How To Fix Your Sleep Without Pills: The Truth About 40+ Women, Menopause, & Insomnia w/ Dr. Shelby Harris

[SPEAKER_01]: The aging thing is not true. [SPEAKER_01]: If anybody tells you it's normal to get a lot less sleep as you get older, find a new doctor. [SPEAKER_01]: Even if they're stressed to pressure anxiety going on, you don't want to ignore the sleep. [SPEAKER_00]: Dr. Shelby Harris, a clinical psychologist and board certified specialist in behavioral sleep medicine, authored the women's guide to overcoming insomnia, and translate science into nightly peace for women in midlife. [SPEAKER_01]: You might be sleeping at hours a night, but if you feel like it's not restorative, that should be a big sign that there might be something going on with your sleep. [SPEAKER_01]: What makes sleep in mid-life uniquely layered? [SPEAKER_01]: Biology

is a big component. [SPEAKER_01]: We see the hormonal changes. [SPEAKER_01]: Then we also see more anxiety and more depression. [SPEAKER_01]: And then the third piece that doesn't get talked enough about is... [SPEAKER_01]: So how do you really bridge that gap? [SPEAKER_01]: People want to quick fix. [SPEAKER_01]: Medication's not a problem, but it shouldn't be a frequent line treatment. [SPEAKER_01]: You have to think about the exit strategy. [SPEAKER_00]: Appnea is often overlooked in mid-life women. [SPEAKER_01]: You don't have to snore to have sleep apnea. [SPEAKER_01]: You can have pauses in your breathing, little chokes and gas. [SPEAKER_01]: The one caveat I always give is if f*** there might be something else going on. [SPEAKER_00]: Expert care

for menopause and sexual health now just to click away. [SPEAKER_00]: Virtual care by her MD offers longer visits, personalized treatment plans, and trusted providers all from the Comforted Home. [SPEAKER_00]: Learn more at her MD.com. [SPEAKER_00]: This episode was sponsored by her MD. [SPEAKER_00]: All right, Dr. Shelby, a dear friend and colleague. [SPEAKER_01]: Hey, girl, hey, all right. [SPEAKER_01]: So me so great to be here. [SPEAKER_01]: Thanks for having me on. [SPEAKER_01]: I'm really happy to be here. [SPEAKER_00]: Oh, my God. [SPEAKER_00]: I actually can say I slept well last night. [SPEAKER_00]: You and I need to talk. [SPEAKER_00]: And I need to see you as a patient. [SPEAKER_00]: And I have been sending people your

way, by the way. [SPEAKER_00]: When I have tried all of my lotions, potions, and environmental changes, so we'll get into that about setting you to room up like a spa. [SPEAKER_00]: Um, yes. [SPEAKER_00]: I have tried all the things. [SPEAKER_00]: Let me tell you. [SPEAKER_00]: Um, so you and I both see women struggling with hormonal changes and discovered that sleeplessness, what a nice word for nighttime torture. [SPEAKER_00]: Um, was a really a hidden tipping point. [SPEAKER_00]: And so what, what was your passion? [SPEAKER_00]: Why was your why? [SPEAKER_00]: Why sleep? [SPEAKER_00]: Well, sleep. [SPEAKER_01]: I've always been interested in sleep since I was a little kid. [SPEAKER_01]: I was a sleepwalker. [SPEAKER_01]: So I was

always like fascinated. [SPEAKER_01]: I know [SPEAKER_01]: I was stassing with like why would I do these things in my sleep and have no idea but it was happening and it's hereditary too. [SPEAKER_01]: So like I was just interested in sleep and then when I took a year between graduating from college and going to graduate school, I was put at the Brown Med School. [SPEAKER_01]: I was put on a study looking at alcohol dependence and they had me going to a rehab. [SPEAKER_01]: So people who were in early rehab, we were actually treating their sleep problems. [SPEAKER_01]: We were using [SPEAKER_01]: But we found that when people were sleeping better, early on, the risk of relapse

reduced significantly because people were going back to alcohol because they weren't sleeping. [SPEAKER_01]: And I was just like, why are we not talking about the importance of that this is 25 years ago? [SPEAKER_01]: Why are we not talking about it in other areas? [SPEAKER_01]: And that's what kind of set to it all off for me. [SPEAKER_00]: I don't ever remember actually learning about sleep in medical school or residency. [SPEAKER_00]: I just remember chronically being sleep deprived and then seeing a study about, I remember driving home one day and following a sleep after being on call for like 40 hours. [SPEAKER_00]: This is before the restrictions and then I walked into the kitchen because it was

morning and my husband was asking me a sentence and I couldn't complete it. [SPEAKER_00]: And he was like, you know, it's really scary. [SPEAKER_00]: He said, you were just driving a motor vehicle. [SPEAKER_00]: I said, no, what's even scarier is that I was just operating on someone now or a half ago. [SPEAKER_00]: And then I saw the data that came out that sleep deprivation is actually worse for you than driving under the influence. [SPEAKER_00]: Or you do worse driving a car. [SPEAKER_01]: It's so e-m is being drug, legally drunk essentially. [SPEAKER_00]: That's crazy. [SPEAKER_00]: Yeah. [SPEAKER_00]: And we were all doing it as medical residents and operating. [SPEAKER_01]: I was operating on people. [SPEAKER_01]: I

was delivering babies and doing cesareans in the middle of the night. [SPEAKER_01]: Yeah. [SPEAKER_01]: No one was talking about it. [SPEAKER_01]: When I started out in the field and was working in Montefierre initially there were surgeons who had saved me like who were older and they would say how can we teach ourselves to live on less sleep and like like the can't fake wake dude like there's only so much you can do. [SPEAKER_00]: there's only and at the time they did have restrictions for pilots and other people that did I don't want to say jobs that were riskier right that could put others in harm is way if you were not able to do your

job at its fullest capacity so we're not going to say we're more important but you know where we could hurt someone by being impaired by lack of sleep and so that always gets me what I want to go back to the sleepwalker because you know I'm a mommy and I did not know [SPEAKER_00]: Um, we would find her in other rooms in the morning. [SPEAKER_00]: So my husband and I always had to make sure that baby gates were up, that the doors were all locked because it was a joke of she's going to come here for saying her name because now she's 16. [SPEAKER_00]: Where's Maya and where's Maya going to be in the morning

because she would do that. [SPEAKER_00]: And I remember taking her into the doctor once like to the sleep clinic at Children's. [SPEAKER_00]: And they basically, you know, try to ask her why and she said she was scared and she would have nightmares and then when she would get up from her dreams. [SPEAKER_00]: So she actually remembered. [SPEAKER_00]: So I don't up that's technically a sleepwalker. [SPEAKER_00]: She remember moving. [SPEAKER_00]: She didn't like, she remembered the intention. [SPEAKER_00]: She didn't remember like wandering around, but then she remembered moving to somewhere. [SPEAKER_00]: You know, her blanket or stuffed animal, but just somewhere else in the house, but then it just stopped. [SPEAKER_01]: Is that what happens to

