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Foreign. Fifty Something podcast. I'm your host, Dr. Nicole Norris. Whether you are in the midst of midlife or you want to prevent the physical and mental signs of aging that occur in midlife, this is the podcast for you. This is a show where I share my knowledge gleaned in family practice, preventative medicine, and aesthetic medicine. To shed light on aging or or better yet, how not to feel or look like you are aging. We should be taking an active role in how we age from an early age. We should not settle with growing old gracefully or letting nature take its course. How we age directly affects our confidence, which impacts all of our relationships with those around us. The length of time in our lives that we feel really good in terms of energy, aches and pains and thought clarity has a definite impact on the mark we can leave on this world. My wish for my listeners is to always be mistaken for being 50 something or less in mind, action and appearance. Let's go. When is the last time you had an amazing night's sleep? You woke up feeling really good and energetic and you actually remember having a dream? Your answer says a lot about your health now and in the future, as well as how long you're going to live. Some studies have suggested that getting seven to eight hours of sleep and following four other good sleep habits could potentially add 4.7 years to your life in a man and 2.4 years of life in a woman. Sleep is foundational to your health mentally and physically, and to your overall quality of life and general well being. If you don't feel amazing and have productive days every day, there is a chance you have crappy sleep. Our ability to get good sleep can be related to our hormones. No way. Jump back Jack. Dr. 50 something is blaming yet another scourge of aging on lack of hormones. Really people, the better sleep we get makes you a better person and it does not have to depend on just the right temperature of the bed, a special cooling mattress, magic bamboo sheets, or Oprah recommended pajamas. It also does not have to depend on distractions for you light sleepers. Do you get up every night around the same time and go to the bathroom even though you really actually don't have to go that bad? But you figure I better go now so I don't have to go later and then you have a hard time getting back to sleep? Do you wake up with the same recurring dream that you didn't get your homework done or you failed all your classes and I have been there and now I'm not there. I now sleep like A very good baby. I dream vividly but no nightmares about school. I wake up rested and can't wait to start the day and dream up my next podcast. I have an aura ring now that monitors my sleep and tells me how rested I am and what my readiness score is for the day, which I am pretty consistently now getting sleep scores of 80 or above. Well, almost always. Ironically, I stayed up too late two nights in a row writing this podcast. But you guys, it's all about the average and the majority. We have a perfect night's sleep every night because life does get in the way. Prior to hormone optimization, I used to fall asleep easily, except on Sunday nights, probably because of just thinking about the week. And every night I would wake up around 2am and will myself to go back to sleep because I really didn't need to use the restroom. But then my anxiety would get the best of me and I would get up and go anyway. Then I would go back to bed and have racing thoughts for an hour or two about stupid unimportant tasks awaiting my attention. And then it was time to get up. This sleep pattern of long days and short nights was not consistent with a happy life or being productive at work. Being 50 something and doing a little research, I realized that I had a sleep disorder related to perimenopause and not having enough of two hormones, progesterone and melatonin. So first, progesterone is made in a woman's ovaries and produces a byproduct when it goes through the liver that causes you to sleep very soundly. This is called a soporific effect. As we age and produce less progesterone, we sleep less soundly. We become light sleepers. We hear every breathing noise our partners make and if it wakes us up, we call it snoring. We hear every laugh or outcry of victory by our kids on their electronics at 2am and we hear every floorboard creak by these kiddos getting up to use the bathroom or our puppies changing their position or trotting across the floor with their claws. All of these things are blamed for our terrible night's sleep. Ladies, if you are vibing with me, this is not light sleeping that is your issue. It is loss of progesterone, which actually can start in your 30s. In my practice, poor sleep history is always a red flag for not enough progesterone production and warrants not just replacement but optimization. I usually start patients on a 100 milligram capsule of compounded micronized progesterone taken at bedtime and I gradually titrate them up to an amazing night's sleep. This is of course body identical progesterone compounded at my favorite compounding pharmacy and micronized for the best absorption. This is not a synthetic progestin like what is in birth control pills. Progestins manufactured by pharmaceutical companies do not have the same soporific effect. They do not improve sleep. Compounded progesterone, however, reverses peri or postmenopausal sleep disorder just in a few weeks. Let me tell you, sleeping soundly through the night can change your life. So when is it too late to replace your progesterone? Well, all my loyal listeners know the answer to this. It's 130. Of course now replacing progesterone only applies to women. Guys do not try and take progesterone. It will not help you and guys do not feel good on it. I do not put men on progesterone. We will talk further about how I can improve a man's sleep. But first, hormone optimization for better sleep is not the only answer to a better night's sleep. Too much alcohol inhibits REM sleep. Certain meds like antihistamines, muscle relaxants, and sleeping pills like Ambien, the generic Azulpidem, Lunesta and trapped Azadone. These are like being hit over the head in order to get a good night's sleep. They totally knock you out, but they also take away your ability to go into the deepest stages of sleep. Deep sleep and REM sleep are the periods of sleep that truly rejuvenate our bodies and make us ready for the next day. We also have to do our part to manage significant stress with daily exercise, meditation, and a constant mindset of being grateful. That last sentence is a mouthful and it's not easy to do, but but persistent stress will definitely