The Truth About Hormones for Sleep, Sleep Disturbances, Melatonin & Perimenopause Sleep Problems | Dr. Jolene Brighten

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1:22Why wait? Ask your doctor. Visit BotoxChronicMigraine.com or call 1-800-44-BOTOX to learn more. Here's the top six reasons you're not sleeping, especially if you're in perimenopause. Number one, progesterone decline, which is usually accompanied by anxiety, racing thoughts, trouble falling asleep, or staying asleep. Number two is estrogen fluctuations. That can be tied to melatonin. What we often see is night sweats as well. You can't fall asleep. You can't stay asleep because you're so hot and sweaty. Number three is cortisol spiking at night. Cortisol should only spike during the day, yet it's spiking at night.

2:08We're going to talk about why for sure. Number four is blood sugar crashes, especially those happening at that 2 to 3 a.m. window that's waking you up. Number five is histamine surges or hidden causes of inflammation. And the last one, you have ADHD. Welcome to the Dr. Brighton Show. I'm your host, Dr. Jolene Brighton. This is going to be a two-part episode where I'm breaking down the six reasons you're not sleeping, especially if you're in perimenopause or menopause, and exactly what to do about them. We're going to talk about hormone shifts. We're going to talk about stress. We're going to talk about ADHD.

2:45We're even going to talk about how your gut might be involved. and I'm going to touch on hormone replacement therapy along with lifestyle changes and targeted support that I personally use and that I recommend for my patients. Now you're going to want to make sure you subscribe because you are going to want to catch part one and part two because all of these things are connected and you're going to find tips that are going to help you throughout this two-part series on sleep. Now, before we jump in, I'd really appreciate if you could go and leave me a review. Wherever you're listening right now, you can go click those five stars.

3:22It means the world to me. It's a super easy way to support the work I do, and it can help women who are searching for this information actually find a resource that can help them that they can trust. So with that said, let's jump in. Number one we're going to go into is progesterone decline and the racing thoughts, anxiety, and insomnia that follows. So the very first symptoms that we honestly see in perimenopause is not hot flashes. It's usually sleep disturbances that are happening before your period or worsening PMS. Now, we typically will see perimenopause symptoms happening. Their onset's going to be about age 35 to 45, somewhere in that range.

4:07It's usually the 7 to 10 years before you go into menopause, but it could be like 15 years. That's totally what some women go through. I mean, some women only have perimenopause for a couple of years. But what I want you to understand is that any woman during her reproductive years can have progesterone issues. We're going to talk specifically about how do you know if this is you and you're having progesterone issues that you can identify that. But what I want to explain is that if you have acute stress or chronic stress, the body can shift to cortisol production and it's in favor of cortisol production at the expense of progesterone production.

4:47And now we are having issues with our sleep, our PMS, maybe having even mood symptoms coming up. I'll definitely talk about solutions, but I want to talk a little bit more about why progesterone is so important for sleep and give you more of the background information that we should have gotten when we were honestly in grammar school. So progesterone is our calming anti-anxiety hormone. If you caught my episode with Dr. Carrie Jones, you know how important it is in the GABA system. I'm going to talk more about that. So progesterone's only made following ovulation and it's by a structure called the corpus luteum.

5:27So we need to ovulate. You need to know that. In your mid, late 30s, 40s, ovulation may become sporadic or that corpus luteum might start failing, which means less progesterone production. And that's sometimes even if your cycle appears normal. And that's because low progesterone might look like you're spotting just a few days before your period, or you're having sleep trouble 2, 3, 5, 10 days sometimes before your period. It just depends on your phase of life and how bad your stress is and how poor that progesterone production is. But your period may be coming still in like a 27-day window or every 30-day window and look normal.

6:13And here's the other thing that I think you should know about being in perimenopause is that progesterone goes first, estrogen doesn't. And so you might have excess estrogen symptoms like irritability, feeling hot and sweaty, but low progesterone. And so you're not getting that calming effect. Now, as I mentioned, progesterone is involved with GABA. Progesterone gets metabolized to allopregnenolone. That supports GABA in our brain. GABA helps us relax, fall asleep, chill out, not be so anxious, not have ruminating thoughts. Brain shuts up. We like that. So as progesterone declines, often before your cycle becomes irregular, if you're in perimenopause, you may notice anxiety, intrusive thoughts, your mental breaks are gone.

