Why Women Are Being Lied to About Sleep with Dr. Carleara Weiss

Today, we delve into the critical topic of sleep during perimenopause and menopause with Dr. Carleara Weiss, a renowned sleep scientist and advisor for Aeroflow Sleep.

Dr. Weiss, who hold a PhD and Master's of Science and Nursing, and a nationally recognized sleep scientist, discusses the significant impact of hormonal changes on women’s sleep patterns. She emphasises how sleep apnea, often underdiagnosed in women, affects overall health, including increasing risks for cardiovascular disease, diabetes, and dementia. 

Dr. Weiss also provides actionable advice and practical sleep and lifestyle strategies, highlighting the importance of understanding circadian rhythms, and how women can advocate for their own health. The episode also explores the crucial need for medical professionals to listen to women's sleep concerns to understand the bigger, underlying health issues picture. 

00:00 Intro

04:02 Dr. Weiss's Journey into Sleep Science

06:31 Recognizing Sleep Apnea Symptoms

11:07 Treatment Options for Sleep Apnea

15:42 Lifestyle Adjustments for Better Sleep

18:27 The Role of Sleep in Overall Health

28:58 Tracking Symptoms and Seeking Proper Care

34:28 Understanding Sleep Stages and Cognitive Function

34:57 Impact of Menopause on Sleep

35:16 Hormonal Changes and Sleep Fragmentation

36:28 Treatment Options for Menopausal Sleep Issues

37:58 Quality vs. Quantity of Sleep

39:23 Blue Light and Melatonin Production

40:57 Creating a Relaxing Bedtime Routine

46:03 Advocating for Better Sleep Health

55:58 Key Takeaways

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Transcript

The menopausal journey, hits women when they are in their, caregiving years. managing responsibility with family, with their jobs. So it's so difficult to find times for themselves to dedicate to themselves.

And sometimes it has that, It's structural, socio guilty, built in that I cannot stop for myself. Now, this is just part of getting older. This just part of menopause. I'm not gonna look into this, but definitely lifestyle changes are so important. weight management is important for menopause and obstructive sleep apnea. And I wanna emphasize that Because of the changes in hormones, women are more likely to start, having a accumulation of visceral fat during menopause, that is usually around the waist. that is something caused by decrease in hormones and increases inflammation, increase the risk for cardiovascular health. So,

It is important for obstruct sleep apnea, but it's important for their health overall. 

Welcome back to the Menopause Disruptor Podcast. This is the podcast where we challenge outdated narratives, unpack science that really matters, and give women the language and knowledge to advocate for their health. With confidence to today's health topic. Sleep, we are gonna tackle one of the most 

Misunderstood and often dismissed aspects of the menopause transition. Our sleep is so vital, and if you've ever been told that poor sleep is just part of aging or handed a prescription without anyone asking why has your sleep changed? This conversation is for you. Shocking statistics. Sleep apnea.

While it is often thought as a condition that primarily men are affected by, the reality is one in five women will suffer from sleep apnea, and yet 90% of them are totally unaware. and this is a hidden health issue. And just one example of how women's sleep health has been overlooked.

I am joined today with Dr. Carleara Weiss. She has a PhD and 

 Master's of Science and Nursing, and a registered nurse. She's also a nationally recognized sleep scientist in the United States and Aeroflow sleeps sleep Science advisor Dr. Weiss completed her PhD and postdoctoral fellowship in sleep and circadian rhythm research at the State University of New York 

And she brings a rare combination of deep scientific expertise and real world clinical experience. For eight years, Dr. Weiss worked directly with adults and older patients in hospitals, nursing homes, hospices, and private practice, giving her a front row seat to how sleep disruptions shows up across the lifespan, and how often women's concerns are overlooked.

Oversimplified. In this episode, we're unpacking what's really happening to sleep during perimenopause and menopause, why doctor led evidence-based education is essential for women To receive proper care and how to avoid the risk of self-guided medical decisions that can sometimes do more harm than good.

We'll also get into practical science back sleep strategies that actually work for midlife women and how understanding. Your circadian rhythm can be a powerful act of self-advocacy. So whether you're waking up at 3:00 AM feeling totally dismissed by your doctor, or simply want to understand your sleep through a smarter, more compassionate lens, you're exactly in the right place.

Please join me and welcoming Dr. Weiss to the Menopause Disruptive Podcast.

Welcome, Dr. Weiss to the Menopause Disruptive Podcast, talking about sleep today. Such an important topic. 

Thanks for having me, Mary. I'm so excited about, talking to you, about sleep and menopause. it is a very important, part of the menopausal journey, so I'm excited to talk to you today.

I always like to ask my guests their backstory. can you, tell us what drew you into sleep science and in particular circadian rhythm research and why it's so important in the menopausal transition.

Yeah, so I started, my career. I'm originally from Brazil, so you're definitely gonna notice my accent, even though I've been here for. Almost 15 years now. so working as a geriatric specialist in Brazil and also my, my personal experience as being a family caregiver, when I noticed that is leap disturbs, uh, any problems associated with sleep are such an important part of aging and how to achieve a healthy aging.

So, For example, my great, great-grandmother, my grandmother, they both had dementia and they had a lifetime of. Untreated obstructive sleep apnea, which is a, a problem that causes, is stopping and breathing and stopping oxygen levels in the brain multiple times during the night. And most people only recognize or think about obstructive sleep apnea as, is snoring at night.

