Natural Fixes for Insomnia and Midlife Sleep Problems with Sleep Doctor Shelby Harris
Show Snapshot:
Make 2022 the year you tackle midlife sleep problems and insomnia head-on with sleep tips from sleep expert Dr. Shelby Harris. We uncover gender-specific biological alterations of sleep throughout a woman’s life, and how hormones, stress, and lifestyle factors can disrupt sleep.
We discuss natural fixes, when to seek medical help, ideal sleep temperatures, and the “magic” of the right wind-down (and wake-up) routines. Get ready to get your Zzzs on!
In This Episode We Cover:
1. Beyond hormones -- other culprits that cause midlife sleep problems.
2. Think you have to accept poor sleep as you age? Think again.
3. Hot flashes, night sweats, racing mind – when to talk to your doctor and when to try at-home fixes.
4. Want to skip medicines? Why try cognitive behavior therapy (CBT) may be the natural remedy you need.
5. Better your odds of sleep with “soft” thoughts, not just soft pillows.
6. The low down on tools like journaling, meditation, mindfulness, and exercise to power sleep.
7. Yes, your bedtime routine matters but the real magic to consistently great sleep is doing this one thing every morning.
8. Body clocks, biorhythms, sleeping partners, room temps – the skinny on what impacts sleep.
9. Can’t sleep? Or won’t sleep? Why top prioritize 7-8 hours even if you think you can do without.
Quotable:
If you have a physician who says to you, “Just deal with it you’re fine, it’s just part of getting older,” find a better doctor. You don’t have to accept poor sleep as you get older.
If you get up at around the same time every single day, seven days a week, you’re going to essentially set your body clock in the morning that will make the nighttime easier. So, essentially if you get up at the same time in the morning, you’re gonna get hungry for sleep at around the same time at night. So, you want to build up an appetite for sleep.
More Resources:
Follow Shelby:
Shelby’s Book:
The Women's Guide to Overcoming Insomnia: Get a Good Night's Sleep Without Relying on Medication
Transcript:
Katie Fogarty (0:03):
Welcome to A Certain Age, a show for women who are unafraid to age out loud. I don’t know about you but I have big goals and plans for 2022. There is so much I want to accomplish personally and professionally and I have learned that I can only move the needle on days when I’ve had a great night’s sleep. If I clock solid, restful sleep, I’m more productive, more optimistic, happier, nicer. And on days where I don’t, watch out.
Which is why I’m delighted to welcome sleep expert Dr. Shelby Harris to the show today. Dr. Harris has helped countless people of all ages, improve their sleep, anxiety and mood. A specialist in behavioral sleep medicine, she ran the behavioral sleep medicine program at Montefiore Medical Center in New York City. She’s also a specialist in Cognitive Behavior Therapy to treat insomnia, anxiety, and depression and is the author of, The Woman’s Guide to Overcoming Insomnia: Get a Good Night’s Sleep Without Relying on Medication. If you want 2022 to be the year where you finally wake up feeling rested and ready to meet the day fully charged, stick around, we’ve got you covered. Welcome, Shelby.
Dr. Shelby Harris (1:11):
Thank you so much for having me, I’m happy to be here.
Katie (1:13):
I’m super happy because I know we’ve tried to make this work for many months, but it’s been tricky because your schedule is busy, which makes sense. A lot of people need help sleeping. We all want to be well-rested but it doesn’t always happen, especially for midlife women. I would love to start with some stage setting. Why does sleep get disrupted and why does it sometimes feel like it gets worse in midlife?
Shelby (1:37):
I think in midlife, there’s a few different reasons why we tend to have sleep problems more. So, one is there’s definitely the hormonal aspect. So, as we start to enter perimenopause, our hormones start to shift a lot so we have bigger drops in estrogen, progesterone. All those things start to change and as that starts to change, it really can disrupt sleep. It changes differently for different women and that can always be a conversation to have with your gynecologist but the hormone changes are a big one. And then we also start to accompany with the hormone changes, we start to see things like hot flashes, night sweats that happen a lot more. A lot of women will start to report to me in their late, late thirties, usually around the forties, that they wake up drenched or that their brain is racing so that can happen a lot too.