7:06And again, this is very common in perimenopause. If it's happening before perimenopause, that shouldn't be considered normal at all. Now, how do you know if this is you? How do you know if progesterone's your problem? You wake up feeling more anxious or irritable the days and nights leading up to your period. It's usually within a five to seven day window before your period. It might just be a couple days before, but like I said, it could be a longer period as well. If you're having trouble falling asleep, staying asleep, waking, feeling rested before your period, even when you're tired, looking at progesterone.

7:44If you're exhausted because of this sleep issue, like the week before your period, and you're like, I just can't get sleep because we usually need more sleep before our period in that luteal phase, then we're looking at progesterone. And if your luteal phase is shortening, your luteal phase should never be shorter than 10 days during your reproductive years. If your period, how do you know? Well, your period's coming sooner. So if your period, it was 28 days, very few of us have 28 day cycles, but if it was 28 days and now it's like 24 days, something's up with your progesterone. Now, if you're like, you know, in your 40s, okay, we're probably in perimenopause.

8:25But if you're in your 20s, absolutely not. We need to check in at what's going on. I'll mention some things that can be a problem. But I just want to make it clear that the shortening of the period, the irregular periods in the perimenopause year is considered normal. The sleepless nights are normal if you don't have enough progesterone. But it doesn't mean we just accept it, okay? It doesn't mean that we're going to be like, oh, I'm just not going to sleep and that's just how it is. But if you're not in your perimenopausal years, you're younger than age 35 and your cycle is shortening, you're starting to have all these problems during that luteal phase, like the PMS, the breast tenderness, the irritability, the insomnia, the anxiety, the racing thoughts, like that is definitely not normal and we need to do something about it.

9:13So let me get to the point. What can we do about it? So before we talk about hormone replacement therapy, we are going to talk about that in this episode. I want to talk about working with your body while your ovaries still have the capacity to ovulate and make hormones. You haven't run out of eggs yet, okay? So there's three areas that we want to address if low progesterone is the problem. Number one is manage stress. Two is our sleep and light timing to support ovulation. And three is nutrients to support ovulation in the corpus luteum so it can do its job. So let's get into the three of these.

9:50So I want to start with managing stress first. Stress, as I mentioned before, hijacks your body's resources and can suppress ovulation, cause the body prioritized cortisol over progesterone production. So we have to talk about managing stress. If we have chronic cortisol elevation, then that can interfere with your brain's hormones signaling to your ovaries. And I want you to keep in mind, if you don't ovulate, you don't make any progesterone. It's the only way you're going to make progesterone, which is why we don't have progesterone when we get into those late-stage perimenopause and we're at eggs.

10:26We can't ovulate anymore. Now, if you have something like primary ovarian insufficiency or functional hypothalamic amenorrhea, then you're not ovulating at an age younger than the perimenopause years, and that's a problem. We have to work on stress because we know that with functional hypothalamic amenorrhea, that's usually we don't eat enough. We overexercise. We've got to balance out that stressor in our life. With primary ovarian insufficiency, we don't call it ovarian failure anymore. It used to be called premature ovarian failure. We don't call it that anymore because some women will spontaneously start ovulating again.

11:04But with that one, we don't know why that there are women that have primary ovarian insufficiency, but we do know that a small portion, it is linked to autoimmune disease. So if you are before age 45, you lose your period altogether. You need to know why. 45 is an acceptable age to be in menopause. 12 consecutive months of no period, you are in menopause. But before age 45, we need to know why and we need to address that. Now, I want you to understand that some women, this will be normal for them based on their genetics. But for the majority, it's not normal. And there are doctors out there who are like, ah, you're 41.

