May 7, 2025 • 21 mins
Waking up during the middle of the night is so annoying and frustrating. There are a few different angles you can use to come up with solutions for your middle of the night awakenings. Here they are.
Take My Udemy Course: The Basics of Bioidentical Hormone Replacement Therapy
DIY Cognitive Behavioral Therapy For Insomnia Book: Calm Your Mind and Get to Sleep
Find a Cognitive Behavioral Therapy For Insomnia Proivder near you: https://cbti.directory/
Dr. Ashley Mason, CBT-I practitioner
Are you ready to give your cells their best chance to not have to stop living before they die by allowing them access to physiologic levels of hormones, but aren't sure how to even get started? Join the waitlist for my new beta program here and help me figure out how best to help wonderful women like you get the hormone care they deserve!
Come visit me: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
Take My Udemy Course: The Basics of Bioidentical Hormone Replacement Therapy
DIY Cognitive Behavioral Therapy For Insomnia Book: Calm Your Mind and Get to Sleep
Find a Cognitive Behavioral Therapy For Insomnia Proivder near you: https://cbti.directory/
Dr. Ashley Mason, CBT-I practitioner
Are you ready to give your cells their best chance to not have to stop living before they die by allowing them access to physiologic levels of hormones, but aren't sure how to even get started? Join the waitlist for my new beta program here and help me figure out how best to help wonderful women like you get the hormone care they deserve!
Come visit me: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Waking up during the middle of the night is so
annoying and frustrating. There are a few different angles you
can use to come up with solutions for your middle
of the night awakenings. Here they are. You're listening to
the Health Courage Collective Podcast, Episode two hundred and one,
When you wake up during the Night and three Ways
to Fix It. Welcome to the Health Courage Collective Podcast,
(00:27):
the show for women who are too busy to slog
through hours of generalized, in applicable, and often contradictory health information,
but too smart to ignore that a few minutes of
focused attention now can prevent years of suffering in the future.
I'm your host, Christina Hackett, a pharmacist who doesn't want
you to live on prescriptions, a certified coach specifically trained
to maximize your potential, and a compulsive learner obsessed with preventative,
(00:52):
cutting edge, holistic and integrated medicine. I'm on a mission
to increase your physical and mental resilience so you can
fearlessly look forward to your next forty plus limitless years.
Your time is now. Let's go, Hi, my friend, and
welcome to another episode. I'm so happy you're here today.
How is your thinking framework working to help you age
(01:15):
at an elite level? If you think through things in
a way that serves you, you can simultaneously be non
overwhelmed and age at an elite level, create an exceptional future,
and enjoy yourself. Right now, if you watched the lessons
and filled out the workbook that went along with last
week's episode, you're already pointed in the right direction. Today,
(01:39):
we're going to talk about waking up during the night annoying. Right.
I've always been pretty intolerant of not sleeping well, so
I get super annoyed when I wake up before I'm
ready and I can't get back to sleep. I'm not
a sleep expert, but I learned some interesting things from
someone who is. She's a world class sleep expert who
leads the Sleep Eating and Affect Laboratory CSF. Her name
(02:01):
is Ashley Mason. She does what's called CBTI, or cognitive
behavioral Therapy for insomnia. CBTI is incredibly effective, way more
effective than any other therapy type modality. The right CBTI
therapist can fix almost anyone's insomnia, So if you or
(02:23):
someone you know suffers from insomnia, it can probably be
remedied with CBTI, which is way cool. Not sleeping well
is an all day problem with big, potentially life threatening effects.
Ashley Mason explains that there are two systems at work
to get your body to produce sleep. She's the leading
expert in this field, and I am most definitely not.
(02:44):
But I'm going to be so presumptuous as to add
one and say that there are three systems that we
can work through to fix sleep in general. But today
we're going to focus on middle of the night awakenings
because people ask me about that a lot. What she
says is that there are two systems seem like they
would be intertwined, but they're actually independent of one another.
(03:04):
One is sleep pressure, which comes from a dentisine building
up in your brain throughout the day. The other is
circadian biology melatonin production and such. When you're on a
normal sleep and wake cycle. Those two do line up,
but one is not dependent on the other, which I
think is super interesting. So you can manipulate either of
(03:26):
those two systems to produce sleep, which cognitive behavioral therapy
or insomnia does. The third system that I'm going to
add is what i'll call this psychological system. This is
a big part of why people wake up during the
middle of the night, and CBTI has specific interventions to
help with psychological sleep impediments, so I'm including it as
another avenue to use to create improvement. Sound good. I
(03:50):
believe that thinking of sleep problems in these three different
categories will help you come up with better solutions or
ideas of what to try. I always love having what
I believe is a clear and useful way to think
through problems in a logical and orderly way. And obviously,
if there are obvious reasons you're being woken up, then
fix those things first. Shut off the power to your
(04:12):
neighbor's house, disable their car engine, put your dog up
for adoption, I mean, whatever it takes. Or get your
plugs in a white noise machine. But that's not as fun. Okay,
let's start with manipulating system three point five. You know
that during the perimenopausal years, your hormones start having some
wild swings. Those fluctuations can absolutely mess with your sleep.
