82: Menopause and Insomnia: Tracey Martin's Guide to Optimal Sleep

Welcome to the Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. Hi, this is Sonya and I am the host of Dear Menopause. Today we have an episode I have been wanting to bring you for such a long time. We are deep diving into sleep. Everything you could possibly want to know about why you're not getting enough, why you're staying awake, but also, more importantly, what you can do about it. Enjoy this conversation with Tracey Martin. Tracey, welcome to Dear Menopause. Thank you very much for having me, sonja. I'm always excited to have my guests on and I think I start every episode with I'm so excited to have you here. But I'm super excited to have you because we're going to talk about a topic that I have wanted to bring to the Dear Menopause audience for ages, but I've taken some time to find the right person and we connected and we are going to talk about sleep. It's a topic that is yeah, it's a topic that, oh my gosh, I get asked about all the time and it's one of the most common issues that women really struggle with when they're going through perimenopause and into their menopausal years is the disturbed sleep, the insomnia, the waking up in the middle of the night and going down a rabbit hole and not being able to get back to sleep. It's been on my radar to find someone and I finally found you.

Well, thank you very much for having me. It's a pleasure. I love sleep, I love talking about sleep, I love having sleep, of course. So if I can help other people sleep, then my job is a enjoyable one to have.

Tracey, why don't you kick off by telling everyone who's listening a little bit about who you are in your background?

Sure, so my name is Tracey Martin. I have a online sleep coaching business that specializes in treating adults who have chronic insomnia. I haven't always worked in the sleep space, believe it or not. When I was a wee baby, in the beginning of my career, I was an army combat medic and worked in that role in Australia and overseas for quite a few years. And then I went and did the paramedic scene and worked as a paramedic and a nurse and really enjoyed that work. Then life took me to Europe where I went and lived for six years and I sort of accidentally stumbled into sleep medicine when I was there, and I am so thankful that I did, because I've absolutely loved the field and find it so much more rewarding than any of the emergency stuff I did beforehand. So I was working in a expert centre in the Hague in the Netherlands and then at the European Space Agency and did a lot of training in sleep medicine and treating various disorders along with the medical team and helping people get back to sleep. So now that's my passion, that's what I sort of inspire to help the world sleep better again, and hopefully I can impart that knowledge to everyone today.

I am really keen to dive into pretty much all aspects of sleep with you, and I'm so grateful that you're now back in Australia. We have you back and you are here to help Australians get better sleep, so why don't you kick us off by just kind of? I think when we spoke before the podcast recording, you talked about the architecture of sleep probably something a lot of people don't even think about. Yeah, so run us through that.

Definitely so. Actually, like when we fall asleep, we go through different stages of sleep. We're not just in this one level of sleep the whole time, we sort of bounce into different levels of sleep. So, as we first drift off to sleep, we enter what's commonly called as stage one, non-rem sleep, which is a suffancy way of saying light sleep. And during this sleep you'll notice that, yeah, someone looks and appears like they're asleep. They have these rolling eye movements. That's really common, but they're actually still aware of everything that's happening around them. And you may have seen this happen, you know, as to a loved one. They're falling asleep watching television. So you think, fantastic, I can change the channel. And then, as soon as they do, their eyes snap open and you're like I was watching that and you're like I'm gonna get you to sleep.

I swear, so you weren't.

