Sleep Solutions in Midlife with Dr. Leigha Saunders ND
Does the idea of a good night’s sleep feel impossible these days? You may fall asleep easily, but BAM! - at 2 am you are wide awake, and no amount of “good sleep hygiene” can get you back to sleep. Then you start your day frazzled by the anxiety of not sleeping, still managing all your regular responsibilities, and end up relying on naps and caffeine to survive the day. Just to do it all over again.
There’s no question. Sleep -good or bad- impacts every area of our lives. But what do you do when good sleep feels so out of reach during midlife? Dr. Leigha Saunders is joining me today to talk about how she helps women focus their barely functioning brains on the pieces of the sleep puzzle they do have control over.
Dr. Leigha will share how hormone therapy can support better sleep and why cortisol often gets such a bad rap when actually, in proper doses, is key to our survival. We also talk about how important it is to practice self-compassion and resiliency as you get to know this new body of yours in midlife.
In the episode you’ll learn:
- Why sleep challenges can begin before you stop having a cycle
- The algorithm Dr. Saunders uses to identify the first line of sleep support for her clients
- Why women in midlife are vulnerable to the “amygdala hijacking”
- Why we need to respect the role of cortisol in our brains more
- The risk of doing nothing to support good sleep
To learn more about Dr. Leigha Saunders and her work, check out her website at www.leighasaundersnd.com and follow her on IG @drleighasaundersnd. Be sure to cash in on her offer to listeners for $100 off The Better Sleep Bootcamp with coupon code MIDLIFEFEAST100!
Episode #42: When Melatonin & Sleep Hygiene Aren't Enough to Help You Sleep Through the Night in Perimenopause with Sarah Wilde
Jenn Salib Huber 0:02
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Selena Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hey there, welcome to this week's episode of the midlife feast. I'm so excited to welcome back Dr. Leah Saunders. One of my favorite naturopathic doctors from Canada from Ontario, to talk to us about the hormonal connections and and not just estrogen and progesterone to sleep in perimenopause and menopause. So in this conversation, we talk about progesterone, estrogen, hormone therapy as well. We talk about cortisol, some of the myths about cortisol and you know how it gets bullied, which is a new term that I love how cortisol gets bullied, and just a little bit about why melatonin has led us both down. So it's a really, really great conversation, especially if you're looking to understand those hormonal connections a little bit more deeply. If you are interested in learning more about sleep, and especially the connection to food, and learning a little bit more about how we might be able to support our sleep with what we're eating and understanding things like the role of carbohydrates and the role of protein. There is an entire module in the midlife peace community on sleep. And there's also a recorded live q&a with Dr. Leah from a couple of months ago where she answered all kinds of questions about hormone therapy in particular, and how it may or may not influence sleep and your other symptoms. So that is a great resource for you. And be sure to check the show notes as well because Dr. Leah has given us and given given our listeners a code on her sleep bootcamp. So on with the show. Welcome Dr. Leah Saunders back to the midlife feast. How are you today?
Dr. Leigha Saunders 2:06
I'm doing really well. Thanks for having me back, Jim.
Jenn Salib Huber 2:10
Awesome. So you are our favorite sleep expert. And you have been in the midlife he's community doing an awesome q&a. You have been on the podcast twice, I think maybe once or at least once, maybe twice. I'm not sure. But you're back. And I'm so excited to have you back. And we're going to touch on everyone's favorite topic, which is hormones and sleep. And trying to dive a little bit deeper into the hormonal connection with our favorite hormones, estrogen and progesterone, of course, but also kind of touching on some of the ones that come up a lot, but I find aren't included in the bigger picture of Hormonal Health and midlife which is you know, maybe cortisol and melatonin, anything else that you'd like to add to the mix? So why don't we start by talking about why is sleep such a shit show once we hit like late 30s, early 40s. Whenever that early perimenopause happens, what is going on from a hormonal perspective that might be giving us such grief?
Dr. Leigha Saunders 3:14
That's the million dollar question.
Jenn Salib Huber 3:17
I know right for the money.