(04:34):
Progesterone is the main one I think of because it's
so important for sleep, and often just getting progesterone levels
steady and back to physiological levels is enough. But fluctuations
of all of the other levels also cause sleep disturbances,
especially if sudden drops in estrogen are causing night sweats.
So working with an experienced expert to get your hormone
(04:55):
levels back in the friend zone can be a game changer.
I'm a fan of bioidown hormone replacement therapy. I see
its effects daily. But that doesn't mean that you have
to be You should decide whatever feels good to you.
But I do think you deserve to feel good in
your body and enjoy this time of your life. If
you're curious about the basics of what bioidical hormone replacement
therapy even is, I have a super cheap view to
(05:16):
me course you can take to learn enough to see
if you think it's worth pursuing. I could happily talk
about it forever, but that's all I'll say for today.
Especially if your sleep problems seemed to come out of
nowhere in your forties, your hormone levels are likely playing
a role, maybe a leading role, maybe the doodagonist. Do
(05:36):
you know what that term is? You're smart, so you
probably do, but I had never heard of it before.
I've been reading a book about writing fiction, which I've
really loved, even though I don't write fiction and I
don't really plan to. Plus, it's written by someone who
lives in Taylorsville, Utah, which is where I grew up,
so I feel like I should know her, even though
I don't. Anyway, I learned about a douteragonist that's the
(05:57):
second main character after the protagonist, but however they rank.
I'm sure your hormones are playing some kind of role
in the nightly drama of your sleep. Okay, so let's
backtrack to system number one. Sleep pressure. A dnosine causes
what we call sleep pressure. It builds up and builds
up throughout the day as it's supposed to, until we
(06:17):
feel the unmistakable siren song of our pillow at night.
You know what that feels like, right. A lot of
what cognitive behavioral therapy for insomnia works on is properly
building up enough sleep pressure to be able to produce
sleep at bedtime, especially in the early weeks of therapy.
Definitely check out the links I'll put in the show
notes for CBTI. If your problem is falling asleep, I
(06:41):
think of sleep pressure as more involved with being able
to get to sleep in the first place, but that's
not all it is. You want to have just the
right amount of a dentisine pressure that you can easily
fall asleep and stay asleep when bedtime comes around. Some
interventions that will help you build up that sleep pressure
are to not have any caffeine at all, and include
from decaf coffee after eleven o'clock am. I'm sure you've
(07:03):
probably heard before that caffeine doesn't wake you up. It
just blocks the a dentosine receptors from receiving a dentosine,
so it prevents you from feeling tiredness. And caffeine can
stick around on those adentisine receptors of your brain for
longer than you think, so a caffeine cut off of
eleven o'clock am will make sure you get enough sleep
pressure at bedtime. Another intervention during treatment for insomnia is
(07:26):
to not allow yourself to take any naps. If you
don't have sleep problems, they're not inherently bad, but taking
a nap deflates the balloon of that build up of
a dentisine pressure, and it might prevent you from having
enough sleep pressure at bedtime, especially if it's late in
the afternoon or if it's longer than forty five minutes.
Something that I haven't heard sleep experts like Ashley talk about,
(07:47):
but has been shown to increase a dentisine pressure in
a good way is exercise. Demanding that your body do
some physically exhausting stuff during the day can help you
feel appropriately tired and ready for sleep at bedtime, but
you shouldn't exercise too close to bedtime. Sleep pressure it's
a good thing when it happens in an appropriate amount
(08:08):
and culminates at the correct time of night. Learning how
to manipulate it to your advantage can help you get
better sleep all right. The second system we can work
through is the circadian rhythm system. This is a lot
of what you hear about around quote sleep hygiene, and
it's important. Our bodies definitely operate in rhythms or cycles.
(08:28):
We have Oltradian rhythms, circadian rhythms, and Infridian rhythms. I
find them very fascinating. Oltradian rhythms are about ninety minutes long.
When we're operating at a high level, we still need
some kind of break in focus or a physical break
or other positive disruption every ninety minutes to keep us
going without a break of some kind. Every ninety minutes,
our performance starts to wane. Infridian rhythms are our different
(08:52):
lengths longer than twenty four hours, most commonly the approximately
twenty eight day Infridian rhythm called the Instrull cycle. Life
is better when you work with and respect the power
of these natural rhythms. Circadian biology is fascinating because there
are optimal times of day for all kinds of things. Obviously,
(09:13):
we're made to sleep when it's dark and work when
it's light. Our natural production of melatonin is a big
asset to our ability to sleep well, and that's affected
by light, light that gets into our eyes, and even
light that lands on our skin. I'm sure you probably
know by now not to let blue light or even
white light into your eyes an hour or two before bedtime.