So this light level of sleep, it's still like our sort of stepping stone to get into lower levels of sleep. So we're only in light sleep for a little while. Then we go down into stage two, non-rem sleep, and during that stage everything starts to slow down. So our heart rate will start to drop down, our breathing rate will drop down, our blood pressure will start to go down, we start using less oxygen as well. But one of the biggest things that has to drop is our core body temperature, and I think this is where we're gonna hear a lot of women. Okay, because there's a massive relationship with temperature and sleep. So in order to go from light sleep to deep sleep, we need to drop temperature to do that. If you've ever tried to sleep in a hot room at night, you'll know how restless it is and how difficult it is to fall asleep. So during this deeper level of sleep, we have what's called a sensory gating mechanism as well. It starts to drown out surrounding what we call stimuli or sort of noise or sound. So if we hear a noise, for example, our brain says to it it's just a noise I'm expecting to hear, and if it is, it's like your neighbor's dog that's always barking, or if you live on a train line there's always a train that goes at 2am your brain starts to learn that that's normal and it will keep you asleep because it identifies as a normal noise. But if it's a new noise that you're not expecting to hear, you will wake up from it. So this is why we always sleep so terribly the first few nights we're in a hotel room, for example. All these new creaks and groans of a house or a hotel, it's gonna wake us up out of sleep constantly. So that mechanism kicks in during these lower levels of sleep. One really important thing that happens in these deeper sleeps is our memory and how we store memories. So as we go into these levels of sleep, our short-term memory reservoir, which is called our hippocampus you don't have to remember that but effectively it processes itself and just sort of asks itself. I think memory is from today that it's worth remembering, and if it is, it will put it back into your cortex, your long-term memory reservoir, and so that's how we remember things it's through sleep. As sleep drops down even further into deeper sleep, we go into sort of stages three and four of what's called non-REM sleep. Our heart rate may drop even further, even down to 40 beats per minute. We have all these wonderful things that happen. That's really important for our body's health. Okay, for example, we have something called our lymphatic system that flushes away a lot of sort of toxins and builds up. That happens in our brain during everyday use. All of our different body systems are doing effectively what I would best describe as like a system check. Am I working perfectly? No, I'm a little bit out, so I'll readjust and get back on track. So this deeper level of sleep it's really essential for our body to sort of remain a homeostasis effectively, to sort of summarize it. So in these deeper levels of sleep, we're in there, depending on the individual, for 20 minutes or so, potentially. Then we'll go out into what's called REM sleep. Okay, so REM stands for rapid eye movement, and it's called this because, effectively, our body, we become paralyzed during this level of sleep. We don't move at all, we have no muscle tone going on, but the only thing that's moving are our eyes, which are darting back and forth very rapidly. Hence the name rapid eye movement. Unfortunately, a lot of sleep scientists weren't very original with the naming of these, hence it's in this level of REM sleep. This is when we dream. Okay, so this is when dreaming activity begins. And if you were to put electrodes on your scalp and measure the activity of your brain on a metabolic level, our brains are really, really active. In fact, they're just as active as if we were awake. Okay, and so to kind of determine whether someone's awake or if they're actually dreaming, you have to measure things like the eye movement and the muscle tone of the body to really make sure if they're awake or if they're asleep. Now, rem sleep. If deep sleep was really good for the body, I want you to think, is REM sleep is really good for the mind and our cognitive development? Okay, so before we mentioned that in memory we go from long term to short term memory in deep sleep, now in REM sleep, we're taking those new memories and now we're interconnecting them with all of our other memory banks and sort of. So this is how, not just remember things, but being able to apply those, those knowledges, to everyday sort of circumstances. Okay, so that's effectively the difference between knowing something and having wisdom. Okay, also, that's something that's really happening during these REM levels of sleep is the emotional centers of our brain sort of get heightened and processed. So the way we deal with emotions and process them happens a lot during REM sleep. So I always like to sort of have that expression you know, the time heals all wounds. It's not quite true. It's time plus REM sleep that heals all wounds, which doesn't have the same sort of. It's not as catchy, it doesn't have it. But you effectively like when you remember something that may be traumatic, that happened when you were a child, when you remember it now as an adult, yes, you remember being very upset, but you don't have that same emotional response, you don't start crying because you've remembered that instance. So that's how REM sleep can help regulate those emotions. So at the end of the REM sleep then there's generally one full sleep cycle and that takes around 90 minutes per person per sleep cycle and we have another one and another one and a good sleep will probably have about five in a night. Sometimes we'll have small little awakenings in between those sleep cycles. That's completely normal. Sometimes we just don't remember them or attach any emotional significance to it. So we don't really remember in the morning that we woke up, but we all have some normal awakenings. What's actually interesting if you look at sort of your sleep architecture over the course of the night. Most of the sleep cycles at the beginning of the night are made up predominantly of the deeper sleep, but the sleep cycles towards the end of the night are made up predominantly of the REM sleep. So if you're missing out on a big chunk of your sleep, whether it's in the beginning of the night or in the middle at the end, you can sort of see sometimes the symptoms that people start to experience in their day to time environment. It can be like a direct sort of reflection of the type of sleep that they're predominantly missed out on. So I think that's really interesting sometimes and it's really helpful for patients to sort of have that light bulb moment and go oh, that makes so much sense why this happens to me, while I'm always a bit grumpy or a little bit sort of emotional and things like that in the daytime because of their sleep.

So for someone that is waking. I think the most common time for lots of people is that 2, 3, kind of time in the morning, and maybe they're getting up and doing a wee and then they're coming back to bed. But then there's struggling to go back to sleep because the mind starts playing all those wonderful games on us that it does. Is that because you were in a REM stage of sleep that your mind is that active?

So, whatever it is that pop is, at the end of a sleep cycle. You sort of have that little awakening where you've sort of become a little bit aware. The senses in your bladder have told your brain hey, I'm full, I could be emptied. So you've gotten up and you've emptied your bladder. That's got nothing to do. Necessarily. It's a part of sometimes aging. Or if you've had a drink leading up to it, the fact like the thing that woke you up and the fact that you can't get back to sleep are two very separate problems. If you have a bladder condition, for example, that's keeping you awake all the time but then you can get back to sleep quickly. It's just waking you up a lot Then that's an issue to seek treatment for the bladder. If you're having problems getting back to sleep, then that's something you can focus on in terms of if it's a long-term problem, through insomnia therapy, so to speak.

Okay cool, that is super interesting. So how to sleep? Do we actually need?