Dr. Leigha Saunders 3:19
Yeah, well, the one thing I want people to know right away is that your menstrual cycle can still be regular and hormone changes can influence your sleep, your mood, your energy, your metabolic health, again, without having those obvious changes to your cycle, because I think one of the first things that happens is people and women will dismiss those changes as being related to their hormones, if there's not something obvious that they can pinpoint as it relates to their hormone health, or their menstrual cycles. And this might be them just missing it, or it's sometimes their healthcare practitioner, right, they go in and say, you know, all of a sudden, I've noticed, like, I have a lot of trouble with my sleep. The most common pattern I hear women in my practice described is that they fall asleep, find it appear exhaustion, but then they wake up in the night, often at the exact same predictable time. And they struggle in getting back to sleep, and then maintaining their sleep over the course of their night. And when they bring that up to their health care provider, sometimes a follow up question is, you know, it could just be related to my hormones, and then they'll be asked, Well, are you still menstruating? Is it regular? And if they say yes, it's like, oh, well, then it's not right. Yeah, it must be. It must be because you have two or three kids, your parents are getting older, your kids are getting older, you're commuting back into the office, right you're trying to maintain this busy schedule or you have your own other health challenges or your parents have those health challenges now or your kids are in a million extracurricular activities and and and right so we often will attribute those disturbances to other things outside of our hormones. That's not to say those things don't influence of course, right. We have an increased in have an increase in life stressors and psychosocial stress around midlife due to all of those factors. So we want to take that into consideration. But our ability to respond to those stressors becomes challenged because of the hormone fluctuations that we're experiencing, which sometimes aren't obvious, because our menstrual cycle is still regular.
Jenn Salib Huber 5:23
Yeah, and that, and that is exactly what happened to me and even as a fellow nd and even as someone who probably should have recognized the other signs, because I was 36, or 37, I had three kids under the age of seven. It was very easy to dismiss as something other than perimenopause. And of course, we I know Hindsight is 2020. And that's always the case. But it really was the first symptom that started showing up consistently was, I would be exhausted, I would fall asleep. And then between two and three in the morning, I would wake up and ping, it was like, I had never slept. And I actually would question Did I actually fall asleep because I was so awake, and would just have such a hard time getting back to sleep. And then that would start the whole cycle of the behavior changes that we start doing the maladaptive ones that kind of keep us awake and lead to all of that sleep anxiety. So yeah, I love that you started with that, because it is such an important thing for people to know that these changes will happen long before you miss a period. Long, long before you miss it, period.
Dr. Leigha Saunders 6:28
Yeah, absolutely. And so what we're responding to always are those hormone fluctuations. So when you're you are menstruating regularly, let's say you're having ovulate Tori cycle, so you're producing progesterone, if that egg that's released from your ovary isn't fertilized, then your hormones your progesterone is going to drop, and so as your estrogen and that drop in those two hormones is going to what is what leads into that next menstrual cycle? And so let's assume pregnancy isn't occurring in midlife for most most people. Although technically it can until your last menstrual, oh, yes, it can for more people are born. And so those hormone fluctuations become more apparent as we get older for a couple of reasons. So one, yes, we will feel the implications of those hormones being withdrawn when we're under increased stress, because ultimately, our hormones are influencing how we feel right. And so when we are in that midpoint of an ambulatory cycle, when estrogen is high, and then it drops off and progesterone starts to build, we will have higher levels of resiliency, we feel more outgoing, we feel energetic sleep is easier, it's easier to focus and concentrate, like we feel like we're on our air a game. Once those hormones start to decrease. It's the withdrawal effect of them essentially, that we feel all of those things are challenged, right? We feel more fatigued, it's harder to do the same exercise you did seven to 10 days before. You don't feel like you have the same capacity to do that. Sometimes I read the same sentence 10 times? What is wrong with me? Like, oh, yeah, I'm just premenstrual, it's gonna be better than, you know, five days. And so we need to remember that and be conscious of where we are in our cycles. Because one, just being aware helps bring some compassion into understanding that it's influencing our those hormone changes are influencing how we feel, right. And so then as we progress typically through our 40s, more and more of our menstrual cycles are becoming an ambulatory, meaning we're not going through and producing an egg through full ovulation. And so we're not getting the same level of hormone production that's in a predictable fashion. So we'll see erratic hormone changes or mad erratic hormone production and levels if we're to look at that bloodwork, let's say, and what we see is that maybe you ovulate later in a cycle than typical. And there's different reasons, we don't really need to go into why that happens. But cycles then start to kind of like stack or overlap on top of each other. And you can see things like elevated estrogen with low progesterone because you're not ovulating, but your body is trying to amp up that ovulation process and we end up feeling the effects then of that higher estrogen and then again, it lowering over time, with or without progesterone being in there. So on top of that, we've got all of the changes that typically happen and those increased psychosocial stress that can happen in our personal and professional lives, right on top of that intermixing to make sleep more difficult and it's harder to sometimes tease out exactly what's happening. So I always like to focus the constant the conversation on like, what do we actually have control over? Right? We don't necessarily have control over the time in which we're entering perimenopause and eventually menopause, but we can help support our body in terms of our metabolic health or what we can do to control our cortisol levels and support melatonin production so that our opportunity for sleep and then good daytime energy the following day is enhanced. And whenever you're short slept, right, everything feels harder and everything feels overwhelming and you can't stick to the plan or do the things that you want to do that help you feel better, right, you sleep in, and then you start your morning in a chaotic fashion, because you were trying to get those extra minutes of sleep. And now you've got to pack everything you normally do in an hour and 20 minutes and get everyone out the door. And then, you know, over caffeinate because you're tired, and then that causes you to be awake a little bit later. And that's the only moment you feel like you have to yourself in the day when your kids are in bed or work has finally stopped pinging you and then you stay up later than you intended because you're like, it's the only time I have, and then you fall asleep out of exhaustion and wake up again. You're like, how is it possible that I'm awake right now? I was so exhausted at 2pm. Right? Because I'm like, hit the ground. So it sounds like I'm reading your mind. It's because I so deeply understand this topic from a personal experience and in working with so many women who struggle and with these things, right? And so then the question is, yeah, how do we start to tease out what's happening? And how do we take into consideration those hormone fluctuations. And again, we can't necessarily control that timing or adjust that timing. But we can put other supports in place, and we can help you feel better in that transitionary time and eventually through menopause, too.
