In this foundational episode of The Healthy Life Approach podcast, host Kristen Beasley explores why quality sleep and sleep hygiene is the first pillar of brain health optimization for women in perimenopause and beyond. Drawing from her personal experience with her father’s Lewy Body Dementia diagnosis and her own journey through hormonal changes, Kristen delivers science-backed insights on stages, sleep tracker metrics, and the often-overlooked dangers of fragmented sleep, including the sobering connection between poor sleep and drowsy driving accidents.
This episode also introduces CBT-I (Cognitive Behavioral Therapy for Insomnia), the gold-standard treatment for chronic insomnia that research shows is particularly effective for perimenopausal and postmenopausal women.
Whether you’re struggling with perimenopausal insomnia, trying to make sense of your Oura Ring data, or simply want to understand what your brain does while you sleep, this episode provides practical, compassionate guidance for treating sleep as the self-care it truly is.
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In This Episode, You’ll Learn:
- Why REM sleep behavior disorder can be an early warning sign of neurological conditions like Lewy Body Dementia and Parkinson’s disease
- How the glymphatic system clears toxins from your brain during deep sleep
- What each stage does for your body and brain
- How to interpret sleep tracker metrics like sleep efficiency, sleep latency, and HRV
- The shocking statistics on drowsy driving and microsleep episodes
- Why falling asleep in under 5 minutes may actually be a red flag
- How declining estrogen and progesterone affect sleep architecture
- What CBT-I is and why it’s the most effective treatment for chronic insomnia
- Why CBT-I outperformed hormone therapy, antidepressants, and exercise for menopausal sleep problems
- Practical tips for creating a sleep hygiene optimized environment
- When your sleep patterns warrant a conversation with your doctor
Key Takeaways
1. Sleep Is Brain Maintenance, Not Just Rest
Your brain doesn’t shut down when you sleep; it gets to work. The glymphatic system, your brain’s “nighttime cleaning crew,” clears metabolic waste, including beta-amyloid (the protein associated with Alzheimer’s disease), primarily during deep sleep. The spaces between brain cells expand by about 60% during sleep, allowing cerebrospinal fluid to wash away toxins that accumulate during waking hours.
2. Understanding Your Sleep Stages
Light Sleep (Stages N1 & N2): Makes up 50-55% of total sleep. This is when your brain produces sleep spindles that help consolidate memories from the day.
Deep Sleep (Stage N3): Makes up 15-25% of total sleep. This is your most restorative stage: when growth hormone is released, tissues repair, and the immune system strengthens. Deep sleep is concentrated in the first half of the night.
REM Sleep: Makes up 20-25% of total sleep. Critical for emotional processing, memory consolidation, and cognitive function. REM sleep is concentrated in the second half of the night, which is why sleeping in often produces vivid dreams.
3. What Your Sleep Metrics Actually Mean
Sleep Efficiency: The percentage of time in bed spent actually sleeping. 85% or higher is considered healthy for adults. Efficiency naturally declines about 3% per decade after age 40.
Sleep Latency: How long it takes to fall asleep. Normal range is 10-20 minutes. Taking longer than 30 minutes may indicate sleep initiation issues. Falling asleep in under 5 minutes is actually a red flag for sleep deprivation.
Heart Rate Variability (HRV): Higher variability generally indicates better recovery and nervous system flexibility. Track your personal trends rather than comparing to others.
4. The Dangerous Connection Between Poor Sleep and Drowsy Driving
- A 2024 AAA Foundation study found that 17.6% of fatal crashes from 2017-2021 involved a drowsy driver
- Approximately 6,000 deaths per year involve driver fatigue
- Driving after 20+ hours without sleep equals driving with a blood alcohol concentration of 0.08% – the legal limit in most states
- Microsleep episodes can occur without warning, even with your eyes open
- People with untreated sleep apnea have 2-6 times higher crash risk
5. Perimenopause Changes Everything About Sleep
Declining estrogen directly impacts sleep architecture and REM sleep timing. Progesterone, which has calming effects through GABA receptors, decreases significantly during perimenopause. This hormonal shift explains why many women who previously slept well suddenly struggle with insomnia, night waking, and unrefreshing sleep.
6. CBT-I: The Gold Standard Treatment for Chronic Insomnia
Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia by the American Academy of Sleep Medicine. Unlike sleep medication, which masks symptoms, CBT-I addresses the underlying patterns that perpetuate insomnia, and the improvements last long after treatment ends.
The five components of CBT-I:
- Sleep Restriction — Temporarily limiting time in bed to match actual sleep time, then gradually extending as sleep efficiency improves
- Stimulus Control — Rebuilding the association between bed and sleep (only go to bed when sleepy, leave bed if awake for 20+ minutes)
- Cognitive Restructuring — Addressing anxious thoughts that fuel the insomnia cycle
- Sleep Hygiene Education — Environmental and behavioral factors that support sleep hygiene
- Relaxation Techniques — Progressive muscle relaxation, deep breathing, and other calming methods
Why CBT-I matters for menopausal women: The MS-FLASH trials (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) found that CBT-I produced larger improvements in sleep for perimenopausal and postmenopausal women than sleep hygiene education, hormone therapy, antidepressants, yoga, or exercise alone.
