0:00

Tired of ads crashing your comedy

0:02

podcast party? Good news! Ad-free

0:05

listening on Amazon Music is included with

0:07

your Prime membership. Just Just head

0:09

to amazon.com/adfreecomedy to catch up

0:11

on the latest episodes without

0:14

the ads. Sleep

0:18

Science and Sleep Health Unlocking

0:28

your sleep potential brought to

0:30

you by cleanmybed.com So

0:35

welcome to another episode of our special series

0:37

on sleep science and sleep health and today

0:40

we tackle a subject which doesn't get a

0:42

lot of air time and that is the

0:44

subject of menopause and its

0:46

effect on sleep and as usual

0:48

I have my co-host Dr. Jill Warner here

0:50

in the studio with us and we

0:52

have a special guest and that is on

0:54

the way all the way from the UK via Zoom Dr.

0:56

Zoe Shadal who

0:58

has 15 years experience as an NHS GP with

1:01

expertise in menopause care sleep problems,

1:04

sexual health and contraception. She's

1:06

an accredited British Menopause Society

1:08

menopause specialist and is

1:11

a member of the BMS Medical Advisory

1:13

Council. Welcome Zoe. Thank

1:15

you, thank you for having me. So

1:17

first of all let's just have a look

1:20

at exactly what menopause is when does it

1:22

happen, how long does it go on for

1:24

from the bit of reading I've done obviously

1:26

it's a very different experience for lots of

1:28

different women and those experiences vary very much

1:31

from not only the time it starts to

1:33

the experiences and the symptoms that they have

1:35

during menopause and how long it lasts. Absolutely,

1:39

so really menopause marks the end

1:41

of reproductive life so it's where

1:43

the female reproductive hormones stop being

1:46

produced and clinically we actually

1:48

define it just as a day in time

1:50

so the menopause is one

1:52

day which is one year after your last

1:54

menstrual period but when we're talking about the

1:56

menopause we're really often talking about a whole

1:59

phase of it. of life and we actually

2:01

think of it as much more as a transition. And

2:04

because actually the hormones don't stop

2:06

being produced just overnight, it's not

2:08

one day, there's quite a long lead

2:10

up to that. And what happens

2:13

is this phase we call

2:15

the perimenopause, which starts many years

2:17

before that last period. So it can be five years,

2:19

it can be 10 years. And

2:22

since puberty, the female reproductive

2:24

system has been managing regular

2:26

menstrual cycles with predictable ups and

2:28

downs of estrogen and progesterone. And

2:31

what starts to happen when on average people

2:33

hit their 40s is actually the

2:35

ovaries don't have such a good

2:37

supply of eggs, the hormone production

2:40

isn't as good and as predictable

2:42

and it can become very chaotic

2:44

and you get these sort of

2:46

surges, highs of estrogen and lows

2:48

and also some cycles that you

2:50

won't ovulate, you have these an

2:52

ovulatory cycles so no progesterone is

2:54

produced. And what it kind of

2:56

causes is a whole sort of mess of

2:58

hormones, very unpredictable. And

3:00

the key thing with that is it

3:02

can cause symptoms. So there are estrogen

3:04

receptors all over a woman's

3:07

body from their brain,

3:09

the heart, the skin, the reproductive

3:11

organs everywhere. And so when the

3:13

hormones start to misbehave a bit,

3:16

we start to see symptoms and there can

3:18

be lots and lots of different symptoms.

3:20

So that's the perimenopause, you then stop

3:22

the periods and you enter something called

3:24

the postmenopause which is when there's no

3:26

hormones being produced by the ovaries at

3:28

all. And so we see this

3:30

whole thing as a transition and in terms

3:33

of how long symptoms last, you're so

3:35

right, it is very, very individual.

3:37

The average woman will have symptoms

3:39

for about 10 years but at

3:41

least one in five women, the symptoms will

3:44

go on for 15 years or more. So

3:46

it can be very lengthy, some people will

3:48

just be a couple of years, it really

3:50

differs and it's quite unpredictable. And

3:54

Joakim, we just say, when we

3:56

talk about symptoms, what are the

3:58

most common, the most frequent ones? that people

4:00

experience, that women experience. So

4:03

we always, when you think menopause, we always

4:05

think of the kind of temperature symptoms,

4:07

so hot flashes and night

4:09

sweats. These are very commonly

4:11

associated, so 75% of

4:13

women will experience these. And there

4:16

actually is the body's, basically the

4:18

thermostat has basically been a bit

4:20

broken with the hormone changes. So

4:22

the effect of losing estrogen on the

4:25

hypothalamus means that out of nowhere, the

4:27

blood vessels will just suddenly dilate, try

4:29

and release lots of heat from their

4:31

skin, someone can turn quite red and

4:33

also have quite a lot of sweating

4:35

for no good reason at all. And

4:37

this can happen frequently during

4:39

the day, but also very importantly

4:41

at nighttime. And you can have

4:43

these, a similar process leading

4:45

to these kind of prolonged sweats at night as

4:47

well, that we call night sweats. These

4:50

are the really classic symptoms of

4:52

menopause, but actually it's often other

4:55

symptoms that impact women even more.