And it, it's so much. More complicated and more complex and simply snoring, right? So, lacking oxygen in the brain multiple times at night for many years of their lives. and now with the research we know that is sleep has this important component in, maintaining brain health and clearing up the, 

Multiple biomarkers and proteins that are accumulating the brain, that leads to dimension, right? So the fact that they had a sleep disturbance is that it was probably dismissed as just being part of getting older or being a woman and gaining a little weight. Part of menopause. It was dismissed. It wasn't treated, and as I said, they ended up having dementia.

So that really draw my interest as a geriatric specialist and look more into sleep and circadian rhythms, how our bio biology rhythms are affected by the transition to getting older and how we can use sleep as a tool to sleep is sleep better, but also to age well.

So before we get into understanding. How to improve sleep and some of the strategies, what ki what percentage are we seeing in the menopause transition with women experiencing sleep apnea?

That's such an interesting question because right now, we are having more research into this, so, we have very limited. Large epidemiological studies that will give you an overview about this at this point. So, um, as many other things that happens to women, this topic has not been so well explored in science.

 I've seen a shift in the past two or three years to have more, information on this. But, from the studies that we have right now, about 50%, any, anywhere from 50 to 70% of the women in the perimenopausal transition. Into menopausal and postmenopausal. They, they report sleep difficulties and obstructive sleep apnea is one of those difficulties.

And also, because of their overall changes. Caused by menopause with estrogen and progesterone levels. How obstructive sleep apnea manifests to these women is different than the traditional clinical presentation that you see as, for example, is snoring. Not all women that are. that have undiagnosed obstruct apnea, we will snore at night, right?

They most likely have, daytime symptoms and daytime complaints, and they will complain about insomnia, not.

Ah.

Yes. So that's where the research is really diving into now that they will not complain about, I woke up because I was snoring, or my husband or my partner told me that I was snoring. They will.

Simply lay awake for many times during the night, or they wake up multiple times during the night and the next day they'll have that brain fog, difficulty concentration, irritability, fatigue, just overall exhausted. And if they're going to a, a clinician that is not really in tune with the newer assessments, they're probably gonna say, you have insomnia.

He's a pill. Four insomnia. And they take that, but it's not treating the obstructive sleep apnea

Yes. So again, women's bodies were never properly researched unfortunately. And as a result, it presents differently. The medical system is just trying to tell us, oh, that is just part of the change. This is just part of the experiences you're gonna have. So then how can a woman distinguish if she's complaining about severe, some insomnia or just insomnia in general? How can she distinguish between whether this is. On the cusp of sleep apnea, it's full on sleep apnea or just simply because she has disruption to her circadian rhythm. higher levels in cortisol, for example, the, wired but tired brain where we can just, you can't just shut it off. So what are some of the key signs to women should start paying attention to?

So that's a very important question. again, from the research standpoint, we have some situations at the women. in this phase of their lives, they will have insomnia and then they will have a treatment for insomnia and they feel better after they have this insomnia treated right. So one of the signs that they should have for the evaluation is, I'm already taking some support.

 Take some medicine that supports my insomnia and I'm still exhausted. I'm still having time fatigue. It's a persistent symptom, and I'm still waking up in the middle of the night multiple times. So if they're still waking up multiple times, it's not insomnia related problem. If they are already taking a treatment for insomnia, right, it's likely that their brain is waking them up to breathe more or to breathe better.

 This is a sign to look for, uh, sleep specialist, ask for a sleep study that no, nowadays those can be done at home too. So most insurance will cover sleep studies at home now. So, ask for a sleep study. Say I've been. Taking medication for insomnia or been taking supplements. I'll support my sleep to reducing insomnia, and I'm still waking up multiple times at night and feeling fatigued the next day.

Okay, at home sleep study, it gives them complete autonomy and in control, get the answers quickly after she presents sleep apnea, she's done her at home studies. What next? Go to the doctor and present with her findings. What's the first thing that she should be doing tackle this right away?

Yeah, so if they, They complete their sleep study, they have the report, their physician is gonna evaluate that, that report, and come up with a, a treatment for obstructive sleep apnea that most likely is CPAP, right? CPAP is the gold standard that we have for, treating obstructive sleep apnea. It's a positive air pressure, so the air is gonna come in and helps maintain the airways open.

 While they are breathing at night. So, uh, ideally they need to have, a follow up and, and support to use the right CPEP, the right amount of time and, um, making sure that they are adjusting well. And I, I can explain a little bit about that. So, for the insurance, at least four hours a night of use of a CPAP. 

So, at least four hours of use. CPAP overnight is what the insurance is gonna look as compliance. And when they go to the physician, the physician's gonna look at that as compliance as well. So at least four hours overnight, uh, using their CPAP. the second thing is that, making sure that they have. the best and more comfortable mask that is appropriate for their CPAP rotation for the pressure that they're gonna use for the airway pressure.

Sometimes it can be a full mask, sometimes can be this, a nose one. So a full mask covers the no nose and the mouth. And, the other ones, can be just the, the ones in the nose. So depends on the physician evaluation as well to determine which one is gonna be best for them. and, and also, 

We have so many options now of additional gear that they can use, like, something to make more comfortable in their face or in the head, or if it goes, around their ears. There's so many options that we can provide for them to make sure that is a comfortable experience. those are the key things.