11:53You must be in menopause. We always want to know why. Because if it's something like an autoimmune disease, it's something like chronic stress, nutrient deficiencies, something going on. We want to address that. And we don't ever want to be without our hormones before it is actually our time to be in menopause because we know based on the research, the research especially on those who have oophorectomies, the removal of their ovaries, the younger they have that done, the higher the risk of dementia and Alzheimer's. We don't want to have these brain conditions. Okay, so going back to the sleep part, you're like, I'm here just to hear about sleep.

12:37So I talked about working on stress. I want to give you some specific support strategies to implement. Firstly, we've got the parasympathetic, the rest and digest of our nervous system, and the sympathetic, fight, freeze, run away. We want to focus. So stress is all about that fighting side of things. We want to focus on the parasympathetic. Walking, breath work, creative hobbies, coloring. We want to do things daily to nurture the parasympathetic activity. Breath work is so tremendous for this. We also want to make sure that we're getting enough calories that match our exercise output. Yes, you can be in a caloric deficit if you're trying to lose weight, but anything extreme and you may lose ovulatory function, progesterone production, and your period altogether.

13:25However, something else I encourage my patients to do is to eat foods rich in vitamin C, peppers, strawberries, citrus fruit, and foods rich in vitamin B5. So sweet potatoes, avocado, fish. And consider bringing on things like adaptogenic herbs. If you're not familiar with adaptogenic herbs, these help you have a more regulated stress response. Like not over the top, freak out. and if you're not familiar with these, let me give you some examples of ones I love. So when I think about energy, having a good amount of energy, I think about rhodiola and eleutherococcus. When I think about like soothing, chill out, don't overreact, asparagus racemosis, and holy basil.

14:14Ashwagandha is one you probably have heard of. It's a really fantastic adaptogen. It really helps with energy, feeling calm, not feeling just overstimulated during the day. I like it personally both during the day and in the evening just because of how it's very just like hush cortisol, be cool cortisol. Now the other thing that I would encourage is sleep and light timing. So inconsistent sleep, late nights, or just sitting in front of bright screens, that kind of light exposure can throw off your internal timing system and your hormones as well. So if you caught the gut health episode, the gut hormone episode, we talked about clocks.

14:58We talked about your gut clock. We talked about circadian rhythm. You probably guessed we were going to talk about circadian rhythm today. And yes, that's important. But it's also important to understand that all of your organs have their own clock as well. Like your ovaries even have their own clock. Now, when it comes to sleep specifically, there's something called the SCN. It's the super chiasmatic nucleus in your brain. It's a master clock. It helps regulate sleep, the whole sleep-wake cycle altogether. It's also involved in some of our hormonal rhythms. And it's, I think, super important to understand that your light exposure can disrupt how the brain is orchestrating the hormones it secretes, even like LH and FSH, which are key hormones needed for ovulation and progesterone production.

15:49After we ovulate, LH is going to pulse to keep that corpus luteum going so that we produce progesterone. So if we have a disruption in our circadian rhythms, that can alter the hormonal cascade. It can contribute to anovulatory cycles if the disruption is really bad or even luteal phase defects. So that's when we have less than 10 days of the luteal phase. I was talking about that before, the short luteal phase. And so that's a low progesterone phase, right? When it should be a high extended progesterone phase. So if we're getting artificial light at night, like exposure to our screens, like our phones, our television, that can disrupt melatonin production.

16:36Melatonin is involved in our reproductive health. In fact, it's an antioxidant that protects our ovaries. So we don't want to mess with our melatonin. I guess it helps us go to sleep at night, but it's also very protective of our cells against free radicals. Hey, Chicago, class it up with Crocs. You know back to school is coming in fast. So why wait to find your new fave footwear? Step into a local croc store and step into your new look. Try it. Style it. Make it yours. Because the right pair doesn't just show up, it shows off. First day fits, handled. Walk out ready for whatever's next. Visit your nearest croc store today.

17:22So if you are exposing yourself to light and that's disrupting melatonin, keep in mind that can disrupt your brain hormones orchestrating ovulation and hormone production. We see this most notably in night shift work. So women who have night shift work or jet lag or erratic sleep schedules, there's a higher prevalence of anovulatory cycles. That means lack of ovulation, shorter luteal phases, and we even see infertility can be an issue. If you have a short luteal phase, that's going to lead to infertility because fertilization happens in the fallopian tubes. Then once egg and sperm meets, it rapidly dividing cells and that little ball of cells goes dividing, dividing, dividing, dividing, becomes an embryo and then lands in the uterus.

