Ep 72 - Managing Menopausal Insomnia through CBTi with Tracy The Sleep Coach

You know what it's like if you don't get enough sleep. You end up grouchy, stressed and struggling to concentrate.
 
We all have times when our sleep is poor, but when it goes on for an extended period, it can have a massive impact on quality of life.
 
Whilst good sleep hygiene can help, sometimes we need to get to the root of what's interrupting the sleep behaviours.
 
What's our relationship with our bed like! How much is the anxiety around not sleeping causing us not to sleep?
 
Well, I got these any many other questions answered when I had a virtual coffee with Tracy Hannigan, AKA The Sleep Coach recently.
 
Tracy uses Cognitive Behavioural Therapy for Insomnia to help her clients to not only get a good night's sleep but to change their relationship with sleep for good.
 
Tracy is ffering listeners of Generation Exceptional a 10% discount on her CBTi for Insomnia online Sleep Recovery course with the code GENX22.
 
Check out Tracy's Instagram channel @Tracythesleepcoach https://www.instagram.com/tracythesle...

or head over to her Facebook Community Sound Sleep Strategies https://www.facebook.com/groups/14935...

You can also follow her on YouTube 'Tracy The Sleep Coach' https://www.youtube.com/channel/UCQle...

Transcript:
 

Tracy Hannigan

Hi everyone. And welcome to another episode of generation exceptional with me, Bev Thorogood.

My guest today is really going to appeal to any of the women out there who really struggle with midlife sleep disruption. My guest is Tracy Hannigan, Tracy, The Sleep Coach, welcome to the show.

Thank you very much. Very excited to be here.

You’re very welcome. This is one that I'm really interested to talk about because I hear so many women tell me how poorly they sleep.  Now I've been quite lucky. I have occasional disrupted sleep. I think that's probably quite normal. It's probably a little bit more frequent now than it was in my thirties, but it's not a major problem for me, but I know some women, it is absolutely ruining their lives, that they're not getting enough sleep.

So I was fascinated to have you on the podcast. I saw you speak a couple of months ago at a Facebook event. And I just thought I have got to get Tracy onto the podcast because the way you talk about managing sleep and repairing sleep patterns, I suppose it's different to anything I'd ever heard before.

Let me stop talking for a moment and introduce you, I'll let you introduce yourself. . Just tell us a little bit about who you are, your background and how you ended up as a sleep coach.

Right.  So my name is Tracy Hannigan. My background is actually as a registered healthcare professional and that has taken different guises over time. I worked in community mental health, courtesy of a degree in psychology, back in the States and obviously in that environment, dealing with a lot of situations and a lot of people who really struggle with their sleep, either as a cause or consequence of their mental health issues.

Moving to the UK and training as an osteopath, obviously seeing a lot of pain issues with sleep issues. And so the more I looked around, the more I saw sleep as just a very fundamental problem. We all have disrupted sleep for short periods, but there is a certain percentage of the population who struggle in an ongoing way.

Often unnecessarily with, with their sleep. And I'm very interested in sleep from a, from a personal point of view as well.

I had my first bout of insomnia in my early twenties, after the death of my husband.

Obviously you would expect that there'd be sleep disruption, but it went on for years. And then another bout a little bit later in life where I learned the tools and the skills that cognitive behavioral therapy for insomnia can give somebody and decided that I would train in this particular technique courtesy of being able to use the other bits of my background and began working in a clinic setting in person with people.

And then when the pandemic hit I took that online.  I'd thought about doing it and then the situation, the context, just gave me that little bit of an extra push.

And so now I'm working completely online with people who are trying to sort out their insomnia.

We'll talk about the methodology that you use in a second or two, but I'm just wanting to pick up, you said in terms of cause or consequence.

That was interesting. So insomnia is the cause of problems or insomnia is the consequence of problems? I'm guessing from what you said it can be either.

It can be either.

What do you see normally? Is it, is it normally that the sleep is disrupted? You mentioned your first bout was after a bereavement, I imagine stress is a major factor when it comes to insomnia.

Yeah. So insomnia can be a cause or a consequence.  Very often in sleep coaching we talk about things that predispose people, make them more likely to be to have problems with sleep in the future. And those are much more common.

So if someone is an anxious person or if they have generalized anxiety, some kind of clinical anxiety disorder or panic disorder, PTSD, your whole collection of mental health issues as well as physical health issues, that can predispose somebody to having difficulty sleeping.

The most common thing is a predisposing factor to anxiety or a personality trait that some of us might unfortunately know all too well, which is an unhealthy level of perfectionism.