Episode Timestamps
00:00 Welcome to the Healthy Life Approach Podcast
01:43 The Importance of Quality Sleep
04:01 Understanding Sleep Disorders
06:19 The Science of Sleep Stages
10:50 Sleep Challenges During Perimenopause
15:09 Creating a Sleep-Friendly Environment
18:53 Using Sleep Trackers Effectively
24:43 The Dangers of Sleep Deprivation
30:15 Cognitive Behavioral Therapy for Insomnia (CBTI)
35:25 Hormone Therapy and Sleep
39:45 Conclusion and Next Steps
Practical Tips from This Episode
Creating Your Sleep Hygiene Environment
✓ Keep bedroom temperature between 65-68°F (18-20°C)
✓ Use blackout curtains or a sleep mask
✓ Consider a white noise machine if noise is an issue
✓ Remove or cover LED lights from electronics
✓ Keep phones charged outside the bedroom or across the room
Supporting Your Circadian Rhythm
✓ Maintain consistent sleep and wake times (even on weekends)
✓ Get natural sunlight within 30-60 minutes of waking
✓ Dim lights 1-2 hours before bed
✓ Use candles instead of overhead lighting in the evening
✓ Avoid screens before bed, or use blue-light blocking glasses
The 4-7-8 Breathing Technique
Used by Navy SEALs to enter a state of calm:
- Inhale through your nose for 4 counts
- Hold for 7 counts
- Exhale through your mouth for 8 counts
- Repeat 3-4 times
When to Talk to Your Doctor
- Sleep efficiency consistently below 80%
- Falling asleep in under 5 minutes consistently
- Taking longer than 30 minutes to fall asleep regularly
- Excessive daytime sleepiness despite adequate time in bed
- Partner reports snoring, gasping, or pauses in breathing
- Significant changes in sleep patterns without explanation
How to Access CBT-I
- Digital Programs: Sleepio (FDA-cleared), Insomnia Coach (free VA app)
- Find a Provider: Society of Behavioral Sleep Medicine provider directory (behavioralsleep.org)
- Ask Your Doctor: Request a referral to a behavioral sleep medicine specialist or sleep clinic offering CBT-I
Resources Mentioned
Products & Tools
- Oura Ring — Sleep and recovery tracking device
- Chilipad — Cooling mattress pad for temperature regulation
- Full-spectrum light therapy lamp (10,000 lux) — For morning light exposure when outdoor light isn’t available – my favorite is SolShine
- Calm App — Meditation and sleep stories
- Sleepio — FDA-cleared digital CBT-I program
- Insomnia Coach — Free CBT-I app from the VA (available to everyone, not just veterans)
Research & Statistics
- AAA Foundation for Traffic Safety 2024 Study on Drowsy Driving
- National Highway Traffic Safety Administration (NHTSA) drowsy driving statistics
- MS-FLASH Trials (Menopause Strategies: Finding Lasting Answers for Symptoms and Health)
- Research on glymphatic system function during sleep
- Studies on progesterone’s effects on GABA receptors and sleep
- Meta-analyses on CBT-I effectiveness for menopausal women
Organizations
- The Menopause Society — For finding certified menopause specialists
- American Academy of Sleep Medicine — Sleep health guidelines
- Society of Behavioral Sleep Medicine — CBT-I provider directory (behavioralsleep.org)
Other Recommended Reading
What Is CBT-I? A Deeper Dive
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured, evidence-based treatment program that helps people overcome chronic insomnia by changing the thoughts and behaviors that interfere with sleep. It’s typically delivered over 6-8 sessions and can be done in person, via telehealth, or through digital programs.
Why CBT-I Works Better Than Sleep Medication
| Sleep Medication | CBT-I | |
| How it works | Masks symptoms | Addresses root causes |
| Duration of effect | While taking medication | Long-lasting (skills for life) |
| Side effects | Possible daytime grogginess, dependency | None |
| Relapse rate | High when discontinued | Low |
| Learning | None | Teaches skills you keep forever |
Research on CBT-I for Menopausal Women
Multiple randomized controlled trials have demonstrated that CBT-I is highly effective for perimenopausal and postmenopausal women:
- MS-FLASH Trials: CBT-I was more effective than venlafaxine, escitalopram, yoga, aerobic exercise, omega-3 fatty acids, and estradiol for treating insomnia in women with vasomotor symptoms
- 2024 Scoping Review: All studies showed significant improvements in sleep hygiene, quality, and insomnia severity in menopausal women receiving CBT-I
- Long-term Benefits: Sleep hygiene and improvements were maintained for up to six months after treatment ended
The CBT-I Approach to Hot Flash-Related Waking
Even when hot flashes wake you up initially, what often keeps you awake afterward is the anxious spiral of thoughts about not sleeping. CBT-I addresses this “secondary arousal.” It won’t stop your hot flashes, but it can help you fall back asleep more quickly when they occur.
Connect with Kristen
📱 Instagram: @kristenjbeasley
🌐 Website: healthylifeapproach.com
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Disclaimer
The content in this podcast episode is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Individual results may vary.
Kristen Beasley is a Certified Functional Medicine, Nutrition, and Brain Health Trainer, not a medical doctor. The information shared reflects her professional training and personal experience, but should not replace consultation with qualified healthcare providers.
This post may contain affiliate links. If you click on these links and make a purchase, I may receive a commission at no additional cost. As an Amazon Associate, I earn from qualifying purchases.
Full Episode Transcript
[Note: Full transcript available below for accessibility and SEO purposes]
Hi, and welcome back to The Healthy Life Approach podcast. I’m Kristen Beasley. I’m a certified functional medicine, nutrition, and brain health coach, and today we’ll talk about the first pillar of Build Your Base: Prioritize Quality Sleep.
Show Sponsor: FullScript
Today’s episode is brought to you by FullScript.
I talk a lot on this show about becoming your own health advocate: about asking better questions, tracking your data, and making informed choices. One question I hear frequently is: “Kristen, where should I actually buy the supplements you talk about?”
Here’s what I want you to understand: the supplement industry has very little regulation. What’s printed on that label? It doesn’t always match what’s inside the bottle. When you’re investing in your brain health, your hormones, your energy—you deserve to know exactly what you’re putting in your body.
