Episode Transcript
Speaker 0
I'm so excited about today's conversation with Dominique Williams about cognitive behavioral therapy for insomnia or CBTI.
Speaker 1
Me too. Because, of course, sleep has started to elude me again, and I feel like I've pulled out all the trusty tools, and nothing seems to be working. It works for a bit, and then
Speaker 0
life happens, things change, your body changes, and you might need to tweak what was working or add new tools to your toolkit.
Speaker 1
Well, yeah. The current tweak that I've added is trying to copy my copy my way through this, and guess what? It's not working.
Speaker 0
Good thing we've partnered with Endy for our reclaim your rest eight part sleep series. Each month, we're dedicating an episode to deep dive on sleep. Everything from how it impacts our weight, health span, and even muscle recovery to the evidence based tools leading experts recommend.
Speaker 1
And who better to partner with on this really than Endy, Canada's leading mattress company? Not just because their mattresses are amazing, but because they really understand how vital a good night's sleep is to helping us be able to shine, to living our lives and using our brains to, like, our health span.
Speaker 0
To be don't forget being nice humans.
Speaker 1
Just occasionally, though. You know, but, you know, until this partnership, it never even really dawned on me how important a mattress was to the perimenopause tool.
Speaker 0
Oh, yeah. Completely missed that really, potentially life changing piece, frankly. Yeah. Speaking of perimenopausal toolkits, our conversation today on CBT CBTI is an incredible tool everyone needs to know about. For all our listeners who wake up wired at two AM and can't get back to sleep or go to bed at nine PM exhausted but lie there wide awake until forever, CBTI might just be the answer.
Speaker 1
Okay. And stop, Mick. I had an epiphany after the conversation. Thinking about everything Dominique tells us, CBTI is a lot like sleep training a baby, but for adults.
Speaker 0
I had never thought You were so right?
Speaker 2
No,
Speaker 1
seriously stop. Right? Yeah. It's like all those Like, when I was pregnant, I read all the books. I wanted a toolkit before I was sleep deprived, and I had, like, every option available to Finn. So I was, like, obsessed with it.
Speaker 0
Of course, you were in true Michelle fashion, but true. We spent years supporting our kids' sleep and things like black curtains, white noise, wake windows, consistent the whole production, and it did eventually work.
Speaker 1
Yeah. And then we hit perimenopause, and we forget that there's tools, and there's routines, and maybe we could apply this to ourselves.
Speaker 0
Thankfully, Dominique Williams from Coven Women's Health specializes in CBTI, and is gonna give us some evidence based tools we can start using tonight.
Speaker 1
CBTI, sleep training for adults.
Speaker 0
If we taught our kids to
Speaker 1
sleep, we can teach ourselves to sleep. This is perimenopause. This episode is brought to you by Endy, Canada's best mattress company trusted by over one million happy sleepers. More couples today are experiencing what's called a sleep divorce, sleeping apart to avoid annoying things like snoring, overheating, or one person tossing and turning all night long. At Endy, they get it. Everyone sleeps differently. That's why their mattresses are designed to help couples rest more comfortably together. With breathable open cell foam, cooling gel, and motion isolating layers that help keep movement and heat from spreading. Because better sleep starts with understanding, communication, and a mattress that works for you both. Learn more at Endy dot com. That's e n d y dot com. Dominique, welcome to the show. We're so excited to have you here today.
Speaker 2
Thank you. I'm excited to be here.
Speaker 0
Great to see you again. Yeah. More than more than the once a year at the National Menopause Show. That's right.
Speaker 1
Although we're both in Waterloo, we do need to go for a walk someday.
Speaker 2
Yes. So Yeah. When it's better weather, Australians don't do well with this. No.
Speaker 1
Neither do neither does this Canadian girl.
Speaker 2
No. That's true.
Speaker 1
Fair. So let's jump in, Dominique, because we are here today to talk about sleep and Mhmm. Specifically how to get back to sleep. And, it's it's a big deal. It's a big thing for a lot of women in perimenopause.
Speaker 2
Yes. It is.
Speaker 1
We're dealing with sleep issues from night sweats, racing thoughts, suddenly not being able to get to sleep through the night anymore. And I understand that the first lines of therapy is CBTI, cognitive behavioral therapy for insomnia, and this is one of your specialties. So can you please tell us, like, what is that exactly?