Yeah, so all of these things make somebody more likely to develop longer-term sleeping problems after a short-term bout of sleeplessness, because it's really important to differentiate because stress can cause short-term sleeplessness.

It happens to all of us, something exciting is going on. Something sad is going on, but what turns that short-term bout of sleeplessness into a longer term sleeping problem? And the answer for a lot of people is one of those traits.

Okay. So is there a genetic predisposition to insomnia, is there a physical predisposition?

So it depends on how you're defining insomnia. When I'm using the term I'm speaking about insomnia disorder, which is a discreet clinical condition. There are a lot of other sleep disorders that people will often describe as insomnia that aren't insomnia. And some of them can have a genetic predisposition, but I would say that the most likely genetic factor would be in those predisposing factors.

The things that make people more likely to develop insomnia.

So if there is a genetic predisposition to a certain kind of mental health condition in the family that will make it much more likely that you will be predisposed to developing sleeping difficulty.

Why do we see such an upsurge in sleep disruption in women as they enter perimenopause and go through their menopause transition? Because anecdotally I definitely see that the majority of women that I talk to, and I talk to lots of menopausal women, as you can imagine. I would say probably 80 to 90% of them have sleep disruption as one of their key symptoms. Where's the connection. Why such a rise?

Yeah, there are a few different explanations for why insomnia becomes more prevalent.

And in the literature, when they are looking at broad population levels, the prevalence ranges from 23 to 65, 70%. So it depends on what kind of community you are in. Obviously in these communities, we're seeing people who are very self-directed about wanting to sort out their issues so the, the number of people seems very large and the number is too large.

And the consequences are too high.

So the question is then why they’re still, (you would think that they would have this one down and there'd be tons of research about this.) picking it apart. I would say that there is. in women who are going through perimenopause menopause and post-menopause, there is a predisposition because of the hormonal change to anxiety and depression.

So those conditions alone are predisposing factors to developing sleeping difficulties. The change in hormone levels can affect the production of melatonin, which can create further sleeping difficulties.

And then you layer on repeated wake-ups because of vasomotor symptoms and hot flushes and all of these sorts of physical symptoms that affect women at night.

And those obviously wake people up, but in the entire context of all the other symptoms that are being experienced, anxiety about being woken up repeatedly at night feeds the sleeping problems. Multifactorial.

I was going to say, is that almost a self fulfilling prophecy here? That actually my sleep is disrupted now I'm anxious about the fact that my sleep is disrupted

So as the anxiety worsens, the sleep worsens.

Exactly. Exactly.

Okay. So let's talk about the methodology that you use because we are all fed the idea (and I am probably I'm one of those people spouting off the idea) of sleep hygiene, you know, make sure you have a regular wake time, a regular bedtime, have a wind down towards bed time, magnesium in your bath.

Then, you know, like magnesium sprays and warm baths before bed. How much of that is rubbish, how much of that being spouting isn't really helpful?  Or does it help?  Because those aren't your methods actually, are they?

Yeah, they are a tiny part of what is considered the evidence-base for working with adult insomnia.

So when we're talking about sleep hygiene, sleep hygiene is what we would consider helpful, necessary for some but not sufficient in and of itself.

No amount of nice smelling sprays on the pillow or warm baths is going to counteract your anxiety about not sleeping at night. It might help you relax, might feel really nice, but the sleep hygiene tips and tricks don't get into the root of what's feeding the insomnia long term.

And that's why we say they're necessary, helpful, but not sufficient in and of themselves. And in terms of the research, sleep hygiene interventions alone are not considered to have any evidence when compared to things that have a lot more evidence.

It doesn't mean that your cup of tea in the evening is a negative thing. It doesn't mean that you shouldn't have a hot bath if you enjoy having a hot bath, but what happens is people go online or they get a handout from their GP with all the sleep hygiene tips and tricks in it. They feel like they have done it all because that's the most easy to access information.

And they are frustrated because it didn't work, you know, in big air quotes “it didn't work”  as they're still having difficulty sleeping. So it sets off this perpetual search and this perpetual anxiety about finding the answer. And I've had people come to me with literal spreadsheets full of things that they do.

Their routines have become so rigid because they have attached a certain order of things and a certainty.  Perhaps a certain spray and I got a good sleep that night when actually it may have nothing to do with it.

And then when it quote unquote “stops working”, it fuels that anxiety even more. Interestingly in terms of sleep hygiene and CBTi there are more and more CBTi - I wouldn't want to call them tips or tricks - but basic principles that are creeping into those lists, which is nice to see.

But without the context and without doing the cognitive work, the behavioral pieces alone are not always enough either. And I can talk a little bit more about that. Talk about how it all works.