And then there are other things that happen too. There’s just more demands on women I think even as we tend to get into midlife. So, a lot of people I work with, have kids at home. People are having kids later in life too now, so some people still have kids who are 10, 11, 12 at home and at the same point, have parents and aging parents and work that they’re dealing with. So, there’s a lot of things that kind of demands on women that are more so than ever before. So, that plus the hormonal stuff, it’s just a firestorm.
Katie (2:56):
Right. So, women absolutely face unique biological alterations of sleep throughout their life. You just touched on it; changing hormones. How do we get hormones back in wack, when should women seek professional help?
Shelby (3:09):
I think it depends, it’s always a conversation for women of just how bad it is for you. I have some patients that have an occasional bad night here and there or they have chronic insomnia issues but they’re not having constant night sweats and hot flashes and they would rather try something like what I do is Cognitive Behavioral Therapy for insomnia. They’d rather try that first, it uses no medication and it’s a really good option starting point for a lot of women. But if that’s just not enough, if you find that your sleep is a wreck even despite trying behavioral solutions, then it definitely is a time to have a conversation with your gynecologist because there’s lots of—whether its hormone replacement, sometimes it’s antidepressants, there’s a lot of things that can help. Women shouldn’t be suffering. So, there’s definitely a tiered approach but don’t just expect that you have to have poor sleep from here on out.
Katie (4:00):
Okay, I love that. Women should not be suffering. I’m one hundred percent on board with that.
Shelby (4:06):
And another thing for me to add to that is that if you have a doctor that you’re seeing who completely minimizes it and says, “Oh that’s part of getting older,” or, “Just tough it out,” you need a better doctor.
Katie (4:17):
Yes.
Shelby (4:17):
So, a lot of times it has been dismissed for years and there’s no need to dismiss it anymore.
Katie (4:22):
A hundred percent, a hundred percent. So you specialize in behavioral solutions, in Cognitive Behavioral Therapy to address sleep problems. Tell us more about that and how that works.
Shelby (4:33):
So, CBT for insomnia, a lot of people talk about CBT in general for like, anxiety and depression. It’s a little bit different in that it’s an evidence-based approach to insomnia in general, regardless of, in many cases, what causes insomnia. We tend to recommend it as a first-line treatment for insomnia, regardless of the cause in most cases because it does not use medication. As I said, it’s evidence-based. It works in sometimes two to eight sessions with a lot of women. So, what is it in general?
So, the B part of CBT is really working on figuring out the ideal bedtime and wake time based on what your sleep is looking like at the moment when we see you. So, it’s a little bit of tracking using diaries for sleep; having people change up their bedtime, sometimes spending a little bit less time in bed to get better quality initially. It’s what you’re doing in bed or out of bed. So, sometimes we have people change up the, again a lot of people will just lay in bed just kind of tossing and turning, trying to force sleep to happen so we change up that to make the bed only be about sleep and sex. And then other things like light exposure, wind-down routines, all that. It’s like multi-component.
And then the C part of Cognitive Behavioral Therapy is really, sometimes I don’t even need to do it with some people but for other people, it’s really about focusing on the worries about sleep because what I tend to think happens with a lot of people is that the more you worry about your sleep or what could happen from not sleeping, the more you try to force it, that’s actually the kiss of death when it comes to sleep. So, it’s teaching people to soften their thoughts, soften their predictions of what will happen, not put pressure on themselves, and using certain techniques to challenge thoughts that you’re having. And then for other people we actually use meditation and mindfulness during the day a lot to help with improving sleep. It’s combining the behavioral techniques plus the cognitive techniques that really are the sweet spot and really can help people pretty quickly in improving their sleep without needing medication.
Katie (6:30):
So, that racing mind that you referred to when you get in bed and start to think of that pressure and you’re like, I can’t fall asleep and tomorrow’s going to be a wreck. I love this notion of softening your thoughts to perhaps deal with that panic. What does that look like and how might we incorporate that into our bedtime routines?