Speaker 2
Yeah. So a lot of people might be familiar with cognitive behavioral therapy where we, identify unhelpful thoughts and behaviors and then work to try and change those for, sort of, a better better emotional well-being. ETI is sort of an offshoot of that that uses sort of similar approaches, and it's now considered the gold standard and first line of treatment for insomnia, not medication. So I have a lot of physicians that will refer to me when people are having problems with sleep. I really love that this approach doesn't try to force sleep. It just aims to reset the nervous system and retrain the brain's relationship with sleep. So we know in perimenopause in particular that sleep can become fragile. That that's maybe a light word for
Speaker 1
a a looser, like,
Speaker 2
nonexistent. Yeah. Shit. That's really hard. And I also has have personal experience with that. So, yes, you're right. We have hormonal shifts, night sweats, heightened anxiety response, and then midlife life stressors and life stressors in general, and they all collide, and then bed can become a source of frustration rather than rest. So CBTI works by trying to break that cycle and rebuild sleep confidence. I like that.
Speaker 0
Build sleep confidence. Yes, please. So we did a little research, and we we found a little bit more detail about what CBTI involves and things like sleep restriction, relaxation training, obviously, cognitive restructuring. Are are we correct? And maybe could you take us through those elements and what yeah. What they mean?
Speaker 2
Yeah. So I'll go through them and maybe expand on them a little bit. But you're hundred percent right. These are the approaches that we use in CBTI. And for some women, we might use all of these approaches depending on what's going on. And for some, it's just going to be sort of based on what they're experiencing. So one of the first things that we ask you to do is to track your sleep with a sleep diary for maybe a week or two. So we can just really identify, is it problems falling asleep? Is it night sweats waking you up? Is it the two AM slash three AM wake, which I'm going to get to that? So what exactly is it? We say, you're not sleeping. What what is that? What does it look like? But you're right. As soon as we use the word sleep restriction, women go, wait. Wait. Wait. I'm already hanging on by a a very thin thread here. I am exhausted, and I'm running on fumes, and now you wanna restrict my sleep. So, usually, I will use the word sleep compression. It's a little bit gentler. So this is not about depriving sleep, but consolidating your sleep a little bit. Because a lot of us will lay in bed for nine plus hours, but we're only actually sleeping for maybe five to six hours. And what that does is it teaches your brain that bed is a place to be awake. Right? So with sleep compression, we're gonna, I'm saying, gently tighten the window so that the body relearns efficient sleep. Because when we're laying there for all of these hours and not sleeping, that's not efficient sleep. You're just reinforcing that bed is not a really safe place to be. It it's associated with maybe tossing and turning and stress, and now we're hot. The reason that it's probably a good idea if you're looking for a therapist that provides CBT I, you wanna make sure if it's if you think it's because of things that you're experiencing, as a result of perimenopause, that they have a good understanding of perimenopause. Because this sleep compression, we do it a lot gentler for someone in perimenopause. Because as we said, there is enough going on without then saying, oh, by the way, we're going to restrict your sleep. Stay up really late. Get up a little bit earlier. It's a lot gentler for someone that's experiencing perimenopause symptoms. But that's in a nutshell, you know, where we are compressing it a little bit, but we just go a lot slower for someone in perimenopause. Interesting. Yeah. So so don't panic if you hear someone say that. It's not a drugstore medicine practitioner. You know, it's not it's not that bad. I think the next one that we probably work with quite a bit, and again, I usually get a fairly strong reaction from women with this one, is the stimulus control, because here is where we are trying to reassociate the bed with sleep or sex, And, again, in perimenopause, it might not be as much sex, but we wanna associate the bed with sleep at least, not stress. So what happens is if we are laying awake for any period of time, we start thinking, we start scrolling. And when we start thinking, if we're not sleeping, it's not usually helpful thoughts. It's why aren't I sleeping? Oh my gosh. Tomorrow is gonna be a horrible day. I've got an important presentation to give, you know. I know if I don't get enough sleep that I'm just a wreck. I haven't slept in two or three nights. Like, you know, what's going on something that long last week to my
Speaker 0
kid's teacher. Yeah.
Speaker 2
And by the way, here's a list of all the reasons why I'm the worst parent in the world. And you know what? Why don't we bring up a mistake we made three years ago just to make it interesting? Fair. Yeah. Your thoughts are not going to good places. Correct. So your brain starts to link the bed then with alertness, with wakefulness. So CBTI, again, gently, we're trying to interrupt this patterns, because in perimenopause, the three AM cortisol spike is real. So we know that hormones and cortisol, depending on the time of year and the time change, AM, there's a natural spike. So this is normal to wake at this time. It's just not maybe normal to stay awake. So the hormones are actually what's causing the awake, but it is your brain that, keeps you awake. So the CBT I is gonna address what's keeping you awake.