Jenn Salib Huber 11:25
And if I'm hearing you correctly, and certainly correct me if my understanding is isn't quite what you're saying. But it really is the fluctuations and the unpredictability. That is the problem in perimenopause, right, it's not so much that you're having periods of high hormones and low hormones and you know, every which way, it's just that it's very unpredictable. And our body doesn't like that. Now that I'm postmenopausal and I don't take hormone therapy. My sleep is better than it has been in 10 years. And I'm clearly low everything right? So it's not just that my hormones are low, it's that they're not fluctuating anymore. They're not on a roller coaster. It's it's predictable. Now, you know, and so I think that, uh, so many of the conversations that especially happen on on social media and kind of in the, the spaces on the internet that maybe shouldn't be, where we're having conversations about sleep. There's, there's the search for the label or the cause or the reason it's like, oh, it's because this hormone is high and this hormone is low, but we really can't pinpoint it to that degree, there really isn't a test, you know, like the urine tests and the saliva test that claim to give that kind of information really can't. And that's correct, right. That hasn't changed.
Dr. Leigha Saunders 12:46
Absolutely. So I often think about perimenopause is like an exacerbation or an elongation of PMS. Most women are familiar with PMS, right. So again, what's happening in PMS is that your hormones are starting to decrease leading up to and those five to seven days prior to menstruation. So we feel the effects of those hormones decreasing. And so when we are going through perimenopause, and those more and more of those cycles are an ambulatory and then all of a sudden you have an ovulation Right. Like you're saying it's less and less predictable. Because before it was like, oh, between day 14 and 16, I ovulate and then I know I feel good for a week and then I know my hormones decrease and my periods coming. That's happening haphazardly. And we feel the effects of it. And so there's no test for PMS. Right? We can of course measure your hormones at any point in your cycle are perimenopause and menopause. But if we take 100 women with PMS and 100, women who don't have PMS and test them at the same point in all of their menstrual cycles, their hormones could all be the same. Their hormones could all be very different. We can objectively look at those results and say, These are the 100 women who have PMS, and these are the 100 women who don't. And so similarly, in perimenopause, I see both sides, like women get frustrated because their health care practitioner won't test their hormones, because their practitioner has said, Well, your hormones fluctuate, and so there's no point. And that is true, right. And so it's all about what is the intention behind that test for fertility purposes. If there's something that we don't understand about your cycle, based on what you're reporting, that is a great, those are great indications to run hormone panels. But when your cycle is otherwise regular, or again, if it's classic PMS or you're starting to experience changes, in perimenopause, we can test your hormones and they'll be completely normal. It doesn't direct our treatment plan. And this is also true and post menopause. And I know that there's even controversy about using those words like but just for timing purposes. Like, I also get annoyed when women are like, Well, I have my hormones tested. They're low. I'm like, yeah, what did you think like you're not menstruating, you're not producing any hormones who I told you you had to measure them. Again, it doesn't tell us anything we don't know. And because like you're not going to be producing any hormones, the only way we'll pick up any hormone level in your blood in menopause is if you're on HRT using replacement therapy, will pick up the amount that's reflective of the dosage that you're taking and then absorbing.
Jenn Salib Huber 15:22
Yeah, so just to be clear that anyone listening, we both understand the urgency of needing to figure this out, that is completely normal. And believe me, if there was a test that I could have taken 10 years ago, I would have probably paid a ridiculous amount of money if it could have pinpointed a solution to my sleep, because those sleep changes were five years really, of you know, really rocky sleep, and feeling so frustrated and exhausted and just crying about my lack of sleep more often than I care to remember. So we have these hormone fluctuations. Thank you for explaining that so clearly, and so beautifully. We can't really test for them. So we have to make some assumptions. So let's say somebody knows that they're in perimenopause. So they're now at whatever age because it isn't bound by age, it's bound by this symptom picture. What are the potential impacts of using estrogen or using progesterone specifically for sleep? Is there is there a reason that people should be asking for this? Or are there other reasons that they may not want to what's what's the deal?