That’s why I personally use FullScript, and it’s the only dispensary I recommend. These are practitioner-grade supplements, the same professional brands I trust for my own protocol. Every product is third-party tested, stored properly, and shipped straight to your door.
When you shop through my FullScript dispensary, you’ll also get a discount on every single order. That matters when you’re building a thoughtful supplement routine over time.
I’ll tell you, I look at everything. My Oura Ring data, my labs, and how I actually feel day to day. And I’ve learned that quality makes a measurable difference. This isn’t about taking more supplements. It’s about taking the right ones, from sources you can verify.
You’ll find my link in the show notes. Setting up your free account takes about a minute, and then you can start shopping smarter.
Your brain health is worth the investment. Make sure your supplements are too.
How are You Sleeping, Really?
Remember the last time you woke up feeling really refreshed? Maybe the sun was coming through your window, and you felt like you could do anything. That’s the power of quality sleep. It’s not just about optimizing another part of your life. It’s a real act of self-care that helps both your body and your spirit. I want to start by saying this because it’s often overlooked: Sleep isn’t just something to improve or track. It’s a way to take care of yourself.
This might sound odd in a conversation about brain health, but think about how it feels to wake up after a good night’s sleep, when your body has gone through all the right stages of rest. Instead of worrying about your sleep scores, you feel clear-headed and ready for the day. Letting go of the need for perfect sleep can help you reach a place where sleep is truly restorative. I’ve seen it happen a lot: someone gets a sleep tracker, starts checking their scores, and ends up more anxious about sleep than before. They worry about getting enough deep sleep, feel discouraged by their numbers, and sometimes even stay awake, worried that their score will be low.
To use trackers more mindfully, focus on long-term trends rather than daily fluctuations. Consider setting specific times of day to review your data, and avoid checking it immediately upon waking. This can help in reducing anxiety. Also, set boundaries like avoiding screen time an hour before bed to limit stress. By understanding your sleep patterns over several weeks instead of obsessing over nightly metrics, you can use this digital tool to enhance, not hinder, your rest.
I went through this myself when I first got my Oura Ring about five years ago. The first night I slept without it, I felt both free and anxious. But I actually slept better when I stopped focusing on the numbers.
There’s a name for this: orthosomnia, which means being obsessed with getting perfect sleep scores. We’ll talk more about it later in the episode.
As we talk about sleep today, keep this in mind: Sleep is very important for your brain, but worrying too much about it can actually make things worse. The goal is to be aware and informed, not to stress about making everything perfect.
I want to tell you why this pillar is so personal to me and why I put sleep FIRST in my protocol.
REM Sleep Behavior Disorder
My father had Lewy Body Dementia. One of the earliest warning signs, years before his diagnosis, was something called REM sleep behavior disorder. At that time, he exhibited this behavior, and very few people were aware that it had a deeper, neurological reason. Let me explain what that means. Most people, when they dream, have their bodies essentially paralyzed. It’s a protective mechanism that keeps you from acting out your dreams. When you dream about running, your brain sends those signals, but your body stays still. That’s normal. That’s how it’s supposed to work.
But with REM sleep behavior disorder, that paralysis doesn’t happen. People physically act out their dreams, sometimes violently. They might kick, punch, yell, or thrash around during sleep. Their bed partner might get hit. They might fall out of bed.
My dad had symptoms of this. He would jump out of bed in his dream and yell out his military identification. He was reliving something from his service. But none of us knew what it meant at the time. We thought they were bad dreams. We thought he was stressed. We didn’t know it could be a warning sign.
Research now shows that REM sleep behavior disorder can precede Lewy Body Dementia and Parkinson’s disease by 10, 15, or even 20 years. It’s one of the earliest biomarkers we have, and it’s often unrecognized or dismissed as ‘just bad dreams.’
If someone you care about is acting out their dreams (not just twitching, but actually moving, talking, or getting aggressive during sleep), please take it seriously. Tell a doctor and ask about a sleep study.
I can’t go back and change what happened with my father, but I can make sure other women know what we didn’t know then.
This is why I care so much about sleep as the foundation of brain health. It’s not just about feeling rested. Sleep is when your brain does important maintenance work, and sleep problems can be early signs of changes in the brain.
If you take nothing else from this episode, take this: Pay attention to sleep. Yours and your loved ones’. It matters more than most people realize.
Phases of Sleep and What Happens During Each Phase
Let’s talk about the incredible things your brain does while you sleep.
Your brain has something called the glymphatic system, which acts like a cleaning crew at night. During deep sleep, it clears out waste, including beta-amyloid, a protein linked to Alzheimer’s disease. Most of this cleaning happens during deep sleep.
During sleep, the spaces between your brain cells actually expand by about 60%, allowing cerebrospinal fluid to flow through and wash away the toxic proteins that build up during the day. Picture this process as your brain’s own nocturnal cleaning crew, pulling an all-nighter to tidy up and maintain a healthy environment. It’s like setting the schedule for a brain-boosting night shift, ensuring everything is fresh and ready for the next day.
Sleep is also when your brain consolidates memories, processes emotions, and repairs itself. When you learn something new during the day, sleep is when that information gets moved from short-term storage to long-term storage. It’s why students who sleep after studying retain more than those who pull all-nighters.
Sleep affects your hormones, your immune system, and your mood regulation. It’s not passive. It’s deeply active as your body is doing important work while you rest.
So when I say “prioritize quality sleep,” I don’t mean obsess over your sleep score. I mean: treat sleep as sacred. Protect it. Honor it. Give your brain the rest it needs to do its important work.