4:58

Because there are receptors everywhere,

5:00

you can get symptoms like

5:03

headaches, like heart palpitations, skin

5:05

changes, changes to the menstrual cycle.

5:09

And the brain is very affected

5:11

by the varying levels of

5:13

hormone. So the brain tends

5:15

to like regular cycles or

5:17

flat. And when you get

5:19

these kind of chaotic hormones in the perimenopause,

5:22

very commonly we'll see mood changes.

5:24

So we have double the rates

5:26

of depression in the menopause,

5:28

which is an increased risk of

5:30

developing anxiety symptoms. And

5:33

also, cognitive changes, so changes with the

5:35

way people think and remember things. And

5:37

I think these are very important, particularly

5:39

in the workplace. Women can

5:41

really struggle with this sort of condition they

5:43

call brain fog. And this

5:46

is the number one thing often women will say,

5:48

this really makes work very, very difficult. And we

5:50

know that about one in 10 women will actually

5:52

leave work because of the

5:55

symptoms of menopause. I've

6:00

shown a lot of women out there have experienced some

6:02

of them. So, Jill wanted to take the opportunity to

6:04

talk to somebody who has gone through it and here's

6:06

her case study with Sadie. Sadie,

6:14

thank you so much for talking to us

6:16

this morning. Perimenopause

6:18

and menopause are such important topics

6:20

at the moment. People are so

6:23

aware that we really are talking

6:25

about an illness for a lot

6:27

of people and just how debilitating

6:29

it can actually be for women.

6:32

Could you just describe to us

6:34

some of the symptoms that you've

6:36

experienced during perimenopause and menopause? Yes,

6:40

sure, Jill. So, I think

6:42

probably initially I suppose

6:44

looking back, I'd say maybe my early

6:47

40s, I started to have

6:50

a few little indicators now of what

6:52

would have been the perimenopause, although I

6:54

wasn't necessarily aware at the time. So,

6:57

they were quite

7:00

insignificant things really, but

7:03

things like a nice bit

7:05

of hair loss, sometimes

7:08

sort of sore breasts, but

7:12

nothing that was sort of

7:15

impacting really on life. But in

7:18

my late 40s, certainly there was a bit

7:20

of a shift and one of the things

7:22

that I really became

7:26

something that was a bit more challenging was when

7:29

my sleep seemed to be affected. So, I had

7:32

a busy job, I'd go to

7:34

bed and literally hit the pillow

7:36

and fall asleep, but I

7:39

would find that I would wake early

7:41

and from perhaps normally waking

7:43

at something like 6am to get up pretty

7:45

early to head off to work,

7:47

I was commuting. That

7:49

kind of started to nudge earlier in

7:51

the morning, the wake up

7:54

may be 5 o'clock and

7:56

then... Did that make you feel

7:59

anxious as a... Well would you say

8:01

say the it's that was happening to you

8:03

is making you feel uncomfortable in other situations.

8:06

It didn't really at that's fine my

8:08

arm i sort of I had a

8:10

lot of energy as was person had

8:12

called lot of energy I didn't sort

8:14

of sit down watching much T v

8:17

as car active so I kind of

8:19

power dawn the and are trying use

8:21

that time to are trying still that

8:23

sign a lot of. I. Do

8:25

that. Perhaps you know, catch up on

8:27

where call or do things I could

8:29

do quietly in house that wouldn't disturb

8:31

anyone else in the household on but

8:34

I try to use the time positively.

8:36

but I just sort of. Pulled.

8:38

It. Ended up working

8:40

longer hours on and. Not

8:43

really. realizing. The

8:45

impact that it was having such took

8:48

some time outside before. That

8:50

lack of sleep or those were it

8:52

wasn't good. That

8:55

that really started to have a bit more of

8:57

a. Physical Effect

8:59

and. You. Know how

9:01

are coping really? Data dials, I'm

9:04

a little bit more and in a

9:06

grumpy or grouchy. At times. So

9:09

perhaps as others. Around me who were

9:11

experiencing you know that as well, but

9:14

I'm be I coped it's quite quite

9:16

a long time actually and was just

9:18

sort of managing. Ah, but yes, it

9:20

did lead. To I'm certainly nicer

9:22

on on that sort of an

9:25

impact that. Ah, had

9:27

some of anxiety we've gained. much

9:29

was a new experience for me.

9:31

as if. Nothing. Else to

9:33

go to that thinking about it that

9:36

the sleep deprivation and at she didn't

9:38

sleep deprived causes quite a lot of

9:40

the same symptoms as the men opposed

9:43

to the to have perished drinks at

9:45

the in in terms of of the

9:47

symptoms that you experience. but see you

9:49

then am that the lack of sleep

9:52

was one of the most troublesome symptoms.