Speaker 0
So would it be fair to say then, if I'm understanding you correctly, so in in a regular sleep pattern, any human, they're gonna have that cortisol spike around two or three AM. The problem is in perimenopause because your hormones are playing, you know, whack a mole or whatever jumping around all over the place. That becomes an exacerbated cortisol. Exactly.
Speaker 2
Exactly. Exacerbated Absolutely. Exacerbated hormone fluctuations. They rise at that time. The body wakes, but the mind panics. So the thing with, the stimulus control where I usually get the the big, like, wait wait wait, is we don't want you to associate the bed with wakefulness. So after fifteen minutes, if you are still awake, you need to get up.
Speaker 1
I don't even wanna hear it.
Speaker 2
I know. I'm so this is like, I told you, women I do not for anybody but women in no. And even with myself, I'm like, no. It's I don't wanna get there. It's cold. It's dark. Bed is so nice. No. We need to get up out of bed. And then we need to go and do something that is, you know, slightly interesting but not stimulating because we want a certain amount of boredom. We want you to do something like reading, maybe listening to some music, even some different yoga poses that you know, you can go on YouTube and just search, like, yoga poses for sleepiness or, you know, drowsiness, do a couple of yoga poses, something that's not going to, you know, completely wake you up and stimulate you. And then when you start to get sleepy, you go back to bed again. But fifteen minutes later, if you went out of sleep, you gotta get up.
Speaker 0
We
Speaker 1
don't want you
Speaker 2
yeah. We don't want the brain to start associating that this is the place where we don't sleep. So you gotta get up again. This won't go on forever. No. I'm not. I'm not. You.
Speaker 1
Seriously? Like, so so Seriously,
Speaker 2
it won't go on.
Speaker 1
It'd be a couple nights, so I might be out of bed more than I'm in bed after two AM?
Speaker 2
That's right.
Speaker 1
Yeah.
Speaker 2
Yes. Yeah. And it does like we said, it doesn't go on forever. I know it feels like it at the time, and this is when probably maybe the next little bit that I'm gonna talk about sort of comes in, where we're talking about our thoughts and how we view our sleep. But it is hard, I think, to sort of wrap your brain around that. It seems counterintuitive that I'm trying to sleep, but I've gotta get out of bed to do that. It does work, but Okay. It's not the fun one. I will say with CBTI, there is a little bit of a commitment. So first of all, like I said, there's gonna be a couple of weeks where maybe you're, keeping a sleep diary so we can see exactly what's going on for you. And then there is going to be experimentation, and some of them might not be completely comfortable. Like I said, it's cold. I don't wanna get up out of bed. I don't wanna go downstairs. You know? But I promise you, we're experimenting so that we can find something that works for you.
Speaker 1
Okay.
Speaker 2
Carry on. It's carry on away from the the not so fun ones. So the next one is the cognitive restructuring, and this is sort of very similar to what we would see in traditional CBT where we're working with the thoughts that fuel whatever is going on, in this case, that fuel insomnia. So I've already mentioned, like, what tends to happen is we're awake and we go, if I don't sleep tomorrow, it will be a disaster. And we're trying to replace these thoughts with more accurate calming truths. Because saying something like tomorrow will be a disaster, that's what we call a cognitive distortion. You might be tired, but it doesn't mean the day is going to be a disaster. We've all had days when we're tired, but it doesn't necessarily mean that that's a bad day. It just might mean that we're tired, more tired than usual. Might mean that we have a little bit more brain fog, which we see in perimenopause, and sleep is a big part of that. Doesn't necessarily mean disaster. So these are sort of the common things we have, like, I'm broken. Something's wrong with my hormones. If there's one thing that women can take away is that your sleep isn't broken, and neither are you. It's just that you're going. Yeah. I mean, insomnia is learned. It might be driven by hormones. That's why I said the hormones might trigger the sleep disruption. We're looking at what is keeping that sleep disruption going. So insomnia is kind of learned by the brain, so it can be unlearned even in perimenopause. So if you take nothing else away from the podcast, take that. You're not broken, and your sleep isn't broken, It's going to be okay. But it may take some time and and some patience and, like we said, a little bit of a commitment. Yeah. So working on all of those thoughts. And like we said, those thoughts aren't great in the middle of the night. This is not a good time.