sleepwalkers that just they outgrow it typically does we always think about it is like sleepwalking sleep talking night terrors like terrors we think about it like an old school car with gears like you're shifting gears between sleep stages and it's like you're getting stuck between wake and deep sleep. [SPEAKER_01]: And that's what, so you're kind of doing both things. [SPEAKER_01]: I had no recollection of it until my granddad thought there was a burglar. [SPEAKER_01]: And I was trying to like walk out the back door and he screamed and woke me up. [SPEAKER_01]: But I didn't know what I was doing it. [SPEAKER_01]: Yeah. [SPEAKER_00]: So is that also what they call hypnogogic hallucinations? [SPEAKER_00]: Totally

different. [SPEAKER_00]: So when I wake up and I think there's a spider next to me and I like start frantically going like this, what is that? [SPEAKER_00]: That's a hypnogic hallucination. [SPEAKER_01]: But there are hypnogic hallucinations when you're waking up, it's like waking up, it's a hypnogic hallucination. [SPEAKER_01]: Those are hallucinations. [SPEAKER_01]: Those are different from walking and talking. [SPEAKER_01]: When I was opening the door, I was sleepwalking and my dad literally just was screaming, [SPEAKER_01]: So, I thought it was safety. [SPEAKER_01]: Yes, for anybody who does this, gates up, but if you start doing it or didn't now grow it and you started as a teen and adult, get it evaluated for sure. [SPEAKER_01]:

Can be medications, can be other things we always want to not ignore it. [SPEAKER_00]: No, for sure. [SPEAKER_00]: And that's why we took my daughter, you know, and they didn't seem to concern because we were doing all the preventative measures. [SPEAKER_00]: And then I think, you know, I can't remember what age exactly she outgrew it. [SPEAKER_01]: Yeah, I was 12 when I would grow it. [SPEAKER_00]: So yeah, she was a little bit younger. [SPEAKER_00]: I think, or at least I stopped finding her in other areas of the house. [SPEAKER_00]: So for sure. [SPEAKER_00]: Okay. [SPEAKER_00]: See, see where we're already off off off. [SPEAKER_01]: Yeah, everyone talks about sleep, and they just mean insomnia. [SPEAKER_01]:

It's a huge field. [SPEAKER_01]: It's like a whole specialty, and there's so many sleep disorders out there. [SPEAKER_01]: And I love talking about all the strange things we do in our sleep. [SPEAKER_01]: So it's all good. [SPEAKER_00]: I do too. [SPEAKER_00]: I was fascinated personally and also medically, you know, about dreaming about sleep, about lack of sleep and all the things, because I've struggled. [SPEAKER_00]: Yeah, actually way before a pair of menopause and menpause, I struggled as a teenager and then obviously for me, it really got bad in residency because I had to train myself because I also had a baby at the time. [SPEAKER_00]: So I had to train myself to be up to

nurse. [SPEAKER_00]: or to address the needs of the baby. [SPEAKER_00]: And also, if my picture went off, I had to, so it was almost like I trained myself to never allow myself to go into a deeper state of sleep because I was so worried about missing the baby crying at home. [SPEAKER_00]: And so, and it's like I never recovered from that. [SPEAKER_00]: I've always been my husband jokes like the lightest sleeper. [SPEAKER_00]: I can hear the whimper of a puppy like in my sleep. [SPEAKER_00]: And he is always shocked at how well I can hear when I'm sleeping. [SPEAKER_01]: It is a [SPEAKER_01]: question, I probably get asked at least once a week. [SPEAKER_01]: People

say to me, I was a great sleeper until I had my kids. [SPEAKER_01]: Then when I had my first kid or what it whichever could, they weren't sleeping well, but then a few months later they started sleeping well, but I continued to sleep poorly. [SPEAKER_01]: Why is that? [SPEAKER_01]: And it's that same reason. [SPEAKER_01]: And then the other thing is with people who have pages that have to go off or get calls and work on call. [SPEAKER_01]: That's like that just makes it hard too. [SPEAKER_01]: So you have like the double whammy. [SPEAKER_00]: Yeah. [SPEAKER_00]: I had the double whammy and I had it simultaneously going on with the same kind. [SPEAKER_00]: I had a

baby but I was like, well, if I'm not sleeping at work, why you sleep at home? [SPEAKER_00]: I mean, uh, you know, that who knows. [SPEAKER_00]: Yeah, otherwise logic. [SPEAKER_00]: Yeah, get it out of the way. [SPEAKER_00]: Have a young, get it out of the way. [SPEAKER_00]: Yeah. [SPEAKER_00]: Your trained and cognitive behavioral therapy, a gold standard that many doctors still don't offer, actually don't even know about. [SPEAKER_00]: Yeah. [SPEAKER_00]: for menopause related distresses. [SPEAKER_01]: Well, I would argue that insomnia treatment should be frontline for any issues, right? [SPEAKER_01]: So we often think about the old school way of thinking about it is insomnia's secondary to another issue, right? [SPEAKER_01]: So you're having more model

problems. [SPEAKER_01]: Once we get the more model problems that then you're insomnia will be fine. [SPEAKER_01]: Depression, anxiety, then you're insomnia will be fine. [SPEAKER_01]: What we actually even pay in any other medical issues, what we find is that in a lot of the cases, if you're not addressing the insomnia specifically, [SPEAKER_01]: it continues on for various reasons. [SPEAKER_01]: So we need to treat it with its own kind of... [SPEAKER_01]: It's own weight and really think about it because if you're not sleeping well, it impacts all the other things. [SPEAKER_01]: So we think about parameda positive menopause, what are some of the common symptoms that women have? [SPEAKER_01]: Hot flashes, night sweats, they're having more

anxiety, more stress. [SPEAKER_01]: They're waking up at three in the morning, like really, you know, tense. [SPEAKER_01]: And there's so many of those symptoms that are happening. [SPEAKER_01]: Depression. [SPEAKER_00]: It's a waking up to pee. [SPEAKER_00]: Like that's what they tell me they're disrupted because of the GSM. [SPEAKER_00]: Yes. [SPEAKER_00]: So, so coming. [SPEAKER_01]: But if you're sleeping better, it helps with a lot of those other symptoms. [SPEAKER_01]: It doesn't mean it's going to cure everything. [SPEAKER_01]: But I always think of sleep as like the bedrock for all the other things that are happening. [SPEAKER_01]: And if you're not coming in with like a good solid foundation, it's going to make it harder to make

