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Ah, sleep.
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We're sitting at brunch on a Saturday, a few of us friends sitting around.
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What are we talking about?
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Sleep?
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We're talking about sleep and how we're waking up at three in the morning or it's hard to go to sleep, or both.
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And we tried this and we tried that and what worked for you and what worked for you Sleep.
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When I met today's guest, she told me about her method of helping her clients with their sleep issues in midlife and I was intrigued, so I think you will be too.
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Let's talk about it.
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Welcome to Mind your Midlife, your go-to resource for confidence and success.
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One thought at a time.
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Unlike most advice out there, we believe that simply telling you to believe in yourself or change your habits isn't enough to wake up excited about life or feel truly confident in your body.
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Each week, you'll gain actionable strategies and oh my goodness, powerful insights to stop feeling stuck and start loving your midlife.
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This is the Mind your Midlife Podcast.
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I confess to you that I do not typically have a problem falling asleep and my husband I think for many years has been jealous of that.
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We're working on it for him.
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It's getting better for him, but I have always been one to get in bed and I love to read a novel, something for fun, before I fall asleep, and then I go to sleep, sleep and then I go to sleep.
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However, as I hit my 50s, I definitely noticed that I was waking up more during the night, and sometimes it's a quick wake up where I just need to flip over, and maybe you'll recognize this in yourself as well.
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I think maybe our bodies can't be in the same position as long as they used to be able to be without moving, so that we don't get stiff.
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So a lot of times I kind of wake up quickly, I need to flip over to my other side and then I go right back to sleep.
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But there is often, somewhere around three in the morning, a time when I wake up and my brain is just going, going, going and worrying, worrying, worrying.
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And my brain is just going, going, going and I'm worrying, worrying, worrying.
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And I have a sort of mini meditation that you heard me talk about on a previous episode, which I will link in the show notes, where I talk through how you relax, kind of from your toes to your head, and that is usually really helpful.
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But why is it happening and are you trying to treat your sleep issues with various things.
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Have you thought about medication?
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Do you not want to do that?
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Have you thought about taking supplements?
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Do you not want to do that?
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What have you tried?
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There's so much out there.
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There's so much out there, and my guest today is going to help us with some totally free and intriguing concepts related to sleep.
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Morgan Adams is a transformative, holistic sleep coach who works with midlife women to conquer that battle with sleepless nights without relying on sleep medications.
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She herself went through a major long-term struggle with insomnia and a dependency on sleeping pills for almost a decade, so she really gets it.
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I am super excited to have this conversation.
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Okay, welcome, morgan.
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Thanks for joining me today.
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Thanks for having me, cheryl.
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I'm looking forward to this, and here's why Sleep is probably the number one if not number one close to it topic that everybody in their 40s and 50s is talking about, and I mean, even like I go to brunch on Saturday with my friends, we're still talking about it.
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Yes, everywhere we're talking about it all the time, and I know that you have had issues and you ended up trying sleeping pills as a solution, so I want to know more about that.
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Tell us about.
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Yeah, well, you're right.
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I mean, I did try sleeping pills.
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So let me kind of just take you back a while.
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This was about 20 years ago when I went through my bout of insomnia, and at the time I was actually working as a pharmaceutical sales rep, so my currency, if you will, was medications.
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It was a very, you know, well known thing, and I had insomnia for a couple of months.
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So basically, my issue was having trouble falling asleep, which we call sleep onset insomnia.
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And after a couple months of this, I just got fed up and I went to my primary care doctor and I was given a given a prescription for Ambien.
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So, being that I was in pharmaceutical sales and just a pill for every ill, if you will, I didn't think anything of it.
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So I took the pills.
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It did help me get to sleep faster, but I paid on the back end pretty badly, with a lot of grogginess and brain fog the next day, and I actually ended up switching careers somewhere around this point into more of a public health PR role and I was responsible for, like writing copy very quickly on demand, like snap your fingers and there should be copy ready.
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And I remember several times in this job, where I got reprimanded because, if they needed something quickly, my brain was not.
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Basically, my brain was foggy and I had not cleared out the Ambien from the night before.