I'm just thinking as well, you know, certainly I found for me my sleep hygiene at that surface level isn't always great.  I’m a bit of a night owl always have been. But actually what I do find is even when I, you know, when I put myself into that position where actually I'm going to really focus on getting to bed on time and doing the things like not having backlit lights, that sort of thing. It does help me get off to sleep, but it doesn't stop me waking up at three o'clock in the morning with my head full of stuff and not being able to get back off to sleep again.

Yeah. It's a different category of experience. And I have to say that because a lot of people who come to me come after doing online sorts of methods, they have much better sleep hygiene than I do. And they still have sleeping difficulties, you know, they've got a dark room, that room is cool.

Now these things, again are not necessarily negative things, unless you start obsessing about them. That's when they actually feed the problem rather than helping with the problem.

I think as well, you know, I guess if you've put all of these sort of factors into place and you're having the warm bath you know, you've got your bamboo sheets or whatever else it might be, if it's not working, suddenly that becomes “there must be something fundamentally wrong with me. If I'm doing everything I'm being told to do, and I still can't sleep. What's wrong with me.”

Now you've already mentioned CBTi which is the methodology, the system, (I don't know whether that's the right word) that you use to help people.  Talk us through what CBTi is.  I know what CBT is, cognitive behavioral therapy. But if you could do me a favour please and just go through in essence, what CBT is and why CBT for insomnia is your chosen methodology?

Yeah, CBTi is my chosen foundation for the work that I do, because it is where there's over 30 years of evidence behind it.

It works for over 85% of people for whom it's suited. It's very effective. Unfortunately it's just not that well known and it does get confused with CBT.

Are they very different?

They are different in the sense that CBTi the behavioral component focuses on both physical behaviors around sleep, as well as mental behavior.

So in behavioral sleep medicine and in cognitive behavioral therapy world, we think of thought patterns as behaviors, the mental behaviors.  CBTi works on the physical behaviors around sleep, as well as the mental behaviors around sleep.

So somebody comes to me and they're having difficulty with sleeping. Some of the tools that we use for the mental behaviors for the cognitive side, they are very similar and are often drawn from the work that is done with CBT, but we focus exclusively on the thoughts and emotions and feelings behind the sleeping issue rather than more broadly, because that's, for me, that's outside of my scope of practice.

But the behavioral pieces that apply to the physical sleep world are usually not things that are ever addressed in CBT for say anxiety or phobias, for example.

So there is some overlap but the pieces that don't overlap are more around the behaviors around sleep. So things like not spending nine hours in bed, trying to catch a few minutes of extra sleep when you're able to only generate six hours, because it's a little bit like rolling out a pizza dough.

If you only have a six inch blob of dough and you try to roll it out onto a nine inch pizza plate what's going to happen. It's going to get full of holes. It's going to get thin around the edges. It's not going to support what you need to put on top of it. It's a great analogy for sleep.

And that sort of thing is not addressed in CBT for things like anxiety.

Okay. Gotcha. Gotcha. What about this idea that all adults need between seven and nine hours sleep.  I think I now realize that I work best on about seven hours and 15 minutes. Seven hours and 15 minutes I feel great.  If I have less than that, I feel a bit groggy. And if I have more than that, everything aches. , I found that seven 15 is my sweet spot, but we're all so unique and so different is that one of those sort of throw away lines, like 10,000 steps, 7 to 9 hours sleep, what should we be getting? Because cause I think we get hung up on, oh gosh, I haven't had my full seven hours sleep. I'm not going to get through the day when I'm not sure, is that true?

Such a good question. So somebody's individual sleep need is genetically determined and there's going to be an optimal amount of sleep for a given individual. Unfortunately, the soundbites are, you know, if you don't get eight hours, you're going to have strokes and all of this other stuff is going to happen to you.

And it's just, that's like saying everybody needs to wear a size six shoe. It's just not the case. If you imagine a bell curve, the majority of people say that they feel pretty good in that seven to nine hour range. And really it's not the amount of hours that's the important piece. It’s about is whatever sleep you're getting enough for you to feel refreshed and able to do what you need to do during the day.

And for some people that might be six and a half hours for some people that might be nine hours and it actually creates problems for people who need less sleep to start searching for more sleep.

Oh, tell me more about that.

So it is like if somebody has, and I heard the wonderful podcast, can't remember the name of the podcast now, this gentlemen was definitely a perfectionist type personality who created projects out of everything and had been reading that he needs eight hours of sleep. We take this hypothetical person. And he is able to generate six and a half hours but really wants eight because eight is supposed to be the optimum.

