The Truth About Hormones for Sleep, Sleep Disturbances, Melatonin & Perimenopause Sleep Problems | Dr. Jolene Brighten

Dr. Brighten: [00:00:00] Here's top six reasons you are not sleeping, especially if you are in perimenopause. Number one, progesterone decline, which is usually accompanied by anxiety

racing

thoughts, trouble falling asleep, or staying asleep. Number Number two is estrogen fluctuations. That can be tied to melatonin. and What we often see is night sweats as well.

You can't fall asleep. You can't stay asleep 'cause you're so hot and sweaty. Number three is cortisol spiking at night. Cortisol should only spike during the day,

yet it's spiking at night. We're gonna talk about why for sure. Number four is blood sugar crashes, especially those happening at that two to 3:00 AM window that's waking you up.

Number

five is histamine surges or hidden causes of inflammation. And the last one you have A DHD. welcome to the Dr. Brighten Show.

I'm

your host, Dr. Jolene Brighten. [00:01:00] This is going to be a two part episode where I'm breaking down the six reasons you are not sleeping, especially if you're in perimenopause or menopause, and exactly what to do about them. We're gonna talk about hormone shifts. We're gonna talk about stress.

We're gonna talk about A DHD. We're gonna talk about how your gut might be involved. And I'm gonna touch on hormone replacement therapy along with lifestyle changes and targeted support that I personally use and that I recommend for my patients. Now you're gonna wanna make sure you subscribe 'cause you are gonna want to catch part one and part two because all of these things are connected and you're gonna find tips that are gonna help you throughout this two part series on sleep. Now, before we jump in, I'd really appreciate if you could go and leave me a review wherever you're listening right now, you can go click those five stars. It means the world to me. It's a super easy way to support the work I do, and it can help women who [00:02:00] are searching for this information actually find

a

resource that can help them, that they can trust.

So with that said, let's jump in. Number one we're gonna go into is progesterone decline and the racing thoughts, anxiety and insomnia that follows. So the very first symptoms that we honestly see in perimenopause is not hot flashes.

It's

usually sleep disturbances that are happening before your period or worsening PMS.

Now, we typically will see perimenopause symptoms happening. Their onsets gonna be about age 35 to 45, somewhere in that range.

It's

usually the seven to 10 years

before

you go into menopause, but it could be like 15 years. That's totally

what

some women go through. I mean, some women only have perimenopause for a couple of years.

But what

I want you to understand is that any woman during her reproductive years can have progesterone issues. We're gonna talk specifically about how do you know if this is [00:03:00] you and you're having progesterone issues, that you can identify that.

But what I wanna explain is that if you have

acute

stress or chronic stress, the body can shift to cortisol production and it's in favor of cortisol production at the expense of progesterone production. And now we are having issues with our sleep, our PMS, maybe having even mood symptoms coming up.

I'll

definitely talk about solutions, I I wanna talk a little bit more about why progesterone's so important for sleep and give you more of the background information that we should have gotten when we were honestly in grammar school. So progesterone is our calming anti-anxiety hormone. If you caught my episode with Dr. Kerry Jones,

you

know how important it is in the A system. I'm gonna talk more about that. So

So progesterones only made following ovulation and by a structure called the corpus lium. So we need to ovulate. You need to know that

in

[00:04:00] your mid, late thirties, forties, ovulation may become sporadic, or that corpus lium might start failing, which means less progesterone production.

And that's sometimes even if your cycle appears normal.

And that's because low progesterone might look like you are spotting just a few days before your period, or you are having sleep trouble 2, 3, 5, 10 days sometimes before your period. Uh, it just depends on your phase of life and how bad your stress is and how poor that progesterone production is. But your period may be coming still in like a 27 day window or every 30 day window and look normal.

And here's the other thing that I think you should know about

being

in perimenopause, is that progesterone goes first.

Estrogen doesn't. And so you might have excess estrogen symptoms like irritability, feeling hot and [00:05:00] sweaty, uh, but

low

progesterone. And so you're not getting that calming effect. as as I mentioned, progesterone's involved with gaba. Progesterone gets metabolized to allopregnanolone that supports GABA in our brain. GABA helps us relax, fall asleep, chill out, not be so anxious, not have ruminating thoughts like brain shuts up. We like that. So as progesterone declines

often

before your cycle becomes irregular, if you're in perimenopause, you may notice anxiety, intrusive thoughts.

Um, your mental breaks are gone. And again, this is very common in perimenopause. If it's happening before perimenopause, that shouldn't be considered normal at all. Now, how do you know if this is you? How do you know if progesterone's your problem? You wake up feeling more anxious or irritable? The days and nights leading up to your period.

So It's usually within a five to seven day window before your period. It might just be a couple days before, but [00:06:00] like I said, it, it it could be a longer period

as

well. If you're having trouble

falling

asleep, staying asleep, waking feeling rested before your period, either when you're tired, looking at progesterone.

If you're exhausted because of this sleep issue, like the week before your period and you're like, I just can't get sleep. 'cause we usually need more sleep before our period. and that luteal phase then we're looking at progesterone and if you're luteal phase is shortening, your luteal phase should never be shorter than 10 days during your reproductive years.