Speaker 1
So if I'm having that thought, how do I put the brakes on it? And is it putting a new thought in my like, do I go to bed with a mantra that if I wake up, this is what I'm going to think instead? Or
Speaker 2
Yeah. So, what what I like people to do first is part of what we do in CBTI is a little bit of sleep education. Because the first thing I think is, like, when we were talking about this this natural rise in the hormones, when people understand a little bit of the physiology, that can even take away a little bit of the anxious thought about why am I awake, what's going on. So sleep education, when women learn that waking at night is normal, that alone can lower that anxiety. Sleep sleep changes happen across our our lifespan, and insomnia is actually maintained by the fear of wakefulness, not the wakefulness itself. So the first thing we might do is a little bit of education. So when you're waking up, you understand that your body is naturally waking up at this time because of this reason. So we're normalizing that for you. Waking is common. Waking in perimenopause at this time is common. It's not necessarily insomnia. And then we want to identify the loop. So like I said, what are the thoughts that are coming up? I woke up. I checked the time. I panicked. Now I'm awake. Now I'm sort of reinforcing that loop. Absolutely no clock watching. No clocks near the bed. No phone near the bed. If you need to use it for an alarm, turn it over. Because, again, what happens is we, we pick up our phone and we go, oh, gosh. It's three o'clock. Okay. If I go to sleep now, I'll get four hours of sleep. That'll be fine. We're awake half an hour later. Okay. If I just shut my eyes and go to bed now, I get three and a half hours of sleep. And inevitably, what happens is it's two hours later. It's three hours later. It's it's three and a half hours later. Well, I might as well just get up. So it doesn't matter if you have three hours until you get up or ten minutes until you get up. We wanna retrain the brain to get back to sleep, so no looking at the clock. Turn the clock around, cover it up, put your phone across the other side of the room. Because if your alarm does go off, if that's what you're using it for, it's actually better to and this is, again, uncomfortable. I know. Get out of bed to turn it off because if you hit the snooze because you're tired and you go back to sleep, we're not increasing the sleep efficiency. Fair. So no clocks. Okay. Alright. And then we're looking to interrupt the cycle, and we can do that with, a couple of the things that, like you said, that these are the components that make up CBT I. One of them you mentioned was the relaxation training. And so it's not that's not necessarily about, like, calming down harder, but regulating our nervous system. Because, again, we know in perimenopause, those fluctuations in estrogen mean that we have this sort of heightened, you know, anxious response. For sleep, we need to have the parasympathetic system turned on. We call that the rest and digest stage. And so how do you do that? Well, maybe it's better to talk about how don't you do that. Googling googling symptoms in the middle of the night is not going to do it. Looking at the clock every five minutes and going, oh, I'm still awake, not going to do it. Rehearsing mentally what your next day is going to look like, probably not going to do it. So what kinds of things do we work on to help you with that? So and this might be a bit of a personal preference. Some people really like guided imagery, and there are lots of apps that you can use for that that are just a really nice gentle, you know, guided kind of, you know, you're by the beach or wherever is a nice calm place that you feel like. Some people use imagery. We teach them how to do sort of imagery on their own and ground themselves with sort of body based grounding, so we're we're tapping into all of the senses. Different kinds of paced breathing. And it sounds a little bit sort of counterintuitive because a lot of women have hot flashes at night. Mhmm. But if your hands and feet, your periphery are warm, that can be really calming. So even if you have nothing on the rest of you, even just your hands and feet being warm can be really nice and calming. And then cognitive shuffling. And this one you can use if you're actually out of bed as well. If you're looking for something that's sort of, you know, mildly interesting, but you have no emotional attachment to it because we don't wanna start having that nervous system response Mhmm. We use something called cognitive shuffling. There's a couple of different ways you can do this. The one I like the best is you choose just, random object that you have no attachment to. So let's just say an apple. And then you start with the first letter a, and you just start naming in your head anything you can think of that starts with an a. Aardvark, Ents, airplane, whatever it is that you can think of, and then you move on to the p, and then you move on to the next p, and then you move on to the l, and then you move on to the e. Right?
Speaker 1
And, hopefully, by the time you get to the second p yourself.
Speaker 2
Hopefully, you're so bored. You're just like, yeah. This is this is not fun. I'm going to bed. If it doesn't you know, if if you need to go to another word, hey. Go to the next word, and you pick something else, like, I don't know, you know, constantly start with the yeah. Something that you you don't have any kind of, like, that's not going to get you. You know, if my husband picked the oilers and the oilers happened to lose that night, don't pick, like, the oilers because now you're getting worked. Up.
Speaker 1
So can I ask you? So so first relaxation techniques that you mentioned, we should be doing that in bed, those fifteen minutes while we're trying
Speaker 2
Yes.