And this person's always interested in optimizing their life. Well, that's like taking that six hour blob of pizza dough and trying to stretch it out onto a plate that's too big. You actually give yourself insomnia. And in the research world, when they are testing, short-term sleeping medications, they actually induce insomnia in healthy people who don't have sleeping troubles.

By having them do things like stay in bed for 12 hours when you can't generate 12 hours of sleep.  Their sleep becomes broken and unhealthy.

So how do you know if you're getting enough sleep?

That is a very common question. You know, how do I know what my number is?  In the process of CBTi that becomes clear, but if you are falling asleep within 15, 20 minutes but not less than five. If you wake up a couple of times in the night and you fall back to sleep within that same amount of time, 15, 20 minutes. And if you wake up in the morning, feeling refreshed, whatever that number is, is your number.

You got to embrace your number and not search for a different one.

It's really, important because actually I know there's, there's certainly been times where I felt like I've slept really well but felt exhausted when I've woken up and I'm guessing it's because we go through all these different stages of sleep, light sleep, REM sleep, deep restorative sleep, et cetera.

I have a Fitbit that tells me, I have no idea how accurate it is, the levels of sleep that I've been in. How can we, how can we make sure that we're getting to those deeper kind of more restorative levels of sleep?

Having good sleep that is satisfying for us, that has a good quality - we'll generate the amount of time that we need in each of these kinds of sleep areas.

So people ask me about different kinds of tracking devices.

And unfortunately, although they're getting better with are you asleep or are you awake, they're still not great. They're really not very good about what phase of sleep people are in. So people often show me their graph and, oh, I've got like three minutes in deep sleep. What's wrong with me?

It doesn't necessarily mean you actually only got three minutes of deep sleep because the brain will generate the sleep that it needs.

If you have had a period where you've been extremely sleep deprived, And then you have a really deep sleep and you spend the whole time dreaming and you wake up exhausted because the brain is saying, I need this kind of sleep. So as soon as we fall asleep, I'm going to get all of that sleep.

So avoiding as best people can , having things like insomnia, treating sleep apnea etc, that's really important, particularly for women as we get older and our hormones change, those hormonal changes affect more than the skin just above our knees and our wrinkles and things. It affects all of our soft tissues and makes us more prone to sleep apnea, which really destroys sleep quality.

And being mindful of things like not too much alcohol that also can destroy sleep quality. If we can get out of the way of our sleep system. it does a pretty good job of giving us what we need.

Good. Good. Good. So how does does CBTi look then? What actually happens?

Yeah. The first and most important thing when somebody comes to me or any other therapists doing CBTi is that they are screened for safety.

So like I was saying, insomnia is just one of many, many different kinds of, of conditions. And some of the interventions that are suggested to some people, when doing CBTi in the beginning can make people more sleepy.

If they have another sleep disorder already, that makes them sleepy, they could become unsafely sleepy. So you first get screened for these sorts of things, any untreated or out of control,mental health issues, things that would get in the way of CBTi then what happens typically, at least in the beginning to get a foundation is we do a prospective sleep diary.

So we look at what does the sleep actually look like going forward because human beings are not good at necessarily knowing, what their sleep is like on average because we tend to focus on the worst nights. Sometimes looking at diary data over a couple of weeks, it's actually really easy to pick out, you know a statement such as when I have a bad night, it wrecks the rest of the week.

Yeah, it doesn't always, and sometimes you can show that to people right. In their data. And in standard CBTi which isn't necessarily appropriate for everybody we want to use the principles and apply them to the person's situation. But we typically do behavioral interventions first because they help reinforce the idea in a person's lived experience that their sleep system is not broken.

These interventions typically make people sleepy and the first one is geared around helping create the appropriate size pizza plate for the amount of sleep that someone can generate.

This helps deepen someone's sleep quality so that the sleep they are getting, even if it's not enough is a better quality and is more refreshing and restorative.

And then we look at behaviors around sleep in the bed that can interfere with people's association with the bed.  Because before we develop sleeping difficulties, we don't think about our relationship with our bed.

It's a completely unconscious thing. We get sleepy, we lay down, we fall asleep. So if you have a relationship like that for years and years, and then suddenly your relationship is that sometimes I sleep and sometimes I toss and turn and sometimes I lay here sweating and upset, and sometimes I lay here worrying about what's going to happen tomorrow, or I'm going to have an argument with my spouse, the relationship becomes confused.

And so adjusting people's relationship to their bed vis their behavior, whether they're in bed or out of bed, is the second, most powerful thing that we do. And then when someone is feeling a little bit more confident in their ability to sleep, we don't stop there. Even if people are sleeping really well.

