SPEAKER_02 0:13

Hello and welcome back to Empower Your Menopause, the podcast where we ditch outdated advice and give you the real tools to help you thrive in midlife and beyond. I'm Coach James. I'm joined by my co-host Coach Julie, and we're really excited about today's episode. If you've ever stared at the ceiling at 2am wondering if sleep is just another thing you're losing in menopause, this one is definitely for you. Now we know that sleep struggles are one of the biggest complaints women have during perimenopause and beyond. And we also know that most advice out there is either too generic, unrealistic, or occasionally flat out wrong. So we brought in a heavy hitter for this episode. Meet Dr. Catherine Darley. Now, Dr. Catherine is an absolute leader in natural sleep medicine. She combines her knowledge of sleep and circadian disorders with her training as a naturopathic physician to bridge these two fields, and she's treated patients for more than 20 years along with training healthcare providers in sleep medicine. She now focuses on teaching people the sleep skills they need to thrive at home and at work and to have a high quality of life. So we're going to dive right in now with Dr. Catherine about what's really going on with your sleep during menopause, what's circadian rhythms have to do with it, and most importantly, what you can finally do to start getting the rest you deserve. So if you're tired of being tired, grab a copper, maybe make that a decaf one, and let's get straight into it. So, Dr. Catherine, why don't you just say hello and share a little bit of a fun fact about yourself and why you're passionate about sleep?

SPEAKER_00 1:42

Well, uh, so welcome. I'm very glad to be here. And a fun fact about me is that I also love to be out in nature and really support nature cure, which nature cure supports us. So that's another uh interesting little wrinkle about me.

SPEAKER_02 2:03

Sure. And how did you get into the whole sleep thing then? What prompted it? Was it personal experience? How did it come about?

SPEAKER_00 2:11

You know, I've been interested in sleep since I was in college, and I followed that interest with some special group projects, individual projects, and so I've worked my whole life actually in sleep medicine and sleep research in different ways. And uh I sleep well, I really do. I prioritize my sleep, so when I'm not sleeping well, I notice the difference. Um, one thing that was interesting is when I was a kid, 12 years old, I sleep, I was a sleepwalker, and one night I sleepwalked out of our house and into the neighbor's house and into their house through to the other side. So um that is an interesting sleep phenomenon.

SPEAKER_01 2:59

Indeed. I yeah, I've never been a sleepwalker, but I know I know people who are people really active in their sleep. There's all sorts of different ways to sleep, I suppose. But let's let's let's ask the burning question, right? What can women expect with their sleep during menopause? It's a big transition.

SPEAKER_00 3:20

It's a huge transition, and sleep is one of the most common complaints that women have during menopause. Our sleep gets interrupted by the hot flashes, night sweats, but then there's other kinds of lifestyle factors too. As women are going through menopause, is often one of the busier times in their life. Maybe they're in that sandwich generation where they've still got teens and young people that they're raising, plus, they're starting to do some senior care and take care of the elders in their life. So it can be really a very busy time. And with the hormone changes, it really makes our sleep have a hard time withstanding the changes and the lifestyle factors both.

SPEAKER_02 4:11

Sorry, go ahead, Julie. Sorry.

SPEAKER_01 4:13

I was just gonna say you're you talked about hormones. So, what's actually happening like hormonally and neurologically that messes with our sleep at this time of life?

SPEAKER_00 4:23

Yeah, well, we have estrogen center uh estrogen receptors throughout our body on most cell types. People may not know that, and it has an effect on our brain, actually. So as we're going through menopause and we're losing those high levels of estrogen that we had at an earlier time, it actually is impacting our brain and the sleep centers. One of the things that is really important for sleep, and there's this overlay between sleep health and our hormones is temperature regulation. This is an area that I think could serve more people to know is that we typically have a 24-hour pattern in our temperature. As our temperature is rising, we become more alert, we are more active and awake. As our temperature is dropping, it impacts our sleep. We become sleepy and we sleep well when it's low. So these you know, hormone changes that impact our temperature regulation, that's one of the mechanisms by which we our sleep kind of suffers during menopause.

SPEAKER_01 5:42

So, is that why some women like can fall asleep really easily, but suddenly at two o'clock you're wide awake and counting ceiling fan rotations or whatever that might be?