Once they receive a diagnosis of obstructive sleep apnea and they wanna have the best supplies and the best support to be adhering to the treatment.

Now oftentimes women are reluctant to seek any treatment because it may not be covered under insurance, and because the medical has never made a solid connection in the past between health. Hormonal fluctuations, menopause and sleep apnea. Women are just not tuned in, to this being a problem.

So of course it comes with education, having you on a podcast exam, for example. But is now saying, or insurance that maybe has always been there to support all the equipment like the CPAP equipment, for example, the testing to. allow women to take a positive stance proceed with treatments, proceed with testing.

Is that right?

That's right. And I'll say that a positive shift on that to make more accessible. And even with the home studies, for example, it's been the past five years, to have more flexibility and be more accommodating for all patients, but it's.

I.

Really benefiting women, right? That, having these studies done at home, for example, having more flexibility with different types of masks that can be used, that are more flexible and fits better for a female body than for a male body.

So those, those changes, as I said in the past five years or so, they are being more positive for women, but. the problem I would say is that the information about those changes is not there. So if you don't know about it, you're not gonna advocate for yourself about receiving the best care, and also to have this flexibility available for you.

Yeah. And again, it's only been the last five years. So the question is how quickly has their medical system caught up with what little research has come out in the last five years? And is this even something that's even making it into mainstream? Exactly. So we have voices like you, help us share this information, is there any lifestyle adjustments that a woman can do either to prevent or at least, diminish the possibility of sleep apnea or if she has sleep apnea, sleep problems, can she integrate lifestyle changes that can help?

Yes, absolutely. That's, that's an important question as well because, as we were talking in the beginning, this transition for the menopausal journey, hits women when they are in their, caregiving years. managing responsibility with family, with their jobs. So it's so difficult to find times for themselves to dedicate to themselves.

And sometimes it has that, It's structural, socio guilty, built in that I cannot stop for myself. Now, this is just part of getting older. This just part of menopause. I'm not gonna look into this, but definitely lifestyle changes are so important. weight management is important for menopause and obstructive sleep apnea, and I wanna emphasize that.

 Because of the changes in hormones, women are more likely to start, having a accumulation of visceral fat during menopause, and that is usually around the waist. so that is something caused by, decreas in hormones and increases inflammation, increase the risk for cardiovascular health. So.

It is important for obstruct sleep apnea, but it's important for their health overall. So this, weight management, having, uh, try to build more muscle, right? So having exercise to build muscle, have attention to their diet. those things are so important for obstructive sleep apnea, but also for their health in overall in this menopausal transition.

Yes, absolutely. And in terms of, Diet. Iyou spoke about this earlier, that sleep apnea and just sleep problems just in general are, have significant health risks if it's not taken seriously, and I have said this before, I've had other guests say this before that if there was a panacea. For menopause symptom management, would be sleep. If you don't have good control of your sleep, this is a critical health issue. You named, dementia as being one potential because. brain isn't flushing out the proteins, if I understand which it

Yes.

in the rest digest state when it's at sleep. let's talk about what other key health markers we should be thinking about terms of, because the big three are heart, brain, and bone. So the impact of poor sleep, sleep disturbances, Insomnia, or even, being deprived altogether of sleep, what's happening in the body.

Yeah, so I'll take just a quick step back to clarify what sleep does for those things and then we can understand better when we not sleeping well, what the problem is. 

I like that. If

okay.

what,

Yes.

more apt to have the buy-in to do something about

Yes, exactly. I I really, like to do this when, I go out in the community to do lectures about, uh, health aging and brain health and all this. And I like to start always talking what sleep does, right? So sleep is the. Restorative way that our body has to stay functional and to stay healthy.

So all systems in our body, in our cells, in our body respond to a biological clock that we have in the brain. And this biological clock sets the timing for everything. So from the time that we wake up until in one day, and then the next 4 24 hours. Our biological clock is set in the stage for every function that we have in our body, and that includes, cell division, immune system, metabolism, strength thinking, mood, everything, hormone regulation.

Everything is associated with sleep in the biological rhythms or the circadian rhythms that we have in our brain. So. If you are sleeping well, your immune function is regulated, your digestive system is working better. You have the ability to regulate your hormones better. Your, you can recover physically better, you can recover from your brain function better, right?

So all this physiological systems are affected by sleep. So. The moments that you stop sleeping the recommended hours or having a reduced quality of your sleep, then all those symptoms are gonna, uh, feel that something is missing because they don't have the enough time to recover. 

One typical example is that somebody that is, has a deadline at work and then is pulling in, uh, late nights of work or even all nights, as soon as they submit a deadline, they get sick, they get a code, they have like a, uh, a neck spasm. they start feeling so. Right, because over the course of those days of not sleeping well, they did not have enough time for the physical and mental recovery, so they.

Yeah. So then when you start noticing those things, this type of connections is very clear that, a sleep is the, the one powerful tool that we have to maintain our bodies healthy. So another example that I like to give is, hunger and appetite regulation. So we have two hormones that are deeply regulated by sleep.

 there are, uh, leptin and ghrelin. So. They tell us when it's time to eat and when it's time to stop eating. So tell us when your body is satisfied, right? So if you're not sleeping well, those hormones become dysregulated. So what, what we see in the research is that, people who have, Sleep deprivation either by a couple hours or long-term sleep deprivation, such as night shift workers that are constantly doing nights, spending the night awake, right?

