Podcast Summary: The Tamsen Show – Episode: How to Finally Get to Sleep in Menopause

Episode Details:

• Title: How to Finally Get to Sleep in Menopause
• Host: Tamsen Fadal
• Guest: Dr. Shelby Harris, One of the Country's Leading Sleep Experts
• Release Date: July 2, 2025

Introduction to Sleep Challenges in Menopause

In this episode of The Tamsen Show, host Tamsen Fadal welcomes Dr. Shelby Harris, a renowned expert in sleep medicine, to discuss the pervasive issue of sleep disturbances during perimenopause and menopause. With over 60% of women reporting sleep problems during these life stages, the conversation delves into the multifaceted nature of sleep challenges and effective strategies to overcome them.

Notable Quote:

Dr. Shelby Harris [02:05]: "Sleep is like the bedrock. It's not one of the pillars. It's the stuff that everything else builds on top of sleep."

Understanding Sleep Disturbances in Midlife

Dr. Harris highlights an increasing trend of younger women in their late 20s and early 30s seeking sleep treatments, a shift driven by heightened awareness of sleep's importance. She emphasizes that sleep issues in midlife women are often intertwined with hormonal fluctuations, psychological stressors, and social responsibilities.

Key Points:

• Biological Changes: Fluctuations in estrogen and progesterone levels can disrupt sleep.
• Psychological Factors: Increased anxiety and depression during perimenopause contribute to insomnia.
• Social Stressors: Women often juggle careers, late parenthood, and caregiving roles, exacerbating sleep difficulties.

Sleep Hygiene and Its Importance

The duo discusses the foundational practices of sleep hygiene, comparing it to dental hygiene. Dr. Harris outlines essential components such as maintaining a cool room temperature (ideally in the 60s Fahrenheit), ensuring a dark and quiet sleeping environment, and investing in comfortable bedding.

Notable Quote:

Dr. Shelby Harris [07:55]: "Sleep hygiene is like dental hygiene. It's brush floss every single day. And that helps to prevent a cavity. Same thing for sleep hygiene."

Sleep Hygiene Tips:

• Room Temperature: Keep the bedroom cool, around 60-68°F, adjusting based on personal comfort and regional humidity.
• Comfortable Bedding: Replace old mattresses and pillows to prevent discomfort.
• Darkness: Use blackout curtains or eye masks to block early morning light, especially during summer months.

Differentiating Insomnia and Sleep Apnea

Dr. Harris elaborates on the distinction between insomnia and sleep apnea, two common sleep disorders that often coexist but require different treatment approaches.

Insomnia:

• Definition: Difficulty falling asleep, staying asleep, or waking up too early, causing daytime dysfunction.
• Duration: Short-term (at least one month) or chronic (three months, three nights a week).
• Perception: Subjective feeling of inadequate sleep, regardless of actual sleep duration.

Sleep Apnea:

• Definition: Repeated interruptions in breathing during sleep, leading to fragmented sleep and reduced oxygen levels.
• Types: Primarily obstructive sleep apnea, where airway obstruction occurs due to relaxed muscles.
• Gender Differences: More prevalent in men initially, but rates in women increase post-perimenopause due to hormonal changes affecting airway rigidity.

Notable Quotes:

Dr. Shelby Harris [10:28]: "Insomnia is trouble falling asleep, staying asleep, or awakening earlier than you would like to."

Dr. Shelby Harris [13:14]: "Sleep apnea happens more in women once they hit perimenopause because of the loosening of the airway."

Restless Leg Syndrome and Its Impact

Restless Leg Syndrome (RLS) is another condition Dr. Harris addresses, noting its higher prevalence in women and its frequent misdiagnosis as insomnia or anxiety.

Key Points:

• Symptoms: Uncomfortable sensations in the legs (and sometimes other body parts) that create an urge to move them, disrupting sleep.
• Causes: Often linked to iron deficiency; Dr. Harris recommends checking iron levels and considering supplementation.
• Treatment: Behavioral changes, iron supplementation, and medications when necessary.

The Role of Alcohol, Caffeine, and Diet

Addressing lifestyle factors, Dr. Harris explains how alcohol and caffeine consumption can significantly impact sleep quality, especially as metabolism slows with age.

Alcohol:

• Effects: While it may induce sleep initially, alcohol leads to fragmented and non-restorative sleep due to withdrawal effects during the night.
• Recommendation: Limit alcohol intake to at least three hours before bedtime.

Caffeine:

• Effects: Stimulant that can delay sleep onset and reduce sleep quality.
• Recommendation: Avoid high-caffeine beverages within six hours of bedtime.

Dietary Tips:

• Evening Meals: Have heavy meals at least three hours before bed. A light snack combining complex carbohydrates and protein, like Greek yogurt with granola and berries, can promote restorative sleep.
• Notable Quote:

  Dr. Shelby Harris [35:29]: "Heavy meals, like your big meal, you wanna limit that within three hours of going to bed."

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Dr. Harris advocates for CBT-I as the first-line treatment for insomnia, highlighting its effectiveness over medication-based approaches.

Key Points:

• Components:
  • Sleep Restriction: Limiting time in bed to increase sleep drive.
  • Stimulus Control: Associating the bed exclusively with sleep.
  • Cognitive Restructuring: Addressing negative thoughts about sleep.
• Advantages: Long-term solutions without the risks associated with sleep medications, such as dependency and side effects.