Before we get into the details, here’s a quick question: Which stage of sleep gets shorter as we age? Think about that as we talk about sleep stages. Knowing about these stages can help you understand what your body needs and, if you use a tracker, what the numbers mean.
Sleep cycles through stages roughly every 90 to 110 minutes. Most adults go through four to five complete cycles per night. The stages cycle in this order: light sleep, deep sleep, back to lighter sleep, then REM. Then the cycle starts over.
Light sleep is the first stage and makes up about 50 to 55 percent of your total sleep time. The first part is very short, just a few minutes, and is when you’re moving from being awake to asleep. This is when people might say, “I wasn’t asleep!” even though they actually were.
The second stage of light sleep is sometimes called “core sleep.” During this time, your heart rate slows, your temperature drops, and your brain makes special wave patterns called sleep spindles. Research shows these spindles help your brain organize and store what you learned during the day.
Deep sleep, also known as slow-wave sleep, accounts for about 15 to 25 percent of your total sleep time, but this percentage decreases as we get older.
This is the stage when your body does its most important repair work. Growth hormone is released, tissues are repaired, the immune system is strengthened, and as I just mentioned, your glymphatic system is clearing out metabolic waste from your brain.
Here’s something important: most deep sleep happens in the first half of the night. That’s why going to bed at a reasonable hour is so important. If you stay up until midnight and wake up at 6 am, you might be missing out on deep sleep.
According to the National Council on Aging, the deepest stage of sleep, Stage 3 (NREM), typically lasts 20-40 minutes per cycle. This amount is common and healthy for older adults.
REM sleep is when most dreaming happens. Your brain is very active, almost as much as when you’re awake, but your body can’t move. This temporary paralysis, like in my father’s story, is a way your body protects you from acting out your dreams.
REM sleep makes up about 20 to 25 percent of your total sleep time, and most of it happens in the second half of the night. That’s why sleeping in on weekends can lead to more vivid dreams. You’re finally getting those longer REM periods you may have missed during the week.
REM sleep is critical for emotional processing, memory consolidation, and cognitive function. Chronic REM deprivation has been linked to mood disturbances and difficulty with learning and concentration.
All of these stages are important. Light sleep helps you move into deeper sleep. Deep sleep restores your body and cleans your brain. REM sleep supports your thinking and emotions. The goal isn’t to maximize one stage, but to let your body move through all of them naturally.
Sleep Disruption in Perimenopause
Here’s the tough truth for women in perimenopause: Sleep often gets disrupted during this time. It happened to me, too.
Hot flashes wake you up drenched in sweat. Anxiety keeps your mind racing at 3 am. You fall asleep fine, but can’t stay asleep. Or you’re exhausted all day but wired at night. Your sleep, which used to be reliable, suddenly becomes unpredictable.
This isn’t your fault. Lower estrogen levels directly affect how you sleep. Your brain is adjusting to a big hormonal change, and sleep is often the first thing to be affected.
Estrogen and progesterone both play roles in sleep regulation. Estrogen affects the timing and quality of REM sleep. Progesterone has a calming, sedating effect through its interaction with GABA receptors, which are the same receptors targeted by anti-anxiety medications. When these hormones fluctuate and decline, sleep suffers.
If you’re having trouble sleeping right now, please know you’re not doing anything wrong. Your body is going through real changes.
Tips for a Better Night of Sleep
There are things that can help: not to make your sleep perfect, but to support your body as much as possible during this time.
Here’s a simple tip to get started: tonight, put a glass of water by your bed. Staying hydrated can help your body control its temperature and might reduce some nighttime issues. You could also try using a cooling pillow or incorporating light stretching into your routine to further enhance relaxation before sleep. Another tip is to introduce calming scents like lavender or chamomile in your bedroom to create a soothing atmosphere. Small steps really can make a difference. If you want to join in, share a photo of your bedside water or your new sleep tip on Instagram, tag me @kristenjbeasley, and use the hashtag #FirstWinSleep. When we share these small actions, it helps build a sense of community and can inspire others, too.
Your body works best with a regular routine. Going to bed and waking up at about the same time each day, even on weekends, helps keep your body’s clock on track. This is actually more helpful than focusing only on how many hours you sleep. According to recent research, maintaining a regular sleep schedule can help you sleep better and reduce your risk of insomnia. You do not need to follow a strict routine; simply try to keep your sleep times consistent most days.
Your circadian rhythm is your body’s internal clock. It controls not just sleep, but hormone release, body temperature, digestion, and dozens of other functions. Maintaining consistent sleep and wake times supports all of these systems.
If you remember one thing from this section, let it be this: Choose a bedtime and wake-up time that fit your life, and try to stick to them most days. It doesn’t have to be perfect or strict; just do your best most of the time.
Getting natural sunlight in your eyes within the first 30 to 60 minutes after waking tells your brain it’s daytime. Imagine opening the door and feeling the cool morning air. Letting the sky’s light reach your eyes helps reset your body’s clock and helps you make melatonin at the right time later on.
Here’s the science: Light enters your eyes and hits special cells in your retina that have nothing to do with vision; they’re just light sensors. These cells send signals directly to your brain’s master clock, the suprachiasmatic nucleus, which controls your circadian rhythm.
You don’t need to track this or buy any special device. Just go outside in the morning, even for 10 minutes, without sunglasses. Let the light reach your eyes. Even on cloudy days, outdoor light is much brighter than indoor light—usually 10 to 50 times brighter, even when it’s overcast.