SPEAKER_00 5:53

Yeah, that's one of the reasons, but there are many reasons. It could be an undiagnosed sleep disorder. I'm hoping that we have the chance to talk about uh actual sleep disorders that do increase in women as they go through menopause because this isn't really under-recognized area that uh you know, women can have obstructive sleep apnea. And actually, we think about obstructive sleep apnea, or we used to think about obstructive sleep apnea as a condition that was affecting mostly men, older men, maybe overweight men. But what we now know is that once women go through menopause, the rate of obstructive sleep apnea in women and in men is the same. Uh, but women just often don't get diagnosed. And and that's one of those disorders that can cause us to wake up in the middle of the night, have that fragmented sleep.

SPEAKER_01 6:53

Sure, sure. What what might some other disorders be? I mean, I know we have different different phases in our life, we have different kinds of disruptions to our sleep patterns, right? Young parents with with new kids or parenting elders or just stress in general, but those are those are circumstances that I think people understand at least a little bit why. So, what what are some of the other disorders that women can experience at this time of life?

SPEAKER_00 7:23

The other disorder that increases quite significantly after menopause, and it's actually over 50% of women who are postmenopausal have restless leg syndrome. You've probably heard of that, is when people will feel like they just have to move their legs in the evening, could be a little bit of a skin crawling feeling. Usually it's worse when you're sitting or sedentary, laying down, you're in a confined space, and that actually correlates with a movement disorder that happens during sleep. So restless legs happens in the evenings, we're aware of it. It can make it difficult to fall asleep at the beginning of the night. It's associated with another disorder called limb movement disorder, and that happens in the night. People just kind of jerk periodically, and you might think, well, so what? But it keeps us in the lighter stages of sleep. So there's four stages of sleep uh stage one, two, three, and rem. And if we have any of these sleep disorders, it will keep us just getting stage one, stage two, and wakefulness in the night. We won't get that deep sleep, we won't get REM sleep that we need to really function and be at our best. Okay.

SPEAKER_01 8:42

Yeah, that makes sense.

SPEAKER_02 8:44

One of the terms that gets mentioned quite a lot when it comes to sleep and the issue of sleep, Catherine, is circadian rhythm. And I know that you this is something that you love to delve into. I wonder if you could just give a quick circadian rhythm 101 for our readers. What is it? How does it affect us? Can we use it to our advantage in menopause, or is that the issue that's challenging women in menopause? I wonder if you could just explain a little bit about that to us.

SPEAKER_00 9:15

Yeah, I would love to. So we have this 24-hour rhythm in our function where our entire body, every organ system, is set to be more active during the day and then in a more restful state at night. And the other piece about circadian rhythm is that we're all set to be on a slightly different schedule. And this is not something that's just our preference or a choice, it is something that is biologically hardwired. Think of it like if you're tall or short, if you're a morning person or a night person, those features are really something that's given to us, it's not something that we choose. So if a woman is uh preferring to be on that morning schedule because that's when she naturally wakes up, and then maybe she's falling asleep earlier in the evening than some others, it's best to live in in rhythm with our body clock. We call it chronotype, and there's three chronotypes morning, evening, or neither, which is middle of the road. And uh, so one question I really love for people to think about is if the entire world was on your schedule, school schedules, work schedules, banking, uh, medical offices, everybody was on a schedule that fits you best, what would that be? And can you organize your life to sleep on the schedule that suits you best? One thing we see as women get older, men also, is our body clock will tend to shift earlier, so we tend to be more morning types. That's not true of everybody. The most important thing is to honor your own personal chronotype.

SPEAKER_02 11:11

Yeah, well, I I certainly can't stay up as as long as I used to when I was when I was a younger man. That's definitely for sure. So, are you actually saying then that there is some such thing as people naturally being night owls? I guess some people are more awake later in the evening, other people more awake late earlier in the day. Would that be right?

SPEAKER_00 11:34

Absolutely, yes.

SPEAKER_02 11:37

Yeah, yeah. So, how can is there a way of retraining your rhythm at all? Or are these things, these chronotypes, are they actually set in in a certain way?

SPEAKER_00 11:48

That's a great question. They're actually set deep in the brain. There's an area called the uh anterior hypothalamus, and it has this little cell population that is uh directing us to be more of a morning type, evening, or neither. And really think about it as something like your eye color or how tall you are. There's no good or bad or virtue of one or the other, it's just uh human variability.

SPEAKER_02 12:20

Excellent.

SPEAKER_01 12:21

Interesting. So so if we're talking about sleep skills, I think you know, sleep skills and sleep hygiene, there there must be a myriad of of recommendations that that women can try, especially at this stage of life. Um, what are some practical things that that we can learn, or what are some practical things that you recommend? I'm sure there's no one size fits all, of course, depending on chronotype and and other lifestyle factors, but where do where do you start with all of that? How do you decide?