That's a great question and, as you can imagine, it actually changes a lot over the course of our life. So when we're a newborn you know babies we have what's called polyphasic sleep, which means you sleep multiple times in the day. As you get a little bit older, into childhood, you go to a biphasic, so sleeping twice in a day. Little kids will have their daytime nap, but it's like a little bit older We'll go to monophasic, so having one set sleep in a daytime. So when you're a newborn baby, you probably need a good 14 to 17 hours of sleep. Toddlers might be needing around 11 to 14. Doctors moved to sort of 10 to 13 school age between 9 and 11 hours of sleep. Teenagers they need like 8 to 10 hours of sleep, which unfortunately sometimes it's hard to get them to do. As we reach our adult years we should be aiming between that 7 to 9 hours of sleep. Now some people can get by on a little bit less sleep, like 6 hours. We call them short sleepers, but they are quite rare. A lot of people socially short sleep themselves, but they actually need a lot more sleep than that I was going to say.

I would imagine that there's a difference between somebody who can be healthy and functioning on that short sleep versus I think that the term used was like a social short sleeper, where they just literally don't get enough sleep which then leads to different health conditions and inability to kind of function properly throughout the day, that sort of thing.

It's actually really interesting. There's a lot of studies that look at people who do sort of socially short sleep themselves and they feel like they're doing fine, then they're coping really well. But it's sort of like a bit of a misconception. They sort of have gotten used to being sort of sleep deprived. They think that that's normal and they don't sort of see that it's an issue. It's until they start getting really good sleep, for longer amounts of sleep, that they actually notice the difference.

Yeah, yeah, I think we've all probably experienced that at some point in time. One of the things that we were going to talk about and I'm keen to know a lot more about, is insomnia. Yeah, I suppose. First of all, the definition of what insomnia actually is.

Insomnia is a sleep disorder that's stopping us getting a total amount of sleep. It's sort of characterized as it takes you more than 30 minutes to either fall asleep initially, or if you wake up in the middle of night and you can't get back to sleep for sort of 30 minutes or more. That's sort of in a nutshell. Normally there needs to be some daytime symptoms like, for example, fatigue, tiredness, that sort of goes with it, For it to be considered chronic. It needs to be happening at least a couple of times a week for a minimum of at least three months for it to be considered chronic insomnia or long-term insomnia.

Yeah, there's probably lots of menopausal women listening to this thinking that potentially they are a chronic insomniac without even really knowing it.

Yeah, I think a lot of my patients who have chronic insomnia have had it, unfortunately, for years or decades. They sort of pinpoint the beginning of their insomnia in their menopausal years is when it all starts.

I think or I feel like there's this perception with sleep that we brush off bad sleep. It's very much like, oh, I'm just having terrible sleep, just can't sleep, but we put up with it for a really long time and it does just become our norm and we accept that as our norm.

Yeah, which is such a shame because I think that it's becoming more and more talked about our sleep now and it's becoming more recognized how important sleep is to our health, has so many positive health benefits and so many terrible things that happen to our health if we're not getting enough sleep. So I definitely think it's becoming more talked about. But you're right, it's really common that people don't focus on their sleep as much as they should and hopefully that narrative is going to start changing in the future.

You've already mentioned that. A number of your patients' clients that you see do find that there was that link back to their perimenopause menopausal transition with when the insomnia started. Why is that?