Notable Quote:

Dr. Shelby Harris [21:18]: "CBT-I, Cognitive Behavioral Therapy for insomnia is really the gold standard treatment. It's the first line treatment for insomnia ahead of medication."

Napping and Sleep Debt

The conversation touches on the benefits and drawbacks of napping, emphasizing moderation to prevent disrupting nighttime sleep.

Recommendations:

• Duration: Limit naps to 20 minutes to avoid entering deep sleep stages, which can cause grogginess.
• Timing: Nap before 2 PM to prevent interference with nighttime sleep.
• Caution: Excessive daytime sleepiness despite adequate napping may indicate underlying sleep disorders requiring professional evaluation.

Notable Quote:

Dr. Shelby Harris [41:49]: "So if you're someone who tends to be an okay sleeper and maybe you're just not getting enough sleep because you've been working or the kids or whatever it is that's going on, then a nap can be really beneficial. So 20 minutes, that's what we recommend."

Menstrual Cycle's Influence on Sleep

Dr. Harris explains how menstrual cycles can temporarily disrupt sleep patterns, with increased insomnia preceding menstruation.

Key Points:

• Timing: Sleep disturbances often occur three to five days before the period begins.
• Mechanism: Fluctuations in estrogen and progesterone impact mood and physiological comfort, affecting sleep quality.
• Normalization: Sleep patterns typically return to baseline after menstruation starts.

Sleeping with a Partner: Sleep Divorce vs. Sleep Alliance

The episode explores the concept of "sleep divorce"—partners sleeping in separate bedrooms to improve sleep quality—and introduces the more harmonious approach of a "sleep alliance."

Sleep Divorce:

• Definition: Couples choose to sleep apart due to differing sleep needs or disturbances like snoring.
• Pros: Can reduce sleep disruption and improve individual sleep quality.
• Cons: May carry a negative stigma and emotional implications.

Sleep Alliance:

• Definition: A collaborative approach where partners agree to sleep separately on selected nights while maintaining intimacy through pre-sleep routines.
• Advantages: Preserves relationship intimacy without compromising sleep quality.
• Notable Quote:

  Dr. Shelby Harris [38:57]: "Sleep alliance... you together come up with a plan. And it doesn't have to be every day or every night. It can be three nights a week."

Debunking Common Sleep Myths

Dr. Harris and Tamsen tackle prevalent misconceptions about sleep, particularly the belief that older adults need less sleep.

Myth: Women need less sleep after 40.

• Reality: Sleep requirements remain consistent, typically seven to nine hours per night. Significant reductions may indicate sleep disorders needing evaluation.
• Notable Quote:

  Dr. Shelby Harris [50:05]: "If you see a doctor who tells you that it's normal to sleep less as you get older, find a new doctor."

Myth: Engaging in excessive cardio close to bedtime hinders sleep.

• Reality: While intense exercise within three hours of bedtime can be stimulating, regular daytime exercise generally promotes better sleep.

Supplements: Melatonin and Magnesium

The discussion delves into the efficacy and considerations of using melatonin and magnesium supplements for improving sleep.

Melatonin:

• Function: Regulates sleep-wake cycles; primarily effective for jet lag and adjusting sleep timing.
• Usage: Low doses (1-3 mg) are recommended. High doses can lead to vivid dreams, nightmares, and daytime sedation.
• Caution: Not a standalone solution for chronic insomnia and should be used under professional guidance.

Magnesium:

• Function: Acts as a relaxant, calming the body and mind to prepare for sleep.
• Types: Different forms like magnesium threonate are available, each with varying absorption rates.
• Benefits: Helps in reducing stress-induced insomnia but does not directly induce sleep.

Notable Quote:

Dr. Shelby Harris [45:35]: "Magnesium is really good as a relaxer... Melatonin often gets touted as like this insomnia cure. It really is not."

Success Stories and Takeaways

Dr. Harris shares an inspiring success story of a patient who overcame chronic reliance on sleep medications through behavioral changes and CBT-I, underscoring the transformative potential of non-pharmacological treatments.

Key Takeaways:

1. Consistency is Key: Maintain regular sleep and wake times to stabilize circadian rhythms.
2. Minimize Compensatory Behaviors: Avoid excessive efforts to force sleep, which can exacerbate insomnia.
3. Seek Professional Help: If sleep hygiene practices fail after two weeks, consult a sleep specialist for evaluation and advanced treatments.

Closing Advice: Dr. Harris encourages women to prioritize their sleep health, dispel myths, and utilize evidence-based therapies to achieve restorative sleep during perimenopause and menopause.

Final Notable Quote:

Dr. Shelby Harris [55:14]: "There's better treatments out there for different sleep disorders. So definitely get evaluated because it's not worth going through life just like not sleeping well when we can actually help you."

Conclusion

This episode of The Tamsen Show provides a comprehensive exploration of sleep challenges during menopause, offering actionable insights and expert guidance. Listeners are empowered to take proactive steps towards better sleep through understanding, consistency, and professional support.

Follow-Up Resources:

• Show Notes: Available on The Tamsen Show website, including links to Dr. Harris's recommended tools and further reading.
• Books: The Women's Guide to Overcoming Anxiety by Dr. Shelby Harris.
• Sleep Specialist Directory: Visit the Society of Behavioral Sleep Medicine website for certified practitioners.