#42 - When melatonin and sleep hygiene aren't enough to help you sleep through the night in perimenopause with Sarah Wilde

Most women notice changes in sleep as they transition through perimenopause, and many go to great lengths to be able to fall asleep, and stay asleep, more easily.

In this episode, Sarah Wilde introduces us to CBTi, and how this novel approach to helping us get more sleep is worth exploring. Sarah helps women sleep better so that they wake up feeling rested and ready to take on their day.

Sarah suffered from insomnia for years after her second child was born, until she discovered Cognitive Behavioural Therapy for Insomnia (or CBTi), which transformed her sleep at night.

Fast forward through a career change from attorney to Cognitive Behavioural Hypnotherapist, Sarah now helps peri- and post-menopausal women to get better quality sleep using natural and proven CBTi. You can learn more about Sarah on her website or follow her on Instagram @beyond_insomnia.

Ditch the “I’ll be good today” loop in 5 days with the Midlife Morning Makeover Email Challenge! ☀️ Head to menopausenutritionist.ca/morningmakeover

Click here to hang out with me on YouTube!

Looking for more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free guides and learn what I've got "on the menu" including my 1:1 and group programs. https://www.menopausenutritionist.ca/links

Transcript

Jenn Salib Huber  0:02  
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Salib Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Welcome to this week's episode of the midlife feast. If you are like so many of the women that I talk to you and work with and aren't sleeping or find it so hard to fall asleep or stay asleep or just don't even know what a good sleep looks like anymore. You will definitely want to listen to this week's episode with Sarah Wilde who is a cognitive behavioral hypnotherapist and she uses something called CBT AI, which is a specific type of cognitive behavior therapy focused on sleep. And we talk about everything from myths around sleep. So what is enough sleep, can you get too much sleep. And she also gives us some really practical information about things that we can start to do to just make it a little bit easier to feel like sleep is something that is working with us or for us and that we don't have to work quite so hard. So definitely a great episode for anybody in midlife, whether or not sleep changes have hit you yet because for most people, they do at some point. welcome Sarah to the midlife feast.

Sarah Wilde  1:30  
Yeah, thank you. I've been looking forward to this.

Jenn Salib Huber  1:34  
I'm really excited because you are asleep coach. And sleep is a topic that comes up so much, even just in dinner conversations with people about midlife and perimenopause. And I know that as someone who has had, you know, children, and when my kids were small, it was all we talked about. And then it felt like there was a little bit of a reprieve from talking about sleep all the time. And now that I'm 45 It's the topic of conversation again all the time, but it's about ourselves. So you do a specific type of coaching. And the reason that I wanted to bring you on is because I had never heard of this before. So can you tell the listeners what CBT i is what does that stand for?

Sarah Wilde  2:16  
Yes, well, CBTI is an acronym I throw around a lot. And it's not helpful. But what it stands for is cognitive behavioral therapy for insomnia. It's a laser focused approach to insomnia. It's not CBT therapy, per se, that's different and CBT. therapists often aren't actually trained in CBT. I interestingly. But yeah, it is laser focused on treating insomnia disorder, which is you know, is what many of us do struggle with come perimenopause and menopause time. And often is one of the first symptoms as perimenopause sneaks up on us. And our sleep tends to go on the fritz. And it can be kind of why Why am I not sleeping properly, everything was fine. And now I'm tossing and turning or waking in the middle of the night. And CBTI. The good news is, it's almost like the world's best kept secret, which is terrible. Because CBTI has got so much evidence for it. It's been around for about 40 years now. And it is actually the number one recommended approach to treating insomnia disorder in the UK, which is where I'm based, and in the US, and in Canada, and in Australia. I mean, you know, sleep doctors are united in this as a first line approach. So that's the sort of, you know, outline, but what it actually does the meat on the bones is, you, you, you took you take a insomnia as a holistic issue. And what we look at is sort of three pillars really to the first we look at habits, and it's kind of looking at what are we doing around our sleep, that is making what could be a temporary sleep issue into a long term chronic issue. And that could be to do with how we treat our bed and our bedroom. Is it a place of all things, and it tends to be a haven at this time of life day? And I don't know about you, but you know, it's a place where you kind of escape from the family, and you can go and have a bit of you time when you're in bed. Oh, yeah. So Fridays, especially

Jenn Salib Huber  4:34  
Friday nights, the kids and my husband know that my favorite thing in the world is that once everyone has kind of settled into their evening entertainment, I retreat to our room, tuck into bed, watch a show and go to bed early.