Getting morning light is one of the best free ways to improve sleep, and it’s a nice way to start your day. If going outside isn’t possible due to the weather, I recommend a full-spectrum light therapy lamp. Research shows that full-spectrum light provides benefits similar to those of natural sunlight. Look for lamps with 10,000 lux, which is over six times brighter than a 100-watt incandescent bulb. When using a light therapy lamp, place it about 16 to 24 inches from your face and use it for 20 to 30 minutes each morning. It’s best to do this at the same time each day, ideally within an hour of waking, to help reset your body’s internal clock. I’ll share specific recommendations in the show notes.
A cool room helps most people sleep best, usually around 65 to 68 degrees Fahrenheit. Your body temperature drops at night, and a cooler room can help. If you have hot flashes, try cooling sheets, a fan, light sleepwear, or a cooling mattress pad like a Chilipad. I’ll share some options in the show notes on my website.
Keeping your room dark at night is important for good sleep. Even small amounts of light can make it harder to sleep by lowering melatonin. Try blackout curtains or a sleep mask if you need to. Even the light from a phone charger or digital clock can affect your sleep.
A quiet room helps, too. If noise is a problem (like traffic, neighbors, or a snoring partner), a white-noise machine or fan can help block out sounds. The steady noise covers up sudden sounds that might wake you.
Your bedroom should feel like a peaceful place, not a workspace. Try to keep screens and work out of the bedroom so your brain connects it with rest. If you can’t fall asleep, don’t let your brain link your bed with not sleeping. If possible, get up and read or do something quiet until you feel sleepy. I know someone who used to toss and turn every night, but when they started reading in another room when they couldn’t sleep, they fell asleep faster over time. If it’s too cold to get out of bed, that’s okay, try a meditation or bedtime story app like Calm. You can also do 4-7-8 breathing: breathe in for 4 counts, hold for 7, and exhale for 8. This technique helps calm your mind.
Your brain needs time to switch from being active to getting ready for sleep. A simple wind-down routine, even just 15 to 20 minutes, can help signal to your body that it’s time to rest.
This could be reading a book (not on a screen) or gentle stretching. A warm bath or shower can help because the subsequent drop in body temperature signals sleep to your body. Journaling can help if your mind tends to race with tomorrow’s to-do list. Or simply sitting quietly with a cup of herbal tea.
Your routine doesn’t have to be complicated. It just needs to be regular enough that your brain gets used to it. You’re creating a signal that tells your body, “Sleep is coming.” For example, my husband and I started using candles instead of overhead lights in the hour before bed, and it’s helped us feel sleepier.
This is where gentle awareness helps—not tracking everything, but just noticing your own patterns.
Some people find that caffeine after noon affects their sleep. Others can drink coffee at dinner and sleep fine. Some people sleep poorly after alcohol, even though it feels relaxing in the moment; alcohol disrupts sleep architecture and often causes waking in the second half of the night. Some people wake up hungry in the middle of the night because their blood sugar drops.
Personal Story with Low Blood Sugar at 3:00 AM
Let me share a story. For months, I kept waking up around 3 am with a racing heart and didn’t know why. I tried everything: magnesium, meditation, all the usual sleep tips, but nothing worked.
Eventually, by just paying attention and noticing patterns, I realized I was having low blood sugar in the middle of the night. My body was making cortisol and adrenaline to raise my blood sugar, and that’s what was waking me up with a racing heart. I solved it by eating a snack before bed with protein and fat, which completely resolved it. Something like a handful of nuts or a piece of cheese.
I didn’t need a special device to figure this out. I just needed to be curious and patient with my own body.
So I encourage you to be curious: What helps your sleep? What makes it worse? You probably know more than you realize.
Understanding OuraRing or Sleep Tracker Scores
Now I want to talk about something that might help if you use a sleep tracker: understanding the numbers it gives you.
I use an Oura Ring, and I’ve talked about the risk of overemphasizing the numbers. But when you understand what the metrics mean, and when certain patterns should lead you to talk to your doctor, these tools can be really helpful. To make these conversations easier, use simple, direct questions. For example, you could say, “I’ve noticed my deep sleep averages under 5%. Could we explore why?” Using clear words like this can make doctor visits more productive.
So let me walk you through the key metrics, what’s considered normal, and what trends might be worth discussing with your healthcare provider.
Sleep efficiency is the percentage of time you actually spend sleeping compared to the time you spend in bed trying to sleep. It’s a simple calculation: if you’re in bed for eight hours but only sleeping for six and a half, your sleep efficiency is about 81%.
Here’s what the research tells us about sleep efficiency:
* 85% or higher is generally considered healthy for adults
* Young healthy adults often show sleep efficiency above 90%
* As we age, sleep efficiency naturally declines: about 3% per decade starting around age 40
* By age 80, a sleep efficiency of around 80% may be perfectly normal.
If your sleep tracker often shows efficiency below 80%, especially if that’s new for you, it’s worth paying attention to. Low efficiency can happen for many reasons, such as trouble falling asleep, frequent nighttime waking, or lying awake in the early morning.
But remember: one night of low efficiency doesn’t mean much. It’s the patterns over weeks and months that matter. If you see your efficiency going down over time, that’s something to share with your doctor.
Sleep latency is how long it takes you to fall asleep after you turn out the lights and intend to sleep.
The normal range for adults is between 10 and 20 minutes. A recent research review of healthy adults found the average is around 11 to 12 minutes.
Here’s something many people don’t know: falling asleep too quickly can be just as important as taking too long to fall asleep.
If it consistently takes you longer than 20 to 30 minutes to fall asleep, this may indicate difficulty with sleep initiation possibly from anxiety, poor sleep hygiene, or circadian rhythm issues.
But if you fall asleep in less than 5 minutes, that can be a warning sign of sleep deprivation or a sleep disorder.
When researchers want to measure how sleep-deprived someone is, they actually test how quickly they fall asleep during the day. A sleep latency of less than 8 minutes during daytime testing is considered a sign of excessive sleepiness and has been associated with impaired performance.