9:56

It. Was yes and I think it has out there

9:58

was that. It's we are. Say

10:00

that was probably like a cumulative

10:02

effect and ah, perhaps if I

10:05

could have sold status an early

10:07

a point and perhaps you know

10:09

understood a little bit more about

10:12

the. Impact of pass

10:14

which sing easter jin arm and that

10:16

that was a very natural process and

10:19

other such something has to be expected.

10:21

I'm on land bit more how to

10:23

manage that I've seen I would. I

10:26

could have improved to sleep which

10:29

would have prevented. Some other things yes

10:31

and he he mentioned just now as well

10:33

that you have been trying to be very

10:35

quiet in the house when you're up early

10:38

and didn't get it concern you that your

10:40

symptoms and being a little bit grumpy might

10:42

be affecting other members of the family as

10:44

well. Yes,

10:46

Definitely. Ah and ah. You

10:49

know you're not. You're. You're not

10:51

your best self and you are aware that you're

10:53

not your best version. Of yourself

10:55

on. And and it's

10:57

difficult for a single much more you worry about

10:59

it, the more it can impact. On your sleep

11:02

so am I Was was lucky that I

11:04

could. Get get to sleep praise late but.

11:06

It would be the early

11:08

breaking that was difficult and

11:10

I was fortunate the my

11:13

husband's already heavy sleeper so

11:15

I wasn't actually disturbing should

11:17

sleep on Thoughts are nevertheless

11:20

yeah, the impact on the

11:22

or on friends or family

11:24

unit colleagues When when you're.

11:26

Not. Claiming that your best com. A

11:29

and in that and that where is

11:31

it safe if once you'd realize this

11:33

was this was what was happening which

11:36

treatments which you say with most helpful

11:38

for you said. So

11:41

I kind of. I.

11:44

Think during the The Perry Men a

11:46

pause I wasn't really aware of what

11:48

was going on says really when the

11:50

men masaccio met a puzzle that I

11:52

rarely had the sort of health impact

11:54

and that just happened to coincide with

11:56

cause it's so there was some. as

11:59

to be a longer worn out experience of

12:01

actually being sort of

12:03

starting on hormone

12:05

replacement therapy. But I did

12:07

that probably after about 18 months and

12:10

did quickly see an improvement in

12:13

my sleep. And yeah,

12:15

and that helped everything. But

12:18

I think experiencing, when the menopause

12:20

actually experienced quite a lot of

12:22

cognitive issues.

12:24

So that was, I

12:27

think, a lack of sleep was really impacting

12:29

on those as well. So could you just

12:31

expand on those a little bit? What sort

12:34

of cognitive issues were you experiencing? So

12:37

I noticed changes in my memory.

12:40

I started to forget things. I

12:43

became very reliant on post-it notes,

12:45

on alarms on my phone. I

12:48

really had to plan my days

12:50

very carefully. And

12:53

something like an important appointment, I could just

12:55

completely go out of my head. So

12:59

it kind of had an impact on

13:02

my executive function, my

13:04

planning, time management, all those things

13:06

were really affected. And

13:08

it was quite bewildering actually, because

13:10

I was aware there was something

13:13

significant going on, but it

13:15

wasn't something that I

13:17

could just change by attitude. It

13:21

was something that just,

13:23

things weren't working in my brain was working

13:25

in a different way. And

13:28

yeah, it was just baffling,

13:30

bewildering, very hard to explain

13:32

to anyone. So

13:34

I did talk to doctors,

13:37

whatever, different people about it,

13:39

but it just felt quite

13:41

bewildering to talk about. But I now...

13:43

Once you started on the HRT, how

13:45

quickly were you able to return to

13:49

a more normal type

13:51

of what you would expect of yourself? Very

13:55

quickly, the sleep improved. I

13:58

think the... Probably

14:01

the lack of estrogen, once that

14:03

was being replaced, serving that

14:05

seemed to have an impact, positive

14:07

impact on sleep. So I was

14:09

sleeping for longer, sleeping better, less

14:12

quality of sleep. And

14:15

yeah, gradually things started to

14:17

improve. It

14:20

took some time for the dosage to

14:22

be sort of tweaked, so it suited

14:24

me. I think it's a very sort of

14:26

individual process. People

14:33

can respond differently and not everyone can take

14:35

HRT, of course. But

14:37

that was really helpful for me. That was a turning

14:39

point. It was, yes, absolutely.

14:42

And then I know that you've

14:45

also tried some other ways

14:47

of helping with the various symptoms.