For work. In those situations, they feel more hungry, they feel less satisfied, and they're craving more. high processed food. High fat food, So as a consequence, you say you talk to a woman that start working as a, at the, as a night shift nurse and say, oh, I gained 10 pounds in my first year because I was doing night shift.

Yes, because your hormones are dysregulated. It is affecting their overall health and say, oh, I become pre-diabetic after I start doing the night shift. Yes, because your hormones are deregulated. You are craving more food. We're craving more processed food, fat food. And then you become more inflammated.

 if they are per menopausal, they have the, a accumulation of visceral fats that also includes inflammation. Makes, even if they never had a family history of diabetes, they can become pre-diabetic or even develop diabetes because of not sleeping well. 

hence. The adage shift workers takes at least five to 10 years off your life. This is understandable.

Yes. Yes. So if you put this, on top of being in the menopausal journey 

 the hormone shift is in estrogen and progesterone. They affect how sleep works. So we are already feeling some physiological changes in our body that will impact sleep. So if we need to be very mindful about our lifestyle, our diet choices, dietary choices, and also.

Make an effort to stay active, and find time for physical activity so we can, fight those problems with better tools, right? And maintain proper sleep even though we are going through different transitions in our lives.

Right now when you talked about the two hormones associated with appetite, ghrelin, and leptin.

Yes.

Is the reverse true poor sleep? Sleep disruptions, can they actually do the reverse in which we lose appetite?

Well, so from those two hormones, is unlikely that we're gonna lose the appetite, because of the sleep deprivation, what may cause sleep, lack of appetite. Chronic stress and sleep deprivation

we are talking about a different mechanism, right? So aside from having the hormone is being affected, if we have a strong mental health component associated with that, that can definitely affect appetite and decrease appetite.

This leads me to another area of questions and not to identify anybody, but I did come across a case with a woman. We discussed her sleep and she was quite concerned. Grossly sleep deprived insomnia, not sleeping for a very long time, rapid weight loss, which is very unusual. I too did kind of did some research to try to figure out if there was a causation or correlation in this women's case. the solution was to throw pharmaceuticals at it. Her doctor said. just give you some sleeping pills. You'll be on it for a short period of time. That should fix everything. You'll get back to a good night's sleep. You'll get your appetite back in order your weight back in order. What is the danger when our medical system recognizes sleep as just something to quickly fix with a pill?

Wow. That's, that's really concerning because as we are just talking how sleep is, uh, powerful and impacts many other systems in our body. So if we're only, Try to provide a pill to fix the sleep for a short time, or assuming that is gonna be only a localized solution. we are missing out the big picture because the need to be the affecting.

The whole system. So it is unlikely that we are gonna have a sleep problem that is isolated. So the sleep problem is gonna happen because we have a hormone that is, affected and that hormone is affecting the, the muscle structure for. For obstruct sleep apnea, for example, or is affecting the sleep architecture for insomnia, for example, or it is affecting the thermal regulation.

So we start having hot flashes and that's affecting sleep. So sleep is not an isolated problem. And I would say quite honestly, nothing, in our bodies are isolated problems. We are systemic human beings. So one problem might, may be perceived as something is small, but they are either a reflection of something bigger or they're part of a bigger component that needs to be evaluated as a whole.

 The bigger picture, as you said, because there could be something more going on metabolically, perhaps.

Yes, absolutely.

Yes. In this woman's case, interestingly enough, she did push to get some blood work.

Hmm.

the blood work came back showing that her, neutrophils, which is the white blood cells in the body, were quite low. Now, again, I was wondering whether there was a correlation with sleep a correlation with appetite, or one caused the other. Interesting. Her white blood cell count was low, which could have been related to maybe other things, but it certainly drove home the point that there was more going on because the white, these neutrophils are produced in the bone marrow. could we just sort of look at that holistically? If we're seeing drastic changes in, say, blood cell counts and all of the first line defense. That a woman would have to fight off infection, disease, illness, So how could we, and let me just phrase this in such a way, we see that by ignoring these subtle indications, like the sleep is telling us a story, the sleep architecture is telling us a story. Then other underlying health concerns, whether they're related or not. what could be happening? Big picture from, either menopause or just, metabolic health in general.

So about this specific case, there's so many things that could be happened, so I cannot. Give an explanation for that specific case. However, I would say for women that is experiencing this per menopausal journey or already in the postmenopausal side, if they're not feeling like themselves, they are having sleep problems, they are not feeling like themselves, that's enough to seek evaluation.

Right. 

And usually that's where we have problems finding help because, even when I talk to, to physicians that have been in, practicing for many years, Because we know that the science and the healthcare system were not, designed or organized in a way to be welcoming for women that having this type of complaints that it's like, I don't feel like myself.

 I remember from my grandmother for example. It's just. You're menopausal. You just wait it out and you're gonna feel better. In a couple years, that used to be the response that women get, and I think up to this day, if you don't, you need to find a provider that is really. Prepare to take you in and do a thorough examination, including blood work, including your sleep studies, including, asking about your h uh, your lifestyle, your diet.

