Episode Transcript
Speaker 0
Ladies, hold on to your hats because we have some super exciting news. Today, we are kicking off a brand new initiative here at This Is Perimenopause called reclaim your rest with Endy.
Speaker 1
So many women struggle with sleep issues and disturbances during perimenopause, and it's often one of the first symptoms. But it's so insidious that we don't even recognize what's going on and neither do most of our medical provider.
Speaker 0
Which is why we're tackling these issues head on and giving our listeners the information they need to reclaim their rest. And who better to partner with than Endy, Canada's leading online mattress.
Speaker 1
Our reclaim your rest with ND series will feature a variety of experts on topics like how sleep impacts your health span, the connection between sleep and muscle recovery, and tools like CBTI. You're not gonna wanna miss a single episode.
Speaker 0
And while you're listening, make sure you stay tuned until the end of each episode because we've got a big giveaway coming as part of this series. And I don't wanna spoil the surprise, but it is going to be awesome.
Speaker 1
We're kicking things off with one of our favorite guests, doctor Jennifer Zelovitsky, the clinical director of women's health and vitality at MedCan. For our listeners who don't know doctor Jen or her MedCan program, it's an incredible six month evidence based program dedicated to personalized care for menopause and perimenopause to help women feel their
Speaker 0
best. Today, we're talking with doctor Jen about identifying the root causes of your sleep issues to help you reclaim your rest.
Speaker 1
Because if you're not sleeping, nothing else is working. This is perimenopause.
Speaker 0
And before we get into today's episode, here's a quick word from our new sponsor.
Speaker 1
This episode is brought to you by Indi, Canada's leading online mattress brand trusted by over one million sleepers. Let's talk about sleep because there's nothing more essential than a good mattress to wake up feeling your best. And these mattresses are designed to keep you cool and supported all night long so you wake up feeling refreshed and ready to take on your day. With three comfort options, plush, medium firm, and firm, you can find the perfect fit for your body and sleep style. And the best part, Endy delivers straight to your door, so upgrading your sleep is simpler than ever. Check them out at Endy dot com. That's e n d y dot com.
Speaker 0
Doctor Jen, we are huge fans of you and your approach with perimenopause care as you know. So today, we want to talk to you a little bit about sleep. And I think that every woman going through perimenopause can, attest to the fact that their sleep has changed in some way or form. And, so when people come into your clinic and they've that that, you know, they're suffering maybe from some symptoms, is sleep one of the first things you tackle?
Speaker 2
Yes. And I think this has been an evolution for me as I've spoken to more women and as I've learned and and heard their stories and really worked through symptoms with them is that I will now start by saying, tell me what a typical night looks like for you.
Speaker 0
Oh, serious? Okay.
Speaker 2
Yes. Sleep is now widely ex or becoming more widely accepted, in the menopause community as really the tip of the iceberg when it comes to the menopause transition. Sleep sometimes goes off the rails even before your periods start to change.
Speaker 0
Yeah. For sure.
Speaker 2
Right? It's some it can be the very first or the cardinal symptom, and we can't ignore it because so much of the other things that come up with menopause and the menopause transition flow from the tip of that iceberg. Right? So if we don't get your sleep right, nothing else is really gonna be falling into place. And that makes it sound simple, but it's not a simple problem to solve.
Speaker 0
No. For sure. We were just talking yesterday with, our last week with a personal trainer, and he was saying we were talking about physical and nutrition and but sleep was still one of the, like, the penultimate things that we need to have under control in order for the rest of everything else to kinda flow properly.
Speaker 2
For sure. And, also, I mean, all there's been a lot of talk and a lot of controversy about perimenopause and the risk of cardiovascular disease and dementia and, you know, some implication that maybe hormone therapy can prevent those things. And the truth is there's some evidence out there that hormone therapy in and of itself can help prevent, you know, bad health outcomes, but, really, it's more the sleep aspect. So if hormone therapy happens to be what cures your sleep disturbances, whatever it is that cures your sleep disturbances, women who sleep better stay healthier later in life. And so I think it's really that connection there. So for some women, it might be the hormone therapy. But whatever it is, and we're gonna talk about a whole bunch of different possibilities. Whatever it is that remedies your sleep is then gonna unlock that future of good health for you.