14:49

Could you describe some of those

14:51

as well, Sadie? Yes,

14:53

sure, Jill. So as I explained, there was

14:56

quite a long sort of gap between treatment

14:58

just because of

15:01

COVID and so on. So I'd

15:03

had breathlessness, the

15:06

cognitive issues, diagnosed

15:08

with asthma, allergic

15:10

background. So I

15:14

started to look into things that would help

15:17

dial down, should we say a response to

15:20

any allergic response? So there

15:23

were all sorts of things. I tried most

15:25

things, but certainly things like exercise,

15:28

yoga, meditation, so perhaps shifting

15:30

from more high

15:34

intensity cardiovascular

15:36

type of exercise, perhaps dialing it down

15:38

to the gentler form of exercise,

15:40

you know, and say

15:42

things like Pilates yoga were really good. And

15:47

then I think about it, actually sort of

15:49

listening, learning

15:51

from other women about their experiences

15:53

through the menopause and

15:56

things, the Davina

15:58

McCall programs that were shown. here

16:00

in the UK were really

16:02

helpful. There were two of those.

16:04

My husband actually

16:07

watched them first and he suggested, you know,

16:10

they might be helpful. And, and

16:12

that was really helpful to have an understanding

16:14

of what's going on with my cognitive function.

16:17

So once I

16:19

think I had an understanding of what was

16:21

going on, I could then use

16:24

tools like nutrition, exercise,

16:28

managing myself, so

16:31

there's more. Are you now in a situation

16:34

where everything's totally under control and you're

16:36

fine and you're back to being you?

16:39

Exactly. I feel like me again, yes, it

16:42

was like from going from someone sort of

16:44

switching off my brain or part of my

16:46

brain, it was the

16:49

difference in the hormones, just it was like someone had switched

16:51

my brain back on again or that part and

16:54

I could remember things, I could plan

16:56

things, I could sort of have fun again.

16:58

So yeah. That's such

17:00

a positive message for everybody who is

17:02

listening to this today, that if you,

17:05

if you follow these programmes, if you

17:07

do everything that we just

17:09

talked about, you can go back to being

17:11

you again. Definitely, without

17:14

a doubt. Sadie,

17:17

thank you very much indeed. It's great to

17:19

talk to you and lovely to hear that

17:21

you yourself are now feeling very well. Thank

17:24

you. Thank you, Jill. Well,

17:30

thank you Sadie for sharing your experience and

17:33

lots to take in there. Of course, lots

17:35

of mentions of the sleep aspect of menopause

17:38

amongst other things and certainly sounds like she

17:40

had struggled through that phase but lots to take

17:43

out, very positive message in the end but sleep

17:45

being one of the main reasons why

17:48

she was feeling pretty rotten for a couple of

17:50

years. Absolutely. It's really

17:52

huge. So we know that more than

17:54

50% of women will experience sleep

17:56

disruption and the research says sort of 40 to

17:58

60% that... surveys,

18:00

recent surveys suggest more than 80% of

18:03

women will have disrupted sleep

18:05

during this phase. And sometimes it can

18:08

be the first symptom. So, you know,

18:10

you can be going along in your 40s

18:12

having had perfect healthy normal sleep and

18:14

suddenly you can't sleep. What

18:17

we see with sleep is lots of

18:19

different things can happen. But the most

18:21

common thing is broken sleep. So you

18:23

might fall asleep okay at the beginning

18:26

of the night, but actually you wake

18:28

up frequently during the night and that

18:30

can be it can be hot bushes. Night is

18:32

quite small in that, but sometimes it's just

18:34

out of the blue and you don't know

18:36

why and it, you know, it can be

18:38

very difficult for people to know what's going

18:40

on, particularly if they're not having other symptoms

18:43

of the perimenopause or menopause at that time.

18:46

And that's exactly what Sadie has

18:49

described. She said

18:51

it's so disturbing. You're awake early in

18:53

the morning having gone to sleep okay

18:55

when you first went to bed. But

18:57

then what do you do with yourself

18:59

at five o'clock in the morning? And

19:01

it seemed to affect other

19:03

issues for her as well. She ended

19:05

up with breathlessness. Is that something

19:07

else that's frequently a symptom? Well,

19:09

it's not a frequent symptom, but what we know

19:11

is that there are almost any

19:14

system of the body can be

19:16

affected by menopause. So breathlessness is

19:18

something we can see partly because there

19:20

are estrogen receptors in the lungs as

19:23

well, but also sometimes related to anxiety.