Yeah, so obviously a lot of changes are happening through our body when we're entering these perimenopause and menopause years, a lot of hormonal changes. A really key part of that is a drop in estrogen and a drop of progesterone. Okay, now, the human body is a wonderfully complex and intricately designed machine and if something starts to go a little bit off track sometimes it can have a negative knock-on effect to other systems in our body. One of these common knock-on effects is temperature regulation, which I feel like a lot of women will go. Oh, yes, okay, having those hot flushes and those night sweats. And, as we spoke about, there's a very intricate connection between our temperature and our ability to fall asleep. Okay, so if we're having hot flushes and our body's too warm, it's very difficult to get back to sleep, so that's a very common cause for women to start waking up in the middle of the night. Also, a lot of these hormonal changes. A consequence of that is that you can start to have an increase in another hormone called cortisol. Now cortisol sort of gets demonized a lot of the time. Cortisol is a stress hormone. I don't know if you've ever heard of the fight or flight response or effectively that sort of. You know that reaction the body has to some sort of you know whether a danger or something like that, you know heart rate will go up, our body will prepare itself. That's cortisol sort of doing its job. Okay, so if our body is in this sort of heightened state of stress or cortisol levels are high, one of the things that that does is it blocks our ability to fall asleep. That's sort of what cortisol does. And if you think about it from a like an evolutionary perspective, I mean that's cortisol doing its job. We haven't really evolved from our caveman hunter and gatherers. You know, for example, if you're a little caveman and you're sleeping in your cave and a mountain lion walks in, you know so it's an acute stress like, oh my goodness, stress, stress, stress, cortisol levels go up. He wouldn't last very long if he wanted to go to sleep. So that sort of heightened level of stress will block our ability to sleep. And if you think about it from this perspective, if something you know heaven forbid it never does but if you had a really bad day, you know, loved one was in the hospital, massive stress in your life you wouldn't imagine you're going to sleep well that night. Yeah, yeah, being raised. So, unfortunately, a raised level of cortisol can occur for some women who are going through menopause, and that's often marked by inability to fall asleep initially, or to get back to sleep in the night if you've woken up, something else that can happen again. Another one of those negative knock on effect is a lot of the really essential vitamins and minerals that are responsible for good sleep quality can become low or deficient. Okay, some of them for example, magnesium and zinc, calcium B vitamins, vitamin D these can start to be lowered, okay, and that can definitely have a negative impact in your sleep quality and, like the depth of your sleep. Another annoying side effects for menopause. It does also increase your risk of some other sleep disorders as well. Now, sleep apnea, if you don't know, it's a breathing disorder that stops us getting deep quality sleep. So, as we're getting down to those deeper layers of sleep and our REM sleep, especially, the muscles in our upper airway will start to relax. Okay, sometimes they can close completely even, or you may have snoring, but effectively, the oxygen levels in your blood will start to go down because you're getting less breath in as you're sleeping and the body will wake you up. Okay, now, you won't always remember those awakenings. But if someone's like listening to you sleep, they'll often say, oh, you were snoring and then you stopped breathing and I was very worried for you. So if you do notice that you're sleeping for a long period of time nine, 10 hours but you wake up exhausted, you have headaches and cotton mouth, if you know that you snore, these can be some things. To seek an appointment with your doctor to test whether you have something like sleep apnea. Another one's restless leg syndrome. That can also increase during menopausal years, and that's effectively what restless leg syndrome is. It's an uncomfortable sensation, your extremities and you have to feel like you have to get up and move. It's like an overwhelming power to. You want to get up and stretch and that can impact your sleep in terms of like getting up to stretch in the night. But once you are asleep as well, it can kind of manifest in like spasmic movements and sort of twitching, and so if your bed partner sort of just says, hey, when you're asleep you kick a lot, again, that can be impacting the depth of your sleep and getting out of those deeper layers of sleep. So if you feel like that might be, you make an appointment with your GP and see if you can get a sleep test to rule these kind of things out. And lastly, I think one of the things that I think a lot of menopausal women will find is that they'll start to change maybe a few behaviors in their daytime that may have a negative impact on their sleep, and they get it. I mean, it's a really tough time in someone's life. They're tired, and so things like napping in the daytime might be something that you know you start to do to try and get yourself through the day. You might start exercising less, and I get it. You're tired. The last thing you want to do is put on your runners and go to the gym, but you know, less exercise means less quality of sleep, okay. So these sort of knock on effects sometimes they can all pull together and just impact your sleep in a really negative way.

Yeah, so it's really interesting, isn't it? So sometimes we need to get back to the root cause. It's not. You know, your symptomology might be manifesting through your sleep, but when you actually start looking at the root cause of okay, so what is causing that? Or sleep, bad sleep, however you want to categorize it it's often yeah, it's not the sleep itself, it's actually other behaviors throughout the day that are then impacting.

And that's definitely the case when it comes to insomnia. Okay, so often the case. When someone starts to have sleeping problems, initially a lot of it's because of, you know, a higher level of stress has entered their life, okay, and then, like, cortisol levels will become raised as a result of that. You know whether that's, you know, a relationship breakdown, work, stress, death of a loved one, whatever it is that's caused your stress menopause, for example, pregnancy, childbirth, cortisol levels were raised, children in general, children in general. To be honest, effectively, your cortisol levels will be raised and it's really difficult to get to sleep, but that's in like that short-term, acute phase. But when you're not sleeping for, like Paulie, for a few nights in a row, you might not realize that you do it, but you'll start to change some behaviors and the way you're thinking about your sleep in order to get better sleep.

Okay, some of these might be yeah, you might start napping in the daytime, you might start having more caffeine, having an exercise, you'll die Extra glass of wine of anything, thinking that it's going to help you sleep when it's a first effect, 100%.

Definitely. And another thing, a big thing that people do is they'll go to bed early and I look, I get the mentality is like I slept so terribly, I'm going to go to bed early tonight. So I'm, you know, if I'm sleepy, I'm in there or fall asleep quickly, but then they're in bed and it's like, oh, I'm not quite tired, so I'll watch TV or I'll play on my phone or I'll read my book, and you start introducing new things into the bedroom. That's not sleep. And effectively, your brain has this wonderful conditioned response. Effectively, a lot of the time now it's it's awake in bed when it should be asleep. And when you're awake in bed, not sleeping, I think a lot of people would sort of identify the kind of thoughts they start to have. Use. They start to think of all the things they need to do tomorrow, all the things that's happened today, or like any sort of worry and stress that will happen, and that becomes a triggered response. Okay, your brain starts to learn that when it wakes up in bed, that's where it goes, okay, and it's all. So that's interesting.

