> 00:18:00.730 has access to good internet wireless service 00:18:00.730 --> 00:18:03.950 that they could even do it virtually, but almost 00:18:03.950 --> 00:18:07.109 everybody in the world has a telephone. And what 00:18:07.109 --> 00:18:09.269 was great about our study, if I do say so myself, 00:18:09.390 --> 00:18:14.089 is... The women who we had delivering the intervention 00:18:14.089 --> 00:18:18.930 had, before the study, no experience with sleep 00:18:18.930 --> 00:18:23.589 medicine at all. They were trained to be CBTI 00:18:23.589 --> 00:18:26.650 coaches for this study. They were following a 00:18:26.650 --> 00:18:28.769 protocol, so it was a manualized intervention. 00:18:29.230 --> 00:18:32.609 But the fact that it was over the phone and it 00:18:32.609 --> 00:18:37.529 was offered by women, by master's level clinicians, 00:18:38.349 --> 00:18:41.230 who had not previously been sleep specialists, 00:18:41.490 --> 00:18:45.410 suggests that in principle this model of delivery 00:18:45.410 --> 00:18:49.869 that could reach many, many women is a possibility. 00:18:50.029 --> 00:18:53.950 It hasn't ever been tested in trials, so we don't 00:18:53.950 --> 00:18:57.329 know that for a fact. But we do know that historically 00:18:57.329 --> 00:18:59.849 they did something similar with smoking cessation, 00:18:59.950 --> 00:19:03.529 where they trained people to... talked to folks 00:19:03.529 --> 00:19:05.589 over the telephone who would call a hotline number 00:19:05.589 --> 00:19:08.230 and they would get coaching on cutting back on 00:19:08.230 --> 00:19:12.329 smoking. And 20 years ago, that was a very big 00:19:12.329 --> 00:19:15.289 deal. And so it's a model that has been used 00:19:15.289 --> 00:19:17.809 with other health promotion concerns. Yeah, Alcoholics 00:19:17.809 --> 00:19:19.950 Anonymous uses a component of that model, right? 00:19:20.029 --> 00:19:22.250 Where you can access your sponsor via phone call 00:19:22.250 --> 00:19:24.250 or text. It's not the first time you've heard, 00:19:24.309 --> 00:19:26.609 hey, coaching works or partnership works, accountability 00:19:26.609 --> 00:19:29.690 works. But really interesting that, again, two 00:19:29.690 --> 00:19:31.630 pieces of information I want our listeners to... 00:19:31.930 --> 00:19:35.990 acknowledge here one is that the first line recommendation 00:19:35.990 --> 00:19:40.150 from is it the american oh it's it's the american 00:19:40.150 --> 00:19:43.430 college of physicians the european insomnia network 00:19:43.430 --> 00:19:46.890 the american academy of sleep medicine it's everyone 00:19:46.890 --> 00:19:50.869 is saying try this first we have now work that 00:19:50.869 --> 00:19:53.190 you are you know an author on that says this 00:19:53.190 --> 00:19:56.430 works women need to have this tool in their toolbox 00:19:57.160 --> 00:19:58.680 And here's something kind of fun that you might 00:19:58.680 --> 00:20:01.619 enjoy. So in our study, the MS Floss study, we 00:20:01.619 --> 00:20:04.039 got these really beautiful improvements in sleep, 00:20:04.099 --> 00:20:08.400 right? We had no change in vasomotor symptoms 00:20:08.400 --> 00:20:12.039 in these women. So we didn't have to get rid 00:20:12.039 --> 00:20:14.839 of the vasomotor symptoms to get the improvements 00:20:14.839 --> 00:20:18.980 in sleep. But what we did see was on a measure 00:20:18.980 --> 00:20:24.259 that asked women how... disturbing how much interference 00:20:24.259 --> 00:20:27.240 in your day do you have from your vasomotor symptoms 00:20:27.240 --> 00:20:30.440 that dropped in the cbti group compared to so 00:20:30.440 --> 00:20:34.579 women had insomnia their insomnia got better 00:20:34.579 --> 00:20:36.980 their hot flashes stayed exactly the same but 00:20:36.980 --> 00:20:39.420 the hot flashes didn't bother them so much because 00:20:39.420 --> 00:20:42.720 they slept yes they because they slept or because 00:20:42.720 --> 00:20:46.460 something about the process of cbti which um 00:20:46.460 --> 00:20:51.359 does look at people's attitudes and perspective 00:20:51.359 --> 00:20:54.980 about sleep also generalized perhaps to their 00:20:54.980 --> 00:20:56.960 attitudes and perspectives about their hot flashes. 00:20:57.039 --> 00:21:00.359 Wow. Did these women have sleep trackers on like 00:21:00.359 --> 00:21:03.759 a watch or something like that? Because I am 00:21:03.759 --> 00:21:07.859 wondering whether they saw an improvement in 00:21:07.859 --> 00:21:10.660 a sleep tracker or was it just that they felt 00:21:10.660 --> 00:21:12.980 better? Like when you think you're feeling better 00:21:12.980 --> 00:21:16.450 because it's saying you slept better? Or it was 00:21:16.450 --> 00:21:18.670 just like, no, I genuinely feel better, but I 00:21:18.670 --> 00:21:20.690 have no idea what my sleep tracker was saying. 00:21:21.049 --> 00:21:22.890 That's a super good question. I'm glad you brought 00:21:22.890 --> 00:21:25.750 it up. So no, they did not have trackers on them. 00:21:25.789 --> 00:21:27.809 And if they had had trackers on them, we would 00:21:27.809 --> 00:21:30.710 have asked them not to use them. Good. You have 00:21:30.710 --> 00:21:33.089 to understand that insomnia isn't like a liver, 00:21:33.230 --> 00:21:36.049 right? It's not a thing. It's not pneumonia. 00:21:37.130 --> 00:21:41.339 It is in part based upon... subjective experience 00:21:41.339 --> 00:21:44.180 perspective there are people who are shorter 00:21:44.180 --> 00:21:46.559 sleepers and some people who are longer sleepers 00:21:46.559 --> 00:21:51.220 and so really to successfully treat insomnia 00:21:51.220 --> 00:21:54.960 you want people's feelings about their sleep 00:21:54.960 --> 00:21:58.799 to change that's not that's not made up it's 00:21:58.799 --> 00:22:02.000 a real part of the syndrome right the thing about 00:22:02.000 --> 00:22:05.119 trackers too is trackers aren't really measuring 00:22:05.119 --> 00:22:08.450 sleep What they're measuring is movement, and 00:22:08.450 --> 00:22:11.970 they're measuring pulse rate, maybe in some cases 00:22:11.970 --> 00:22:17.279 sweat. They tell you, oh, you spent this much 00:22:17.279 --> 00:22:18.900 time in deep sleep and this much time in REM, 00:22:18.920 --> 00:22:21.779 and that's actually bogus. That's an algorithm 00:22:21.779 --> 00:22:25.019 that's taking some combination of how much you're 00:22:25.019 --> 00:22:27.460 moving and how much your heart rate or respiration 00:22:27.460 --> 00:22:30.940 has dropped, and they're saying, we deem this 00:22:30.940 --> 00:22:34.960 to be sleep versus wake. And the algorithms are 00:22:34.960 --> 00:22:37.799 proprietary, so you will never know, nor can 00:22:37.799 --> 00:22:40.660 I as a researcher know, what's behind the scenes 00:22:40.660 --> 00:22:43.880 with research grade. accelerometers you can get 00:22:43.880 --> 00:22:45.640 that information but you can't with like the 00:22:45.640 --> 00:22:49.980 popular trackers so the the trackers are great 00:22:49.980 --> 00:22:52.960 if you're wearing one and you're trying to systematically 00:22:52.960 --> 00:22:55.839 make changes and see how your sleep's getting 00:22:55.839 --> 00:22:59.960 better or worse over time your tracker you you 00:22:59.960 --> 00:23:04.779 can monitor within person change but you shouldn't 00:23:04.779 --> 00:23:08.579 take the data too seriously I've got people that 00:23:08.579 --> 00:23:09.980 get up in the middle of the night and they're 00:23:09.980 --> 00:23:12.299 checking their tracker data to see how much have 00:23:12.299 --> 00:23:14.200 I slept, how much deep sleep have I gotten already. 