Speaker 1
So maybe can we get into some different approaches? You know, what what medications, you know, work with what issues. I mean, is that is that a thing? Like, certain depending on what the sleep issue is will determine where you start in terms of medication or approaches.
Speaker 2
Right. So first, I will usually tease out, are you having trouble falling asleep or staying asleep or both? Mhmm. Are you waking up multiple times during the night? And if so, why? Sometimes they can tell me exactly why they're waking up. Right? Like, I'm sweating. I'm soaking the bed. I have to change my pajamas. I have to throw the covers off. Okay? Sometimes it's I'm snoring, or I wake up feeling like I stopped breathing. Okay? Well, that might be something entirely different. Or I really can't fall asleep. My brain just goes and goes. I worry about crazy things. I have a great example of this from myself the other night. I lay in bed worrying in the middle of the night about whether I should be taking my own garment bags to the dry cleaners so I didn't have to get plastic bags around my clothes. I think I can worry about this sometime other than three AM.
Speaker 0
But How long did you stay up doing that? Reminisce.
Speaker 2
I I look. I do this for a living, so it was brief. I was like, we can do this we can do this tomorrow. This isn't a three AM problem, but or, you know, sometimes it's your dog won't. My I have three dogs. Like, sometimes my dogs just wake me up, and there's nothing really I can do much about that except try to control my environment. Restless legs. That's another great one. Well, my legs won't stop kicking, and I I'm I'm having trouble. Sometimes it's major stressors. So we we try to tease it out, but often by finding out is it falling asleep or staying asleep, we can get we can kind of get started down one road or the other because a true menopause transition sleep disturbance is typically a story like, I have no trouble falling asleep. I can't wait to get into bed and fall asleep, but then I wake up over and over, or I wake up at two AM, and there's nothing I could do. I'm always waking up at two AM, and then I'm up for hours. Right? Yeah. So that's a more classic, situation where it's perimenopause. But, of course, there are non perimenopause related reasons a woman can be having sleep disturbances, and we really wanna get to the root of it, because you don't wanna assume. Right? Just because a woman is in her forties and she's having irregular periods or whatever, you don't wanna assume that's the only thing going on or that's you know, there's nothing else that could potentially be impacting her ability to sleep. So it's really important to tease all of that out.
Speaker 1
So, two AM wake up, that was me, losing my freaking mind because I also was, I had a bout of insomnia in my twenties, and I went to sleep school in my twenties. So I was a like, I was ahead of the curve on the sleep hygiene thing. I can actually be in the bedroom sleeping with my phone, and I can pick it up to turn off an alarm or whatever and not actually look at the time. Like, I'm I'm very well trained. All that to say, two AM would roll around in my early forties, and I was awake and, like, not just awake, like, plugged into an electrical socket, awake. Awake. So what do you do for that? What is your when it's not when you've teased out all the other things, you're like, okay. No. This is a classic. Your hormones are wreaking havoc. What do you do?
Speaker 2
So a patient coined that for me as tired wired. She's had no other way to describe it. It's just I'm tired wired. I'm exhausted, but my brain won't let me sleep.
Speaker 1
Yep.