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And what I came to understand many years later actually probably four years ago when I started this work in sleep is that in 2013, the manufacturers of Ambien were asked by the FDA to change their dosing requirements for women, because what they found was that women were getting basically double the dose of men, so they were getting double doses, which explains in retrospect why I had such grogginess and foggy brain at that time.
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I didn't really feel fully alert until lunchtime.
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So imagine kind of missing the, you know, the first half of your day in terms of you're physically there, but I guess they call it presentism You're present, but you're not really there.
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I didn't know there was a word for that.
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Yeah, there's absenteeism there's present is I don't know it's.
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Basically I was physically there at work, but my mind was like not fully functioning at this point, right, so yeah, that is how, like, I started with the pills.
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Well, I'll pause and say I do know of a few friends of mine who have, and maybe still do, use Ambien, so it's interesting how common that is.
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For me, my issue has always been waking up around 3am and not being able to go back to sleep.
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I can go back, I can go to sleep at night, so that knock on wood like that I didn't have.
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But I know that this is an issue for people and I have heard them say exactly what you're describing.
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I can't like get my head together in the morning.
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I feel I'm in a fog.
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So it sounds like you ended up really kind of needing that after a while.
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Yeah, I did.
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I mean, I really I became somewhat psychologically dependent on that and maybe to an extent physically dependent on it I'm not quite sure, because it was so long ago you know, about 20 years ago that I was on them, but I stayed on them for about eight years, wow.
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And what was sort of the impetus for me stopping the pills was meeting a guy who is my husband now.
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We were starting to date at that point and he said to me you know, when you take those pills, it really freaks me out because you, you kind of act like a zombie after you've taken the pills, which was true Because I don't, you know, you basically I don't know what the correct word for us, but you're kind of zoned out, that's not a very scientific term, but it was just like I was just not there mentally, just not there, and that really got to me because I was like gosh, this may not be the best solution for the sleeping issues.
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So I did what I don't recommend people do and I just took myself off the pills without getting guidance from my prescribing provider.
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So if you're listening, and you're on either a sleeping med, a psychiatric med or really any med for that matter, and you want to stop taking them, it's really the best thing to get your physician who's prescribing it to give you some directions on how to safely titrate yourself off.
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But I, you know, just kind of went rogue.
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I didn't know any better right, and I've got a lot of grit and determination so I made it work out for me and I was able to get off the pills, you know, just by just sheer, sheer force of will.
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Yeah, I appreciate you saying that people should see their doctor, though, because I believe that can be a tough one to get off of and it can mess with your head a little bit.
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Yeah, yes, it definitely can.
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And I mean I'm working with a lot of women in my practice who are on the meds on different types of meds some Ambien, some other meds like benzos, the meds on different types of meds some Ambien, some other meds like benzos and and I think they come to me because I share my story so publicly you know it's on my website, it's, you know, on podcast interviews.
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It's just like I'm very out out there with that story because I think it's so relatable and I think there's been sort of a shaming.
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People feel ashamed, like I've had clients who come to me feeling ashamed that they're on pills and I just want to break that shame because there is no shame.
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It's a medication and it's there for a reason and anyone who's listening should not feel bad about themselves because they're on a sleeping pill or any pill for that matter.
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You know what.
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I really agree and I had sort of an interesting experience at a doctor's appointment recently because I am not on any medicine at the moment.
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But the doctor was so shocked at that when I said I'm not on any medicine.
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It made me realize it's very, very common for people to need a medication for something and you could argue maybe we're taking too medication, too many medications, but there are medications people really need and no one should feel bad for that and apparently it's very common.
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Very common.
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Yeah, you're an anomaly, I'm an anomaly, but to be in midlife and to be not taking a medication is is not the norm, right At all, right At all, yeah.
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So we definitely don't want anyone to feel bad about, about whatever it is that you need, now that we're talking midlife a little bit, let's make this bigger, because I know that well from my experience and from other people I've talked to.
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Sleeping is a problem a lot in the perimenopause period, which can be years and years and years and years and menopause, and it could be falling asleep, it could be waking up in the middle of the night, it could be night sweats, it could be all these different things, but it's definitely an issue for a lot of people.