Sarah Wilde  4:47  
Yes, yeah. Which is, you know, it's really common. It's really, really common, and it's an really nice thing to do. But if you are having trouble with your sleep, it's actually a really bad idea. Because we are we We are confusing the role of our bed and our bedroom, in our mind, when really it has to be a haven just for sleep, or sex, one or the other. But if we start introducing, you know, playing on our phone, watching telly doing work, even, we change all of these things, then the bed in the bedroom loses its meaning for us. And as I say, if you've got a sleep problem, then then that's not the way to go. So these are the sorts of behaviors and also the chasing sleep behaviors that we that we might have, like, going to bed earlier or lying in at the weekends, when sleep becomes an issue, then we're thinking about it, and we're trying to get it. And that's when we start to change our routines. And we have elaborate everyone has a bedtime routine. Do you have a bedtime routine? Even if it's just taking your makeup off at night?

Jenn Salib Huber  5:54  
Yeah, no, I definitely do. And you know, and I think that a lot of people who have experienced sleep changes in midlife have thought about a lot of these things. So is there a difference between CBTI and what I think a lot of people have read about as sleep hygiene? Or are they interrelated, but not exactly the same? You know, because I think that that is the part that I found really interesting about what you were doing is that it seemed like it incorporated sleep hygiene, but it was more than just sleep hygiene.

Sarah Wilde  6:30  
Yeah, yeah. I think that that explains it well, because sleep hygiene. Whilst it's important, because it can be the difference between those say, sort of the temporary sleep issue, because starting to move into a sort of chronic insomnia issue. It's funny, because women that come to me have usually got all the sleep hygiene advice, nailed. Because it tends to be the first thing that you're either told about by the doctor or, you know, if you're going on Dr. Google, this is the stuff that they're telling you to do. And it's the stuff that we get done. Because, you know, we're we're serious about our sleep, you know, it's it's a really important for functioning. So often, often the sleep hygiene bits, we do check that they are all in place, because sometimes some people aren't aren't doing those things, you know, once sleep goes wrong, then we tend to be very focused on trying to get it right again. And this is what I meant by US started to change behaviors, or the sleep hygiene that you were talking about. Most women I see are following sleep hygiene guidance. And it might actually be an issue of the pendulum swinging too far. Because the sleep hygiene becomes almost a you know, a sort of an order a rule, so everything has to be perfect, especially if something has been tried and it worked, then you're sort of chasing that again, it's okay. Well, I did this this this, so I have to do it again. Because then I might get the sleep.

Jenn Salib Huber  8:03  
Oh, yeah, you get very superstitious about it. Yeah, no, definitely sleep was the first thing that went for me in early perimenopause, and I was 37 or 38. And I had the very classical wake up at two or three in the morning, wide awake for no good reason and couldn't get back to sleep. And, you know, my kids were finally sleeping through the night. And it just felt like I was anxious going to bed every night because I would do all the right things. No caffeine, you know, not no strenuous exercise, no TV in bed, reading a real book, you know, no blue lights, like I had this list of 10 things that felt ritualistic that I would do. And then I'd go to bed and it was like, Okay, and what's tonight gonna bring? And then if it did work, I would think, Oh, it's working. But then if I did the exact same thing, and it didn't work the next night, I think, what the heck, what did I do? Yeah, so yeah, frustrating.