So if you often say you fall asleep as soon as your head hits the pillow, think about it: your body might be telling you that you’re not getting enough sleep.
Your tracker may show something called “restfulness” or “nighttime movement.” This captures how much you’re tossing and turning, and how often you wake briefly during the night.
Some movement during sleep is totally normal. We all change positions during the night. Your brain naturally cycles through sleep stages, and brief moments of waking are a normal part of healthy sleep. But excessive movement or frequent wake-ups can indicate environmental disruptions, such as noise, light, or temperature issues. It might be a partner’s movement or snoring affecting your sleep. It could be breathing disturbances that cause you to stir. Or it might indicate restless legs or other movement disorders.
If your tracker often shows a lot of movement or low restfulness, try to figure out why. Does it happen at certain times of night? After certain meals? On nights when you’ve had alcohol?
If you use a tracker like Oura, you’ll also see metrics for heart rate variability (or HRV) and resting heart rate.
Your resting heart rate is simply how many times your heart beats per minute while you’re at complete rest. Normal adult resting heart rate ranges from about 40 to 100 beats per minute, but what matters most is your personal baseline. According to the Cleveland Clinic, a change in the time between your heartbeats (known as heart rate variability) can reveal clues about your health, including possible heart conditions or mental health issues like anxiety and depression. Counterintuitively, higher variability is generally better as it indicates your nervous system is flexible and responsive. Lower HRV may indicate stress, impaired recovery, or infection.
The key with these numbers is to watch your own trends over time, not compare yourself to others. What’s normal for you might be very different from someone else.
Here’s my guidance on all this sleep data:
Don’t worry about any single night’s numbers. Your tracker isn’t perfect. Even the best ones only match clinical sleep studies about 75-80% of the time.
Instead, look for patterns over time. Watch for things like very little deep sleep, even when you spend enough time in bed, numbers that are very different from what’s normal for your age, or big changes in your usual sleep patterns without a clear reason.
These patterns, combined with how you feel, provide valuable information.
Effects of Microsleep
Imagine you’re driving on the highway and your mind drifts off for just two seconds. In that short time, your car travels the length of a football field without anyone guiding it. This isn’t just a made-up example. It’s a real risk that comes with fragmented sleep. Now I want to talk about how poor sleep can affect your safety in real life. Please listen closely.
According to Nursing Fundamentals, losing just a couple of hours of sleep each night can build up to a significant sleep debt by the end of the week, even if you do not remember waking up during the night. These disruptions prevent you from getting enough restorative rest and can affect your well-being.
Here’s where this becomes dangerous.
When you’re sleep-deprived, even if you don’t feel very tired, your brain can have something called microsleep. These are short, involuntary moments of sleep that last just a few seconds, sometimes even with your eyes open.
During microsleep, your brain basically shuts off for a moment. You stop taking in information from around you, and your decision-making shuts down. This can happen without warning, and you might not even realize it.
The statistics here are sobering, and I want you to hear them.
A 2024 study by the AAA Foundation for Traffic Safety estimated that nearly 18 percent of all fatal crashes from 2017 to 2021 involved a drowsy driver. That translates to roughly 6,000 deaths per year involving driver fatigue.
The National Highway Traffic Safety Administration estimates that drowsy driving causes 91,000 police-reported crashes annually, resulting in about 50,000 injuries and nearly 800 deaths. And researchers believe the true numbers may be 8 to 10 times higher than official reports, because, unlike alcohol, there’s no test for drowsiness at crash scenes.
In practical terms, if you fall asleep for just 3 seconds while driving on the highway, your car will travel the length of a football field (about 300 feet) without anyone steering.
Here’s a surprising fact: driving after being awake for more than 20 hours is like driving with a blood alcohol level of 0.08 percent, which is the legal limit in most states.
People with untreated sleep apnea have a 2 to 6 times higher crash risk than the general population. The fragmented sleep from repeated breathing interruptions leads to chronic sleep deprivation and excessive daytime sleepiness.
But microsleep can happen to anyone, not just people with sleep disorders.
Research shows that even one night of very little sleep (less than four hours) can lead to more microsleep episodes the next day. What’s especially concerning is that people often don’t realize they’ve had a microsleep. They might think they were awake the whole time or just zoned out for a moment.
Please take these warning signs seriously:
* Frequent yawning
* Difficulty keeping your eyes open or frequent blinking
* Drifting from your lane
* Missing exits or traffic signs
* Difficulty remembering the last few miles you drove
* Wandering, disconnected thoughts
If you notice any of these signs while driving, pull over. Even a short nap of 15 to 20 minutes can help, but it’s not a replacement for getting enough sleep overall.
And if your sleep tracker consistently shows fragmented sleep or high movement, or if you fall asleep instantly when you lie down, please consider whether you might be carrying significant sleep debt.
This isn’t meant to scare you. It’s about being aware. Your sleep affects not just how you feel, but also your safety and the safety of others on the road.
If you’ve tried all the helpful tips and still have major sleep problems, it might be time to talk to your healthcare provider.
When Your Sleep Tracker Shows You Might Need a Sleep Study
This is actually my husband’s story. I bought him an Oura Ring to help him see his sleep patterns, specifically how much time he spent in movement and awake periods. There was enough data for us to discuss with his primary care physician and to get him scheduled for a sleep study.
My husband used to joke that I was just being too sensitive about his snoring and movement. But his Oura Ring showed he moved much more during sleep than I did. That data gave us something concrete to show the doctor.
Talk to your doctor if you notice:
* Sleep efficiency consistently below 80%
* Sleep latency consistently under 5 minutes or falling asleep too fast.