00:23:14.319 --> 00:23:18.160 I think that's a mistake because the information 00:23:18.160 --> 00:23:21.220 isn't, the data aren't that good, really. And 00:23:21.220 --> 00:23:25.259 it also is creating a preoccupation with sleep 00:23:25.259 --> 00:23:29.400 that is unhealthy. You know, we sleep to live. 00:23:30.559 --> 00:23:35.240 live to sleep and we shouldn't be obsessed with 00:23:35.240 --> 00:23:39.819 getting a perfect amount of sleep every night 00:23:39.819 --> 00:23:43.519 it doesn't help yeah yeah or feel less than because 00:23:43.519 --> 00:23:45.599 we didn't right you know it's like oh if that's 00:23:45.599 --> 00:23:47.819 if the goal is a perfect eight hours right with 00:23:47.819 --> 00:23:49.599 you know what upwards of one hour of restorative 00:23:49.599 --> 00:23:52.299 sleep then it's like i failed right it's a and 00:23:52.299 --> 00:23:54.000 again i feel like for women it's it's another 00:23:54.000 --> 00:23:57.309 metric by which we can see that we failed. Right. 00:23:57.430 --> 00:24:00.410 And add that to the list of many failings. Not 00:24:00.410 --> 00:24:02.990 effective. The other day I woke up and I was 00:24:02.990 --> 00:24:04.769 like, oh, I feel so tired. I don't feel like 00:24:04.769 --> 00:24:06.829 I slept very well, but my sleep score said I 00:24:06.829 --> 00:24:09.250 slept fine. I'm like, no, this is not right. 00:24:09.349 --> 00:24:11.789 I don't feel like I don't feel rested. So that's 00:24:11.789 --> 00:24:13.910 a good example of how the subjective piece of 00:24:13.910 --> 00:24:16.069 sleep. Yeah. Well, so you're telling us that 00:24:16.069 --> 00:24:18.349 sleep trackers might not be the most objective 00:24:18.349 --> 00:24:21.029 way to even quantify sleep, but let's talk about, 00:24:21.089 --> 00:24:24.130 let's break down CBTI into what it actually is, 00:24:24.190 --> 00:24:27.029 because I think Anyone familiar with CBT as a 00:24:27.029 --> 00:24:28.910 therapy approach is like, okay, I know what this 00:24:28.910 --> 00:24:31.190 is. It's therapy, right? It's talk therapy. I'm 00:24:31.190 --> 00:24:32.589 going to sit in a room with somebody. But there 00:24:32.589 --> 00:24:35.609 are tools within CBTI, correct? Like there's 00:24:35.609 --> 00:24:37.509 certain kind of protocols. Do you mind sharing 00:24:37.509 --> 00:24:40.970 a few of those? Oh, sure. So CBTI is, of all 00:24:40.970 --> 00:24:44.890 the CBT protocols, I think one of the best because... 00:24:46.000 --> 00:24:48.740 It is grounded in an understanding of what are 00:24:48.740 --> 00:24:52.460 the physiological mechanisms within us that help 00:24:52.460 --> 00:24:56.940 with sleep, which are largely our homeostatic 00:24:56.940 --> 00:24:59.839 drive. Our need to sleep works in partnership 00:24:59.839 --> 00:25:04.480 with our circadian sleep -wake cycles. And so 00:25:04.480 --> 00:25:10.180 CBTI is trying to, and it works upon a process 00:25:10.180 --> 00:25:12.779 of something that's called conditioned insomnia. 00:25:13.000 --> 00:25:17.319 We, you remember Pavlov? Yes. Pavlov's dog got 00:25:17.319 --> 00:25:20.039 conditioned that when the bell rang, food was 00:25:20.039 --> 00:25:22.380 coming, so the dog would salivate even in the 00:25:22.380 --> 00:25:26.390 absence of food. We can be conditioned to think 00:25:26.390 --> 00:25:28.829 of bed and bedroom as being a place where we're 00:25:28.829 --> 00:25:32.750 awake and anxious about being awake. And so cognitive 00:25:32.750 --> 00:25:35.309 behavioral therapy is going to be addressing 00:25:35.309 --> 00:25:38.410 both these processes from a behavioral point 00:25:38.410 --> 00:25:42.849 of view and also this conditioned insomnia. So 00:25:42.849 --> 00:25:45.069 some of the main tools that people are probably 00:25:45.069 --> 00:25:50.680 aware of is one is called stimulus control. Behavior 00:25:50.680 --> 00:25:53.140 comes under control of certain stimuli. So what 00:25:53.140 --> 00:25:55.400 we're trying to do is impact that conditioned 00:25:55.400 --> 00:25:59.599 insomnia by telling people bed is for sleep. 00:25:59.680 --> 00:26:02.819 When you're in bed, you can sleep, you can be 00:26:02.819 --> 00:26:05.180 intimate with your partner or even cuddle with 00:26:05.180 --> 00:26:07.660 your kids, but you don't read, you don't surf 00:26:07.660 --> 00:26:10.000 the nets, you don't watch television, you don't 00:26:10.000 --> 00:26:13.400 do work, you don't eat, you don't nest there. 00:26:14.079 --> 00:26:17.299 You have a wind down time before bed to get at 00:26:17.299 --> 00:26:20.619 what you were talking about earlier. you are 00:26:20.619 --> 00:26:24.259 going to not nap during the day. Because if you're 00:26:24.259 --> 00:26:26.519 napping during the day, you're pulling out of 00:26:26.519 --> 00:26:29.759 the bank that need to sleep that's been building 00:26:29.759 --> 00:26:31.880 up all day. Now you don't have as much need when 00:26:31.880 --> 00:26:34.299 you go to bed. I'm definitely not a napper. I 00:26:34.299 --> 00:26:39.319 can't nap. And it really encourages having a 00:26:39.319 --> 00:26:41.940 consistent rise time in the morning. Because 00:26:41.940 --> 00:26:44.819 if there's one thing our bio rhythms like more 00:26:44.819 --> 00:26:47.700 than anything, it's consistency. And it's much 00:26:47.700 --> 00:26:50.339 easier to maintain a consistent rise time than 00:26:50.339 --> 00:26:52.140 a consistent bedtime. Because there's so many 00:26:52.140 --> 00:26:53.880 things at night that can impact your ability 00:26:53.880 --> 00:26:57.019 to go to bed at a certain time. But if there's 00:26:57.019 --> 00:27:00.390 one... cbti recommendation i would make for everybody 00:27:00.390 --> 00:27:03.089 it would be to get up at the same time every 00:27:03.089 --> 00:27:05.549 day no matter how you slept the night before 00:27:05.549 --> 00:27:07.829 i love that no matter if it's your birthday or 00:27:07.829 --> 00:27:12.369 it's christmas so for me my usual wake time is 00:27:12.369 --> 00:27:14.869 6 30 a .m just because the boy i'm helping the 00:27:14.869 --> 00:27:17.650 boys get ready for school but the weekend i do 00:27:17.650 --> 00:27:21.190 want to sleep in but annoyingly i can't because 00:27:21.190 --> 00:27:25.130 my body will actually wake up between 6 30 and 00:27:25.130 --> 00:27:27.299 7 a .m It's a good thing. It's a good thing. 