Sleep Talk: Episode 39 – Menopause

Originally at: https://sleephub.com.au/podcast-39/

Episode 39: Menopause

Menopause is a time of significant changes in sleep, as well as a range of other symptoms. Why does this occur and how can symptoms be addressed? In this episode we talk with Dr Sonia Davison, Endocrinologist and expert in Women’s Health.

Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) host the monthly podcast, Sleep Talk, talking all things sleep.

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Audio Timeline / Chapters:

  • 00:00 – 03:05 Introduction
  • 03:05 – 26:55 Theme – Menopause
  • 26:55 – 27:40 Clinical Tip
  • 27:40 – 30:08 Pick of the Month
  • 30:08 – 31:23 What’s Coming Up?

Next episode: What to eat for sleep

Links mentioned in the podcast: 

Presenters:

Guest interviews:

Sonia Davison

Dr Sonia Davison is an Endocrinologist with a special interest in Women’s Health. She is a Clinical Fellow at Jean Hailes for Women’s Health and has an adjunct appointment at the Women’s Health Research Program, Monash University. Sonia is President-Elect of the Australasian Menopause Society (AMS) and was editor of AMS’s Change magazine for 9 years. Sonia is in private practice in Melbourne at Cabrini Medical Centre and at Jean Hailes for Women’s Health. Her PhD and postdoctoral research examined sex steroid physiology in women, including measurement of androgens and their relationships with age, mood, sexual function and cognition.

 

Regular hosts:

Dr Moira JungeDr Moira Junge is a health psychologist working in the sleep field, who has considerable experience working with people with sleeping difficulties in a multidisciplinary practice using a team-based approach. Moira is actively involved with the Australasian Sleep Association (ASA) and a board member of the Sleep Health Foundation. She has presented numerous workshops for psychologists and is involved with Monash University with teaching and supervision commitments. She is one of the founders and clinic directors at Yarraville Health Group which was established in 1998. In addition to her expertise in sleep disorders, her other areas of interest and expertise include smoking cessation, psychological adjustment to chronic illness, and grief and loss issues.

 

Dr David CunningtonDr David Cunnington is a sleep physician and director of Melbourne Sleep Disorders Centre, and co-founder and contributor to SleepHub. David trained in sleep medicine both in Australia and in the United States, at Harvard Medical School, and is certified as both an International Sleep Medicine Specialist and International Behavioural Sleep Medicine Specialist. David’s clinical practice covers all areas of sleep medicine and he is actively involved in training health professionals in sleep. David is a regular media commentator on sleep, both in traditional media and social media. David’s recent research has been in the area of non-drug, psychologically-based treatments such as cognitive behavioral therapy and mindfulness in managing insomnia, restless legs syndrome and other sleep disorders.

Connect with David on Twitter or Facebook.

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Transcript:

Dr. David Cunnington: Welcome to Sleep Talk. This is episode 39. And welcome, Moira.

Dr. Moira Junge: Hello.

Dr. David Cunnington: In this episode, the theme is menopause and the impact that menopause can have on sleep. We will get to that in a little while. But what have you been working on recently, Moira?

Dr. Moira Junge: Well, we are preparing for the Sleep Down Under Australasian Sleep Association Conference which is in Sydney this year in October. All of those of you listening who are may be eligible to or available to go. I really recommend you try and go to that conference. It’s our annual scientific conference. I put in two symposium ideas, one was the great debate which we often do and that has been accepted, which is great.

Did I tell you this year what the debate is on?

Dr. David Cunnington: No.

Dr. Moira Junge: Do you want to know?

Dr. David Cunnington: Of course!

Dr. Moira Junge: It’s usually a bit of just tongue in cheek a bit of controversial topic. And this year, it’s titled In Terms of Sleep Health, the Body Clock Trumps the Upper Airway. So it’s pitting the people who are interested in the psychology, circadian rhythms, all that sort of side of things as opposed to the upper airway, meaning – or the sleep apnea and respiratory stuff.

So we have two teams assembled and I think I might get them to argue the opposite to what their profession actually is.

Dr. David Cunnington: Nice.

Dr. Moira Junge: So that’s good. And then also looking at a panel discussion around how to do big scale public health campaigns, what we could learn in the sleep world from the likes of quit Smoking and SunSmart. They are decades ahead of us.

Dr. David Cunnington: That sounds great.

Dr. Moira Junge: Because with the parliamentary inquiry hopefully, what will happen is there will be a large scale of public health education and awareness. So yes, so that’s going to be through a panel discussion around that as well.

Dr. David Cunnington: Fantastic.

Dr. Moira Junge: What about you? What has been keeping you busy?

Dr. David Cunnington: So I’m really fortunate to be able to run some education for training sleep specialists in Victoria and that I ran recently. And myself and Dr. John Swieca put it together. I mean we just had a great day. We were very fortunate to have Sean Cain from Monash University.

Dr. Moira Junge: Oh, big gun!

Dr. David Cunnington: Exactly! He’s really at the forefront of research into light and the circadian rhythm.

Dr. Moira Junge: And a great speaker.

Dr. David Cunnington: And a great speaker.

Dr. Moira Junge: A bit of fun too.

Dr. David Cunnington: So he really anchored things. It was really good and I just love that sort of teaching and helping sort of teach the next generation about how to manage people with sleep problems.

Dr. Moira Junge: And psychological. Did you touch on that?

Dr. David Cunnington: I did. So I talked on sleep 101 at the start of the day. Really trying to get to how we conceptualize sleep and busting some of the myths about sleep so that people can do psychoeducation?