If your period, how do you know? Well, your period's coming sooner. So if your period, it it was 28 days, uh, very few of us have 28 day cycles, but if it was 28 days and now it's like 24 days, something's up with your progesterone. Now if you're like, you know, in your forties, okay. We're probably in perimenopause, but if you're in your twenties,

absolutely

not.

We need to check in at what's going on. [00:07:00] I'll mention some things that can be a problem, uh, but I just wanna make it clear that the shortening of the period, the irregular periods in the perimenopause year is considered normal The sleepless nights are normal. If you don't have enough progesterone, that doesn't mean we just accept it, okay?

It doesn't mean that we're gonna be like, oh, I'm just not gonna sleep. And that's just how it is. But if you are not in your perimenopausal years, you're younger than age 35, and your cycle is shortening, your're, starting to have all these problems during that lal phase, like the PMS, the breast tenderness, the irritability, the insomnia, um, the anxiety, the racing thoughts like that is definitely not normal and we need to do something about it.

So let me get to the point. What can we do about it? 

So before we talk about hormone replacement therapy, we are gonna talk about that in this episode. I wanna talk about working with your body while your ovaries still have the capacity to

ovulate

and make hormones. You haven't , run out of eggs [00:08:00] yet. Okay. So there's three areas that we wanna address. If low progesterone is the problem, number one is manage stress.

Two is our sleep and light timing to support ovulation. And three is nutrients to support ovulation in the corpus luteum

so so

it can do its job. So So let's get into the three of these. So I wanna start with managing stress first.

Stress,

as I mentioned before, hijacks your body's resources and can suppress ovulation cause the body prioritize cortisol over progesterone production.

So we have to talk about managing stress if we we have chronic cortisol elevation. Then that can interfere with your brain's hormone signaling to your ovaries. And I want you to keep in mind, if you don't ovulate, you don't make any progesterone. It's the only way you're gonna make progesterone, which is why we don't have progesterone.

When we get into those late stage per menopause and we're at eggs, we can't ovulate anymore. Now, if you have something like primary [00:09:00] ovarian insufficiency or functional hypothalamic a amenorrhea, then you are not ovulating at an age younger than the perimenopause years, and that's a problem. We have to work on stress because we know with with functional, hypothalamic a amenorrhea, that's usually we don't eat enough.

We overexercise. We've gotta balance out that stressor in our life

with

primary ovarian insufficiency. We don't call it ovarian failure anymore. We used to call premature ovarian failure. We don't call it that anymore 'cause some women will spontaneously start ovulating again. But with that one, we don't know why.

That

There are women that have primary ovarian insufficiency, but do know that a small portion, it is linked to autoimmune disease. So

if

you are before age 45, you lose your period altogether. You need to know why 45 is is an acceptable age to be in menopause. 12 consecutive months [00:10:00] of no period.

You

are in menopause.

But before age 45, we need to know why and we need to address that. Now, want you to understand that some women, this will be normal for them based on their genetics, but but for the majority it's not normal. And there are doctors out there who are like, ah, you are 41, you must be in menopause. Hmm. We always wanna know why.

Because if it's something like an autoimmune disease, it's something like. Chronic stress, nutrient deficiencies, something going on. We want to address that. And we don't ever wanna be without our hormones before it is actually our time to be in menopause because we know based on the research, the research, especially in those who have ectomies, the removal of their ovaries, the younger they have that done, the higher the risk of dementia and Alzheimer's.

Like we, we don't [00:11:00] want to have these brain conditions. Okay, so going back to the sleep park, like right, you're like, I'm here just to hear about sleep.

So I talked about working on stress. I wanna give you some specific support strategies to implement. Firstly, we got the parasympathetic, the rest and digest of our nervous system and the sympathetic fight, freeze, runaway. Um, we wanna focus, so stress is all about that fighting side of things. We wanna focus on the parasympathetic walking breath work, creative hobbies, coloring.

We wanna do things daily to nurture the parasympathetic activity. Breath work is so tremendous for this. We also wanna make sure that we're getting enough calories that match our exercise output. Yes, you can be in a clerk deficit if you're trying to lose weight,

but

anything extreme and you may lose ovulatory function, progesterone production, uh, and your period altogether.

Something else I encourage my patients to do is to [00:12:00] eat foods rich in vitamin

C.

peppers, strawberries, citrus fruit, and foods rich in vitamin B five. So sweet potatoes, avocado, fish.

and

Consider bringing on things like adaptogenic herbs. If you're not familiar with adaptogenic herbs,

these

help you have a more regulated stress

response,

like not over the top freak out.

And if you're not familiar with these, let me give you some examples of ones I love. So when I I think about

energy having a good amount of energy, I think about Rhodiola and aeu. Occus. When I think about like soothing, chill out, don't overreact, react, asparagus, osmosis, and holy basal. Ashwagandha is one you probably have heard of.

It's

a really fantastic adaptogen. It really helps with energy, feeling calm, not feeling, uh, just overstimulated during the day. I like it personally,

both

during the day

and

in the

[00:13:00] evening. Um, just because of how it's very just like, hush cortisol, be cool cortisol. Now the other thing that I would encourage is sleep and light timing.

So inconsistent sleep late nights or just sitting in front of bright screens. That kinda light exposure can throw off your internal timing system and your hormones as well.