(09:34):
Light is extremely important to be able to sleep. It's
also possible that you're waking up in the night because
there's light in your room from an alarm, clock, thermostat,
air purifier, smoke detector, teddy ruckspin If so, turn those
off or cover them with black electrical tape and use
blackout curtains, street lights, headlights, moonlight early summer sunlight. Those
(09:55):
can all wake you up too. Use an eye mask
if you find it comfortable, which I don't. Just make
sure that you're in darkness all night long. Next time
you wake up in the middle of the night, have
a look around and notice if you see any lights
at all, no matter how small, and make a plan
to remove them all the next day. As it turns out,
there are optical times for our circadian rhythm to do
(10:18):
all kinds of things exercise, take medication, eat, learn, work, etc.
It's very interesting, So if you're waking up in the
middle of the night, it could be related to the
times of day that you did things like take your
medication earlier that day. Generally, the more consistent you are,
the better you can. For sure get the circadian rhythm
(10:38):
aspect of your sleep on your side by being as
boring and predictable as possible. Being boring produces a lot
of great health results. Waking up at the same time
every day, getting natural sunlight the first thing every morning,
eating at the same times of day every day, even
pooping at the same time of day is helpful. Sheldon
Cooper was onto something with his scheduling. His bowel movements
(11:01):
to operate like a German train schedule. An important part
of our circadian biology that really helps us sleep well
is temperature control or thermoregulation. It's important that our core
body temperature drop while we're asleep, so making sure you're
in a cool room can definitely help you stay asleep.
(11:22):
It could be that you're waking up during the night
because it's too hot for you to sleep deeply, especially
if your progesterone levels are lower than they used to be,
so you don't sleep as well in general, and your
estrogen levels are fluctuating. Rapid drops and estrogen levels can
cause caught flashes and night sweats. The optimal sleep temperature
is sixty to sixty seven degrees, so do what you
(11:44):
can to get your room about that temperature. There are
awesome companies now that make smart devices to control the
temperature of your bed instead of your whole room or
whole house. I've wanted one for years, but they're pretty expensive,
like two thousand dollars for a mattress cover, so I
haven't gotten that far yet. But they're great and I
still have one on my wish list. Even without a
bed cooling device, there's a lot you can do to
(12:06):
prevent waking up due to suboptimal body temperature. I hate
being hot at night. Well, I hate being hot in general,
and I really hate being hot at night. But I
can't fall asleep if my feet are cold. So for
the past ten years or so, I've been falling asleep
with a cheap, little small heating pad on my feet
for the first fifteen minutes or so, and I think
it's fabulous. It warms up just my feet for about
(12:28):
fifteen minutes, and I fall asleep and the rest of
me stays cool. Then when I heard doctor Mason say
to do that during her Best Sleep Secrets, I was like, aha,
I already figured that one out. But something she mentioned
as especially important for women who wake up during the
night is to never use a duvet or a comforter
or a bedspread. Only one hundred percent cotton blankets because
(12:51):
they're more breathable. I have a rotating list of items
that we don't need to get into that I use
on my bed depending on this season. But I immediately
switched to a one hundred percent cot blanket when I
learned that, because it was the spring, so that was
the right time for my plan, and so far it's
been really great. There are a few other things you
can do to appropriately lower your body temperature, like take
a sauna or a hot bath or hot shower a
(13:13):
couple of hours before bedtime, and wear loose fitting, breathable sleepwear. Also,
caffeine and alcohol both jack up your sleep in other ways,
but they can increase your core body temperature too, as
does eating too close to bedtime. For at least one
hundred reasons, you shouldn't be eating within a few hours
of bedtime four hours if possible, one of which is
that it raises your core body temperature. We've discussed some
(13:36):
of the other ninety nine reasons in other episodes. Lastly,
there's the psychological system. Sometimes you wake up in the
night and ruminate or worry. Cognitive behavioral therapy says that
if you spend a lot of time awake in the
middle of the night to get out of bed and
do something marginally interesting and non productive, like color and
a coloring book or watch an episode of a ho
(13:58):
hum TV show, you don't have to do something you hate,
but it should not be something that you love or
look forward to, or is valuable or productive or stimulating.
Like social media or YouTube, or work work or housework,
anything like that. The reason for this is that it's
really important that you teach yourself that your bed is
for sleeping, not for the torture of staring up at
(14:19):
the ceiling for hours, or for watching TV or working
or doom scrolling or any other type of scrolling. Not
for checking the news or sports scores, or crafting or eating,
or party planning or building lego sets or doing your taxes.