Dr. Leigha Saunders 16:32
Mm hmm. I recently put together a talk on vasomotor symptoms and sleep in particular, so vasomotor symptoms being like daytime hot flashes, or nighttime sweats, night sweats, and how that impacts our sleep, right? And how we can look at using hormone replacement therapy to support those aspects, because they really do go hand in hand. So when sure do your research, yeah, because that's where that's what matters, right? Like, what does the research say? What do we understand about these hormone therapies? And how do people and women respond to them? And how does it influence sleep? So I created this algorithm like I need to brain dump, so I'm going to take you through it. And if you're a visual person, it will end up on my Instagram. So you will be able to find it. But I always I how I think about it is like is the person sitting across from me? Are they still menstruating? Even if it is irregular? If they are still menstruating? Yes, you can use estrogen. But in most cases, we're starting with progesterone. And we can go through that why but progesterone on it's can be used on its own in women with or without a uterus. So some women have their their uterus removed in hysterectomy for different reasons, and might be told that they don't need progesterone, which is true, but progesterone can still provide some benefit. So on its own, and we're talking when I say progesterone, I'm referring to oral micronized progesterone, not the transdermal progesterone or Gam cream. But when we're using oral micronized progesterone, we see that on its own it can have a significant improvement in resolution of vasomotor symptoms. So daytime hot flashes, night sweats, and because of that, but not just because of that it can help with sleep. When we take progesterone orally, it's metabolized by our liver and in the product or one of the byproducts of that process is something called allopregnanolone, which is something that acts on our GABA receptors. Many people are familiar with supplementing with GABA, benzodiazepines, so things like Ativan, those medications that are really great at calming us down and taking away or anxiety. Those types of medications act on our GABA receptors. So when that metabolite acts on our GABA receptors in the same way, we feel calm, and there's a sedative effect associated with that oral progesterone. It is a natural sedative effect, meaning it helps you feel tired and sleepy and calm to induce natural sleep. It's not the same as taking a sleeping pill or sleeping medication in which we see there are actual changes to your sleep architecture if you're put into a sleep study or sleep lab overnight. So for that reason, progesterone can help us sleep better if we're having temperature fluctuations that are disturbing our sleep. But because it also helps induce natural sleep. There are studies that have looked at and shown that it helps women be less responsive to environmental disturbances. So it's to say in a different way, it just helps us sleep better and sleep deeper, right? Because of that. So I will often start with progesterone in women who are experiencing those symptoms, sleep disturbances with or without those vasomotor symptoms. What I will encourage people to do is also track those symptoms because sometimes women will say like, oh, every now and then I do notice some hot flashes or night sweats or trouble sleeping but it seems really unpredictable. When they track it. It often is when those hormones are being withdrawn right. So when they reach their lowest point B Before and during the first one to three days of a new menstrual cycle or during menstruation. And so that's what we understand about vasomotor symptoms too, is that it's not the presence of estrogen, right that causes them or not. It's the withdrawal of, of estrogen in particular, that changes our ability to regulate our body temperature. And so often, progesterone can resolve those hot flushes and improve sleep for at least a period of time for a lot of patients. And then what I'll reconsider and we have conversations with overtime is, okay, are all of your therapeutic goals being met? Or maybe are there other symptoms or concerns or goals that we have where we may or may not want to consider estrogen as well. So estrogen can be paired with progesterone and should be paired with progesterone and women who still have a uterus, and are postmenopausal and that's for uterine protection so that uterine lining doesn't grow uncontrollably, progesterone will keep it in check. But even in women who have had that hysterectomy and have been offered estrogen therapy and told you don't need progesterone, sometimes they come to see me because they're, they feel like their hot flashes have improved or they're using it for other protective reasons, like we can talk about its impact on the cardiovascular system and bone mineral density and whatnot, but they're still not sleeping great. And we can add in progesterone for that additional benefit and its impact on sleep and you know, understand. So if someone is just on progesterone, I'll evaluate like, is progesterone doing