Speaker 2
So then I I first I always think about the the various different things that could be going on and probably are going in in that on in that woman's mind. So you very wisely said, I know the difference between insomnia, which is typically more characterized by having trouble falling asleep or waking up early and just completely up for the rest of the night. And that is that can be, remedied by a combination of things like sleep hygiene, CBT for insomnia, which is a multifaceted approach, sleep restriction, those types of things. And there is a small subset of women in perimenopause who truly have primary insomnia, but more often, it's the other thing. It's the I wake up at two AM. So I really get into whether they're actually having vasomotor symptoms. And women are great at underplaying this or comparing it or thinking I had someone yesterday. It was such a great story. She ranked her night sweats as mild. And then when we really talked about it, it was the typical story of, well, yeah, I'm not, like, soaking the bed. My husband sleeps in a separate room now, and I've stopped wearing pajamas. And the fan has to be on at all times. Right? And I'll throw my blankets off, but I don't have night sweats. And I said, okay. I'm going to respect respectfully upgrade your vasomotor symptoms to moderate severe, if if you're okay with that. I mean, the truth is it doesn't really matter because I there's an amazing study, a graph I love to show at all my talks that's, it shows the impact on sleep and daytime productivity of hot flashes or vadar vasomotor symptoms regardless of whether they're mild, moderate, or severe. So even though the guidelines say, oh, only moderate or severe should get hormone therapy, mild hot flashes at night, mild temperature dysregulation at night has the same impact on daytime productivity and sleep disturbance as severe ones. And in fact, there are studies that show that women who weren't even aware of their vasomotor symptoms. So they there were objective monitors they wore that showed if they had a a hot flash at night. They didn't even have to be aware of it, but they would still be having WASO, which is wakefulness after sleep onset, set, which is, like, the fancy. It sounds like a jujitsu term, but it's like, I I it's a term for those waking up for no reason. So that's one. We have to make sure.
Speaker 0
But I'm sorry. And I would tell you that I've never had a night sweat or whatever, but what you just described, I'm like, no. I I kick off I now sleep in boxer shorts and a tank top and leg warmers because I get jumpy legs. And and then I but I kick all the blanket. But I would tell you I've never I've never had an yeah.
Speaker 2
Oh, it's Sometimes now I I I'm trying to, like, correct the terminology and be like temperature dysregulation. Because if you say to a woman, do you have temperature dysregulation? Oh, yeah. Right? So I almost think it's time for a little bit of a a change in the terminology. But the other things that are the other chemicals that are impacting our sleep at night other than the hormones, are or is orexin. So we have this chemical called orexin, which is our wakefulness. It's a wakefulness neurotransmitter, and it, it it it is suppressed by estrogen. So I think of estrogen as, like, the teacher on the school yard, and she's keeping these kids from, like, bouncing around and jumping on everything. And when the teacher leaves, it's like, woo hoo. We're gonna go crazy now. So the orexin there's more orexin, and then there's orexin receptors in the in the hypothalamus, and they have an interplay also with with temperature. But, predominantly, it's wakefulness. So it's like it it's a it's flooding these receptors. And so, there are medications now, fortunately, that we can talk about that specifically target that, but it can be just pure wakefulness. Fullness. That the the the normal channels, the things that are supposed to be suppressed at night are no longer suppressed. And so it's all bets are off, and you're awake. Serotonin's also a chemical in the brain that can influence our sleep patterns. And this can this can come into play if perhaps you have mood symptoms, of perimenopause or baseline mood symptoms. So women who have anxiety or depression are more likely to have sleep disturbances and vice versa. If you're waking up all the time, it can it can have a negative impact on your mood and cause more anxiety. You know, it's not acceptable for women to go years and years with sleep deprivation. I don't know any human being that could go months or years on end without sleeping well and not be depressed, anxious, irritable, and tired, frankly, just exhausted.
Speaker 1
And yet that is so not that's it's so normalized for people
Speaker 0
to be
Speaker 1
like, I don't sleep.
Speaker 0
And some people wear it as a badge of honor. Oh, yeah. I I yeah. I haven't slept in years. I don't I'm like, oh my god.
Speaker 2
Need more sleep when we reach midlife. I know, how it felt. I used to be okay with five hours, and and I could function really, really well. Those days are over.
Speaker 1
So there there are a variety of medications and, other tools like, cognitive behavioral therapy for insomnia that you use, and you you you target that depending on what the specific issues are.
Speaker 2
Exactly.
Speaker 0
Yeah. Yeah.