Uh, come up with a plan for exercise that is feasible for you. if you don't find a provider that is in all this. I'm afraid that women will continue to be dismissed. So the more we talk about those small change that can be happening at even 10 years before they get menopause, it may not show in a blood work, for example.

So if they are per menopausal and they got a blood work. They see the estrogen levels there, they'll see progesterone levels there. But the women, you tell you, I don't feel like myself. I have brain fog. I'm annoyed. I'm irritated all the time. I don't have any patients with my husband and my family.

 I'm struggling to have attention and concentration of work, At this point might be important to look at small interventions with, supplementing estrogen, for example. Even though as I said, like the blood work may say that they don't need hormone replacement therapy yet, but there's some new, the therapy is emerging.

Now that says, okay, we, we don't need to wait until she hits the extremely low levels to start preaching them. Right? So I think that's where, we should draw a line as women say, okay, this. Provider here dismissed me, said that it's nothing. My blood works fine, but I'm not feeling okay, so I need to find a provider that is gonna listen to this and is gonna dig deeper into this, and we are gonna fight together.

Yes. And oftentimes in this day and age, it's hard to find another provider. We're so limited. So this is where the point where the advocacy comes in and presenting your case. And I often say that one of the best ways that you can prove that I don't feel like myself anymore is to track symptoms.

Everything, whether you're cycling or not, track everything, how you respond to food, how you respond to exercise. Did you even have the energy to even wanna go out and exercise or move the body? Do you even have the desire to be amongst friends? How is your cognitive function like track everything. this is your whole complete big picture and very important to be able to advocate having that evidence in hand. But on, just looking at the whole architecture of our sleep, as you spoke of, and when we need that deep sleep versus a rem sleep versus the light sleep. Let's speak to the role of all those factors that could interfere with the sleep architecture, light exposure, meal timing.

 and then also nervous system regulation in supporting circadian rhythm. 

Yeah. So, we know that typically we have, we transition from different sleep stages over the night, and they are all. Equally important for physical, mental, and cognitive recovery. So we start the night at, light sleep and we transition progressively transition to deep sleep stages and, REM sleep.

we spend about 25% of the night in light sleep light sleep is very important for physical recovery. So all the things that we mentioned about muscle recovery, cell division, hormone regulation, muscle recovery, all those things, happen. During the light sleep stages and then during a slow wave sleep with his, which is a deep sleep stage and REM sleep, which also a deep sleep stage.

Those, those. Different phases of sleep, just so to speak, are important for, uh, cognitive recovery and also for mental health recovery. I say this because for example, for women who track sleep with Fitbit or any other app to, to track sleep, they say, oh, I only had 25% of light sleep. You are right on point.

We only need 25% of light sleep. Or, I had, um, I don't know, seven hours of sleep and 25% was light sleep. That's. Okay. That's exactly what you should be looking at. Um, and then as I said, the re sleep and the, slow wave sleep, they're important for cognitive function, for cleaning out the toxins that are accumulating the brain, during the day.

And also for, mental health. They're more studies coming out about re sleep, dream cons, dreams and memory consolidation that are important for mental health. So. This is the normal sleep stage. As we, go for the menopausal journey, we have changes in estrogen and also progesterone. But we start experiencing some change in the sleep architecture because then we have.

Less REM sleep that is caused by the declining in hormones. In the menopause. We also have more zip fragmentation caused by, uh, the hormone change. So having more zip fragmentation means that the women are likely to wake up more time having less, slow wave sleep and less REM sleep. That's associated.

We have more short term memory impairment or forgetting things or having difficulty. Remember the names of things, right? So like they wake up in the day and like, um, forgot what they're gonna do, right? Have that. Lapse in the memory, which is so typical that, uh, women refer to us. So those things are physiological change that happen in the brain for the menopause.

And let's not forget, hot flashes that is caused by, also decreasing hormones, both affecting the thermal regulation, that center that we have in the brain. So now we have the system that is, uh, is like the heater in our house, right? That is going off when it's not supposed to go off. It's typically during sleep that it goes off.

So, the heater is on, and then it makes, waking up more time, more often. So. Those are symptoms that are physiological symptoms driven by hormones, but doesn't mean that you have to have those symptoms for the 10 years of your life before menopause, and then for another 30 years after you hit menopause, there is treatment for that.

We, we should be. Informed about treatments that can regulate our hormones, so maintain our bodies functioning better as we age.

Yes, You know, even though it might be common, it doesn't mean we have to normalize it, nor should we, like we have been for years and years and years. 

 exactly because once again, those are, symptoms in the sleep process, but they will affect the entire body over time. So. Not, not sleeping well and not having the proper clearance in the brain, or not having a proper memory. Consolidation that it needs to happen in the brain is not something that is gonna be a sleep problem.

It's gonna be a increased risk for dementia, right? So we need to treat those things, we need to take, charge to advocate. Say, I cannot just accept that I'm gonna have. 10 years of sleep problems and then after that I'm gonna have dementia. That's not acceptable. We need to advocate for something better.

And of course it starts with education and awareness. I agree. So it doesn't come down to just the qual, the quantity of sleep we have, you know? And you gave an example a woman. I might get seven to 10, but it's broken up in chunks that over the course of the night, she may have got her seven, but it was fragmented, like you said, a chunk here, a chunk here.