There's something psychologically important about knowing in your body that
when you lie down in bed, it's to sleep, not
(14:42):
to learn knife throwing techniques or to refine your thinking
about tariffs. If you don't frequently spend large amounts of
time awake in bed in the middle of the night,
I like what my coach instructor Brian Johnson suggests to
see those times as opportunities to meditate. When you're awake
and would rather not, you can seize the opportunity to
(15:02):
get some extra meditation minutes in practice getting better at
whatever you normally do. To meditate, focus on your breath
and nothing else. See your thoughts flow past you like
leaves drifting down a stream. Go through a guided meditation
script that you have memorized. Whatever, it's a useful way
to buff up your meditation muscles. You can also try
(15:24):
a body scan slash relaxation, where you focus all of
your attention on tightening up one body part and then
letting it completely relax, and then moving on to the
next body part, usually starting with your feet, and then
your ankles, then your lower legs, et cetera, until you
get to your face. That's a great way to practice
maintaining focus but also feeling pleasantly relaxed. I'm weird, as
(15:47):
you already know, and somewhere along my journey of life,
I developed the habit of doing something similar tighten and relax,
and then imagining that body part melts or dissolves down
into the bed and I slowly stop existing. I find
it helpful if you can't control your thoughts and you
always wake up worrying. There are two CBTI techniques that
(16:08):
are usually not introduced till several weeks into treatment that
you might find useful. If you wake up and spend
a lot of time worrying about all kinds of things,
try this scheduled worry time. You can keep a pen
and paper next to your bed. If you're worried you'll
forget what to worry about. What you do is schedule
(16:28):
a time every day that is absolutely set in stone.
During that time, you worry about all of your life's problems.
So keep a running list. Whenever you start to worry
or think of something worth worrying about, write it down
on your list and know for sure that you will
indeed worry about that later. You're not ignoring it, you're
(16:49):
just scheduling it at your next specified scheduled worry session. Then,
when four fifteen comes around or whatever time you set,
get out your list and really do you a thorough
job of worrying about all of the items on your list.
It's a good way to dismiss worry thoughts with confidence,
knowing that they will be dealt with. This could also
(17:10):
work for just to do items. Sometimes we have things
that we don't necessarily need to ruminate or wring our
hands over. We just don't want to forget to do
something important. Write it down somewhere you're one hundred percent
sure you'll come back to it later. Then you can
dismiss it and go back to melting until you don't exist.
The second CBTI technique is for people who wake up
(17:31):
worrying about the same thing every time. For them, it's
useful to schedule several fifteen or thirty second time periods
every day to write down how much they believe that
thought that they worry about in the middle of the night.
Ashley Mason gave this example of a real patient of hers,
and I think it's a perfect example, so I'll just
repeat it. She had a patient who had multiple sclerosis
(17:53):
who would wake up every night thinking, I'm never going
to be able to make it through the day. That
was her one worry thought every night. She sounds like
a wonderful and strong woman who had more to deal
with than most people. Doing everyday things that the rest
of us take for granted was extremely difficult for her.
Doctor Mason had her write down like six times a
(18:13):
day or something how much she believed the thought I'm
never going to make it through the day. In the
middle of the night, she believed it ten out of ten.
In the early mornings, she believed it nine out of ten,
and every single day, as the day progressed, she believed
that thought less and less until her last check in
at the end of the day when she didn't believe
(18:35):
it at all, because she did in fact make it
through the day, and more often than not, it wasn't
as bad as she was anticipating. Doing that exercise taught
her that she didn't actually believe the thought, and realizing
that helped her get out of its grip in the
middle of the night until eventually it faded away as
her reason to wake up. Your worry thought might be different,
(18:57):
but doing some kind of thought work several times throughout
the day can help you get a better handle on
it so that you can control it instead of the
other way around. It might take some time, and you
might even need someone else to help you, but conscious
and intentional work throughout the day really can dissolve a
recurrent worry thought that's keeping you up at night. Don't
just try to dismiss it. Work with it. There's always
(19:20):
a ton more to talk about about sleep, but I
hope understanding these three separate sleep systems can help give
you an idea of how to tackle your middle of
the night awakenings. Your hormone levels, the sleep pressure system,
the circadian rhythm system, and the psychological system. I know
it can be so frustrating to want to sleep, and
(19:43):
to know how important sleep is to your overall well being,
and to still wake up in the middle of the night.
If you struggle with sleep more than a little bit,
and you've already tried everything you can think of, consider
seeing a cognitive behavioral therapy for insomnia provider or listening
to one and describe what they do, and then following
the steps of the treatment to the letter, either via
(20:05):
an app or there's a book describing the approach. I'll
put links in the show notes to Rachel Mason and
to the name of the book she recommends in a
couple of apps that work this way. She says the
only problem with the DIY approach is that people usually
think that their sleep problem is different or a special case,
so they don't follow it to the letter. But if
you do follow it with exactness, it'll work. The main
(20:29):
advantage of working with a provider is that you're more
likely to follow the program precisely, which is why it's
more likely to work. Interesting. Thank you so much for
being here today. You are awesome. Next week we're going
to talk about how to make your healthy choices automatic.