Speaker 2
So if if the issue is is, predominantly or partly hormonal, of course, estrogen, if that's appropriate for you, can definitely help settle settle your brain down through multiple channels, but mainly by just turning turning those hot flashes, dialing the temperature dysregulation down. Progesterone, which is often paired with estrogen, also has unique properties in that it does protect the uterus against, you know, irregular bleeding and hypertrophy. But in the brain, it acts on the GABA receptors, which are the relaxation, feel good, antianxiety receptors. So it does help a lot of women's sleep. There was actually a lot of controversy about this at the recent menopause society conference because one of the one of the presenters said, look. The studies do not show that progesterone actually has a positive impact on sleep. And everyone there but everyone there was like, but it does.
Speaker 0
Was this a male was this a male presenting?
Speaker 2
Or He's a he's a really good dog. He's a really he's really an expert. No. He's an expert. But but, you know
Speaker 0
No fair.
Speaker 2
I I don't I don't know why why, for some reason, the studies show mixed mixed results when when we actually treat women. And, yes, it is not always the answer, but for a great number of women, the progesterone really does help them with their sleep. And, it's it's doesn't always work, and that that's where maybe other factors are at play like the orexin receptors. Right? And now we have wonderful medications called DORAS or dual orexin receptor antagonists. What these do is they create a little bit of a blockade at those orexin receptors so that the orexin can't attach to the receptor and and and wake you up and stimulate your your wakefulness. They're very different than traditional sleeping pills, which we can also talk about the harms the potential harms of of those. But they're they're very different in the sense that they are not habit forming, and this is wonderful. And it's what I love to reassure women about. I have a patient from years back who, you know, she got the Sunday night scaries. So every Sunday night, she would take Adora. And she she was doing that for a really long time. She didn't have to take it anymore or any less. She just said, it's perfect. The one night a week that I know I'm not gonna sleep, I take it. And so it was sort of like proof positive for me that you see, this is something that you can take as needed, whether that's every night for a little while or sporadically. Maybe maybe when you have a busy day at work, you have trouble sleeping the night before, but they're specifically targeting the problem. So it's not like a Band Aid solution. It's like we know what the issue is. We know the chemical we're trying to target. Let's target that specifically.
Speaker 1
And is Adora the actual drug, or is that the brand?
Speaker 2
No. There there are there are two there are two types, in Canada that I'm aware of. Lembrexant, which is the trade name Dvigo, and, Deridorexant, which is Quivivik, the weirdest name ever, but it's it's good. It's a good medication. I just hate saying it. It sounds weird.
Speaker 0
Do do I go to my family physician? Like, if I'm getting HT through my OB GYN, do I go to my family physician for this? Or
Speaker 2
Your family physician should be familiar with these medications. They have been around for almost a decade.
Speaker 0
Will I feel groggy groggy in the morning?
Speaker 2
So the the the rule of thumb is typically that you wanna make sure, first of all, that there are no contraindications, and there's only one or two contraindications for this medication. You wanna make sure you can get in about seven hours of sleep. It's not good for, like, a shift work where you're like, I gotta catch a quick four hour nap, then you would wake up feeling groggy. But if you can get seven to eight hours, which is what we wanna be aiming for anyway, it can be a wonderful choice. It can be associated with vivid or disturbing dreams. So in some women, you might experience that, but there's two different ones you can try. So you can play around a little bit with dosing and the specific type. If the dreams are not disturbing, I would say take it as a good thing that you're actually achieving that REM sleep. Right? So it's some of us, we haven't been dreaming for years. We're not achieving deep enough sleep. So suddenly, it's like, oh my goodness. I had this whole crazy dream, and it's like, that's kind of sometimes okay to have a crazy dream.
Speaker 0
I have one last dumb question. Is this something that my husband can take too, or is this female only? Yeah. Yeah. Yeah. Okay.
Speaker 2
We just
Speaker 0
are, like, you're not
Speaker 2
Clears it. I don't wanna get, you know, like,
Speaker 0
if it's
Speaker 2
a yes or no. As long as he clears
Speaker 1
To be clear, doctor Jen is not prescribing this to No. No.
Speaker 0
No. No. But the Internet.