SPEAKER_00 12:56

Yeah, so the first thing is to simply get enough sleep. One thing that we've seen over the last hundred years or so is that with societal values and lifestyles changing, sleep has really gotten truncated. Uh, the first data that we have, you know, scientifically collected data was is from 1914. And how much sleep would you guess that people were getting on average? 1914. Do you guys want to put forward a number?

SPEAKER_02 13:30

I I'll have a guess at 12 hours.

SPEAKER_00 13:33

Yeah, I was gonna say 10, but um Julie, you're a little closer, nine and a quarter hours. Nine and a quarter hours a night. And do you know anyone who gets nine and a quarter hours a night?

unknown 13:46

No.

SPEAKER_01 13:47

I don't know anybody who gets eight. No.

SPEAKER_00 13:50

Right. So it's uh over a third of us now get only six hours or so on work nights. To put that into perspective, six hours of sleep is enough sleep for probably only two to three percent of us. So uh, you know, one of the things that I'd really like people to uh identify is how much sleep they do best with. And often when I talk to somebody about this one-on-one, they'll start say, Well, I can get by on X amount of sleep. And then I reframe and I'm like, you're probably overly familiar with that number of how much sleep you can get by on, how much makes you feel great? And you know, there's five domains that is impacted by sleep. Our physical health, in terms of diabetes, hypertension, arthritis, all of those worse if we're not getting enough sleep. Then there's your mental health. How you know, are you feeling anxious or panicky or depressed? Just one night of being sleep deprived uh definitely increases anxiety. And so many women struggle with anxiety. Then there's physical performance, things like being alert and coordinated when you're driving or when you're working out, and then cognitive performance, everything from simple memory, remembering we've got this podcast today, to really complex uh story, prop storytelling or problem solving, taking the world of sleep medicine and winnowing it down into something useful in our time together. And then the last piece that I think really impacts women's quality of life is emotional intelligence. How well are you able to identify your own emotions, identify the emotions of the people around you and really um have empathy and have understanding and all of those things?

SPEAKER_01 15:58

Yeah. I I imagine that's especially important because in menopause, when we're already sort of all over the place with moods and um and energy levels, that that can really take uh that can take a big hit, I suppose. Because we're so we're supposed to be, right? The in air quotes, the caregivers and the the ones who care about everybody and everything. But that um I don't think that's so much the case after we hit this phase of life. Um but having less sleep would certainly explain some of that, I would think.

SPEAKER_00 16:33

Right. And you know, if somebody's wanting to improve their quality of life and they're getting less sleep than they probably need, a great test I like to do is called the 10 by 10 test. It's spending 10 hours a night in bed for 10 nights in a row and really letting yourself on a deep, deep level catch up on your sleep and identify how much you sleep, how much you do best with. That's not something that somebody who has insomnia would do, but that's someone who's chronically sleep deprived could do to help themselves figure out how much sleep they do best with and also just reconnect with that feeling of really being on the top of your game. Sure.

SPEAKER_02 17:21

So what's your sorry, go ahead. Insomnia is one of the things that people colloquially at least say to us a lot. You know, I've I've turned to an insomniac since I became menopausal. Now this idea of waking up at three o'clock in the morning, uh mind worrying as Julie said before, staring at this uh at the ceiling fan. Is that an actual condition then menopause-related insomnia, or is it just because there's something else going on that is affecting sleep so deeply at this stage of life?

SPEAKER_00 17:59

Well, there is that change in our temperature regulation that can influence sleep that women are experiencing and you know very, very familiar with. There also is insomnia, and we decide we define insomnia as either taking more than 30 minutes at the beginning of the night to fall asleep, being awake in the middle of the night, or waking up too early and not being able to get back to sleep, but having that sense that you just hadn't gotten enough sleep. And insomnia affects about 15% of all people every year, and more so, you know, higher percent in those uh post-menopausal women. Uh so you know, it is both the physiological changes and the life circumstances that so many women are in.

SPEAKER_01 18:56

Sure. And things like um, I mean, what things like lifestyle factors, meal timing, exercise, um, you know, screen use, I expect those are all factors. How do you how do you address those?