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So you mentioned to me when we were talking earlier that there is a treatment that you called CBT-I that potentially can help.
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So tell us a little bit about that.
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Yes, thank you for mentioning that.
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So CBTI is called cognitive behavioral therapy for insomnia.
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It's been around since the eighties, so it's it's sort of the test of time and it's really the gold standard for treating insomnia, actually above sleeping pills.
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So the American Academy of Physicians recommends CBTI over sleeping pills.
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The problem is we don't have a lot of people who are practitioners of CBTI worldwide.
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So when you are like someone like me who went to their primary care doctor, primary care doctors, unfortunately in this country, in the US, are only getting about two hours of sleep science training in their medical school, so they are not really given the skills to help somebody with insomnia.
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Hence here's a list of sleep hygiene recommendations, or here's a prescription for Ambien or fill in the drug of choice.
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They quite often don't know about CBTI, and so part of what I like to share is the information that it does exist.
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There are practitioners out there, like me, who use CBTI to help their clients and I call them clients because I'm a coach but if you, you know patients for people who are in different practices and basically, in a nutshell, what CBTI is?
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It's a way to change your thoughts, behaviors and attitudes around sleep.
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So if you have insomnia, you basically have one of three things going on.
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You either have a disruption in your homeostatic drive, which basically is a fancy way of saying you're not sleepy enough, yet you don't have that sleep drive built up.
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Number two you have some kind of circadian disruption and that means basically you're sleeping at irregular or inappropriate times for your body clock.
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And then the third is arousal, high level of arousal, and that could be either physical arousal, like heart beating fast, breathing heavily.
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It could be psychological arousal anxieties and worries and stress, stress or it could be conditioned arousal, which is sort of like going back to Pavlov's bell.
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Someone who is in conditioned arousal really connects their bedroom and their bed with anxiety.
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And so with CBTI, cbti actually works on all three of those sort of like underlying reasons for insomnia.
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So it's really effective as a tool, general statistics on it working 70 to 80% of the time it will be successful in helping somebody overcome the insomnia.
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And what's really great about it this is what I love it's that it's something that doesn't involve any kind of psychopharmacology or pharmacology at all no meds involved and there are no side effects either.
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So, like I shared with my story about the Ambien yeah, I did get to sleep faster, for sure, but the side effects the next day were just not manageable.
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So CBTI does not have those side effects, which is wonderful for people to hear, and it takes.
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You know, it takes varying amount of time for people to go through a CBTI protocol, but you know, a couple of months is usually sort of the timeframe where I'm usually able to help people kind of get over the hump of the insomnia part.
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So this is going to probably be a big, huge question that is impossible to answer in a podcast episode.
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But so somebody who's going through that treatment what kinds of things are would they expect to be doing or trying or changing, if that makes sense?
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Yeah, so one of the main things so you've got the behavioral piece and you've got the cognitive piece what really kind of moves the needle the most is the behavioral interventions, and so a couple I'll share a couple of those and what those are.
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So one is called time in bed restriction.
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Okay, so think about somebody who has insomnia they might be in bed, physically in bed, for 10 hours, but they're only generating seven hours of sleep.
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So what we're actually trying to do is match the amount of time in bed with the time that they're actually able to physically generate sleep.
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So we want them in bed closer to seven hours than to eight hours.
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So what we end up doing is we sort of compress their window of sleep-wake schedule to facilitate that over a period of several weeks.
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So it's the sleep-wake cycle, or the sleep-wake schedule is sort of the moving target.
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We kind of manipulate it from week to week based on how much sleep they're actually getting.
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We're trying to improve their sleep efficiency, which is the percentage of time that they're actually in bed sleeping.
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So that looks to be, you know, 85% of the time in bed we want to be sleeping.
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So if it's lower than that, we'll manipulate the time in bed a little bit.
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And then there's another strong, strong behavioral component called stimulus control.
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Sounds so very clinical, doesn't it?
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Basically and this is something probably a lot of people have heard before it's a couple of things using your bed only for sleep and intimacy, right.