its job, or do we want to add in estrogen for either to reach our goals or for other therapeutic indications. And if somebody is no longer menstruating, they come to see me because they're in menopause. The research is quite clear that combined hormone therapy is most effective period, and most effective for addressing sleep disturbances. And that combination that we see is transdermal estradiol, or through the skin, meaning in the form of gel patch, or cream, the gel in the pouch are going to be what's most studied, because the creams are typically compounded, and so transdermal through the skin estrogen paired with that oral micronized, progesterone over at least six months shows the best outcomes and influence on our sleep architecture. And so that's where we'll evaluate that person who's sitting across from me if they're again in menopausal, say, okay, the research says that we should use combined therapy. And if they still have a uterus or not, we can if both they still have a uterus, we have to use some form of progesterone. And if they do not, the option is still there. And so then I work through my algorithm and say, Okay, are you ready to initiate combined therapy, and they may have a preference to say, like, start low and go slow, right, or maybe they have a history of estrogen positive concerns conditions, either personally, or in their family history, like breast cancer, or ovarian cancer, in which case, we can still consider, you can still consider estrogen. It's not a strict contraindication. But of course, and understandably, many patients are hesitant about that. So we'll start with progesterone, and then again, reevaluating over time to look at that combined therapy for the best potential outcomes. And I always like to have the conversation of the risk of doing nothing. And that's a conversation that's so often and I would say, way too often left out of the practice of medicine. So often our conversations focused on like, what are the benefits? And what are the risks of doing this thing, right of taking the medication or taking the supplement or taking or having a receiving a procedure. And so one thing we also know to be true is like there are inherent risks if we sit back and do nothing about addressing our concerns. So we do nothing about your lack of hormones. And if we do nothing about your lack of sleep, we know that that can drive certain physiological processes and increase your risk for concerns and conditions that can ultimately be life threatening, right or, or carry a considerable level of morbidity. And so I always want patients to understand like your sleep is so important, it really is that fat foundation of health, I think, inherently we know that especially when we're not sleeping. And like I said, if you're not sleeping, then what's the opportunity? Or what's the chance that you have the capacity to keep up with the exercise and activity that you want right to be maintaining and supporting your mental health to be doing your meal prep and planning as well as you want to be doing because when you're tired, all of those things are harder. And then everything is
Jenn Salib Huber 24:31
Dr. Leigha Saunders 24:33
Our risk just increases more and more and then right women come and see me and they're not happy because they're so tired. And they're they've also gained weight which because they're unable to keep up with the physical activity and dietary habits that they want to rate and so we've got to tease out until like, Okay, if we start with sleep, and you feel better in the day, you have more capacity to handle those stressors and to do the things that you want to do. And here's how supporting your hormones. in midlife can play a role in that sleep
Jenn Salib Huber 25:03
improved. Thank you for that that's a really, really great explanation especially about how progesterone works. Because, you know, progesterone is one that I think is under utilized for many people. And it is such a relatively safe option. For most people, I always put in my disclaimer about being hormone sensitive, and it made me feel like a big pile of garbage, which is not uncommon. I hear that a lot. And I think sometimes people suffer through, you know, trying to get through it when it's just not going to be the right thing for them. But that being said, for people who take it, and it works well, and they can tolerate it without any side effects. It can be a huge game changer. And like people love it. So I love that you walked us through why that it's not just because it's supporting progesterone, that there's actually something a byproduct of it essentially is part of being metabolized. That also is helpful. So, you know, estrogen and progesterone are such big conversations in the sleep and perimenopause conversation, can we talk a little bit about cortisol because cortisol is another hormone that obviously makes an impact on our health and obviously, is an important and important consideration and many things. But I feel like there's a lot of misinformation and myths about sleeping cortisol. So what do you think? What do you think about cortisol and sleep?