Speaker 2
Corner, and I'll hand out prescription. So it's it's, like, it's for anybody who has trouble. It's one of the safest and most wonderful options for sleep that that we've had in a really long time because most of the other options are terrible. I don't like I don't like prescribing them. And so then other other than that, there can be mood mood related dysfunction and sleep. Depression can happen with or without perimenopause, and one of the main symptoms of depression is is sleep disruption. Early morning wakening or with anxiety, trouble falling asleep. And, in those cases, something like a serotonin, an SSRI or an SNRI might actually be part of or the whole solution. Sometimes in conjunction, I have patients who are on combinations of hormone therapy and Adora or an SSRI and Adora or all three. And we sort of just we have to solve all of those problems to get you sleeping really well.
Speaker 1
And this is why, PSA, from us, you need more than a ten minute appointment to sort through this stuff. Right? It's complex. And there are solutions, but you've gotta parse to your point, doctor Jen. You've gotta parse it out.
Speaker 2
You do. And that's why I really I love explaining to women all of these different facets of sleep because you can go to your doctor and say, you know what? I'm thinking this might be my issue. I've ruled all of these other things out, and I'm really interested in this medication. And if your doctor says, I've never heard of that, say, well, can you go look into it and let me know if you think it's appropriate for me? You might be actually helping your doctor. You're putting a new tool in their toolbox that they didn't have before.
Speaker 1
For sure. I think it's also we're a little naive, especially in a country where we have had free health care for our entire lives, and we're now in a bit of a crunch where that just isn't working the way it once was. But we also have this naive assumption that we can just roll in and that the doctor sitting across from us is magically gonna read our minds and know everything about every ailment on the planet and be able in that short period of time, which they are they are that's how their world is structured. That's how they get paid. Right? It's not it's not them saying it can only be ten minutes. Right? That's how this is funded. To think that they're gonna be able to figure this out is just it's ridiculous. Right? We need to help them.
Speaker 2
Well and they're missing the whole component of it that's perimenopause for the most part. I mean, you're lucky if you have a doctor where that even goes through their mind that your sleep problems could be because of of perimenopause and and and have an understanding of the myriad ways that perimenopause affects the brain and the sleep center. Yep. So that's that's a big ask.
Speaker 1
I have one more question for you, doctor Jin, in terms of things that contribute. So I finally started taking vaginal estrogen and their vag Vagifem, and I couldn't believe within a very short period of time, that's not always the case for everyone as I understand it, but it's a very short period of time. I no longer had urgency. I no longer was leaking if I had a bad cough or I tried to get on a trampoline, which does not happen very often anymore. But you know? Yes. And I stopped having to wake up to pee.
Speaker 0
Like, ever? You never wake up to pee anymore?
Speaker 1
Well, now it's like once in a while. It used to be two or three times a night. Now I'm like, oh, yeah. I didn't get up last night. And, like, is that also a thing?
Speaker 2
Yes. We didn't even work our way down to that, but, yes, of course. And that could be hard to tease out because sometimes women are like, well, I wake up and I have to pee, but I don't know if I wake up because I have to pee or I have to pee because I woke up.
Speaker 1
I, in a million years, would never have said I'm waking up because I have to pee. I would have been I was always like, oh, well, I'm up. I'm gonna pee.
Speaker 2
Yes. So my dog or
Speaker 0
my husband has woken me up because they had to pee. And so now I may as well go pee too.
Speaker 2
Exactly. Saves me the trouble of next time I have to pee. That's a really good point. Vaginal it's not just even, like, having to pee, but it can be vaginal irritation and itchiness, and that can disrupt your sleep. Pain can disrupt your sleep. Oh my gosh. If you I can give you all the hormones in the world, but if you have a frozen shoulder and if you've lived through that kind of pain, forget it. You're not you're not sleeping. Right? And then life stressors. I I wish hormones could fix a divorce or or a job transition or, you know, emptiness syndrome. Yeah.
Speaker 0
Death. Anxious child.
Speaker 2
I wish. And, fortunately, we do go through little, bumps in the road that, you know, can't always be fixed, and we have to sort of then turn to a little bit of sleep hygiene, a little bit of therapy to work through those those issues. But, but, hopefully, we come back around if it's not something such as a true depression, a true anxiety disorder, and and it it tends to be temporary and situational.