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So there are a lot of people out there with insomnia who are basically setting up shop on their bed.
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Work read everything, yeah exactly.
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They're doing all the things in their bed, but they're not sleeping as much in their bed.
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And they're doing all those things in bed in hopes of catching some sleep, like maybe I'm in bed, I'll sleep.
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Well, it doesn't quite work that way.
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So we're trying to really kind of limit their time in bed to the sleeping hours or intimacy.
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And then the other piece of stimulus control is getting out of bed and doing something if you're not able to fall asleep.
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So there's varying rules on this.
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I have strayed a little bit from the purest rule, the purest rules.
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If you go back to the grandfathers of CBTI, they will say if you're not asleep within 20 minutes, get up and do something.
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Or if you're awake for more than 20 minutes.
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I don't quite agree with that rule of 20 minutes because, number one we don't want you looking at the clock.
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That just creates more sleep anxiety.
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And what's so magical about 20 minutes?
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Right, yeah, I get that.
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Yeah, like what 20 minutes?
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Who decided that?
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Seems kind of arbitrary.
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So really how I use it in my practice is I say, okay, if you're lying in bed and you're becoming anxious about the fact that you're not sleeping, you're tossing and turning and feeling that sort of like.
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It's almost like a switch in your head where you're just like I'm just not going to sleep.
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Like you, just you're like, okay, this is not going to happen.
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That's really a cue to get up and go to another room, ideally, and do something.
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That is and again, this is where I veer off from the purist.
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The purist will say do something boring.
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I don't really think boring is really what we're looking for.
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I think we're looking for something just not stimulating, something that's relaxing and enjoyable, because it shouldn't be a punishment.
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You shouldn't look at that as like your punishment time being out of bed.
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So ideally it would be reading.
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Or I had one client who just did the loveliest thing she wrote handwritten greeting cards to her friends during that period of time when she couldn't sleep.
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So like she got to, you know, her friends got some nice cards in the mail.
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Like who gets those anymore?
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So it's really a matter of just doing something chill and dim light until you start to become sleepy again, and then you go back to your bed rather than just using your bed as the place for worrying and bed bought sleep.
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Yeah, a couple of things stand out to me from that.
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Number one, just the permission to get out of bed, I think maybe is freeing, because, yes, it feels like the opposite would be true.
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That, gosh, once I get out of bed, forget it, I've lost, we're done, you know yeah.
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I appreciate that you're saying that's not the case, and I don't know what the other thing was.
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Well, let me.
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Let me let, while we're on that thread, I do want to say that I have run into this issue sometimes with women who, if they these are not usually my clients, but they're like people that I'm just talking with in general, like in presentations they'll say to me sometimes well, if I can't sleep and I'm awake at three o'clock, sometimes I'll just get out of bed and start working.
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I'll basically begin my day like they're essentially beginning their day.
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And I'm always a little bit leery of that, because if you're, if you're starting your workday at three in the morning, you're basically activating your brain.
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You're likely in front of some lights, some blue lights, and so essentially, kind of what you're doing to your brain is you're training it to be up at 3am to work like workday started.
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So if you want to extinguish that behavior, you don't want to keep doing that.
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You don't want to like make it your workday, you don't want to put on the pot of coffee.
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Oh gosh yeah, If you know, you know, like you're just training yourself to have that cycle repeat night after night.
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So anyway, just a slight tangent on things not to do when you're awake at 3am.
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That's a good point.
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That's a good point.
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I hear you on the dim light, the avoid the blue light and not get to work, and you're right.
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I have heard people say that, well, I may as well just get up and start my day.
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Well, maybe there's a there's a time for that, if it's five or something.
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Right, yeah.
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If it's a little bit or like I can see that if it's like a little bit earlier than your normal wake time, the general rule of thumb is like if it's 45 minutes before your wake time, okay, you can get up and start your day, but you don't want to start it that early, unless you want that to be your workday.
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Yeah, yeah, you want to be a shift worker, because we do get into a habit, for sure.
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Yeah.
00:21:49.228 --> 00:21:54.795
So I want to go back to something you said before that really caught my attention, and that was you said.