19:25

So, you know, there can be lots

19:27

going into that sense of breathlessness. And

19:30

actually it's interesting. We

19:32

think about these sleep problems over

19:34

the menopause, but there is an increase in one

19:37

of the respiratory sleep problems as well obstructive

19:39

sleep apnea. And we

19:41

think the reason for that is that it doubles at the time

19:43

of the menopause in women. We

19:45

think the reason is that part of

19:48

the respiratory tone that we have, what

19:50

helps us regulate our breathing overnight is

19:52

driven by the hormones. And when they

19:54

drop, we're not so good at folding

19:56

this kind of tone and keeping the

19:58

airways open. ways

20:00

the respiratory system can be affected

20:02

by low oestrogen. But also,

20:04

you know, it can be nights when

20:06

hot flushes causing it. But

20:09

actually sometimes women don't have any of

20:11

those or they don't actually have any

20:13

anxiety or depression. It's

20:15

just the hormone changes themselves that affect

20:17

sleep. And we know if we monitor

20:19

hormone levels over time, as

20:23

oestrogen falls and as follicle stimulating

20:25

hormone goes up, which happens

20:27

around the time of the menopause, we'll

20:29

start to see less deep sleep, shorter

20:32

duration of sleep and just overall worse

20:34

sleep quality. So even in the absence

20:36

of any of those symptoms, sleep just

20:38

seems to get worse. And

20:41

we talked quite a lot during this series

20:44

about sleep quality and that it

20:46

isn't necessarily length of sleep but

20:48

quality of sleep that is so

20:51

important for our general well-being. When

20:54

people come to you, Zoe, and they say

20:57

this is what's happening, what do you advise

20:59

them in terms of how to improve their

21:01

sleep during this period? Yeah,

21:03

you're so right. So that fragmented sleep

21:05

is often the most hard to

21:08

cope with. And I think it's

21:10

that kind of frequent waiting that can

21:12

also really have an impact on the next

21:14

day's functioning. So what we see is

21:17

so unfair for people experiencing the menopause.

21:19

Not only are they dealing with feeling

21:21

a bit crappy in the daytime anyway,

21:23

a bit depressed, a bit

21:25

anxious, then all sleep just makes all of

21:28

that worse and also makes the cognitive function

21:30

worse as well. So I think for

21:32

me, sleep is the absolute key symptom

21:34

to get on top of in menopause because

21:36

I think then it can have a knock-on effect on

21:38

other things. And I think the

21:40

first thing to do is try and work out what

21:43

is it? So is there something that's

21:46

going to be more difficult for people? It's a

21:48

really individual experience. And is it obviously

21:50

a hot flush as a night fit? Is it

21:52

obviously the anxiety that's creating that

21:54

kind of empathetic nervous system activation?

21:56

And try and pinpoint it. We

21:59

might not think out which might

22:01

just be the hormones causing havoc and

22:03

then think about how to treat those symptoms. So

22:06

the most effective

22:09

treatment is something like hormone replacement

22:11

therapy or menopause hormone therapy

22:14

and this is where you replace the

22:16

oestrogen. So you give them an oestrogen

22:18

and if they have a uterus you

22:20

might also need to give a progestogen

22:22

to protect the lining of the womb.

22:24

So it's often the use of two

22:26

hormones and this is the most effective

22:28

way of treating lots of the symptoms like hot

22:30

flushes, it can help with the mood and the

22:32

anxiety as well but

22:34

it also can help improve sleep and

22:37

so we know it can improve sleep architecture,

22:39

we see a bit more deep sleep when

22:41

you use HRT and it can help to

22:44

reduce those makings as well. So for some

22:46

people this will be a really good first

22:48

option and it will make them feel better

22:50

in lots of ways. Some people

22:53

can't take HRT or they might choose

22:55

not to and this is particularly for

22:57

women that have had a history of breast cancer.

22:59

So this is a group that HRT

23:01

is usually contraindicated. So for

23:04

those people we would always want to think

23:06

is there something else we can do about

23:08

the symptoms? Actually there's lots

23:10

of treatment options but lots of non-phonomal

23:12

medications that we can use. Some of

23:14

them are antidepressants that are also quite

23:17

good for sleep as well. And then

23:19

we also need to think about some of

23:22

the non-pharmacological treatment, so

23:24

cognitive behavioral therapy for insomnia.

23:27

Now I don't know if you've spoken about this

23:29

before on other podcasts but

23:31

this is a really really effective program

23:34

where you're really targeting some of the

23:36

thoughts and the behaviours around sleep and

23:38

you might think well if someone's hormones

23:40

have gone wrong how can this help?

23:43

But actually we know it can be really

23:45

effective for women during the menopause transition

23:48

and it's partly because although

23:50

the hormone problems have started the sleep

23:52

problem and they've triggered it, actually

23:55

it can become an entrenched

23:57

habit partly due to the

23:59

anxiety leaping and also some of

24:01

the changes people make to their behaviour.

24:03

And so whether or not

24:06

you have HRT, CBT-I can

24:08

be also really, really helpful

24:10

and particularly if you're not going to access

24:12

HRT, that might be a really good option. And

24:15

also make sure... I was just going

24:17

to say, we have talked about CBT

24:19

on a previous podcast, but again, could

24:21

you just expand a little bit more

24:24

on the sort of questions that you're

24:26

asking people so that they do consider

24:28

what's happening to them and what they

24:30

can do to control those

24:34

anxieties and problems? Yeah.

24:36

So the idea really is it's

24:38

all about how insomnia develops. So

24:41

we know that insomnia is this

24:43

chronic ongoing sleep problem. So it's where

24:45

you struggle with sleep at the beginning of the night,

24:47

wake up a lot or wake up too early. And

24:50

if that's been going on a long time, often

24:52

it means that there's

24:54

this kind of mismatch between

24:57

what the body... you want the body to do and what

24:59

it does when you get into bed at night. And

25:01

so often there has been

25:03

a sense of anxiety around sleep.