There was a disruption in between her slow wave or disruption in her REM that pulled her out of the sleep. So it really comes down to the quality of that sleep.

Yes, and this is something that I see frequently for these sleep studies and for the overall studies that I run, that, what brings women. And in is saying that, aside from not having a, a long duration for sleep is that I don't have a good sleep quality. I don't feel refreshed when I wake up in the morning.

I feel like I need to lay in bed for 10 hours to, if I'm lucky, I'm gonna have five out of 10 hours. So now they start having an anxiety worrying about, oh my gosh, it's, it's. Almost bedtime, and I know that I'm gonna lay there awake for five hours, like I don't wanna do that again. But it's so formalized that it's like, oh yeah, this is what it is.

But it, there are options. So it's really important to have this conversation to say that, it, there are options, there are treatment options that can help.

 what about exposure to blue light? We hear a lot in the media now

Mm-hmm.

off your devices a couple hours before bed, your screen time, even TVs and computers. How accurate is this advice we're hearing?

So this advice come from the circadian biology, right? Light exposure, has a direct impact on melatonin production in the brain. So we have cells in our retina that communicate, directly with the brain to tell the brain to produce melatonin or to shut down melatonin. So melatonin, 

is, The hormone that tells our body that it's time to fall asleep. So if we, we have melatonin, a stable melatonin production and. The better yet is that we have a schedule that we do that every day at the same time. Like going to bed the same day every D time, and then waking up the next morning every day at the same time.

 that's really helpful for a biological clock. So this, a device to avoid light comes from this, that, light shuts down melatonin production because tells the brain that this. They still need to, they need to stay awake or alert for longer because it's still daytime outside. So it really comes from the biological, aspect for a circadian rhythm.

So it is an important device, to avoid light. and I typically say at least one hour before you're going to bed. But then, something that we don't talk enough is that what are you gonna do in this one hour before you go to bed? Right?

just about to ask you.

Yeah, so like, oh, don't, no tv, no phone, no iPads, no nothing.

Electronic devices this one hour before you're going to bed. So what are you gonna do? Just gonna sit around being anxious. No, you try to fill out that one hour with your bedtime routine and looking for things that are. Promoting relaxation because our brain is gonna work as a computer. So if you have multiple tabs open in your computer, if you can close down the computer, but it's draining the energy, so it's draining the power of your computer.

So we wake up the next morning. My battery life is only 20%, but I wasn't using my computer all night. Yeah, but you have all those tabs open, draining the energy, so you have to do the same thing for your brain. So that one hour that you avoiding light exposure for a natural producing produ production of melatonin in your brain, try to use that one hour to other things that hap help your body understand that sleep is approaching.

So things that I recommend for this time, as I said, um, close all those steps. So for me, for example, I, I know what I, my schedule's gonna look back the next day and I have family, I have a toddler. So I have use that time to start organizing. It's for the next day. So my brain doesn't have to think about those things.

When I go to bed. It's, everything is there. It's organized, I don't have to worry about it. And it can be as simple as I have the outfit for tomorrow ready. So I don't have to think, oh, is this knowing what I'm gonna wear or what are my daughter's gonna wear? It's there. I took that out of my brain, right?

reading is something that really helps me. So. I'm gonna read something. I'm gonna read a book for my daughter, or my husband is gonna read a book for my daughter, and I'm gonna take 10 minutes break because I, I need that 10 minutes to myself and I'm gonna do my yoga on that 10 minutes,

Of

right?

Yeah.

So we, we do this and, a warm shower, and I understand that during the summer that's more challenging. So I say you take the shower and the temperature that you like, but before you finish a shower, increase the water temperature, have that warm shower because it helps regulating the temperature. Our temperature needs to decrease so we can fall asleep and stay asleep.

So, if your temper your body temperature is too high, you're gonna have a hard time falling asleep and staying asleep. And that's how, why hot flashes also impact our sleep, right? So, try to have the warm shower, which seems counterproductive. Like, oh, I'm, I'm having a hot flash and I'll take a warm shower.

Yes, you're gonna do the counterintuitive thing, because that's gonna help roll the bodying temperature.

Okay. 

 it's a stimulus to the hypothalamus to say, no, no, no. You've got heat coming in. You can turn off your internal thermostat.

exactly. so we, we need to use that hour wisely. And the other thing that I say is that because you're doing a behavioral change that has physiological consequences, It's not like taking a pill for a sleep, for example, right? If you take a pill, it's gonna work in 30 minutes, it gonna knock you out.

You are doing a physiological change with behavioral change. Those things take a longer to start noticing the effect. But once you notice the effect, you're not gonna wanna do anything else. You wanna continue with your routine.

and it gives you that sense of agency all over again, like we said earlier on. So I got to control the. The, um, the behavior, or I got to control the outcome

Yes. This is something that I, I, when I talk to people, that's the things that I recommend the most, right? you understand the physiology and you understand why the behavior has changed the physiology, so now you're gonna stick to it because you, you know the outcome, you know the consequences, you know the benefits for your health.

So I'm like, yeah, I can do this. And it is not something. Easy to do, but is rewarding and physically and mentally rewarding as well.