movement on the other things. [SPEAKER_00]: Well, it's a vital sign, too, but I joke with what I do with sexual health because patients are like, I'm like, you want anything for your low libido and they're like, no, Dr. Javay and I'm like, why they're like, cause I would rather sleep and I hear you. [SPEAKER_00]: They're like, fix nicely, probably. [SPEAKER_00]: that and then a little address the sexual health. [SPEAKER_00]: But I'm like, that's so true. [SPEAKER_00]: She's like, I see the bed and I want to go to sleep. [SPEAKER_00]: I don't want to mess around because I'm only getting you know, two or three hours of quality sleep as it is. [SPEAKER_00]: So I don't

want to take time to be intimate or to have sex. [SPEAKER_00]: Like, I'd rather be sleeping and I'm like, [SPEAKER_00]: That's the most honest answer, so then we prioritize, like you would recommend, and we take care of the sleep. [SPEAKER_00]: But I want you to pause for a moment. [SPEAKER_00]: And so we talked about some of the adverse things that can happen when you don't sleep, right? [SPEAKER_00]: But can you talk about the benefits of sleep? [SPEAKER_00]: Like what happens when we sleep well? [SPEAKER_00]: Like what is our body doing while we're sleeping? [SPEAKER_01]: So there's different stages of sleep that are happening. [SPEAKER_01]: So you have light, sleep, like we're just stage one when

you're falling asleep. [SPEAKER_01]: That kind of like, I'm a wake or I'm asleep. [SPEAKER_01]: And then stage true is this, I always consider like a middle level. [SPEAKER_01]: And that's when you have a lot of, it's restorative for energy, but you have a lot of memory. [SPEAKER_01]: We see certain things on a sleep study that happen. [SPEAKER_01]: And you have a lot of memory formation then. [SPEAKER_01]: Then you have deep sleep. [SPEAKER_01]: That's stage three. [SPEAKER_01]: People always like, I want deep sleep all night long. [SPEAKER_01]: You actually don't have it all night long. [SPEAKER_01]: You have about 20% of the night is that deep, deep sleep. [SPEAKER_01]: That's when your body is repairing itself.

[SPEAKER_01]: So we think about if you exercise, if you've gotten injury, if you're younger growing, right? [SPEAKER_01]: These are all the things that your body, your cells are literally repairing themselves and growing. [SPEAKER_01]: So it's super important that's when growth hormone comes out and then REM sleep happens. [SPEAKER_01]: And REM sleep is really important for memory, for mood. [SPEAKER_01]: If you're not getting enough REM sleep, you can have a lot more mood instability. [SPEAKER_01]: So we really think about a kind of a sprinkling of the different stages throughout the night to keep everything at that baseline as I was talking about. [SPEAKER_00]: So your book, author, yay for you, shows that women experience in some

of the across their lifespan from puberty to menopause. [SPEAKER_00]: What makes sleep in midlife uniquely layered? [SPEAKER_00]: And how do you help women understand the shifting root causes? [SPEAKER_00]: So you talked about this, hormones versus anxiety versus behavior, does it all just kind of go together? [SPEAKER_01]: I always think about sleep in midlife as this perfect storm [SPEAKER_01]: three different ways. [SPEAKER_01]: So like we just said, the hormones, biology is a big component of it, right? [SPEAKER_01]: And I see women all the time in my practice and they're mid to late 30s who are starting to have some of those changes happen, but people don't always put two and two together. [SPEAKER_01]: So we see

the hormonal changes. [SPEAKER_01]: Then we also see more anxiety and more depression and women just in general. [SPEAKER_01]: And then the third piece that doesn't get talked enough about is the societal kind of stressors [SPEAKER_01]: So, they're in the sandwich generation when they're starting to go through a parameda pause and menopause, so they have, as I'm there, have the parents they're taking care of, the kids who are younger and becoming teenagers, there's that's just, and they're working more than ever. [SPEAKER_01]: So, inside the house, outside the house, so there's no demarcation between day and night, it's just like go, go, go. [SPEAKER_01]: So, that's that, like you put those three areas together, and it's like

no wonder we have more insomnia than men a lot of the times. [SPEAKER_00]: And so your trailblazer in really leading this charge to start recognizing and using cognitive behavioral therapy as first line treatment for women. [SPEAKER_00]: What resistance have you seen in clinical care? [SPEAKER_00]: And how do you help both women [SPEAKER_00]: And providers kind of bridge that gap and be like because when I mention it, they're like, don't should be come on. [SPEAKER_00]: Can't you just give me a pill? [SPEAKER_00]: Like, that's the first thing I hear. [SPEAKER_00]: Yeah, you just give me a pill and I'm like, well, that's not a long term fix. [SPEAKER_00]: Hear me out because now you are menopausal

and this is your forever stage. [SPEAKER_00]: I mean, I know when you was postmenopausal, but it doesn't mean you're not, you're not going to have symptoms. [SPEAKER_00]: So how do you really bridge that gap? [SPEAKER_01]: I love that question. [SPEAKER_01]: There's a few things that I think are the big barriers right now. [SPEAKER_01]: So one is the name of it. [SPEAKER_01]: So I'm a psychologist. [SPEAKER_01]: I'm a therapist by training, love therapy. [SPEAKER_01]: But I think there's still that stigma for a lot of people. [SPEAKER_01]: So when you call something cotton to behave with therapy, it's a little bit of like typical therapy, cotton to behave with therapy. [SPEAKER_01]: It's not. [SPEAKER_01]: It's very behavioral

and working on like it training your brain so that you're not like you the anxious about sleep. [SPEAKER_01]: And it's short term. [SPEAKER_01]: I see people generally forward to eight sessions. [SPEAKER_01]: I don't even see them every other week. [SPEAKER_01]: I see them online like every two weeks usually it's short term. [SPEAKER_01]: So I think that has to kind of get. [SPEAKER_01]: destigmatized a bit for people to think you're not going to long-term therapy for years. [SPEAKER_01]: It's very effective. [SPEAKER_01]: Like you were talking about the medications, people want to quick fix. [SPEAKER_01]: CBTI one times take a number of weeks. [SPEAKER_01]: I said, you got to give it at least a month, two months,

to really see if we're going to, if it's going to stick and hold. [SPEAKER_01]: The medication, the way I was talking is like there's, medications not a problem, but it shouldn't be of her blind treatment, because you have to think about the exit strategy. [SPEAKER_01]: A lot of these women are getting started on meds in their 30s and 40s and they might not have any side effects from it right now, but put them when they're 60, then we might have more cognitive issues, more risk of balance issues, walls, we need to think about that because it's rare that you just stop a pill and you start sleeping well again. [SPEAKER_01]: So you need to have