Speaker 0
So doctor Jen, what are some of your nonnegotiables when it comes to sleep?
Speaker 2
So for for women in the menopause transition, seven to eight hours. If I'm giving you all the tools, but you're gonna be doomscrolling or or working on your job until
Speaker 1
Which aren't those the same thing most of the time?
Speaker 2
Two. Well, yeah, exactly. Well, it can be two AM and say, well, it doesn't matter. I'm just gonna go to bed at two and wake up at six. I'm then I'm you're just gonna be tired, and you're just not giving yourself the opportunity to get the sleep that you need to feel restored and to avoid brain fog and all of those things that happen when we're not sleeping well. So that's one nonnegotiable. And get and solve it with with the right solution that is how am I gonna put this? Identify the root of the problem, and then solve the root of the problem. And the third is around substances.
Speaker 0
Gotta plug my ears.
Speaker 2
Sorry. I can't help you if you're gonna go have an espresso at ten PM or you're going to have five glasses of wine at eight PM or you're gonna eat dinner at eleven PM. I I I I can give you anything in the world, but I can't be there in your house to to to remind you not to do the things or, like, even the good things, like exercise. Don't exercise an hour before bed, unless it's, like, restorative yoga and it's gonna help you sleep. There are certain things you you really have to do. I can't do them for you. But, really, when it comes to, like, sleep hygiene and do's and don'ts and no phone in the room and no no TV in the room. I think if you're if you're solving the problem and you're reasonable about your sleep hygiene, the rest can the rest you'll sleep no matter what, basically, is what I'm saying. I don't think it's always realistic not to have your phone. It's my alarm clock. Like, what am I supposed to do?
Speaker 0
I want my I wanna know if my son needs me in the middle of the night. Like
Speaker 2
That's the other thing. I have two girls in university. My rare is on it at now at night, and I'm like, I need to be reachable. Some people have a job where they're on call. Like, you don't always have the luxury of those things, but I'm here to tell you from my, you know, firsthand experience. If you've got everything else together, that won't matter.
Speaker 0
Can I ask you? So I've been on HT for a while. It did definitely help with my sleep disturbances. Now for whatever reason, some of it is anxiety for sure. And just like, Sun being at university, and he's having some anxiety issues. And he's the only one in the world, though, of course, that's that's struggling with first year university because anyway. No. They like, they're all going through it, but they they're not talking to each. Each. Anyway, I digress. So I'm curious. Do I anxiety aside because the sleep issues have have reared up before this. Do I then consider tweaking my HT, or do I look at this other sleep pill that you talked about, which I've already forgotten the name of? I'll have
Speaker 2
to go back. Like, what Dual orexin receptor antagonist. Yeah.
Speaker 0
Yeah. So derma.
Speaker 2
I think it depends. Did you if you felt a bump up in your temperature dysregulation.
Speaker 0
Oh, well, a little maybe. Yeah. Maybe.
Speaker 2
That might be why. You might wanna look to, good old relaxation therapies. Mhmm.
Speaker 0
Like We do a lot of breath
Speaker 2
work in the middle of it. Like work, meditation. Those can be extremely helpful tools at bedtime. I like you know, I know you guys know Alana McGinn. So do do you know Alana?
Speaker 0
I know the name, but I'm having trouble.
Speaker 2
Oh, okay. So she's a sleep expert. I thought for some reason, I thought
Speaker 0
you guys are Jan. Is she is that why I know? Alright. She don't With Gina? Is Yes. Yes. That's right. Sorry. Thank you.
Speaker 1
I appreciate it.
Speaker 2
She's on Gina Libby, and, yeah, and I had her on my podcast back in the day. She's a sleep expert. Mhmm. And she has a really good, a really good method, especially for women in this stage of life. And it's like the one hour before bed that you set aside and you divide it by three. So you take your hour before bed. The first twenty minutes, you get ready for the next day. That means putting out your clothes. It means preparing your lunches, but it also means jotting down or putting in your phone a list of all the things you have on your mind that you could potentially worry about during the night. And you say, I've got this now. I've got this documented, so I won't forget anything. And then tomorrow, I can I can look at this if I need to? But for tonight, I'm gonna set this aside and put it away. Yes. The second twenty minutes are getting yourself ready for bed. So all of your rituals, whether it's a shower and then put on all your face creams and get yourself all ready. And the last twenty minutes is just for you. You can do whatever you want. You can read a book. You can meditate. You can stare at the ceiling.
