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The Sleep Doctor: The 4 Hormones Wrecking Your Sleep & What to Do About It — Transcript

by Tamsen Fadal · 9,235 words · 1,409 segments · language en · Watch on YouTube

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1:06>> Do you think there's a lot more people
1:07walking around with sleep apnea than
1:09they even know at this point?
1:11>> 100%. In midlife, up to 50% of women
1:14will [music] have sleep apnea. Nine out
1:16of 10, 90% of them do not know that they
1:19have it.
1:19>> What is happening when we wake [music]
1:21up at 2:00 or 3:00 in the morning wide
1:24awake and can't get back to sleep? Do
1:25you suggest they right away go talk to a
1:27sleep [music] specialist or can you
1:29start with your general practitioner or
1:30OB/GYN?
1:33So should we be all taking melatonin?
1:35What about those Hatch alarm clocks?
1:36[music] Getting outside first thing in
1:38the morning, do you think that's
1:38important? Dr. Andrea Matsumura is a
1:41board-certified sleep medicine physician
1:43who's going to tell you exactly why you
1:45can't [music] fall asleep or stay asleep
1:47and what to do about it.
1:50If you're in perimenopause or menopause,
1:52I would say it's safe to assume your
1:54sleep has probably become something you
1:56think about all the time. Falling
1:58asleep, staying asleep, waking up
2:00feeling exhausted, constantly waking up
2:03to pee, waking up anxious if you fell
2:05asleep, and the nights can feel endless.
2:08And I I totally get it. I have been
2:10there. The other night I actually woke
2:11up at like 3:00 in the morning and
2:13stared at the ceiling for a while.
2:14The worst part though is that sleep is a
2:16foundation of everything. So, when your
2:18sleep goes, it starts to really unravel
2:21the rest of your life. And that's why I
2:23have invited a Dr. Andrea Nat Samara on
2:26the Tamson show. She is a
2:27board-certified sleep medicine
2:29physician, menopause expert, and creator
2:32of the Dream Sleep Method. And today
2:34she's going to teach us exactly what is
2:36happening in our bodies and uh maybe
2:38give you the tools so maybe starting
2:40tonight you can get a better night's
2:41sleep. If you haven't yet, please hit
2:44follow, leave us a review. It is one of
2:46the best ways to help this show grow,
2:48and I really love reading each and every
2:50one of your comments. So, let's go ahead
2:53and get started. Dr. Andrea, welcome to
2:55the show.
2:56>> Thank you for having me.
2:57>> It's good to see you. We were together a
2:58few months ago, and I was I guess I was
3:00just so impressed with how you broke
3:02everything down and made me feel like it
3:04was all going to be okay that night.
3:06>> Well, you know, we live with a lot of
3:09anxiety around getting to sleep and
3:11staying asleep, and then that just
3:12builds on itself. So, anything I can do
3:15to help women break that down and feel
3:18like sleep isn't a luxury, it's
3:19something that we all need.
3:21That's if we don't have sleep, nothing
3:23else works as well.
3:25>> I do think we consider it a luxury like
3:27we were lucky enough to do that instead
3:29of hey, I really need to do this for my
3:31health. So, what led you to become a
3:34sleep expert and really dig into and
3:37look at women's health and the health of
3:40their sleep in perimenopause and
3:41menopause?
3:42>> Well, I was practicing as a primary care
3:44doctor, and at the end of every
3:47appointment, people would say,
3:50"Oh, I'm having trouble sleeping. Can I
3:51get something for that?
3:52>> As like an after thought?
3:53>> Yeah, you know, as I'm walking out. And
3:57I was being a
3:59you know, a good primary care doctor and
4:00saying, "Yeah, certainly I can help you
4:02with that. Let me give you a little
4:03sleep aid." And the more I got to learn
4:06about sleep and realized gosh, everybody
4:09is having trouble sleeping and
4:11everybody's having trouble taking care
4:13of all their other chronic medical
4:14conditions, I started focus more on
4:16sleep, realized that there was a
4:18fellowship, went to school to study
4:20sleep medicine. When I got out of my
4:23sleep medicine fellowship, I was in
4:25perimenopause and didn't even know it.
4:27So, I started seeing a lot of women and
4:31I was working in an all male practice
4:34and everybody right away said, "Oh, can
4:37you see the ladies for us?"
4:40>> All the women that were going through
4:41perimenopause and menopause?
4:42>> Can you see all the ladies for us? We we
4:45really think that you they'd be better
4:47served.
4:47>> Yeah.
4:47>> And so, I started to see all of these
4:50patterns and then I realized it kind of
4:52hit me in the face,
4:54these patterns are the same that I'm
4:56experiencing and you know,
4:59I quickly became the women's expert for
5:02sleep. And then I started to dive into
5:04perimenopause and menopause, had my own
5:07menopause story where I went to four
5:09different physicians before I finally
5:11was started on menopause hormone
5:13therapy.
5:14>> That sounds familiar.
5:15>> Yeah. [laughter] So,
5:17>> [gasps]
5:17>> unbelievable, right?
5:18>> Even the experts. And I I do have to say
5:20though, every time I have a doctor come
5:22in here and say that they went through
5:24the same thing, I think it makes all of
5:25us feel a little bit better. Whether
5:26it's about sleep or hormone therapy or
5:28menopause or whatever it is.
5:30So, let me ask you this. For women who
5:32feel like their sleep has suddenly like
5:34fallen off the charts and they're not
5:35able to do it anymore once they hit
5:37perimenopause, what do you say to them?
5:39What's happening to our bodies during
5:40that time?
5:41>> You know, so the changes between
5:43estrogen, progesterone, testosterone and
5:46melatonin, they really
5:48they completely destroy the circadian
5:52rhythm of our sleep.
5:53>> So, what does that mean?
5:54>> And the [clears throat] circadian rhythm
5:55is really your pacemaker for sleep. So,
5:58we have clock genes in our brain that is
6:01what controls the circadian rhythm of
6:03every person, whether or not you're an
6:05early bird or a night owl. And then we
6:08also then in the hypothalamus, that is
6:11that is where they're housed, but then
6:13the pineal gland also houses melatonin.
6:16Then you have estrogen feeding receptors
6:19in the brain. You also then have
6:21progesterone that prepares us for sleep,
6:24testosterone which really helps us with
6:26deep sleep. And when all of those levels
6:28start to change, it it really just
6:31changes how we fall asleep, how we stay
6:34asleep, how deep of a sleep we can get
6:37into, and that's when we start having
6:39those middle of the night awakenings.