* Sleep latency consistently over 30 minutes or difficulty falling asleep.
* A pattern of very little deep sleep despite adequate time in bed
* Significant changes in your typical patterns without explanation
* Excessive daytime sleepiness despite what seems like adequate sleep
* Your partner reports that you snore, gasp, or pause in your breathing.
If you snore loudly, gasp for air, or wake up tired even after enough time in bed, tell your doctor. Sleep apnea is common and treatable, but it’s often missed in women. Women don’t always have the classic symptoms, as we’re less likely to snore loudly and more likely to feel tired or have trouble sleeping. Additionally, women may experience less obvious symptoms such as morning headaches, mood changes, or frequent urination. Recognizing these signs can be crucial in seeking timely medical advice and appropriate treatment.
If anxiety or depression is keeping you awake, that’s important to talk about too. Sometimes sleep problems are a sign of something else that needs care.
Before we get into hormones, I want to share something that research shows is the most effective treatment for chronic insomnia. The best part is, it doesn’t involve medication.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Cognitive Behavioral Therapy for Insomnia, known as CBT-I, is an effective, practical, and non-drug treatment for insomnia, though many people may not be familiar with it. Even though the American Academy of Sleep Medicine recommends it as the first treatment for chronic insomnia, most people have never been offered it.
CBT-I stands out from sleep hygiene tips or medication because, while sleeping pills only cover up insomnia symptoms, CBT-I tackles the root causes that keep insomnia going. It helps retrain your body and mind to sleep well again. Studies show that about 70% of people still sleep better six months after finishing CBT-I, which shows how long-lasting the benefits are. With medication, sleep problems often come back when you stop taking it, but CBT-I gives you results that last.
CBT-I is typically delivered over six to eight sessions, either in person, by phone, or through digital programs. It has five main components:
Sleep Restriction: This might sound odd at first, but it’s like a short boot camp for your sleep. If you’re only sleeping five hours but lying in bed for eight, your brain starts to link the bed with being awake and frustrated. Sleep restriction means you only spend as much time in bed as you actually sleep, then slowly add more time as your sleep improves. It’s a practical challenge that helps you build better sleep habits, and it works.
Stimulus Control: This step helps you reconnect your bed with sleep. The rules are simple: only go to bed when you’re sleepy, use your bed just for sleep and intimacy, and if you can’t fall asleep after about 20 minutes, get up and do something quiet until you feel tired again. I mentioned this earlier, and this is where it fits in.
Cognitive Restructuring: This part deals with the anxious thoughts that keep you up at night. For example, you might think, “If I don’t fall asleep soon, tomorrow will be a disaster,” or “I haven’t slept well in weeks, so something must be wrong with me.” CBT-I teaches you to notice and change these thoughts so they don’t keep the insomnia going.
Sleep Hygiene Education: This covers the environmental and daily habits we’ve discussed, such as room temperature, lighting, caffeine, alcohol, and maintaining a regular sleep schedule.
Relaxation Techniques: These include things like progressive muscle relaxation, deep breathing, and other ways to calm your body before bed.
Here’s why this matters for you: studies on perimenopausal and postmenopausal women show that CBT-I leads to bigger improvements in sleep than sleep hygiene, hormone therapy, antidepressants, yoga, or exercise alone. For example, CBT-I improved sleep efficiency by about 20% more than hormone therapy, showing how effective it is for women in this stage of life. A study called MS-FLASH, or the Menopause Strategies: Finding Lasting Answers for Symptoms and Health trials, compared multiple interventions for menopausal women experiencing sleep problems. CBT-I emerged as the most effective treatment. Notably, 60% of participants who underwent CBT-I reported their sleep as ‘much better’ compared to only 30% for those who received other interventions.
Here’s something interesting: even if hot flashes wake you up, it’s often the anxious thoughts about not sleeping that keep you awake. CBT-I helps with this by addressing those thoughts. It won’t stop hot flashes, but it can help you get back to sleep more quickly when they occur. It’s normal to have some nights disrupted by hot flashes. Setbacks are part of the process, and knowing this can help you stay motivated and keep working toward better sleep.
The main challenge has been access. According to a recent review, there are far fewer trained CBT-I providers than needed, with only 752 specialists identified worldwide, most of them in the United States, highlighting an ongoing gap between demand and available care.
Resources for CBT-I
Digital CBT-I programs like Sleepio and Insomnia Coach (a free app from the VA) have proven to be effective. Sleepio has even received FDA clearance as a treatment for insomnia disorder.
The Society of Behavioral Sleep Medicine has a website directory to help you find trained providers near you.
Some health systems now provide CBT-I through their behavioral health departments or sleep clinics.
If you’ve been dealing with chronic insomnia, trouble sleeping at least three nights a week for three months or more, and your doctor has ruled out a sleep disorder, I encourage you to ask your doctor about CBT-I before trying sleep medication. It takes more effort than just taking a pill, but the skills you learn can last a lifetime. That fits with our goal here: building habits that support your brain health for the long term. So, when will you take your first step toward better sleep? Consider starting a sleep log tonight to track your patterns and progress.
Before we leave the topic of sleep, I want to talk about something that might be relevant for many of you—especially if you’ve had a hysterectomy or are in postmenopause.
Progesterone and Sleep
Now, let me be clear: I’m a health coach, not a doctor. I can’t prescribe anything or tell you what hormones you should or shouldn’t take. This is educational information, not medical advice. Hormone therapy decisions should be made with a qualified healthcare provider based on your individual health history and needs.
But I can share what research says and what I’ve experienced myself, because I think it’s important.
According to a 2016 review, hormone replacement therapy has been shown to improve sleep quality in women who experience vasomotor symptoms during menopause.