Sarah Wilde  9:01  
It is very frustrating. Because Because you try, you know, you try to chase that perfect night again, by putting everything back in place. And, and that and that creates its own vicious circle, because you become sort of fixated on what I need to do to get a night's sleep. And unfortunately, that actually, again feeds into the problem. Because your mind is then completely active. Like you say, You're worrying before you go to bed. And that can start you know, that can be a daytime issue as well. You're thinking about it all day. How am I going to sleep tonight? How am I going to function tomorrow? And that just makes things worse, unfortunately.

Jenn Salib Huber  9:42  
But let's talk about some myths about sleep because I love myth busting, especially when it comes to things that you know, I think that we put out we invest a lot of time and energy into trying to make true for us. So what are some of the big myths surround sleep that you encounter with the women that you're working with, that just aren't serving us anymore that we just need to let go of.

Sarah Wilde  10:08  
Yeah, yeah, well, I think the top one has to be the, I need eight hours sleep goal. And unfortunately, that becomes a stick to beat ourselves with, because, and it is unhelpful. It's exactly the word because we get this in our head that eight hours is the golden number. So anything that isn't eight hours is then failing. And that really feeds into, you know, how we think about sleep, and how much effort we then have to put into sleep, when the truth is that how much sleep we need is a really individual thing. It's like, you know, like our shoe size. Most people if you think of the distribution, the population, the adult population, you know, it's like a hill. So most of us are in the middle of that chunky bit of hill. And that's the kind of six to eight hours threshold, well, you know, we can be anywhere in there. And, and also, sleep needs change over our lifetime as well. But then on the outliers, a little foothills either side, you've got people who can get away with less than that, and people who need a bit more than that. So all we know is that it's very individual, it does change over our lifetimes. And then actually having too much sleep is is detrimental to our health is having too little, which most people would never appreciate. It's kind of more is better idea is really out there. Yeah. So tell

Jenn Salib Huber  11:30  
me about that. Because I actually haven't heard that, like stated that way before. So how was getting too much sleep bad for us?

Sarah Wilde  11:39  
Yeah, well, I again, they don't really know the exact mechanisms. But when they've studied populations, and looked at how much people how much sleep people actually get, and then linked that to health outcomes. And there was a very strong correlation between, you know, a lot of sleep, so we're talking to the regularly 10 plus hours every night can have detrimental health outcomes, which sounds really strange, because as I say, We're all very much hooked into an idea that we need more, not less. But know that kind of both ends of the spectrum, mirror each other in in many ways in terms of health outcomes.

Jenn Salib Huber  12:18  
Really interesting. Yeah, if we can't rely on the number of hours that we're getting, should we be How should we be measuring our quality of sleep? What are your thoughts on things like sleep trackers and apps that tell us, you know, you spent this much time in this stage of sleep? What are your What are your thoughts on those?

Sarah Wilde  12:39  
Well, sleep trackers, they're everywhere, now you've got your Apple Watch, or you can get any app downloaded on your phone. And they they are limited, they are pretty good in showing how much we move, they tend to be based on how much we're moving around at night. And then they use that and some fancy equation to give us an idea of when we were supposedly waking up in our in the night's sleep. Unfortunately, they're not very accurate, they can be pretty accurate, but not accurate enough. And to give you a real idea, because if it just on a very common sense idea, when you're awake at night, often you're lying in your bed, quite still just sort of looking at the ceiling. So any kind of actigraphy you know, motion sensing that you might be having is not even going to pick that up as being asleep. But the problem is, is that we then get quite fixated with the results of our night's sleep. And it all becomes about what is my phone told me about my night's sleep. And we're not checking in with ourselves and saying, actually, how do we feel about our night's sleep? You know, we think we're using a nice ruler, but the ruler actually isn't that accurate and doesn't serve us very well. So I'm not a big fan. Because as I said, people can get caught up in what does the numbers show me? And that doesn't necessarily reflect what happened or really how your body's feeling. And your mind.