Shelby (6:46):
So, for some people, and it’s totally counterintuitive, some people they’re getting in bed when they think they should go to bed or often times it’s because they have a significant other who goes to bed at that time. You just might not actually be sleepy enough at that time. I always tell people, go to bed when you’re actually sleepy, not before then. So, if I have somebody stay up a little bit later until they’re genuinely sleepy, sometimes that actually just stops the racing thoughts. It’s kind of weird because the sleepiness takes over. So, you might be getting in bed too early.
The other thing to think about is what are you doing the half-hour to an hour before bed. So, if you really have a brain that’s just racing and no matter what time you go to bed it doesn’t work or doesn’t quiet down, I’ll have people do some journaling for ten, twenty minutes. I also love people to write worry lists basically so, what are all the things that are on your brain, what can you control, what can’t you control? Cross off the things that are out of your control, let go of it. And then sometimes it’s just a to-do list, a simple to-do list. Getting it out of your brain is super beneficial because what you go to bed with on your brain is going to be there when you get up in the morning.
And then the other thing that I do all the time, now more so than ever, is I have people practice meditation. But a lot of people are using meditation as this kind of, almost like a sleeping pill. They’re using a lot of the meditations, they put it on in bed and they fall asleep to it. That’s okay as kind of like an intermediate kind of step, but the goal is really to be able to get in bed and fall asleep without needing anything. So, I actually have people practice meditation during the day so they get better at noticing when their brain’s racing and letting it go. If you get better and stronger during the day, then it’s actually easier to let it go at night.
Katie (8:22):
That makes so much sense. I love the idea of doing meditation during the day rather than having the pressure to make meditation work for you in the evening because I think a lot of us sometimes think, we read in women’s magazines, we hear from our friends, we absorb from pop culture that if you have this magical bedtime routine, you’re going to be able to fall asleep well and it puts a lot of pressure on it. But I have read on your own website and in some of your social media posts that you’ve made that really the morning routine is what’s truly key to sleep. We are going to be taking a quick commercial break, but when we come back, I want to hear about why your morning routine actually makes bed happen more easily. We’ll be back after this break.
[Ad break]
Katie (10:14):
Okay, Shelby, we’re back. We talked about the myth of the magical bedtime routine making sleep easier but I want to now talk about why the morning routine is what sets you up for a good night’s sleep.
Shelby (10:26):
Yeah, I think there’s definitely, I mean it’s not to ignore the nighttime at all. It’s definitely important that you treat your brain like it’s on a dimmer switch and to slowly relax into sleep, but if you’re ignoring the morning you’re just making it harder for you at night.
The morning is important because if you get up at about the same time every day—and it’s not pretty to do on the weekend, I get that—but if you really use an alarm and get up around the same time every day and get light exposure first thing in the morning for ten, fifteen minutes, try to turn on the lights around you, use a dawn simulating light if it’s dark out still, or just open up the shades and have a cup of coffee. If you can do that, it helps to set your biological clock to know when morning happens and when night time happens. If you get up at around the same time every single day, seven days a week, you’re going to essentially set your body clock in the morning that it then will set the night time easier. So, essentially if you get up at the same time in the morning, you’re gonna get hungry for sleep at around the same time at night. So, you want to build up an appetite for sleep, and getting up at the same time really helps to build the appetite so that you get hungry for sleep at the same time every night.
Katie (11:30):
That makes sense. And then you can turn on that dimmer switch that you talked about. So, what is a dimmer switch that you know to be effective for your patients? What does a wind-down look like?
Shelby (11:41):
Wind down, it’s so personal. It’s funny people will say, “Do these 5 things for a better sleep.” No, if you don’t like to read, I’m not going to force you to read. Find something for you that’s quiet, calm, and relaxing that you can ideally do most of out of bed and that doesn’t use a screen because the screen, yes it can keep you up, but I think the bigger thing with screens is that we tend to get sucked into social media, we check work emails, we then like, binge watch shows online. So, it’s find something that doesn’t use a screen for you that is quiet. So, for me, it’s often doing some gentle stretches. I start the evening usually watching a little bit of TV or on my phone, and then I switch to turning it off, do some stretches, deep breathing, sometimes I read, sometimes I don’t and then I get in bed. Other people like to do some knitting, adult coloring, some evening yoga, listening to podcasts or meditations. But it’s doing what works for you in dim light. And really the ideal is to do about 30 to ideally 60 minutes before bed to really start dimming things down. But if you can’t even find 30 minutes, start with 5 minutes, 10 minutes. And then once you have that little buffer, move it to 15 minutes. You can’t just crash into bed and expect sleep to happen.