Until then, use the three sleep systems to stay asleep
all night long and don't be normal. Thank you so
(20:50):
much for tuning into the Health Courage collective podcast. I
am truly honored that you have paid me the enormous
compliment of your time and attention. I would be so
grateful if you would share this podcast with someone you
know and subscribe so you never miss an episode. This
podcast is for entertainment and information purposes only. Statements and
views on this podcast are not medical advice. This podcast,
(21:11):
including Christina Hackett and producers, disclaim responsibility for any possible
adverse events by use of information contained here it. If
you think you have a medical problem, consult a Licensed
Positions
Waking up during the middle of the night is so
annoying and frustrating. There are a few different angles you
can use to come up with solutions for your middle
of the night awakenings. Here they are. You're listening to
the Health Courage Collective Podcast, Episode two hundred and one,
When you wake up during the Night and three Ways
to Fix It. Welcome to the Health Courage Collective Podcast,
(00:27):
the show for women who are too busy to slog
through hours of generalized, in applicable, and often contradictory health information,
but too smart to ignore that a few minutes of
focused attention now can prevent years of suffering in the future.
I'm your host, Christina Hackett, a pharmacist who doesn't want
you to live on prescriptions, a certified coach specifically trained
to maximize your potential, and a compulsive learner obsessed with preventative,
(00:52):
cutting edge, holistic and integrated medicine. I'm on a mission
to increase your physical and mental resilience so you can
fearlessly look forward to your next forty plus limitless years.
Your time is now. Let's go, Hi, my friend, and
welcome to another episode. I'm so happy you're here today.
How is your thinking framework working to help you age
(01:15):
at an elite level? If you think through things in
a way that serves you, you can simultaneously be non
overwhelmed and age at an elite level, create an exceptional future,
and enjoy yourself. Right now, if you watched the lessons
and filled out the workbook that went along with last
week's episode, you're already pointed in the right direction. Today,
(01:39):
we're going to talk about waking up during the night annoying. Right.
I've always been pretty intolerant of not sleeping well, so
I get super annoyed when I wake up before I'm
ready and I can't get back to sleep. I'm not
a sleep expert, but I learned some interesting things from
someone who is. She's a world class sleep expert who
leads the Sleep Eating and Affect Laboratory CSF. Her name
(02:01):
is Ashley Mason. She does what's called CBTI, or cognitive
behavioral Therapy for insomnia. CBTI is incredibly effective, way more
effective than any other therapy type modality. The right CBTI
therapist can fix almost anyone's insomnia, So if you or
(02:23):
someone you know suffers from insomnia, it can probably be
remedied with CBTI, which is way cool. Not sleeping well
is an all day problem with big, potentially life threatening effects.
Ashley Mason explains that there are two systems at work
to get your body to produce sleep. She's the leading
expert in this field, and I am most definitely not.
(02:44):
But I'm going to be so presumptuous as to add
one and say that there are three systems that we
can work through to fix sleep in general. But today
we're going to focus on middle of the night awakenings
because people ask me about that a lot. What she
says is that there are two systems seem like they
would be intertwined, but they're actually independent of one another.
(03:04):
One is sleep pressure, which comes from a dentisine building
up in your brain throughout the day. The other is
circadian biology melatonin production and such. When you're on a
normal sleep and wake cycle. Those two do line up,
but one is not dependent on the other, which I
think is super interesting. So you can manipulate either of
(03:26):
those two systems to produce sleep, which cognitive behavioral therapy
or insomnia does. The third system that I'm going to
add is what i'll call this psychological system. This is
a big part of why people wake up during the
middle of the night, and CBTI has specific interventions to
help with psychological sleep impediments, so I'm including it as
another avenue to use to create improvement. Sound good. I
(03:50):
believe that thinking of sleep problems in these three different
categories will help you come up with better solutions or
ideas of what to try. I always love having what
I believe is a clear and useful way to think
through problems in a logical and orderly way. And obviously,
if there are obvious reasons you're being woken up, then
fix those things first. Shut off the power to your
(04:12):
neighbor's house, disable their car engine, put your dog up
for adoption, I mean, whatever it takes. Or get your
plugs in a white noise machine. But that's not as fun. Okay,
let's start with manipulating system three point five. You know
that during the perimenopausal years, your hormones start having some
wild swings. Those fluctuations can absolutely mess with your sleep.
(04:34):
Progesterone is the main one I think of because it's
so important for sleep, and often just getting progesterone levels
steady and back to physiological levels is enough. But fluctuations
of all of the other levels also cause sleep disturbances,
especially if sudden drops in estrogen are causing night sweats.
So working with an experienced expert to get your hormone
(04:55):
levels back in the friend zone can be a game changer.