those techniques in those skills in place. [SPEAKER_01]: And I think the other big problem is that there aren't enough trained providers in it. [SPEAKER_01]: So people who really want to see someone who's a true specialist, so just don't many of us, and that's a big problem in the field. [SPEAKER_01]: That's why I wrote my book, that's why there's apps. [SPEAKER_01]: But if you're more complicated, you're on meds, or you want that real tailoring, then you really want to see someone impertinent. [SPEAKER_00]: My mother actually ended up in the hospital from Benadrill, [SPEAKER_00]: So her doctors kept denying, so she definitely has after she struggled with cardiovascular disease and having her quadruple bypass at 45, she

just became very anxious because she went through almost chums died, right, at a very young age and wasn't expecting it. [SPEAKER_00]: And so she had trauma. [SPEAKER_00]: Now I can recognize it was trauma. [SPEAKER_00]: and fear of almost going to sleep and thinking and then she would have racing thoughts. [SPEAKER_00]: And her doctors thought it was better than treating the underlying issue or maybe they just didn't know or have the tools or I don't want to blame them because I get it. [SPEAKER_00]: I'm a doctor. [SPEAKER_00]: I don't know everything. [SPEAKER_00]: But they let her, they told her it was safe to take Benadrol. [SPEAKER_00]: every night for two years. [SPEAKER_00]: And so I was

on a trip with her and we were sitting at dinner and she goes, I don't feel well and I go, oh my god, mom, is it your heart? [SPEAKER_00]: And she goes, I don't know, she got dizzy, she got hypotensive, she kind of fell to the ground. [SPEAKER_00]: We had to call the squad. [SPEAKER_00]: And [SPEAKER_00]: low and behold, cardiac rule out, thank God, but it ended up being Benadural withdrawal. [SPEAKER_00]: I mean, you would never think right over the counter medication. [SPEAKER_00]: Not even, we're not even talking ambient or one of the prescriptions. [SPEAKER_00]: We're talking over the counter. [SPEAKER_00]: How many people? [SPEAKER_00]: I know a lot of women who come to me

say, oh, I just take a Benadural. [SPEAKER_00]: Jimmel, and it's like, uh, you can't do that long-term either. [SPEAKER_01]: No, and in the reality too, is that [SPEAKER_01]: I was literally just having this conversation or the patient this morning who went to the pharmacist and the pharmacist was like, I would rather you take Benadryl than you take this Sonata, your prescribed. [SPEAKER_01]: I was like, actually reverse that. [SPEAKER_01]: The Benadryl has way more data on cognitive problems and falls thanata that you were prescribed. [SPEAKER_01]: I would rather the prescription than the over-the-catery. [SPEAKER_01]: A Benadryl still people suggest it and we really never use it in the state field. [SPEAKER_00]: Yeah, and I will tell

you after my mom's experience, I will never tell a woman, you know, I'm my prescriber, especially women will come to me and say, hey, I can't sleep at all when I'm traveling, particularly when they're environment changes. [SPEAKER_00]: I might go, I'll give you ambient for your trip or short term, but long term, we have to figure out, you know, once I've done the hormones and everything, then I send them your way. [SPEAKER_00]: I say, you need to figure out what's going on to fix this. [SPEAKER_00]: So sleep-to-sorted breathing, apnea is often overlooked in midlife women because they don't fit the typical stereotypes, right? [SPEAKER_00]: Which is you think of the kind of over ideal bodyweight

gentleman or the gentleman with a really, you know, thick neck or um you just don't think of midlife women. [SPEAKER_00]: So what signs should both women and clinicians be on the lookout for for apnea? [SPEAKER_01]: Yeah, the the questioner that's used a lot is called a stop bang questionnaire. [SPEAKER_01]: It really is not very effective for women. [SPEAKER_01]: So if you're going to someone who's just using that as your questionnaire, like, to screen you, it's probably a might be missing things. [SPEAKER_00]: So it'll be that sounds more like my life in a stop bang. [SPEAKER_00]: I mean, that's a sexual update to sleep. [SPEAKER_00]: I'm sorry. [SPEAKER_00]: I had to go there, girl. [SPEAKER_00]: I

told you, I don't know if it's in the day, it isn't funny yet. [SPEAKER_00]: I was like, I haven't heard of it. [SPEAKER_00]: Okay, tell me more. [SPEAKER_00]: It's being a little bit. [SPEAKER_01]: or I look at because I see women come to me with insomnia and I'm like I think you have sleep back near to or I think that's the main thing going on. [SPEAKER_01]: It presents less of the typical for many women, less of the typical like excuse me for making this dough. [SPEAKER_01]: It's the [SPEAKER_01]: It can be very, you don't have to snore to have sleep bathnia. [SPEAKER_01]: You can have pauses in your breathing, little chokes and gas. [SPEAKER_01]: It's

much more subtle, gets missed all the time. [SPEAKER_01]: And then the other things I think about are like, how do you feel? [SPEAKER_01]: Do you feel like your sleep is not restored it? [SPEAKER_01]: Do you feel like you have broken sleep at night? [SPEAKER_01]: Do you notice like women don't often say like, I'm super sleepy. [SPEAKER_01]: I'm falling. [SPEAKER_01]: I'm taking naps. [SPEAKER_01]: I'm like, they're more like, I'm tired. [SPEAKER_01]: I'm just dragging all the time. [SPEAKER_01]: And you kind of insomnia. [SPEAKER_01]: But if you have any of these other symptoms, you might have an apnea like a pause in your breathing that's waking you up. [SPEAKER_01]: and then you have insomnia on top of

it. [SPEAKER_01]: So we kind of need to treat both things. [SPEAKER_01]: And the one caveat I always give is if you go and you're pretty convinced there might be something going on with the quality of sleep, and they give you a homesleep study. [SPEAKER_01]: Home sleep studies are great. [SPEAKER_01]: A lot of people don't even want to see a doctor, or sleep doctor, because I don't want to sleep in lab with all the stuff. [SPEAKER_01]: Sleep the homesleep studies are generally pretty good, but there's screeners. [SPEAKER_01]: So if we know that if we see on a homesleep study, that you have apnea, [SPEAKER_01]: Then we know you have apnea. [SPEAKER_01]: We're pretty good at it.

