August 7, 2025 • 45 mins
Join the hilarious and insightful trio of Dr. Aoife O’Sullivan (MD, MSCP), Dr. Christine Hart Kress (DNP, MSCP), and Dr. Rebbecca Hertel (DO, MSCP)—aka The Dusty Muffins—as they dive deep into the world of sleep with renowned expert Dr. Andrea Matsumura, MD.
In this episode, you’ll uncover:
Packed with expert advice, relatable stories, and plenty of laughs, this episode is your ticket to sleeping like a goddess!
The Dusty Muffins:✨ Dr. Aoife O’Sullivan → @portlandmenopausedoc
✨ Dr. Rebbecca Hertel → @drrebbeccaherteldo
✨ Dr. Christine Hart Kress → @christinehartkress_dnp
📸 Instagram → https://www.instagram.com/thedustymuffins
🔗 Linktree → https://linktr.ee/thedustymuffins
Guest – Dr. Andrea Matsumura:
🌙 Instagram → @sleepgoddessmd
🌐 Website → https://sleepgoddessmd.com
(Disclaimer: The Dusty Muffins are doctors, but they’re not YOUR doctors. Always consult your doctor for personalized advice.)
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
In this episode, you’ll uncover:
- The DREAM Sleep Method—a holistic approach to better rest (Daily habits, Resting environment, Emotions, Archetype, and Medical factors).
- How hormones like estrogen & progesterone impact sleep (especially during midlife).
- Why melatonin works best in sustained-release form.
- The truth about sleep apnea in women and alternative treatments.
- Why alcohol sabotages REM sleep (and your mood!).
- How Cognitive Behavioral Therapy for Insomnia (CBT-I) can transform your nights.
Packed with expert advice, relatable stories, and plenty of laughs, this episode is your ticket to sleeping like a goddess!
The Dusty Muffins:✨ Dr. Aoife O’Sullivan → @portlandmenopausedoc
✨ Dr. Rebbecca Hertel → @drrebbeccaherteldo
✨ Dr. Christine Hart Kress → @christinehartkress_dnp
📸 Instagram → https://www.instagram.com/thedustymuffins
🔗 Linktree → https://linktr.ee/thedustymuffins
Guest – Dr. Andrea Matsumura:
🌙 Instagram → @sleepgoddessmd
🌐 Website → https://sleepgoddessmd.com
(Disclaimer: The Dusty Muffins are doctors, but they’re not YOUR doctors. Always consult your doctor for personalized advice.)
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for a real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of
(00:28):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in, Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is
(00:51):
the Dusty Muffins.
Speaker 2 (00:54):
I am a doctor Recer Hurdle.
Speaker 3 (00:55):
I'm a Board certified ostroopathic family medicine physician in a
Menopause societyfied practitioner. I have a private tele medisine practice
and I see patients in several different states.
Speaker 1 (01:07):
I am doctor Ifa O'Sullivan, a Board certified family physician
and Menopause Society certified practitioner, and I see patients through
my telemedicine practice here in Oregon and Washington.
Speaker 4 (01:19):
I'm doctor Christine Harcrass, a Board certified Women's Health Nurse
practitioner and Menopause Certified practitioner, and I see patients via
telemedicine in several states as well.
Speaker 1 (01:31):
So, doctor Mats and more, thank you so much for
being here and joining us today being our fourth muffin.
Speaker 5 (01:37):
Oh, thank you so much for having me.
Speaker 2 (01:40):
This is going to be We have a ton of
questions for you.
Speaker 3 (01:43):
Yes, I actually have a when we get into the
question part that I actually had a patient this week
and somehow we got on to I think she just
asked me the question of like, so, how do we dream?
Why do we dream? And I'm like, I think it's
rem and I.
Speaker 2 (01:59):
Said, guess what.
Speaker 5 (02:00):
We're having a sleep specialist on.
Speaker 3 (02:02):
I'm going to ask you that question for you.
Speaker 1 (02:05):
Fantastic And speaking of dreaming, you actually have something called
the dream method, right I do?
Speaker 5 (02:12):
I do? It is called the dream sleep method, And
every letter stands for a part of how I approach
somebody's sleep. So you know, I try to I try
to bring this holistic approach because I think a lot
of people in the sleep world, for better or worse.
(02:32):
You know, the way that our medical system is organized.
We focus on abnormal breathing, but there's so many other
things that can affect somebody's sleep. So that's why.
Speaker 2 (02:45):
Do you want to tell us?
Speaker 5 (02:46):
Tell us so dream? The D stands for daily habits,
So what are you doing throughout your day that is
helping you prepare? I would say, you know, to be
able to relax. Are you on the go all the time?
Are you not you know, giving yourself down time? Are
(03:08):
you eating enough? Are you drinking enough water? All of
that kind of stuff. And then our stands for resting
habits or resting environment rather resting environment. So is your
environment dark, cool? Quiet? Is it loud? Or do you
live next to a really busy street? Do you have
(03:28):
one hundred pound dog in your bed or you know,
or a very loud partner who's snoring all the time.
All of these things can affect your sleep. And then
the E stands for emotions. We all know that anxiety
depression PTSD. They affect your ability to get to sleep
and day asleep. A stands for the archetype, which is
(03:52):
really your circadian rhythm. So are you an early bird,
a night owl fallen into societal norm and then M
is for medical conditions. So do you have sleep disordered breathing?
Do you have a hormone deficiency, do you have an
autoimmune disorder? Do you have a pain syndrome or a
(04:13):
neurodegenerative disease that is affecting your ability to get into
the right stages of sleep.
Speaker 4 (04:19):
Yeah, I was on your website and I took the
sleep Goddess architect archetype quiz.
Speaker 2 (04:26):
I thought that was really interesting.
Speaker 4 (04:29):
How do you use that in practice? Do you have
patients go out and take it and then use it
to help reset their circadian rhythm?
Speaker 5 (04:38):
Well, I use it so that people know what their
circadian rhythm is. So some people are not in tune
with their circadian rhythm. We live kind of in an
early ish society. So if you're an early bird, that's
a person who wants to go to bed before nine o'clock,
you know, or by nine o'clock they're waking up around
four or five. The person who is a night owl,
(05:01):
they love going to bed midnight one am, two am
and then waking up at eight, nine or ten. Yes,
And then the person that kind of fits into societal norm,
which is the athena is somebody who goes to bed
at ten, wakes up at six, goes to bed at eleven,
wakes up at seven. So the Artemis is the early bird,
(05:23):
the Aphrodite is the night owl, and the athena is
fitting into societal norm. And you know, it's important because
that's kind of one of the that's the one of
the key elements around then developing somebody's plan for how
we're going to strategize around helping them improve their sleep.
(05:44):
Because if you're a person, you know, a lot of
people think that they're early birds. I mean, for God's sake,
the New York Times comes out with an article that
says that everybody should be an early bird. And so
then you have everybody else who's not an early bird,
you know, freaking out over here in the back saying.
Speaker 2 (06:00):
I'm my gosh, I got to wake up early.
Speaker 5 (06:02):
I'm not gonna you know, get as much done. And
there's you know, they're telling me that I might get
you know, some sort of illness, when that's not true,
you know, And I actually I remember when that article
came out, and I you know, was a keyboard warrior
and told them a few things and said that why
are you doing this to people causing anxiety? So and
(06:24):
to find out who you are?
Speaker 3 (06:26):
Is that kind of like your natural you know, if
you were to go to bed at a natural time
and wake up at a natural time, right, Because I
would tell you, like, during my work day, I need
to be up by five am or five point fifteen,
so I really strive to get to bed between nine
and thirty. But if I were on a weekend and
(06:46):
didn't have time, I would probably be like between ten
and eleven and up between six and seven. Like that's
just what my body would naturally do. And so when
you answer those are women supposed to our people supposed
to answer that based on like what would you naturally
do if you were just a naturally good bed on
the weekend, we didn't have anything else to do, right.
Speaker 5 (07:06):
That's how you want to answer those questions. And that's
why I put that as part of my method, because
it is buried for some people. They've been living a
different life for so long that they have no idea
what their natural circadian rhythm is. And every single cell
in our body is functioning on a circadian rhythm and
(07:27):
it's based on that core rhythm that is housed in
your brain. You know, we've got clock chens in our brain.
That's what we're born with. We can fake them out,
but we really can't change them.
Speaker 1 (07:43):
I'm not one hundred percent sure Rebecca does sleep. I
think she's got some vapiar DNA in there, because that
woman gets so much done in a day. It would
take me three days to do what she gets done
in a day. So I don't know if she does
actually sleep all.
Speaker 3 (07:57):
Yeah, No, I think it's it's just different in her
I don't know.
Speaker 4 (08:01):
If you saw her posts on Friday morning, it was
like she had gone to the gym, made breakfast. This
is what I saw, gone to the gym, made breakfast,
went to a graduation, and then made it to work,
and of course got dressed in her magnificent closet. And
I was like, are you kidding me? It was eight
o'clock in the morning.
Speaker 2 (08:20):
No, I was like that it was right, but it
wouldn't surprise me.
Speaker 3 (08:25):
That's a lot I think when you have six kids
and three dogs and your kids moved back in in
a full time other job, you know, there's just time
management skills that you must have in order to do
other things that you need to do.