SPEAKER_00 19:14

Yeah, so um let's go through those one by one. Exercise absolutely improves sleep, and so that's something that we want to keep emphasizing. Even you know, there's so many reasons that women as they go through menopause and into older life need to stay active and keep exercising purposefully, building muscle, building bone mass, all of those things. And sleep is another uh area that absolutely benefits from exercise. So we want people to be exercising four days a week with a combination of aerobic and uh strength training kinds of exercises, not just one exercise, but as many different types of exercise and and include your recreational, you know. I want people to be able to do stuff that's fun, that's still, you know, it's using your body and it's technically exercise, but it's a fun activity like dancing or Zumba or going biking or going swimming, you know, going to a recreational kind of swim with grandkids or kids or whatnot. So, um, so the exercise piece, and if you have difficulty falling asleep as early in the evening as you want, exercise timing actually makes a difference. If you're exercising at before four o'clock in the in the afternoon, it's gonna help shift your body clock just a little bit earlier so you have an easier time falling asleep at night and waking up in the morning. If you're exercising after 7 p.m., it's gonna push your body clock later. So you fall asleep a little bit later, wake up a little bit later. So you can use the timing of these routine activities to your benefit.

unknown 21:10

Okay, cool.

SPEAKER_01 21:13

And meals like meal timing?

SPEAKER_00 21:16

Yeah, so meal timing, um, we want to have our first meal within an hour of waking up. That also influences our circadian rhythm and our sleep, keeps us on that earlier schedule. The reason it's so important with some of our habits to stay early is because we've got other habits that push us late, and so we want to kind of balance them out. So having your first meal within an hour of waking and having meals at a regular time actually meal timing helps also in train our circadian rhythm. We want uh when people, young people, when people are young, excuse me, stembling. Over my words here. When people are young, they have a really high amplitude or robust circadian rhythm, where they are widely awake or deeply asleep. And as we get older, our circadian amplitude gets a little muted. So we're a little bit awake, we're a little bit asleep. And all of these activities that we can do to strengthen our circadian rhythm and make it more robust, more high amplitude, that is going to help us have that energy, daytime energy, and that deep sleep that we had when we were younger. So that's why I keep bringing it up. So meal times should all be starting within the same half hour across all days of the week. And if you're you know eating later on weekends, it's gonna help push your body clock later so that you're uh staying up later Friday night, Saturday night, Sunday night, having insomnia.

unknown 22:59

Okay, yeah.

SPEAKER_02 23:01

What's the number one mistake, would you say, that people make when it comes to getting to sleep, to actually get going to sleep and having a decent night's sleep?

SPEAKER_00 23:15

I want to say two things.

SPEAKER_02 23:17

Okay, we'll take two.

SPEAKER_00 23:20

Yeah, the top two. Uh so the first one is light at night. I think at this point, many, many people have heard to turn off your devices and turn down the lights in that um hour or so before bed. Lots of times when I'm talking with that one on about that one-on-one with people, they say something like, Oh, I heard that, but I haven't done it because I didn't really think it could make that big of a difference. Let me tell you, it can make a huge difference. And so the actual recommendation, and this is gonna surprise you, is that for three hours before bed, we're supposed to be in dim light that is equivalent to about 10 candles. That is hard to do because three hours before bed, we're in a really active phase of our day, right? We're finishing up the house stuff, maybe we're finishing up some work, we're on our devices for some entertainment or whatnot. So, uh, a great strategy is for people to get blue blocking glasses. Uh, they're kind of reddish-tinted glasses that are billed as blue blockers, and you just wear those for a couple hours before bed, it makes everything look like this beautiful sunset color and can make a huge difference in people's sleep in just a week or 10 days of wearing them. So, that is one um recommendation I have, and just think about how for most of human history in the evening we've been in sunset, candlelight, firelight, and our body is designed for that kind of light. That allows our natural melatonin, the one that we produce in our brain, to start to rise so that when we hit the sheets, we're already drowsy. And I think that's one of the problems with people getting into bed and not feeling sleepy at all, is they've been getting this blue light, which uh blue light is much more prevalent in morning sunlight. And so blue light tells our body it's morning, time to get going. And uh so those blue blockers allow our melatonin to rise so that we're sleepy when we get into bed.

SPEAKER_02 25:44

Are you a fan of the of the snooze alarm, Catherine?

SPEAKER_00 25:50

I'm not, not really. Uh, because what ends up happening is that people get the uh however long they're snoozing, could be 10 minutes, could be 40. They just end up getting light sleep, and we want to be getting deep sleep, rem sleep as much as we can without that interruption of the snooze alarm.

SPEAKER_02 26:11

Okay. And how about naps? Um, are naps helpful in midlife for women, or should they try and avoid them? What you what's the thinking there?