[SPEAKER_01]: We've caught it. [SPEAKER_01]: And then they can go and treat it. [SPEAKER_01]: But it misses, it misses apnea good amount of times too. [SPEAKER_01]: So then we might need to do an in lab study. [SPEAKER_01]: So if it comes back negative and your doctor's like, you're fine. [SPEAKER_01]: Don't worry about it. [SPEAKER_01]: I might try to push a little bit more. [SPEAKER_01]: There might be something else going on. [SPEAKER_00]: So what do you say to the patient because this is what I say. [SPEAKER_00]: So this is the second push back. [SPEAKER_00]: I'll get after can you just give me a pill. [SPEAKER_00]: Yeah, is Dr. Javade I'm telling you I'm not sleeping well at

home and now you want me to go sleep in a lab or sleep in a foreign environment. [SPEAKER_00]: So what what do you what do you say to that and can I give them an ambient or just that throw off your results. [SPEAKER_01]: That's where our home sleep study is a good place to start. [SPEAKER_01]: Most insurance is always a start with home sleep study. [SPEAKER_01]: They can, and I've done them myself. [SPEAKER_01]: It can either be like an under, like a nasal can, you'll on the other hand and a pulse ox or simple. [SPEAKER_01]: And then there's some like watchpats. [SPEAKER_01]: I literally a watch with a pulse ox. [SPEAKER_01]: And you don't even

have to like return it. [SPEAKER_01]: You just throw it up. [SPEAKER_01]: Nice. [SPEAKER_01]: They're crazy. [SPEAKER_01]: And so like if this shows something, then you don't have to sleep in a lab. [SPEAKER_01]: You're fine. [SPEAKER_01]: So let's not worry. [SPEAKER_01]: The ambient is always something to discuss with the prescribing doctor, any sort of sedating medication. [SPEAKER_01]: Only reason. [SPEAKER_01]: Like, sometimes we use it in the lab, I'll have patients sleep with it. [SPEAKER_01]: If it's the only way they're going to get like two hours of sleep at night, you don't need a perfect full night either. [SPEAKER_01]: We just want to see your breathing. [SPEAKER_01]: But sometimes the medications can worsen, this is the other

thing. [SPEAKER_01]: They can worsen underlying apnea. [SPEAKER_01]: So people who might have apnea, but you're like, oh, you know, I just want to, or they're like, I just want to pill. [SPEAKER_01]: If you think there's apnea, you might actually make their apnea worse, even though they're very, they might now have more breathing issues and they might wake up with more problems long term. [SPEAKER_00]: Yeah, an apnea can lead to problems, right? [SPEAKER_00]: Correct me if I'm wrong with heart disease and I need to have good enough oxygen to your brain with a whole whole host of the storm. [SPEAKER_01]: You need cardiovascular issues. [SPEAKER_01]: We see a lot of, we're talking about midlife, right? [SPEAKER_01]:

So there's a lot of issues with people with apnea that struggle to lose weight. [SPEAKER_01]: right so because you're not sleeping you're literally not sleeping and it can create metabolic syndrome issues so we really want to treat that apnea if it's if it's really and it doesn't you have to have a mask on your face too people all have to assume that that's the treatment that's not the only treatment so we have lots of treatments for different saveries and types. [SPEAKER_00]: And I had that stereotype in my head, too, of the, you know, over-ideal bodyweight gentleman or someone who's got, you know, a thicker knack. [SPEAKER_00]: It wasn't until really I went for my ACLS

and started doing surgery. [SPEAKER_00]: And it was talking to the anesthesiologists who would do a thorough examination, right? [SPEAKER_00]: Of soft palate, mouth, nose, everything, and give people an anesthesia score to see whether or not they were good candidates to do an office surgery because I did a ton of an office procedures as a gynecologist. [SPEAKER_00]: at my tiny patients, the ones that were super fit, that the anesthesiologist was like, no, not a candidate. [SPEAKER_00]: You know, due to their anatomy, and it's not their neck. [SPEAKER_00]: It's like in their mouth. [SPEAKER_00]: And so I think for women, I want that messaging to be, please don't self-blame our love if you're snoring, because I hear

women say, well, I'm snoring now because I'm fat, or I'm snoring now because I've gained weight. [SPEAKER_00]: And it's like, well, you don't know what's going on. [SPEAKER_00]: You don't know your anatomy. [SPEAKER_00]: I agree with you that women really need to understand what's going on and are they happening or are they just snoring? [SPEAKER_01]: Exactly. [SPEAKER_01]: And the other thing to think about too is that when you start to have hormonal changes, there is a loosening of the airway. [SPEAKER_01]: So api is essentially when you fall asleep for all the listeners, when you fall asleep things loosen, right? [SPEAKER_01]: And that's what happens. [SPEAKER_01]: Your muscles loosen. [SPEAKER_01]: And when you have apnea, they

essentially loosen so much that you have a full or partial closure. [SPEAKER_01]: So that's the [SPEAKER_01]: And you wake up. [SPEAKER_01]: It doesn't have to be that prince, but you're taking if you're taking a sedating medication. [SPEAKER_01]: This is going to happen more and we want women to realize that like it might not be because of weight. [SPEAKER_01]: It just might be like you said the anatomy and then once you hit mid-life things just your air muscles loosen to begin with. [SPEAKER_01]: So that can also help things. [SPEAKER_01]: It doesn't have to mean you gained weight or who knows many different things that we can we have to look at. [SPEAKER_01]: But yeah, thin, fit

women, I had women in the early 20s that I diagnosed with apnea all the time that I send them off and we find they have it. [SPEAKER_01]: And they're shocked. [SPEAKER_00]: The shocked. [SPEAKER_00]: And so I don't want them to feel alone. [SPEAKER_00]: And I'm so glad that you said that that you can you've seen it as young as their 20s and people that you wouldn't think fit in that stereotype, at least that, you know, I thought of even as a doctor until I really, really learned. [SPEAKER_00]: The red conditioning. [SPEAKER_00]: You add a you help women retrain that brain away from fear and moving more towards that rest and relaxation. [SPEAKER_01]: Yeah, I think

so the sleep threats that we talk about in sleep medicine is it's really like when women aren't sleeping well. [SPEAKER_01]: And this is the thing that I hear the most often is I get in bed and my husband and my partner's not snoring that much, but they just breathe and I focus on the breathing. [SPEAKER_01]: Or [SPEAKER_01]: I mean, sometimes let's be real. [SPEAKER_01]: If there's no room going to mount, we need to get that evaluator, have them sleep apart. [SPEAKER_01]: Like, there's sometimes it's just hard to sleep through those things. [SPEAKER_01]: But they're listening out. [SPEAKER_01]: I've had patients listen out for, they'll hear their heartbeat, or they'll listen for the air conditioning and

really, like, try to fix the air conditioning system because it's something that could get in the way they're asleep. [SPEAKER_01]: So it's really about [SPEAKER_01]: What is a realistic thing that's happening routinely that you just physically can't sleep through versus are you scanning the environment for things that are getting in the way of you being able to sleep? [SPEAKER_01]: And so we might do the typical like your plugs, all that sort of stuff, but are you really glowing it out of proportion? [SPEAKER_01]: So then I might actually do exposure exercise. [SPEAKER_01]: This is anxiety, right? [SPEAKER_01]: So if you're the air conditioning, I might have you sit and just listen to the air conditioning on