Jenn Salib Huber  14:10  
Yeah, I see that all the time with respect to things like movement as well. But you know, don't rely on step count to decide whether or not you've moved enough. You know, kind of don't let don't get bullied into closing your rings on your Apple Watch. You know, just because you can close them or you think that you should we should be having a little bit of you know that introspection and awareness around like, do I feel like I moved enough? Is this the right kind of movement today? And same with sleep? I'm assuming? Do I feel rested? Do I have energy to get through my day without feeling like I need a nap? Do I constantly feel like I'm yawning or tired? Those are probably more reliable, subjective assessments than just relying on the data that you can gather with an app right?

Sarah Wilde  14:56  
Yeah, absolutely. And also it can set the tone If your day, straight out of getting out of bed, you know, you can wake up look at your phone, and it says no, you didn't sleep very well, I know that well, that's me doomed for the day then. And, and that's, that's so unhelpful because actual studies of you know, cognitive functioning particularly about during the day is that actually we can be okay. And a lot of it has to do with how we will then manage ourselves during the day to get through the day. So no, I'm really not a fan of those at all.

Jenn Salib Huber  15:36  
So, so we've talked about the myth about how many hours and we've talked about, you know, the technology. What's one other big myth that people hold on to for dear life that maybe isn't helping them get more sleep?

Sarah Wilde  15:51  
Well, I think it's the idea that insomnia is a biological problem, and somehow needs some kind of biological cure. And actually, what what we know about insomnia, and I'm talking about insomnia disorder, not a diff any other type of insomnia or any kind of other sleep disorder. But what we know about insomnia is that it is something that happens, like there's normally an event that that sends our sleep into threats. So it could be in menopause, and perimenopause. And then what we do is that we start chasing sleep, and looking for ways to fix our problems. So we change our behaviors, we're starting to get more worried about sleep, and how we're going to function. And then a vicious cycle is is created. And that actually makes us sleep worse. So the way to treat that, as I said, is using CBT AI, cognitive behavioral therapy for insomnia is a really good tool, because it specifically targets those worries and behaviors that turn as sort of a sleep issue into a long term sleep problem. And, and even when they've done studies, I mean, you know, sleeping pills in the UK, it's not quite the same as in the US, and Canada. You know, generally speaking over here, sleeping pills are quite heavily regulated, not generally have given out that much. But, you know, when they've done studies comparing the effects of sleeping pills against CBTI, as an intervention, they found in the short term, that that pretty much equally effective. And in the long term CBTI interventions are more helpful, because obviously, once you stopped taking sleeping pills, a you can get rebound insomnia, and also it hasn't done anything to address any kind of vicious circle behaviors and thoughts that are that are keeping that sleep problem going. Yeah, so. So really, it's kind of counterintuitive, because when you're not sleeping, you do kind of think, oh, you know, if you've especially if you've been to the pharmacy and tried every over the counter solution, you can, which was certainly me, you know, I don't, you know, I bought everything I could lay my hands on to try and fix my sleep problems that you can, if that doesn't work, inevitably, it won't. You can end up thinking, right, that's it, I just need a pill from a doctor. But no CBTI has been shown to be to be really effective. And of course, sleeping pills don't help you sleep makes a date to choose, which is a different type of sleep.

Jenn Salib Huber  18:41  
Is it the quality versus quantity kind of sleep? You know, much?

Sarah Wilde  18:46  
That's very much my approach, Jen, it's kind of we're looking for fixing the quality. First off, that's the first sort of target is how to make your sleep as efficient and the best quality we can make it.

Jenn Salib Huber  19:01  
Yeah. And it's so true. But those thoughts, though, you know, I remember feeling you know, like I said, anxious before I would go to bed. And you know, if I woke up in the night, even though I wasn't clock watching and I wasn't you know, doing all those things. One of my first thoughts was often Oh my God, have I gotten enough sleep, you know, and it's like I would I would be able to like gauge based on how much light was coming in from the curtains, whether it was you know, five or six. And, but once I don't know if this is part of CBT or not, but I either read or heard somewhere or something, you know, just tell yourself, I'm awake. And if I fall asleep, I fall asleep. And if I don't, I don't I will still be okay. And so instead of going into that cycle of oh my god, have I slept enough? What do I have on the go today? Am I going to be too tired? Am I going to want to camp like all of these things that used to be part of that trigger? And be like, Well, I'm awake now. And like, probably 80% of the time I do fall asleep. But you know, I had to Like train myself to stop that default programming around, you know, don't worry about it, if you're tired for a day and you don't sleep, it's not the end of the world, you know, like you're not going to world isn't gonna come crashing in and just kind of giving myself that permission to have a bad night's sleep and not have to worry about it, to me felt like the biggest shift I needed to make Am I thinking versus adding in more things to do to you know, to do more, I actually had to do less, which is an interesting thing.