6:40>> Yeah, I feel like you I checked the box
6:42for every one of those things,
6:43especially when I went into
6:44perimenopause unbeknownst to me. I
6:47didn't know what was going on, and the
6:48harder I tried, the worse it got. I
6:50mean, I really I really felt that cycle
6:51back and forth. Um so, beyond being
6:53tired
6:55and feeling crappy the next day, what
6:58happens when we don't get enough sleep?
7:00>> So, you can't clean the waste products
7:03out of the brain. That's really the long
7:05and the short of it. And we do that
7:07during slow wave sleep or our
7:10the deep sleep. And that's kind of like
7:12a dishwasher for all of the brain cells.
7:15And if you are not able to get enough of
7:17that sleep, then you wake up with the
7:18brain fog. You feel like you're slogging
7:21through the day.
7:21>> Mhm.
7:22Um what are the waste products? What
7:24what does that mean?
7:25>> So, all the chemical reactions that are
7:26happening in the brain, that's the
7:28easiest way to say it. We everything
7:31that we're doing, every process that we
7:33do, every movement that we do, every
7:35thought, those are all chemical
7:38reactions in the brain that are
7:39happening. And then we have these waste
7:40products that develop throughout the
7:42day, and we need to clean the brain out.
7:44And if we're not getting into the right
7:45stages of sleep, then we're kind of
7:48there's this dysregulation.
7:50>> And we we certainly see that. Um so
7:53I guess I think about this like, you
7:55know,
7:56not being able to fall asleep is one
7:57thing and that's like completely
7:58annoying and I don't know if you you I
8:00know you have advice for what to do when
8:02you can't do that. Waking up in the
8:03middle of the night, I don't know if
8:05that's worse or not, but somehow I feel
8:07like it's worse. Because I feel like I
8:09can't I know that that moment that that
8:11happens, I don't know that I'm going
8:12back to sleep at all and it's
8:14always 2:00 or 3:00 in the morning. What
8:16is happening when we wake up at 2:00 or
8:183:00 in the morning wide awake
8:21and can't get back to sleep?
8:22>> So for many of us, especially in
8:24midlife, that's when we have those
8:26fluctuations in estrogen and that
8:28affects then our cortisol. So for a lot
8:32of women, cortisol starts to spike
8:34earlier and then you have these
8:36middle-of-the-night awakenings. And then
8:38we we start we tend to catastrophize
8:41sleep, you know, so or wakefulness
8:43rather. So then you get up in the middle
8:45of the night and you're thinking, "Oh my
8:46gosh, I'm going to have a terrible day.
8:48I've got a big day tomorrow. I have a
8:49presentation or whatever it is that you
8:51have to be doing." And I like to give
8:54women a plan. So when you wake up, say,
8:58"Okay, I'm going to do A, I'm going to
8:59do B, I'm going to do C to help myself
9:02get back to sleep." So that you don't
9:04wake up and you start to panic.
9:07>> What do you do as a I always want the
9:08doctors to tell me what they do. What is
9:09your What do you do when you wake up? Or
9:11do you? Maybe you don't. Maybe you sleep
9:12soundly.
9:13>> I I get to.
9:14>> Okay, what do you do when you wake up at
9:162:00 in the morning? What is your go-to?
9:18>> First, uh you know, well, it doesn't
9:20happen all that often, but I remember
9:22when it started happening to me because
9:25I was known as a person who could sleep
9:27anytime, anyplace, anywhere. And then it
9:31started happen to happening to me and I
9:33would say, "Why is this happening to
9:35me?" And I would get so
9:37But then I I immediately put on
9:39something calming, like some sort of
9:41meditation. I get out of bed. So, you do
9:44not want to stay in bed. If you are in
9:46bed, and you know, okay, I'm having
9:49trouble getting back to sleep. I know
9:50I'm not going to get back to sleep. You
9:52have to get out of bed because you your
9:55brain needs to associate the bed with
9:57sleep or intimacy only.
10:00>> It feels counterproductive though to get
10:01out of bed because you think, I'm just
10:02going to lay here 5 minutes more. Maybe
10:05I'll be able to fall back to sleep.
10:07>> It feels painful to actually get
10:09[laughter] out of bed. It doesn't feel
10:11good.
10:12>> painful.
10:12>> And then you also feel like I'm going to
10:14wake myself up even more.
10:16But that really doesn't happen. I I
10:17usually tell women, you know, pick an
10:20insomnia chair or a couch or someplace
10:24that you know that you can get to. We
10:26don't want people cooking, cleaning,
10:28working, exercising, and then either
10:31read a really boring book, maybe write a
10:33list of the thoughts that are racing
10:35through your mind,
10:37do some meditation, and when you feel
10:39sleepy enough, then you can get back
10:41into bed. And again, also give yourself
10:44some grace. Like maybe you're not going
10:46to be firing on all cylinders tomorrow,
10:48but you're still going to make it
10:49through the day.
10:50>> Yeah, cuz that brings me to all those
10:51other questions, like what happens when
10:52you don't get enough sleep. So, you wake
10:54up in the middle of the night, find a
10:55know where you're going to go, right?
10:57Find a chair, a sofa, a blanket,
10:58whatever it is. Get a book and read it.
11:00Don't try to do any Don't try to be you
11:02know, declutter the closet right that
11:04night. Okay? All right, that's good
11:06advice. Um a lot of people that you
11:08know, we've we've done sleep episodes
11:10before, and and it is the top topic.
11:13Like people want to talk about sleep,
11:14which is why I was so excited that you
11:16said yes to come on here. A lot of
11:18people complaining about they have to
11:19get up in the middle of the night and
11:20pee, which is is different than just
11:22waking up at 2:00 in the morning, and
11:24then they can't go back to sleep.
11:25>> Yes.
11:26>> What do we do there?
11:27>> Well, so the first question I ask people
11:30is, are you getting up and going to the
11:33bathroom because you're waking up to go
11:36to because your body's saying oh I have
11:38to go to the bathroom are you awake and
11:40then you say well
11:42I think I have to pee so I might as well
11:44just get up.
11:45>> Two different things.
11:45>> different things but for for people who
11:48are actually waking up and having to go
11:50to the bathroom repeatedly especially
11:52for women it may be a sign of sleep
11:55apnea.