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When we were talking about percentage of time in bed sleeping, you said generate sleep.
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Yes.
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And I find that terminology very interesting because maybe it flips around, it moves us away from this I'm trying to go to sleep thing to something that I don't know how to put it into words, but anyway, interesting term.
00:22:17.214 --> 00:22:18.178
Yeah, it's well.
00:22:18.178 --> 00:22:21.227
You know I don't use that term a whole lot, but it's rather clinical.
00:22:21.227 --> 00:22:32.099
But it's really more like if you think about, everyone's body has the capacity to produce or generate a certain amount of sleep, and yours may be different than mine.
00:22:32.099 --> 00:22:33.961
Like you, you might really really need a certain amount and sleep, and yours may be different than mine.
00:22:33.961 --> 00:22:37.948
Like you, you might really really need a certain amount and I might need less than that.
00:22:37.948 --> 00:22:42.897
So that's kind of how I use that term is generating.
00:22:42.897 --> 00:22:52.365
It's just like we have this sleep drive that needs to be satisfied and that is satisfied with our larger chunk of sleep at night.
00:22:52.827 --> 00:22:55.674
And that is satisfied with our larger chunk of sleep at night.
00:22:55.674 --> 00:22:59.056
I just like.
00:22:59.056 --> 00:23:11.765
I like that whoever's listening is hearing that too because I like this idea that we need maybe not even need we want to sleep because that's a part of life and that's what we need to do, as opposed to, I think sleep feels like okay, I did as much as I could.
00:23:11.765 --> 00:23:14.415
Now let me give in, if you know what I mean.
00:23:14.415 --> 00:23:15.939
Yeah and yeah.
00:23:15.939 --> 00:23:21.540
So I mean, all of us know we shouldn't think about it that way, but I think we still end up thinking about it that way Sometimes.
00:23:21.560 --> 00:23:23.246
Yeah, I would agree, I would agree.
00:23:23.375 --> 00:23:24.215
Yeah, yeah.
00:23:24.215 --> 00:23:37.863
So then the other thing that stuck with me from a couple of things that you said was, if you're trying to minimize the amount of time that you're in bed and not sleeping, do people end up staying up later?
00:23:37.863 --> 00:23:43.240
Because I wonder, if that feels like I don't know how well that would work, you know.
00:23:43.560 --> 00:23:46.507
Yes, interesting, interesting observation.
00:23:46.507 --> 00:23:51.826
Yes, quite often they will end up end up staying a little bit later Because they're compressed.
00:23:51.826 --> 00:23:54.711
They're basically compressing that time in bed.
00:23:54.711 --> 00:24:05.664
So if they go to bed, a lot of times people will go to bed at like I'm just throwing this out at nine, because they always feel like they need more sleep, because they have insomnia.
00:24:05.664 --> 00:24:10.344
So they're like I'm going to go to bed at nine in hopes of getting extra sleep.
00:24:10.344 --> 00:24:14.063
But the problem is is they're not actually adequately sleepy.
00:24:14.063 --> 00:24:22.403
Their sleep drive has not had a chance to fully build up over the course of the day and so they get in bed at nine o'clock and they're not really sleepy.
00:24:22.403 --> 00:24:25.136
They're just sort of like doing it to kind of check the box.
00:24:26.098 --> 00:24:41.401
So in a such so the pure, so the purist for CBT I keep going back to the purist because I don't know there's there's just some opinions that I have on like some of the things that they've done Some of them will have the client or patient stay up to like one o'clock in the morning.
00:24:41.401 --> 00:25:01.489
Now, I personally don't agree with that degree of keeping somebody up for that long, because then you're getting into the whole circadian rhythm issue and the fact that people who are staying up so late sometimes suffer ill health consequences because our circadian rhythm, we're diurnal creatures.
00:25:01.489 --> 00:25:04.077
You know we should be sleeping during the night, right?
00:25:04.077 --> 00:25:14.356
So there's a fine, fine line there that I'm trying to straddle, and so quite often I'll do a little bit more of a gentle, what I call the sleep compression.