Speaker 0
Mhmm.
Speaker 2
Whatever you wanna do, but it creates this really nice separation between your day and your night, and I found it really, really effective for myself. So that might be very helpful for going through these these situations where it's sort of, like, out of your control. You can't control your son's experience and his anxiety. I can tell you it's really, really normal
Speaker 0
Yeah.
Speaker 2
Especially around midterms.
Speaker 0
And that's when that's when it all erupted. Right?
Speaker 2
Every year they go through this. I mean, my daughter's in fourth year, and she still freaked out two weeks ago. So I I I can reassure you as a mom of a fourth year and a second year, you go this again. Oh, yeah. Okay.
Speaker 0
Great. I was hoping it was a while.
Speaker 2
You know the other side of it. And then I even remind my daughters. I'm like, you know why this is happening. Right? Because it happens every year. And then they're like, I know. I said, and every year you get through it. I know. So it can't make it better in the moment, but it can it can give you perspective that, we've been here before. They have the midterm freak out and you know?
Speaker 0
I can still sleep through this. It's okay. Totally. Thank you.
Speaker 2
I'm here to tell you they all survive it. Yep, definitely. It's a quench, they're being stressed, they're being tested.
Speaker 1
Intentionally, right? Like it's part of the- Intentionally.
Speaker 0
Yeah, mhmm,
Speaker 1
yeah. Yeah. Part of the process. Totally. Are you a good sleeper?
Speaker 2
I I am now. I I think Oh. I went through years, you know, when my kids were little.
Speaker 0
Mhmm.
Speaker 2
I I slept with one eye open, and I, didn't sleep very much, and I didn't sleep very well. And I think we all kind of go through that when our kids are little. I was always sort of, like, more anxious, wired that way. Now I'm a really good sleeper. I have to say we had a number of issues to get through to get there. I, without, like, TMI, I'm like, I'm just I'm just like you. I'm like, I'm a woman who went through a terrible perimenopause. I was having I had a very large fibroid. I had hideously heavy bleeding where my iron was in my in my boots, and I had leg aches and everything from my iron being so low. So I had surgery. I went on iron. I did all the things. Once that was corrected, I started to already feel my sleep improved. But then, of course, temperature dysregulation kicks in, went on some estrogen therapy, so that improved. And then I really started therapy, so that improved. And then I really started looking at, committing to seven to eight hours of sleep. So my rule of thumb now is I aim for eight hours knowing the reality of the situation is the dog's gonna wake me up at some point. Something's gonna happen at some point that'll wake me up, but I'll go back to sleep, and I'll still there's some comfort in my brain of knowing I've given myself that cushion of the extra
Speaker 0
hour. I like that.
Speaker 2
Right. So I typically will get seven to seven and a half hours realistically.
Speaker 1
Yeah.
Speaker 2
And I don't beat myself up if a night a bad night happens, and I don't get that much. But I but and I think exercise is the also really key thing. I've started Oh, yeah. Prioritizing Mhmm. And shocking what a what a difference that makes in your sleep.
Speaker 0
I need to go do that after this podcast.
Speaker 2
I didn't do it yet. Yes. It cannot be underestimated, the power of exercise on your sleep.
Speaker 1
Yeah. And so for anybody listening who's just totally overwhelmed now, because it it is a lot. Right? And and we're we the three of us on this call, different backgrounds, different people, but similar, like, it's been a journey to get to a point. You know? Michelle, you were sleeping well, and now you're not again. Right? And I think the key is, you know, take the time and find a practitioner who's gonna take the time with you to sort out what it is. Right? Like, maybe you have an iron deficiency that is going unnoticed or unaddressed. Maybe you're really low in vitamin d. Maybe you're like, there's all of these different things, and I think the social media feeds can be dicey because you read about, oh, all I need to do is take more vitamin d, and I'll be fine. Well, maybe. But maybe not. Right? You've gotta figure out what's going on with you and then step by step, start doing all of the things that are gonna get you there.
