8: Why You’re Still Tired (Even When You Sleep)

Hey, it’s Megan. Grab your coffee and let’s have a convo.

Introduction

I am so excited to bring you part two on sleep. Last week we went over why sleep is important. Hint, basically everything related to your brain, mood, energy, immune system, stress level, and overall health. This week we’re gonna dig into what things beyond your sleep environment and your wind down routine that could be affecting your sleep.

Sleep Apnea: The Silent Culprit

So the first big culprit is sleep apnea. It is more common in men, but plenty of women have it. Dr. Michael Grander talks about the unique shape of our airway, which has a 90 degree angle in it. Super cool for walking upright, not as helpful for easy access to air, especially when we’re laying down.

Extra weight, even muscle. I know our audience is much lower in the muscled out neck area, but if you have one, well done. I know you had to work twice as hard as your male counterparts to get that muscle. And here’s the perimenopause connection: lower muscle tone in the mouth, throat, and tongue area—this naturally can happen when estrogen starts to decline. And that can lead to sleep apnea.

Basically, your brain and body are getting little stints with no oxygen, which fragments your sleep so your body can’t get into deep or REM sleep because it keeps waking itself up to get more oxygen because no oxygen means no life. So your body takes this pretty seriously.

This is truly problematic because sleep apnea is a risk factor for heart, liver, kidney, immune system issues, as well as neurodegenerative disease. Women are more than twice as likely to develop Alzheimer’s disease after 60 than they are to develop breast cancer, and they also make up two thirds of all Alzheimer’s patients.

Signs You Should Talk to Your Doctor About Sleep Apnea:

• Snoring – Does your partner or people that you have sleepovers with tell you that you are snoring like a chainsaw?
• Waking up gasping or snorting
• Waking up suddenly stressed out and not knowing why and finding it hard to fall back to sleep
• Feeling like you’re sleeping through the night but not restored – like the sleep that you got did nothing for you, like you never got into actual deep sleep
• Being tired during the day – This could be for a lot of reasons, but if you have explored all of them and you can’t come up with any reasonable answer, it’s worth the conversation

Your doctor can send you home with an at-home test and there are lots of options from CPAP machines to devices that get you to sleep on your side to mouth guards.

Insomnia: When Stress Keeps the Party Going

Our next big culprit is insomnia. This one is interesting because I think it’s easy to confuse with stress. True insomnia is having trouble falling asleep or staying asleep or waking up too early for at least three nights a week for three months that cause issues with your ability to function during the day.

So major life stressors can start these bouts, but they often continue because of the stress of not sleeping, which leads to a really bad location association situation with your bed. Remember we talked about this last week when making your bed location and situation game stronger? This makes it weaker.

So every time that you get into bed and you’re tired and ready to go to sleep, but your anxiety spikes, and you start spiraling about the bad sleep that you will get, and then you know how exhausted you’re going to be the next day, you’re not going to have a great location association with your bed.

In that state, we often call it tired and wired, meaning your body is ready for sleep, you are tired, but your waking signal is too strong, and cortisol is a bully, as Dr. Carrie Jones tells us.

After the initial insomnia trigger, the stress about not sleeping is what keeps this very not fun party going. And in perimenopause, this often gets worse because cortisol and declining estrogen are doing a complicated dance that makes everything harder to stay asleep.

Okay, does this sound like you? If it takes you more than 30 minutes to fall asleep, or if you wake up for more than 30 minutes during the night over the course of several months, insomnia could be an issue.

Your Three Step Approach:

Step 1: Notice Your Anxiety Response

Pay attention to your body when you’re going to bed. Does it make you anxious to get into bed? Are you stressed like you’re gonna take a Calculus exam that you didn’t study for? Just noticing this pattern can be part of the first step.

Step 2: Remove the Effort

Stop putting effort and energy into falling asleep. This is so much easier said than done. It took me absolutely years to figure this one out. It helps to not look at a clock. I don’t have any visible in my room. I have a red face clock that I keep face down on my nightstand in case I really need to check and see what time it is. But generally after 8:30 PM, I don’t look at a clock ever.

Part of my insomnia year conditioning, I have always been able to maneuver my house and other places that I’m familiar sleeping with without looking at any of the clocks. It’s like my brain remembers that there’s a microwave in the kitchen and it knows to walk past with looking down or looking the other way. It’s a very useful skill.