Speaker 1
To get back to sleep. And then if if it they don't work, we get out of bed and we do
Speaker 2
Out of bed.
Speaker 1
Cognitive free what did you call cognitive Cognitive shuffling. Shuffling. Shuffling. So that's Yeah.
Speaker 2
So you're literally when when you is shuffling through images and, you know, if I said apple, I mean, the first thing that happens is you picture an apple. When your mind is shuffling through those images that we said don't have sort of any emotional attachment, it can't worry at the same time. That's not how our brains work. We can't just stop thinking. You're thinking twenty four seven even when you are asleep, and our brains don't work in the negative. So if we just say, don't think about that. This is not the time to think about that. Like, don't think about that. We think about it.
Speaker 1
So I can use this, though, like, just if I'm anxious in general. Like, this doesn't have to be Yes. I've never Yes.
Speaker 2
Like we said, these are very, very similar approaches and techniques that we use in more traditional cognitive behavioral therapy. When we're working with women who may have the heightened anxious thoughts in perimenopause or just in general, these are very, very similar techniques. Breathing, breath work is probably one of the first things that we put in place. Yeah. And, again, there's lots of different kinds of breath work. I like the diaphragmatic breathing or the belly breathing. You might hear it be called belly breathing. Mostly because there's lots of research behind that type of breathing that says if you utilize it, you practice it, you put it in place, it's actually very, very effective in switching on the parasympathetic nervous system and calming yourself down. Yes. So, yes, you wanna do one of these things, fifteen minutes. If no sleep, get out of bed, dim lights, boring activity, and then back to bed when sleeping.
Speaker 1
Can it still be blackout? Can I do I have to put lights on?
Speaker 2
No. You don't have to put a light on if you're comfortable kinda walking around. You're not gonna, you know, fall over in the middle of the night and and kind of hurt yourself or something like that.
Speaker 1
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Speaker 0
Go to this is perimenopause dot com to subscribe and join the thousands of women who have realized they need and deserve better. I think for, maybe for my fellow type a listeners out there, you touched just touched on something in the context of practicing breathing. And Yeah. So that was a big struggle for me in terms of relaxation techniques because I didn't at the time, this is, you know, ten years ago now, really understand how to build a habit. And so I would try relaxation breathing, but in the height of when I needed it, which is not the time. And then I'd be frustrated because it wasn't working.
Speaker 1
Mhmm.
Speaker 0
And Yeah. It actually ended up contributing to my anxiety spiral. So just I think you you mentioned practice somewhere in there and that really tweet
Speaker 1
like Yes.
Speaker 0
You know? Yes. I I joke that I hate meditating, and I don't really but it's it's a legacy thing for me where I'm like, well, I tried it. I can't do this, you know, that whole type a. If I'm not good at it way, then I'm just not good at it. But you you it's good to practice these things during the day before you're in your stress spiral at night and awake and it's dark and and I I just hot tip from me to you. Yes. That will pay off. Yeah.
Speaker 2
Yes. And so, yes, whenever I'm working with someone that's having anxious thoughts and we're putting sort of, you know, some breath work into place to, help with the body responses that come up with anxious thoughts. If we're going through something like, let's say, diaphragmatic breathing and the other reason I like this one is because it doesn't ask you to hold the breath. I think when you're having an anxious thought, asking someone to hold the breath for something like I know a lot of people like box breathing. I don't think that's always helpful if you're spiraling a little bit with thoughts. We're trying to calm the body, and and holding the breath can feel, a little bit stressful. And so, yes, the first thing I will tell them is you need to probably practice it four times a day. I would ask you to practice it when you first wake up, maybe at lunch or some kind of natural break in the day, in the afternoon if you have a little bit of time, and it only has to be a couple of minutes at a time. And then when you're going to bed so there's there's two ways that this helps. Like you said, first of all, it starts to train your brain that this is how we calm you down. This is how we calm down. And it's sort of like when when you've done a sport for a long time or you do something in the gym, some kind of activity, and you've been away for a little while, and you go back to it, and your body just remembers how to do it. It's exactly the same with breathing. When your body and your brain learn, this is how we calm ourselves down, then what happens is if you are having anxious thoughts, anxious body response, and you start the breathing, your body remembers. Says, oh, yeah. That's right. This is how I calm myself down. The other part is some of the research shows that something like diaphragmatic breathing when it's practiced long term consistently day in day out, it can, prevent having the body response in the first place. So it's kind of a twofold benefit that you get from something like that. But