Speaker 2 (08:39):
Yeah, that's all.
Speaker 3 (08:42):
And hormone therapy because when I wasn't on HT, I
could not organize shit.
Speaker 5 (08:49):
So I'm with you.
Speaker 3 (08:52):
Yeah, yeah, that was one of the skills I lost.
It was devastating.
Speaker 4 (08:57):
And so women always ask like, what's the optimal sleep?
Is that very based on I love it, I love
the guests based on your I mean, is that very
based on your archetype? I know, yesterday I did a
I did a lecture for a bunch of women, and
(09:19):
I was like, look, you got to start putting yourself
to bed. You need sleep, So treat yourself like you
treat you your kindergartener and get yourself to bed so
that you can get enough sleep. So what are your
thoughts on you know, optimal sleep and a number in
terms of number of hours for example.
Speaker 5 (09:37):
Yeah, so that's a loaded question because women are uh,
you know, we're from an early age. Uh. In our
society generally speaking, everybody is a lotted from not getting
enough sleep. You know, burning the candle at both ends,
I'll sleep when I'm dead, you know, all of those
kind of phrases. Right, And then women specifically are socialized
(10:00):
into thinking that it is the norm never to get
enough sleep. Well, you're menstruating and you're in pain, or
now you have children, or you're taking care of someone,
or now you're in perimenopause. I mean, you know, it's okay,
it's okay, you're never going to get enough sleep. And
I'm saying that because yes, the recommendation is to get
(10:20):
seven to nine hours of sleep, but there is this
new phenomenon that is now bubbling up called orthosomnia, and
that is a fixation on getting perfect sleep. So then
we are inducing more problems because people, you know, you're
on social media. It's sound bites, right, it's not truly
(10:43):
you know, medical, a medical consultation, right, So then you're
getting all of these sound bites and your feed is
flooded with you should get seven to nine hours of sleep.
So then you get fixated on that. And what I
tell people is that every fifteen minutes counts. So if
you've been struggling with sleep, and let's say you've only
(11:05):
been getting five hours to sleep, but now you've made
it to five hours and fifteen minutes, that's a win.
So every fifteen minute increment of sleep gain is going
to be a big benefit for you.
Speaker 1 (11:19):
I love your approach the way it's just so positive
and step wise and encouraging, you know, and that everyone
is a work in progress.
Speaker 5 (11:33):
You know.
Speaker 3 (11:33):
Sometimes it can be really difficult, especially for midlife women
to have that positive outlook. I feel like, right, I
think that there's something that changes in that, and so
to turn that back to a positive is really really
great way of doing that, And that's probably a good
segue I think into you know, one question I've had is,
you know, why is it in midlife or perimenopause where
(11:56):
you know, sleep kind of starts to go like sideways
and wonky. You know, how much of that is hormonal?
How much of that is not hormonal? Is it a
conglomeration of both things that are going on in a
woman's life during this time.
Speaker 5 (12:09):
Well, you know, that's in part why I did develop
the dream sleep method, because I wanted to catch all
of the things right. And in fact, you know, estrogen
modulates melatonin, and the more research I've been doing around melatonin,
if you have a reduction and estrogen, then you have
a down regulation of estrogen receptors which are modulating melatonin's release.
(12:33):
That combined with all of the other things that meloton
that excuse me, that estrogen effects. Right, so you have
all this you know, dysregulation around temperature control, around you know,
your ability to get to sleep and or stay asleep,
and so that alone affects women. And then you have
(12:54):
this reduction in progesterone, right, so then you don't have
that abba effect that your body needs. And you know,
both estrogen and progesterone also play a role in supporting
the structures of the back of the throat. So then
there's this increased potential in obstructive sleep apnea that happens
(13:18):
for women once they have this reduction of estrogen and progesterone.
And you know that is and then there's a stigma
because we haven't you know, we haven't made uh, sleep
apnea sexy yet, right, Like everybody loves wearing eyeglasses even
if they don't even even if they don't need them,
(13:40):
because eyeglasses are sexy. Right, we we haven't made using
treatments for sleep apnea sexy yet. But you know, I mean,
and not everybody needs positive airway pressure or so there's
a whole host of things around that, you know.
Speaker 3 (13:58):
I because those second, they're not sex right, and I
hear it every day.
Speaker 5 (14:05):
They're just like, can you turn over to.
Speaker 3 (14:07):
This big mask?
Speaker 5 (14:09):
Hey honey, you want to get it on right exactly,
And there's all this trepidation when in fact, you know,
sleep apnea is an independent risk factor for heart attacks
and strokes, so we really and also it contributes to
I mean, you're not breathing in your sleep, so we
want you to have high quality sleep. Even if you're
(14:29):
not getting your seven to nine hours, at least the
hours you are getting should be high quality. So I'm
constantly saying, you deserve to get better sleep. Let's help
you get better sleep.
Speaker 3 (14:43):
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I'm doctor rebeca hurdle Board certified osteopathic physician and certified
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(15:06):
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Speaker 1 (15:22):
And what are some other options for some patients who
don't need the positive pressure and there are some other
treatment options they that might be available.
Speaker 5 (15:30):
To Yeah, so you know, women tend to have REM
related sleep apnea, so they will have clustered events of
abnormal breathing during REM sleep, so that averages out to
either low, moderate or high mild sleep apnea, which is
a perfect indication for an oral appliance. So oral appliances
(15:55):
are much less you know, invasive in terms of you know,
the and there's a lot of different types of masks,
but let's face it, they're all made for men's faces.
So oral appliances really can work quite well for a
woman and improve the quality of sleep, improve oxygenation, and
(16:16):
then you get into all the right stages of sleep,
because it's all this vicious cycle. I mean, if you
don't have enough melotonin, then you're not getting into the
right sleep stages. So your sleep architecture, that's what we
call it. You're not getting all of the right stages
or enough of the right stages of sleep. Same is
true if you're not breathing in your sleep.
Speaker 1 (16:36):
And if you're not breathing properly during your RAM sleep,
and we know RAM is very important part of sleep.
That's really detrimental, isn't that to your.
Speaker 4 (16:44):
Yes, So what are your thoughts on supplementing melatonin? Should
women be doing that? Is there a dosage?
Speaker 5 (16:54):
Yes?
Speaker 4 (16:55):
You know, because when estrogen's low, melotonin is low. I
think I saw something on your way wesite that I
was like, oh man, maybe I shouldn't be taking as
much melatonin as i'd hate.
Speaker 5 (17:04):
Right, So there you know. Of course, in the United
States we have no regulation of supplements, and so that's
why I did a post recently on making sure that
it's third party tested and then understanding why you're taking
what you're taking. Right, I say that all of the
time to my patients, you don't need a whole lot
of melatonin. So all of the melatonin that's sold out there,
(17:28):
that's five, ten, fifteen, twenty, that's just too high. So
we only need one to three milligrams of melatonin, and
there is some data that's being published now finally around
sustained release and sustain release mimics our physiology a whole
lot better, and it's keeping people asleep. So the immediate
(17:49):
release melatonin helps people fall asleep, but it's not really
helping people stay asleep. So the sustained release again is
mimicking that. How melatonin's curve stays elevated and then you
finally have a wash out period when you're waking up.
I'm you know, I'm probably going to get a lot
of shade from other sleep docs around promoting melatonin. But
(18:12):
the more research and deep dive I do, the more
I'm convinced it may be the next you know, hormone
like vitamin D. How we all came to understand that
we need vitamin D. I really think that melatonin is
part of this enhancing your your lifespan and the longevity
of you know, the just improving longevity. I really think
(18:36):
that it is a missing link because if again, if
you don't have enough melatonin, then that affects your sleep
architecture and you have more oxidative stress, So then you
have deterioration of cells at a faster, more rapid rate,
and then it just kind of builds on itself, and
by age fifty we have almost fifty percent reduction and
(19:00):
melatonin production.
Speaker 3 (19:03):
And when you look at it makes sense, right if
it's related to estrogen.
Speaker 1 (19:08):
Yeah, it starts to fall or kind of around the
same time as our progesterone starts to fall, doesn't it.
So it's like a double whammy because that progesterone is
so important for us getting to sleep as well. So
it's no wonder half the country is up at three
am in the morning haven't been unable to get to sleep.
Speaker 3 (19:24):
But you know, yes, yeah, so would that be would
that be something to add where you know I usually
will start progesterone or you know in these mid left
women who need it. So is it progesterone first versus estrogen?
You know, if they're having sleep issues, progesterones definitely to
play because of that calming affect and ability to fall asleep.
(19:45):
But it's interesting because is that keeping them asleep or
is it they need to add some of that sustained
release Lo doo smelotonin to keep them then asleep.
Speaker 5 (19:56):
So you know, progesterone. I think in the and what
I have read is that it is really helping you
with sleep onset, but it's not necessarily the maintenance of sleep, right,
It's not keeping you asleep. It is really the estrogen
component and the modulation of melatonin that is actually helping
(20:20):
sustain sleep throughout the night. So you know, what I
would say is are my approaches. If somebody comes to
me and we do this full evaluation and we start
out on hormone therapy and then you are still having
problems sleeping. After we have we feel like we've arrived
(20:42):
at the right dose right of your hormone therapy, then
I say, let's start with, you know, a deeper evaluation.