Dr. Leigha Saunders 26:28
Cortisol should follow we call it diurnal variations, it's just a fancy way of saying it is supposed to change in level and amount produced in our body and released by our adrenal glands over the course of 24 hours. So we should actually get a nice little boost and release of cortisol in the morning. And that should help you get up and go, it should help you feel motivated to start your day and have the energy to to get going. And it should slowly decrease over the course of the day and reach a low point, but not yet its lowest point in the afternoon. But that's where a lot of people will experience that afternoon energy crash for a lot of reasons. And then it should, again, slowly lower over the course of the afternoon and evening to reach its lowest point when you would be getting ready to initiate sleep. And then over the course of the night, again, it starts to rise to have a nice spike in the morning. And that's something called your cortisol awakening response. So yes, cortisol is often bullied, there's a couple that get bullied, it's a good way to put cortisol and estrogen. Because we think it's like the root of all evil, right? Like it makes us fat. And it makes us stressed, it makes us tired, it makes us moody. But we need cortisol without it you die. Like don't hate on it completely. And so we need it because it gives us that energy and motivation and ability to respond to the stressors that we we have. I always like to give the analogy of our adrenal glands being the SWAT team, like they should be called in when shit hits the fan, when rave was like big things are happening. Unfortunately, they're being recruited on a daily basis for things that are not maybe as important or as stressful, but they are perceived to be very stressful. And again, going back to that conversation about what do we have control over? Sometimes we don't have control over, you know, our kids temper tantrums or what's happening with our client at work or right, our parents health crisis, or, or all of those things that are outside our locus of control. But we do have control over how we regulate our blood sugar. Right, and if our blood sugar is regulated, then that's going to take off the stress from your adrenal glands to regulate that too. So when we have a dip in our blood sugar, which happens when you skip meals, or when you're not getting enough protein and healthy fat or complex carbohydrates, or overnight, don't forget, when you're in bed, you're fasting, right. And so if we haven't fueled our body appropriately during the day, and we're fasting overnight, sometimes our blood sugar will hit that critical threshold again, either in the day or at night, where Cortisol is released, because part of cortisol job is to encourage stored blood sugar to be released so that we have immediate fuel ready to run from that lion, tiger or bear. Hopefully there's no Lion Tiger bear in your picture. But we think that there is it feels as though there is right so that shunting cortisol that can happen throughout the day or again at night at that two to 3am Mark, again increases our perception of stress because one of cortisol is other job is to encourage us to scan our environment for potential threats. So when you wake up at two or three or four and you're like, why did that seem like it was such a big deal? Morning when you're thinking about what you were thinking about? Or all of a sudden you're worried about something that you weren't worried about before you're you wake up to pee and then your mind starts ruminating or racing thoughts pop through and through your head? It can be related To that shunt and cortisol, that for some people who have those high levels all day, right, you're go go go, you're always on extraversion mode responding to everything in your environment and not supporting those other pieces you have control over, then that extra amount overnight or again, once we get into that window of like, three 4am onwards, you're bridging on where cortisol is naturally rising anyways. And then when we pair it, we can talk about melatonin, where we see shifts in our circadian rhythm, or internal body clock. All of those things paired together to see what we often see is like, people start waking up earlier than they want to, in the morning and those early hours, and they're like, how is it possible that I'm awake for the day?
Jenn Salib Huber 30:44
It's like disheartening, when it happens, for sure. Because you just know that you're not going back to sleep, like it's just done. I used to say that if I could, if I could get to 430. Or if I woke up, you know, kind of in that 430 to 530 window, I knew that I was done. Like, you know, there was just and I never look at the clock, but you can always like you can always tell you can sense it, you know, and it Yeah, it's just not a fun place to be. Before we touch on melatonin, what I think is interesting, too, is that relationship to, you know, that perceived stress and about how, especially when we're in perimenopause, and we're experiencing a lot of the mood changes that we know can happen. There's also changes happening in our amygdala. The amygdala is very densely populated with estrogen receptors in particular, and the amygdala is in the part of the brain that helps us to scan situations. And there's something called the amygdala hijack, which has been described as basically, you know, it completely hijacks the conversation with the thinking part of your brain that is rational and calm, and just freaks out. And so you know, in these moments, especially of I think, like, feeling like we're having difficulty coping, feeling like we just have lost our filter, feeling like we're having maybe even those melt moments of mental rage. There's a lot going on in our brain that is leading to short circuits everywhere. It's not just short circuits in our thermostat, it's like short circuits and all of the systems that have been working very reliably for most of our life, and then all of a sudden, it all changes and the proverbial shit really does hit the fan. So so much self compassion to people who just feel like they're, they're losing it, you kind of are for a while. So don't beat yourself up for that, like so much is changing, right? But yeah, so the relationship with cortisol is real. But it's not something that can be fixed quickly, easily. With a supplement like there isn't anything that you can do that just shuts it off. Right,
Dr. Leigha Saunders 32:52
exactly. And there's some really interesting research coming out from a group in particular, I think they're based out of Switzerland, and they focus a lot on self compassion and resiliency through perimenopause. And they've actually looked at the hormonal link with it too. And so the short of it is, women who are more resilient will have fewer physical symptoms of perimenopause and menopause, even though their hormone fluctuations are the change are the same, sorry. So set a different way. It's like if you're able to cope with your stressors, if you have those foundational pieces in place where you know what helps you manage your stress, whether it's gathering with a community or having a spiritual practice, or exercising or keeping your blood sugar balanced or being engaged in your health care, experience, whatever it is, and there's some standardized ways that they measure this. But, again, people and women who rate higher on a resiliency score who could feel that they can better cope with and manage their stress. Don't find the transition through perimenopause and menopause so difficult. And I find that so fascinating because they're experiencing the same hormone changes and fluctuations and withdrawal as women who are rating lower on that resiliency scale and feeling really overwhelmed by their stress. So it really demonstrates that mind body connection. And when they looked at the hormone implications, women who go through more sudden onset menopause. So surgical induced or drug induced would be the most sudden onset right? So ovaries and uterus are like removed literally overnight and or drug induced if you're on an estrogen blocking medication, compared to somebody who goes through a more gradual withdrawal. Those women again, and we see that in the research, like those women who have surgical or drug induced menopause are more likely to have severe, more severe sleep disturbances and more frequent and severe vasomotor symptoms if they're not addressed. So there's an interplay there were again, it's like how can we support our body? What do we have control over it? How can we build that resiliency? What do we need access to and for a lot of women, it might be the first time ever or the first time I'm in a long time where they're prioritizing what they need, and their time for them, or access to resources for them, because they're so used to taking care of everybody and everybody, everything else. And so my message would be like that it's okay. Right? It's okay to say like, actually, I need to prioritize my therapy appointments, or I need to prioritize my workouts, or I'm going to invest in this meal planning, or food delivery, or like, whatever it is that helps you take off that mental load and decisions to again, have more not that you want to focus on controlling everything, but it's like, what do you know, are your non negotiables that when are there in place, you feel like you do have a higher capacity to handle your stressors, because that's how you manage the cortisol interplay, right, as a supplement can maybe help take the edge off. Yeah, but it's not going to do anything compared to what those other things will.