00:25:14.356 --> 00:25:25.807
So if they're going to bed at nine, I might, you know, challenge them to stay up till 10 to get their sleep drive a lot more, you know, built up so that they're sleepier.
00:25:26.147 --> 00:25:50.295
And what often ends up happening for the people who have those middle of the night wake ups, those wake ups will often diminish because they're sleeping through them, because they've really just built up their sleep drive Not all the time, because there's a multitude of reasons for why people are waking up, but that often that going to bed later can often counterintuitively help people sleep better.
00:25:50.295 --> 00:26:08.761
And then what we'll end up doing sometimes is we'll have them, you know, go to bed later and then, once their sleep efficiency has been built up to like 85% or more, we'll go back a little bit gradually, allowing them like more sleep, maybe 1530 minutes more sleep a week until they kind of get that sweet spot.
00:26:08.761 --> 00:26:17.664
So you're kind of just looking for that just real nice, comfortable sleep schedule that fits your, that fits you know your needs for sleep.
00:26:17.925 --> 00:26:19.190
Okay, interesting.
00:26:19.190 --> 00:26:24.303
Yeah, it's not exactly what I expected you to say, which makes it even more interesting.
00:26:24.703 --> 00:26:26.428
Well, a lot of it is a lot of.
00:26:26.428 --> 00:26:50.079
It does seem quite counterintuitive, and that's the interesting thing about when people are having sleep issues like insomnia, some of the common sense things that we might do, such as go to bed earlier and sleep in, they end up backfiring on us Because, like you know, think I mean I used to do this all the time when I had insomnia and had a bad night of sleep I'd want to sleep in and that would.
00:26:50.079 --> 00:26:57.765
There are a couple problems with sleeping, and is number one that that extra sleep, that extra half hour, is really kind of fragmented sleep.
00:26:57.765 --> 00:27:04.616
It's not your deep sleep, your restorative sleep, and by sleeping in what you're doing is you're cutting into your sleep drive for the following night.
00:27:04.616 --> 00:27:22.943
So even if you've had a I know it sounds, it sounds really unpalatable to hear but if you've had a really bad night of sleep, the best solution is to really get up at the same time you're normally getting up even if you haven't had enough sleep, because you're allowing that sleep pressure even more of a chance to build up.
00:27:23.905 --> 00:27:34.586
So you'll, you'll likely, like you'll likely, sleep better that night after a bad night of sleep, because your body is sort of going to compensate and really kind of grab that deep sleep.
00:27:35.307 --> 00:27:39.696
Interesting Quite often not 100% of the time, but that's usually sort of the pattern that people have.
00:27:40.338 --> 00:27:46.942
So that leads me to a question, and this is completely for me, but maybe, if you're listening, this will affect you as well.
00:27:47.583 --> 00:27:49.166
I'm sure it will, someone out there.
00:27:50.596 --> 00:27:54.544
If I've had a long week and I'm just thinking to myself.
00:27:54.544 --> 00:27:57.048
Man plus, I travel a lot.
00:27:57.048 --> 00:28:09.382
So if I'm home on the weekend, I'm excited to be home, and I am excited if I don't have to go anywhere in the morning and I just want to relax, and so I am so excited that I want to stay in bed for a little bit longer and sleep a little bit later.
00:28:09.382 --> 00:28:19.757
And I know that in general I probably shouldn't do that and I should have similar schedule every day, and we're not talking about until noon, but maybe a couple of hours later.
00:28:19.757 --> 00:28:25.377
But I really enjoy it most of the time and I find it relaxing and it's like my treat to myself.
00:28:25.377 --> 00:28:33.162
So does the fact that I look at that in a very positive way help at all, even though maybe I shouldn't mess up my schedule?
00:28:39.934 --> 00:28:41.278
You are like a gazillion other women I've talked to.
00:28:41.278 --> 00:28:42.961
Trust me, cheryl, a lot of people are asking this too.
00:28:42.961 --> 00:28:55.103
We really want to make sure that we kind of keep the same schedule on between the weekend and the weekday, because our bodies and brains don't know the difference, like our circadian rhythm can get really misaligned if we stray too far out on the weekend.