We may need to do, you know, home a sleep study,
whether or not it's in a sleep center or a
home study, that's fair game at in any part of
(21:04):
this evaluation. But when we think about supplements and medication,
I will first start hormone therapy and then if I'm
not making any headway with this sleep, then we do
a deep dive evaluation. And that's when I would say
maybe we should try melatonin. And I'd say a third
(21:25):
of my patients continue to have problems sleeping. So it's
a little combination of a lot of things. And you know,
when we think about insomnia, chronic insomnia is a specific condition, right,
and the only true successful treatment for chronic insomnia that's
been studied is kind of to behavioral therapy for insomnia,
(21:49):
and we always want to use that in concert with
whatever supplement or medication we're using. I am not a
person who prescribes medications for sleep that are prescription medications.
The fine print for every single one of those medications
(22:09):
says not to use it for more than two weeks.
Speaker 4 (22:12):
So many women are coming on sleep medications and I
you know, I tell them, I'm like, we're getting you
off that stuff.
Speaker 1 (22:20):
It's like all the time, like jellybeans, just take some TRASD.
Speaker 4 (22:25):
And they're not sleeping any better. They're not sleeping any better,
except they're complaining that they're so groggy. And you know,
the other thing that I've been seeing more and more
of and especially on social media, and I think it's
the understanding. I think a lot of clinicians don't understand
that progesterone gets you to sleep, estrogen keeps you asleep.
(22:46):
Is that I'm seeing people are just escalating on progesterone
and not estrogen, and so women are in three four, five,
six hundred milligrams of progesterone.
Speaker 5 (22:58):
I'm like, I don't know where.
Speaker 6 (22:59):
I don't say that, I don't know how they're funk
warning because I tried once to take three hundred milligrams
and it was a really bad day because I actually
went on site somewhere to do menopause hair and I
felt like my whole day.
Speaker 4 (23:15):
Like my head might as well have been inside inn HVAC.
Like I just I was like, oh God, why can't
they Like everything was like a mm, So, what do
you think about, you know, all these providers that are
just escalating on progesterone and people are walking around like zombies.
Speaker 5 (23:32):
Well, I would like them to think about the fact
that maybe they need to see a sleep specialist and
maybe somebody else needs to take a look. And you know,
it's all the nuance of care, right there's no one
just you know, easy prescription. I'm not saying that every
single person needs to be on melotonin because frankly, there's
(23:55):
a lot of you know, people will say, but I
have nightmares, because that is a side effect and for
some people it's quite dose dependent, and it could even
be a small dose that makes them have nightmares. It
should not make you feel groggy in the morning. But
to your point, I have you know, people come to
see me with loads of medication, right, They come in,
(24:19):
you know, with their three hundred dollars a month worth
of stuff, and I start talking about scaling it back,
and immediately they say no, no, no, no, I can't
sleep without it. And I have to say, now, hold on.
You came here as in a consult because you can't sleep,
so all this stuff isn't working, right. I mean, you
(24:41):
just told me you have this elaborate three hour plan
to help you get to sleep, and you're still feeling
like you're not sleeping because that's why you're here. So
these aren't working for you, right.
Speaker 1 (24:57):
I find out really interesting the way you say melatonin
is kind of released in a curve.
Speaker 2 (25:03):
I did not understand that.
Speaker 1 (25:06):
I actually thought you got a little bit of a
spike of melatonin around the time we're supposed to start
getting sleepy and ready to go to bed. So that's
so interesting that they're thinking of doing this slow release melatonin.
Speaker 2 (25:20):
Which sounds like it would suit our bodies. Much better.
Speaker 5 (25:23):
Well, it's a chronobiotic, so it's not a sleep bait,
but it is sold as a sleep bait over the counter,
so it actually starts the cascade of sleep. So it's
a pretty complex mechanism because we have these ganglion cells
in our eye that directly connect to the super chismatic
(25:45):
nucleus and then the hyperbellamus and then that then sends
a signal to the pineal gland which is behind the
third ventricle, and you know, all this stuff is happening.
So we release melatonin on our average around four or
three hours before we actually hit the pillow.
Speaker 3 (26:04):
Want the Dusty Muffins at your next event? We do panels,
live podcast and talks that bring the heat literally corporate
see me or retreats. We've got you, So hit us
up at the Dusty Muffins three three three at gmail
dot com or dms on Instagram at the Dusty Muffins.
Speaker 5 (26:19):
So, if we're going to take it as a supplement,
you want to take it two hours one hour before
you fall asleep. Are you intend to fall asleep? And
that is if somebody is following their circadian rhythm and
they're having trouble getting to sleep and stay and asleep. Now,
somebody needs to realign their circadian rhythm. So let's say
(26:41):
somebody who's a night owl, but they they have to
get up really early for a job. That's a totally
different story. So this is not about circadian realignment. This
is simply replacing what you have lost. We've heard that before, right,
try and right. This is replace seeing what we are
losing to help us get some sort of balance, because
(27:06):
we'll never get to that point where we were before
we lost it, but we'll get to a point where
we're at least not feeling all of the symptoms.
Speaker 1 (27:16):
And could you talk to us a little bit about
what does alcohol do to our sleep architecture.
Speaker 2 (27:21):
There's a part of me that doesn't want to know this.
Speaker 5 (27:25):
I know here we are.
Speaker 2 (27:27):
I think we need to know, we need to know.
Speaker 5 (27:30):
That's a party pooper question. Anyway, I'm with you, because
of course I cannot. I just can't handle alcohol anymore.
And so I kind of think that maybe when we
were younger, we just drank so much that we just
didn't even notice that we weren't getting any sleep, right, right,
(27:50):
And now we're better about it, but we drink just
a little too much and it just messes our sleep
up completely and then you have to make up for
you you lose an entire day. So the half life
of alcohol hits right right in the middle of people's
sleep typically, So if you're drinking alcohol in the evening,
(28:11):
you're at a party, and then you go to sleep,
you know, four hours later, which is when you're supposed
to be hitting your biggest, your biggest segment of REM sleep,
that's when it starts to cause all of this awakening
and it really interferes with REM sleep. So that's why
you think, you know, I didn't get any sleep at all,
(28:35):
even though you feel like, well, I felt like I
slept you know, a good you know, amount of time,
but it doesn't feel rested because it was disrupting your
REM sleep, which is when you know, all of the
emotional processing is taking place and the consolidation of the.
Speaker 1 (28:54):
Day has happened, and you can really feelish, can't you?
Speaker 2 (28:57):
Girls like it?
Speaker 1 (28:58):
Just you you have those wake ups thru the night
you might have been sleeping.
Speaker 4 (29:03):
Creation Yeah, yeah, So here's I know, I know everybody
wants to know this. Why Why is everybody up between
one and three? Why is it those hours.
Speaker 5 (29:16):
You know, that's a good question. I haven't really done
enough digging on why specifically it's those hours other than
kind of connecting dots, and so those dots would be
you know, is that when we don't have enough melatonin
production that it's not sustaining sleep. Is that when our
(29:37):
body then got used to it developed like a new
highway in the brain when we were having this dysregulation
from a reduction in hormones. You know, if you're talking
about midlife, right, it did our body then accommodate, right
and say, well, we know we're going to wake up anyway.
So I'm just learning this new pathway and I'm anticipating
(29:59):
even and though it's over, I've learned a new pathway
and I'm just going to stick with it. And you
have to remind you have to retrain your brain. You
have to tell it you can, you can get rid
of that pathway. Now, that's where cognitive behavioral therapy comes
in for insomnia, that you have to retrain it. You
have to say, nope, I want you to start using
(30:22):
the original pathway when I was actually getting better sleep.
That's the neurological pathway. I need you to start using
I want you to forget about this learned pathway that. Yeah,
so that's that's why there's all this you know, controversy
around medications versus kindative behavioral therapy for insomnia. But simply,
(30:45):
we just really haven't done enough research on melatonin. And
it's scary, just like it was, just like vitamin D was.
You know, I remember when vitamin D started, you know,
hitting the scene as a necessary hormone, and there were
or some naysayers, and you know, it was there was
all this initial controversy, and it was simply because we
(31:06):
didn't have enough data around why why is it that
we need to replace it? Why is it that we
need vitamin D? And and you know, melatonin is a hormone.
It's not it's not a it's not a mineral, it's
not a you know, it's it's a hormone. It's it's
hitting a lot of different things in our body. Yeah.
Speaker 4 (31:28):
One of the things I found really interesting when I
was doing some research on osteoporosis is that three milligrams
of melatonin is good for both yes, Yeah, which once
I found that out, I felt a lot less guilty
about all the melatonin.
Speaker 5 (31:43):
I think I don't want to know how much money released.
Speaker 4 (31:46):
Now it just goes so I fall asleep.
Speaker 3 (31:53):
Can we touches a sec on that? Magnesium particularly, I
think it likes me, although I do the three and
eight at night.
Speaker 5 (32:00):
I don't know aviation. But but you.