that long. [SPEAKER_01]: And listen to it. [SPEAKER_01]: I'm and set yourself as such. [SPEAKER_01]: I'm not going to sleep tonight. [SPEAKER_01]: I'm not going to sleep tonight. [SPEAKER_01]: So you get over the like kind of anxiety that happens and it's like going over a bridge. [SPEAKER_01]: It's the same sort of thing. [SPEAKER_01]: So we might do that. [SPEAKER_01]: And then the other thing, too, is that sometimes people are getting in bed too early or they're sleeping in or they take a nap, so they're not as sleepy as they normally would be when they get in bed. [SPEAKER_01]: So if I limit their time in bed a bit, believe it or not, they're going to fall

asleep faster. [SPEAKER_01]: And when they have an awakening, they're so sleepy because they're not allowed to fall eight hours in bed. [SPEAKER_01]: They actually fall back as sleep faster because they're too sleepy to scan for the threats. [SPEAKER_00]: I love that advice. [SPEAKER_00]: I hear women say to me, though, that they dread the night time, or as soon as it starts to get dark in the summer, they can actually feel their anxiety because they already are preparing themselves for a night of not sleeping or tossing and turning all night. [SPEAKER_00]: So I've heard it. [SPEAKER_00]: I just didn't hear that phrase until I read it from you. [SPEAKER_00]: So very interesting. [SPEAKER_00]: For longevity, we

know this and for resilience, sleep cycles matter. [SPEAKER_00]: What's one overlooked marker or metric that every woman in mid-life should be tracking and how does a provider use that piece of data to personalize care? [SPEAKER_01]: So I think, I don't think everyone needs all the fancy trackers that are out there like the rings or watches because if you have insomnia, it actually can worsen insomnia in some people because they don't have hyper-focused on it. [SPEAKER_01]: But I think just getting old school and just writing down your sleep on it, I have a few examples of my book and get them online easily. [SPEAKER_01]: Just writing down your sleep during the night and just like, what

time did I get in there? [SPEAKER_01]: What time I wake up, have you used all that stuff? [SPEAKER_01]: And then just looking at how much sleep you're getting on average and the thing that I think it's missed a lot is the quality of your sleep. [SPEAKER_01]: So you might be sleeping. [SPEAKER_01]: People focus like, do you sleep eight hours a night? [SPEAKER_01]: fine. [SPEAKER_01]: But if you feel like it's not restorative, if you're tired, if you feel two, three hours after waking up, you could go back and take a nap or you need to rest, that should be a big sign that there might be something going on with your sleep. [SPEAKER_01]: Even if you

think you're asleep the whole night. [SPEAKER_01]: So it's really about how you're feeling, usually you're at your peak energy level. [SPEAKER_01]: If you wake up, let's say it's seven by 10, 10, 30 in the morning, you should have much more energy. [SPEAKER_01]: You might not write when you first get up. [SPEAKER_01]: If you're still dragging by that time, there's probably [SPEAKER_00]: So this is a question that I didn't have ahead for you, but I'm just curious because I get so many questions about this, just over the counter, not necessarily trackers, but recommendations, whether it is thermoregulatory pajamas, sheets, what else am I thinking about? [SPEAKER_00]: You know, should people sleep blindfolded? [SPEAKER_00]: I was for

a while sleeping with noise blockers because I do sleep next to a snore. [SPEAKER_00]: And then one of my girlfriends made a comments me, well, if he has an event, then you won't hear him [SPEAKER_00]: Forget that. [SPEAKER_00]: Now it's like forget those. [SPEAKER_00]: So I got rid of those noise canceling. [SPEAKER_00]: But Bose makes them. [SPEAKER_00]: I was like, okay, I can't do that anymore. [SPEAKER_00]: Because God forbid if something happens, I want to obviously not be that, you know, impaired. [SPEAKER_00]: But what are some of the things that actually do work? [SPEAKER_00]: Because you know, everyone's trying to enter to this menopause market, right? [SPEAKER_00]: And so there's so many sworn by solutions.

[SPEAKER_00]: But what are some of the things that actually you see in work and can help with an overall sleep program? [SPEAKER_01]: Yeah, I think we're talking about tailoring, right? [SPEAKER_01]: So if you're feeling yeah, things happening with the quality of your sleep or you're waking up a lot of night or you're not for very long, think about the temperature, right? [SPEAKER_01]: That's a huge one. [SPEAKER_01]: And I really do think these are very cost prohibitive for a lot of people, but like [SPEAKER_01]: and I don't get paid by them at all, but like eight sleep, ooh, or they're these, you can get the mattress itself, but you can also get like mattress pads that

go on one side of the bed. [SPEAKER_01]: And that actually can really, it's like basically thin jets of water in them. [SPEAKER_01]: And so you put the, you put the base under your bed, and you don't even know there's water in it or jets or anything. [SPEAKER_01]: And it just, it can make your temperature go down in the middle of the night. [SPEAKER_01]: So if you're someone who wakes up warm, your flash, you're having hot flashes, nice sweats. [SPEAKER_00]: in the middle of the night. [SPEAKER_00]: Mom, go ahead. [SPEAKER_00]: Shelby, I think eight sleep needs to pay both of us because I will tell you it was a game changer for me. [SPEAKER_00]: And I

feel bad sometimes recommending it because it is more expensive on the, it is expensive. [SPEAKER_00]: It is, but I remember sitting in a green room and there was a bunch of doctors in the back and we were all going through paramedics, and then the pause, and we were talking about what are we doing to sleep because we're traveling, we're talking, we're speaking, you know, living your life and all 100% of us had eight sleep. [SPEAKER_00]: Yeah, and said it was a game changer because for me, it probably auto-regulates the temperature over 20 times a night. [SPEAKER_00]: I'm no longer waking up. [SPEAKER_00]: I'm also on hormone therapy, but I'm no longer waking up in the

middle of night with that half-lash. [SPEAKER_01]: And the reality is woman therapy can really help a lot of people, as you obviously now, but it doesn't help everyone, right? [SPEAKER_01]: So like there's a lot of residual sleep problems for various reasons. [SPEAKER_01]: So exceeding T is really also something weirdly that can help with the hot slashes in the mall night without even doing any temperature things. [SPEAKER_01]: But I do think people keep their rooms too warm, or they keep it at the temperature they want, or they have a bed partner that just has a different internal thermostat. [SPEAKER_01]: And I really think that's a great product. [SPEAKER_01]: And then also like sweat-wicking pajamas. [SPEAKER_01]: I