So

So if you caught the gut health episode, the gut hormone episode, we talked about clocks, we talked about your gut clock, um, we talked about circadian rhythm.

You probably are guess we were gonna talk about circadian rhythm today. And yes, that's important, but it's also important to understand that all of your organs have their own clock as well, like your

ovaries even have their own clock. Now, when it comes to sleep specifically, there's something called the SCN. It's the super charismatic nucleus in your brain. It's a master clock. It helps regulate sleep, uh, the whole sleep wake cycle altogether. It's also involved in some of [00:14:00] our hormonal rhythms, and it's, I think, super important to understand that your light exposure can disrupt How the brain is orchestrating the hormones it secretes, even like LH and FSH, which are key hormones needed for ovulation and progesterone production. After we we ovulate, LH is gonna pulse to keep that corpus lium going so that we produce progesterone. So if we have a disruption in our circadian rhythms that can alter the hormonal cascade.

It can contribute to anovulatory cycles if the disruption is really bad. Um, or even luteal phase defects. So that's when we have less than 10 days of the, of the luteal phase. I was talking about that before, the short luteal phase. And And so that's

a

low progesterone phase, right? When it When should be a high extended progesterone phase.

So if we're getting artificial light at night, like exposure to our [00:15:00] screens, um, like our phones,

our

television, that can disrupt melatonin production, melatonin's involved in our reproductive health. In fact, it's an antioxidant that protects our ovaries, so we don't want to mess with our melatonin. Yes, it helps us go to sleep at night, but it's also very protective of ourselves against free radicals.

So. If you are exposing yourself to light, and that's disrupting melatonin, keep in mind that can disrupt your brain. Hormones, orchestrating ovulation and hormone production, we see this most notably in night shift work. So women who have night shift work or, you know, ja lag or erratic sleep schedules, there's a higher prevalence of anovulatory cycles.

That means lack of ovulation, uh, short luteal phases, and we even see infertility can be an issue. Do If you have a short luteal phase, that's gonna gonna lead to [00:16:00] infertility because fertilization happens in the fallopian tubes. Then once egg and spur meets, it rapidly dividing cells, at that little bowl of cells goes, dividing, dividing, dividing, dividing, becomes an embryo.

And then lands in

uterus, and it's gonna land there sometimes around like day eight, day nine, after ovulation. And if by day 10 your corpus lithium is failing, there's no time there for implantation for beta HCG to rise and to signal to the ovary.

Keep

going with progesterone. So if you've been struggling with cycles where the luteal phase is less than 10 days and trouble conceiving, look at what's going on with your progesterone.

Start to implement some of these things. Okay, tangent from the sleep stuff. Let me ring it back to sleep support. Now if you want to test your progesterone to know for sure, like progesterone's an issue for you, you can test five [00:17:00] to seven days following ovulation. On a 28 day cycle, we say Diet eight 19 to 21, and and you can see if your progesterone's insufficient. That could be what is leading to your sleep problems. So to support natural progesterone production, we wanna prioritize a regular wake time, get 10 to 20 minutes of sunlight within an hour of waking, avoid bright screens at 9:00 PM or wear blue light blocking glasses.

And this is all to work with the circadian rhythm that will affect your ovaries in producing progesterone. Now the third thing we can do for progesterone support is to look at our nutrient intake key nutrients that we wanna look at. Zinc. That's gonna support your FSH

LH

production from the brain ovulation corpus odium function.

And it's also important for progesterone receptor sensitivity. So when the hormone's [00:18:00] secreted, it's got a doc on cells. So we wanna support the receptors that are on the cells. Vitamin B six. You may have heard me talk about this one before. It's fantastic. Supports progesterone synthesis. B six deficiency is actually associated with a shorter luteal phase.

So if you're that person having less than 10 days, um, or you're someone who's having PMS symptoms, look at vitamin B six. Magnesium. When do we never love magnesium? It's always, we always love magnesium. Magnesium can help with calming our nervous system, so it can help on the cortisol stress side of things.

And it's also needed for hormone metabolism. So if we wanna lower our cortisol fast, we wanna be looking at.

Quality

sleep, adaptogenic herbs, bringing in magnesium, and if we wanna get those progesterone levels up, everything I just talked about. And then also maybe considering Vitex and Vitex is thought to

act

[00:19:00] on the brain to support that LH production so that when the corpus, lutetium ovulates, it's like, keep going, make our progesterone.

So those are the key things I would look at for helping with the progesterone aspect of why we're not getting enough sleep. I know I mentioned supplements, my adrenal support and my women's,

uh,

hormone balance supplement. Um, there's actually a period problems kit altogether. I will link at the show notes if you want to purchase those.

Great. I'll give you a 15% off if you don't

use

the label as a guide on what to look for in terms of dosages. Uh, Uh, the last thing I'll mention too, while I'm thinking about supplements is my acetol. We often use that to, especially for women with PCOS who have anovulatory or regular ovulation. We will often use my acetol for ovarian function, for ovulation support, for insulin resistance, [00:20:00] uh, but it also can help with sleep.