Katie (12:53):
I love that you mentioned, that makes so much sense to me. I get into bed and I want to be my husband who starts snoring immediately and I’m always super jealous. Why isn’t he up worrying about the things that I’m worrying about? You did allude to partners earlier in our conversation. You said that sometimes you’re getting into bed too early, simply because your sleeping partner is. Many of us are sharing beds with people, do you have any nuggets of advice for people on how to co-sleep with somebody in a way that makes everybody well-rested?
Shelby (13:26):
I think there’s a bunch of different issues that can come up for that. For some people, they’re on different body clock schedules. Some people have a significant other that can sleep later and go to bed later, other people it’s earlier. So, if you can find time and have a frank conversation of well, my body clock is a little different than yours, we need to not tie getting into bed at the same time because it ends up making me more resentful that you’re snoring or whatever it is, that has to be a frank conversation. Go to the bed earlier, be intimate for a little bit if you want, and then when it’s time to go to bed, go to bed later.
For other people, the bigger thing that I see a lot of times is more of like, the snoring and the noise and some people say, “Well my significant other is so loud that I don’t get good quality sleep.” Then it’s a conversation about maybe getting that person evaluated. And if that person doesn’t want to get evaluated for sleep disorder like apnea then that’s a bigger conversation that needs to be had. And if that person has gotten treated for sleep problems and it still is an issue but they’re doing everything they can because they value your sleep too, then sometimes there’s actually value in sleeping separately, spending the beginning of the night together, being intimate, whatever you need and then when it’s actually time to go to sleep, sleep separately because it kind of melts away a lot of the resentment and then you sleep better and you’re better together during the day.
Katie (14:45):
I love this piece of advice and you’re just jogging this thought in my head. I remember seeing, I can’t even remember where, somebody’s home where they had twin beds and I remember thinking, that’s so strange. And I have definitely had points in my marriage where I’m like, I would love my own bed. [laughs] For the listeners who know my voice but may not know me, I am not tall, I am 5’4” my husband is not tall either but I am one of these people that thrashes around in the bed and we finally got this gigantic, comically oversized bed for us two tiny people to share because it’s tricky, it’s tricky to share a bed. So, that’s a great piece of advice even if some people are thinking that sounds very 1950s and not romantic. We’re old enough to know that we don’t have to, we can do these things, we can choose to do things that are good for us. My piece of advice is to buy yourself a California King and make that work.
Shelby (15:40):
There’s a big stigma in our society that if you sleep separately it’s a big problem. But if you both come to this mutual agreement because you both sleep better separately, then more power to ya. I don’t love the shaming about sleeping separately if it really does bring you better sleep and you’ve tried other things to try and improve it.
Katie (16:04):
Yes, that makes so much sense. So, quick question for you. We all know that humans have been sleeping forever no matter what bed they’re in; separate, big, caves, whatever. This is something that is just part of being human. But now we have all these different gadgets to help us with something that really feels like should just be sort of coming more naturally. We’ve got white noise machines, we have mediation apps as you referred to earlier, we have multiple different kinds of sleep trackers, Apple watches, et cetera. Where do you stand on these tools?
Shelby (16:35):
I think there are different types of tools. I’m all for white noise, ear plugs, noise-canceling headphones, if there are specific things that are, light-blocking shades, dawn simulators. If they’re helping to enhance your sleep environment.