00:27:27.299 --> 00:27:29.680 It is a good thing from a circadian point of 00:27:29.680 --> 00:27:31.619 view. For sure. But, you know, sometimes I just 00:27:31.619 --> 00:27:33.420 want to stay in bed. I would love to sleep a 00:27:33.420 --> 00:27:36.660 little bit longer. And then it also means I can't 00:27:36.660 --> 00:27:39.380 do things on a Friday night or a Saturday night 00:27:39.380 --> 00:27:42.700 because then I need to be in bed by 9 p .m. Otherwise, 00:27:42.779 --> 00:27:45.220 I'm not going to get my full sleep and then it's 00:27:45.220 --> 00:27:47.940 going to affect me. So I've become boring as 00:27:47.940 --> 00:27:50.579 I've gone older. So this is a diatribe on life 00:27:50.579 --> 00:27:54.079 in your 40s. But is there any added benefit? 00:27:54.240 --> 00:27:56.559 This is literally just a personal question to 00:27:56.559 --> 00:27:58.720 getting up with the sun. So like in Singapore, 00:27:58.920 --> 00:28:01.660 right, we are 12 months a year the same schedule. 00:28:01.700 --> 00:28:03.319 We don't have daylight saving. We're on the equator. 00:28:03.339 --> 00:28:05.839 I love it. I love the fact that it's 12 hours. 00:28:05.839 --> 00:28:10.450 Oh, me too. It suits me so well. But is there 00:28:10.450 --> 00:28:13.069 any added benefit to waking up with the sunrise 00:28:13.069 --> 00:28:15.650 in your given location, knowing that in a lot 00:28:15.650 --> 00:28:17.670 of locations, it isn't the same time every day? 00:28:18.049 --> 00:28:23.289 Right. Early morning light is very good for, 00:28:23.349 --> 00:28:27.369 again, anchoring your circadian clock. Get up 00:28:27.369 --> 00:28:29.130 at the same time, and if you can get early morning 00:28:29.130 --> 00:28:33.009 light exposure, it just sort of helps, like I 00:28:33.009 --> 00:28:35.730 said, anchor the day, and the rest of the day 00:28:35.730 --> 00:28:40.420 will unfold. That's great, since you have the 00:28:40.420 --> 00:28:42.099 sun coming up at the same time every day. As 00:28:42.099 --> 00:28:44.160 you mentioned, most people do not in other parts 00:28:44.160 --> 00:28:46.960 of the world. Some people use bright light boxes 00:28:46.960 --> 00:28:49.240 for that purpose. They'll get up in the morning, 00:28:49.259 --> 00:28:51.000 and they'll have a box sitting on the kitchen 00:28:51.000 --> 00:28:52.779 table where they're having their morning coffee 00:28:52.779 --> 00:28:54.740 and reading the paper or the news on their phone, 00:28:54.799 --> 00:28:56.759 and it'll be shining in their eyes, and it provides 00:28:56.759 --> 00:29:00.059 kind of a simulation of morning light to do that 00:29:00.059 --> 00:29:02.920 anchoring effect. Have you heard of that? I have 00:29:02.920 --> 00:29:05.579 not, but when we were in Norway over Christmas, 00:29:06.240 --> 00:29:09.619 there was pretty much no light. So I guess like 00:29:09.619 --> 00:29:12.000 those locations definitely need something like 00:29:12.000 --> 00:29:14.200 that. Well, and that early morning bright light 00:29:14.200 --> 00:29:16.539 exposure can also help for people who have seasonal 00:29:16.539 --> 00:29:18.420 affective disorder, who get depressed in the 00:29:18.420 --> 00:29:21.079 dark, you know, times of the year. So that's 00:29:21.079 --> 00:29:22.740 incredible. Cause I was thinking, I was like, 00:29:22.779 --> 00:29:25.740 we are actually really lucky that our wake time 00:29:25.740 --> 00:29:28.259 could coincide with our sunrise every single 00:29:28.259 --> 00:29:29.380 day. Pretty much. Cause you know, we get it right 00:29:29.380 --> 00:29:30.960 before seven o 'clock or around seven o 'clock. 00:29:31.059 --> 00:29:32.539 So that, you know, it kind of works for a lot 00:29:32.539 --> 00:29:35.309 of schedules in Singapore. That's so interesting. 00:29:35.809 --> 00:29:39.309 So how should we think about planning for sleep? 00:29:39.390 --> 00:29:41.690 So waking at the same time is one way to do it, 00:29:41.750 --> 00:29:44.529 but how do we kind of reverse engineer from the 00:29:44.529 --> 00:29:48.170 wake time into the night before? Like, what are 00:29:48.170 --> 00:29:50.630 we doing to make that sleep as restful as possible? 00:29:50.809 --> 00:29:53.309 Okay. So one of the things I didn't mention a 00:29:53.309 --> 00:29:54.950 moment ago when I was talking about those stimulus 00:29:54.950 --> 00:29:58.400 control recommendations, another big... and CBTI 00:29:58.400 --> 00:30:01.859 is something that's commonly called sleep restriction, 00:30:02.180 --> 00:30:04.079 which I don't like the name of that because we're 00:30:04.079 --> 00:30:06.160 not actually trying to restrict how much sleep 00:30:06.160 --> 00:30:08.880 people get. It's really more bed restriction 00:30:08.880 --> 00:30:12.200 because a lot of people who have insomnia are 00:30:12.200 --> 00:30:14.460 spending too much time in bed. They're spending 00:30:14.460 --> 00:30:16.299 too much time in bed because they think, I didn't 00:30:16.299 --> 00:30:17.960 get enough sleep last night, so if I go to bed 00:30:17.960 --> 00:30:20.200 earlier, I sleep in later, then I'm going to 00:30:20.200 --> 00:30:22.299 have time to get all this extra sleep. And they 00:30:22.299 --> 00:30:24.819 wind up spending way more time in bed than they 00:30:24.819 --> 00:30:28.819 need, which actually is bad. for making those 00:30:28.819 --> 00:30:32.079 underlying processes work. So it's time in bed 00:30:32.079 --> 00:30:34.839 awake rather than time in bed. Right, because 00:30:34.839 --> 00:30:37.160 if you only need seven and a half hours sleep 00:30:37.160 --> 00:30:39.519 at night, you biologically only need that much 00:30:39.519 --> 00:30:41.539 and you're in bed for 10 hours a night, then 00:30:41.539 --> 00:30:43.259 two and a half hours, you're just lying awake. 