Jenn Salib Huber 36:05
It's what I call putting your oxygen mask on first, like you have to ask yourself early in the day, what do I need? What do I need to do to meet my needs? Especially if you're used to putting everyone else first? Okay, so quickly, let's talk about melatonin. So everybody loves melatonin? But should we? I
Dr. Leigha Saunders 36:26
know, it is interesting. So there's what is the bio biological plausibility, I think, is the term where when we observe something, doing something, so Melatonin is a hormone that gets high before sleep. And so then we extract from that, okay, if I supplement with melatonin when I'm having trouble sleeping, it must help me sleep, right. And so that's not true fully. So we see in the research that melatonin, melatonin mostly helps with decreasing the time it takes to fall asleep. Okay, so if it's taking you a half an hour or longer, that's typically too long, when when we're looking at what we call sleep onset latency, we want you to get into bed and put your head on the pillow and typically fall asleep within five to 2025 minutes. By the time you're thinking about the act of falling asleep, it's been too long, you don't have to watch the clock that as a measurement. So melatonin might help reduce it, right. So when we're looking at an intervention, if we can understand how clinically relevant it is, or clinically meaningful it is, it's helpful, if it's taking you 30 minutes to fall asleep, and all of a sudden, it's taking you 15, that's gonna feel really different. Right? Or if it's, if it's 20 minutes, and now it's 10. It's a 50% improvement. But the actual minutes are quite small, right? The 10 to 15 minute improvement, but it's going to feel different, it's going to be what we call clinically meaningful. If you get 15 or 10, or 15 more minutes of total sleep in a night, that's not going to feel that different. That's not meaningful, right? So there's a study in a systematic review that was published, it was like melatonin significantly increases total sleep time, like why let's look at this. And when I looked at the results, it's like melatonin increased total sleep time by eight minutes. And I'm like, I feel okay, I'm pretty sure if that's the best I can do or offer people I'm not gonna happen, I'm not gonna have a practice, people are gonna fire me pretty quick, right? So when we look at that idea, it's like, okay, we think, again, if melatonin is involved with the process of sleep, and we supplement it, it must help us. But the research is really clear, it mostly helps with falling asleep, and especially in those who are working shift work and who are jet lagged. And that now we can understand why it doesn't typically help a whole lot with increasing total sleep time. And I would say like, that's what I see in my practice as well. If there is a form there is you know, immediate release and sustained release the sustained release. Melatonin is actually prescription actually, melatonin period is prescription in Europe, or at least most of Europe. And there's a system of release. Yeah, yeah. My sister is from England. And I'm like, I'll just pick up some melatonin before you come in. She went to the health food store and they looked at her like, tell you that's a prescription. You can't just
Jenn Salib Huber 39:18
they it's It's definitely like in in the Netherlands euro or in Germany, like Italy. I was just in Italy recently, and there was like melatonin tea that you could buy like at the grocery store. Okay, so Yeah, that must just be in the UK. Interesting. But technically, they're not that Europe anyway. Right.