Step 3: Surrender to Waking Up

So the next part of this is even more difficult but works. Surrendering in the middle of the night to the wake up. When I can do this, I can usually fall back asleep. If you can’t, get out of bed because you don’t want to create that location association that we were talking about earlier with your bed. So go do something gentle that won’t get you stressed out in another location until you’re ready to go back to sleep.

This is when all of that bedtime hygiene becomes really handy. Last week we talked about a cool, dark, quiet room, a bedtime wind down routine to let that huge predictive machine between your ears know exactly when sleep is supposed to happen, and location association for bed—sex and sleep.

There are some great self cognitive behavior therapy resources. I’ll put the links in the show notes, which is a gold standard for treating insomnia.

Quick pause. If you’re finding this helpful, do me a favor, hit the subscribe so this pops up in your feed every Wednesday morning. And if you think of another woman in your life also lying awake at 3 a.m. wondering WTF is happening to her body, share this episode with her. We’re better together. Okay, back to it.

Good Sleep Starts in the Morning

So let’s go through some other tools in our toolkit that you can try to help have better sleep hygiene and address short bursts of sleep issues. First, good sleep starts in the morning. If you sleep like the dead, ignore everything. But if you have listened this far, I imagine sleep is at least a little bit of an issue. I’m going to be honest, none of these are going to be the ultimate fix, but they are incremental movers.

Morning Sunlight

So first thing, get sunlight in your eyeballs first thing in the morning. This is important for your circadian clock—it needs to know it’s daylight. Blue light from the sun versus indoor lights. So it knows cortisol should be rising when you get that blue light in your eyes. Yes, cortisol is necessary. It gets you up and it gets you moving, gets you motivation. Without it, you would never get out of bed. It becomes a problem when it’s high at the wrong time.

So if you live in a place where it stays dark after you start work and get out of work, then you can use an artificial sun lamp like the kind that they use for seasonal affective disorder. The key is to let it hit your eyeballs at a side angle so you don’t get that light in the front of your eyes, which can be straining. Okay, so what does that mean? It means that when you’re putting makeup on in the morning, you can put it on your counter and you can put it at 10 o’clock or 1 o’clock. And the other thing is that you want to look for a 10,000 lux light so that it’s replicating sunlight.

Otherwise, go outside without sunglasses on. In your backyard, do a little walk around the block. If you can catch some actual sunset sunlight in your eyes, this is also really helpful at letting your body know what time of day it is and it supports your circadian clock.

Caffeine Timing

Okay, caffeine timing. It takes 30 minutes to kick in and you want to let your cortisol rise naturally first. So it’s best to wait about an hour before you drink coffee for it to be most effective. Or if you work even later than an hour after you wake, time it 30 minutes before you need your brain fully functioning.

Then depending on how caffeine sensitive you are, find a cutoff that works for you. Start with noon being that cutoff and then you can walk it back as necessary. Some people need a 9 a.m. cutoff time and others can work with it later. Your body is your body and no one else’s. So this will take some self experimentation. But remember, caffeine has a really long half life. If it’s swimming around in your body, your brain is going to be more stimulated, which is not good for sleep.

Movement

Move your body. Check your workout timing if your heart rate is going to go up. You may need to move it up to earlier in the day. But a gentle walk after dinner is a great way to get some steps and to let your eyes and brain know what time of day it is.

Your Before-Bed Toolkit: 4 Supplement Options That Actually Help

Okay, let’s talk about your before-bed toolkit—four supplement options that actually help. Here’s the thing, these aren’t sleeping pills. They don’t knock you out. They help you relax and take your arousal down a few notches. And that means that you can play with the timing to figure out what works for your body.

Melatonin

So melatonin is a naturally occurring nighttime hormone. It tells your body it’s time for night. It doesn’t actually make you sleepy. And here’s why this matters in perimenopause: this hormone naturally starts to go down as we age and especially during perimenopause. So it can be a useful supplement or support if you’re having some sleep problems.

Melatonin is on a seesaw with cortisol. But like I mentioned earlier, cortisol is a bully and will always beat melatonin. So how is melatonin useful? It’s giving your body nighttime signals, not actually making you sleepy.