00:30:43.420 --> 00:30:47.019 And that is not psychologically a good thing 00:30:47.019 --> 00:30:50.940 for supporting. That's an example of a thing 00:30:50.940 --> 00:30:53.799 that can go into planning. A person can come 00:30:53.799 --> 00:30:55.740 up with a plan. They can say, I'm going to spend 00:30:55.740 --> 00:30:59.299 no more than eight and a half hours in bed at 00:30:59.299 --> 00:31:03.119 night. And I'm going to get up at this same time, 00:31:03.220 --> 00:31:05.799 which means I'm going to aim to go to bed at 00:31:05.799 --> 00:31:08.180 that time. Maybe I'll not be able to do that 00:31:08.180 --> 00:31:09.900 every night, but that's what I'm going to aim 00:31:09.900 --> 00:31:13.700 for. So here's your sleep plan. The trouble with 00:31:13.700 --> 00:31:17.299 sleep plans, in my experience, is people get 00:31:17.299 --> 00:31:20.549 sloppy pretty easy. They don't want to get up 00:31:20.549 --> 00:31:24.230 at 7 if they had a bad night's sleep or a short 00:31:24.230 --> 00:31:27.309 night's sleep. They don't want to give up their 00:31:27.309 --> 00:31:31.150 reading on their phones in bed. They don't want 00:31:31.150 --> 00:31:33.569 to do it. But that's really no difference than 00:31:33.569 --> 00:31:36.289 going to the gym, right? People set up a gym 00:31:36.289 --> 00:31:38.309 plan for New Year's every year, and then they 00:31:38.309 --> 00:31:40.930 wind up, I don't want to go to the gym. So I 00:31:40.930 --> 00:31:44.430 have a colleague, my husband and I know someone 00:31:44.430 --> 00:31:48.339 who... Later in his life, he became rather strict 00:31:48.339 --> 00:31:50.779 about his sleep schedule. And so we'll be at 00:31:50.779 --> 00:31:52.519 a conference together and they'll have some late 00:31:52.519 --> 00:31:54.160 night event. He'll look at his watch and say, 00:31:54.200 --> 00:31:55.660 nope, it's nine o 'clock, it's my bedtime, I'll 00:31:55.660 --> 00:31:58.220 see you tomorrow. It's just a priority for him. 00:31:58.259 --> 00:32:02.079 That's just what he does. Well, not everybody's 00:32:02.079 --> 00:32:04.680 willing to do that. Yeah, it's true. I was speaking 00:32:04.680 --> 00:32:07.059 to a client yesterday and she was saying that, 00:32:07.119 --> 00:32:09.500 oh, I think I'm going to change my doctor because 00:32:09.500 --> 00:32:11.900 this HRT isn't working for me. And I said, what 00:32:11.900 --> 00:32:14.000 are the issues? So she named what her issues 00:32:14.000 --> 00:32:16.680 were. One of them was, I'm not sleeping great. 00:32:16.759 --> 00:32:19.880 I don't feel well. Then my question to her was, 00:32:19.980 --> 00:32:24.819 are you doing the right things to help you sleep 00:32:24.819 --> 00:32:29.700 well? Because if your sleep hygiene isn't optimal, 00:32:30.140 --> 00:32:33.000 then you can't blame it on the hormones yeah 00:32:33.000 --> 00:32:35.200 do you find that that's what people tend to do 00:32:35.200 --> 00:32:38.369 they think that it's Just my hormones are affecting 00:32:38.369 --> 00:32:42.289 it. Yeah, but when you sort of dig in, then you 00:32:42.289 --> 00:32:45.089 realize actually maybe it's because, like you 00:32:45.089 --> 00:32:46.990 said, you're scrolling at nighttime or you're 00:32:46.990 --> 00:32:50.109 exercising late into the evening. Or you're drinking 00:32:50.109 --> 00:32:53.230 too much coffee. Some people become, maybe when 00:32:53.230 --> 00:32:55.410 they were in their 20s, they could drink six 00:32:55.410 --> 00:32:57.509 cups of coffee a day. But now if they're drinking 00:32:57.509 --> 00:33:00.670 more than two after like 11 a .m., it can impact 00:33:00.670 --> 00:33:07.079 their sleep. Some people are enjoying half a 00:33:07.079 --> 00:33:09.920 bottle of wine at dinner and overnight, which 00:33:09.920 --> 00:33:12.119 works great in helping you fall asleep, but then 00:33:12.119 --> 00:33:14.680 as it burns off, it wakes you up. It's like we 00:33:14.680 --> 00:33:18.299 said earlier in our research study where we got 00:33:18.299 --> 00:33:21.279 very beautiful improvements in sleep. We didn't 00:33:21.279 --> 00:33:25.319 change the vasomotor symptoms at all. HRT is 00:33:25.319 --> 00:33:28.579 going to be working on... the vasomotor symptoms 00:33:28.579 --> 00:33:30.980 and some of those things it's not a sedative 00:33:30.980 --> 00:33:34.420 yeah so and i think sue you know you said it 00:33:34.420 --> 00:33:36.420 first thing on this podcast and it broke my heart 00:33:36.420 --> 00:33:39.220 but then i you know i i have resilience aging 00:33:39.220 --> 00:33:43.130 i mean you just got to be realistic about the 00:33:43.130 --> 00:33:45.190 eight cups of coffee you drank in your 20s and 00:33:45.190 --> 00:33:48.029 not working for you in your 40s this is a similar 00:33:48.029 --> 00:33:49.630 you know kind of mantra that we're using with 00:33:49.630 --> 00:33:51.309 clients all the time in terms of nutrition and 00:33:51.309 --> 00:33:53.450 fitness you know just because you could go to 00:33:53.450 --> 00:33:55.869 back -to -back HIT classes six times a week in 00:33:55.869 --> 00:33:58.490 your 20s and be no problem doesn't mean that's 00:33:58.490 --> 00:34:01.069 the approach for your 40s and I think acknowledging 00:34:01.069 --> 00:34:04.400 the refinement in approach especially if you're 00:34:04.400 --> 00:34:06.339 able to acknowledge that hormones are changing. 00:34:06.339 --> 00:34:09.019 So she can acknowledge, his friend, that HRT 00:34:09.019 --> 00:34:11.480 was part of her treatment plan because her hormones 00:34:11.480 --> 00:34:13.960 needed it. Then perhaps she could also acknowledge 00:34:13.960 --> 00:34:16.219 that it's time to evolve her sleep quality, her 00:34:16.219 --> 00:34:18.300 sleep schedule, her workouts, whatever it may 00:34:18.300 --> 00:34:21.539 be. And everybody is different. They're different 00:34:21.539 --> 00:34:23.639 in how much sleep they need, and they're different 00:34:23.639 --> 00:34:27.539 in how strict they need to be with these different 00:34:27.539 --> 00:34:30.739 kinds of behavioral strategies. It's not unusual 00:34:30.739 --> 00:34:33.820 for, so I put people through a CBTI program and 00:34:33.820 --> 00:34:37.480 we have a pretty rigid plan for the six weeks 00:34:37.480 --> 00:34:39.940 that I'm working with them. But then at the end, 00:34:39.940 --> 00:34:41.360 they're going to go off and live their life. 00:34:41.480 --> 00:34:44.360 And so we talk about how do you modify this plan 00:34:44.360 --> 00:34:48.239 over time? And I have an approach to encouraging 00:34:48.239 --> 00:34:51.980 people to do that. But some people can go immediately 00:34:51.980 --> 00:34:54.579 back to the most sloppy sleep habits and they 00:34:54.579 --> 00:34:58.199 continue to sleep fine. Interesting. Some people... 00:34:59.369 --> 00:35:01.610 cannot. And the people who cannot are kind of 00:35:01.610 --> 00:35:03.530 mad about it. They'll say, well, it's just not 00:35:03.530 --> 00:35:05.769 fair. My husband, as soon as he puts his head 00:35:05.769 --> 00:35:07.969 on the pillow, he passes out and he sleeps all 00:35:07.969 --> 00:35:09.829 night. You know, if you have a gluten allergy, 00:35:10.130 --> 00:35:12.949 it's not fair, but you still can't eat wheat. 