11:56That might be a symptom. You could also
11:59have genitourinary syndrome of
12:01menopause. There are all of these
12:03factors that suddenly play a role into
12:07why you might be waking up in the middle
12:08of the night and having to go to the
12:09bathroom.
12:10>> So if someone's listening to this right
12:11now and says okay I'm in my early 40s
12:14late 30s early 40s yes I have a
12:16stressful job I get that. I don't know
12:18if [clears throat] I'm in perimenopause
12:19or not or maybe I am but sleep is just
12:21not working for me. What do you suggest
12:24they do do you suggest they right away
12:26go talk to a sleep specialist or can you
12:28start with your general practitioner or
12:30OBGYN where do you begin?
12:32>> I think any one of those. So anybody who
12:36has some idea about sleep is where you
12:39need to start and that's hard. Sometimes
12:41general practitioners don't know
12:43sometimes OBGYNs don't know and
12:46sometimes sleep clinicians they only
12:49focus on sleep apnea and that's it. So
12:52you know I jokingly say that I carry
12:54around a box of tissues when I see my
12:56patients because
12:58they've already been to see another
13:00sleep specialist most of them and
13:02they finally are getting some answers
13:04after like 7 to 10 years of not getting
13:07enough sleep but you know women do not
13:10present the same way that men do when it
13:13comes to sleep apnea and many many women
13:16they're not overweight they're doing all
13:19the right things and they have sleep
13:22apnea.
13:23>> Do you think there's a lot more people
13:24walking around with sleep apnea than we
13:26than they even know at this point.
13:28>> 100% so there in midlife up to 50% of
13:33women will have sleep apnea. Nine out of
13:3610, 90% of them do not know that they
13:39have it.
13:39>> How dangerous is sleep apnea?
13:42>> So it can be pretty dangerous. If you've
13:43got moderate or severe obstructive sleep
13:46apnea, you have up to a 25% increased
13:49risk of having a heart attack or a
13:50stroke.
13:51>> In your sleep?
13:52>> Uh just generally speaking, it increases
13:55your overall cardiovascular and
13:57neurocognitive risk. So brain health and
14:00heart health basically is at risk.
14:03>> Can you explain sleep apnea and what it
14:04is?
14:04>> Sure. So sleep apnea is really an oxygen
14:07deprivation state. So for the most part
14:11people will have obstructive sleep apnea
14:13and there's central sleep apnea but
14:15that's a whole different thing. So
14:17obstruction is happening at the back of
14:19the throat so the soft tissues collapse
14:21too much and then you have an oxygen
14:23deprivation state. So it's pretty
14:25technical when I interpret a sleep
14:27study.
14:28Uh you know, so many seconds you have to
14:31have below your baseline of oxygen
14:33level, you have to have respiratory
14:35depression, you may have an arousal.
14:37There's all of these components to a
14:39sleep study.
14:40But we then quantify all of that and if
14:43you have five or more abnormal breathing
14:45events an hour, that is sleep apnea.
14:49>> If 90% of the women that are in
14:50perimenopause or menopause have sleep
14:52apnea and don't don't really know it or
14:54don't know what's going on. If someone's
14:56listening right now, how can they
14:57decipher whether or not nah, I don't
15:00have great sleep or oh my gosh, I need
15:02to be really concerned that that's a
15:04possibility.
15:05>> Yeah, that's a great question and it's
15:06not easy because all of the screening
15:09tools are really gender biased. They are
15:12all focusing on men's symptoms more than
15:16women's symptoms. So there's one that I
15:19that's notorious for me at least is
15:21called the STOP-BANG And the G at the
15:23end of this screening tool stands for
15:26your gender. So, already
15:28>> STOP-BANG?
15:29>> STOP-BANG. So, already, if you are a
15:32woman, you don't get that point.
15:35And And so, and women do not have loud
15:38snoring, they don't have witnessed
15:40apneas, they typically will have
15:42insomnia.
15:44They kind of just have general they
15:47malaise, they don't feel well. They
15:49might have more migraine headaches, they
15:51might have more depression.
15:53That's the symptoms.
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17:07>> Migraines have been coming up a lot
17:09lately for for me, just in conversation,
17:12and a lot of women saying it's happening
17:14during this perimenopause and menopause
17:15stage, and I know it's one of the
17:17symptoms. Is it because of sleep apnea?
17:20>> You know, it's hard to say if it's only
17:22because of sleep apnea, but I I'm We do
17:25know that there's a hormonal component
17:27to migraine headaches. But, if you're
17:30having them and you've already kind of
17:32started on some sort of hormone therapy
17:34and you've you're continuing to have
17:37middle of the night awakenings, because
17:39starting on hormone therapy doesn't cure
17:41everybody's sleep.
17:42>> Mhm.
17:43>> They're still up to 50% of those women
17:46who will continue to have problems with
17:48sleep.
17:49>> All right. So, if somebody's listening
17:50and says like maybe that's me, what is
17:52the first step that a woman should do if
17:55she thinks she might have sleep apnea?
17:57>> Yeah.
17:58>> You know, start having a conversation
18:00with your doctor or your your provider.
18:02Really, that's the first step is start
18:05asking questions. Have a have a road
18:07map, because like I said, the awareness
18:10of sleep apnea or sleep disorders like
18:13restless leg syndrome, chronic insomnia,
18:15which I I feel as a as a complex medical
18:19condition.
18:20That's not at the at the forefront of
18:23your primary care provider's mind most
18:26of the time. So, go in there with, you
18:29know, a set a list of symptoms that
18:32you're having. Hey, I'm going to bed at
18:33this time, but I'm not falling asleep
18:35until this time. So, that's one of the
18:38questions I will ask. How many hours are
18:40you actually sleeping? Because you might
18:42be in bed for 9 hours, but you're only
18:45getting five
18:47>> And is that a signal that
18:48>> That's huge.
18:48>> Okay.
18:49>> A huge red red flag. If you're
18:51consistently waking up in the middle of
18:53the night, if you're waking up and you
18:55feel unrefreshed.
18:57So, some people will wake up and say, I
18:59feel worse
19:01>> Right? I'm more tired after I sleep.
19:03>> tired than I did when I was going to
19:06bed.
19:07>> But, all those are signs to you that you
19:09need to go and see somebody. And do you
19:11recommend a sleep specialist then right
19:12away?
19:13>> You know, for the most part I do because
19:15you have to tease out all the nuances.