yeah. And as far as meditation, I'm actually not very good at med like, traditional meditation myself. So but I think people think you have to sit there and sort of, you know, chant something or have this mantra or whatever it is. I would say things like vacuuming. For me, that is it sounds ridiculous, but it's meditative because it is, a repetitive movement. You're not necessarily having to concentrate your thoughts on it. Walking can be meditative. Washing the dishes can be meditative. Things like coloring or painting, any of those things where it's just sort of that repetitive moment, that that's meditation. I think people are already doing it. They just don't really realize it. But, yeah, if it's work no problem. And then the last part of the CBT eye is the sleep hygiene. And I think most people are fairly familiar with, you know, sleep hygiene and and the things that you should have in place for a good night's rest, like, you know, a dark room, a cooler room. Now in perimenopause, and I will say, my poor husband has to live with this. I literally have the heat off and the window open in the winter and deal with it because I have to have freezing. It has to be freezing. You just add a blanket or something, but I I have to be freezing. So people know, yes, going to bed at the same time, waking up at the same time, having a gentle wind down routine at night, maybe warming the body for a certain time before you go to sleep, like having a shower or a bath or, you know, some kind of heating pad because when you cool the body down, you get nice and sleepy, you know, not eating too much before you go to bed. So those kinds of things, I think people are fairly familiar with. But, again, when we're working with someone who's experiencing symptoms as a result of perimenopause, we're going to include probably a few different strategies. So temperature regulation is going to look a little bit different because we know that, you know, hot flashes that happen at night, the night sweats, really interfere with sleep. So do you have sheets that are cooling sheets maybe? Are you really cooling down the room? Do you have sleepwear that might be a little bit more cooling? Can you leave changes of sleepwear beside the bed? Do you have water? Do you have a cooling pack so that you can if you need to get changed, get changed, you know, get yourself comfortable, get back to sleep? This is another one that we all don't like to hear about alcohol timing is a little bit more important in perimenopause. I know, and most women know, if you drink wine, you probably are going to have a heart flash at night. Like, I I know that. So I have to sort of be aware of that. If I'm choosing to have wine, I'm choosing to have a hot flash at night. That's the way it is for me. But alcohol timing might be something that we look at if your sleep is being disrupted.
Speaker 1
I love that you said alcohol timing and not, like, taking it out.
Speaker 2
No. No. We're not taking that away from anybody. Please. Please. No. We're not taking it away. But, yeah, it might be the timing or, you know, when we talked about sort of some of the cognitive restructuring and the thoughts, I I have accepted that this might happen. And so I'm preparing myself for that a little bit, that I've got things in place because I may have a hot flash if I choose to have a glass of wine and it's dinner time. I'm not advocating day drinking.
Speaker 1
Oh, but day drinking is
Speaker 2
the absolute best. It's the best. Just drink at two o'clock and then you're good. I know.
Speaker 1
Yeah. Or brunch.
Speaker 2
And then you're Even
Speaker 1
brunch. I mean, stop. Yeah. Let's do breakfast. In the morning.
Speaker 0
With a tequila and your Caesar or Bloody Mary.
Speaker 2
Yeah. Do your first date.
Speaker 1
Drink if you don't start at breakfast. I mean, honestly. No.
Speaker 2
It's fun.
Speaker 1
Yeah. So how how, like, how long does it take to start seeing some of the results of CBC?
Speaker 2
So, again, like we said, it's a little bit of a commitment. Most people I work with will start to see some benefit within two to four weeks with continued gains, I would say, over six to eight weeks. And we're continually tweaking things, but it's not sort of a one and done. It's not like, you know, you said, well, I tried breathing. It didn't work. We're asking you to try it for a certain period of time and kinda run that experiment, Use your sleep diary. What changed? What didn't change? We're coming back. Okay. Now let's try maybe something like this. Put that in place for a little while. So it is a little bit of a time, but, Yeah. Some people in two to four weeks will say, you know, I'm I'm already seeing some benefit.
Speaker 1
And seeing some benefit means, like, at what point do I get to sleep through the night again? Like, is that is that ever a possibility again?
Speaker 2
Yeah. Absolutely. Yeah. Absolutely. It's a possibility again. Everybody's perimenopause, menopause journey is a little bit different. Some women have no hot flashes. Some women have hot flashes for several years. Some women have hot flashes for years and years and years. So it may be that you, still have a bit of disrupted sleep, but you can get back to sleep really quickly. Like, you you've worked with yourself enough to know it's okay. I can get back to sleep. I think it depends what's going on with you and what else is going on in your life, other health issues. So it's it is a little bit individualized. But, yes, I think it's possible to have good sleep efficiency.