00:35:13.449 --> 00:35:15.769 And it's sort of the same way. If you at this 00:35:15.769 --> 00:35:19.849 stage in your life are a person who can't use 00:35:19.849 --> 00:35:23.329 your screens in bed, who can't spend too much 00:35:23.329 --> 00:35:25.769 time in bed, who have to get, it's not fair, 00:35:25.849 --> 00:35:30.829 but It's just how you are. And to realize that 00:35:30.829 --> 00:35:33.929 it's somewhat under your control. If you decide 00:35:33.929 --> 00:35:36.429 to go on vacation and throw all of these things 00:35:36.429 --> 00:35:38.809 out the window and your sleep, you know, is terrible, 00:35:38.929 --> 00:35:44.570 you don't feel so scared and alarmed because 00:35:44.570 --> 00:35:48.130 you understand that. I'm not following my own 00:35:48.130 --> 00:35:50.289 plan, which works best for me. That's a choice 00:35:50.289 --> 00:35:52.849 I'm making for this point in time. And I can 00:35:52.849 --> 00:35:54.710 always get back on the plan when I get back home. 00:35:54.789 --> 00:35:58.289 So that's exactly what we say. You know, it's 00:35:58.289 --> 00:36:01.579 like I will have every now and then a beer. knowing 00:36:01.579 --> 00:36:04.159 full well it is not going to go well for my sleep 00:36:04.159 --> 00:36:05.860 and it never does so it's like i know it and 00:36:05.860 --> 00:36:09.260 i show it and that's fine but i don't feel victimized 00:36:09.260 --> 00:36:11.360 by right right you know i feel actually empowered 00:36:11.360 --> 00:36:13.820 by that knowledge because i can then choose to 00:36:13.820 --> 00:36:15.460 to have a better night's sleep with the tools 00:36:15.460 --> 00:36:17.300 that i do have yeah i think that's part of the 00:36:17.300 --> 00:36:20.880 reason also why we decided to make the change 00:36:20.880 --> 00:36:23.500 of like giving up the not like totally giving 00:36:23.500 --> 00:36:27.019 up alcohol but not drinking yeah so You know, 00:36:27.059 --> 00:36:29.159 like Amanda said, that when we make that conscious 00:36:29.159 --> 00:36:32.420 decision, we know exactly what we're doing. And 00:36:32.420 --> 00:36:34.920 I think that is, like you said, that's empowerment. 00:36:35.440 --> 00:36:38.179 Very much so. Yeah, very much so. So let's talk 00:36:38.179 --> 00:36:40.179 about things a little bit less in our control. 00:36:40.960 --> 00:36:43.559 I am a mom of little littles, right? So I'm a 00:36:43.559 --> 00:36:46.000 later in life mom who has little tiny kids, five, 00:36:46.139 --> 00:36:48.619 four, and one, almost two. Oh no, I can't believe 00:36:48.619 --> 00:36:52.679 it. And I do find that obviously kind of the 00:36:52.679 --> 00:36:55.460 sleep rhetoric in this community of moms with 00:36:55.460 --> 00:36:58.000 little kids is basically like, can't fix it, 00:36:58.059 --> 00:37:00.239 don't try, struggle through the first five years, 00:37:00.280 --> 00:37:02.739 hope for the best. And definitely it's something 00:37:02.739 --> 00:37:05.199 that I reject personally in my own life because 00:37:05.199 --> 00:37:07.380 we did some pretty, you know, you mentioned people 00:37:07.380 --> 00:37:11.010 who are strict about sleep. I always say if zero 00:37:11.010 --> 00:37:14.090 or one is like co -sleeping in a big bed with 00:37:14.090 --> 00:37:17.610 no bedtimes and 10 is like a military prison. 00:37:18.090 --> 00:37:20.730 My house is a nine. So that's kind of how we 00:37:20.730 --> 00:37:23.909 run it. But realistically, do you have maybe 00:37:23.909 --> 00:37:26.429 some softer tips or some more introductory tips 00:37:26.429 --> 00:37:30.190 for families like mine with little kids to get 00:37:30.190 --> 00:37:32.550 a little bit more sleep, better sleep? You know, 00:37:32.570 --> 00:37:34.949 my feeling about kids, when I was raised, my 00:37:34.949 --> 00:37:37.349 son was born when I was in my 40s. So I was a 00:37:37.349 --> 00:37:42.489 late mom. And, you know. At that time, there 00:37:42.489 --> 00:37:45.150 was a book by a man named Richard Ferber. I don't 00:37:45.150 --> 00:37:47.190 know if Ferber is still out there. Ferbering. 00:37:47.570 --> 00:37:49.670 Again, you don't touch sleep training without 00:37:49.670 --> 00:37:51.369 talking about Ferber. Yeah, so everybody was 00:37:51.369 --> 00:37:54.090 about Ferbering when I was raising my son. And 00:37:54.090 --> 00:37:58.849 perhaps because I was an older mom and he was 00:37:58.849 --> 00:38:01.929 my only, perhaps just because of the way we run 00:38:01.929 --> 00:38:05.409 our household, the strictness of that plan didn't 00:38:05.409 --> 00:38:09.030 work for me. And so for a number of years, my 00:38:09.030 --> 00:38:11.070 kid would, in the middle of the night, call, 00:38:11.190 --> 00:38:14.050 Mom! And I'd get up and I'd go in there and sit 00:38:14.050 --> 00:38:15.690 next to the bed and I'd put my hand on him and 00:38:15.690 --> 00:38:17.010 he'd go right back to sleep and then I'd go to 00:38:17.010 --> 00:38:19.610 bed and I'd go back to sleep. And it worked fine 00:38:19.610 --> 00:38:24.150 for both of us. So I think each family has to 00:38:24.150 --> 00:38:27.670 figure out what strategies are best for them. 00:38:28.110 --> 00:38:31.030 And to remember, this doesn't last forever. You 00:38:31.030 --> 00:38:33.849 know, kids grow up. Their bodies and brains are 00:38:33.849 --> 00:38:37.460 still... changing learning how to sleep for one 00:38:37.460 --> 00:38:40.099 thing and learning the societal expectations 00:38:40.099 --> 00:38:41.840 that they're going to sleep in their own bed 00:38:41.840 --> 00:38:43.559 for this period of time and not going to but 00:38:43.559 --> 00:38:45.380 you've got so many things going on with kids 00:38:45.380 --> 00:38:48.039 right you've got siblings bothering one another 00:38:48.039 --> 00:38:51.460 oh yeah that's in my house my um i've got 10 00:38:51.460 --> 00:38:53.539 year old and eight year old twins three boys 00:38:53.539 --> 00:38:57.000 they all sleep in the same room And 100%, the 00:38:57.000 --> 00:38:59.099 eldest, I know it's Kyan. Sorry, Kyan, I know 00:38:59.099 --> 00:39:02.380 it's you. He will disturb his brothers. But then 00:39:02.380 --> 00:39:05.179 yesterday he had tennis in the evening. And when 00:39:05.179 --> 00:39:07.380 we got back, I opened the door very quietly. 00:39:07.659 --> 00:39:09.900 And I think the twins thought it was Kyan because 00:39:09.900 --> 00:39:13.489 they were waiting up for him. I'm like, I'm here. 00:39:13.730 --> 00:39:16.789 I'm going to sleep. So, you know, I know that 00:39:16.789 --> 00:39:18.750 they will wait for each other. They will always 00:39:18.750 --> 00:39:20.869 mess around with each other. And that's just, 00:39:20.889 --> 00:39:23.650 that's just what they do. Yeah. They do that 00:39:23.650 --> 00:39:27.949 or they get sick or they have a nightmare or 00:39:27.949 --> 00:39:31.929 they develop anxiety about the dark or, you know, 00:39:31.949 --> 00:39:34.250 there's all sorts of things that, and kids are 00:39:34.250 --> 00:39:36.829 also under a lot of stress and strain these days, 00:39:36.929 --> 00:39:41.320 right? Pressures at school. And so I think. There 00:39:41.320 --> 00:39:46.159 is some truth to this. This is a hard stage and 00:39:46.159 --> 00:39:50.000 it will pass. And each family gets to decide. 