I'm a fan of bioidown hormone replacement therapy. I see
its effects daily. But that doesn't mean that you have
to be You should decide whatever feels good to you.
But I do think you deserve to feel good in
your body and enjoy this time of your life. If
you're curious about the basics of what bioidical hormone replacement
therapy even is, I have a super cheap view to
(05:16):
me course you can take to learn enough to see
if you think it's worth pursuing. I could happily talk
about it forever, but that's all I'll say for today.
Especially if your sleep problems seemed to come out of
nowhere in your forties, your hormone levels are likely playing
a role, maybe a leading role, maybe the doodagonist. Do
(05:36):
you know what that term is? You're smart, so you
probably do, but I had never heard of it before.
I've been reading a book about writing fiction, which I've
really loved, even though I don't write fiction and I
don't really plan to. Plus, it's written by someone who
lives in Taylorsville, Utah, which is where I grew up,
so I feel like I should know her, even though
I don't. Anyway, I learned about a douteragonist that's the
(05:57):
second main character after the protagonist, but however they rank.
I'm sure your hormones are playing some kind of role
in the nightly drama of your sleep. Okay, so let's
backtrack to system number one. Sleep pressure. A dnosine causes
what we call sleep pressure. It builds up and builds
up throughout the day as it's supposed to, until we
(06:17):
feel the unmistakable siren song of our pillow at night.
You know what that feels like, right. A lot of
what cognitive behavioral therapy for insomnia works on is properly
building up enough sleep pressure to be able to produce
sleep at bedtime, especially in the early weeks of therapy.
Definitely check out the links I'll put in the show
notes for CBTI. If your problem is falling asleep, I
(06:41):
think of sleep pressure as more involved with being able
to get to sleep in the first place, but that's
not all it is. You want to have just the
right amount of a dentisine pressure that you can easily
fall asleep and stay asleep when bedtime comes around. Some
interventions that will help you build up that sleep pressure
are to not have any caffeine at all, and include
from decaf coffee after eleven o'clock am. I'm sure you've
(07:03):
probably heard before that caffeine doesn't wake you up. It
just blocks the a dentosine receptors from receiving a dentosine,
so it prevents you from feeling tiredness. And caffeine can
stick around on those adentisine receptors of your brain for
longer than you think, so a caffeine cut off of
eleven o'clock am will make sure you get enough sleep
pressure at bedtime. Another intervention during treatment for insomnia is
(07:26):
to not allow yourself to take any naps. If you
don't have sleep problems, they're not inherently bad, but taking
a nap deflates the balloon of that build up of
a dentisine pressure, and it might prevent you from having
enough sleep pressure at bedtime, especially if it's late in
the afternoon or if it's longer than forty five minutes.
Something that I haven't heard sleep experts like Ashley talk about,
(07:47):
but has been shown to increase a dentisine pressure in
a good way is exercise. Demanding that your body do
some physically exhausting stuff during the day can help you
feel appropriately tired and ready for sleep at bedtime, but
you shouldn't exercise too close to bedtime. Sleep pressure it's
a good thing when it happens in an appropriate amount
(08:08):
and culminates at the correct time of night. Learning how
to manipulate it to your advantage can help you get
better sleep all right. The second system we can work
through is the circadian rhythm system. This is a lot
of what you hear about around quote sleep hygiene, and
it's important. Our bodies definitely operate in rhythms or cycles.
(08:28):
We have Oltradian rhythms, circadian rhythms, and Infridian rhythms. I
find them very fascinating. Oltradian rhythms are about ninety minutes long.
When we're operating at a high level, we still need
some kind of break in focus or a physical break
or other positive disruption every ninety minutes to keep us
going without a break of some kind. Every ninety minutes,
our performance starts to wane. Infridian rhythms are our different
(08:52):
lengths longer than twenty four hours, most commonly the approximately
twenty eight day Infridian rhythm called the Instrull cycle. Life
is better when you work with and respect the power
of these natural rhythms. Circadian biology is fascinating because there
are optimal times of day for all kinds of things. Obviously,
(09:13):
we're made to sleep when it's dark and work when
it's light. Our natural production of melatonin is a big
asset to our ability to sleep well, and that's affected
by light, light that gets into our eyes, and even
light that lands on our skin. I'm sure you probably
know by now not to let blue light or even
white light into your eyes an hour or two before bedtime.
(09:34):
Light is extremely important to be able to sleep. It's
also possible that you're waking up in the night because
there's light in your room from an alarm, clock, thermostat,
air purifier, smoke detector, teddy ruckspin If so, turn those
off or cover them with black electrical tape and use
blackout curtains, street lights, headlights, moonlight early summer sunlight. Those
(09:55):
can all wake you up too. Use an eye mask
if you find it comfortable, which I don't. Just make
sure that you're in darkness all night long. Next time
you wake up in the middle of the night, have
a look around and notice if you see any lights
at all, no matter how small, and make a plan
to remove them all the next day. As it turns out,
there are optical times for our circadian rhythm to do
(10:18):
all kinds of things exercise, take medication, eat, learn, work, etc.