So

my

acetol

is another one to consider, and it's a nice stack if you're having ovulatory issues and sleep issues to be like, let me just add this on to everything that I'm doing in terms of my lifestyle, and of course your diet. and if you're wondering what foods to eat to support progesterone, we wanna focus on mineral rich whole foods. Um, seeds. You can use it as part of seed cycling, leafy greens, lentils, liver, or you can consider a liver supplement. Um, I also, if you want a style of eating that is gonna support you, uh, in optimizing your hormones and is anti-inflammatory, dr Brighten.com/plan, it's free.

There's no liver in the plan, just so in case you're worried, but but there is a ton of tasty food to support your

hormones.

Now let's talk about the progesterone, HRT. If you've been tracking your cycle [00:21:00] and you're working on lifestyle strategies, you're still struggling with sleep anxiety, PMS, you're over age 35, this might be a good time to consider bioidentical progesterone.

Now, as long as your arteries are working, I love doing all the natural stuff, but sometimes using

oral

micronized progesterone, which we take at night, can be super helpful as because it has those sedative effects and it

will

affect the GABA pathways in the brain. Not topical, not progestin, oral bioidentical progesterone.

So this is especially helpful for women who are in perimenopause. Um, if they're still cycling

but

they ovulate inconsistently or they're just, their corpus lium is just not doing its job. And, And, uh, if you're still cycling, it can be used cyclically like 10 to 14 days, uh, per month to mimic your natural rhythms in your period if that's still present.

But if you're not cycling, then you can just take it every day. There's no [00:22:00] reason

if if

you're no longer having periods only only do it for half the month. So when would you consider using this? You're skipping periods. You are not ovulating consistently. PMS is insane. It is just off the chain and it's really interfering with your life.

You're You're having significant anxiety. I, you know, if that anxiety is happening in the weeks before your period. I would consider progesterone over anti-anxiety medication because it is effective. An anxiety medication isn't gonna be effective if progesterone is your problem. It might take the edge off, but we gotta address like what is actually going on.

If you've ruled out other causes of sleep disruption, natural support hasn't moved the needle, then we wanna consider using progesterone hormone replacement therapy. And while I'm going over like these six reasons, people are not sleeping, I just wanna remind you, sleep [00:23:00] apnea is real. Not getting enough oxygen to your brain while you sleep is bad for your health.

And that's a good reason to consider a sleep study. Remember, I'm a doctor, I'm not your doctor. And we may need to rule out other things. And if we've ruled out all of those things and it's like, yeah, no, it's just happening before my period, or I'm in perimenopause, I'm not sleeping anymore. Let's look at at, let's look at that progesterone hormone replacement therapy. Okay,

so we're gonna go into number two reason why you're not sleeping now, which is the estrogen fluctuations that impact sleep. So estrogen fluctuations are actually often tied with night sweats, hot flashes. Um, Um, and so like, maybe we should talk about

how

to know if this is the issue affecting you first.

So Okay, let's go to the number two reason why you might not be sleeping, which is estrogen fluctuations. Those impact sleep. A lot of times because we're too hot to sleep, we're sweating, we've got night sweats, we've got hot flushes, but estrogen's also tied to melatonin. So So here's what we're gonna cover in this section.

How to know if this is an issue.

We'll

definitely talk about when to consider using hormone replacement therapy or menopause hormone therapy. And we're gonna do a deep dive into natural approaches,

non

estrogen [00:24:00] alternatives that support estrogen balance and symptom relief. So if you're not a candidate for hormone replacement therapy or you are just not wanting it, let's, we'll talk about some other options.

And by the way, menopause hormone therapy, that's used in, mes term we use in menopausal women. the And the reason is because we're not trying to replace it to the levels. They were

pre

menopause. But hormone replacement therapy, I often use that term because as many times as I say menopause hormone therapy, people are always like, oh, do you mean hormone replacement therapy?

Like, yeah, we, same, same. But with hormone replacement therapy. Um, I mean you can call it either or, but with hormone replacement therapy

in

medicine, we often think of that before a menopause because we are trying to replace hormones to the levels they should be if you're post menopause, menopause hormone therapy.

But guess what? We're using all the same stuff. We're using all the same stuff. Anyhow, okay, let's get get into the sleep. so why does estrogen [00:25:00] fluctuating disrupt your sleep? So the thing to know about estrogen is it plays a major role in regulating your core body temperature, but also neurotransmitters like serotonin. And in other episodes we've talked about dopamine, acetylcholine, and all those things. Uh, but it's also interacting with melatonin.

All All of these are critical for deep, stable sleep. So actually going to sleep. And that's the thing. Sleep isn't just about being in bed for eight hours. Sleep is about waking up, feeling rested and restored, getting the right quality sleep.

Now postpartum. We definitely have trouble with estrogen. I mean, if you've ever had a baby and you start sweating, that can also be disrupting our sleep And perimenopause. Estrogen doesn't just

gradually

decline. That'd be super sweet, but it doesn't.

It

spikes, it crashes and it does it all unpredictably, and that creates temperature dysregulation.

It also creates mood instability, [00:26:00] and it can disrupt your circadian rhythm. I think it's really important to understand if you have functional hypothalamic AM amenorrhea, actually, if you're heading into functional hypothalamic am amenorrhea, you're undereating, over training. You could start having these hot flashes, night sweats as well. So with estrogen, fluctuating night sweats, early waking, fragmented sleep. You

may

even try to like fall asleep and maybe go to sleep easily, but you don't stay asleep and you're waking up a lot. These things are all par for the course, so how do you know if this is you?