Speaker 3 (32:02):
Know, there's a lot a lot of talk around that
the different types of magnesium, which you know, are good
for different things. And I will have women that come
to me they're like, I started magnesium glass, I sleep great.
Speaker 5 (32:16):
I'm like, okay, yeah, I mean it enhances relaxation, muscle relaxation.
You know, that's all about the the electricity, you know,
like your positive and negative ions and that that's really
the focus on magnesium. And yes, there's different types of magnesium.
But honestly, there sometimes people will say, well, I've I
(32:39):
started on this one and it works. I'm like, great,
I'm not going to change it, you know, but yes,
the data is is out that yes, magnesium place and
is the one to go. And that's uh, you know,
that is a it's a compound, right, So it's so
that is that is the one that tends to be
(33:01):
the most active in terms of relaxation centers to help
you actually then get into falling asleep, so it helps
with getting to sleep, it doesn't necessarily help sustain asleep.
So that's the thing.
Speaker 3 (33:16):
Right, So it's still the calming effect.
Speaker 5 (33:18):
It's it's really the calming effect. And it's so low
you know. I mean it's water soluble, so you know,
you take a little too much, you might have diarrhea.
But okay, I take a megsic.
Speaker 2 (33:34):
You need it.
Speaker 5 (33:35):
That's you know, that's you need it. But no, that's
what I always would tell. That's what I tell people.
You know, Calcium constipates, magnesium makes you move, right.
Speaker 1 (33:48):
I tell my patients. And when the when the bottom
is falling out of your world, take maxit trate and
let the world fall out of your bottom.
Speaker 5 (34:00):
Oh my gosh, I've never heard that.
Speaker 2 (34:01):
That's I love it. That's a cute little in the
mone Oh.
Speaker 3 (34:07):
And then I did promise my patient why do we dream?
Speaker 5 (34:11):
Do we?
Speaker 3 (34:11):
I know this is that it may not be a
quick explanation, but she's like, why why do we dream?
So I said, well, I have just a person on
our podcast.
Speaker 5 (34:19):
Well, ramsleep is really important for emotional regulation and that's
why we dream. So when we are in ramsleep, that's
when we're doing majority of dreaming. There is some data
that's coming up that's some like your deep stage of sleep,
which is and three. You may have some but you know,
I'm not convinced yet because there's not enough data. Right,
(34:42):
So but and three or you're slow wave sleep. Or
for people who use wearables, right, because almost everybody has
a ring or a watch or something. So something on
your body is called a wearable, something that you put
next to you or that you sleep keep on. Because
a lot of people use their phone, right, that's called
(35:04):
a nearrable. It's not as accurate. And in fact, the
most accurate wearable is only seventy five percent accurate. So
I think it's okay for trends. I don't think that
it's fabulous for it's not. It hasn't hit the market
for diagnostic testing yet, right, but slow waste. So when
(35:29):
you think about sleep, you know, and I and I
now describe it based on how people are looking at
their their data. Right. So you have light sleep, deep sleep,
and rem sleep. And so your deep sleep is the
physical restoration. That's where all of the physical components are are.
(35:51):
You know, that's when your growth hormone is released. That's
when you're repairing physical health and doing some memory consolidation.
But rampsleep is really all about emotional regulation and consolidation
of memory. That's why you're dreaming a lot. A lot
of times there's things that have happened in the day
(36:13):
where things that are going to happen that you end
up dreaming about. And you do not have to remember
your dreams to dream. I mean to know that you
are dreaming, right. So a lot of people will come
to me and say I haven't dreamt for two years,
and I would say, well, then you would not be
alive talking to me, like you in order to survive,
(36:34):
you have to dream.
Speaker 3 (36:36):
So that's so interestacinating stuff.
Speaker 2 (36:39):
I think dreaming is fascinating.
Speaker 1 (36:40):
Yeah, I would just like if last of my dreams
were about open water and fish? About what open water
and fish?
Speaker 3 (36:47):
Ye? I don't like to dream. Running Are you flying?
I'm running like away from people, like in circles, like
trying to go and run away from someone like and
then you wake up Mike.
Speaker 1 (37:03):
Christine, Wait a second, are you flying like?
Speaker 2 (37:07):
Wonder like you're yourself super girl? Jump in my god.
Speaker 4 (37:13):
I don't know what that means.
Speaker 2 (37:14):
That's that's rough something that.
Speaker 5 (37:16):
That might mean, you know, kind of goes with the
with the concept that you're building the plane as you
fly it. So maybe you're building something pretty cool. Maybe
something's happening.
Speaker 1 (37:31):
She she's building lots of things, as long as they
don't just fall.
Speaker 3 (37:36):
Yeah, or when you trip, when you trip and then
you wake yourself up.
Speaker 4 (37:44):
Yeah, isn't that fascinating? We all dreams a little bit different.
Speaker 5 (37:49):
When people When people have sleep APNA that isn't diagnosed,
one of the classic dreams is that they're underwater that
they can't breathe. That's are you know, struggling to to
get out of you know, from underwater.
Speaker 2 (38:08):
Yes, that makes sense because you're a.
Speaker 3 (38:12):
Little bit more about that.
Speaker 4 (38:13):
Yes, any advice on sleep testing, you know, I think
sometimes people are apprehensive about going you know, I know
there's you know, you could do home study. Let me
ask this question, who is a good candidate who needs
to be in office versus home study? And what are
(38:35):
some advice about getting yourself through it? If it makes
you a little anxious thinking about people watching you sleep.
Speaker 5 (38:43):
Wow, Okay, so you know home study versus in the
sleep center sleep study. There are specific clinical indications if
somebody needs to be in a sleep center. So if
maybe you have a lotung disease or heart disease or
(39:04):
a neuromuscular disorder, you know, like people who have als,
they just need to have an in the sleep center
sleep study, even if they don't really have any symptoms
quite yet, right, because they have a tendency to hypoventilate
and they don't realize it when they're sleeping. People who
are very symptomatic and they have a negative home sleep
(39:26):
study should have an in lab sleep study. And you
know that's really important because women tend to have a
higher false negative rate, and so you know, really we
should be doing we should figure out a way to
refine testing so that people can either do it in
(39:46):
their home. And there are certain levels of testing, so
everybody knows about the in lab testing versus the home
sleep testing. In lab testing is called a type one study,
a home study is called a type three. But there
is one in between that you can still do at home,
called a type two. And the reason why they're not
as popular is because they pay out the same as
(40:07):
the type three, so you're not getting more, you know,
so there's a reason why. But it does capture more data.
All this to say, women have a higher false negative
rate because again they tend to have REM related sleep apnea.
We can't really capture rem as accurately as we can
(40:28):
in an in lap study as we can in a
home study and other some home studies that are really
touting the fact that they can capture all stages of sleep,
and that's cool, that's great, but they still have a
higher false negative rate, especially when it comes to women,
because again, women tend to have lower levels of sleep apnea,
(40:49):
so we might not catch at all. So you know,
there's this endless debate. Should we do one night, should
we do two nights? Should we do three nights? And
I really think the more that I've been reading about
it because I practice one particular way, because that was
the constraints of a practice right where everybody got one night.
If it was negative, we'd you know, lobby with the
(41:09):
insurance company to do a second home night, or we'd
bring them into the sleep lab if their insurance allowed
us to write, because you know, insurances don't really care
what we think. So now in my own private practice,
I'm probably going to do a multi day home study
because I think that you get better data that way,
(41:31):
and then you can really see what's happening in a
person's night. And I'm looking at home devices that really
have information specific to data around women to outcome data
around women. And again that's because they have a mild
(41:54):
sleep apnea for the most part, but it is severe
during rem sleep more so not everybody, but that tends
to be the pattern and you don't always capture that
on a home study. So I've had many women come
to me and say, well, I was told I didn't
have sleep apnea. So then I evaluate all the data
and say, you know what, let's do it again, but
(42:14):
we're going to do it this way, and then we
capture it and maybe you know, atnia hypopnia index is
just one way. That's that's one type of sleep apnea,
you know. And of course all the studies are done
mostly on guys, right, but you know, I'm convinced that
there are other phenotypes of sleep apnea that we have
yet to discover that might be really you know, gender specific,
(42:40):
but we're not looking for those because we we can't
get treatment covered for those.
Speaker 1 (42:50):
And it's so important, especially the way so many of
the studies are done on men compared to women.
Speaker 2 (42:55):
So I love that you're going to focus on that.
Speaker 1 (42:57):
You're opening your own practice here in Oregon at the
end of the summer, right, will you tell us a
little bit about that.
Speaker 2 (43:03):
I'm going to be your first patient. Will you tell
us a little bit about that?
Speaker 1 (43:06):
And also where our listeners can find you on social
media and the internet.
Speaker 5 (43:13):
Yes, so I will be opening up my private practice
where we will everybody gets to go through the Dream
Sleep method, and you know, you get a plan, a toolkit,
you may get a sleep study. Not everybody needs a
sleep study. And you know, just a little bit more
(43:33):
about that, there aren't any really great screening tools for
women to see whether or not somebody's at high risk
for sleep ATNA. I mean the stop bang that is
used widely. One of the questions the G is what's
your gender? Okay, so if you're a guy, if you're
a woman, you already have minus a point and that
(43:57):
could have been the threshold to get you a sleep study. Right, So,
I we have yet to find a really great screening tool,
especially for women around ruling in high you know, pretest
probability for sleep ATNA. But yes, so I will be
doing I will have a private practice. I'm working on
(44:21):
having in person one day a week and then the
rest would be virtual. Typically that would be follow up
visits virtually, and and that's going to be happening at
the end of the summer. And I forgot what else
you ask me?