19:18It's not that simple and a lot of women
19:21will have a home sleep study performed,
19:24but there's a pretty high rate
19:26anecdotally, at least in my experience,
19:28that women will have negative home sleep
19:31studies, but if you do a different type
19:34of sleep study, which is either in a
19:36sleep lab or what we call a type two
19:38home sleep study, you tend to catch more
19:42mild obstructive sleep apnea. And what
19:44we know about mild obstructive sleep
19:46apnea is that maybe the cardiovascular
19:48risk isn't there as it's not as
19:51prominent. However, if you're having
19:54trouble sleeping because you have mild
19:56obstructive sleep apnea, then that
19:58chronic sleep deprivation holds the same
20:01risk.
20:02>> I mean, when you go night after night
20:04and week after week, we've heard you 8
20:07hours is how you how long you should
20:08sleep, but how how long should be you be
20:10sleeping and how long should that be, I
20:13guess, deep sleep?
20:14>> Yeah. So, you know, the the American
20:17Academy of Sleep Medicine recommends 7
20:19to 9 hours of sleep. What I tell women
20:23and everybody is really focus on
20:26quality, not quantity, because if you're
20:29in bed for 10 hours, but the quality is
20:31poor,
20:32that's that's not helpful. What you want
20:34to focus on is the quality of sleep. So,
20:37I don't want people thinking, "Oh my
20:39gosh, I'm only getting 6 hours. I'm
20:41destined for dementia." Right? That's
20:44that's not what I want women to walk
20:46away with. I want people to know that
20:48there's
20:49always something you can do for your
20:51sleep and that every 15 minutes counts.
20:54>> You bring up dementia. Let's talk a
20:55little bit about that. Are those some of
20:57the things that you see if somebody's
20:59not sleeping or do you see that as
21:01something that could be a problematic
21:03down the line?
21:04>> So, the good news is that you could have
21:07trouble sleeping for decades, but if we
21:09can help you get higher quality sleep,
21:13then you're more likely than not able to
21:16to kind of
21:17not have to make you won't have there's
21:19no guarantee that oh my gosh, you're
21:21destined for a dementia. I really think
21:23that it's multifactorial. I think that
21:26women carry a huge mental load that is
21:29not really factored in quite yet. Then
21:32we have all of these hormonal changes.
21:35Then we may have a delayed diagnosis if
21:37we have obstructive sleep apnea or
21:39restless leg syndrome or treatment for
21:41chronic insomnia.
21:42>> Does a lack of sleep cause dementia? Is
21:44that one of the causes of it?
21:45>> Well, if you're chronically sleep
21:47deprived, then you're not able to get
21:49into all the right stages of sleep. You
21:50asked about the percentages and it's
21:53really about your total sleep time. So
21:56based on your total sleep time, you
21:58should have certain percentages of each
22:01stage of sleep. And fun fact, really
22:03your staying in stage two sleep. There's
22:06four stages of sleep
22:08the most time. So trackers I've got a
22:10tracker on.
22:12They're not all they're cracked up to be
22:14and there are way more advanced ways of
22:18identifying stages of sleep. These are
22:21surrogates and and they prime people. So
22:24I feel like a lot of people really worry
22:26about their stages of sleep when it it's
22:28really still just an estimate and we
22:30can't focus too much on this when it's
22:34not diagnostic.
22:36>> I guess it just makes me happy when it
22:37tells me to go to bed or start winding.
22:39Tamsin, you've got to start winding up
22:41for sleep. All right, I know you're big
22:43on solutions. So I want to talk about
22:45some of these solutions. When it comes
22:46to sleep, first let's talk about where
22:48hormone therapy fits in and what types
22:50of hormone therapy that we're talking
22:52about.
22:52>> So you know, first of all, if somebody
22:55is in perimenopause or menopause and
22:57they really are having a lot of trouble
23:00with sleep. That is one of the many
23:02symptoms around perimenopause or
23:05menopause. And it may be worthwhile if
23:08you meet criteria and it's not There's
23:10no contraindication to start on hormone
23:13therapy. Now, for a lot of women, it
23:16helps their sleep. Estrogen,
23:18progesterone Uh progesterone is really
23:21that hormone that helps us relax, get
23:24ready for sleep. Estrogen really helps
23:27with sustaining sleep.
23:28>> Okay.
23:29>> And then testosterone really helps with
23:31deep sleep.
23:32>> It's interesting though, most of the
23:33time if you ask you think progesterone
23:36is the magic pill, but it really is the
23:38estrogen and progesterone. And then
23:40you're saying also added testosterone.
23:42>> Yes, for some women.
23:43>> Okay.
23:43>> So So not everybody needs testosterone,
23:46but we're also not reaching for it as an
23:48option as often as we should. So for
23:52everyone, you really should start on
23:54estrogen and progesterone if you can.
23:56And then reassess. And then you may
23:58consider starting on testosterone. I
24:00have a lot of women who will say, "That
24:02was the missing link for me."
24:05>> Mhm.
24:05>> But then even after most women will
24:08start on that, there's still up to 50%
24:11of those women who will continue to have
24:13problems with sleep.
24:14>> I had to increase my dosage. It went up
24:16a bit by bit, but I'm at 200 mg right
24:19now, which I I'm like, "Oh my gosh, how
24:20much bigger can the pill be?" But But
24:22I'm sleeping most of the time.
24:24>> Yeah.
24:25>> Talk about the role alcohol plays
24:27because I think my life since 2020
24:31I [snorts] mean, 2018 I thought I was
24:32still kind of cool and I could have
24:34drinks before I go to bed or go out for
24:36margaritas. Then 2020, COVID hit. Then
24:402021 I was still kind of like, "Okay."
24:42And then 2023, 4, 5
24:45Mhm. Nothing.
24:46>> Mhm.
24:47>> A glass of wine
24:48>> Yeah.
24:48>> I can't go to sleep or I wake up. It's
24:50just It's really remarkably
24:52different for me. Is that perimenopause?
24:56Is that age? Is that
24:58What is it? But it really does impact
25:00sleep.
25:00>> It does, and I'm sad too
25:03>> [laughter]
25:03>> I'm sad with you. Maybe we just have a
25:06drink during the podcast and not wait
25:09until bed. I don't know. I don't know.
25:11I'll think about that.