If you're waking up hot, drenched in sweat, sheets are wet. Even if the room is cool, even if you've got the best pajamas in the world, you probably have estrogen problems. If you're noticing new mood swings,

vaginal

dryness, more fine lines, wrinkles, droopy breast, like breasts start to sag, that can signal to low

estrogen

issues.

If your sleep has [00:27:00] gotten worse after you've missed a period, or your cycle is having changes, start looking looking at estrogen. And if you notice, um, like brain fog, new anxiety and uh, mood swings happening again, anxiety can be related to progesterone, but that's usually happening just before our period. If anxiety is kind of consistent overall, that that could be estrogen.

So when should we

consider estrogen hormone replacement therapy? If your symptoms are severe, then I would definitely recommend talking to your doctor about a low dose topical or transdermal

estrogen.

'cause it can be like seriously a game changer for your sleep, like for for your sleep. for Hot flashes, for night sweats, for brain fog.

Um, and when I say transdermal estrogen patches, gels cream, these things that bypass the liver mimic your body's own estrogen. We don't have to worry about the clot risk as much like we do [00:28:00] with like the birth control pill. It is different than the birth control pill. It's a lower dose than what we would use in the birth control pill.

The other thing about, um, estrogen is that it can help with that thermo regulation, so it can stabilize your body temperature. And in addition to that, it's gonna support serotonin and melatonins. We're gonna have better mood, better sleep. Um, if if you don't know, the conversion goes serotonin to melatonins, you make serotonin, then you make melatonin from that.

And I would also say that if you are going to use estrogen, consider using it with oral micronized progesterone. If you have a uterus, if you have a history of endometriosis, if you're just like, I wanna feel less anxious

and

sleep.

And

What a lot of patients that I use estrogen would say is that their early morning , waking

gets a lot better. So no longer waking at like four or five, six, maybe you have to wake at six, but

they're

not waking up before [00:29:00] its time. A lot of women experience more mood

stability

when they're taking

estrogen.

if you if you have mood instability like before your hormones dip,

uh, in your cycle, or

know,

Perhaps, what you're finding is that your cycles have become irregular and now your mood's more unstable. Good time to start looking at estrogen.

Well, Let's also talk about natural strategies that support estrogen, imbalance and sleep. So whether or not you're a candidate for hormone therapy or you just wanna explore natural options, first I wanna talk through

how

to work with your body to ease the estrogen related symptoms, but with the caveat that this is only while your ovary is still in the capacity to make estrogen.

So we want to look at supporting our estrogen metabolism through our liver and our gut estrogen's. Cleared first through the liver, phase one and two, detox, then through the gut via the estrobolome. [00:30:00] If you're having poor clearance through the liver or you have dysbiosis we talked about in the gut, um, hormone episode, then we can start to have a dysregulated estrogen.

Then we start having night sweats and we start having sleep issues. So how can we support. that? We can eat cruciferous vegetables, cooked , cruciferous vegetables, making sure we're getting plenty of fiber. If you grab that drBrighten.com/plan meal plan, you're gonna get plenty of fiber and we wanna make sure that we're hydrating every day.

Now, the goal isn't to drop estrogen, , super

fast

or to be try to push clearance through the liver. It's just to support what your body

does

naturally. As I talked about in the gut health episode, calcium deep glucarate is another one that helps with both the liver and the gut

with

clearing estrogen. And we we might wanna consider probiotics to support the estrobolome that will help [00:31:00] lower the reabsorption of estrogen in the gut.

Necessarily it's going to cause you not to reabsorb estrogen,

but

it's going to help your body modulate it more appropriately. We do want some reabsorption, especially in late phase perimenopause and menopause. So if we make estrogen, we do wanna reabsorb some of that if we're getting low on it. supporting your your stroum, your your gut health, your detox pathways, definitely important.

We also want to promote serotonin and melatonin. Naturally. Estrogen is gonna support serotonin production, and as I said, serotonin is converted to melatonin at night. When your

your estrogen

drops, you're gonna make less serotonin, you're gonna make less melatonin, you're going to struggle to sleep. So how can we support all that?

Back to magnesium again, definitely great. But vitamin B six helps here as well. So magnesium vitamin B six gonna help if your stress, gonna help your progesterone. Also going to help here in supporting your

[00:32:00] serotonin.

And with that, I would say you want magnesium glycinate. ' cause that glycinate molecule is going to further promote sleep.

The other thing you can do is eat tryptophan rich foods, pumpkin seeds, Turkey, we all know about that one, right? If you're eating that at dinner, that is a building block for serotonin, then you're gonna convert that into melatonin. And then again, I'm I say this so many times, reduce bright light and light at night.

Um, we wanna aim for morning sunlight, but dim ever all the lights in the evening.

I I

even have my patients who struggle with sleep go by candlelight like once a week and they're like, I got the best sleep. Plus it was just like super fun. Like some people are like, it was romantic. Other people are like, it was like I was camping.