That's amazing. I really like the analogy about all the tabs being open on the computer. That's essentially what we're doing with our brain when we don't wanna give it that time to close all the windows.

Yes. Yes. And it, it drains the energy, it drains the battery life. So we are doing this to ourselves without noticing, but now that we know we can start making changes.

Right. So how are you getting in front of the medical community to educate them proper sle sleep hygiene, and recognizing that sleep apnea is a real thing for menopausal women.

I, I've been very fortunate. I would say that I've encountered people who are opening to listen, to those, to those problems and to. Understand that we need to do more research, but also we need to listen to the women more I, as I said, I've been fortunate to pair with, companies, community centers, and even have a role in, publishing my articles and publishing my research and having this information being presented out there and seeing more and more people become interested.

And I would say to you that. As much support that I'm seeing from the research community. I'm seeing support from the women that are out there living their lives and noticing that those things are important for them. So it's a synergy. It's really a synergy. So I've been doing this, So I graduated 20 years ago and I feel, as I said in the past five years, it is been the most open I've ever seen for listening to the people.

 and to be open to listen to the research that we do and making changes.

Uh, it is wonderful. Yeah. I'm just taking a quick peek at the Arrow Flow sleep website and I see there's a whole entire section of in the resource section and we'll get that link in the show description of the importance of women's sleep hygiene just a plethora of resources as to why addressing Women's sleep health matters other educational resources. This is one of the under evaluated, under appreciated, as you said earlier, areas in a woman's health, particularly in the menopausal years that. Is screaming for attention and it's finally getting, it's

It finally getting it.

Yes.

It's finally getting it. So I'm very, very, as I said, I'm very, Happy with the synergy that we have right now, that this area, it's finally receiving the attention it deserved and also having the positive, benefits for the women that

Yeah.

definitely deserves that. Mm-hmm.

Yes. That's so good. So looking ahead, what excites you most then, as you've seen the yardstick move in the last five years? what is exciting you most about the future of sleep science, particularly of course with women and menopause?

that's I would say, it's a sensitive question in a way that, as I said, I started on this because of my grandmother, being a clinician, being a geriatric provider. And I said, I wanna do more research. So I,went through the research pathway because of my grandmother, seeing how much she struggled, and I don't wanna.

My mom to have the same struggles. I don't wanna the same struggles to myself. And I certainly think that when my daughter becomes an adult woman, she has all the resources available for her. So that's, what motivates me the most. And I, I feel that the research that I do, I have colleagues in multiple universities in the United States and across other countries too.

Wonder.

we are getting to some. Powerful recommendations about dietary changes, dietary supplementation, and also ways to evaluate women in a very specific way to be mindful about their transition for the menopause and understand that. The clinical presentation that we have for men and for women are different, and we need to be assertive about looking women with the respect that they need.

So this is what I, I see for the future that we gonna be making change that will become standard for every practice and for every research. Right now, as we said at the beginning, you need to be lucky to find one provider that received the education and has the knowledge to address women's complaints or, concerns in a specific way.

But I, I feel like the more we progress with this research and with the resource that we have, this is gonna become a norm that now.

yeah.

When women walk the door, okay, you are per menopausal. This is how we're gonna approach you. It's not gonna be something that the woman needs to fight for it and have so much stress associated with it.

Exactly. quoted by famous Dr. Stacy Sims. We are not small men.

Yes.

We'll present in so many different ways. The outcomes might be the same in terms of health factors with the brain health and, dementia and heart health. But the mechanisms by which we treat it or how they present have to be taken into consideration to find the right solutions. This has been amazing. I always like to finish with this new thing we're doing now and we're going to do that rapid fire. It's a little thing that I stole from Brene Brown. I don't know if I have the rights to do it. So very quick questions.

Mm-hmm.

but it's also very insightful

Okay.

anything we may not have re gotten from you yet.

Dr. We,

Mm-hmm.

alright. I'm sure this is an obvious answer. Morning person or a night owl.

Morning person now, but I wasn't at hour before having kids. Okay.

One sleep myth, you'd love to retire forever.

That we can't sleep only die. We need to sleep now or we gonna die sooner,

Good one. Most underrated sleep habit.

going to bed at the same time every day.

Yes.

That really sets the stage for the biological clock and all the hormonal regulations gonna go from there, so that's really underrated.

Consistency. Consistency. Consistency. Yes. One thing you wish every doctor understood about menopause and sleep. I think we touched on this one several times.

 but if I can narrow down to one thing is that listen to the women, that we can have a textbook of how every symptom needs to present, but for them is different and for them needs to be evaluated in different way.

Love that. Yes. one of the biggest mistakes women make when trying to fix their sleep.

 wow, that's a tough one. But I would say one, the biggest mistake is just lying awake in bed for hours. So if they cannot fall back asleep, get out of the bed. Try to do something that relaxes them, either physically or mentally relaxation, and then try to come back to bed again. If you stay in bed awake for two hours, we creating a negative enforcement to the brain that the bed is supposed to, you are supposed to stay awake in bed and then it's gonna be a much bigger problem to come back from that.

So train the brain if you're not sleeping.

Get out of that. Yeah.

Smart. I like that. best Sleep Supporting habit that costs nothing.

 bad sleeping habits cost nothing. Hmm. Wake up at the same time every day. I would say this. so pair the bedtime with the wake time. Wake up time. So now you have your biological clock on a schedule, and then all your hormones are gonna be regulated from there.