Dr. Leigha Saunders 39:34
Right. Yeah, that is true. And or if it's available over the counter, there is a prescription version. And that version is what's well studied. And you'll see it in the literature and it's a prolonged release form. And certainly in Canada, you can get like a prolonged release version of melatonin, and that can be helpful for people. But I don't see in my practice that it's typically the thing that makes a big difference. And by the time people end up seeing me they've already Friday, right. So if it was a magic fix, I think we would, we would know. And that would feel pretty certain by now. But we do see shifts happening in our circadian rhythm as we get older. So there's a decreased sleep drive, meaning we don't feel the same need or don't have the same need for as much sleep, which is what we will typically start observing right in our parents until maybe somebody isn't well, and the, the amplitude at which melatonin is produced gets a little bit lower, as well. And we'll see some erratic production, which is why I use my dad as an example. So like, often we'll have that like afternoon or evening nap on the couch, right. And then he struggles to fall asleep and he'll eventually fall asleep and then wake up at two or three for an hour and go back to bed and sleep till five or six, right. So that can become very predictable. But we can put things in place like light exposure and caffeine timing and meal timing and exercise timing and whatnot to make sure that we consolidate as much sleep as possible to protect those circadian rhythm changes. And that Light Darkness exposure is number one. And I also think that that's something we sometimes undervalue. Because we live in such an artificially controlled environment, right? Like we are really dark deprived when you think about it, because we can have lights on and screens on all the time, so often, and it comes down to understanding like, okay, in the morning, I need light exposure to wake me up to blunt that melatonin to encourage that rise of cortisol, so I feel energized to get up and go. And in the evening, I need that light exposure to be really minimal to allow melatonin to rise, and for cortisol to stay low. And that's how we start leveraging that cortisol and really leveraging that melatonin production, as well.
Unknown Speaker 41:50
Oh, my goodness, thank you so
Jenn Salib Huber 41:51
much. That was like 40 minutes of awesome information about hormones that I know will be so appreciated. I always appreciate your time. Thank you so much. Before we get to my famous last question, I know that people love you, and we'll want to learn more from you. So can you tell us a little bit about the course that you have?
Dr. Leigha Saunders 42:12
I can so I have a course called the better sleep bootcamp. And it's a five step framework for women who want to fix their broken sleep. And so you can get $100 Off with coupon code, midlife feast. 100.
Jenn Salib Huber 42:24
Awesome. We'll have that in the show notes. For sure. Thank you,
Dr. Leigha Saunders 42:27
I take you through those five steps of understanding your sleep cycles and your sleep schedule, how to lower and leverage cortisol for better sleep, how to eat, and your eat for better energy and sleep. And you've put together a beautiful module for our participants in that module of the course as well how to embody that sleeper that you want to be because sometimes we need to shift our mindset around sleep. And if we were always told that sleeping in you know, you're lazy or you sleeping you die or sleep isn't a priority, right? If we're if we're prided and acknowledge for our lack of sleep, or our ability to always be in that productive gogogo mode, sometimes we need to reclaim that relationship we have with the idea of rest. And then of course, I take people through pinpointing their hormone sleep connection, if you're paying attention, those five things fell asleep.
Unknown Speaker 43:21
Oh, I missed that. That's awesome.
Dr. Leigha Saunders 43:25
framework, it's five steps to take women in particular who have had trouble sleeping since having kids no matter how long ago that was, since turning 4040 or entering menopause. Those are the real things we know influence our sleep. And I'm always humbled and amazed at the results that people have when they do the work and understand and start sleeping better. It's life changing.
Unknown Speaker 43:48
It's so amazing.
Unknown Speaker 43:50
That's so great.
Jenn Salib Huber 43:51
Thank you so much. And like I said, we'll have all the links and everything in the shownotes. So what do you think is the missing ingredient in midlife?
Dr. Leigha Saunders 43:59
That I think it's our ability to reclaim rest. Right? So, yes, we're gonna go go. And even before we hit record, you know, you asked me how how I'm doing I'm in a different stage of life, or maybe bordering where I have young kids, but I'm, you know, trending towards 40. And so noticing some hormone changes and fluctuations. And that's the the piece is like we have to remember to take that time for ourselves and that we deserve it. We would never deprive our kids or pets of rest or food or water. And so often we do that for ourselves. And it can take a different approach or a mindset shift to embrace that and reclaim that but often women feel guilty, right? People feel guilty for taking a break or realizing or expressing that they need rest. But it's the thing that's going to change everything and when you realize the world doesn't end when you take a break and if anything it actually hits a hole A lot better.
Jenn Salib Huber 45:01
So true. Oh my goodness. So true. Thank you. Thank you. Thank you and and I hope that you have a great day.
Dr. Leigha Saunders 45:09
Amazing. Thanks again for having me.
Jenn Salib Huber 45:13
Thanks for tuning in to this week's episode of the midlife DCED for more non diet health hormone and general midlife support, click the link in the show notes to learn how you can work and learn from me. And if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing because it helps other women just like you find us and feel supported in midlife.
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