Speaker 1 (44:38):
That's exciting?
Speaker 2 (44:40):
Where they are you?
Speaker 5 (44:41):
Oh? Yeah, my website. So I'm Sleep Goddess MD. I
love love Greek mythology and so that's you know, that's uh,
that's what I want for everyone. I want everyone to
sleep like a goddess.
Speaker 1 (44:58):
I love that. Thanks for joining us day today. It's
been such a pleasure to have you.
Speaker 5 (45:05):
Thank you for having me. This is fun.
Speaker 2 (45:08):
Yeah, we're so happy to meet you.
Speaker 4 (45:10):
Finally.
Speaker 1 (45:11):
Yes, So for all our listeners, follow doctor Mattsimura online
and if you're living in Oregon, you can start to
see her at the end of the summer.
Speaker 5 (45:21):
All right, Thanks,
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for a real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of
(00:28):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in, Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is
(00:51):
the Dusty Muffins.
Speaker 2 (00:54):
I am a doctor Recer Hurdle.
Speaker 3 (00:55):
I'm a Board certified ostroopathic family medicine physician in a
Menopause societyfied practitioner. I have a private tele medisine practice
and I see patients in several different states.
Speaker 1 (01:07):
I am doctor Ifa O'Sullivan, a Board certified family physician
and Menopause Society certified practitioner, and I see patients through
my telemedicine practice here in Oregon and Washington.
Speaker 4 (01:19):
I'm doctor Christine Harcrass, a Board certified Women's Health Nurse
practitioner and Menopause Certified practitioner, and I see patients via
telemedicine in several states as well.
Speaker 1 (01:31):
So, doctor Mats and more, thank you so much for
being here and joining us today being our fourth muffin.
Speaker 5 (01:37):
Oh, thank you so much for having me.
Speaker 2 (01:40):
This is going to be We have a ton of
questions for you.
Speaker 3 (01:43):
Yes, I actually have a when we get into the
question part that I actually had a patient this week
and somehow we got on to I think she just
asked me the question of like, so, how do we dream?
Why do we dream? And I'm like, I think it's
rem and I.
Speaker 2 (01:59):
Said, guess what.
Speaker 5 (02:00):
We're having a sleep specialist on.
Speaker 3 (02:02):
I'm going to ask you that question for you.
Speaker 1 (02:05):
Fantastic And speaking of dreaming, you actually have something called
the dream method, right I do?
Speaker 5 (02:12):
I do? It is called the dream sleep method, And
every letter stands for a part of how I approach
somebody's sleep. So you know, I try to I try
to bring this holistic approach because I think a lot
of people in the sleep world, for better or worse.
(02:32):
You know, the way that our medical system is organized.
We focus on abnormal breathing, but there's so many other
things that can affect somebody's sleep. So that's why.
Speaker 2 (02:45):
Do you want to tell us?
Speaker 5 (02:46):
Tell us so dream? The D stands for daily habits,
So what are you doing throughout your day that is
helping you prepare? I would say, you know, to be
able to relax. Are you on the go all the time?
Are you not you know, giving yourself down time? Are
(03:08):
you eating enough? Are you drinking enough water? All of
that kind of stuff. And then our stands for resting
habits or resting environment rather resting environment. So is your
environment dark, cool? Quiet? Is it loud? Or do you
live next to a really busy street? Do you have
(03:28):
one hundred pound dog in your bed or you know,
or a very loud partner who's snoring all the time.
All of these things can affect your sleep. And then
the E stands for emotions. We all know that anxiety
depression PTSD. They affect your ability to get to sleep
and day asleep. A stands for the archetype, which is
(03:52):
really your circadian rhythm. So are you an early bird,
a night owl fallen into societal norm and then M
is for medical conditions. So do you have sleep disordered breathing?
Do you have a hormone deficiency, do you have an
autoimmune disorder? Do you have a pain syndrome or a
(04:13):
neurodegenerative disease that is affecting your ability to get into
the right stages of sleep.
Speaker 4 (04:19):
Yeah, I was on your website and I took the
sleep Goddess architect archetype quiz.
Speaker 2 (04:26):
I thought that was really interesting.
Speaker 4 (04:29):
How do you use that in practice? Do you have
patients go out and take it and then use it
to help reset their circadian rhythm?
Speaker 5 (04:38):
Well, I use it so that people know what their
circadian rhythm is. So some people are not in tune
with their circadian rhythm. We live kind of in an
early ish society. So if you're an early bird, that's
a person who wants to go to bed before nine o'clock,
you know, or by nine o'clock they're waking up around
four or five. The person who is a night owl,
(05:01):
they love going to bed midnight one am, two am
and then waking up at eight, nine or ten. Yes,
And then the person that kind of fits into societal norm,
which is the athena is somebody who goes to bed
at ten, wakes up at six, goes to bed at eleven,
wakes up at seven. So the Artemis is the early bird,
(05:23):
the Aphrodite is the night owl, and the athena is
fitting into societal norm. And you know, it's important because
that's kind of one of the that's the one of
the key elements around then developing somebody's plan for how
we're going to strategize around helping them improve their sleep.
(05:44):
Because if you're a person, you know, a lot of
people think that they're early birds. I mean, for God's sake,
the New York Times comes out with an article that
says that everybody should be an early bird. And so
then you have everybody else who's not an early bird,
you know, freaking out over here in the back saying.
Speaker 2 (06:00):
I'm my gosh, I got to wake up early.
Speaker 5 (06:02):
I'm not gonna you know, get as much done. And
there's you know, they're telling me that I might get
you know, some sort of illness, when that's not true,
you know, And I actually I remember when that article
came out, and I you know, was a keyboard warrior
and told them a few things and said that why
are you doing this to people causing anxiety? So and
(06:24):
to find out who you are?
Speaker 3 (06:26):
Is that kind of like your natural you know, if
you were to go to bed at a natural time
and wake up at a natural time, right, Because I
would tell you, like, during my work day, I need
to be up by five am or five point fifteen,
so I really strive to get to bed between nine
and thirty. But if I were on a weekend and
(06:46):
didn't have time, I would probably be like between ten
and eleven and up between six and seven. Like that's
just what my body would naturally do. And so when
you answer those are women supposed to our people supposed
to answer that based on like what would you naturally
do if you were just a naturally good bed on
the weekend, we didn't have anything else to do, right.
Speaker 5 (07:06):
That's how you want to answer those questions. And that's
why I put that as part of my method, because
it is buried for some people. They've been living a
different life for so long that they have no idea
what their natural circadian rhythm is. And every single cell
in our body is functioning on a circadian rhythm and
(07:27):
it's based on that core rhythm that is housed in
your brain. You know, we've got clock chens in our brain.
That's what we're born with. We can fake them out,
but we really can't change them.
Speaker 1 (07:43):
I'm not one hundred percent sure Rebecca does sleep. I
think she's got some vapiar DNA in there, because that
woman gets so much done in a day. It would
take me three days to do what she gets done
in a day. So I don't know if she does
actually sleep all.
Speaker 3 (07:57):
Yeah, No, I think it's it's just different in her
I don't know.
Speaker 4 (08:01):
If you saw her posts on Friday morning, it was
like she had gone to the gym, made breakfast. This
is what I saw, gone to the gym, made breakfast,
went to a graduation, and then made it to work,
and of course got dressed in her magnificent closet. And
I was like, are you kidding me? It was eight
o'clock in the morning.
Speaker 2 (08:20):
No, I was like that it was right, but it
wouldn't surprise me.
Speaker 3 (08:25):
That's a lot I think when you have six kids
and three dogs and your kids moved back in in
a full time other job, you know, there's just time
management skills that you must have in order to do
other things that you need to do.
Speaker 2 (08:39):
Yeah, that's all.
Speaker 3 (08:42):
And hormone therapy because when I wasn't on HT, I
could not organize shit.
Speaker 5 (08:49):
So I'm with you.
Speaker 3 (08:52):
Yeah, yeah, that was one of the skills I lost.
It was devastating.
Speaker 4 (08:57):
And so women always ask like, what's the optimal sleep?
Is that very based on I love it, I love
the guests based on your I mean, is that very
based on your archetype? I know, yesterday I did a
I did a lecture for a bunch of women, and
(09:19):
I was like, look, you got to start putting yourself
to bed. You need sleep, So treat yourself like you
treat you your kindergartener and get yourself to bed so
that you can get enough sleep. So what are your
thoughts on you know, optimal sleep and a number in
terms of number of hours for example.