Speaker 1
Could we maybe
Speaker 0
do a so, ten years ago, I started waking up at two AM, and a frying pan couldn't get me back to sleep at that point. I was just so wired and frustrated, and it was awful. And I think that's probably not uncommon. I know it's not uncommon in in perimenopause, especially, you know, there's more, you know, in the menopause community, there's a recognition now that that sleep disruption sleep disruption is often the initial symptom even long before other things like period changes and or hot flashes and or more traditional symptoms start kicking in. I'd say that and probably in my experience also the anxiety. Could you walk us through, you know, I've come to see you. I'm Yeah. Desperate. I haven't slept properly in a long time, and I two AM was my magic hour. It was like clockwork. Like
Speaker 2
Yeah. Yeah. Between two
Speaker 0
and two zero two AM, I was awake. What do you what is your what would you counsel me to do?
Speaker 2
Yeah. I mean, first of all, I, at at clinic, which is Coven Women's Health, we're a a virtual online clinic that offers really multidisciplinary approach to supporting women with hormone health. So not just perimenopause, might be PCOS, you know, might be post cancer, but we take, a very holistic view. So we we're going to do a very, very good workup to sort of make sure that it is what you think it is. I mean, we wanna make sure that physically, you know, we're not missing anything for you. Mhmm. So it might be ordering some blood work for you. It might be talking about other things that you've got going on that might be physiological. And then, you know, yes, if you, if we found that hormone therapy was a good fit for you, it could be that you start hormone therapy. And, you know, some people will say to me, well, if it's if I just take hormones, won't that won't that just stop everything? And I think these things work really well together. So Mhmm. The hormones, like I said, are going to treat that biological, but CBTI treats the relationship with your brain and sleep. Because by then, you may have learned that I'm awake. I'm not getting back to sleep.
Speaker 0
Sedan is in is there. And I think you touched on earlier, and and maybe you could remind us what you said. But it was that the it's not it's not the insomnia. That's the insomnia isn't keeping you awake. Or what was it that you said? It was really good, and now I can't remember it.
Speaker 1
It was
Speaker 2
just Probably can't remember it.
Speaker 0
Yeah. But but essentially Not not. Yeah. Oh, dear. Yeah.
Speaker 2
Yeah. What happens when This is like a joke for the hormones. The hormones, like, I think I said something like I think I said, like, the hormones will trigger the fluctuation in hormones trigger the sleep disruption, and the CBTI address is what keeps it going. Sorry. That that's the
Speaker 0
key thing. Yeah. So the hormones can alleviate that boom, you know, feeling like you're gonna bounce out of bed or that Yes. That that exacerbated cortisol Yes. Response, if you want
Speaker 2
to know more. That's right.
Speaker 0
But Yeah. The CBTI so, yeah, it's not again, back to we always say, it's not one thing. You need an extensive toolkit. So please continue. I've I've interrupted you.
Speaker 2
No. No. No. No. That's okay. That that's a very good point. Because someone will say, yeah. If I just take the hormones, wouldn't it be better? And, yes, sometimes that will be enough. Some women will take the hormones and find that some symptoms are improved, but sleep issues or disruption keeps happening for a variety of reasons. And then some women, like myself, are not appropriate for hormone therapy, and so we need to put other things in place. If you came to see me, you know, like I said, first of all, I'm going to sort of ask you to keep a sleep diary so I can see exactly what's going on. But also, I like to take, like, a bio psychosocial approach when I'm working with women. So, yes, physically, what's going on for you? Not just perimenopause, but what else is going on? Like, some women, you know, we've got aging parents. Maybe we've got children growing up and leaving home or in adolescence. We've got relationships. Maybe we've got a partner sleeping next to us that's snoring. There's all kinds of things going on in our lives that can also impact sleep. So, we're gonna be looking at all of those things and other psychological things as well. It could be that you have a history of low mood. It could be that you have a history of anxious thoughts. What else is going on for you? Because it's not just about kind of working on one thing. We might be this might be the priority. You might start with sleep, and that might influence other things, But we're also gonna be maybe working through some of those other things as well, and hopefully, they work together to kind of improve both of those things or three of those things for you. So it is quite in-depth, and I will say a coven when you do an intake with our health coach, it is very, very in-depth. We wanna work out exactly what your goals and your needs are and how we can kind of serve you best.
Speaker 1
And is it, like, a six month program or, like, a is it one off visits, or how does that all work?
