6 Common Sleep Questions From Midlife Women Answered by an Expert Sleep Physician   

January 5, 2023

Valerie Cacho MD

Why can’t I stay asleep? Do sleep supplements help? A quick Google search will lead you down a rabbit hole of information, some of which may not even be backed up by a professional! It may plant a seed of worry or confusion — and that too can also disrupt your sleep cycle. 

As a holistic, integrative sleep doctor, it’s my life’s mission and passion to educate people how to get better sleep and live better overall. I believe that by helping you uncover the root of your sleep problems and providing you with the right tools, your overall quality of sleep will be better in the long run. 

So, I made a list of the most common questions I get from my clients and I asked you all on Instagram to submit your sleep quandaries as well. We tackled a bunch of topics from sleep supplements and sleep paralysis to hacks for falling back asleep. 

Don’t forget to sign up for my newsletter, there’s a lot of cool things coming up. I’ll be hosting live monthly sleep and health webinars. And if you aren’t following Sleephoria on Pinterest already, come give us a follow! Our account is @sleephoria and our boards are packed with great visuals about sleep and women’s health. 

Without further ado, let’s answer your sleep questions! 

Is melatonin safe for long term use?

Dr. Val: It’s a very good question and my question in return is: Why are you taking melatonin? Are you masking a potential underlying medical sleep condition that can be causing poor sleep? As far as we know in the kids population, melatonin is safe. As we get older, about age 55, we have decreased melatonin from our pineal gland, but the question always is why do you need it. 

Oftentimes as women go through perimenopause and menopause, some of the reasons why we have trouble sleeping is because of hormones. However, hot flashes can cause sleep disturbances as well. Studies have shown that taking 3 milligrams of melatonin for 3 months during perimenopause can be helpful for those with insomnia.

I sleep X-amount. Is that enough sleep?

Well, what does enough sleep mean and what are you worried about? Some people are often worried about their brain health. I like to think of a whole pie when we talk about brain health. Sleep is a big chunk, but it’s not the only chunk. 

Something to keep in mind when you’re asking how much sleep do I need versus how much sleep is enough is to pay attention to how you feel during the daytime. Are you needing to have 2, 3, or 4 cups of coffee and it’s not even 10 AM yet, right? Are you falling asleep in your meetings? Are you needing to take a nap? Is it taking you longer to read an email? Those are some signs that you probably do need to have an increased amount of sleep. 

On average, researchers suggest 7 to 9 hours for most adults. For cardiovascular prevention — meaning, reducing the risk of heart attacks and high blood pressure — getting at least 6 hours is what research shows most helpful. 

The question that remains is what is keeping you from getting an adequate amount of sleep? We’ve all got 24 hours in a day, what are you prioritizing? This comes to my number one tip: Prioritize your sleep. If you really want to get better sleep, then make it be at the top of your list. 

What do I do for my busy mind? I feel physically exhausted and tired, but my mind won’t shut off.

What is keeping your mind busy? Are you taking enough time for yourself during the daytime to slow down, to pause, to hit the reset button? A really great exercise is to write down all your thoughts. We call this a thought download. All the things that are swirling around in your brain, just jot it all down. Sometimes I invite people to set a timer even if it’s for two minutes to get everything out there. It makes you feel so much better and the more regularly you practice this, the easier it gets. 

Is there a common theme with those thoughts? Maybe you’re worried about or dreading work. Maybe that’s a sign to take a look at the work you’re doing. Is it still meaningful? Is it still giving you purpose? Because that can actually contribute to some of our difficulties with sleeping, especially if you’re getting Sunday scaries.

Sleep is controlled by the brain. So, there is an overlap between sleep and our thoughts, emotions, and behaviors. I know that “self-care” is such a buzzword, but it is important to take care of yourself. 

Is sleep paralysis a real sleep issue?

Yes, it’s a condition in which you wake up and your body can’t move, it’s paralyzed. It typically only lasts a couple seconds. It can be a normal phenomenon or it can be a symptom or sign of sleep deprivation or narcolepsy. Narcolepsy is something we see more commonly. 

When our bodies go into REM sleep, our brains are very active and we can have very vivid dreams. Sleep paralysis is a protecting mechanism for our skeleton muscles to be paralyzed so we don’t act out our dreams. 

Sometimes for folks who are sleep deprived or have narcolepsy, you go in and out of REM and as you’re waking up from or going into REM, your brain is still cognizant but your body is already asleep. That’s really what paralysis is. 

What are your thoughts on sleep supplements?

Supplements can be beneficial. One of the common things I say to people is that sleep happens when your brain waves slow down. Supplements can help by relaxing your nervous system. There are a lot of herbal formulations that can help, several sleep promoting teas have a combination of chamomile, passionflower, valerian root, or lavender which can make you feel drowsy. The caution I have with supplements or teas is that if you drink too much fluids right before going to bed, you’ll have to wake up and urinate. I encourage people to use them as helpers, but not the long term solution. The long term solution is always looking at why you’re having a hard time slowing down or relaxing your body or mind and address those issues. 

I can’t stay asleep. What should I do? How can I fall back asleep?

Well, what is keeping you from staying asleep? As we go through perimenopause and menopause, hot flashes are a big sleep disruptor, another one is mood changes. Drops in blood sugar levels could play a role in waking you up in the middle of the night depending on when you eat, which can be a side effect of intermittent fasting. If you ate a lot in the morning but not so much in the evening or night, you may be waking up in the early morning because your low glucose levels are telling your brain to get out of bed and eat.

If you are concerned about feeling exhausted during the day and think the quality of your sleep is to blame, it’s good to talk to a physician about your symptoms. Women in mid-life can have undiagnosed obstructive sleep apnea, a medical sleep condition when the muscles of the upper airway relax at night, which leads to nighttime awakenings. This condition is easily detected from a sleep apnea test. Obstructive sleep apnea is undiagnosed in many populations, but more so women.

What to do if you can’t fall back asleep? One of my biggest recommendations (and this is part of sleep hygiene) is just get out of bed because you don’t want to associate any frustrations, negative energies, or tossing and turning with your bed. You want your bed to be a calm, inviting place just for sleep. So if you wait there for hours hoping and wishing for sleep to come, it doesn’t necessarily work that way. Stay out of bed until you start feeling sleepy again. Notice those sleepiness cues — eyes getting heavy, starting to yawn, and muscles feeling heavy — and then go back to bed. 

My favorite saying is if you’re going to the kitchen, what are you going to do? You’re going to cook and eat. If you’re going to the gym, you’re going to lift some weights and exercise. If you see your bed, you’re going to want to sleep. 

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