mean, there's not one brand. [SPEAKER_01]: There's still one size fits all. [SPEAKER_01]: That's kind of what I, the Oslo ear buds, they would use to be bows. [SPEAKER_01]: Like those are really popular. [SPEAKER_01]: If you can, if you like sleeping with earbuds, then go ahead. [SPEAKER_01]: If you have, you're not able to block all the light your room, then like there's eye masks. [SPEAKER_01]: It's really about finding what works for you. [SPEAKER_01]: And then also with the temperature in the room, like there are cooling bedding products. [SPEAKER_01]: So like, you don't have to go eat sleep, [SPEAKER_01]: Slumber Brothers, other companies out there that make like cooling pillows, cooling mattress pads, cooling sheets. [SPEAKER_01]: So

you could start with that and then work your way up to the cost ladder. [SPEAKER_00]: the other question I get a ton and I'm actually curious for myself too is that we tell people to stay out their phones to not watch TV, especially if they're having problems, right? [SPEAKER_00]: And to create this like sleep environment, what about apps? [SPEAKER_00]: How do you feel about apps? [SPEAKER_00]: Because I used calm for a while, but then patients will say to me, you're telling me to stay off my phone, Dr. debate, or put it in a different room, and then you're telling me to use an app. [SPEAKER_00]: They're like, mmm, so which one is it? [SPEAKER_00]: Or

is it a different answer for everyone? [SPEAKER_01]: No, I would I actually recommend. [SPEAKER_01]: So the blue light thing from the screens is actually quite hotly debated in the field of sleep medicine. [SPEAKER_01]: Okay, interesting. [SPEAKER_01]: The data, I mean, it does impact somewhat, but it might not be the thing that's causing the insomnia of hours to fall asleep for many people. [SPEAKER_01]: The bigger issue many of us argue is it's more of like, what are you getting sucked into? [SPEAKER_01]: Most people are like, doomed scrolling on their phone. [SPEAKER_01]: And then they're getting the text. [SPEAKER_01]: And like, it's like, you can blame it on the belight. [SPEAKER_01]: Like, you can put on the

blockers all you want. [SPEAKER_01]: But if you're still on like, doomed scrolling on things, they could luck with that. [SPEAKER_01]: So it's really, it's really about the phone, and I think the talking about or the content on the phone, but then also talking about the meditation and stuff that people are doing, would be actually think about and sleep medicine. [SPEAKER_01]: So I had people do the meditation during the day. [SPEAKER_01]: I'm having them practice strengthening their ability to let go of things during the day because at night when you wake up at three in the morning I don't want you taking your phone out and getting sucked into it and want you stronger from your

daytime practice so ideally that's when I want people off their phone is like just before bed and not relying on the apps to fall asleep to they can do their own meditation but try to keep it away because it's usually most people can't trust themselves with it so I can do them scroll during the day. [SPEAKER_00]: Alright, rapid fire girl, you ready? [SPEAKER_00]: Okay, a hormone or hormone imbalance that may keep women awake that doctors don't test for. [SPEAKER_01]: Okay, I mean, not, you're much more of a specialist than I am, believe it or not. [SPEAKER_01]: And the, the hormone stuff, we just are still learning and sleep medicine more about the hormone relationship performance.

[SPEAKER_01]: Believe it, like when I bought my book in 2015, 2016, there were so little unsleeped women. [SPEAKER_01]: Oh, there still is. [SPEAKER_01]: I mean, we're learning. [SPEAKER_01]: Yes, okay. [SPEAKER_01]: I don't like that thing or something. [SPEAKER_01]: They're not, I think there's a lot that's probably not being addressed. [SPEAKER_01]: I'll leave it at that. [SPEAKER_00]: All right. [SPEAKER_00]: That's sleep a tip for women balancing night sweats and anxiety. [SPEAKER_00]: Oh. [SPEAKER_01]: Um. [SPEAKER_01]: I would make sure, if you're having anxiety, you're waking up sweaty, make sure it's not also a nocturnal panic attack, because those happen a lot and people don't realize it. [SPEAKER_01]: But if you're waking up in your sweaty, I mean,

first of all, I'll go with the night, the sleep, sweat-wicking pajamas, the cool bedding, and then what is it you're waking anxious about? [SPEAKER_01]: So if you're anxious about certain things, that always seem to hit hot, [SPEAKER_01]: be on your mind in the middle and get it out of your brain before bed. [SPEAKER_01]: So like we talk about worry time really worrying the heck out of things for 20 minutes in the early evening, writing and all time getting out of your head and then after worry times over you say not now during worry time tomorrow. [SPEAKER_01]: And it sounds very simplistic but it's like you're allowing yourself to worry and then those other 23 and

a half hours you say nope, I'm not going to worry about now but I'm going to worry the heck out of it for those 20 minutes during my signed worry time [SPEAKER_00]: Is that, and it doesn't hit people at night because they're not addressing maybe work or kids or parents or everything else because they have time to pay attention to their worry. [SPEAKER_00]: Is that why it hits people at night? [SPEAKER_01]: Very common reason people will often be so sleepy at bedtime they pass out and then they'll say, why don't I always wake up at two or three in the morning. [SPEAKER_01]: Usually they've had a natural awakening that always happens. [SPEAKER_01]: We have natural

awakenings, but you've slept a few hours. [SPEAKER_01]: So now you're allowed your brain can be a little bit more alert. [SPEAKER_01]: So you need to get things out of your brain before a bit. [SPEAKER_01]: Feel it? [SPEAKER_01]: Feelings on melatonin. [SPEAKER_01]: Melatonin is wonderful in low doses for certain things, for shift work, for travel. [SPEAKER_01]: It's great for jet lag, but it's not the most effective thing for just standard insomnia. [SPEAKER_01]: The people will take way too much of it. [SPEAKER_01]: and not meant for long-term correct. [SPEAKER_01]: We mostly use it to shift people's sleep wake schedules, night owls to become early birds, things like that, and we use it for a few weeks to

months just to get you set. [SPEAKER_00]: Is there a singular wish or piece of advice that you recommended each clinic offered two minute puzzle patients regarding sleep? [SPEAKER_01]: single wish or advice, that's a great question. [SPEAKER_01]: It would just be like, are you content with your sleep? [SPEAKER_01]: Are you content with it? [SPEAKER_01]: Do you feel well rested? [SPEAKER_01]: Do you feel like there's any problems? [SPEAKER_01]: And if there isn't, to give an automatic referral to an asleep specialist. [SPEAKER_00]: I love that so much because I think that's the easiest place to start is for providers to even ask the question. [SPEAKER_00]: You won't know that there's a problem or an issue with your patient

