unPAUSED with Dr. Mary Claire Haver

Episode: The Sleep Crisis in Menopause – Insomnia, Sleep Apnea & Solutions

Guest: Dr. Andrea Matsumura (Sleep Medicine Specialist)
Date: March 10, 2026

Episode Overview

This episode of unPAUSED is dedicated to unraveling the often-overlooked sleep crisis among women navigating perimenopause and menopause. Dr. Mary Claire Haver sits down with Dr. Andrea Matsumura, an esteemed sleep medicine specialist, to discuss why women’s sleep is so frequently disrupted and minimized, the unique presentations of sleep disorders in women, and practical, evidence-based strategies for improving sleep and overall health during midlife and beyond.

Key Discussion Points & Insights

Normalization and Minimization of Women's Suffering

• Why are women’s sleep complaints minimized?
  • Societal conditioning means women are expected to tolerate more suffering, from painful periods to sleeplessness in motherhood and menopause.
  • "We are taught that we are supposed to suffer more. And then you hit menopause, you hit midlife, and then you become invisible, and then you're supposed to suffer." – Dr. Andrea Matsumura (00:05)

Personal Context: Dr. Matsumura’s Journey

• Grew up experiencing medical dismissal; motivated her to become a healthcare advocate for women.
• "I need to take care of all of the people who don't have a voice and who are muffled and silenced and dismissed..." – Dr. Matsumura (07:34)

Sleep in Medical Training & Practice

• Both Dr. Haver and Dr. Matsumura note the lack of sleep education in medical training (09:04).

• Sleep is a foundational pillar of health, impacting cardiovascular risk, cognition, depression, anxiety, and quality of life.

  "Sleep is truly our core pillar of health. That's why I call it a vital sign." – Dr. Matsumura (10:17)

Defining Insomnia

• Insomnia: Inability to fall or stay asleep, feeling unrested upon waking.
• Chronic insomnia: At least 3 times per week for 3 months or more (11:31).

Gender Gaps in Sleep Research & Diagnosis

• Most sleep research and screening tools center men, making women’s presentations easy to overlook (12:04).
• Many women with sleep apnea do not exhibit typical “male” symptoms like loud snoring, delaying diagnosis (14:03).

The Physiology of Sleep

• Four stages: Stage 1 & 2 (light sleep), Stage 3 (deep/slow wave, physical restoration), REM (emotional/memory consolidation).

• Deep sleep is concentrated in the first part of the night; REM occurs more in the latter half (21:37).

  “That deep sleep or slow wave sleep, we're supposed to get in that first one third of the night, and then REM sleep is usually in the last half...” (21:37)

What is Restorative Sleep?

• Waking refreshed, “rainbow and birds chirping” feeling, clearheaded, and emotionally regulated (19:49).

Sleep Trackers: Pros and Cons

• Useful for spotting trends but not diagnostic tools.
• Trust how you feel over the data (22:59).
• "Ask yourself first before you wake up, how you feel before you start looking at your data." (22:56)

Hormones and Sleep Regulation

• Estrogen: Supports temperature regulation and REM.
• Progesterone: Calms the brain, supports airway.
• Testosterone: Aids in deep, sustained sleep (25:49).
• Loss of these fuels midlife sleep changes.

Notable Quotes & Memorable Moments

• On Sleep as a Core Pillar:

  “If we are not getting the quality, not just the quantity of sleep, then everything is off bets.” – Dr. Matsumura (10:51)

• On Diagnosis Delays:

  “Women tend to have insomnia. They tend to have this... tossing and turning. And I love it: Women never say that they snore. They say that they purr." – Dr. Matsumura (45:53)

• On Hormone Therapy:

  “Hormone therapy helps, but up to half of those who start on it still have trouble sleeping. So we have to look at the other organic causes.” – Dr. Matsumura (61:32)

• On Shift Work:

  “There is good data out there that shows that if somebody has untreated sleep apnea or untreated insomnia, that once we begin to treat it, you can get yourself back to baseline.” (53:02)