Either way worth a try. Now I talked a bit about supporting your nervous system in the progesterone section, but I wanna say again

that that we gotta support the, um, nervous system, but also thermo [00:33:00] regulation. So estrogen helps with our nervous system modulation and resiliency to stress. and helps with inflammation as well.

And without it, we are prone to mood issues, to sleep fragmentation, heat dysregulation, getting overheated at 

so before bed, I would

recommend

deep breathing or somatic exercises to help you unwind before bed. you're on YouTube right now, after you watch this video, look up somatic exercises. Keep your environment cool, is a must. Lightweight sheets, fans, air conditioners, cooling, mattress pad, uh, whatever it takes, try to make that room as cool as possible and yourself as cool as possible.

I would also say, you know, considering things like passion flower, uh, l-Theanine at night, this can help promote more deep. Restful sleep. That's something that you'll find in my adrenal calm [email protected]. [00:34:00] Go ahead. You can buy that one or you can check out what's on the label.

No

pressure ever to buy my stuff.

Okay. Now, when it comes to melatonin, melatonin can can be helpful orally for, helping you fall asleep if you've got jet lag,

circadian

rhythm, that's like misaligned. But I just wanna caution you in using melatonin because for some women it can make them groggy. It can worsen their mood, and higher dose is not better.

So we usually look at like 0.3 to one milligrams because that's often more effective than higher dosages. We sometimes use higher dosages if you have endometriosis, if you are going through fertility treatments, you have infertility, um, you have like chronic inflammation from a chronic condition. But But for sleep, we wanna use that lower dose.

Now there are herbal alternatives to estrogen, but I'm gonna tell you they don't work as well as hormone replacement therapy. But if you can't [00:35:00] or you don't wanna use hormone replacement therapy, certain herbs have been shown to help modulate estrogen

receptors and

ease symptoms. So, black cohosh that can help, uh, with reducing hot flashes in some women.

We talked about

Rola before.

That's gonna support your hypothalamic pituitary adrenal access, the HPA access that can help with improving mood and energy.

some women would

find red clover helpful. It does contain phytoestrogens that may support vasomotor symptoms like the hot flashes for some women.

But I just want you to understand like these herbs are not one size fits all. Not all herbs are safe for everyone, especially if you have hormone sensitive conditions, you always wanna check with your provider. And you can also talk to your provider about other medications that might help with sleep.

So if you're like, I'm trying all these things, but I just really need to get sleep, sometimes there's, you know, people are opting for short term of low dose [00:36:00] SSRIs, um, or they are, you know, reaching for sleep medications in the short term. I, I personally always wanna try to optimize sleep naturally because that has no side effects.

But But in some cases, sleep gets so bad that you do need to bring on like what we call like the big guns in medicine. And I don't want you to feel ashamed or like a failure because you've tried everything and it's not working and sometimes. We use sleep medications while we get

HRT

working as well, and then we're able to come off those things.

So again, no one size fits all. You got to do what is best for you and what works best for you.

The last part of this episode is gonna be all about

cortisol, and we're gonna

talk about how to lower cortisol or at least get it regulated. So Cortisol your main stress hormone if you don't know, but you probably know why now. And

I

wanna talk to you about why it might be waking you up in the middle of the night [00:37:00] and exactly what you can do about it.

So

this can happen at any stage of your life. What we see if you're in perimenopause is declining estrogen, progesterone. They remove some of the natural buffering against stress

hormones like

cortisol, uh, and, just like they help with our stress response. So if you're, um, postpartum, this could be happening to you as well.

If you you have a really

stressful

job, if you have had a major life event, uh, that can be disrupting your cortisol as well. So.

Yeah. I just want you to also understand that if you're in a phase of life where you don't have your estrogen and progesterone and then you add chronic stress or like over exercising or undereating,

you

can flip the natural rhythm

And

instead of being calm at night and alert in the morning, your your cortisol spikes at night when it should be low, and then you're up and you're like, what's going on here? So when cortisol spikes in the [00:38:00] evening, it's gonna disrupt sleep, raise our blood sugar,

and

it's putting your nervous system in a fight or flight

state

That sympathetic that we talked about before. So So how do you know if cortisol is your problem? You feel tired during the day, you're wired

at

night.

You have the classic wired and tired feeling where Your brain is amped up, but your body is exhausted when your head's on the pillow. If you're waking up the same time every night and your thoughts are racing and you're feeling like anxious or in a panic, that could be related to cortisol.

But But you know, what we often see with cortisol is you're having trouble shutting down in the evening. Even with the best sleep hygiene, you're just not getting to bedtime and you just, you get to bedtime, but you're like, I just can't fall asleep.

If If you wake up with morning headaches, that might also be a sign that you have HPA [00:39:00] access dysregulation,, hypothalamic pituitary adrenal access dysregulation.

So what can you do? Anchor your circadian rhythm with consistent wake times and morning

sunlight. So

waking within the same hour, like is it 6:00 AM? Is it 7:00 AM about the same time even on weekends? Get the morning sunlight. Consider

the

calming adaptogens like ashwagandha that I talked about before.

And

even nutrients like phosphatidylserine. Phosphatidylserine can help with modulating and bringing down that amine cortisol, if your mind is racing L-theanine, if you've got the low progesterone issues, bring in the passion flower, like get that like sleep cocktail going, but it's more than just taking supplements, right?