That's why you see that pattern of you know what I refer to as going down the rabbit hole. So that is actually a triggered response. From the first few times that you did that, it becomes a learned behavior.

And I think a lot of people would have sort of identified with a scenario that they're. They're watching TV in the evening on the couch and it's time to get really sleepy, so they think really, I'm going to go to bed, I'm right there, I'll get in. I'll you know, calmly, get in and they're awake. You know, that's my husband, we do.

I have this conversation with him. He falls asleep on the lounge watching anything all the time, but then we go to bed and he's like I'm going to read for a bit or I'm. You know, I'm not quite ready to go to sleep. I'm like you were asleep Like exactly and minutes ago on the lounge.

Yeah, and it's a. It's a triggered response and when someone has long-term chronic insomnia, these, this triggered response it's, it just becomes built into their system and they just don't realize it. It's because I've spent so much time awake in bed. Every time your brain wakes up it's like, yep, this is what I do when I'm in bed. I'm awake and I overthink and I stress and I worry and all these terrible things that kind of cross my mind is doomsday scenarios, potentially depending. Oh yeah, and then people start to worry about their sleep. They start, you know, thinking, oh no, please, let me have a good night's sleep tonight and get sleep. Anxiety and stressing about health impacts their work performance, all these different things that they worry their sleep, sleeplessness will cause this all sort of snowballs effect into chronic insomnia. So when we want to treat chronic insomnia, we want to sort of tackle all of that head on.

Oh wow, this is fascinating, which I knew it was going to be, which was why I was so excited to talk to you, okay, so what, then, are the tips that you would give any woman that's listening or any person that's listening? Let's not be gender specific. Any person that's listening that is experiencing some insomnia now realizes that's what they're struggling with how do they go about getting a better night's sleep?

There's some tips to improve your sleep, whether, no matter who you are and what stage of life you're in, there's definitely some different things we can do to optimize a good night's sleep. The first thing I'd say is optimize your bedroom. We want to make it dark, quiet and cool. Now darkness should be obvious. We need darkness. One of our big things about dark is it actually increases a hormone called melatonin, which is effectively this big signal to the brain that says it's dark, you should be sleeping now. We need melatonin in order to sort of initiate good sleep. Okay, if we're introduced to darkness, those signals in the brain get heightened. If you have light in your bedroom, especially as sort of morning approaches if you live in a really nondocountry, for example, gets really light really early then that's sort of effectively a big cue to your brain. Your awake alerting signals okay, sort of kick in and your brain will wake up Okay. So definitely having a dark bedroom environment whether you use blackout curtains or an eye mask for example, if that doesn't overheat you too much can be a really great way to make it dark. Making it quiet is also really important, as I said before, that sensory gating mechanism if you live in like a city or a busy area and you've got noises constantly waking you up. I mean, it's hard to soundproof a room, but if you need to wear earplugs or something like that, if you can find one that's comfortable, then that can be a really great way to take away some of those noises. Or you could use something like white noise, which will help filter out a lot of those noises. Another big one and probably this is the most important about the bedroom environment is to make it cool. Okay, I think a lot of couples have that argument. One wants the heater on, one doesn't want the heater on. I will hunt 100% side with the person who says a cold bedroom is best. Now, the teaching says 18 degrees is the optimum level. It depends a little bit on who you are, especially if you're going through your menopause and overheat, if you're having these night sweats and overheating. Taking those steps to make sure your bedroom environment is cool or even cold opening the window, having the fan, air conditioner if that's needed, especially if the north of Australia to help cool you down. Now, I didn't say I don't want you to be cold in bed. There's nothing worse than being freezing in bed. You sort of I can't fall asleep if I'm cold. Yeah, Pulling up in a little ball and being tense, that's terrible. That's the sleep. That's not what I'm after, but I want you to be warm in bed but breathing in cold air, Okay. Okay. So you want to go into your lungs and that will definitely help lower your core body temperature, which, like I said, is needed in order to get good quality sleep. Okay, so that's definitely one tip helping optimize your bedroom, making sure it's a perfect sleeping even. Another thing I'd suggest to people is to seek both light and darkness at different times of the day. So, as soon as you get out of bed, one of the best things you can do this is what I do is I go outside and I sit outside and I face the sun and get that wonderful direct sunlight. There's the quality of the light that we get from the sun. It's that different kind of quality and level of sort of frequency of light is like a massive stimulation to your brain saying you need to be awake now, Okay.

And it doesn't work the same through glass does it? You've actually got to get outside into the sunlight.