The trackers are a different issue in that I think they’re great. They’re not as accurate as people always think they are. Some can be more accurate than others. I think they’re great for people who don’t make sleep a priority in their lives and they could sleep better, but they don’t make the time for sleep. So, it would be great to say, you don’t get in bed until midnight and you get up at 6 AM but the person could probably be going to bed earlier and can if they do. So, I think it’s great to bring light to that kind of stuff. But if you’re someone who has insomnia, meaning you can’t sleep no matter how hard you try to sleep more, the watches have actually been shown in research to create more stress for people and actually worsen their insomnia. So, you have to think about what you want it to do for you and if it’s just to shine some light on whether you’re burning the candle at both ends, do it. But if it’s making you more anxious, don’t bother anymore, get rid of them.
Katie (17:48):
No one needs more stress in their life.
Shelby (17:50):
It’s not worth it.
Katie (17:50):
Not worth it at all. So, you touched on earlier in our conversation, women who can’t sleep, who are having trouble, who are having maybe chronic insomnia. You just said something about sometimes people are choosing not to sleep; they’re not getting into bed, they won’t prioritize sleep. What do you say to a patient who may not understand that they need to make sleep a priority? What would you say to a listener on this show right now who is thinking, I only need like 6 hours? I’ve got too much to get done to prioritize sleep.
Shelby (18:24):
Well, I usually ask people if you really don’t have insomnia and you should be getting more sleep and you can if you try, I always encourage people just take two weeks. Commit to it for two weeks and then let’s talk in two weeks. If you can commit to getting more sleep in two weeks, you might find that you’re actually more efficient at doing the things you need to do during the day and not spinning the wheels that you can actually start to make more time for sleep at night. I usually encourage people, two weeks and then re-evaluate.
Katie (18:52):
And Dr. Harris, how is your sleep?
Shelby (18:54):
My sleep is okay most nights. I have an almost 12 year old and a 6 year old so once in a while, my 6 year old came in a little early this morning because she had a nightmare and these things happen. I’m in perimenopause and I don’t sleep perfectly every night, but I aim for consistency, not perfection. So, I’m happy with how I am content with my sleep five nights a week so I’m doing fine and I’m pretty good at keeping the same bed time and wake time seven days a week.
Katie (19:19):
Yeah, perfection is totally overrated. I also read on your website that you are a 17-time marathoner. Is this correct?
Shelby (19:27):
It’s crazy to hear it. Yeah, I am, hoping to get to 20 in the next 10 months or so.
Katie (19:33):
That is astonishing, congratulations. That’s totally amazing. But I wanted to ask you about how running impacts your sleep. Does it help? What role does regular exercise play? I know that I try to exercise regularly, I know that many of my listeners do as well. I’d love to hear, especially from you, somebody who makes running an enormous part of her life, what role exercise does or does not play in healthy, wonderful, restful sleep.
Shelby (19:58):
You don’t need to be a marathon runner. You can be, 20 minutes of just getting your heart rate up a little bit. That’s what we see that is very beneficial for sleep at night. It’s not the cure necessarily for someone who has chronic, chronic insomnia but I still think that if you want to sleep at night, it’s like a battery that’s recharging. If you’re not using it during the day, it doesn’t need to recharge as much at night. So, getting a little bit of movement in, getting 20 minutes of getting your heart rate up here and it is really helpful.
Now, the timing is also important. Try not to do the getting your heart rate up within three hours of bed because that can impact your ability to fall asleep, make it a little bit more difficult. The sweet spot for a lot of people is between 4 to 6 hours before bed. So, if you can get a little exercise in 4 to 6 hours before bed, by all means, give that a try. But for a lot of people, myself included, there’s no way with two little kids, there’s no way I’m gonna be like, “Goodbye, I’m gonna go for my run at 5 PM now,” or even 4 PM, it just doesn’t happen. So, I am a morning exerciser. It doesn’t make my sleep drastically better at night, but I do find that I’m using my battery, it’s good for me and my stress reduction which will help sleep as well. And where it really helped me is it keeps me honest of the weekends because my kids sometimes will sleep a little later than I do and on the weekends I run with a run club so it keeps me accountable to get up about the same time every single day, seven days a week, and that helps me immensely with the night as well.