25:12>> I mean, we have we change the way when
25:15we metabolize alcohol. So, we're just
25:17not as good at metabolizing it. And then
25:19it really affects your REM sleep.
25:21>> Okay. And what what stage is REM sleep?
25:24>> So, REM sleep is when you're dreaming.
25:26And you tend to have your dream sleep in
25:28the second half of your night. So,
25:30stereotypically, that is when a person
25:32starts to cycle through REM. And you
25:35know, textbook says that you should have
25:37three to four REM cycles and with each
25:39cycle it's supposed to get a little bit
25:40longer.
25:41>> Mhm.
25:42>> So, if alcohol is disrupting your REM
25:44sleep, then you really don't That's
25:46where you're doing all of your emotional
25:48processing, some memory consolidation.
25:51That's where the emotional regulation
25:53happens. So, you feel like crap when you
25:57wake up in the morning if you've had a
25:59little too much to drink. And you
26:01basically are just you feel like a
26:03zombie. And then when you go to bed the
26:06next night, typically your body does
26:08what we call REM rebound. So, it makes
26:11up for losing the night before. And it
26:15gives you more opportunity to capture
26:17REM sleep the next night.
26:19>> So, if you have a drink the second night
26:21you're better maybe? [laughter] I don't
26:23know. Is it Is it that you've had too
26:25much of I mean, I think even a glass of
26:27wine right now impacts me.
26:29>> Right, because we we do not metabolize
26:32it as well. And when we don't metabolize
26:34it as well, then it's half-life is right
26:36around the time if we drink it really
26:39close to bedtime, right around the time
26:41that you should be getting into REM
26:44sleep. So, that half-life. And And
26:47really what we're doing is we're just
26:48medicating ourselves to kind of pass
26:51ourselves out, but it really doesn't
26:53allow us to get into those stages of
26:55sleep that we need.
26:56>> So, if you're going to have a drink or a
26:58glass of wine,
26:59>> [laughter]
27:00>> Dr. Andrea, you know I'm trying.
27:02If you If you're Just know Should you do
27:04it over
27:05I don't know. Treat it like caffeine.
27:07What do you do? Do you do it earlier in
27:08the day?
27:09>> it you Everybody knows themselves. Like
27:12I I think if you can get away with one
27:15drink, great, but for most people they
27:17usually start to complain if they have
27:18two or more.
27:20If you know that it's even one drink,
27:22then you have it earlier during the day.
27:24I mean, there is this big business of
27:26mocktails nowadays, right?
27:29>> Still haven't found a non-alcoholic wine
27:31I like, but you know.
27:32>> Okay. All right. Well, we'll we'll work
27:33on it. My dad has something he used at
27:35over Thanksgiving and it's like um
27:38It's like a filter and he mixes it
27:40around in the drink. It's like it You
27:42know, it's like a little filter and it
27:43takes us the sulfites out of it, I
27:45guess, of the wines. I don't Is that
27:46helpful? Does that help the wine? I'm
27:48trying here for anybody who Anybody who
27:50is going to say, like, "Why didn't you
27:52ask this?"
27:52>> I mean, it's worth It's worth a try.
27:54>> Okay.
27:54>> Okay. It's worth a try. I actually saw
27:56that and it piqued my interest, so then
27:58I looked it up online and
28:00>> you some. He was so funny. We were We
28:02were at the table and everyone's like,
28:04"What is he doing?" And I go, "I don't
28:05know. My dad is like he's a trans- He's
28:07the king of Yeah, DIY hacks."
28:09>> [gasps]
28:10>> So, you created something called the
28:12DREAM method. And when I interviewed you
28:13back in October, we had an event
28:16together here in New York. We talked
28:18about it. And it's a method to help
28:20women understand why they're not
28:22sleeping so well and then what to
28:24[clears throat] do about it. So, can you
28:25walk us through the DREAM method that
28:26you have in terms of real life?
28:29>> Yeah, definitely. So,
28:31I developed the DREAM sleep method
28:32because
28:33women were coming to me saying, "Hey, I
28:35got told I didn't have sleep apnea, but
28:37I still can't sleep." And what I found
28:40is that there's so many different
28:42components to helping you get to sleep.
28:45And if we're only touching on one, we're
28:47only going to get halfway.
28:49>> Okay.
28:49>> So, the D stands for daily habits. What
28:52are we doing during the day that could
28:54be contributing to our inability to get
28:56to sleep or stay asleep? So, are we
28:58feeding ourselves correctly, you know,
29:00providing ourselves with the right
29:01nutrition, right hydration, down time,
29:04are we totally stressed out all day? So,
29:07all of those pieces actually play a role
29:09in getting ourselves to sleep. R is for
29:12your resting environment. So, I mean, if
29:15you've got a bad bed, you got to change
29:17it. If your pillow doesn't feel good,
29:19change it. If it's too hot, too cold,
29:22you know, you have to make your
29:23environment ideal.
29:25>> What's an ideal temperature to sleep in?
29:27This is for my husband, I'm just asking.
29:29>> Well, so, you know, it's different for
29:31everybody. I I I typically don't like to
29:34say, "Oh, it should be, you know, 65°
29:36or whatever." I tell folks because
29:39typically with partners, one is cold and
29:41one is hot.
29:42>> Yes.
29:42>> Right? So, then there's a whole market
29:44for beds beds and blankets to
29:47individualized temperature control.
29:49But, generally, you want your room dark,
29:51cool, and quiet.
29:52>> So, cool is
29:53>> Cool is better.
29:54>> What's cool?
29:55>> better.
29:5665.
29:57>> Oh, I love you. All right, I like that.
29:59Thank [laughter] you. I just wanted
30:00evidence of it to take back to Ira.
30:03Okay, what's the E stand for?
30:04>> So, the E stands for emotions. We all
30:06know that anxiety, depression can
30:09certainly rear its ugly head in the
30:11bedroom when you're not distracted by
30:13anything else. And we need to address
30:15those. Those are real issues and
30:17someone's ability to get to sleep.
30:19>> Mhm.
30:19>> And then the A is archetype. It's really
30:22it's my way of describing your circadian
30:25rhythm. Are you an early bird? Are you a
30:27night owl? Are you somewhere in between?
30:29Because if you don't know and you're
30:31fighting against your circadian rhythm,
30:33then that's going to be really difficult
30:35to get you into all of the right stages
30:37of sleep.
30:38>> Does that mean what time you go to bed
30:39and And time you wake up?