Speaker 5 (09:37):
Yeah, so that's a loaded question because women are uh,
you know, we're from an early age. Uh. In our
society generally speaking, everybody is a lotted from not getting
enough sleep. You know, burning the candle at both ends,
I'll sleep when I'm dead, you know, all of those
kind of phrases. Right, And then women specifically are socialized
(10:00):
into thinking that it is the norm never to get
enough sleep. Well, you're menstruating and you're in pain, or
now you have children, or you're taking care of someone,
or now you're in perimenopause. I mean, you know, it's okay,
it's okay, you're never going to get enough sleep. And
I'm saying that because yes, the recommendation is to get
(10:20):
seven to nine hours of sleep, but there is this
new phenomenon that is now bubbling up called orthosomnia, and
that is a fixation on getting perfect sleep. So then
we are inducing more problems because people, you know, you're
on social media. It's sound bites, right, it's not truly
(10:43):
you know, medical, a medical consultation, right, So then you're
getting all of these sound bites and your feed is
flooded with you should get seven to nine hours of sleep.
So then you get fixated on that. And what I
tell people is that every fifteen minutes counts. So if
you've been struggling with sleep, and let's say you've only
(11:05):
been getting five hours to sleep, but now you've made
it to five hours and fifteen minutes, that's a win.
So every fifteen minute increment of sleep gain is going
to be a big benefit for you.
Speaker 1 (11:19):
I love your approach the way it's just so positive
and step wise and encouraging, you know, and that everyone
is a work in progress.
Speaker 5 (11:33):
You know.
Speaker 3 (11:33):
Sometimes it can be really difficult, especially for midlife women
to have that positive outlook. I feel like, right, I
think that there's something that changes in that, and so
to turn that back to a positive is really really
great way of doing that, And that's probably a good
segue I think into you know, one question I've had is,
you know, why is it in midlife or perimenopause where
(11:56):
you know, sleep kind of starts to go like sideways
and wonky. You know, how much of that is hormonal?
How much of that is not hormonal? Is it a
conglomeration of both things that are going on in a
woman's life during this time.
Speaker 5 (12:09):
Well, you know, that's in part why I did develop
the dream sleep method, because I wanted to catch all
of the things right. And in fact, you know, estrogen
modulates melatonin, and the more research I've been doing around melatonin,
if you have a reduction and estrogen, then you have
a down regulation of estrogen receptors which are modulating melatonin's release.
(12:33):
That combined with all of the other things that meloton
that excuse me, that estrogen effects. Right, so you have
all this you know, dysregulation around temperature control, around you know,
your ability to get to sleep and or stay asleep,
and so that alone affects women. And then you have
(12:54):
this reduction in progesterone, right, so then you don't have
that abba effect that your body needs. And you know,
both estrogen and progesterone also play a role in supporting
the structures of the back of the throat. So then
there's this increased potential in obstructive sleep apnea that happens
(13:18):
for women once they have this reduction of estrogen and progesterone.
And you know that is and then there's a stigma
because we haven't you know, we haven't made uh, sleep
apnea sexy yet, right, Like everybody loves wearing eyeglasses even
if they don't even even if they don't need them,
(13:40):
because eyeglasses are sexy. Right, we we haven't made using
treatments for sleep apnea sexy yet. But you know, I mean,
and not everybody needs positive airway pressure or so there's
a whole host of things around that, you know.
Speaker 3 (13:58):
I because those second, they're not sex right, and I
hear it every day.
Speaker 5 (14:05):
They're just like, can you turn over to.
Speaker 3 (14:07):
This big mask?
Speaker 5 (14:09):
Hey honey, you want to get it on right exactly,
And there's all this trepidation when in fact, you know,
sleep apnea is an independent risk factor for heart attacks
and strokes, so we really and also it contributes to
I mean, you're not breathing in your sleep, so we
want you to have high quality sleep. Even if you're
(14:29):
not getting your seven to nine hours, at least the
hours you are getting should be high quality. So I'm
constantly saying, you deserve to get better sleep. Let's help
you get better sleep.
Speaker 3 (14:43):
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(15:06):
and more. My approach bloods eminine based medicine with a
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Speaker 1 (15:22):
And what are some other options for some patients who
don't need the positive pressure and there are some other
treatment options they that might be available.
Speaker 5 (15:30):
To Yeah, so you know, women tend to have REM
related sleep apnea, so they will have clustered events of
abnormal breathing during REM sleep, so that averages out to
either low, moderate or high mild sleep apnea, which is
a perfect indication for an oral appliance. So oral appliances
(15:55):
are much less you know, invasive in terms of you know,
the and there's a lot of different types of masks,
but let's face it, they're all made for men's faces.
So oral appliances really can work quite well for a
woman and improve the quality of sleep, improve oxygenation, and
(16:16):
then you get into all the right stages of sleep,
because it's all this vicious cycle. I mean, if you
don't have enough melotonin, then you're not getting into the
right sleep stages. So your sleep architecture, that's what we
call it. You're not getting all of the right stages
or enough of the right stages of sleep. Same is
true if you're not breathing in your sleep.
Speaker 1 (16:36):
And if you're not breathing properly during your RAM sleep,
and we know RAM is very important part of sleep.
That's really detrimental, isn't that to your.
Speaker 4 (16:44):
Yes, So what are your thoughts on supplementing melatonin? Should
women be doing that? Is there a dosage?
Speaker 5 (16:54):
Yes?
Speaker 4 (16:55):
You know, because when estrogen's low, melotonin is low. I
think I saw something on your way wesite that I
was like, oh man, maybe I shouldn't be taking as
much melatonin as i'd hate.
Speaker 5 (17:04):
Right, So there you know. Of course, in the United
States we have no regulation of supplements, and so that's
why I did a post recently on making sure that
it's third party tested and then understanding why you're taking
what you're taking. Right, I say that all of the
time to my patients, you don't need a whole lot
of melatonin. So all of the melatonin that's sold out there,
(17:28):
that's five, ten, fifteen, twenty, that's just too high. So
we only need one to three milligrams of melatonin, and
there is some data that's being published now finally around
sustained release and sustain release mimics our physiology a whole
lot better, and it's keeping people asleep. So the immediate
(17:49):
release melatonin helps people fall asleep, but it's not really
helping people stay asleep. So the sustained release again is
mimicking that. How melatonin's curve stays elevated and then you
finally have a wash out period when you're waking up.
I'm you know, I'm probably going to get a lot
of shade from other sleep docs around promoting melatonin. But
(18:12):
the more research and deep dive I do, the more
I'm convinced it may be the next you know, hormone
like vitamin D. How we all came to understand that
we need vitamin D. I really think that melatonin is
part of this enhancing your your lifespan and the longevity
of you know, the just improving longevity. I really think
(18:36):
that it is a missing link because if again, if
you don't have enough melatonin, then that affects your sleep
architecture and you have more oxidative stress, So then you
have deterioration of cells at a faster, more rapid rate,
and then it just kind of builds on itself, and
by age fifty we have almost fifty percent reduction and
(19:00):
melatonin production.
Speaker 3 (19:03):
And when you look at it makes sense, right if
it's related to estrogen.
Speaker 1 (19:08):
Yeah, it starts to fall or kind of around the
same time as our progesterone starts to fall, doesn't it.
So it's like a double whammy because that progesterone is
so important for us getting to sleep as well. So
it's no wonder half the country is up at three
am in the morning haven't been unable to get to sleep.
Speaker 3 (19:24):
But you know, yes, yeah, so would that be would
that be something to add where you know I usually
will start progesterone or you know in these mid left
women who need it. So is it progesterone first versus estrogen?
You know, if they're having sleep issues, progesterones definitely to
play because of that calming affect and ability to fall asleep.
(19:45):
But it's interesting because is that keeping them asleep or
is it they need to add some of that sustained
release Lo doo smelotonin to keep them then asleep.
Speaker 5 (19:56):
So you know, progesterone. I think in the and what
I have read is that it is really helping you
with sleep onset, but it's not necessarily the maintenance of sleep, right,
It's not keeping you asleep. It is really the estrogen
component and the modulation of melatonin that is actually helping
(20:20):
sustain sleep throughout the night. So you know, what I
would say is are my approaches. If somebody comes to
me and we do this full evaluation and we start
out on hormone therapy and then you are still having
problems sleeping. After we have we feel like we've arrived
(20:42):
at the right dose right of your hormone therapy, then
I say, let's start with, you know, a deeper evaluation.
We may need to do, you know, home a sleep study,
whether or not it's in a sleep center or a
home study, that's fair game at in any part of
(21:04):
this evaluation. But when we think about supplements and medication,
I will first start hormone therapy and then if I'm
not making any headway with this sleep, then we do
a deep dive evaluation. And that's when I would say
maybe we should try melatonin. And I'd say a third
(21:25):
of my patients continue to have problems sleeping. So it's
a little combination of a lot of things. And you know,
when we think about insomnia, chronic insomnia is a specific condition, right,
and the only true successful treatment for chronic insomnia that's
been studied is kind of to behavioral therapy for insomnia,
(21:49):
and we always want to use that in concert with
whatever supplement or medication we're using. I am not a
person who prescribes medications for sleep that are prescription medications.
The fine print for every single one of those medications
(22:09):
says not to use it for more than two weeks.
Speaker 4 (22:12):
So many women are coming on sleep medications and I
you know, I tell them, I'm like, we're getting you
off that stuff.