Speaker 2
Yeah. So you I think what makes us different is I mean, first of all, our medical director is doctor Michelle Jacobson, who is Mhmm. Amazing. And she's a rock star Yes. And just so wonderful to work with. Just amazing. And so you know that you're getting, like, the very, very best Care. Best care as far as your hormone health. Our other differentiator is you're matched with a health and so after that intake, they're going to be saying, these are the programs that we suggest. So it could be, you know, the hormone health program. And as part of that, you're going to meet with Dominique, and she's going to start you with some CBT I. We have a dietitian on staff, so it could be even looking at your caffeine intake, your alcohol intake, all of those things that might be, you know, interrupting your sleep as well. So we have a variety of programs. Again, it's a little bit individualized. You can choose a preexisting program, which might be sexual health or weight management or hormone health, or, yes, you can book with one of our practitioners in in one off.
Speaker 1
That's awesome. And and is it Ontario specific, your practice?
Speaker 2
Right now, it's Ontario specific, but we're hoping in the near future to make that maybe Canada wide or maybe even beyond that, which would be really exciting.
Speaker 0
Yeah. Yes, please.
Speaker 1
And so if I can't get to Kevin Mhmm. And to you, what kind of practitioner am I looking for to help me with my CBT I?
Speaker 2
Yes. So you wanna make sure that someone is trained in cognitive behavioral therapy. And, hopefully, on their profile, they're going to say that they're also trained in CBTI, which is a little bit of additional training. Do they have to be trained as a perimenopause practitioner? No. But then, I mean, I'm a little biased because this is what I do, but I think it's really helpful when they have a good understanding of what someone is dealing with in perimenopause because, again, I said, you know, it's a little bit of a different approach. We're going to be, you know, not maybe being as forceful with sleep restriction, compression. Yeah. We're going to be, you know, looking at gentle movement throughout the day, you know, to see that, you know, if we can sort of get you feeling good and sleepy. Light exposure might be something that we do a little bit differently, the alcohol timing and the temperature regulation strategies. Yeah. So it really is helpful if someone has that as well.
Speaker 1
And when you say that, do
Speaker 2
you mean menopause society certified? Necessarily. You know, usually, they will have on their profile if they work with perimenopausal women specifically. So I'm not even sure if there's a designation of a therapist. There may be. But, you know, I've had some additional training with perimenopausal women, and usually, they will have that in their profile. But these are the kinds of things most therapists will have, you know, a fifteen minute free meet and greet. So these are the kinds of questions that you can ask them ahead of time and just sort of say, this is what I'm experiencing. Is this something that you feel comfortable addressing? And see if you're a good fit. Yeah. I was also gonna say there's some really good apps, on CBTI, and some people find those really helpful. They'll have tools on there, you know, with the guided imagery or visualization, maybe the cognitive shuffling or some of the meditation things, you know, some of the, strategies like getting out of bed. They'll have sleep diaries and things like that. So, you know, you might be able to find a a good free app as well.
Speaker 1
In customer service, I mean I
Speaker 2
do have one on my iPad actually, and it's called CBTI Coach. Coach. And this one has sleep diary tools, assessments, and some resources. So that's that's one that I will sometimes give to people and say, hey. If you if you like kind of to be on your phone or your iPad for your sleep diary, you can use this electronic one. It's, you know, there's probably some paid extras on there, but you can start with it in a in the free form and go from there.
Speaker 1
Thank you. That's a great recommendation. Yeah. And we will include that in the show notes as well. Mental note, Miguel.
Speaker 0
I've written it down. No mental notes. Longer work. No longer work. This has been amazing, Dominique. Thank you
Speaker 1
so much.
Speaker 0
You're welcome.
Speaker 2
You're welcome.
Speaker 0
You kind of alluded or you'd actually outright stated earlier, you know, if there's one thing you take away from this podcast, but maybe we'll have you reiterate or give you the opportunity to answer in a more fulsome manner. What's the one thing you want every woman who's been struggling with their sleep
Speaker 2
to know about CBT I? I I would say that CBT I can help even if you've been struggling for years. It works by retraining the brain and the nervous system to feel safe while you're sleeping again, and a lot of women think insomnia is permanent. It's not. So please please please get the help. It's so important that you sleep well. It's so important. Thank you. Thank you.
Speaker 0
Hey. Thanks so much for listening to the show.
Speaker 2
If you like what you hear, please subscribe and write a review.
Speaker 1
So more women can find us and get a better understanding of what to expect in perimenopause.
Speaker 0
This information is not intended as medical advice. The intent of this information is to provide the listener with knowledge to support more efficient and effective communication with their medical provider.