It's a good idea to not stop there because what hasn't yet been addressed and we begin to address, is why are you terrified of not sleeping in the first place?

Because it is the anxiety of not sleeping well after a short-term bout of sleeplessness. The worry about that short-term sleeplessness is what creates the longer-term problem, which is why you can have an incident or an excitement.

And then after it passes people still aren't sleeping. So working on all of those cognitive pieces, which is the CBT and the mindfulness Acceptance and Commitment Therapy kind of element does that. It's fascinating because it's so individualized to the person and what their particular worries are. So we would kind of pick through which ones of these are rational and which ones aren't. And how can we reframe how we think about sleep?

For example, being up all night can be terrifying for some people, because it's what they're trying “to not do”. And the trying is fed by the fear of being awake.

But if we can reframe that being awake one night by looking at actually the consequences, aren't that bad, because look, you never crashed the car and you used to get in arguments with your spouse when you slept well.

And you just put these things into perspective. And you're building sleep drive, which will build sleep quality in the long run. You just flip it on its head and look at it differently with the support of somebody who's working with you, it takes that arousal down because it doesn't matter how little sleep you've gotten, usually, or what time of night it is, what time your circadian rhythm is telling you, you know, it's time to not be awake, now you should be sleeping.

It doesn't matter how strong those two components of the sleep control system are. If we think of bears coming into the cave and we're responding to sleeplessness, like a bear is coming into the cave, we're not going to be able to sleep.

That's why it is so important to kind of see it through and do the mental work and the work with the anxiety. That is how I now can have bouts of sleeplessness that don't turn into yet another insomnia problem, because I'm very neutral now about when I don't get good sleep.

When does a disturbed sleep pattern become insomnia?

That's a really good question.

So according to the big, big textbooks that define insomnia, you want to be waiting three months before it actually gets defined as insomnia. But if somebody has not been sleeping well for a few weeks and has this kind of pattern and this developing anxiety, I'm not going to tell them that they need to wait for three months before they can get some help.

I really like the idea of doing this, actually writing a kid's book, teaching children or young adults that after their sleeping has settled back down from their teenage years this kind of sleep disruption is normal and to not panic about it, because we could prevent so much ongoing sleeping disturbance.

You know, you go through your life and even if you have a medical condition or if you have pain or if you're having vasomotor symptoms, those things may wake you from your sleep. But if the sleeplessness is like on a 10 scale is like an eight out of 10 and five of it is due to that anxiety, we can reduce that a lot and really help improve people's quality of life.

Yeah just for the listeners, I'm sure most people do know, but when you're talking about vasomotor symptoms, we're talking about that sort of internal temperature gauge in the body so leading into hot flashes night sweats, those sorts of things.  

Okay. So tell us a little bit more about you and your business? The business is Tracy, The Sleep Coach . So how can people get help from you if they are struggling?

There are a variety of different ways that I work. I do run kind of a do it yourself. CBTi based sleep recovery course.

I offer one-to-one calls. So I call it a sleep jumpstart call where you get the entire assessment diary and spend a 90 minute call with me and you leave with a really solid plan based on your needs to tackling things from a behavioral point of view and some things around the anxiety piece

And then a package that includes some follow-up calls. And usually that's more appropriate if there is quite a lot of sleep anxiety or the issue has been really long-standing.

And I do offer a quick start call, which is essentially you can book almost the same day, 30 minute chats. Obviously doesn't have that assessment piece in it.

But I guess people find that helpful for, I would've thought just to reassure that actually this is quite normal. Yeah.

Yes. I had somebody come to me with a perfectly normal sleep diary once very worried about it taking, you know, 10 minutes to fall asleep on waking up in the night for 10 or 15 minutes. And it was simply a matter of education. But that's actually normal. If somebody is taking less than five minutes to fall asleep, we actually consider that a problem.

Okay. Gosh, that's my husband. As soon as his head touches the pillow, and he has been like that for as long as I've known him, I've been talking to him and I'll hear his breathing change. I think, goodness, me, it's only like two minutes since he got into bed. So I guess for him, it's probably his normal if that's the way he's always bee?  Now you've got me worried that he's got a problem haha!

Yeah, we can definitely talk about that. In any of the services that I offer one-to-one is that screening for safety. And there's a really simple assessment. And it tends to revolve on how easy is it for you to fall asleep in weird places, what it comes down to. Cause that's more associated with other sleeping disorders.

Whereas insomnia is that tired and wired kind of can't nap. I can't fall asleep. I wake up.