Sarah Wilde  20:28  
Well, that is that is, that is actually a perfect illustration of, you know, the sort of paradoxical intention, which is a theory in psychology is that, you know, once you put your mind to something and try really hard to do something, or, or achieve something that actually can have the opposite effect. And you're right, you're perfectly right. In that approach. One of the ways that we do you deal with the mind racing and worries about sleep and how you're going to function the next day, is that sense of sort of accepting and mindfulness. So you, so you can sort of take a step back from your thoughts and just say, Okay, I am awake now, just like you said, I may go back to sleep, I may not go back to sleep, but I'm going to be okay. I notice I'm having these thoughts, that I'm worrying about sleep and worrying about how I'm going to sleep tomorrow, you know, function tomorrow, and just noticing them and just letting them kind of pass over you not grab on to them and sort of head down the road with them, you know, clinging on to them. Because they can take you to really, you know, sad, hopeless places. And that that is a really important part of, of my work with with women. Yes,

Jenn Salib Huber  21:48  
I see so many parallels to the work that I do with body image and getting out of the diet cycle. So I often talk about how you have a thought you have a bad body image day or you know, you're just not feeling good in your body, and you have this immediate thought, my body is bad, it's terrible, I have to lose weight, I have to make my body smaller. And you have this like predictable series of events that always ends you back up in the same place, you're not actually getting to where you want to get to. And it sounds very similar that I think people you know, when you do experience sleep difficulties, that, you know, you have this series of thoughts that are kind of on a default replay. But they're not actually getting you anywhere. So recognizing them is is the first step for sure.

Sarah Wilde  22:32  
Yeah, definitely. And, you know, I think part of the process is sort of how to deal with worry specific worries about sleep, which is you know, what we've just been talking about, and also the sort of wider stress and worries that we have about life, and how we deal with those day to day because if we are not dealing with them, then we think of our nervous system as a sort of idling car, you turn on the engine, and it's just sort of buzzing. Well, that's what we want our nervous system to be at that kind of level. So that when we go to sleep, we can gently sort of drift sleep. But if we're worrying a lot about sleep about life, then what we're actually doing is putting our foot on the accelerator and revving our engine. And that means that orange is raving all through the day and then into the night, which makes it even harder to just relax down to that state where we can drift off to sleep. A multi pronged approach.

Jenn Salib Huber  23:34  
Yeah. So are there any other kind of little tips that you can share with maybe women who are in this stage, because what I love about your approach is that it's kind of really independent of the hormonal piece, right? Because it's not treating the hormones. It is I think, more often treating the thoughts, feelings and behaviors that have that are coming up, because we're not sleeping and the worry that we have around it because we hear so much about how important it is. You know, the frustration we have at things like brain fog and fatigue and just not feeling like ourselves, but I just love that it is really independent of the hormonal situation. And it's so applicable to really every stage so what would be one or two things that maybe you might suggest people take a different look at or see through a different lens when when looking at sleep and midlife. Yeah,