Yes. Even no matter how tired you might be, just make sure you don't hit the snooze, guilty, um, coffee friend foe, or it depends.

It depends. So it can be a friend. If you take one cup of coffee at least one hour after we wake, you got up in the morning, not like you have your breakfast. Your breakfast cannot be your coffee, right? Have breakfast, have protein, fiber,

Yes.

you have your coffee. so in that case is a friend. If you have your coffee after 3:00 PM on an empty stomach, then.

You're against yourself.

tested for a being awake. Yes.

Yeah.

Last one coming up. If sleep were prescribed like medicine, what would be the best dosage?

Mm. If was prescribed like medicine, eight hours a night of sleep, that would be the best dose.

Awesome. This has been such a great conversation. Just full of really smart advice, but only just that. The reason behind it, the why. This has been amazing conversation, Dr. Weiss Where can people find you?

 On my website. That is currently carlearaweiss.com. also, Aeroflow Sleep has resources for sleep education. So you can find me there. And we are on social media also, sharing sleep educational components there in a way that everybody can understand and very easy to apply to their lives.

So beautiful knowledge is powered. We'll get all those links in the show description below. Thank you so much for giving your time. Your energy and your expertise on our show,

Thank you so much. It was a pleasure talking to you today.

 Sleep. Let's never underestimate our sleep. It's not just about quantity. It's the quality. So if you're suffering from insomnia and fragmented sleep, you might get six or seven hours in chunks. But if you're disrupting Slow wave, sleep phase and REM sleep.

You are not doing yourself any good. Get it checked. Don't let a doctor push back like the story that I shared. I kid you not. That is a true story. this woman was totally dismissed, told that her sleep problems would disappear with a pill, but never address the underlying issues related to. The weight loss.

Mm. Red flags. Red flags, red flags,I'm so enraged by that. I actually could probably do a follow on episode on that alone.

But let's not keep pointing fingers at the medical system. ' cause there are some great medical practitioners nursing practitioners who are doing some really amazing work educating others. Getting in front of the problem with education, offering resources and tools, be it blogs, live events, speaking engagements, and

Dr. Weiss, is doing just that.

And that is probably my biggest takeaway from this conversation is that we are on the precipice of change just in the last five years she's seen advancement in sleep science and scientific research related to sleep in all of her 20 years in practice. The pendulum is swinging and this is a good thing, but let's get more voices rallying behind it so that we can keep pushing the yardstick towards better health, 

particularly hormonal health that is still severely under-looked and oversimplified. Another big takeaway for me from this episode was that one hour period, that golden period before you go to bed. If we can shut off our devices, our laptops, the television, and take that hour of being really mindful, whether we have kids at home, spending time with them, or preparing them for bed, or preparing ourselves for our next day 

 Take that hour, prepare your stuff. Do some self-care. Have a warm bath or warm shower. A good book, a cup of tea, or sitting down and talking with your partner, your spouse, your children.

My favorite thing to do, meditation and breath work.

Another big takeaway. as I said in my intro, one outta five women are suffering sleep apnea, and yet it goes undiagnosed unnoticed.

We just take it for granted that, hey, if I'm not snoring like my husband is, I can't possibly be having sleep problems. But as the good doctor told us, it shows up differently in women, the fact that we are not getting quality sleep. Or being aroused in the middle of the night. Either jolted awake from a panic attack, some anxiety because our temperature has changed due to the hypothalamus getting different signals as estrogen leaves the body.

These are all disruptors to our asleep. But other things that might be keeping us awake and disturbing our sleep or even depriving us of sleep for a long time are leading to bigger health concerns. The big one mentioned in this podcast brain health and poor sleep being a precursor to both diabetes and dementia.

'cause we're not giving the body that quality time To do all of its clearing house, clearing out the brain of excess waste, for example, poor eating habits because we are so wired and tired and the body just wants fuel and the brain wants glucose. Take a good look at your habits, your sleep habits, your eating habits.

 they might be linked. Chances are there's a bigger health story behind it. March into your doctor's office, armed with the evidence, which is your symptoms, and ask for the help that you need. So this isn't overlooked,

 Advocate, advocate, advocate. and if you have a great doctor who's on your side and listening to you, thank them. Thank them for being so supportive. And then ask them, can you go off and tell a few colleagues of yours to do the same? Maybe that ripple effect will start changing the landscape in women's health. To find more about Dr. Weiss, you can find her on our website

That's spelled C-A-R-L-E-A-R-A-W-E-I-S s.com. The link will be in the show notes. And visit Aero Flow sleep@aeroflowsleep.com.

Andaero flow sleep, leave you with a gift. The results of their wake up call survey. This survey reveals a growing gap in sleep health education and the rise of do it yourself sleep trends. What is do it yourself? Sleep trends? Well, that is people taking their sleep solutions into their own hands.

Which is doing more harm than good sometimes without even realizing it. So it's important that we understand the facts behind these trends so that we can improve our sleep properly. Have a read of that survey. It's linked at shop dot arrow flow sleep.com/. Wake up call and I will have that link in the show description below. Until next time, 

Keep disturbing the conversations around healthcare. Stay informed, Stay educated. And stay wise