Speaker 2
And I think family doctors are obviously very, very busy and stressed and overtaxed, but most are very reasonable. And I think if you come to them with information and a and a strategy, they'll actually appreciate it. Like, I think coming to them and saying, I wanna check my iron, they might be like, no. And it but if you say, you know, I'm having really, really heavy periods, and I've noticed the heavier my periods are getting, the more trouble I'm having with my sleep. I've heard iron deficiency can cause sleep disturbances. I think we should check my ferritin to make sure it's not at a level where I should be concerned. You know, that might come across very differently. I know it's a lot to ask. You don't you don't sign up to be the doctor in your doctor patient relationship.
Speaker 0
No. But you need to be your own advocate. Right?
Speaker 2
You really have to. Nobody else is going to, you know, come in and rescue you. It's important to know that the vast, vast majority of women that I've seen have found relief from their sleep disturbances.
Speaker 1
And and I think that's that's why we that's one of the reasons we well, a, we just we'll take any excuse to talk
Speaker 0
to you because we love you.
Speaker 2
I feel the same.
Speaker 1
Thank you. Thank you. That's a huge that's a huge compliment. But but again, just for people to hear this and realize, oh, shit. This isn't just how it is. And I'm not just not sleeping because I'm getting old or because or older or because there are reasons it is happening and there are solutions. But it does take some time and some investigative work to figure out what's going on and what the solution the right solution is for you and your unique scenario. And I can say so worth it. I was in complete misery, and I now, for the most part, sleep through the night. And I am, like, a different human being. Just ask Michelle. Amazing.
Speaker 2
Oh my gosh. That's amazing.
Speaker 0
Although she's been complaining about jet lag lately. So, you
Speaker 1
know Oh my god. I was away I I was in Italy, which was amazing. And I got back a week ago tonight, and it's kicking my butt.
Speaker 2
I was, yep. I experienced that a couple years ago. It's terrible. It hits differently. So many things hit differently.
Speaker 0
Yeah. Yeah.
Speaker 2
And the other thing too, I mean, we could do a whole other episode on the health benefits of sleep and and the health detriment of not sleeping. So it really is something worth prioritizing. It has an impact on your weight. It has an impact on your cardiovascular health, on your cognitive health, your your mood, and your, vulnerability to mood disorders. So we really need to start taking it more seriously.
Speaker 0
It's like the one pillar. Like, it's like, for me, it's like the one thing. Yeah.
Speaker 2
Totally. Top of the pyramid. Top of the iceberg. It really is.
Speaker 1
Yep. Love it. We'll do our one last question maybe, and then we'll plan to do another episode on what we just what you just said because that's very important as well. What to cap off today, what's the one thing you want every woman to know about sleep and perimenopause?
Speaker 2
So I want them to know that it is actually at the center of the hub or the Venn diagram. There's been, an understanding and awakening in the menopause community that we actually have to look at sleep as the primary central dysfunction in the menopause transition and that many other, outcomes sort of arise from the lack of sleep, and many other symptoms arise from the lack of sleep. And so it's actually very, very important. If someone just says, are you having hot flashes? Are you having irregular periods? Then it's not perimenopause. Find another doctor because they're they're just not aware, or they haven't talked to a lot of women because sleep is always, always checked off as one of the primary concerns when I meet with women. And it's not going to get better on its own. In most cases, you do need to have a really targeted approach and an individualized approach. So don't give up on yourself. Mhmm. Don't accept the status quo, and find an answer to your sleep disruptions. Amazing.
Speaker 0
Amazing. Thank you, doctor Jen. So good.
Speaker 1
Thanks so much for listening to the show. If you like what you hear, please subscribe and write a review.
Speaker 0
So more women can find us and get a better understanding of what to expect in perimenopause.
Speaker 1
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.