It's very interesting, So if you're waking up in the
middle of the night, it could be related to the
times of day that you did things like take your
medication earlier that day. Generally, the more consistent you are,
the better you can. For sure get the circadian rhythm
(10:38):
aspect of your sleep on your side by being as
boring and predictable as possible. Being boring produces a lot
of great health results. Waking up at the same time
every day, getting natural sunlight the first thing every morning,
eating at the same times of day every day, even
pooping at the same time of day is helpful. Sheldon
Cooper was onto something with his scheduling. His bowel movements
(11:01):
to operate like a German train schedule. An important part
of our circadian biology that really helps us sleep well
is temperature control or thermoregulation. It's important that our core
body temperature drop while we're asleep, so making sure you're
in a cool room can definitely help you stay asleep.
(11:22):
It could be that you're waking up during the night
because it's too hot for you to sleep deeply, especially
if your progesterone levels are lower than they used to be,
so you don't sleep as well in general, and your
estrogen levels are fluctuating. Rapid drops and estrogen levels can
cause caught flashes and night sweats. The optimal sleep temperature
is sixty to sixty seven degrees, so do what you
(11:44):
can to get your room about that temperature. There are
awesome companies now that make smart devices to control the
temperature of your bed instead of your whole room or
whole house. I've wanted one for years, but they're pretty expensive,
like two thousand dollars for a mattress cover, so I
haven't gotten that far yet. But they're great and I
still have one on my wish list. Even without a
bed cooling device, there's a lot you can do to
(12:06):
prevent waking up due to suboptimal body temperature. I hate
being hot at night. Well, I hate being hot in general,
and I really hate being hot at night. But I
can't fall asleep if my feet are cold. So for
the past ten years or so, I've been falling asleep
with a cheap, little small heating pad on my feet
for the first fifteen minutes or so, and I think
it's fabulous. It warms up just my feet for about
(12:28):
fifteen minutes, and I fall asleep and the rest of
me stays cool. Then when I heard doctor Mason say
to do that during her Best Sleep Secrets, I was like, aha,
I already figured that one out. But something she mentioned
as especially important for women who wake up during the
night is to never use a duvet or a comforter
or a bedspread. Only one hundred percent cotton blankets because
(12:51):
they're more breathable. I have a rotating list of items
that we don't need to get into that I use
on my bed depending on this season. But I immediately
switched to a one hundred percent cot blanket when I
learned that, because it was the spring, so that was
the right time for my plan, and so far it's
been really great. There are a few other things you
can do to appropriately lower your body temperature, like take
a sauna or a hot bath or hot shower a
(13:13):
couple of hours before bedtime, and wear loose fitting, breathable sleepwear. Also,
caffeine and alcohol both jack up your sleep in other ways,
but they can increase your core body temperature too, as
does eating too close to bedtime. For at least one
hundred reasons, you shouldn't be eating within a few hours
of bedtime four hours if possible, one of which is
that it raises your core body temperature. We've discussed some
(13:36):
of the other ninety nine reasons in other episodes. Lastly,
there's the psychological system. Sometimes you wake up in the
night and ruminate or worry. Cognitive behavioral therapy says that
if you spend a lot of time awake in the
middle of the night to get out of bed and
do something marginally interesting and non productive, like color and
a coloring book or watch an episode of a ho
(13:58):
hum TV show, you don't have to do something you hate,
but it should not be something that you love or
look forward to, or is valuable or productive or stimulating.
Like social media or YouTube, or work work or housework,
anything like that. The reason for this is that it's
really important that you teach yourself that your bed is
for sleeping, not for the torture of staring up at
(14:19):
the ceiling for hours, or for watching TV or working
or doom scrolling or any other type of scrolling. Not
for checking the news or sports scores, or crafting or eating,
or party planning or building lego sets or doing your taxes.
There's something psychologically important about knowing in your body that
when you lie down in bed, it's to sleep, not
(14:42):
to learn knife throwing techniques or to refine your thinking
about tariffs. If you don't frequently spend large amounts of
time awake in bed in the middle of the night,
I like what my coach instructor Brian Johnson suggests to
see those times as opportunities to meditate. When you're awake
and would rather not, you can seize the opportunity to
(15:02):
get some extra meditation minutes in practice getting better at
whatever you normally do. To meditate, focus on your breath
and nothing else. See your thoughts flow past you like
leaves drifting down a stream. Go through a guided meditation
script that you have memorized. Whatever, it's a useful way
to buff up your meditation muscles. You can also try
(15:24):
a body scan slash relaxation, where you focus all of
your attention on tightening up one body part and then
letting it completely relax, and then moving on to the
next body part, usually starting with your feet, and then
your ankles, then your lower legs, et cetera, until you
get to your face. That's a great way to practice
maintaining focus but also feeling pleasantly relaxed. I'm weird, as
(15:47):
you already know, and somewhere along my journey of life,
I developed the habit of doing something similar tighten and relax,
and then imagining that body part melts or dissolves down
into the bed and I slowly stop existing. I find
it helpful if you can't control your thoughts and you
always wake up worrying. There are two CBTI techniques that
(16:08):
are usually not introduced till several weeks into treatment that
you might find useful. If you wake up and spend
a lot of time worrying about all kinds of things,
try this scheduled worry time. You can keep a pen
and paper next to your bed. If you're worried you'll
forget what to worry about. What you do is schedule
(16:28):
a time every day that is absolutely set in stone.