Speaker 1 (22:20):
It's like all the time, like jellybeans, just take some TRASD.
Speaker 4 (22:25):
And they're not sleeping any better. They're not sleeping any better,
except they're complaining that they're so groggy. And you know,
the other thing that I've been seeing more and more
of and especially on social media, and I think it's
the understanding. I think a lot of clinicians don't understand
that progesterone gets you to sleep, estrogen keeps you asleep.
(22:46):
Is that I'm seeing people are just escalating on progesterone
and not estrogen, and so women are in three four, five,
six hundred milligrams of progesterone.
Speaker 5 (22:58):
I'm like, I don't know where.
Speaker 6 (22:59):
I don't say that, I don't know how they're funk
warning because I tried once to take three hundred milligrams
and it was a really bad day because I actually
went on site somewhere to do menopause hair and I
felt like my whole day.
Speaker 4 (23:15):
Like my head might as well have been inside inn HVAC.
Like I just I was like, oh God, why can't
they Like everything was like a mm, So, what do
you think about, you know, all these providers that are
just escalating on progesterone and people are walking around like zombies.
Speaker 5 (23:32):
Well, I would like them to think about the fact
that maybe they need to see a sleep specialist and
maybe somebody else needs to take a look. And you know,
it's all the nuance of care, right there's no one
just you know, easy prescription. I'm not saying that every
single person needs to be on melotonin because frankly, there's
(23:55):
a lot of you know, people will say, but I
have nightmares, because that is a side effect and for
some people it's quite dose dependent, and it could even
be a small dose that makes them have nightmares. It
should not make you feel groggy in the morning. But
to your point, I have you know, people come to
see me with loads of medication, right, They come in,
(24:19):
you know, with their three hundred dollars a month worth
of stuff, and I start talking about scaling it back,
and immediately they say no, no, no, no, I can't
sleep without it. And I have to say, now, hold on.
You came here as in a consult because you can't sleep,
so all this stuff isn't working, right. I mean, you
(24:41):
just told me you have this elaborate three hour plan
to help you get to sleep, and you're still feeling
like you're not sleeping because that's why you're here. So
these aren't working for you, right.
Speaker 1 (24:57):
I find out really interesting the way you say melatonin
is kind of released in a curve.
Speaker 2 (25:03):
I did not understand that.
Speaker 1 (25:06):
I actually thought you got a little bit of a
spike of melatonin around the time we're supposed to start
getting sleepy and ready to go to bed. So that's
so interesting that they're thinking of doing this slow release melatonin.
Speaker 2 (25:20):
Which sounds like it would suit our bodies. Much better.
Speaker 5 (25:23):
Well, it's a chronobiotic, so it's not a sleep bait,
but it is sold as a sleep bait over the counter,
so it actually starts the cascade of sleep. So it's
a pretty complex mechanism because we have these ganglion cells
in our eye that directly connect to the super chismatic
(25:45):
nucleus and then the hyperbellamus and then that then sends
a signal to the pineal gland which is behind the
third ventricle, and you know, all this stuff is happening.
So we release melatonin on our average around four or
three hours before we actually hit the pillow.
Speaker 3 (26:04):
Want the Dusty Muffins at your next event? We do panels,
live podcast and talks that bring the heat literally corporate
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up at the Dusty Muffins three three three at gmail
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Speaker 5 (26:19):
So, if we're going to take it as a supplement,
you want to take it two hours one hour before
you fall asleep. Are you intend to fall asleep? And
that is if somebody is following their circadian rhythm and
they're having trouble getting to sleep and stay and asleep. Now,
somebody needs to realign their circadian rhythm. So let's say
(26:41):
somebody who's a night owl, but they they have to
get up really early for a job. That's a totally
different story. So this is not about circadian realignment. This
is simply replacing what you have lost. We've heard that before, right,
try and right. This is replace seeing what we are
losing to help us get some sort of balance, because
(27:06):
we'll never get to that point where we were before
we lost it, but we'll get to a point where
we're at least not feeling all of the symptoms.
Speaker 1 (27:16):
And could you talk to us a little bit about
what does alcohol do to our sleep architecture.
Speaker 2 (27:21):
There's a part of me that doesn't want to know this.
Speaker 5 (27:25):
I know here we are.
Speaker 2 (27:27):
I think we need to know, we need to know.
Speaker 5 (27:30):
That's a party pooper question. Anyway, I'm with you, because
of course I cannot. I just can't handle alcohol anymore.
And so I kind of think that maybe when we
were younger, we just drank so much that we just
didn't even notice that we weren't getting any sleep, right, right,
(27:50):
And now we're better about it, but we drink just
a little too much and it just messes our sleep
up completely and then you have to make up for
you you lose an entire day. So the half life
of alcohol hits right right in the middle of people's
sleep typically, So if you're drinking alcohol in the evening,
(28:11):
you're at a party, and then you go to sleep,
you know, four hours later, which is when you're supposed
to be hitting your biggest, your biggest segment of REM sleep,
that's when it starts to cause all of this awakening
and it really interferes with REM sleep. So that's why
you think, you know, I didn't get any sleep at all,
(28:35):
even though you feel like, well, I felt like I
slept you know, a good you know, amount of time,
but it doesn't feel rested because it was disrupting your
REM sleep, which is when you know, all of the
emotional processing is taking place and the consolidation of the.
Speaker 1 (28:54):
Day has happened, and you can really feelish, can't you?
Speaker 2 (28:57):
Girls like it?
Speaker 1 (28:58):
Just you you have those wake ups thru the night
you might have been sleeping.
Speaker 4 (29:03):
Creation Yeah, yeah, So here's I know, I know everybody
wants to know this. Why Why is everybody up between
one and three? Why is it those hours.
Speaker 5 (29:16):
You know, that's a good question. I haven't really done
enough digging on why specifically it's those hours other than
kind of connecting dots, and so those dots would be
you know, is that when we don't have enough melatonin
production that it's not sustaining sleep. Is that when our
(29:37):
body then got used to it developed like a new
highway in the brain when we were having this dysregulation
from a reduction in hormones. You know, if you're talking
about midlife, right, it did our body then accommodate, right
and say, well, we know we're going to wake up anyway.
So I'm just learning this new pathway and I'm anticipating
(29:59):
even and though it's over, I've learned a new pathway
and I'm just going to stick with it. And you
have to remind you have to retrain your brain. You
have to tell it you can, you can get rid
of that pathway. Now, that's where cognitive behavioral therapy comes
in for insomnia, that you have to retrain it. You
have to say, nope, I want you to start using
(30:22):
the original pathway when I was actually getting better sleep.
That's the neurological pathway. I need you to start using
I want you to forget about this learned pathway that. Yeah,
so that's that's why there's all this you know, controversy
around medications versus kindative behavioral therapy for insomnia. But simply,
(30:45):
we just really haven't done enough research on melatonin. And
it's scary, just like it was, just like vitamin D was.
You know, I remember when vitamin D started, you know,
hitting the scene as a necessary hormone, and there were
or some naysayers, and you know, it was there was
all this initial controversy, and it was simply because we
(31:06):
didn't have enough data around why why is it that
we need to replace it? Why is it that we
need vitamin D? And and you know, melatonin is a hormone.
It's not it's not a it's not a mineral, it's
not a you know, it's it's a hormone. It's it's
hitting a lot of different things in our body. Yeah.
Speaker 4 (31:28):
One of the things I found really interesting when I
was doing some research on osteoporosis is that three milligrams
of melatonin is good for both yes, Yeah, which once
I found that out, I felt a lot less guilty
about all the melatonin.
Speaker 5 (31:43):
I think I don't want to know how much money released.
Speaker 4 (31:46):
Now it just goes so I fall asleep.
Speaker 3 (31:53):
Can we touches a sec on that? Magnesium particularly, I
think it likes me, although I do the three and
eight at night.
Speaker 5 (32:00):
I don't know aviation. But but you.
Speaker 3 (32:02):
Know, there's a lot a lot of talk around that
the different types of magnesium, which you know, are good
for different things. And I will have women that come
to me they're like, I started magnesium glass, I sleep great.
Speaker 5 (32:16):
I'm like, okay, yeah, I mean it enhances relaxation, muscle relaxation.
You know, that's all about the the electricity, you know,
like your positive and negative ions and that that's really
the focus on magnesium. And yes, there's different types of magnesium.
But honestly, there sometimes people will say, well, I've I
(32:39):
started on this one and it works. I'm like, great,
I'm not going to change it, you know, but yes,
the data is is out that yes, magnesium place and
is the one to go. And that's uh, you know,
that is a it's a compound, right, So it's so
that is that is the one that tends to be
(33:01):
the most active in terms of relaxation centers to help
you actually then get into falling asleep, so it helps
with getting to sleep, it doesn't necessarily help sustain asleep.
So that's the thing.
Speaker 3 (33:16):
Right, So it's still the calming effect.
Speaker 5 (33:18):
It's it's really the calming effect. And it's so low
you know. I mean it's water soluble, so you know,
you take a little too much, you might have diarrhea.
But okay, I take a megsic.
Speaker 2 (33:34):
You need it.
Speaker 5 (33:35):
That's you know, that's you need it. But no, that's
what I always would tell. That's what I tell people.