• On “Sleep as a Vital Sign”:

  “We could be chasing our tail with high blood pressure if somebody is not getting enough sleep... that's why I think that sleep should be a vital sign.” – Dr. Matsumura (77:12)

Key Segments with Timestamps

• Why Women’s Sleep is Overlooked & Dismissed – (00:00–01:10)
• Dr. Matsumura’s Background & Motivation – (06:29–08:51)
• Medical Education’s Sleep Blindspot – (09:04–10:15)
• Defining Insomnia & Prevalence – (11:21–11:57)
• Sleep Gender Bias & Diagnosis Challenges – (12:04–14:32, 45:03–48:52)
• Deep Dive: Sleep Stages – (19:35–21:37)
• Wearable Tech and Data Anxiety – (23:39–24:27)
• Hormones & Sleep Science – (25:40–27:43)
• Movement Disorders: Restless Leg Syndrome – (32:04–36:06)
• CBT-I for Insomnia; Behavioral Approaches – (39:24–45:03)
• Under-Diagnosed Sleep Apnea in Women – (45:03–48:52)
• Melatonin: Myths, Realities, and Dosing – (49:04–55:41)
• Medication Risks (Ambien, Trazodone) – (64:18–66:29)
• Chronotypes and Relationship Dynamics – (67:11–68:50)
• Lifestyle: Exercise, Diet, Light Exposure – (69:01–71:24)
• Sleep Supplements Discussion – (71:24–73:55)
• First Steps for Exhausted Women – (74:25–76:22)
• Sleep Myths & Small Wins Matter – (76:28–77:08)
• Dream Sleep Method (Acronym) – (78:47–81:39)
  • D: Daytime Activities
  • R: Resting Environment
  • E: Emotions
  • A: Archetype/Chronotype
  • M: Medical Conditions
• Empowerment in Midlife & Sleep Health Hope – (82:05–83:23)

Evidence-Based Solutions Discussed

• Hormone therapy can address sleep disrupted by hot flashes and hormonal shifts, but may not be a complete solution.
• Cognitive Behavioral Therapy for Insomnia (CBT-I): Gold standard for reprogramming sleep behaviors and thoughts.
• Addressing Iron Deficiency (esp. for RLS): Ferritin ~100 ng/mL is target for symptomatic relief (35:02).
• Treating co-occurring sleep disorders (apnea, RLS) and considering chronic insomnia as a medical condition.
• Lifestyle Recommendations: Regular exercise, mindful diet (avoid heavy/greasy meals close to bedtime), optimize bedroom (dark, cool, quiet).
• Supplements: Use with caution; melatonin can help if dosed correctly (≤3mg), but more is not better.
• Importance of Personalizing Solutions: There is no “one size fits all”—what works for one may not for another.

Empowerment & Lasting Takeaways

• Sleep complaints are not just “part of aging”: They are common, but not to be dismissed.
• Women are not broken – sleep challenges in menopause are the product of real physiological shifts and require tailored solutions.
• Every 15 minutes of extra sleep is a win; perfection is not the goal.
  • “Let's focus on the little wins and not have to think that we have to be perfect.” (76:28)
• There is always hope and always something that can be done to improve sleep—women need not simply “live with it.”
• Dr. Matsumura’s “Dream Sleep Method” offers a practical checklist for addressing complex, multifactorial sleep challenges.

Resources

• Find a Sleep Specialist: American Academy of Sleep Medicine Provider Directory
• Dr. Andrea Matsumura: Instagram @dreamatsumura | sleepgoddessmd.com
• Dr. Mary Claire Haver: Instagram @doctormaryclaire | thepauselife.com
• Book Mention: The New Perimenopause – Available for preorder.

Closing Thoughts

This episode offers expertise and compassion, challenging the pervasive myth that poor sleep is simply a “normal” or “inevitable” part of menopause and aging. Rather, Drs. Haver and Matsumura equip listeners with practical tools, validation, and hope, affirming that every woman deserves restorative sleep and the chance to thrive in her second half of life.