18:18And it's going to land there sometimes around like day eight, day nine after ovulation. And if by day 10, your corpus luteum is failing, there's no time there for implantation, for beta HCG to rise and to signal to the ovary, keep going with progesterone. So if you've been struggling with cycles where the luteal phase is less than 10 days and trouble conceiving, look at what's going on with your progesterone, start to implement some of these things. Okay, tangent from the sleep stuff. Let me bring it back to sleep support. Now, if you want to test your progesterone to know for sure like progesterone is an issue for you.

18:58You can test five to seven days following ovulation on a 28-day cycle. We say diet 19 to 21. And you can see if your progesterone is insufficient, that could be what is leading to your sleep problems. So to support natural progesterone production, we want to prioritize a regular wake time. Get 10 to 20 minutes of sunlight within an hour of waking, avoid bright screens at 9 p.m., or wear blue light blocking glasses. And this is all to work with the circadian rhythm that will affect your ovaries in producing progesterone. Now, the third thing we can do for progesterone support is to look at our nutrient intake.

19:44Key nutrients that we want to look at, zinc. That's going to support your FSH, LH production from the brain, ovulation, corpus luteum function, and it's also important for progesterone receptor sensitivity. So when the hormone's secreted, it's got to dock on cells. So we want to support the receptors that are on the cells. Vitamin B6, you may have heard me talk about this one before. It's fantastic. Supports progesterone synthesis. B6 deficiency is actually associated with a shorter luteal phase. So if you're that person having less than 10 days or you're someone who's having PMS symptoms, look at vitamin B6.

20:24Magnesium. When do we never love magnesium? It's always, we always love magnesium. Magnesium can help with calming our nervous system. So it can help on the cortisol stress side of things. And it's also needed for hormone metabolism. So if we want to lower our cortisol fast, we want to be looking at quality sleep, adaptogenic herbs bringing in magnesium and if we want to get those progesterone levels up everything i just talked about and then also maybe considering vitex and vitex is thought to act on the brain to support that lh production so that when the corpus luteum ovulates it's like keep going make our progesterone so those are the key things i would look at for helping with the progesterone aspect of why we're not getting enough sleep.

21:18I know I mentioned supplements, my adrenal support and my women's hormone balance supplement. There's actually a period problems kit altogether. I will link in the show notes. If you want to purchase those, great. I'll give you a 15 % off. If you don't, use the label as a guide on what to look for in terms of dosages. The last thing I'll mention too while I'm thinking about supplements is myo-inositol. We often use that to, especially for women with PCOS who have anovulatory or regular ovulation, we will often use myoinositol for ovarian function, for ovulation support, for insulin resistance, but it also can help with sleep.

22:02So myoinositol is another one to consider and it's a nice stack if you're having ovulatory issues and sleep issues to be like, let me just add this on to everything that I'm doing in terms of my lifestyle and of course your diet. And if you're wondering what foods to eat to support progesterone, we want to focus on mineral-rich whole foods, seeds. You can use it as part of seed cycling, leafy greens, lentils, liver, or you can consider a liver supplement. I also, if you want a style of eating that is going to support you and optimizing your hormones and is anti-inflammatory, drbrighton.com slash plan.

22:43It's free. There's no liver in the plan, just so in case you're worried, but there is a ton of tasty food to support your hormones. Now, let's talk about the progesterone HRT. If you've been tracking your cycle and you're working on lifestyle strategies, but you're still struggling with sleep, anxiety, PMS, you're over age 35, this might be a good time to consider a bioidentical progesterone. Now, as long as your ovaries are working, I love doing all the natural stuff, but sometimes using oral micronized progesterone, which we take at night, can be super helpful because it has those sedative effects and it will affect the GABA pathways in the brain.