Sarah Wilde  24:29  
well first just to say yes, it is a really good independent approach that doesn't involve hormones, and has been looked at with just Penny Peri menopausal and postmenopausal women, and it does work regardless of the hormone fluctuations that's going on. So this approach does work for for women like us, Jen so if I had some top tips then for you know looking at see if you're having problems and you think you've got insomnia so I think the first thing we do is we try Want to get back in touch on our body's natural ability to get us off to sleep. And there are a couple of main drives that we can try and work with. And the first is the sleep drive. And that's the one that builds up during the day. So if you imagine you've got like a red balloon, or floppy red balloon, and that's how you wake up in the morning. And then as the day goes on, you are filling up that balloon. And as you get to the evening, what you want is a nice taut full balloon of air, or sleep drive. And then that will help you make the journey into sleep much easier because you're feeling tired. And it's your bad body's natural cue to move into sleep. So to do that, you need to wake up and get up in the morning, but you say, don't lie around the bed, try and get some daytime light outside. That's really important ideally, in the morning, don't wear sunglasses because it's it's it's got to be the light hitting your your retina. Try and be active in some way. And I don't mean a big workout, but just move your body and try not to nap. If you're you know you nap if you're really sleepy like nodding off sleepy. But if you if you're just trying to chase sleep with by napping, then you're making the problem worse, because what you're doing is letting air out of your balloon. So you're gonna have a soggy balloon come the day.

Jenn Salib Huber  26:30  
I love that. I love that.

Sarah Wilde  26:33  
You want a nice talk balloon. And the other two would be to get up at the same time every day, including weekends, I'm afraid. Because again that I know what are you crazy. But if you are chasing sleep, it really is feeding that unhealthy cycle. But it's also again, another natural body process your body clock, your body clock really likes to have regular wake and sleep times. Eat you know even messing with that slightly, you know I'm talking like half an hour can affect you. And you can get jetlag without ever having left your bedroom. And that comes by having really different sleep and wake up times. You're actually traveling through time zones without leaving your bed. So that can give you those kinds of jetlag the feeling sometimes you get when you have been sleep, you know had had

Jenn Salib Huber  27:33  
thought of that that way? That's really fascinating. Yeah, I'm not sure I'm willing to give up my weekend lion a little bit, but I'm definitely going to think about it differently.

Sarah Wilde  27:45  
If you don't have trouble with your sleep, don't have to worry about it.

Jenn Salib Huber  27:49  
This is what I think people some food for thought thinking about that Sunday night insomnia. That is so so common. You know, wow, sir, you've given us so much to think about, I can't thank you enough for sharing your wisdom and for I always like to ask my guests what? And the answer might be obvious or may not be doesn't have to be but what do you think is the missing ingredient in midlife?

Sarah Wilde  28:18  
Well, apart from sleep, obviously. I think something that really cares to me is that, you know, we're at that point where we've got children, perhaps young children, teenagers work, maybe aging parents, that priorities is what comes to my mind. Because often I feel like our to do lists are written for us every day, you know, everyone else, everyone else is sheduled and stuff we have to get done. And then anything we want and need is right down the list and potentially never gets to, you know, we never get to it. And, and one thing I think I really realized is that as you get older, you really have to work at being well, as you get older mentally and physically well, and we need to put that as a priority. So I would say it is prioritizing ourselves, and giving ourselves full permission to do that. And you know, that's always a trouble, I think for women, but it gets more acute as we get to this stage in our lives.

Jenn Salib Huber  29:29  
But self care is all about I love it. Yeah. So if anybody is interested in learning about Sarah, you share some great information on Instagram and your handle is beyond insomnia. Right? Yep. It's beyond underscore insomnia. Perfect. And I will put links to anything that you have on the go and your Instagram profile in the show notes for anybody who wants to learn more from Sarah. Thank you. Thank you. Thank you so much. It has been lovely chatting with you. Now it's my pleasure, Jen. Hey there. Thanks so much for tuning in to this week's episode of the midlife feast. Just remember that the midlife feast community membership is now open for registration and it is the perfect place for you to gather, grow and nourish with other people in midlife who know exactly what you're going through. You can find a link to join this monthly membership in the shownotes. We'd love to have you join us as you feast on midlife. And if you found this podcast episode helpful or any of the episodes on the midlife feast, just a reminder that the best way to help others find us is to rate and review the podcast wherever you tune in.