worsen your sleep. We all have stressors every day. That's life. Learning how to manage and minimize stress is just so important. Going to bed every night and thinking of three things that you are grateful for that happen that day can actually produce better sleep. Taking a whole day to do something relaxing that you enjoy will produce a better night's sleep. And this is the fun of the Oura Ring. The Oura Ring can help you to measure how good of a night's sleep you got by giving you multiple indicators the next day of how good your sleep truly was. It's fun. It's a challenge to get a better night's sleep. Our electronic Addictions are another cause of loss of hours of good sleep. Blue light in the evening tricks your brain into thinking it's daytime, which inhibits the production of melatonin and reduces both the quality and quantity of your sleep. Hormone optimization will definitely help you, but you do have to do your part to improve your sleep as well. So progesterone helps women in midlife get better sleep. But now let's talk about a hormone that improves sleep in both men and women. I just mentioned it. It is melatonin. Melatonin is the chief regulator of circadian rhythms which regulate our body processes. Melatonin is one of the two of the most powerful antioxidants in the body. Antioxidants reduce inflammation and prevent cancer. The other big gun antioxidant in our body is glutathione. Antioxidants can also decrease the risk of diabete diabetes, heart disease. They can also slow down the aging of our cells and prevent wrinkles and brown spots on the skin. Therefore, they are great for patients who are really interested in decreasing the speed of their aging. Melatonin is also an immune system regulator that works while we are sleeping and helps our bodies when we are in recovery mode. There's a myth out there that if we take melatonin in a pill form or any form, we will inhibit our body's ability to make natural melaton. This was actually proven false in 2010. This was actually proven false back in 2010. Taking low dose melatonin between 1 and 10 milligrams, or high dose melatonin, which is up to 50 milligrams, was shown to not change the natural production of melatonin one iota. In fact, a review of multiple studies on melatonin have shown it is nearly impossible to cause any form of harm taking melatonin supplements. This is the truth, you guys. So don't listen to all the stuff that you see on social media that gives melatonin a bad name. Another thing I hear a lot is that I tried melatonin and it just didn't work for me. Well, for one, everyone needs a different dose of melatonin. And two, the melatonin that we purchase at a drugstore is not micronized. So it is about 30 times weaker than what you get from a good compounding pharmacy or a reputable supplement company. I usually start patients off with melatonin 1mg from Designs for Health and then I have them gradually increase the dose by 1 milligram every night until they find their sweet spot of A great night's sleep with good dreams and not too groggy in the morning. For patients that I am trying to maximize the antioxidant effect, such as those with autoimmune disorders, a history of cancer, or who do want the anti aging effects, I continue to slowly and gradually increase their dose into the 10 to 50 milligram range. This is a lot and it is hard to get to that high dose for most people without medical supervision. You should not try doing this alone without talking to a qualified preventative medicine provider or someone who knows their stuff related to hormones. Interestingly though, in Europe, if someone is being treated for cancer or in remission, high doses of melatonin is a mainstay of their therapy. Another patient who requires high doses of melatonin are typically those patients that I am trying to wean off prescription sleeping medications. So yes, the first week you start taking melatonin, you can be a little groggy in the morning. That is very treatable with a cup of coffee. All you need is a cup of coffee and your body gets used to it pretty quickly. Some of my testosterone optimization patients, both male and female, have reported to me that they felt maybe testosterone made them not sleep as well. Well, this makes sense because testosterone converts to dihydrotestosterone or dht. DHT is the hormone metabolite that helps us increase muscle mass and improve sexual function, but it can reduce natural melatonin production. I have been trained that anyone taking testosterone optimization probably needs melatonin optimization as well. You really have to optimize all your hormones in order to feel your best. They just all work together. When you start hormone optimization, best practice is to start optimizing all of them at once. I usually say a starting dose of melatonin in a guy is around 3 to 5 milligrams and in women, 1 to 3 milligrams. Right now, I sleep best with 300 milligrams of progesterone and 7 milligrams of melatonin. And I'm slowly working my way up to 10 milligrams to start getting those antioxidant effects and slow down the aging of my cells. There are also great studies on using melatonin to prevent and treat jet lag for those who do shift work and have constant changing sleep schedules and for those in chronic pain. Now, the last thing that I have to tell you that there are great studies for using melatonin is nocturia. Yes, that means what we were talking about earlier, you guys and girls who get up in the middle of the night to go to the bathroom every single night. Melatonin can actually affect bladder receptors and make you feel like you don't have to go to the bathroom when you wake up in the middle of the night. I promise you you won't wet the bed. Our adult bladders are quite large. You will just really need to get to the bathroom lickety split in the morning. So if you are following good sleep hygiene already with a cool room between 60 and 67 degrees, a dark room with blackout curtains or a sleep mask, earplugs for the light sleepers, and of course shutting down those electronics one hour before bed and you still don't sleep like a really good baby. Consider exploring bioidentical hormone optimization with a preventative medicine provider like me to see if the lullaby effect of hormones can help you. Thank you for joining this episode of the Dr. 50 Something Show. If you are intrigued by this show and never want to miss an episode, click Follow. If you are a really great friend, share it. The content of this episode is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider to answer any questions you may have about your personal medical conditions. Until next time, get fit, get fabulous, get firm, and take care of yourself. Sam.