23:27Not topical, not progestin, oral bioidentical progesterone. So this is especially helpful for women who are in perimenopause. If they're still cycling, but they ovulate inconsistently or their corpus luteum is just not doing its job. And if you're still cycling, it can be used cyclically like 10 to 14 days per month to mimic your natural rhythms in your period if that's still present. But if you're not cycling, then you can just take it every day. There's no reason if you're no longer having periods to only do it for half the month. So when would you consider using this? You're skipping periods, you're not ovulating consistently.

24:13PMS is insane. It is just off the chain and it's really interfering with your life. You're having significant anxiety. If that anxiety is happening in the weeks before your period, I would consider progesterone over anti-anxiety medication because it is effective and anxiety medication isn't going to be effective if progesterone is your problem. It might take the edge off, but we got to address like what is actually going on. If you've ruled out other causes of sleep disruption, natural support hasn't moved the needle, then we want to consider using progesterone hormone replacement therapy. And while I'm going over like these six reasons people are not sleeping, I just want to remind you sleep apnea is real.

25:01Not getting enough oxygen to your brain while you sleep is bad for your health. And that's a good reason to consider a sleep study. Remember, I'm a doctor. I'm not your doctor. And we may need to rule out other things. And if we've ruled out all of those things and it's like, yeah, no, it's just happening before my period or I'm in perimenopause, I'm not sleeping anymore. let's look at that progesterone hormone replacement therapy. Okay, let's go into the number two reason why you might not be sleeping, which is estrogen fluctuations. Those impact sleep a lot of times because we're too hot to sleep.

25:35We're sweating. We got night sweats. We got hot flushes, but estrogen is also tied to melatonin. So here's what we're going to cover in this section. How to know if this is an issue. We'll definitely talk about when to consider using hormone replacement therapy or menopause hormone therapy. And we're going to do a deep dive into natural approaches, non-estrogen alternatives that support estrogen balance and symptom relief. So if you're not a candidate for hormone replacement therapy or you are just not wanting it, we'll talk about some other options. And by the way, menopause hormone therapy, that's used in, that's a term we use in menopausal women.

26:18And the reason is because we're not trying to replace it to the levels they were pre-menopause. But hormone replacement therapy, I often use that term because as many times as I say menopause hormone therapy, people are always like, oh, do you mean hormone replacement therapy? Like, yeah, same, same. But with hormone replacement therapy, I mean, you can call it either or, but with hormone replacement therapy in medicine, And we often think of that before menopause because we are trying to replace your hormones to the levels they should be. If you're post-menopause, menopause hormone therapy. But guess what?

26:52We're using all the same stuff. We're using all the same stuff. Anyhow, okay, let's get into the sleep. So why does estrogen fluctuating disrupt your sleep? So the thing to know about estrogen is it plays a major role in regulating your core body temperature, but also neurotransmitters like serotonin. And in other episodes, we talk about dopamine, acetylcholine, all those things. But it's also interacting with melatonin. All of these are critical for deep, stable sleep. So actually going to sleep. And that's the thing. Sleep isn't just about being in bed for eight hours. Sleep is about waking up, feeling rested and restored, getting the right quality sleep.

27:34Now, postpartum, we can definitely have trouble with estrogen. I mean, if you've ever had a baby and you start sweating, that can also be disrupting our sleep. In perimenopause, estrogen doesn't just gradually decline. That'd be super sweet. But it doesn't. It spikes, it crashes, and it does it all unpredictably. And that creates temperature dysregulation. It also creates mood instability, and it can disrupt your circadian rhythm. I think it's really important to understand if you have functional hypothalamic amenorrhea, actually, if you're heading into functional hypothalamic amenorrhea, you're under eating, you're overtraining, you could start having these hot flashes, night sweats as well.

28:15So with estrogen fluctuating, night sweats, early waking, fragmented sleep, you may even try to like fall asleep and maybe go to sleep easily, but you don't stay asleep and you're waking up a lot. These things are all par for the course. So how do you know if this is you? If you're waking up hot, drenched in sweat, sheets are wet, even if the room is cool, even if you've got the best pajamas in the world, you probably have estrogen problems. If you're noticing new mood swings, vaginal dryness, more fine lines, wrinkles, droopy breasts, like breasts start to sag, that can signal to low estrogen issues.