Glass can definitely impact it especially as well. Something we get from the sun is vitamin D, which is really essential for a lot of different things, especially bone density can decrease in menopause and things like that. So vitamin D is really necessary to help calcium and bone homeostasis. But a plane of glass can block vitamin D absorption. So people think, oh, I'm in the sun, I'm in my office, I'm in a sunny spot, but they're not actually directly in the sun. Okay, and that's how we need the vitamin D from there. So in the morning and throughout the day, seek sunshine, get outside at lunchtime, go for a walk outside, really get that massive sort of influx into your brain saying you need to be awake now. Okay, as nighttime sort of approaches, in the hours leading up to bedtime, this is when we start to dim all the lights. So there's certain kind of lights that really impact our ability to start like secreting those hormones that say it's getting ready for bedtime. Okay, like being malatonic. So fluorescent lights are really bad for our sleep and LED lights, unfortunately, are really bad for these signals as well.

Most times they have LED lights in them now, true as well, and unfortunately screens as well.

So, televisions, computers, phones and, let's face it, most of us have a screen right in front of our face just before we go to bed, at some description, and we talk and people would have heard about blue light and how bad blue light is. That's kind of what it is. It's this quality of light that's really sensitive to our brain, that says, hey, we're not meant to be asleep right now. It's like that wake up, that in your face wake up signal. So we kind of change the lighting in the house to sort of that really deep, golden, orangey kind of light. Candle light would be like perfect. Okay. That's really wonderful quality of light because it's not very intense and it doesn't sort of give that brain wake up signal in our system. So it can help us sort of lull ourselves into sleep. So that relationship in light and darkness at different times of the day is really, really important for good quality sleep. The next tip I have makes me a little bit unpopular and I'll talk about caffeine and alcohol. So caffeine okay, look, I get it. I love my coffee in the morning as well. But what coffee is? It's what's called an adenosine antagonist. Okay, so the thing that actually makes us sleepy is something that we naturally produce in our body, called a denozy, okay, and that's sort of like. When we have high levels of it in our brain, it's what makes us feel sleepy, okay. So when we have a caffeinated beverage, whether it's a triple espresso, whatever your poison is, effectively it's stopping that adenosine from telling. It's telling your brain that it's sleepy, okay. It's not giving you energy, okay. That's a big misconception with caffeine that it gives you energy and wakes you up, not true. It's actually just stopping your brain from saying it's sleepy. It's not getting rid of the adenosine. The adenosine is still there, but it's just blocking it from having an effect. Unfortunately, caffeine it stays in our system for a really long time. There's a term called a half-life, which is sort of what we use in pharmacology, which talks about, like, the potency level of a drug and when it reaches 50%, if we call it the half-life Caffeine, it can take five hours to reach that half-life, okay, and that number can get more and higher and higher as we age. So if you know you're someone who's particularly sensitive to caffeine if you've had a really strong cough and you get those shakes, for example, you know this might be you. So if you're having a lot of caffeine in your daytime, that can still definitely be in your system when you're getting into bed in the evening. Okay. So my general rule for patients no more than two caffeinated beverages no later than lunchtime. By that stage, the time you're getting into bed, is mostly out of your system and you should be safe. Alcohol, unfortunately, is one of the most very unpopular. Alcohol unfortunately falls into a drug class called a sedative, and so what it does is it slows down brain movement. Okay, when we go into those deeper levels of sleep, that brain movement's really important, okay. So when we have a lot of alcohol in our system, the quality of our deep sleep and our REM sleep and we know how important they are for our health will become very fragmented, okay, and it will almost block your ability to get into those deep sleeps. So think about, you know, for example, someone who may have had much more alcohol than they should have. Maybe they've drunk, you know, a bottle of wine, or maybe two, who knows and they've fallen asleep. Okay, there's definitely that perception, that perception sorry that you can fall asleep easily with alcohol which is actually contested in a lot of some studies that show, in terms of the ability to fall asleep quickly, whether it helps or not. But it will definitely affect your quality. So if you measure your sleep architecture, you will have a rubbish night in terms of the quality of your sleep, despite how much quantity of sleep you feel it gives you. So limiting alcohol intake is definitely a big thing if you want to sort of put your sleep. One of my next tips that I would sort of say to someone who is finding that they can't get back to sleep or they're awake in bed and just sleep is not coming, is to get out of bed. Okay, and we call them stimulus control. So when I spoke about that triggered response, you know, your body starting to learn that the bed is a place of, you know, awakefulness. We want to break that, Okay, and that can be quite difficult. We need to break the habit, Okay. So getting out of bed which I get is really hard to do but get out of bed, go to a different area of the house, you know, you can put some dim lighting on, do something that's a calming activity, hopefully something that's distracting, especially if your mind is sort of going down that rabbit hole and racing. Read a book, do a jigsaw puzzle or something like that.

Don't jump on your phone.