25:06

So lots and lots of people

25:08

that are seeing clinic are really

25:10

focused on their sleep. They're actually, even in

25:12

the daytime, they start worrying about whether they

25:14

will be able to go to sleep at

25:16

nighttime. And as they lead

25:18

up to bed, as they get more

25:20

and more tired, they're absolutely exhausted. That

25:22

sense of anxiety builds. And the moment

25:24

they hit bed is where their mind

25:26

starts racing and they feel absolutely exhausted,

25:28

but they feel tired but wired in

25:30

bed. And some... CBT

25:34

is a program. So you will have

25:36

heard of CBT for things like anxiety

25:38

and depression, but it's actually very specific

25:40

and very practical when it's applied for

25:42

insomnia. It's a slightly different

25:45

version. So one of the focus is on those

25:47

cognitions, those thoughts, those anxieties.

25:50

And how can we actually challenge those

25:52

thoughts and actually give almost replacement

25:54

with something that doesn't create that

25:56

same kind of activation in the

25:58

nervous system? But I think

26:00

the key and one of the most

26:03

effective things is the behavioral technique. And

26:05

what's often happened, and we see this a

26:08

lot for women in menopause, is that

26:10

although we don't get much sleep in bed,

26:12

it's an awful long time spent in bed,

26:15

but I see women that are absolutely exhausted,

26:17

this is incredibly busy time of life with so

26:19

much going on. And they can't

26:21

sleep, and they're having terrible sleep, so they

26:23

go to bed earlier and earlier. And in

26:25

fact, you know, have people getting into bed

26:27

at nine, getting up at about

26:30

6.30, they're in bed for sort of nine,

26:32

10 hours a night. But when

26:34

you ask them how much they're asleep, they're asleep for

26:36

five or six hours a night. So

26:39

a lot of that time in

26:41

bed is spent awake, often feeling

26:43

quite anxious. And what

26:45

this creates is this really unhealthy connection

26:47

with bed and being awake. And we

26:49

call this conditioned arousal. So you're

26:51

almost training yourself to be awake

26:54

overnight. And so some of the

26:56

techniques in ZBTI to

26:58

try and reduce that, if you have

27:00

something called sleep or bedtime restriction, where

27:02

you get someone to go to bed a

27:04

bit later and wake up a bit earlier,

27:06

and actually try and sort of squidge together

27:08

the time and actually force them to have

27:10

that sleep in that time, because they're not

27:12

lying there for a really long time, creating

27:15

this unhealthy habit. So there are other

27:17

techniques like that, and I think they're very powerful. And

27:19

that will often be advice I give to someone is,

27:22

we really need to think about your early bedtime, I'm

27:24

not sure it's actually helping you to get

27:26

into bed so early and give yourself this

27:28

huge sleep opportunity. And

27:31

one of the things we've heard from

27:33

quite a few of the people on

27:35

the previous podcast is that a regular

27:37

routine is incredibly important as far as

27:39

your sleep patterns can stand. Absolutely,

27:42

and I think the key thing

27:44

to kind of anchor that is the waking

27:46

up time. So if you can do one

27:48

thing, it's trying to get your waking

27:50

up time as consistent as possible. And

27:53

then the bedtime, regularity is

27:55

important, but also when you choose to get

27:58

into bed matters a lot, they're really... is

28:00

so many people I see get into bed and

28:02

then lie there for an hour waiting for

28:04

sleep to come and it's like getting to

28:06

the table when you're not hungry and just

28:08

sitting there waiting to get some appetite. We

28:11

really don't want, you know, regularity

28:13

is important but don't do it

28:15

too early if you're not sleeping.

28:17

Actually wait until you have that

28:19

really good sleep drive that builds

28:21

up throughout the day and that

28:24

gives the best chance. The

28:27

other treatment I've heard that potentially

28:29

can be helpful is melatonin. Melatonin

28:34

is a hormone that we produce ourselves from

28:36

the pineal glands and as we

28:39

age actually the pineal gland can get

28:41

a bit calcified and sometimes the reduction

28:44

is less. So melatonin

28:46

is controversial and actually there's

28:48

not great data to say that

28:50

it really helps that much with things

28:52

like insomnia. It more helps with timing

28:54

issues so circadian rhythm disorder things

28:56

like that. Actually

28:59

when we're looking at an older population

29:01

melatonin is something to consider. Certainly in

29:03

the UK you can actually prescribe

29:05

it, it's licensed for people

29:08

over the age of 55 only for

29:10

a short term use but if

29:12

it's effective then it can

29:14

be very helpful even in slightly

29:16

longer term use. However in

29:18

my experience that often isn't the

29:21

underlying problem for women in menopause

29:23

so I tend to focus much more

29:25

on the menopause symptoms first. Let's really try

29:27

and get those under control but melatonin can

29:30

be a useful option. There are other

29:32

prescribed options. There are things like

29:34

sedating antihistamines and antidepressants

29:36

and again all

29:38

of them are problems with them. There isn't

29:40

a kind of perfect medication that

29:42

will always work. I

29:44

think when people are struggling you've got to keep an open

29:47

mind and you've got to look at all the options out

29:49

there and try and work with someone to find something

29:51

that really really helps. So

29:54

we've talked about the pharmaceutical options and

29:56

the CBT. Are there other lifestyle changes

29:58

that can be helpful Zoe? Yeah,

30:02

I suppose just sleep hygiene

30:04

or sleep habits but I'm sure you've spoken

30:06

about so things like making sure

30:08

your room is very dark, you know,

30:10

very quiet, have earplugs if they help

30:12

you, that sort of thing. I

30:15

think things very specific to menopause

30:17

is also thinking about the temperature.