30:40>> Yeah. So, if you're an early bird,
30:42typically those folks they like to go to
30:45bed at 8:00, wake up at 4:00, go to bed
30:47at 9:00, wake up at 5:00. Someone who's
30:50a night owl, by definition, it's 12:00
30:52a.m. Waking up at 8:00.
30:54>> Oh, yeah.
30:54>> 1:00 a.m. Waking up at 9:00.
30:57>> Is there an ideal if you're not Well,
30:58like I worked a night shift and I worked
31:00an early morning shift, so I've kind of
31:01been all over the
31:03uh I've been all over the board with
31:04that. I did 2:00 in the morning, I did
31:062:00, you know, I did I've done all of
31:07it. Is there an ideal kind of, you know,
31:10wind it down that you think would be as
31:12good as getting up? I mean, do you have
31:14rules like that? I don't know.
31:15>> You know, I I think that if you can
31:18follow your circadian rhythm
31:20>> Yeah.
31:20>> because again, we have clock genes that
31:22we're born with. They're like eye color.
31:24We can't really change them. We can fake
31:26them out. We can
31:28we can adjust a person's circadian
31:31rhythm with melatonin.
31:32But
31:34you know, I I always cringe when I see
31:37uh one of the major papers talk about
31:39being an early bird because up to 20% of
31:42the population globally is a night owl.
31:45And there are
31:46>> Interesting.
31:46>> there are
31:47you know, different countries who work
31:49later. Like if you go to Spain and try
31:51to go to dinner at 7:00, they think
31:53you're silly.
31:54>> Yes.
31:54>> Right?
31:55So, I think if you can follow your
31:57natural circadian rhythm, you're better
31:59off.
31:59>> Okay.
32:00>> But, you know
32:01that you you do need to figure out what
32:03your what your circadian rhythm is.
32:05>> Your best time of going to sleep, your
32:06best time of waking up, and trying to be
32:08consistent.
32:09>> Right.
32:09>> Okay.
32:09>> Consistency. And then, yeah.
32:11>> What is the uh Keep going. What was the
32:13other one?
32:13>> Oh, M.
32:13>> Oh, M. Yeah, what's the M for?
32:15>> Yeah. So, that's medical conditions. So,
32:18perimenopause, menopause, sleep apnea,
32:20restless leg syndrome, any sort of
32:22neurological condition, any type of
32:25rheumatologic condition. So, you know,
32:27if you've got an autoimmune disorder,
32:29these are all things that can affect
32:30your sleep. And we need to be able to
32:34evaluate and figure out how it's
32:37affecting your sleep because if we
32:38ignore that, then again, we're only
32:40getting halfway.
32:41>> So, I think I had restless leg syndrome
32:44for a while, but I didn't have a word
32:45for it, but I found magnesium spray. Is
32:49that Am I just my father's daughter like
32:51finding solutions for things or is it or
32:54you know, restless leg syndrome is real?
32:56>> Restless leg syndrome is real. It can
32:58affect up to 30% of women in midlife.
33:01That's a lot of people and that has to
33:04do with our iron stores. And so, there's
33:07all this talk right now around iron
33:10stores in women and the changes that
33:13we're making in terms of the normal iron
33:16levels and that marker is ferritin. So,
33:19ferritin is
33:20what we call an acute phase reactant. It
33:22gets complex, but the point is that the
33:25normal ranges were really low and now
33:28there's all this new data coming out
33:30that they should be higher, but if you
33:31have restless leg syndrome,
33:33your ferritin level should be above 70
33:36and really closer to 100. That's huge.
33:39>> Does that mean your iron is low? Is that
33:41what that means?
33:42>> It means the iron stores are low. So,
33:44you might have a normal blood count, but
33:46your ferritin level is going to be low.
33:49>> I've never heard of ferritin level.
33:50>> Yeah.
33:50>> Where do you get tested for that? Is
33:52that
33:53>> just a blood draw.
33:54>> A blood draw? Okay.
33:55>> It you know, like you're getting your
33:57electrolytes, your kidney function, your
33:59blood count, you get a ferritin level.
34:02>> And then you can find out if that's
34:03what's going on and it could be causing
34:05that restless leg syndrome.
34:06>> Right. That's the first thing is to give
34:09somebody iron supplement. Okay. And then
34:12if that it you still have symptoms, then
34:15let's discuss prescription medications.
34:17>> Okay. Let's go to supplements because I
34:19think there's a lot of question about
34:20that. There's there are a lot of things
34:22out there and and I want to go through
34:24them and I know that you're a fan of
34:25certain supplements and have one. Um can
34:28you go into supplements and let's talk
34:29about that and what you think uh
34:31research says about supplements for
34:33sleep and I guess there's magnesium,
34:35there's my spray magnesium, there's
34:37melatonin. Can you talk a little bit
34:38about that?
34:39>> Yeah. So,
34:41supplements are really big market,
34:42there's no doubt about that. I tend to
34:45be pretty judicious around supplements.
34:48>> Okay.
34:48>> So, I try to use as little as possible
34:52because a lot of supplements out there
34:55are a combination of too many things in
34:58my mind and so then you don't know
35:00what's really working for you.
35:02>> And for the most part
35:04they don't they're not sleep aids. So,
35:08supplements are in my mind I define
35:12those as things that are already going
35:14to that are going to support the good
35:16sleep that you already have. They are
35:18not going to fill a hole. They're not
35:22going to cure something. So, a
35:25supplement for sleep is not going to fix
35:28chronic insomnia.
35:30A supplement's not going to fix sleep
35:32apnea.
35:34You know, when I talk about a supplement
35:36for restless legs syndrome, that's
35:37really iron replacement.
35:39>> So, what will a supplement do? Will it
35:41help you go into a deeper sleep?
35:43>> Well, it [snorts] just depends on what
35:44it is, right? There's a whole market,
35:46there's valerian, there's lemon balm,
35:48there's hops, there's melatonin, there's
35:51magnesium, there's L-theanine. They all
35:53have a specific mechanism of action, if
35:57you will, and so that's why I'm not a
35:58fan of things that have like 10 or 12
36:01things in them because you don't really
36:02know what's what's working and what's
36:05not working.
36:06>> Ideally, um I know melatonin confuses a
36:08lot of people, right? And then I I
36:10didn't even realize that there was a
36:12you know, level that you should be
36:13taking or not taking or how long. Can
36:15you explain melatonin?