Do not jump on your phone, especially if that gives you stress, like you know. Looking at you know social media, like that is enough to sort of give you a bit of stress and anxiety. Avoid anything like that that's going to give you that kind of response. When you start to feel sleepy, go back and have another go. Okay Again, if you're not asleep, quickly, or as soon as you sort of identify as they're getting frustrated that you're not asleep, get out of bed, do something calming and then go back and have another go. So trying to prevent that awareness, that triggered response of being awake in bed sort of, is through stimulus control. Another tip I'd say to all sleepers is be regular with your sleep timings. Okay, unfortunately, that means going to bed at the same time and getting out of bed around the same time every day. There's none of this oh, I'll catch up on sleep on the weekend and things like that. Unfortunately, our body acercating rhythm, which is sort of like our body clock, it loves to be regular with our timings. Okay. So going to bed and out of bed at the same time, and you'll notice that the sleep architecture is greatly benefited from that as well. You can sort of take the example. Just say someone extremely regular with their sleep timings. They go to bed at, say, 11 o'clock every night and drop at 7 o'clock in the morning, and that's their regular, like, their regular timings and they're doing it all the time. They're fantastic, but one night it's their birthday. Whatever, they go out and have a fun night out and they go to bed at 2 o'clock in the morning. Even if they're planning on sleeping in that additional three hours where they would normally be in their sleep architecture journey at 2 o'clock, that's where they're going to start. The whole thing won't shift, okay. So that big chunk, that first three hours predominantly of deep sleep because it's the first half of the night, will be lost. You won't make up for it at the end of the day, at the end of the night.

Yeah, so you might still get eight hours sleep. Let's say yeah, but it would have started at that point where you went to bed.

Yeah, if you're looking at the sleep architecture and how much you're in those different stages, it definitely won't be as good as if you were regularly in your regular sleep, in your regular routine. Definitely, my next tip would be get out there and be active. Okay, I think anyone. I mean there's so many benefits to your health. Exercise. It's fantastic for our health in thousands of different ways. Definitely, with regards to sleep, you kind of need to earn your sleep a little bit. Okay, and I mean people would identify with this if they've had a really big physical day, if they've moved house or if they've been a big day in the garden or they sleep well that night. It's sort of that common thing. I did a big book today. I'm going to sleep well tonight, okay, that's definitely true and I get with when you have sleeping problems. Exercise is one of the first things they cut out. You need to be physically active, and it's not just exercising but being physically moving around in your day. We're not sort of built to sit down all the time. Fortunately, the jobs that we do sit all the time a lot of us do have that. So getting up and trying to get at least a minimum of 10,000 steps in your day can just be better for that sort of active movement. Getting up in your lunchtime, go for a walking lunch break, you know, walking meetings, getting off the bus stop at one step earlier or parking further away from your workplace All these little things just to increase more exercise into your day will definitely be beneficial to your sleep. Another one healthy diet, of course. As I said before, a lot of our vitamins and minerals are definitely going to start to become deficient when we get into our perimenopause and menopause years of life, so making sure all of those sort of levels are optimally met is really important as well. So not just having a healthy diet, but having a varied diet is important. So not just having the same meal every single day. You've got a really healthy breakfast, lunch and dinner, but you have it every single day. You might be missing a lot of key vitamins and minerals. That's really essential for your health and well-being. And avoid foods that will impact your sleep. So we know caffeine is definitely going to impact. So having a coffee late. Unfortunately, chocolate also falls into that category and I'm sorry because there's caffeine in chocolate. Well, depending on the chocolate you're reading, but I know I would say I'm terribly unpopular here, but like a late night chocky binge, which I'll be guilty of it myself we're all being guilty from it from time to time but that's definitely going to have a negative impact on our sleep. If we're sensitive to caffeine, alcohol again in the evening is going to impact our sleep. But it's also important to think of any sort of food that may cause your body particular problems. For example, if you have issues with dairy, you're going to have cheese fondue in the evening, then your body is going to be processing that, possibly going into a bit of a state of inflammation and with inflammation comes increased cortisol and your sleep is going to be affected. So, if you know there's certain foods that give you indigestion or heartburn or give you a lot of bloating and problems, but you just have to eat them, maybe aim for a lunchtime or some sort of like earlier in the day, we sort of get that sort of out of your system, that craving of your system, and it hopefully won't impact your sleep at night. The last tip I would give people is to seek help if needed. Okay, if your symptoms, for example your menopausal symptoms, your hot flushes, are waking you a lot during the night and, yes, you can get back to sleep very quickly. So it's not really. Yes, it's waking you up, it's not impacting your sleep so much in terms of insomnia. Then have an appointment with your doctor. Talk about different ways that you can treat those symptoms there it is through HRT. If that's not happening already, in different ways, you can sort of optimize that. But if you've noticed that your sleep has become a problem in your life you can't fall asleep at the beginning of the night, or if, when you do wake up in the middle you find it really difficult to get back to sleep is to seek help from a medical professional who's trained in something called cognitive behavioral therapy for insomnia, which is the program I run and it's considered the gold standard treatment for someone who wants to fix their chronic insomnia, and I think that's a really important thing. Sometimes people need a little bit of help just to help them get through this sleeping issue that they're having.