You know, Calcium constipates, magnesium makes you move, right.
Speaker 1 (33:48):
I tell my patients. And when the when the bottom
is falling out of your world, take maxit trate and
let the world fall out of your bottom.
Speaker 5 (34:00):
Oh my gosh, I've never heard that.
Speaker 2 (34:01):
That's I love it. That's a cute little in the
mone Oh.
Speaker 3 (34:07):
And then I did promise my patient why do we dream?
Speaker 5 (34:11):
Do we?
Speaker 3 (34:11):
I know this is that it may not be a
quick explanation, but she's like, why why do we dream?
So I said, well, I have just a person on
our podcast.
Speaker 5 (34:19):
Well, ramsleep is really important for emotional regulation and that's
why we dream. So when we are in ramsleep, that's
when we're doing majority of dreaming. There is some data
that's coming up that's some like your deep stage of sleep,
which is and three. You may have some but you know,
I'm not convinced yet because there's not enough data. Right,
(34:42):
So but and three or you're slow wave sleep. Or
for people who use wearables, right, because almost everybody has
a ring or a watch or something. So something on
your body is called a wearable, something that you put
next to you or that you sleep keep on. Because
a lot of people use their phone, right, that's called
(35:04):
a nearrable. It's not as accurate. And in fact, the
most accurate wearable is only seventy five percent accurate. So
I think it's okay for trends. I don't think that
it's fabulous for it's not. It hasn't hit the market
for diagnostic testing yet, right, but slow waste. So when
(35:29):
you think about sleep, you know, and I and I
now describe it based on how people are looking at
their their data. Right. So you have light sleep, deep sleep,
and rem sleep. And so your deep sleep is the
physical restoration. That's where all of the physical components are are.
(35:51):
You know, that's when your growth hormone is released. That's
when you're repairing physical health and doing some memory consolidation.
But rampsleep is really all about emotional regulation and consolidation
of memory. That's why you're dreaming a lot. A lot
of times there's things that have happened in the day
(36:13):
where things that are going to happen that you end
up dreaming about. And you do not have to remember
your dreams to dream. I mean to know that you
are dreaming, right. So a lot of people will come
to me and say I haven't dreamt for two years,
and I would say, well, then you would not be
alive talking to me, like you in order to survive,
(36:34):
you have to dream.
Speaker 3 (36:36):
So that's so interestacinating stuff.
Speaker 2 (36:39):
I think dreaming is fascinating.
Speaker 1 (36:40):
Yeah, I would just like if last of my dreams
were about open water and fish? About what open water
and fish?
Speaker 3 (36:47):
Ye? I don't like to dream. Running Are you flying?
I'm running like away from people, like in circles, like
trying to go and run away from someone like and
then you wake up Mike.
Speaker 1 (37:03):
Christine, Wait a second, are you flying like?
Speaker 2 (37:07):
Wonder like you're yourself super girl? Jump in my god.
Speaker 4 (37:13):
I don't know what that means.
Speaker 2 (37:14):
That's that's rough something that.
Speaker 5 (37:16):
That might mean, you know, kind of goes with the
with the concept that you're building the plane as you
fly it. So maybe you're building something pretty cool. Maybe
something's happening.
Speaker 1 (37:31):
She she's building lots of things, as long as they
don't just fall.
Speaker 3 (37:36):
Yeah, or when you trip, when you trip and then
you wake yourself up.
Speaker 4 (37:44):
Yeah, isn't that fascinating? We all dreams a little bit different.
Speaker 5 (37:49):
When people When people have sleep APNA that isn't diagnosed,
one of the classic dreams is that they're underwater that
they can't breathe. That's are you know, struggling to to
get out of you know, from underwater.
Speaker 2 (38:08):
Yes, that makes sense because you're a.
Speaker 3 (38:12):
Little bit more about that.
Speaker 4 (38:13):
Yes, any advice on sleep testing, you know, I think
sometimes people are apprehensive about going you know, I know
there's you know, you could do home study. Let me
ask this question, who is a good candidate who needs
to be in office versus home study? And what are
(38:35):
some advice about getting yourself through it? If it makes
you a little anxious thinking about people watching you sleep.
Speaker 5 (38:43):
Wow, Okay, so you know home study versus in the
sleep center sleep study. There are specific clinical indications if
somebody needs to be in a sleep center. So if
maybe you have a lotung disease or heart disease or
(39:04):
a neuromuscular disorder, you know, like people who have als,
they just need to have an in the sleep center
sleep study, even if they don't really have any symptoms
quite yet, right, because they have a tendency to hypoventilate
and they don't realize it when they're sleeping. People who
are very symptomatic and they have a negative home sleep
(39:26):
study should have an in lab sleep study. And you
know that's really important because women tend to have a
higher false negative rate, and so you know, really we
should be doing we should figure out a way to
refine testing so that people can either do it in
(39:46):
their home. And there are certain levels of testing, so
everybody knows about the in lab testing versus the home
sleep testing. In lab testing is called a type one study,
a home study is called a type three. But there
is one in between that you can still do at home,
called a type two. And the reason why they're not
as popular is because they pay out the same as
(40:07):
the type three, so you're not getting more, you know,
so there's a reason why. But it does capture more data.
All this to say, women have a higher false negative
rate because again they tend to have REM related sleep apnea.
We can't really capture rem as accurately as we can
(40:28):
in an in lap study as we can in a
home study and other some home studies that are really
touting the fact that they can capture all stages of sleep,
and that's cool, that's great, but they still have a
higher false negative rate, especially when it comes to women,
because again, women tend to have lower levels of sleep apnea,
(40:49):
so we might not catch at all. So you know,
there's this endless debate. Should we do one night, should
we do two nights? Should we do three nights? And
I really think the more that I've been reading about
it because I practice one particular way, because that was
the constraints of a practice right where everybody got one night.
If it was negative, we'd you know, lobby with the
(41:09):
insurance company to do a second home night, or we'd
bring them into the sleep lab if their insurance allowed
us to write, because you know, insurances don't really care
what we think. So now in my own private practice,
I'm probably going to do a multi day home study
because I think that you get better data that way,
(41:31):
and then you can really see what's happening in a
person's night. And I'm looking at home devices that really
have information specific to data around women to outcome data
around women. And again that's because they have a mild
(41:54):
sleep apnea for the most part, but it is severe
during rem sleep more so not everybody, but that tends
to be the pattern and you don't always capture that
on a home study. So I've had many women come
to me and say, well, I was told I didn't
have sleep apnea. So then I evaluate all the data
and say, you know what, let's do it again, but
(42:14):
we're going to do it this way, and then we
capture it and maybe you know, atnia hypopnia index is
just one way. That's that's one type of sleep apnea,
you know. And of course all the studies are done
mostly on guys, right, but you know, I'm convinced that
there are other phenotypes of sleep apnea that we have
yet to discover that might be really you know, gender specific,
(42:40):
but we're not looking for those because we we can't
get treatment covered for those.
Speaker 1 (42:50):
And it's so important, especially the way so many of
the studies are done on men compared to women.
Speaker 2 (42:55):
So I love that you're going to focus on that.
Speaker 1 (42:57):
You're opening your own practice here in Oregon at the
end of the summer, right, will you tell us a
little bit about that.
Speaker 2 (43:03):
I'm going to be your first patient. Will you tell
us a little bit about that?
Speaker 1 (43:06):
And also where our listeners can find you on social
media and the internet.
Speaker 5 (43:13):
Yes, so I will be opening up my private practice
where we will everybody gets to go through the Dream
Sleep method, and you know, you get a plan, a toolkit,
you may get a sleep study. Not everybody needs a
sleep study. And you know, just a little bit more
(43:33):
about that, there aren't any really great screening tools for
women to see whether or not somebody's at high risk
for sleep ATNA. I mean the stop bang that is
used widely. One of the questions the G is what's
your gender? Okay, so if you're a guy, if you're
a woman, you already have minus a point and that
(43:57):
could have been the threshold to get you a sleep study. Right, So,
I we have yet to find a really great screening tool,
especially for women around ruling in high you know, pretest
probability for sleep ATNA. But yes, so I will be
doing I will have a private practice. I'm working on
(44:21):
having in person one day a week and then the
rest would be virtual. Typically that would be follow up
visits virtually, and and that's going to be happening at
the end of the summer. And I forgot what else
you ask me?
Speaker 1 (44:38):
That's exciting?
Speaker 2 (44:40):
Where they are you?
Speaker 5 (44:41):
Oh? Yeah, my website. So I'm Sleep Goddess MD. I
love love Greek mythology and so that's you know, that's uh,
that's what I want for everyone. I want everyone to
sleep like a goddess.
Speaker 1 (44:58):
I love that. Thanks for joining us day today. It's
been such a pleasure to have you.
Speaker 5 (45:05):
Thank you for having me. This is fun.
Speaker 2 (45:08):
Yeah, we're so happy to meet you.
Speaker 4 (45:10):
Finally.
Speaker 1 (45:11):
Yes, So for all our listeners, follow doctor Mattsimura online
and if you're living in Oregon, you can start to
see her at the end of the summer.
Speaker 5 (45:21):
All right, Thanks,
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