00:39:50.730 --> 00:39:53.789 What seems to work best for them, given the realities 00:39:53.789 --> 00:39:57.010 of their situation? I very well would have been 00:39:57.010 --> 00:40:00.469 likely to be less enthusiastic about getting 00:40:00.469 --> 00:40:02.730 up if I'd had three kids that are all little 00:40:02.730 --> 00:40:05.610 ones as opposed to one. I do feel like I got 00:40:05.610 --> 00:40:08.650 more stringent as they came, rather than less. 00:40:08.849 --> 00:40:10.250 I think you feel like you have to, don't you, 00:40:10.289 --> 00:40:11.849 when you've got more. It's because otherwise 00:40:11.849 --> 00:40:14.510 they'll just run riot. But my kids still bring 00:40:14.510 --> 00:40:17.090 up a time. This would have been a couple of years 00:40:17.090 --> 00:40:18.989 ago, so they were much younger. But they're like, 00:40:19.070 --> 00:40:21.050 mommy, do you remember that time when you cried 00:40:21.050 --> 00:40:22.769 when you didn't sleep? Because they kept coming 00:40:22.769 --> 00:40:25.750 into my room and I was just tired. And it just, 00:40:25.809 --> 00:40:28.530 it really took a toll on me. And they still remember 00:40:28.530 --> 00:40:30.369 that. I'm like, oh yes, I remember. I remember 00:40:30.369 --> 00:40:34.969 when I was exhausted and it was just too much 00:40:34.969 --> 00:40:37.050 for me. But I do always say to my clients, because 00:40:37.050 --> 00:40:38.710 I've had this question before, and I say to them, 00:40:38.750 --> 00:40:42.530 look, it's your choice. If you are happy with 00:40:42.530 --> 00:40:44.449 your child coming into your room, sleeping in 00:40:44.449 --> 00:40:47.269 your bed, that's fine that's you know something 00:40:47.269 --> 00:40:50.750 that you are again deciding to do but for me 00:40:50.750 --> 00:40:53.070 it wasn't fine and I was really struggling and 00:40:53.070 --> 00:40:56.789 I really needed the sleep um and so again part 00:40:56.789 --> 00:41:00.190 of why I also ran a military operation with with 00:41:00.190 --> 00:41:02.710 the boys you see why we get along I caught your 00:41:02.710 --> 00:41:06.010 semantics there I caught you earlier using three 00:41:06.010 --> 00:41:08.550 words very differently tired sleepy exhausted 00:41:08.550 --> 00:41:11.789 yeah Do you is that intentional that you kind 00:41:11.789 --> 00:41:14.050 of like you said tired and then you said sleepy 00:41:14.050 --> 00:41:15.610 when you're talking about going to the bedroom? 00:41:15.750 --> 00:41:18.210 And I feel like when I think of those three words, 00:41:18.349 --> 00:41:20.750 for some reason, I think sleepy means it's time 00:41:20.750 --> 00:41:22.650 to go to sleep. Like it's time for me to get 00:41:22.650 --> 00:41:26.190 into bed and sleep. Tired means I've done enough 00:41:26.190 --> 00:41:28.510 for today. Like I've used enough physical energy 00:41:28.510 --> 00:41:30.510 that I am now tired. It doesn't it's not a negative. 00:41:30.590 --> 00:41:32.250 It's just that is the end of my day. I am tired. 00:41:32.929 --> 00:41:35.690 Exhausted signals to me. And again, maybe I'm 00:41:35.690 --> 00:41:38.630 reading too deep into semantics that I am beyond. 00:41:39.210 --> 00:41:42.210 what I can handle in this day. Like I'm not just 00:41:42.210 --> 00:41:45.070 tired. I'm now in excess of what I had to spend 00:41:45.070 --> 00:41:47.969 energy wise. Right. And for me, the connotation 00:41:47.969 --> 00:41:51.190 there is exhausted doesn't necessarily mean sleep 00:41:51.190 --> 00:41:56.289 deprived. It means it's a stretch beyond tired, 00:41:56.409 --> 00:42:00.449 you know, that you have overdone. It's just piling 00:42:00.449 --> 00:42:03.469 up. Everything is piling up. It's too much. I 00:42:03.469 --> 00:42:06.159 can't carry it all this anymore. That just sounds 00:42:06.159 --> 00:42:08.559 like a 40 -year -old woman to me. Resonance, 00:42:08.559 --> 00:42:11.420 deep, right? Exhaustion is where, yeah, sometimes 00:42:11.420 --> 00:42:14.239 where we kind of, it's almost like our happy 00:42:14.239 --> 00:42:17.039 place. Yeah. Something we can probably scale 00:42:17.039 --> 00:42:19.420 back. Well, speaking of happy places, our happy 00:42:19.420 --> 00:42:21.300 place on the show is our fun little segment called 00:42:21.300 --> 00:42:24.280 Hot or Hype. So we take experts like yourself, 00:42:24.440 --> 00:42:26.539 we give you some kind of hot button issues in 00:42:26.539 --> 00:42:28.099 your field, and you give us your reflections. 00:42:28.400 --> 00:42:31.019 So hot. means you agree. You're like, yeah, this 00:42:31.019 --> 00:42:33.260 is a good thing, helpful, whatever. Hype means 00:42:33.260 --> 00:42:35.480 not so much, wouldn't recommend it. Is there 00:42:35.480 --> 00:42:38.440 something in the middle? Ooh, great question. 00:42:38.980 --> 00:42:42.079 Liquid? Maybe something with an H. Hyper halfway? 00:42:44.539 --> 00:42:46.719 Powerful, powerful language. But you can definitely 00:42:46.719 --> 00:42:48.900 qualify. Okay. So this is not a one word. You 00:42:48.900 --> 00:42:50.820 can say your thing and then explain your piece. 00:42:51.039 --> 00:42:53.559 All right. So quote we hear all the time in kind 00:42:53.559 --> 00:42:55.539 of high achieving, high performer circles. You 00:42:55.539 --> 00:43:00.309 can sleep when you're dead. I would have to say 00:43:00.309 --> 00:43:03.550 yes. Meaning? Meaning? You can't outsmart it 00:43:03.550 --> 00:43:07.469 forever. You can't. Well, meaning that says I 00:43:07.469 --> 00:43:10.949 can put off sleeping. I don't have to sleep. 00:43:12.159 --> 00:43:14.480 deserve to be able to stay up after my kids are 00:43:14.480 --> 00:43:17.860 in bed and do my own thing. I can sleep when 00:43:17.860 --> 00:43:20.920 I'm dead. I'll do that later. Which really, I 00:43:20.920 --> 00:43:24.239 mean, we're supposed to sleep every day. We need 00:43:24.239 --> 00:43:27.639 to sleep every day. So denying yourself sleep 00:43:27.639 --> 00:43:31.940 is fine. It's a choice you can make, but it will 00:43:31.940 --> 00:43:34.119 come at a cost if you do it consistently for 00:43:34.119 --> 00:43:37.420 a long time. Is it true that you said individual 00:43:37.420 --> 00:43:40.239 sleep needs differ? But when someone says, because 00:43:40.239 --> 00:43:42.219 I've had clients say this to me, like, I'm fine 00:43:42.219 --> 00:43:44.739 on four or five hours. Is there such a person 00:43:44.739 --> 00:43:49.800 that is fine on four or five hours? Yes. However, 00:43:50.199 --> 00:43:53.940 fine on four or five hours in the sense that 00:43:53.940 --> 00:43:55.619 they don't feel like they need any more sleep 00:43:55.619 --> 00:43:58.079 like that and they continue to be productive 00:43:58.079 --> 00:44:00.139 or active with all the rest of the hours. There 00:44:00.139 --> 00:44:02.420 are people like that. Whether that's actually 00:44:02.420 --> 00:44:06.809 good for you or not, I mean, They've done studies. 