Progesterone specifically has a calming effect on the brain. It interacts with GABA receptors, the same receptors targeted by anti-anxiety medications. According to research published in 2008, progesterone treatment in postmenopausal women has been shown to help reduce anxiety and lead to fewer sleep disturbances, which may explain why some women feel they sleep more deeply and experience less anxiety. When progesterone declines during perimenopause and menopause, sleep often suffers. Not just because of hot flashes, but because you’ve lost that calming, sedating hormone.
Here’s where it gets frustrating. I recently asked my local gynecologist about prescribing my hormone replacement therapy because my hormone specialist is out of state. When I told her that my current protocol included progesterone, she said that because I don’t have a uterus, I don’t need it, even though my hormone specialist has prescribed it for two years and it has helped with my sleep.
She told me that prescribing me progesterone without me having a uterus was beyond her scope of practice.
That answer comes from an outdated view. I also want you to have some understanding of our doctors. Most haven’t had much training on menopause or hormone therapy. They should keep learning, but this topic has only become more widely discussed in recent years.
Back to the progesterone – the traditional thinking was that progesterone’s only job was to protect the uterine lining from estrogen. No uterus? No need for progesterone.
But that view ignores what progesterone does for the brain, sleep, mood, and anxiety. The uterus isn’t the only part of the body that benefits from progesterone.
Now, I’m not saying every woman without a uterus should take progesterone. That’s a decision for you and your healthcare provider based on your individual situation.
What I am saying is this: if you’re told you don’t need progesterone because you don’t have a uterus, that’s not the whole story.
You deserve a provider who will discuss the research on progesterone’s effects beyond the uterus, including its potential benefits for sleep and brain health.
Here’s what I’d encourage you to do if this resonates with you: While official guidelines from The Menopause Society haven’t yet addressed progesterone specifically for sleep in women without a uterus, research shows that micronized progesterone improves sleep outcomes through its effects on GABA receptors in the brain, and some clinicians do prescribe it for this purpose.
If your provider says you don’t need progesterone because you don’t have a uterus, you can ask: “I understand progesterone’s role in uterine protection. But I’ve read research showing it also affects sleep and mood through GABA receptors. Can we discuss whether it might be appropriate for my symptoms?”
If they dismiss you or seem unfamiliar with this research, consider seeking a second opinion, ideally from a provider who specializes in menopause, like someone certified by The Menopause Society. You can locate a menopause-certified provider by visiting The Menopause Society’s website, where they offer a directory of qualified specialists. This step can empower you to seek the care that best suits your needs.
You’re not being difficult by asking questions. You’re being an informed patient. That’s what the Own Your Outcomes pillar is all about: empowering yourself through education.
Let Go of Obsessive Tracking Habits
Here’s what I want you to let go of:
Let go of the idea that you need exactly 8 hours of sleep to do well. Everyone’s sleep needs are different. Some people feel great with 7 hours, others need 9. The right amount is what leaves you feeling reasonably rested; not perfect, just rested enough.
Let go of checking your sleep score first thing in the morning. Before you look at any device, ask yourself how you feel. That matters more than any number.
Let go of the pressure to have perfect sleep every night. Some nights will be tough, and that’s okay. One bad night won’t harm your brain health. We want to avoid long-term sleep loss, not the occasional restless night.
Embrace These Tips
Here’s what I want you to embrace:
See sleep as a way to rest, not as something to measure or compete over. You’re not trying to win at sleeping—you’re just giving your body what it needs.
Accept imperfection. You don’t need perfect sleep. Just enough sleep most of the time.
Be gentle with yourself. If you’re having a hard time, you’re not failing. You’re going through something difficult. Perimenopause is tough, and your body is changing. Give yourself some grace.
Your brain does important work while you sleep. Give it the chance to do that by treating rest as something special.
Next Week’s Episode
Next week, we’ll talk about Regulate Metabolic Health, the second part of Build Your Base. I’ll explain why Alzheimer’s is sometimes called “Type 3 Diabetes” and what that means for your eating habits, blood sugar, and the tests you might need.
I’d love to hear from you. Did something in this episode stand out? Did my father’s story remind you of someone you know? Did the part about microsleep and driving make you think about your own sleep habits? Send me a DM on Instagram @kristenjbeasley or email me. I read every message. Additionally, consider joining online communities, such as sleep-focused groups or perimenopausal support forums, to share experiences and gather advice. Connecting with others who face similar challenges can provide valuable support and encouragement.
Free Download
Before you go, if you’re struggling with brain fog or sleep issues and you’re tired of being told it’s just normal aging, I want you to have my free guide: The Brain Fog Solution: Your Guide to Mental Clarity during Menopause. It covers which foods actually help rebuild your brain cells, the sleep strategies that made a real difference for me, and how to have better conversations with your doctor about hormones. Download it free at the link in the show notes.
Thank you for spending time with me today. If this episode spoke to you, please share it with someone who might need it. If you have questions, contact me. I’d love to hear your story.
See you next time. This is Kristen Beasley, reminding you: your healthiest life is within reach. You need the right information and the determination to follow through.
New episodes drop every week. Subscribe to The Healthy Life Approach wherever you listen to podcasts so you don’t miss a single one! Take care of that beautiful brain of yours. I’ll see you next week.
Disclaimer
DISCLAIMER: This podcast is for educational and informational purposes only and is not intended as medical advice. Be sure to consult with a qualified healthcare provider before making decisions about hormone therapy or any medical treatment. Every woman’s situation is unique, and treatment decisions should be made in partnership with your healthcare team based on your individual health history and needs. For further information and help, please check the show notes or visit our website, where I’ve included all the studies and expert references mentioned here.
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