SPEAKER_00 26:23

Naps are a great strategy, actually. You want to be a little scientific about your naps. There's two principles, the length and the timing. So, with a nap, you either want to take it 30 minutes or less, or you want to take it a full sleep cycle, which is an hour and a half or two hours. The reason you don't want to wake up, set your alarm for 45 minutes or an hour, is that you're more likely to be in deep sleep at that time, which is when our brain waves are very high amplitude, very slow, quite different from our waking brain waves. So it takes about 20 minutes to be alert. When if you wake up out of deep sleep, you're gonna feel groggy and just not good. So 30 minutes or an hour and a half nap, and then take it as early in the afternoon as you can. Sometime between one and three o'clock in the afternoon is the perfect time for a nap.

SPEAKER_02 27:18

Yeah, we've talked about several strategies there then. Yeah, blue light glasses, potentially introducing naps, meal times, exercise times. Does there ever come a stage where it's too late to improve sleep patterns, or is it something we can work on throughout our lives?

SPEAKER_00 27:38

Oh, absolutely. We can work on it throughout our lives, and it's worth it. It's really worth it. Um, you know, sleep fuels us. I think about sleep as powering our day, and we want to have the best quality of life we can. And so sleep is part of that foundation for whatever it is that you want to do, you need to have good sleep on your side, and it'll make a difference. Excellent.

SPEAKER_01 28:06

What do you think? Um, just one other question. What do you think about sleep supplements? We hear a lot about melatonin, magnesium, special teas, that kind of thing.

SPEAKER_00 28:17

Yeah, I think that they can be helpful. I always want uh women to not only think about lifestyle and supplements and whatnot, but also think about do I have an actual sleep disorder diagnosis? Obstructive sleep apnea, restless legs, etc., that we talked about. So if you're doing all of the lifestyle things that you that we've talked about, that you're reading about online, seeing on social media, and trying some supplements, and you're just not getting traction, that's a good point after a month or five or six weeks at the most, to go to your physician and say, I'd like to be screened. You know, it'll start with an interview, maybe physical exam, and then go from there if there's any positive findings or or um indicators that you might have a sleep disorder.

SPEAKER_02 29:13

Excellent. Shall we do some quick fire questions to finish off?

SPEAKER_01 29:18

Sure.

SPEAKER_02 29:19

Come on, Julie, you go first.

SPEAKER_01 29:22

All right. Ideal wake up time. Ideal wake up time, seven.

SPEAKER_02 29:29

Nice. Okay. What about thoughts on weighted blankets? Yes or no?

SPEAKER_01 29:37

No.

unknown 29:38

Okay.

SPEAKER_01 29:40

Sleep trackers. Yes, no, good, not so good.

SPEAKER_00 29:46

They are not a hundred percent accurate, but it's wonderful that people are paying more attention to their sleep. So pros and cons.

SPEAKER_02 29:55

Okay. And do you have a weird sleep tip that might actually work for people? Just something that might not be.

SPEAKER_00 30:02

Turn down, yeah. Turn down the thermostat in your home uh an hour or two before bed. That drop in temperature also signals to our body that it's gonna be time to sleep soon and you'll sleep better.

SPEAKER_02 30:16

Okay, so turn the thermostat down is is is the is the tip. Okay, great. Have you got any final wisdom you'd like to share with our listeners, Dr. Catherine, before we before you we let you go?

SPEAKER_00 30:32

I would just give encouragement that yes, we can absolutely improve our sleep at any age, and it is so worth it. If you give yourself 10 days of really prioritizing your sleep and getting all the sleep that you need, you will feel better.

SPEAKER_02 30:48

Awesome. And where can readers, uh listeners, sorry, find out more about you? And what services do you actually offer as a doctor in sleep?

SPEAKER_00 31:02

Yeah, so you can find me online at Skilled Sleeper, both social media and my website is skillsleeper.com. And I have created a terrific library of sleep courses. I have one specific for women. It takes us through the lifespan of all the changes at different periods in our life, and that would be a great service for people. And there's other courses, you know, uh CEO course, family sleep course. You can see them all at skillsleeper.com.

SPEAKER_02 31:41

Awesome. So if you've loved this episode, share with your fellow midnight scrollers and subscribe so you don't miss out on what's coming next. We've been James and Julia Fabulous Beyond 40 with our new friend, sleep expert, Dr. Catherine, reminding you to stay strong and stay fabulous, and we will see you next time. Take care.