During that time, you worry about all of your life's problems.
So keep a running list. Whenever you start to worry
or think of something worth worrying about, write it down
on your list and know for sure that you will
indeed worry about that later. You're not ignoring it, you're
(16:49):
just scheduling it at your next specified scheduled worry session. Then,
when four fifteen comes around or whatever time you set,
get out your list and really do you a thorough
job of worrying about all of the items on your list.
It's a good way to dismiss worry thoughts with confidence,
knowing that they will be dealt with. This could also
(17:10):
work for just to do items. Sometimes we have things
that we don't necessarily need to ruminate or wring our
hands over. We just don't want to forget to do
something important. Write it down somewhere you're one hundred percent
sure you'll come back to it later. Then you can
dismiss it and go back to melting until you don't exist.
The second CBTI technique is for people who wake up
(17:31):
worrying about the same thing every time. For them, it's
useful to schedule several fifteen or thirty second time periods
every day to write down how much they believe that
thought that they worry about in the middle of the night.
Ashley Mason gave this example of a real patient of hers,
and I think it's a perfect example, so I'll just
repeat it. She had a patient who had multiple sclerosis
(17:53):
who would wake up every night thinking, I'm never going
to be able to make it through the day. That
was her one worry thought every night. She sounds like
a wonderful and strong woman who had more to deal
with than most people. Doing everyday things that the rest
of us take for granted was extremely difficult for her.
Doctor Mason had her write down like six times a
(18:13):
day or something how much she believed the thought I'm
never going to make it through the day. In the
middle of the night, she believed it ten out of ten.
In the early mornings, she believed it nine out of ten,
and every single day, as the day progressed, she believed
that thought less and less until her last check in
at the end of the day when she didn't believe
(18:35):
it at all, because she did in fact make it
through the day, and more often than not, it wasn't
as bad as she was anticipating. Doing that exercise taught
her that she didn't actually believe the thought, and realizing
that helped her get out of its grip in the
middle of the night until eventually it faded away as
her reason to wake up. Your worry thought might be different,
(18:57):
but doing some kind of thought work several times throughout
the day can help you get a better handle on
it so that you can control it instead of the
other way around. It might take some time, and you
might even need someone else to help you, but conscious
and intentional work throughout the day really can dissolve a
recurrent worry thought that's keeping you up at night. Don't
just try to dismiss it. Work with it. There's always
(19:20):
a ton more to talk about about sleep, but I
hope understanding these three separate sleep systems can help give
you an idea of how to tackle your middle of
the night awakenings. Your hormone levels, the sleep pressure system,
the circadian rhythm system, and the psychological system. I know
it can be so frustrating to want to sleep, and
(19:43):
to know how important sleep is to your overall well being,
and to still wake up in the middle of the night.
If you struggle with sleep more than a little bit,
and you've already tried everything you can think of, consider
seeing a cognitive behavioral therapy for insomnia provider or listening
to one and describe what they do, and then following
the steps of the treatment to the letter, either via
(20:05):
an app or there's a book describing the approach. I'll
put links in the show notes to Rachel Mason and
to the name of the book she recommends in a
couple of apps that work this way. She says the
only problem with the DIY approach is that people usually
think that their sleep problem is different or a special case,
so they don't follow it to the letter. But if
you do follow it with exactness, it'll work. The main
(20:29):
advantage of working with a provider is that you're more
likely to follow the program precisely, which is why it's
more likely to work. Interesting. Thank you so much for
being here today. You are awesome. Next week we're going
to talk about how to make your healthy choices automatic.
Until then, use the three sleep systems to stay asleep
all night long and don't be normal. Thank you so
(20:50):
much for tuning into the Health Courage collective podcast. I
am truly honored that you have paid me the enormous
compliment of your time and attention. I would be so
grateful if you would share this podcast with someone you
know and subscribe so you never miss an episode. This
podcast is for entertainment and information purposes only. Statements and
views on this podcast are not medical advice. This podcast,
(21:11):
including Christina Hackett and producers, disclaim responsibility for any possible
adverse events by use of information contained here it. If
you think you have a medical problem, consult a Licensed
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