30:20

So we know when we want

30:22

to sleep, we have to drop our

30:24

own core body temperature a little bit

30:26

to get to sleep and that should

30:28

ideally remain lovely and low and

30:31

stable throughout the night. So

30:33

obviously that's where the hot flashes and night sweats are

30:35

very problematic but

30:37

actually just really being conscious of that

30:39

temperature issue, making sure your room is

30:42

nice and cool, packed up,

30:44

having a hot bath or shower before you

30:47

go to bed to allow that release of

30:49

heat from your skin and drop the core body temperature

30:51

a bit can help. Some people who

30:53

are experiencing hot flashes and night sweats have

30:55

shown me actually, they've taught me in clinic

30:57

a clever hack which is you

30:59

can buy these cooling pads for bed and

31:02

I've had a number of patients who

31:04

really swear by these sort of chilli pads

31:06

that they put in their bed and help them to

31:08

cool temperature and apparently it's much cheaper if you buy

31:11

them from the pet aisle rather

31:13

than the menopause product aisle. So

31:15

you can buy a cooling pad for your dog and actually use

31:17

it in your bed but

31:19

things like that can be helpful.

31:22

I think also the things you've

31:24

taken in the day, so we

31:26

always talk about caffeine but caffeine

31:28

can also make menopause symptoms worse.

31:30

So I've had plenty of women

31:32

with palpitations and headaches that they

31:34

really improve if we can reduce

31:36

that caffeine use and keep that

31:38

to the early hours and unfortunately

31:40

metabolism changes in menopause and alcohol

31:42

can become much easier, much more hard

31:44

to tolerate as well so avoiding

31:47

those things as well. Exercise,

31:50

so this is a phase of

31:52

life that we see people's activity

31:54

drop so it's partly I think

31:56

just life stresses pressures,

31:59

getting a bit old. are. And I think

32:01

it's also partly the symptoms of the

32:03

menopause just make everything a bit harder

32:05

for people. But we know that if

32:08

we can get really good regular exercise

32:10

or activity, that can really help with

32:12

sleep health as well. And then like

32:15

we always say regularity. So exactly as

32:17

you said earlier Jill, the timings,

32:19

make sure you're having regular waking

32:21

up times and often not too

32:23

early a bedtime. And

32:27

just listening to all of these ways

32:30

that people can manage their

32:32

symptoms. It's striking me

32:34

having listened to people talking for

32:37

the last year in a series of podcasts about

32:40

how much the menopause symptoms

32:42

are the same as sleep

32:44

deprivation symptoms. And therefore

32:46

the two are inextricably linked aren't

32:49

they? So focusing on your sleep

32:51

has to be the first thing

32:53

that you think about. You're talking

32:55

my language. This is exactly why the

32:57

sleep is just so important. So I've

32:59

been working as a menopause specialist for

33:01

quite a long time, but I've had

33:03

a really long standing interest in sleeping.