00:44:06.849 --> 00:44:08.449 Now, these are people who wouldn't necessarily 00:44:08.449 --> 00:44:10.769 consider themselves short sleepers, but they've 00:44:10.769 --> 00:44:13.289 done studies with people who are getting consistently 00:44:13.289 --> 00:44:15.969 less than five hours of sleep at night for prolonged 00:44:15.969 --> 00:44:19.750 periods of time. And those individuals are like 00:44:19.750 --> 00:44:22.070 three times the increased risk for car accidents. 00:44:23.289 --> 00:44:26.469 For some of them, it's almost like driving slightly 00:44:26.469 --> 00:44:30.969 drunk because your reaction time and your attention 00:44:30.969 --> 00:44:36.090 concentration are slowed. whether a natural short 00:44:36.090 --> 00:44:39.809 sleeper who lives that way for a long time suffers 00:44:39.809 --> 00:44:43.550 any of these kinds of sequelae. I'm not sure 00:44:43.550 --> 00:44:48.210 from the literature, but I think what we do, 00:44:48.269 --> 00:44:51.510 we don't know that there's the number eight hours 00:44:51.510 --> 00:44:53.230 of sleep at night. That's just completely made 00:44:53.230 --> 00:44:56.389 up. There's no hype. That's hype. Absolutely. 00:44:58.360 --> 00:45:00.780 What the right amount is, it does vary from people 00:45:00.780 --> 00:45:02.840 to people, but it's probably somewhere in the 00:45:02.840 --> 00:45:07.039 range from six to nine. And then you start dropping 00:45:07.039 --> 00:45:09.440 off. And when you start getting people who are 00:45:09.440 --> 00:45:12.659 either sleeping like less than five every night 00:45:12.659 --> 00:45:18.250 or more than 10, that's not. Good for you. I 00:45:18.250 --> 00:45:21.250 said 12 -hour night sleep for an adult is not 00:45:21.250 --> 00:45:24.550 recommended. Well, now and then it's okay. But 00:45:24.550 --> 00:45:26.110 if you're doing it every night, there's something 00:45:26.110 --> 00:45:28.769 not right. And I got to be a little snarky, like 00:45:28.769 --> 00:45:30.610 show me somebody sleeping five hours that's like 00:45:30.610 --> 00:45:33.329 jacked, meaning like muscular and has great muscle 00:45:33.329 --> 00:45:36.190 density because your muscles ain't growing in 00:45:36.190 --> 00:45:38.650 four or five hours. I had a genetic test done, 00:45:38.690 --> 00:45:41.150 which actually showed that I'm a long sleeper. 00:45:41.150 --> 00:45:42.849 I don't know how accurate it is, but it says 00:45:42.849 --> 00:45:45.820 I need to have... Nine hours plus sleep. And 00:45:45.820 --> 00:45:49.340 I do feel that I do need more sleep. Sleep is 00:45:49.340 --> 00:45:52.500 always one of my big sore, well, it's a sore 00:45:52.500 --> 00:45:54.420 point for me. Like if I don't get enough sleep 00:45:54.420 --> 00:45:56.780 or if I'm, you know, go to sleep too late. Yeah, 00:45:56.780 --> 00:45:59.059 mommy's crying. Mommy, I'm definitely crying. 00:45:59.940 --> 00:46:02.780 Mommy, mommy needs her sleep for real. All right. 00:46:02.820 --> 00:46:06.300 Hot or hype soup? Melatonin supplements. That's 00:46:06.300 --> 00:46:10.860 a middle H. So there are people who are melatonin 00:46:10.860 --> 00:46:14.699 deficient. As an actual disorder? Actual disorder. 00:46:14.880 --> 00:46:17.860 A blood test can tell you whether you're melatonin 00:46:17.860 --> 00:46:20.820 deficient. And those individuals definitely benefit 00:46:20.820 --> 00:46:25.239 from melatonin. There's good evidence that melatonin 00:46:25.239 --> 00:46:28.179 is very useful for jet lag when you're going 00:46:28.179 --> 00:46:29.820 across all these time zones. And I know people 00:46:29.820 --> 00:46:32.139 in Singapore travel a lot. That's so relevant. 00:46:32.659 --> 00:46:36.579 The trouble with melatonin use, and it's quite 00:46:36.579 --> 00:46:40.159 prominent in the States, is for one thing in 00:46:40.159 --> 00:46:43.739 the States, But melatonin is not FDA regulated. 00:46:44.039 --> 00:46:46.099 Mostly people are buying it over the counter. 00:46:46.380 --> 00:46:48.920 And you don't know when you get a bottle of melatonin, 00:46:48.920 --> 00:46:50.760 it says it's five milligrams. If there's actually 00:46:50.760 --> 00:46:52.679 five milligram pills in there or if some of them 00:46:52.679 --> 00:46:54.460 are 10 or if some of them had no melatonin at 00:46:54.460 --> 00:46:56.639 all. You have no way of knowing that because 00:46:56.639 --> 00:47:00.739 it's not regulated. But the other thing is melatonin 00:47:00.739 --> 00:47:03.440 is designed to rise and fall naturally in the 00:47:03.440 --> 00:47:08.409 body. and at its peak it's at maybe 0 .8 0 .9 00:47:08.409 --> 00:47:11.670 milligrams so when someone's taken 10 milligrams 00:47:11.670 --> 00:47:14.789 of melatonin every single day they're running 00:47:14.789 --> 00:47:16.730 the risk even though melatonin leaves your body 00:47:16.730 --> 00:47:18.690 fairly quickly they're running the risk that 00:47:18.690 --> 00:47:21.710 basically they've got more melatonin in their 00:47:21.710 --> 00:47:25.570 body all the time than it naturally would be 00:47:26.010 --> 00:47:30.489 as it rises and falls. And the rising and falling 00:47:30.489 --> 00:47:33.090 is part of the activating, telling your brain 00:47:33.090 --> 00:47:35.090 it's time to go to sleep or it's time to wake 00:47:35.090 --> 00:47:39.429 up. So you're running the risk that you're, and 00:47:39.429 --> 00:47:43.090 melatonin isn't a sedative. It's a hormone that, 00:47:43.110 --> 00:47:44.630 again, is supposed to just signal your brain 00:47:44.630 --> 00:47:49.269 it's time to sleep. So I think it is way overused, 00:47:49.269 --> 00:47:52.750 in the States at least. And I think for many 00:47:52.750 --> 00:47:55.510 people, it's actually more of a placebo, makes 00:47:55.510 --> 00:47:57.309 them feel better than does any good to their 00:47:57.309 --> 00:48:00.690 sleep at all. I heard that if you take exogenous 00:48:00.690 --> 00:48:03.550 melatonin, it will reduce or stop the production 00:48:03.550 --> 00:48:06.469 of endogenous melatonin. So then you become reliant 00:48:06.469 --> 00:48:08.250 on it. So if you start taking it regularly enough 00:48:08.250 --> 00:48:10.900 that... You will then need to keep on taking 00:48:10.900 --> 00:48:12.880 it. Is that true or am I just making this up? 00:48:12.920 --> 00:48:15.739 You know, I'm not 100 % sure that that's true 00:48:15.739 --> 00:48:17.820 or not, but it makes sense to me that it might 00:48:17.820 --> 00:48:20.699 be. I remember I had a client once who came to 00:48:20.699 --> 00:48:23.059 me and she was taking 20 milligrams of melatonin 00:48:23.059 --> 00:48:26.440 every day. And I said, hmm, that's rather a lot. 00:48:26.500 --> 00:48:28.219 I don't think I've ever seen anybody take that 00:48:28.219 --> 00:48:30.159 much. She says, oh, I've been doing it for years. 