I had a question in my head and my menopausal brain has just done its normal thing and the question’s completely escaped me. What, what was it?

I will come back to that.  Okay. So where can people get hold of you?

People can find me through my website, www,tracythesleepcoach.co.uk. I'm also on Instagram @Tracythesleepcoach and brand new sparkly slowly growing YouTube channel again, tracythesleepcoach.

If you put it in, you'll find me in all of my places. I do run a free Facebook group called Sound Sleep Strategies that is underpinned by the fundamentals of CBTi and there are a lot of video resources in there to help people get started.

Brilliant. So you've got your Facebook, your Instagram. Tell me about the course, this DIY course.

I guess most of us want a quick fix with everything. It's human nature, isn't it, to want to quick fix which is probably why things like sleeping tablets and all the rest of it are such a go to for a lot of people, I think that certainly for a lot of women in menopause, you know, that that sense of relief. Just, just give me a sleeping pill and now I can get a good night's sleep. How how long does it take to put things right. If that's not too open ended a question and the DIY course that you're talking about how much of this can we do ourselves? Because it sounds like something you would need to work with a therapist.

Yeah. So how long is how long does it take to work through? This really is how long is a piece of string? However, People can learn the skills that they need to learn in terms of understanding their sleep patterns, understanding how to adjust their sleep patterns, depending on what their issue is and getting a really good head start on using the tools to help them identify where their anxiety lies and what to do about it within sort of like 6 sessions.  Usually 4 to 6 sessions, depending on how long the sessions are. And that's why the course is geared toward being six weeks long. I'm actually thinking of, of extending it a little bit, but sometimes we have something that goes on too long it's difficult for people to kind of maintain the consistency with it.

The Sleep Jumpstart that I offer. It is quite an intensive 90 minutes where we look at all of these things. I explain the fundamentals and give a person a plan, but in that kind of four to six session, four to six week mark people can learn those skills themselves and they can do it themselves.

I know a lot of people who've done really, really well learning to apply those fundamentals to their own situation. And then I'm always around to help tailor it if it needs to be further tailored.

Yeah. So tell me about the sleep recovery course.

Yeah. It it's a 6 week course with a 6 week built in mindfulness component. Mindfulness is what I would put into any program because it helps with that sitting with the anxiety piece. So I think it's really, really important not to just use relaxation techniques, like a hammer on a nail, like, Ooh, I need to fall asleep I'm going to do a relaxation technique. 

But because of hyper arousal that feeds insomnia as a 24/7 problem, Mindfulness is a fantastic way for people to really easily practice in their daily life. So I run them in parallel. Each module of the course working through the mental pieces and the physical behavioral pieces has a mindfulness module attached to it.

So it goes through a basic sleep education, understanding how the sleep system works and helping people identify where their sleep behaviors may have gone wrong and potentially contributed to the problem. And then we look at the physical environment. So there is a sleep hygiene component to it with a bit of a twist it's all focused on that hyper arousal piece rather than a prescriptive “if you take a bath at this time, that's the best”.  There is kind of more expansive concept of sleep hygiene module. There's a set of modules on understanding what it is that you are thinking and what those fears are. And teaching people how to use the tools.

They can dig into their own fears around what and why is it that not sleeping is scary because there's a difference between discomfort and something being scary, but we often pair those things together. So helping people unpair those mental and emotional responses and working with those and then really, how do you not do things like take a six hour blob of dough and try to stretch it out onto an eight hour piece of pizza.

And then when you're getting really good sleep for whatever hours that is for you, how do you expand it out until you get the amount of sleep that you need? That's deep in quality, refreshing and allows you to live the life that you want to live and be prepared for future sleep blips.

The last module in the course is all about acknowledging that in the future, things are going to affect our sleep. We cannot help that from happening. What we can do is we can be aware of what our patterns are, what we tend to want to do, whether that's going to be a helpful thing for sleep or not.

And just reframe how we approach those short-term bouts of sleeplessness.

It sounds absolutely brilliant. And I know you're very, very generously offering listeners, a 10% discount on the D I Y course with the code GENX22, which I'll put in the show notes anyway, which is very, very kind.

And this has been fascinating. Some of it I can't really relate to because I wouldn't say I have any major sleep issues, I have occasional problems as most women do. But what would be three top tips for someone who maybe doesn't have severe insomnia, but just, you know, wants to have better sleep hygiene if we're allowed to kind of go down that route.

Yeah, definitely. The number one tip that I give people I think is particularly pertinent to women who are waking up in the middle of the night is to stop watching the clock and letting the clock tell you how you should be responding the next day to how your day is going to be. We spend a lot of time cycling in and out of, of light sleep and deeper sleep.