33:06

And weirdly, I haven't really put

33:08

them together until a few years

33:10

ago. This is clearly the most

33:12

important thing for women in the menopause to really

33:14

focus on because if you get that right, it

33:17

really can help with so many things. So

33:19

it's something I think is very

33:21

important and we lack in a

33:24

lot of research. We really need more

33:26

research to fully understand these links and

33:28

the ways we can use hormones and other

33:30

things to help people. But I think I hope

33:32

it's coming. What's

33:35

fascinating about this discussion is that it doesn't

33:38

seem like it's something that's been

33:40

very much highlighted when it comes to the stage of

33:42

life. And I guess what's interesting is

33:44

that because there hasn't been a lot of research

33:46

and other research is coming out or is that

33:49

because it just hasn't been publicized

33:51

and given enough here, Tom? I

33:55

think you're right. I think for a long time, so

33:58

about 20 years ago when I was at medical school,

34:00

I was told that really the only symptoms

34:02

of the menopause were being hot

34:05

and sweaty and actually

34:07

we know a hell of a lot more now, we

34:10

really have learnt a lot more but I

34:12

mean to be fair even 15 years

34:14

ago, there was this idea of core

34:16

symptoms of the menopause and sleep was

34:18

one of those four core symptoms so we've

34:20

known it's been important but I think

34:23

like lots of things to do with sleep,

34:25

it's been a bit dismissed and it hasn't

34:27

had the spotlights on it and it's been

34:29

a bit ignored and I think that's been

34:31

really cultural, actually we haven't always

34:34

put that importance and really understood sleep as

34:36

being as important as it is, it was

34:38

something that we could give up and actually

34:41

busy women across the world give up their

34:43

sleep for all the other things they've got to

34:45

do all the time, it's something people just think they

34:47

can do without. We can do everything,

34:49

can't we? We

34:52

expect to just manage everything. Yeah, everything

34:54

and who cares if you don't fall

34:56

into bed till three hours, you know,

34:59

lace them and everything needs to be

35:01

done but I think also

35:04

the increasing research about sleep and

35:06

the impact on health that

35:08

we've seen over the last five

35:10

years has really helped put a focus on

35:13

it in the menopause as well and actually I

35:15

suppose the negative sign of

35:17

that is people will often worry much

35:20

more about losing sleep now so people will

35:22

come to clinic and they'll say not

35:24

only is it awful because I'm not feeling good

35:26

in the day but I'm really worried what it's

35:28

going to do to me, you know, I'm worried

35:30

that this is going to lead to dementia or

35:32

lead to heart disease and things like that and

35:34

often during the menopause

35:36

because your brain isn't functioning so well, that

35:38

is a worry that people have. So I

35:40

think obviously we really need to

35:42

reassure people about that and we don't want to

35:45

create lots of anxiety about that but also to

35:48

really know how important sleep is and

35:50

to put that focus on it but

35:52

I've been surprised myself in my menopause

35:54

training over years,

35:58

I couldn't find anything. really

36:00

helpful on sleep and that's why I published

36:02

an article a few years ago on this

36:05

and I really couldn't find that much

36:07

to guide what we should do and

36:09

often in menopause clinics, people

36:12

would help all the other symptoms and when someone still couldn't

36:14

sleep at the end it would be oh

36:16

sorry about that don't quite know what to do

36:18

we'll send you back to a GP and you know

36:21

see how you go good luck and

36:23

I think it was almost an area they

36:25

don't have confidence in you know actually there

36:27

isn't very good sleep training in certainly in

36:29

the UK in medicine we get very little

36:32

sleep specialty training so I think people just

36:34

can't really know how to approach it or what

36:36

to do about it. So

36:39

a final question that we've been asking this

36:41

of all our specialists that have been on

36:43

this series, what's your bedtime routine look like?

36:46

Okay I am actually quite a good

36:48

sleeper annoyingly to everyone I'm a

36:50

good sleeper I find it very easy to sleep

36:52

I think it's very important so I do make

36:55

time for it. I don't always

36:57

follow all of the advice correctly so I tend to

36:59

work quite late in the evening I make sure I

37:01

take a bit of time off to have dinner with

37:03

my kids and when I've got my youngest down to

37:06

sleep I hit the computer and do lots of work in the

37:08

evening so I'm often finishing work

37:10

and jumping straight into bed but

37:13

what I do tend to do is I do

37:15

tend to close off my day really well so

37:17

I'll finish the day knowing that I've done all

37:19

the tasks I need or I'll make a little list for

37:21

the next day and so I have

37:23

a little kind of my own little toast work

37:26

routine and that really helps my brain

37:28

switch off I don't get into bed I don't

37:30

think about work when I'm in bed and

37:32

I fall asleep quite quickly and actually I

37:34

suppose I don't drink any caffeine at all

37:37

so I cut out caffeine some time ago

37:39

after just my own research and

37:41

that probably helps me a

37:43

little bit as well. Actually

37:45

the biggest thing is when I know my sleep is on

37:48

the edge of doing something a bit unhealthy

37:50

is when I wake up in the morning and

37:52

I check my phone and I look straight to

37:54

emails that then has a knock-on

37:57

effect to make me wake feeling anxious.

38:00

So I never, when I'm being good,

38:02

I never look at my phone first thing

38:04

in the morning. I don't check my emails. I'll always

38:06

make sure I've got up, I've gone and had a

38:08

drink and done other things before I walk, have a

38:10

look. And actually that, the morning, is more important to

38:13

my sleep than anything else actually. Ah,

38:16

that's a good tip. Thank you very much,

38:18

Dr. Zoe Sadell. Thank you for your time

38:20

today. And thank you to my co-host, Dr.

38:22

Jill Warner, who's been such a brilliant to

38:24

ask of good questions throughout the series. And

38:26

for now, it's goodbye. A

38:30

hawk. Oh

38:55

Tired of ads interrupting your gripping investigations. Good

38:58

news, Ad-free

39:00

listening on Amazon Music is included with

39:02

your Prime membership. Ads shouldn't be

39:04

the scariest thing about true crime. Just

39:07

head to amazon.com/ad-free true crime to

39:09

catch up on the latest episodes

39:11

without the ads. Enjoy thousands of A-Cast shows ad-free for Prime

39:14

subscribers. Some shows may have ads.