36:16>> Sure. So, melatonin is made in the
36:18pineal gland of the brain. It does a lot
36:21of different things, but it's really our
36:23marker for starting the cascade of
36:25sleep. So, first and foremost, melatonin
36:29is a hormone.
36:31It is not a sleep aid. It is a clock
36:33starter. So, it starts the cascade of
36:37sleep. So, taking it right at bedtime is
36:41not typically recommended.
36:43And we really don't need a whole lot if
36:46we're going to use it for what I call
36:48circadian support. So, again, circadian
36:52is basically Circadian rhythm is the
36:56mechanism that allows you to get to
36:58sleep, stay asleep, get into the stages
37:01of sleep that you need to get into.
37:04What I didn't even learn in my
37:05fellowship is that we lose melatonin
37:07production as we age and that we lose up
37:10to 50% by age 50.
37:13>> So, should we be all taking melatonin?
37:15>> You know, there's no there's no
37:16published data that says absolutely.
37:18There's a few studies out there that say
37:20that taking melatonin isn't problematic
37:24for the replacement. There are studies
37:27out there that say long-term dose
37:28long-term use of melatonin is safe.
37:31There's actually studies out there that
37:32say that it may be cardioprotective
37:35because it it's it works against
37:37oxidative stress, free scavenger,
37:41free radicals.
37:43It supports immune system. I mean, it's
37:45a hormone.
37:45>> Yeah.
37:46>> So, in my mind, I think that we don't
37:49have enough data out there quite yet to
37:51say that everybody should be on it, but
37:53it just might be the next vitamin D.
37:56>> Mhm.
37:56>> And we just don't know enough about it
37:59like we do now about vitamin D. I
38:01remember when vitamin D came out and
38:02everybody said, "Wait, why do we have to
38:03take this? It's a hormone." One of the
38:06other pieces is that melatonin, if you
38:08take it long-term, you're not going to
38:10ruin the production in your body. So, a
38:13lot of people think, "Oh, if I take it
38:15for too long, then I'm going to stop
38:17producing my own melatonin." That has
38:20been debunked. So, lots of studies say
38:23that that is not true.
38:24>> Should you take the lowest amount?
38:25>> The lowest amount. So, you know, when
38:28we're and there's different reasons why
38:30we prescribe melatonin in a sleep
38:32medicine practice for our patients. So,
38:35if you're using it for jet lag, you take
38:38a a low dose.
38:40>> 1 mg?
38:41>> Wait, what do you take it for in jet
38:42lag?
38:43>> So, you want to adjust your circadian
38:45rhythm so that you you prevent having
38:47jet lag.
38:48>> Oh.
38:48>> So, typically every
38:51every hour of of of change that you're
38:55going into, so let's say seven, it might
38:57take you up to seven days. So, for every
39:00hour that you're shifting is a day that
39:04you have to recover. So, of course,
39:06there's a big business in adjusting your
39:08circadian rhythm. So, yeah.
39:11>> There's no quick fixes for sleep,
39:12though.
39:13>> No.
39:13>> [laughter]
39:13>> No. No. No. No.
39:15>> That's hard for people because when
39:16people they want to know like what can I
39:18do tonight?
39:19>> Yeah.
39:19>> Is there something if there's a a woman
39:22or a man listening that says, "What can
39:24I do tonight
39:25>> Yeah.
39:25>> to start figuring this out?"
39:27>> I know. It You're right. It's largely
39:29behavioral when we're thinking about
39:32insomnia, getting to sleep, staying
39:33asleep.
39:35So, the first thing that I tell folks
39:37all the time is you want to get to bed
39:39at the same time and you want to wake up
39:42at the same time. And a lot of people
39:44literally I'll get some side eyes, hard
39:47eye rolls like, "I already do that." And
39:49yes, but do you? Do you really do that?
39:53>> Mhm.
39:53>> Because if you start to to write down
39:55when you're getting into bed,
39:58people are surprised. It's it's the same
40:00thing My my analogy is is when you're
40:02trying to lose weight
40:04and you think, "I I I don't
40:06>> Oh, I ate perfectly today.
40:08>> [laughter]
40:08>> And then you start writing everything
40:09down and you realize, "Oh, yeah. I had a
40:12piece of pizza or [laughter]
40:14I had, you know, a cookie or, you know,
40:17all of those things count. So,
40:20trying to get to bed at the same time
40:22and waking up at the same time is
40:23really, really important. Our brains
40:25like routine.
40:27>> That's good to know. I mean, I think
40:28that it's really important. I I did that
40:31for a while and I'm trying to do it
40:32again. I think when I there's the time
40:34change, my body gets very confused. It's
40:37dark out, it's light out. It's so dark
40:39starting at like 4:30. I, you know, New
40:41York City. And so, you know, I feel I
40:43feel like I'm tired earlier.
40:45>> Yeah.
40:46>> Okay. So, we we covered that there's no
40:48quick fixes, but I do know that diet and
40:51exercise are always a part of
40:52everything. No matter what we do, we
40:53always kind of drill back and say you
40:55got to go to the root. How important are
40:57diet and exercise when it comes to your
40:58sleep?
40:59>> They're really important. So, there is
41:02lots of data out there that shows that
41:04exercise really helps people get to
41:06sleep, stay asleep, promotes deep sleep.
41:10So, you really want to move your body.
41:12It doesn't really matter what you're
41:13doing as long as you're increasing that
41:15heart rate, and you're giving yourself
41:18enough bursts of that increased heart
41:20rate throughout the day. So, again,
41:22there's studies that show that, you
41:24know, you don't have to go a whole hour
41:25at once. If all you can do is fit in 5
41:28minutes here, 10 minutes there, but
41:30you're increasing your heart rate,
41:32you're moving your body, that's going to
41:33be beneficial for sleep.
41:35Then the other piece is with nutrition
41:37and food intake. You really want to
41:40avoid eating a very heavy meal right
41:42before bed. That will affect your
41:44ability to get to sleep and and to stay
41:47asleep as well. So, you want to try to
41:50eat your heavy meal of the day a little
41:53bit earlier. So, you know, I usually
41:55tell people 3 hours is a good window.
41:58Like, try not to eat too late right
42:01before bed.
42:02>> And caffeine, I didn't mention caffeine
42:04cuz I was already upset about the
42:05alcohol part. What about caffeine?
42:07What's the What's the drop dead time?