You also need to create a

screen free

wind down routine and give signals that your nervous system is safe, that your body is safe. [00:40:00] So it's not just about sleep hygiene,

it's it's

about giving your adrenal glands a rhythm and a routine that they can trust because disrupted circadian rhythm, really these disrupted routines, they can be a type of stress.

So

So let's go through a routine. 'cause I think that would be helpful. And you can let me know, are you doing this routine already? I'd love to hear it in the comments. Are you already doing this routine? Do you have something similar? Are you gonna try this out?

Have you try it out, tell me how it works.

 So when you wake up in the morning, we, within 30 minutes of waking, we want to get morning sunlight and start

fueling our body. Your body needs to get the signal. The day is started and that means fueling not

fasting. So we want you to eat a protein-rich breakfast within 30 minutes of waking

if

possible.

This going to prevent a cortisol spike because your cortisol will spike when your blood sugar starts to [00:41:00] get low. So we wanna aim, but you know, maybe it's not 30 grams, at least 20 grams, but so let's say aim 20 to 30 grams of protein eggs, squeak yogurt, protein shake leftovers for dinner.

If you heard my episode, Liz Wolf,

she

does protein powder into orange juice. Which vitamin C baby that's gonna support your adrenal glands. Why do I want you to avoid fasting? Okay, Okay. fasting when you have adrenal issues. Is going to push your body into stress mode. Fasting

is

a form of stress. It's a good stress done at the right time.

But

if you're already having cortisol problems without fuel, your body is going to rely on cortisol to raise your blood sugar. So

your cortisol is gonna come up, your stress hormones are gonna come up. It's gonna tell your liver, give it up baby, gimme some sugar into my bloodstream.

And And that is gonna make the very problem you are trying to fix so much worse.

If you are taking [00:42:00] adaptogenic herbs, you're taking something like My adrenal support, you're taking B vitamins, you are going to do that first thing in the morning

after

breakfast.

Okay?

So why say that is especially anything with B vitamins? That can cause an upset stomach. I am someone, so I take adrenal support and be active.

Plus in the morning if I don't have food in my stomach, I am

so

sick and I'll be in like a 10:00 AM meeting and I'm like, why do I feel like I'm gonna throw up B vitamins now? Um, you know, I love a B complex like the B active plus, but if you're like, what are like the two B vitamins? If you had to pick two, I would say B five and B six support the adrenal glands.

And B six is going to help with that conversion of getting into melatonin. It's gonna help with your progesterone. So if I only had to pick two, that would be two. But B vitamins work together in a lot of processes, so that's why I prefer to be [00:43:00] complex. Okay, so. We're doing the wake up,

we

eat food, we take our supplements, and then maybe that's when you get your morning sunlight.

If you wanna drink coffee out in the sunshine, do it. If you wanna go outside for a 10 to 20 minute walk, no glasses on in the first hour of waking, do that. that. But we we need to be getting

sunlight

and food to tell the brain and the adrenal glands and our entire hormonal system like this is the time that we are awake.

Now, following, um, eating, that's when you want to do an exercise. So maybe you're doing that midday, maybe you're doing it in the morning. You wanna move your body earlier in the day though. Strength training, moderate cardio, get it all in before 2:00 PM that again, we wanna support the healthy cortisol cycling.

Um, definitely avoid intense workouts before bed. If you're struggling to sleep, like if you're someone who like gets off of work and then you do an intense workout at [00:44:00] 7:00 PM and you're not sleeping, you you might wanna just check that one and maybe you wanna do yoga. Mobility exercises are great at any age.

It's a great thing to do before bed. So if you do need mo movement at the end of the day, keep it more gentle. Now, throughout your day, eat regular meals, protein, fiber, fat. No skipping lunch? No. Just having coffee. No, just having a donut.

I

know I hate on the donuts all the time. Donuts are good, but they're not good on their own.

If you're having issues with cortisol, because

if

you destabilize your blood sugar, you will destabilize your like stress response and your cortisol health. So steady blood sugar, steady cortisol, we love that. So. So In the evening, this is where you wanna start focusing on winding down. And we want to eat a good dinner, so eat dinner on time and don't graze afterwards.

We wanna finish our last meal within [00:45:00] two to three hours before bed because that can disrupt sleep if we eat too close to bed. And we wanna make sure that dinner is structured to

have

things like sweet potatoes, rice, quinoa, like carbs that support serotonin in a calm brain. It doesn't have to be a whole lot.

It

can be a small amount. And then we wanna have that protein and we wanna have fiber rich food as well. Now in the evening, like dinner

or

a few hours before dinner, this is when you might wanna take your phosphatidyl, searing, your ashwagandha, your altheine, your passion flower, all those things that we have talked about.

I generally, personally, I like to take it, I take my adrenal calm about an hour before bed and then I like to get in bed and read. It works for me. I can fall asleep. Um, you, if you follow me online, you know I read romantic and I laugh because I'm like, I will get to a spicy scene and I'll be [00:46:00] totally nodding off.