if you don't take the time to ask that singular question. [SPEAKER_00]: Okay, going to get personal. [SPEAKER_00]: How do you unwind after your own sleepless night? [SPEAKER_01]: If I had a rough day, which I do, I'm human, right? [SPEAKER_01]: The first thing I do is I, in the morning, so we're talking about in the morning, right? [SPEAKER_01]: I am the last of the whole water. [SPEAKER_01]: And then I try to get in a work at, I work at in the morning, but I won't necessarily do a really hard work at. [SPEAKER_01]: I'll walk really briefly, I'll do something that's kind of like a lower intensity exercise, and I get a lot of light, and that

is what helps me during the day. [SPEAKER_01]: And I accept that I'm gonna be tired, but I'm probably gonna sleep better the next night. [SPEAKER_00]: I love that because you're doing what so few women do, which is we extend grace to so many people but sometimes we hold back on that grace for ourselves and that's what I remind patients to who are so hard on themselves and like the same grace you're extending to other people extend it to yourself exactly exactly. [SPEAKER_00]: So women often hear though, oh, it's just stress when when they do complain to their doctor and they finally are able to articulate or get the time or they say it's aging, before

they're told it's sleep, what's the truth every provider needs to say, train or treat for? [SPEAKER_01]: So I think we need to [SPEAKER_01]: I tend to assume sleep first and foremost, before I think about the other things. [SPEAKER_01]: So first of all, the aging thing is totally not true, right? [SPEAKER_01]: So we get a little less sleep as we get older, but not usually hours less. [SPEAKER_01]: And it's a little bit more broken because of pain and having to urinate more at night things like that. [SPEAKER_01]: But if anybody tells you, oh, it's totally normal to get a lot less sleep, but you get older, find a new doctor, first and foremost. [SPEAKER_01]: You thought

that there's not listening to you? [SPEAKER_01]: And you're like, but my sleep is not feeling right. [SPEAKER_01]: get a different doctor. [SPEAKER_01]: Because like I said at the beginning, we think of sleep as a separate, it's like related but separate too. [SPEAKER_01]: Even if there's stress to pressure anxiety going on, you don't want to ignore the sleep. [SPEAKER_01]: If you get help someone sleep better, just in spite of all the other things going on, you're actually going to help their outcomes for depression and anxiety with a short sleep treatment. [SPEAKER_01]: So don't ignore it. [SPEAKER_01]: If a doctor is just telling you, oh, this is normal, or let's work on the other things first. [SPEAKER_01]:

Nate, try to find someone who's listening to you. [SPEAKER_01]: You're the [SPEAKER_00]: I love that I say that I say that the patient's all the time, nobody knows your body better than you do. [SPEAKER_00]: No one does. [SPEAKER_00]: So shhh. [SPEAKER_00]: Okay, so it's 2035, which is actually not that far away. [SPEAKER_00]: In Someday, as finally treated as a serious, as seriously as cardiac risk, menopause care includes sleep diagnostics. [SPEAKER_00]: How did we get there? [SPEAKER_00]: What did it take to change both clinically and culturally? [SPEAKER_01]: I think we are slowly getting there. [SPEAKER_01]: The younger generations are actually better about it. [SPEAKER_01]: Is that idea of like, I'll sleep when I'm dead? [SPEAKER_01]: You

know, like, I work in the city that never sleep. [SPEAKER_01]: That culture is slowly changing, I think. [SPEAKER_01]: So we're getting there, and there are companies that are now really trying to value nap rooms, relaxation rooms, really having limits. [SPEAKER_01]: I think that's actually we're going in the right direction. [SPEAKER_01]: I think for clinicians, I think we need better [SPEAKER_01]: better screeners and just people, but primary care is often in July and like they're the first line, you know, providers a lot of times. [SPEAKER_01]: So like having a good screener of your sleep issues and just asking how we're using sleep and a lot of people are too busy to even ask that. [SPEAKER_01]: I

think we need to get there when it comes to behavioral treatments. [SPEAKER_01]: I think we need to know where the where to refer. [SPEAKER_01]: A lot of providers have no idea where to find someone who does CBTI for example. [SPEAKER_01]: We have great [SPEAKER_01]: So, I think more education and just trying to not ignore the question or not ignore asking about sleep because people just they wait for the person to bring it up because they're in so much distress and that's not going to work. [SPEAKER_00]: No, that's not going to work. [SPEAKER_00]: So actually we'll take away then are to track your sleep pattern, not just interruptions, advocate for next level care. [SPEAKER_00]: Don't be

afraid to ask your provider, you know, do you screen for sleep issues, do you diagnose them, do you refer, or are you just writing this off? [SPEAKER_00]: And then try CBTI protocols before relying on sleep aids. [SPEAKER_00]: Would you say that or would you say in conjunction? [SPEAKER_01]: Yeah, I would say try first a lot of times people prescribe men's and then come to me because they want to get off of them or that it's not working great. [SPEAKER_01]: We like to try CBTI ideally first though. [SPEAKER_00]: I cannot thank you enough for your time today. [SPEAKER_00]: I love catching up with you and all the things so can you tell the listeners where they

can keep up with you what you're up to and how to learn more about sleep. [SPEAKER_01]: So, you could look, if you want to just learn about me and learn about sleep, go to my Instagram at Sleep Doc Shelby. [SPEAKER_01]: I'm pretty active on there, and I do a lot of education posts, but I also do like a weekly AMA. [SPEAKER_01]: So, people ask me, not personal questions, more general questions, and that's a great place to really catch up with me. [SPEAKER_01]: You'd also go to my website, Dr. ShelbyHarris.com, and then I have the, my book, the women's guide to overcoming insomnia, and I have essential guide to children's sleep that just came out about

two months ago too. [SPEAKER_01]: So, [SPEAKER_01]: lots of ways to learn about me and my treatments. [SPEAKER_00]: When midlife women can't sleep, every part of life starts to crack, health, memory, mood. [SPEAKER_00]: Dr. Shelby Harris, reconnects what's been broken. [SPEAKER_00]: Retune your rest, share this with anyone, lying awake, wondering if it's them or their body. [SPEAKER_00]: It's preventable. [SPEAKER_00]: Thank you so much for joining us today and for continuing to be a strong voice in the field and disrupting healthcare for women everywhere. [SPEAKER_00]: this is more than a conversation. [SPEAKER_00]: It's a call, a call to build something better. [SPEAKER_00]: Subscribe, share, and bring more disruptors into this room. [SPEAKER_00]: For unfiltered insights and bold

ideas, go to Drsomee.com to sign up for the monthly disruptor newsletter and follow us on social at Drsomee. [SPEAKER_00]: We're not waiting for a seat at the table. [SPEAKER_00]: We're building our own table.