And that's totally normal. If you wake up one night at three o'clock. For whatever reason. And you look at your watch and you say, oh, M G it's 3:00 AM. nd tomorrow is going to be a disaster. You're accidentally training your safety system to say, oh my, if I'm, if I'm going through one of these lighter phases of sleep, I better wake up and really check that something really scared her and something really upset her.

So it leaves you less places to hang any anxiety about waking up in the night. If we don't know what time it is - and to be honest, knowing that you're awake for 47 minutes in the middle of the nigh - it doesn't help your sleep at all.

You cannot use that information. So my number one tip is always to stop watching the clocks, take your alarm clock, turn it around, face it away from you. Don't look at your phone for lots of reasons, but particularly for the stimulation of the, of the time piece.

The second thing is that no matter how well or poorly you might've slept the night before, if you're having any difficulty at all with sleep, always get up at the same time of day.

So pick a time that works for you throughout the week on average, and even in the beginning, even on the weekends in the beginning, get up at a consistent time. This will allow you on nights where you're not sleeping so well to have almost a training effect. Your brain will say, Ooh, I only get this amount of time to sleep I better sleep more deeply and get what I need because she's going to get up and start her day.

Having lie ins also can mess with our circadian rhythms and as we get older, our circadian rhythm is going to shift anyway. So it just helps introduce a little less chaos into that, into that picture.

Just, just on that so get up at the same time. Are you then therefore saying go to bed at the same time or just, just make sure you have the wake time nailed?

So, if someone is sleeping reasonably well, I would say, don't worry about what time you go to bed. Getting up at the same time is a more important piece, but if somebody is not sleeping well, getting up at that, that consistent time, what happens is if somebody is not sleeping well, they may take quite a long time to fall asleep. It doesn't help them to get into bed and lay there and wait for it to happen because usually that creates stress and anxiety, which then becomes associated with the bed. So the correlate to that would be go to bed when you are sleepy enough to fall asleep.

Brilliant. And your 3rd one?

Don't be in bed if you're not happy to be there. So I've gotten to a place now where I'm very emotionally neutral about when I'm awake in the night. I'm not awake nearly as much as I used to, but life still happens. I still wake up thinking about things,  as long as I'm kind of content and relaxed and feeling neutral about it I stay in bed.

It's really advisable if you are laying there tossing and turning fretting worrying, sweating, being upset. that you take those feelings and you bring them someplace else, have them out in the living room.

If you can sit in a chair you don't like,  have that experience there. You'll be building sleep drive because you're awake and you're physically active and you will be helping to improve the association with your bed.

You take those feelings. Do what you need to do with them. Go back to sleep when you're really sleepy. And it's not like, oh, I did that for two days and it didn't work. It is a retraining process. You're simply saying, look, brain sleepiness bed. Oops, didn't work this time. Let's do it again. Brain, sleepiness, bed, and doing that with consistency can help rebuild that positive association with your bed.

And that is actually one of the most evidence-based standalone approaches for all of the tools we have in behavioral sleep medicine, so simple.

But I think the idea of getting up when you're absolutely exhausted and you're not sleeping, you're wide awake and your head's spinning, the idea of getting up and going into a different room and doing something different, feels counter intuitive. It feels like, well, I'm never going to sleep if I'm sat up in a chair. Although I must admit, I know I've had times where I've got out of bed and gone down to the living room, sat on the sofa and fallen asleep like that.

I've actually had some really good quality sleep on the sofa.  Am I therefore building up other patterns whereby I associate good sleep with the sofa?

Such and good point because the caveat to this particular technique, if it's appropriate for somebody is to not surf and fall asleep elsewhere.

Because if you have a really angsty relationship with your bed and you've got lots of sleep drive, cause you're not sleeping well and you can't sleep in bed, but you got a lot of negativity there and you go to the sofa and you don't have that negative. And you're already up. So you're not like trying to force yourself to sleep.

You're not doing something to try to sleep. Your arousal comes down. That bear leaves the cave and wow you fall asleep. You can actually develop a sleeping association with your bed, with your sofa or your recliner and if that works for people, that's fine. My mother still sleeps on the sofa after 20 years, it works for her relationship.

But what happens then is if you decide you want to be sleeping back in your bed, you have two hurdles, you have to tear yourself away from the place you're getting sleep and recreate the sleepiness association with your bed. So what becomes a nice reassuring short-term fix can create longer term problems.

Just being really aware of that is real important. .

That's really good to know.

Now in true menopausal fashion I've remembered what I was going to ask about 10 minutes ago. It always is there. If I just hang around long enough, it normally comes back.