I'm like, clearly this does not do it for me. Anyhow, so you wanna take, even, make sure you take your supplements and then again you can do your like, gentle

yoga

journaling. Maybe do legs up the wall. That's so great at the end of the day for your nervous system. Try to do to do five minutes of deep breathing if you can.

And then, you know, maybe it's like doing a puzzle reading, like things that just start to calm your nervous system and get you in the rhythm for sleep. The goal in the evening is to cue safety. It's to signal a certain nervous system that like, get vulnerable, baby. It's okay. You're safe. Go to sleep. And then, uh, about an hour, within an hour of bed.

this

is where we wanna start dimming the lights. If If you're gonna watch tv, nothing that amps you up. Wear blue light blocking glasses, or, you know, if you're on your phone, have the tinted apps.

So, ideally after 8:00 PM but if it's, but most people, most of my [00:47:00] patients are like, I can do this within an hour.

So within an hour,

ideally

before eight. But choice choice is yours now, for bedtime, ideally we wanna go to bed between 9 30, 10 30 pm We wanna be in bed before our second when hits. If you've ever had adrenal issues, you know what I'm talking about. Let me say this. If you're a parent and your child has ever been tired, but then you miss an nap window and then they seem manic.

They seem just outrageous. Over the top. They're emotionally breaking down. that, that second wind of cortisol coming on.

We We are perpetual toddlers. Okay? Toddlers wanna go to bed. They don't want the bedtime routine. And like adults do the same thing.

Toddlers get a second wind, adults get a second wind as well.

So if your body's starting to feel tired, go to sleep. I don't care if there's laundry. People can wear wrinkle clothes. Okay, [00:48:00] go to sleep. Because if you've got cortisol problems and you delay that, you're gonna get a second wind. The body's gonna be like, oh, I thought, I thought we were going to bed. We're not going to bed.

Spike the cortisol. And then you're like, oh, but my body's so tired. And then, and you can feel weepy like and the but your cortisol cortisol's like off the chain.

Um,

and again, as we talked about, like those progesterone and those estrogen issues, stress can be at the root of that.

So

By skipping your sleep, you're gonna cause more hormone problems in the future.

I hate to be the one to tell you that now humans do better with a cool, dark, quiet room. Sometimes we need noise

machines,

like noise canceling machines, um, like white noise. That's what I'm trying to say. Uh, and sometimes you gotta run the ac Sometimes you sleep with only a sheet on,

uh,

and then you just gotta be dark. Wear an eye mask if you can't keep your room dark.

Now, the thing that I didn't mention, I should have [00:49:00] mentioned is that, uh, magnesium, I, I had said magnesium glycinate before that one. Taking at dinner or taking like within an hour of bed.

A lot of people don't have tummy troubles when they take

my tummy

troubles. I have such a mom, but a lot of people don't have issues uh, with magnesium on an empty stomach.

So it is just about what's true for you, what works for you. But I realize I didn't mention the magnesium.

So in summary of our like adrenal supported day for

better

sleep, I want you to know you don't fix cortisol with a single supplement.

You

You do it actually by living in rhythm every day, eating consistently every day, waking with the light, moving wisely, winding down with intention and if you're gonna supplement, supplementing at the right times

with the

right supplements to fit your needs.

But I don't ever want anyone to think I can just outs supplement a poor diet lifestyle. 'cause you can't Now that you have listened to this episode, you understand how progesterone, estrogen, and cortisol all [00:50:00] impact your your sleep. And you've got some things to do, some homework, if you will. Not unlike somewhere, but some tools to help you sleep.

You've

got a great foundation honestly, to start making changes

to

really work with your hormones.

And And listen,

I do get asked all the time, if there was just one supplement you'd recommend for sleep, what would it be? 'cause I know I list it off a ton. It would be magnesium, hands down, specifically magnesium glycinate. Not just because it's gonna support melatonin, it's gonna support healthy neurotransmitters, but it's also calming the nervous system.

It supports with hormone metabolism. It's gonna help your adrenal glands function. Really overall magnesium is one we can all benefit from. So if you, I just wanna say that because

if

you did feel overwhelmed in this episode, mag Magnesium would be the one.

Okay, so

this

is just the beginning of you starting to understand the sleep puzzle.

Like

what is going on with your sleep [00:51:00] in part two.

I'm gonna be sharing three commonly

overlooked,

but very real reasons you still might not be sleeping. We are gonna talk about blood sugar crashes at night, exactly what to do about that histamine surges that literally nobody is talking about, but is such a problem for women who are dealing with high

estrogen,

uh, poor estrogen clearance neurodivergent women, women with PMDD.

And then we're also going to talk about what happens

when

you have a DHD and Neurodivergence in the mix. So definitely make sure you follow, you subscribe to the show. You don't, you definitely don't wanna miss this next episode.

And

if

this episode you're listening to right now helped you. Please take a moment to leave a review.

It's the best way to help other women discover this information

And

leaving your review shows me tremendous support and I'm super grateful for it. It makes me feel, [00:52:00] um, amazing because me and my team do work really hard to bring you the best information. So thank you so much

for

being here. Please let me know if this information has helped you, and I will see you in part two.

Thank you so much for joining the conversation. If you could like, subscribe or leave a review, it helps me so much in getting this information out to everyone who needs it. If you enjoyed this conversation, then I definitely want you to check out this.