Yeah, awesome. So tell us then a little bit about CBT insomnia because people may be familiar with the term CBT cognitive behavioral therapy. I know it gets talked about in lots of areas of your life that you can use it, but you work with this type of CBT that is just for insomnia.

The insomnia specific. Okay. So, when I mentioned sort of that journey from like the beginning of your insomnia to the end of your insomnia, so, like at the beginning there's cortisol, that's what's keeping you awake. But then all these subtle behavioral changes you've started to do and like these thought processes that you've started to change, these are cognitive changes and these are behavioral changes that you've adapted for your sleep and it's not as a coping mechanism but it's what's keeping your insomnia from going away. Okay, so when we do cognitive behavioral therapy, we effectively look at all of these new behaviors that you've sort of started or sort of changed as a result of the insomnia and we try to rectify them. So every week we sit down one-on-one for about an hour over the course of quite a few weeks and we go through I could tell you, sleep homework, okay different behavioral changes to make different ways to actually reset your sleep drivers effectively and then to deal with sort of you know, ability to get better sleep again through your behavioral changes. We also look at the cognitive changes as well and different methods you can use to help like, for example, turn your brain off at night. You know having that really active brain. You know telling your brain to shut up a little bit. You know it can be a really beneficial way to sort of get back to sleep. So with CBTI cognitive behavioral therapy, we go through all of those different stages and I give you help and some tips and tools for you to break these habits and get your sleep back to original factory settings for want of a better term we reset all of your sleep back to normal.

So how long does that process on average? Obviously, I would assume it's different for every patient. Every patient is a little bit different.

So I mean, the journey for everyone is a little bit different depending on where your biggest issues with your sleep are. Normally people start sort of seeing sleep improvements after a couple of weeks of the therapy, but normally the actual program goes for, you know, between six, eight weeks or so. What I do with my patients is there's no real sort of maximum session sort of time, so I'll sort of stick with you and sort of get you through that sort of process until we've sort of gotten your sleep up to the level that we're happy with, and then we'll part ways Like okay, you've got me for six sessions, and six sessions only kind of continue that journey until sort of we're happy with where your sleep sort of you know, at the end of it.

Okay, that's amazing and I will share in the show notes how anybody that is interested in finding more about you and potentially working with you do that. Do you want to give? Do you have a website? Do you want to give that a bit of a shout out?

Yeah, I mean, if you look me up, you can find me at TM insomnia treatment. That's allonewordcom. You'll find all the information about me, about insomnia, about a bit more information about CBTI and the programs, and then you can book directly through my website. That way you do not need a referral from your doctor to come and see me. You can book in tomorrow if you want to. You don't have to go to see your GP to get referrals and then have long wait times. Now I do all of my sessions online, so it doesn't matter where you live in the world, we can see each other. Okay, it's all on the computer. I'll send you an easy link and we'll have our sessions that way.

Yeah, that's wonderful. Thank you so much that. So much information in this episode. It's going to, I think, keep a few people occupied for a while, but absolute gold in terms of the whole description around what's going on, what's interrupting the sleep, why it is, and some really solid takeaway tips on what you can actually do. Change your, change that pattern. Don't get out of that pattern. You don't have to accept that. You just asked someone that has all sleep.

No, no, this doesn't have to be you. This zombie state of insomnia doesn't have to be your life sentence. There is help out there and it's easy to get. So I encourage people to seek help and reach out to me if they feel I can help them with their sleep More than happy.

Amazing Tracy. Thank you so much. Now I'm going to wrap up with a question that I asked all of my guests and I forgot to prep you ahead of time. I am putting you on the spot, but it's a fun question, tracy what are you reading, listening to or watching right now that is bringing you joy?

Bringing me joy, like in the sleep space or just in life in general. Just in life in general. I love this question. I mean, I'm a big sucker for books. I can get lost in a good book forever. Oh, I've got to admit it, but I've sacrificed a bit of sleep over some time. I've been reading the most books that I'm absolutely obsessed with. So one of my favorite authors has just bought out a new book and that just yeah, that just dies me, and it's a fantasy book which I absolutely adore.

But yeah so.

Tell us what books are called and who's the author. Brandon Sanderson's the author and he just does a lot of sort of different fantasy books. He's one of my favorite authors, so I can highly recommend anything, and if you're interested in reading fantasy novels, which is definitely my bread and butter, so yeah, but that's something that brings me a lot of joy, I'm going to go with Brandon Sanderson. Yes, yeah he's a Okay, I'll link through to that in the show notes, as well as if anyone else is looking for some new reading material.

Yeah, of course, Wonderful Tracy. Thank you so much for your time. I know that this is going to be really impactful for a lot of people listening. Oh, you're most welcome. Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of Dare Menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you because you are my biggest driver for doing this work If this chat went way too fast for you and you want more head over to stellarwomencomau to see why it feels like midlife is messing with your head.