42:09>> You know, you really shouldn't have any
42:10caffeine 6 hours before you go to bed.
42:13>> 6 hours? Because
42:15>> Because again it all has alerting and
42:18stimulating effects in the brain. And it
42:21has a half-life and it will keep your
42:24brain awake for about 30 The studies
42:27show that you're losing about 30 minutes
42:30of sleep if you drink caffeine too late.
42:32So when people say, "I can drink a whole
42:34cup of coffee and go right to bed." I
42:36usually tell them, "You're just proving
42:38to me that you're chronically sleep
42:39deprived."
42:41Because
42:42>> for a long time.
42:44>> this other
42:45chemical in the brain called adenosine.
42:47Adenosine is what builds up all day long
42:50and makes us sleepy. So it is fighting
42:53for that same receptor. So that's why
42:56when we wake up in the morning
42:58honestly we we probably should wait a
43:00couple of hours to drink our coffee
43:02because that's when
43:03>> You're killing me.
43:04>> adenosine [laughter] is is building up
43:06just a little bit.
43:07>> Right.
43:07>> But you know, it's also a ritual. Like I
43:10myself love having a cup of coffee.
43:12>> I'm going to just say Dr. Andrea does it
43:14and I'm allowed.
43:15Uh getting outside first thing in the
43:17morning. Do you think that's important?
43:18>> I do. I do think it's important and if
43:21it's dark where you're living and you're
43:24and you can't get sunlight, that's why
43:27it's important because sun is what fires
43:29off your circadian wake. So there's
43:32there's this whole homeostasis in the
43:34brain. When you wake up and the sun hits
43:38your eyes because we've got these nerve
43:40cells in the eye that connect directly
43:42to our wake center in the brain that
43:43fires off our wake cycle.
43:46That's that is hard when you're living
43:49somewhere and it's dark. So then I
43:51usually tell folks, "Use one of those
43:53bright lights."
43:54>> Mhm.
43:55>> And it's 10,000 lux. That's what all the
43:57studies were were done on. 10,000 lux is
44:00the intensity of the light that you
44:02should use.
44:03>> And so if you're turning that on,
44:05putting that on first thing in the
44:06morning.
44:06>> First thing first hour. If you do it too
44:08late, you're just going to move your
44:10bedtime later because that homeostasis
44:12is sleep pressure is really low and wake
44:16cycle is really high. And then they kind
44:18of crisscross over the day so that your
44:20sleep pressure is really high when you
44:22go to bed and your wake cycle, your
44:24circadian wake is really low when you go
44:27to bed.
44:27>> What about those hatch alarm clocks?
44:30>> [sighs and gasps]
44:30>> Yeah. There's a
44:32>> [laughter]
44:32>> People probably ask you about everything
44:34I know, right?
44:35>> I know, right? I mean, you know, so
44:36here's the thing. I think that it gets
44:40There's too many gadgets and and simple
44:43is better, right? So, if you need bright
44:47light, I have a I have a light for
44:48myself. I live in the Northwest and it's
44:50dark when I wake up and it's dark when
44:52I'm going home for the day.
44:54>> put it turn it on when you
44:56>> So, yeah, so I tell people like if
44:57you're looking at your computer screen,
44:59if it's off to the left or to the right
45:00of your computer screen, that's probably
45:02a good distance. Okay. So, it's about 12
45:04in away from your face. You don't want
45:06to look directly into it because it's
45:08very bright. So, it's off to the side
45:11and it's within the first hour of waking
45:13for, you know, anywhere between 10 and
45:1520 minutes.
45:16>> Okay.
45:17All right.
45:18Now, if there's anybody listening that
45:20feels very defeated about their sleep,
45:22what do you want them to know?
45:25>> One, it's not your fault.
45:27There are There's a lot of physiology at
45:29play here.
45:30>> Mhm.
45:31>> Two, there's always help. There's always
45:34something we can do. It's not always
45:36comfortable, but there are solutions.
45:39And three, 15 minutes, every 15 minutes
45:43counts because let's say you're only
45:44getting 5 hours of sleep and you do all
45:47the things and you say, "I'm only
45:48getting like 5 hours and 15 minutes."
45:50But, you multiply that by seven, by 30,
45:5431 days, 12 months, that's a lot more
45:57sleep.
45:57>> It's a lot more sleep. And when you're
45:59sleep deprived, you'll you'll take
46:00you'll take 15 minutes. It feels like
46:02gold.
46:03>> Is there one practical thing people who
46:06are listening can do tonight to at least
46:08get started in the process of getting a
46:10better night's sleep?
46:11>> Make sure that you've got a routine. So,
46:14again, one of my analogies is when we're
46:17hungry, we don't just open the
46:18refrigerator door and start shoveling
46:20food in our mouth.
46:21We owe it to ourselves to have a routine
46:24for sleep, whether or not that's I like
46:26to put on my favorite pajamas or not. I
46:29like to brush my teeth, wash my face. If
46:33you have some sort of spray that you
46:35love,
46:36uh you know, white noise machine, eye
46:38mask, ear plugs, whatever it takes,
46:41develop something and stick to it. I
46:43always tell parents we're so dedicated
46:46to our children's sleep cycle or if you
46:49don't have children, you always know
46:51somebody you know, that you're visiting
46:53with and is oh, we have to get, you
46:54know, our kid to bed. Well, we owe that
46:57to ourselves. Why do we lose that when
46:59we're adults?
47:00>> I don't know. It's a it's a whole
47:01learning curve.
47:02>> need it.
47:03>> We matter.
47:03>> Yeah.
47:05>> Dr. Andrea, thank you so much. It's It's
47:07so good to see you again. I I felt like
47:09the last time that we talked, I sat
47:10there and I went, "Wait a minute." I
47:12think we had 20 minutes and I could go
47:13on with you for, you know, hours and
47:15hours cuz I really do think if you're
47:17not getting a good night's sleep, what
47:19do you how are you even going to eat
47:20right or work out right or all the other
47:22things we talk about? So, I certainly
47:24appreciate it.
47:25>> Well, thanks for having me.
47:26>> Yeah, and thank you all for listening.
47:28If you have not left a review yet,
47:29please take a moment wherever you're
47:31listening from. It truly helps the
47:33podcast grow and I read every single one
47:35of your comments. You can find more from
47:38Dr. Andrea across her social media and
47:40her website and be sure to check the
47:42show notes for all the links. I'll see
47:44you for the next episode.

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