Sleep is often not a friend to women in midlife and beyond. Some may fall asleep quickly but wake up in the middle of the night unable to go back to sleep. Other may have difficulty falling asleep at all. Either way, sleep patterns affect every other aspect of our lives. Dread of the bed is real.
In December 2021, Hot Flashes & Cool Topics interviewed Dr. Lynelle Schneeberg, an expert in the sleep field, about ways to get a better night’s sleep. Dr. Schneeberg is a board-certified sleep psychologist and assistant professor at the Yale School of Medicine. She uses cognitive behavioral therapy for insomnia (CBT-I) to help adults sleep well. Her expertise is invaluable for women with midlife sleep struggles, insomnia and waking up in the middle of the night
With cognitive behavioral therapy, Dr. Schneeberg directs patients to log their sleep patterns for two weeks and, through a process called sleep compression, she uses the results to find out what times a person tends to fall asleep and wake up. From that information she creates a sleep schedule that accommodates those times. The sleep schedule then promotes an effective pattern of rest that the patient can implement in daily life.
Dr. Schneeberg shares that when patients wake up in the middle of the night, many begin to stress about being awake. From that stress comes an association with our bed to frustration and anxiety, which can then lead to patterns of poor sleep and insomnia. Many try to solve this problem by going to bed earlier or staying in bed later, but by doing so, they are only adding more time for their bodies to be in bed and stressed while awake.
A strategy Dr. Schneeberg uses is called stimulus control therapy. This type of therapy consists of a person keeping something by their bed that is relaxing and distracting to help them fall back asleep. Someone can keep a book, listen to a podcast or audiobook, or even do a crossword puzzle until they feel themselves getting tired. She emphasizes that the items by the bed should not include anything that will induce stress, rumination or analysis.
What about sleep apps? Dr. Schneeberg believes that while the apps can be helpful, some are simply not engaging enough for midlife women. She does recommend using the app feature where people read stories to help you fall asleep. Matthew McConaughey has a wonderful set of stories on the Calm App.
For those struggling with hot flashes, falling asleep and staying asleep can also be a big challenge. Dr. Schneeberg recommends that women should look at the various environmental factors in the bedroom to help with their sleep. Check what type of pajamas you’re wearing and research different brands of cooling pajamas that may keep you more comfortable. Keep the shades drawn (in the upward position if they are verticals) to keep the room cool all day and comfortable at night. Is your partner keeping you awake? Do you have a child that sleeps in the bed? These are additional factors that need to be addressed in order to improve sleep.
When asked what midlife women should avoid before bed, Dr. Schneeberg suggests having a bedtime routine and sticking to it (same time to sleep and same time to get up in the morning). It is vital to be aware of that window of time during the evening where you feel most drowsy and try to fall asleep during the time. It is similar to a bell curve and if you miss that peak time, you may have difficulty then falling asleep.
Waking up during the night may seem like a problem, but according to Dr. Schneeberg, it’s quite normal. Everyone wakes up anywhere from two to six times a night. However, once you wake up and begin stressing about it, that is when you have trouble going back to sleep. It is helpful to keep those calming items next to the bed to distract and relax you.
Dr. Schneeberg explains core sleep and that through a hyponogram, one can see the different 4 stages of sleep: REM sleep, stage one, stage two, and stage three. Deep sleep (stage 3) may be more important that REM sleep, for it happens at the beginning of the night. The first five and a half hours of sleep a person gets are the best sleep, and if someone receives that much sleep and then is awake the rest of the night, they have gotten enough rest to function. This knowledge also helps lessen people’s sleep anxiety, for if they already had five and a half hours, they do not awaken worried about not getting a full night’s sleep.
Dr. Schneeberg believes a consistent sleep routine is very important and that all the best sleepers wake up and go to bed at the same times. Everyone needs different amounts of sleep within their individual routines so one person may go to bed at 10:00pm and wake up at 5:00am feeling well rested while another may need to sleep until 7:00am to get their full night’s rest. She also debunks the concept of “catching up” on sleep as not realistic, for attempting to “catch up” only further throws off the internal clock.
Napping is a common way people gain more sleep, and Dr. Schneeberg assured us that taking a nap is completely fine, as long as it is at the right time and the right length. Naps should ideally be taken between 12 PM and 4 PM and be around thirty minutes to an hour long. Taking a nap too late or early can affect your sleep schedule for the entire day.
Dr. Schneeberg directs many of her patients to start with going to a sleep center to visit with a sleep doctor. After the patient has been evaluated for medical sleep disorders, a sleep psychologist can step in and help the patient deal with any stress, anxiety, depression, or environmental factors that may be causing the sleep problems.
When asked about ways to help midlife women with young children get better sleep, Dr. Schneeberg spoke about the accidental mistakes parents make when sleep training. By laying down in your child’s bed with them until they fall asleep, you’re creating a pattern where the child cannot sleep without you there and will seek you out in the middle of the night. To help fix the problem, Dr. Schneeberg suggested a trick called the bedtime ticket. You give your child a few “tickets”, which can be anything from sticky notes to pieces of paper. When they ask for you or something else in the middle of the night, you have them give you a ticket before doing it. When they run out of tickets, they have to go to sleep. It is also helpful to keep a basket of things that your child finds relaxing by their bedside that they can use when struggling to sleep.
Additional suggestions included using your bed for sleep, intimacy and calming activities only and avoid clock watching during night. Finally, we asked Dr. Schneeberg for her opinion on sleep supplements. She explained that while many people try melatonin and other supplements, she prefers to fix the problem at its source. However, she does suggest the rescue protocol, which is when a person keeps a reliable sleep aid in their medicine cabinet to use if they do not sleep well for two nights in a row. Many of her patients feel better just knowing the rescue option is there.
Dread of the bed is significant for many midlife women and may affect their mental health, daily activities and enjoyment of sleep itself. Please remember that there are options and treatments that can lead us to a restful night’s sleep.
Link to episode:
Sleep Better with Dr. Lynelle Schneeberg