Most people are also taking an extremely high dose at five to 10 milligrams. Adults only make about half a milligram a day. So melatonin does a lot of things like lower your blood pressure, lower your body temperature, decreased insulin production. So low melatonin can affect weight gain, it can affect insulin sensitivity, and it can also increase hunger and cravings.

So if you’re going to supplement, start with one milligram. You may have to get a pill cutter and start your timing about one hour before bed. Many people take too much too late and then they have a melatonin hangover. So again, each person is unique, so you may need to do some self-experimentation.

I recommend a third party tested brand because many melatonin supplements do not have the amount that’s actually listed on the bottle in them. And it’s also important to know that there is no negative feedback loop with melatonin. That means that if you use a supplement, it doesn’t decrease your body’s ability to make melatonin. It’s also really useful for jet lag. There are medications that can lower your melatonin production. So if you are on any, do a little research and see if you’re affected.

Glycine

Glycine—this helps to calm your brain. It doesn’t make you sleepy. But if you have a racing brain and can’t fall asleep, or you’re like me and you fall asleep just fine, but you wake up at 3 a.m. with your brain feeling like it had a shot of an espresso, it can be really helpful. I generally recommend a three gram dose, and it’s an amino acid, so it’s safe to try a higher dose if this isn’t working for you. I actually take it in the middle of the night if I wake up at 3 a.m. I just go put a little bit in water, swirl it around, drink it, and go back to sleep. It works pretty fast.

Ashwagandha

Ashwagandha—this is another stress support. It’s an adaptogen. I love it and it works really well for my body and a lot of my clients, but it does not agree with everyone. It’s very helpful for stress before bed or even in the middle of the night if you wake up and are unable to fall asleep. 300 milligrams twice a day of the KSM-66 is a specific strain that has been used in a lot of trials on stress.

I happen to use a tincture and it’s about three quarters of a dropper and that has about 800 milligrams when I’m stressed at night. And I take that either when I know I’m stressed going to sleep or if I wake up in the middle of the night and I’m having a really hard time falling back asleep.

Magnesium Glycinate

Magnesium glycinate—so the glycinate probably sounds familiar. It’s glycine with magnesium, which is a nice and relaxing combo. So you can try between 200 to 400 milligrams to start.

Timing Is Everything

So back to the timing thing. The great thing about all of these is that they don’t specifically make you sleepy, they help you to relax. So you can play with when you take them. If the most stressful part of the day is dinnertime, you can take them then and see how your body responds. When I’m super stressed, I take them earlier in the day and then in the evening. You don’t want to take ashwagandha too close to waking because it works by helping to lower your cortisol. And in the morning, you really want that cortisol spike to get your day going.

Other Tools: Meditation & Progressive Muscle Relaxation

Okay, other things that you can do. Meditation—this is a maintenance thing. It won’t make you sleep better tonight, but over time it will. The two things that moved the needle the most for me on the sleep front were my ex-husband moving out and taking a meditation course. These two things happening were the start of my very first adult experience sleeping through the night, which was absolutely incredibly magical.

It has been compared to CBT for sleep and over the long term is slightly less effective, but that’s still pretty stellar compared to the gold standard for insomnia. So if you want the stress and sleep benefits, it can be a really great tool.

Progressive muscle relaxation is a technique for relaxing the muscles. I have linked a guided one in the show notes. It decreases anxiety and lowers insomnia scores, specifically in perimenopausal women in a 2024 trial. It was shown to have meaningful improvements in vasomotor symptoms like hot flashes, as well as improve insomnia and sleep quality.

There are lots of other nervous system tools out there, things like meditation, breathwork, yoga nidra, but PMR is a great place to start.

Your Next Step

If you have the bandwidth to focus on your sleep—remember no shoulds here—pick one thing that sounds interesting to try this week. Sleep and stress are uniquely linked and in perimenopause, they often become something we need to spend a little bit more time addressing.

Can you do me a favor? If this was helpful, share it with one person who might need to hear it today. Our bodies didn’t come with a user manual and this perimenopause thing can feel confusing and lonely, but you’re not alone. You’re not crazy and you’re definitely not broken. And maybe someone in your life needs that reminder too. Let’s spread the word and be kind to each other and ourselves.

Now the legal bit. I’m a nutritionist, but I’m not your nutritionist. This podcast is for information and education only. No client relationship was formed. Always seek medical advice when necessary. I’ll see you next Wednesday morning.