I heard a term a little while ago that I'd never come across before, but by God it's me  - sleep procrastination.

Have you come across that? I'm sure you probably have.

I wrote a feature in The Independent on sleep procrastination!

Well, I'd not heard of this. And then I heard a gentleman talk about it on a podcast and I thought I do that! I can be beyond tired sort of midnight with every ounce of my being screaming at me to go to bed.

And I will find a dozen different jobs to do-  a little bit more surfing or the end of another Netflix episode. And actually, my husband's the complete opposite. He will walk away midway through a program. Cause his body says it's time for bed. I'm tired. And he'll just say I'm off to bed now. And I'm like, how can you not watch the end of this episode?

Talk to me about it? Because it's a real thing for me. And when we're talking about that cognitive behavioral piece, I know that I am sometimes in danger of getting anxious about the fact that I procrastinate about going to sleep. And that makes it worse.

Hmm. Yeah. Sleep procrastination is really common and it's on both ends of the spectrum.

So sometimes people will wake themselves up prematurely in the morning to have time for themselves or time for certain activity. Some people will stay up later than they should. They're denying themselves sleep opportunity, as we would say, because they are trying to get other things done. And I think people fall into two camps there.

The procrastinator camp in general, for whom this is just the thing. Yeah. Lots of other areas as well, to be fair. And in the boundaries issue, because I think a lot of people, particularly women who tend to, for better or worse, take on kind of a caregiving role, we give, give, give, give to other people all day long.

And we give to our business all day long and we give to all of these things except for us. And it's the only time where we feel we can go and we're still conscious. Right. And part of us wants that conscious time with ourselves. And I think one of the things that I learned, because this was an issue for me, and it's sometimes an issue for me still is really time-blocking and managing time and boundaries more appropriately so that I can have that time for myself during the day to do the things.

It really did help the procrastination piece for me, especially for me as a fellow procrastinator, it weaves its way in to so many different arenas.   I could spend six hours doing two hours of work, but if I'm time blocking, I'm now blocking time for myself at the beginning of the day, in the middle of the day and the end of the day, and stacking those times with myself as habits on the things that I'm already doing.

It's like being given a smaller handbag, you have to decide what you're going to put in that handbag. And it helps you choose where you want to put your energy and how you want to direct your energy during that gap. So working on those boundaries and time management pieces will often leave people feeling like they don't need to do that at night, or they don't need to do it in the morning, or at least not so much, but it's a really fascinating phenomenon and it can lead to insomnia in some people because of the worry about not getting enough sleep.

What you've just said that around sort of giving too much to the business. You know I work far more hours in the day now that I work for myself, than I did when I was working you know, in my paid job, my employed job. But it doesn't feel like work a lot of the time. I enjoy doing it.  I'm working for myself.

It's a blessing, isn't it? But it does bleed out.

But actually it does mean, as you say, I don't give myself a huge amount of time for me during the day. And maybe that is why, you know, come the evening when Mark has gone to bed, cause he does generally go to bed before I do, I have this, this time, this block of probably two hours that is just for me. And I guess I'm probably hanging on to it. It's one of those things where, you know, logically I know I should be going to bed, but emotionally I'm clinging on to this time. I haven't really made the connection as I've always been a night owl but I don't think I've ever procrastinated around sleep in this way.

Absolutely fascinating. It is a really, really interesting topic.

Really interesting. I mean, I would think, well, I want time for myself. I'm going to go knit or something like that, but what do I end up doing? Like, well, let's scrub the stains off the back of the pots, you know, just like weird things like that.

I just sit there watching Netflix or scrolling through Instagram.

Anyway. Tracy, thank you so much. I think this is a fascinating conversation. I think sleep is one of those things where we really don't, even to this day still don't really know a huge amount about. I do think that we underestimate how important sleep is in our lives. Certainly for me. I know that when my step is disrupted , my stress is higher and when my stress is high my sleep is disrupted. It does seem to go hand in hand. And when we've got brain fog already with perimenopause, actually lack of sleep and stress,don't help with brain fog.

So, I think for anybody listening, if you are struggling, genuinely struggling with poor sleep do look Tracy up, Do go and grab her sleep recovery course, even if that's just a foot in the door to get an idea of what all this is about before they come to you for some one-to-one help, .

I love the way you explained it all, you make something complicated feel really simple.

Well, not necessarily easy, but it's actually very straightforward once you understand how it works.

Brilliant. Thank you so much. It's been an absolute pleasure. Thank you for giving me your time and we will talk to everybody again soon.

Thanks for listening guys. Take care.