Katie (21:30):
That’s such a smart hack; to really commit to doing something that gets you up and out of bed early so that you can keep that seven-day-a-week schedule. I myself do morning yoga classes, I’ll often commit to playing platform tennis in the morning because I’d much rather be sleeping but I know if I promised three other people that I’m joining them on a paddle court, I get myself up and going. So that’s wonderful advice for our listeners if they’re looking to prioritize sleep this year, that they really commit themselves to something that gets them up and out the door so they can get that exercise in and help with their circadian rhythm.
Shelby (22:05):
Exactly. And also keep in mind that if you’re doing it at times of the year when the sun is out, you’re getting light exposure on top of that. So, you’re getting the double whammy of exercise plus light exposure and it really can be beneficial in the long run.
Katie (22:16):
Fabulous. So, our time is beginning to come to a close. We’re gonna move to our speed round but before we do I just want to ask you, I know that you’re a media expert on sleep, that you talk about this a lot, you obviously cover this with your patients, you have so many conversations on this topic. I would just love finally to hear from you, what do you think the biggest misconception is that people have about sleep, what do you want our listeners to leave with? The one thing that might help them get their Zs on in 2022?
Shelby (22:42):
There are two things actually, not just one. So, the first one is what I was talking about earlier, so if you have some physician and you’re in midlife and you have a physician who says to you, “Just deal with it you’re fine, it’s just part of getting older,” find a better doctor. You don’t have to accept poor sleep as you get older, that’s the first thing.
The second thing is that sleep hygiene, limiting the caffeine, exercise, worry control, all that stuff is really helpful but it’s not always enough. So, if that’s not enough, there are other really in-depth treatments like CBT for insomnia, seeing a sleep doctor just to make sure there’s nothing else going on like sleep apnea or thrashing at night that could impact your sleep. Try sleep hygiene as a first-line treatment, but if it’s not enough, then definitely see a doctor because there are really great evidence-based treatments out there, don’t suffer in silence.
Katie (23:36):
Fantastic advice. Don’t suffer in silence. That is what we should all be taking on. Thank you for sharing that, we’re gonna head into our quick speed round. This is just a one or two-word answer to complete the sentence. Are you ready?
Shelby (23:49):
Yes.
Katie (23:50):
Okay. Alarm clock or phone alarm?
Shelby (23:54):
Old school alarm clock.
Katie (23:55):
Nice. TV in the bedroom, yes or no?
Shelby (23:58):
No.
Katie (23:59):
No. Eye mask?
Shelby (24:02):
If you want.
Katie (24:03):
Okay. Best pillow type? Because there are so many; memory foam, down, buckwheat, down alternatives. Does pillow matter?
Shelby (24:11):
No. Whatever works for you.
Katie (24:12):
Okay. Best sleep position.
Shelby (24:15):
Whatever works for you.
Katie (24:16):
[laughs] I like these answers. Weighted blanket?
Shelby (24:23):
Helpful for some, need more data on it.
Katie (24:26):
Okay, and then finally, room temperature?
Shelby (24:31):
Upper sixties, though there’s a bit of a range. Try not to go about 72ºF.
Katie (24:36):
Perfect. I love these nuggets of wisdom.
Shelby before we say goodbye, how can our listeners find more about your work, your services and your sleep tips?
Shelby (24:46):
So, the first thing you can always, I have a book that’s The Women’s Guide to Overcoming Insomnia: Get a Good Night’s Sleep Without Relying on Medication. So, you can get that very easily online on Amazon. And that’s really helpful for people with insomnia. I also have an Instagram where I post almost daily, just random tips about sleep and that’s @sleepdocshelby. And I also have a website, which is just D-R like doctor, drshelbyharris.com. You can find me there, I have a practice in Westchester so I see a lot of people in New York City and New York state as well on Telehealth.
Katie (25:21):
Thank you, Dr. Harris, I will put all of that into the show notes.
This wraps A Certain Age, a show for women who are aging without apology. All January long we are featuring guests who have ideas for rebooting our systems, from sleep to goal setting, to faith, to relationships. Join us every Monday to get your ’22 on track.
Special thanks to Michael Mancini who composed and produced our theme music. See you next time and until then: age boldly, beauties.