00:48:30.380 --> 00:48:32.760 I said, does your doctor know you're taking this 00:48:32.760 --> 00:48:34.719 much melatonin? So I really was leaning on her 00:48:34.719 --> 00:48:38.659 to go to her physician because. She seemed to 00:48:38.659 --> 00:48:40.219 have no side effects that she was reporting, 00:48:40.360 --> 00:48:42.880 but I just can't believe it was good for her 00:48:42.880 --> 00:48:44.840 if she was getting that much melatonin, which 00:48:44.840 --> 00:48:46.239 we don't know. It sounds like a heavy hand and 00:48:46.239 --> 00:48:49.539 good for years. I also wonder that because it's 00:48:49.539 --> 00:48:52.190 not FDA approved and it's not. technically a 00:48:52.190 --> 00:48:54.010 medication that people are like, oh, this is 00:48:54.010 --> 00:48:56.510 fine. I'll just take this and it will help me 00:48:56.510 --> 00:48:58.289 sleep. And it's not like I'm popping sleeping 00:48:58.289 --> 00:49:00.389 pills or something. Well, and they think it's 00:49:00.389 --> 00:49:02.170 going to put them to sleep, but it's not supposed 00:49:02.170 --> 00:49:04.730 to put them to sleep. It's not Ambien. It's a 00:49:04.730 --> 00:49:07.769 hormone. Do you have a strategy for deploying 00:49:07.769 --> 00:49:10.690 melatonin for jet lag? I do have a strategy. 00:49:10.730 --> 00:49:13.269 And what it involves is about three days before 00:49:13.269 --> 00:49:17.650 you travel, you start taking melatonin at the 00:49:17.650 --> 00:49:21.030 time of day where you are. when it would be bedtime 00:49:21.030 --> 00:49:24.650 where you're going. So it's not a sedative. It 00:49:24.650 --> 00:49:27.829 won't make you sleepy, but it's starting to put 00:49:27.829 --> 00:49:30.869 in there for a few days in advance the signal 00:49:30.869 --> 00:49:34.829 that at that time you're going to then want to 00:49:34.829 --> 00:49:36.869 be going to sleep when you arrive where you're 00:49:36.869 --> 00:49:39.230 going. And then you could do the same thing in 00:49:39.230 --> 00:49:41.250 reverse when you're coming back home. I'm doing 00:49:41.250 --> 00:49:44.369 it. I have terrible jet lag going to the U .S. 00:49:45.309 --> 00:49:47.409 worse jet lag when I'm coming back from the UK 00:49:47.409 --> 00:49:50.369 back to Singapore like I really really struggle 00:49:50.369 --> 00:49:52.570 and purely because we tend to go for a longer 00:49:52.570 --> 00:49:54.349 period of time when we're there for four to six 00:49:54.349 --> 00:49:57.230 weeks by the time I'm like all fully settled 00:49:57.230 --> 00:50:00.010 in with UK timing and I come back and then I'm 00:50:00.010 --> 00:50:02.170 like oh I can't see this is just too much but 00:50:02.170 --> 00:50:04.789 I'm gonna try that yeah and about five milligrams 00:50:04.789 --> 00:50:07.349 that was my next question okay five milligrams 00:50:08.039 --> 00:50:10.659 three days before you travel, at what would be 00:50:10.659 --> 00:50:13.300 the bedtime in the destination. That's correct. 00:50:13.480 --> 00:50:15.920 So interesting. See, that's the hard -hitting 00:50:15.920 --> 00:50:19.480 news we need, Sue. All right, a couple more hotter 00:50:19.480 --> 00:50:23.440 hypes. Midnight snacks. So I wake up, I'm hungry. 00:50:23.739 --> 00:50:26.739 Do I eat? No, it's a hype. Should not do that. 00:50:27.609 --> 00:50:30.449 Your body can become habituated to doing that. 00:50:30.570 --> 00:50:32.190 So then you naturally wake up. And then you're 00:50:32.190 --> 00:50:34.849 going to wake up whether you need to be eating 00:50:34.849 --> 00:50:37.690 or not. And then you're going to have strikes 00:50:37.690 --> 00:50:42.710 again. All right. And last one, nightcaps. I'm 00:50:42.710 --> 00:50:44.510 just going to do a little glass of wine, take 00:50:44.510 --> 00:50:48.599 the edge off, help me get to bed. Well. As we 00:50:48.599 --> 00:50:51.159 talked earlier, the trouble with alcohol is as 00:50:51.159 --> 00:50:52.760 it starts to burn out of your system. Now, if 00:50:52.760 --> 00:50:55.119 it's a little nightcap, it probably won't make 00:50:55.119 --> 00:50:57.579 a difference. And it may take the edge off and 00:50:57.579 --> 00:51:00.440 help you fall asleep. But it's, again, something 00:51:00.440 --> 00:51:02.239 you can become habituated to. And, of course, 00:51:02.239 --> 00:51:04.519 it's very easy with alcohol for the little bit 00:51:04.519 --> 00:51:06.239 to become a little bit more and become a little 00:51:06.239 --> 00:51:09.099 bit more. And the more and more, then the more 00:51:09.099 --> 00:51:11.340 it increases your risk for sleep problems. Absolutely. 00:51:12.099 --> 00:51:14.940 Well, Sue, I say this with love. You have successfully 00:51:14.940 --> 00:51:18.980 completed your 40s. We ask every guest on the 00:51:18.980 --> 00:51:21.360 show to share some wisdom for women in their 00:51:21.360 --> 00:51:24.320 40s. And we ask the question, what is your 40s 00:51:24.320 --> 00:51:27.000 formula? So with the advantage of having lived 00:51:27.000 --> 00:51:29.460 them, what is your 40s formula for our listeners? 00:51:29.820 --> 00:51:31.659 Well, since we've been talking about sleep, what 00:51:31.659 --> 00:51:34.739 I will say is, you know, there's a lot of things 00:51:34.739 --> 00:51:37.119 that can impact sleep negatively, adversely for 00:51:37.119 --> 00:51:41.820 women in their 40s. I would encourage all women 00:51:41.820 --> 00:51:46.199 in their 40s to aim to have a regular sleep schedule. 00:51:47.599 --> 00:51:50.659 And if they have any conditions that are impacting 00:51:50.659 --> 00:51:53.000 their sleep, medical, psychological, emotional, 00:51:53.219 --> 00:51:57.639 or situational, that can be treated to not hesitate 00:51:57.639 --> 00:52:05.579 to go ahead and seek help. And panic about your 00:52:05.579 --> 00:52:11.199 sleep will not be useful. So remember that just 00:52:11.199 --> 00:52:13.280 like we have many things that cause sleep problems, 00:52:13.380 --> 00:52:16.179 we have many strategies to help treat these problems. 00:52:16.880 --> 00:52:19.099 And if you're obsessing about your sleep, it's 00:52:19.099 --> 00:52:21.420 only going to make it worse. You can't fall asleep 00:52:21.420 --> 00:52:24.300 when you're upset and anxious. Love that. Remove 00:52:24.300 --> 00:52:28.679 the obstacles. Stay calm. Stay calm. This is 00:52:28.679 --> 00:52:30.519 going to get better. Thank you so much for being 00:52:30.519 --> 00:52:31.980 on the show today, Sue. We've really learned 00:52:31.980 --> 00:53:01.679 a lot. You're welcome. Thank you. So Sue, as 00:53:01.679 --> 00:53:03.199 you can see, if there's little stumbles like 00:53:03.199 --> 00:53:05.699 that, you can just restate and then we'll tighten 00:53:05.699 --> 00:53:08.260 that up in the editing. So let's see if this 00:53:08.260 --> 00:53:11.519 lives up to your pitch. Yeah, I know. It's like, 00:53:12.159 --> 00:53:15.420 you better say all this stuff. No, I'm just kidding. 00:53:15.500 --> 00:53:15.960 I know you will.