Dr. Moira Junge: Yeah.

Dr. David Cunnington: That’s really the cornerstone of how we get people sleeping better is getting them to better understand …

Dr. Moira Junge: And managing expectations.

Dr. David Cunnington: Exactly. Manage expectations, busting the myths.

Dr. Moira Junge: Good to hear.

Dr. David Cunnington: So the theme for this month’s podcast is sleep and menopause and not only to tell people that menopause can be a challenging time for sleep. Sometimes it’s hard to tease out how much it might be an aging effect or a stage of life effect from just being busy. What’s attributable to menopause.

For many women menopause can really make a difference between sleep and just working and then just not working at all across that transition. So what do you see, Moira, in people around menopause?

Dr. Moira Junge: I’m so glad we are doing this episode. It’s so long – it’s so overdue, isn’t it? I see that it’s an area that it is often the person’s first experience with poor sleep. Certainly, their first experience often is coming to talk to someone about sleep or any health professional at all. Usually, some of them just sail through with not too many health problems and they hit menopause and often they are attributing it to menopause. Sometimes they are not and they are not surprised when we start talking about where you are, where are you with menopause?

But I find they just wanted to know more. I need to know more about it. I think that we – well, I certainly don’t know enough about sleep and menopause and because it is hard to tease out exactly what the contributing factors are because as you say, sometimes it can be that big time with the more senior at work, they still have dependent children, aging parents, and all the pressure of those can be a big factor. And that the heat at night or heat at night and day, a factor obviously, it’s really hard to sleep when you’re waking all the time with all that dysregulation of your temperature.

And yeah, and then the aging effects anyway. As you said, it’s hard to know how much is menopause. So the approach really has been we are trying to normalize things, trying to just send OK, within the difficulties that are there, let’s see what sleep you can get. Try a lot of self-care, a lot of managing expectations, a lot of just saying, “This might be pretty awful for some time,” and educating them around not being too reliant on medication. But obviously, it’s outside of my expertise anyway but really going hard on the cognitive, behavioral, emotional, mindfulness sort of strategies.

Dr. David Cunnington: Because the hormonal changes in menopause is our expertise we’ve got an endocrinologist. So that’s what Sonia Davison is going to help us out with. Sonia has a special interest in women’s health. She is an endocrinologist and President-elect of the Australasian Menopause Society. So thanks a lot, Sonia, for helping us out with the podcast.

Dr. Sonia Davison: You’re welcome.

Dr. David Cunnington: What sort of changes occur across the menopause for women?

Dr. Sonia Davison: Well, let’s start maybe for some even 10 years before menopause. Menopause is the last egg and the last menstrual period. But hormones unwind in probably the 10 years before that. And estrogen levels start to fluctuate quite a lot.

The typical age of perimenopause is about 47 so, a little 5 years before menopause. But for some women, it can even start from about the age of 40. When estrogen levels start to fluctuate, that’s when you can start to get symptoms. And by the time of menopause, your estrogen level which is the main estrogen we have is estradiol. It bottoms out. So throughout reproductive life, your estradiol level is about 400. At menopause, that’s 20 which is quite a dive.

But there’s a huge amount of fluctuation in the years as those eggs are running out and the pituitary is trying to do what it always does, and that’s get the ovaries to make estrogen. And women have symptoms in this time, quite marked symptoms and they can include flushes and night sweats and sleep disturbance, which is the focus of today but also, mood instability just because those levels start to fluctuate wildly.

And then after menopause when the levels are very low, women can have on-going symptoms which are really quite drastic some women. 20% gets severe symptoms, 20% of women will have no symptoms and every other woman will be somewhere in the middle.

Dr. David Cunnington: And what sort of impact can that have on women?

Dr. Sonia Davison: Huge. Absolutely huge. So as women go through life, puberty is challenging as most of us know. We both know that. Reproductive life, you’re sort of getting to your rhythm. You know what you’re doing and life and career challenges or whatever and all of that.

But then for women, when they are in their 40s typically, these hormonal fluctuations start and sleep disturbance can happen, mood disturbance can happen. They can have flushes and sweats. They can have anxiety. They can have crankiness. They can have low mood. They can have all sorts of other symptoms, urinary symptoms, joints aches and pains. It doesn’t sound fun, does it? And for some women, it just is not fun. And some women can end up being almost suicidal. They have such intense symptoms. And I think a large part of perimenopause and menopause that cause these women’s quality of life to reduce is that they have an impact on sleep.

Dr. David Cunnington: Yeah, absolutely. So some of the things or the most common thing that women will describe to me is the hot flushes but I wonder whether that’s just the most obvious thing or the thing that gets attributed to menopause. Are there other features apart from the hot flushes?

Dr. Sonia Davison: I think that’s just the tip of the iceberg. And when they’ve done research, they’ve actually shown that women have a lot more temperatures dysregulation than they actually can detect in the form of a hot flush or night sweats.

Some women drench a beach towel at night through perimenopause and menopause. They are sweating so much. I mean that’s just absurd, isn’t it? A terrible physiological normal. This is normal. But to drench a beach towel and have to wake up and sort of wring it out and have to change pajamas, change sheets, et cetera. I think that’s just a horrible thing to have to go through. And women do. That’s when women need help when they’re not sleeping, when they are having debilitating flushes and sweats.

But there are lots of symptoms here. There’s a terrible symptom crawling under the skin. It’s called formication. It’s like ant is crawling under the skin. And that can be associated with restless legs as well which of course can happen overnight and that be disruptive to sleep as well.

So it’s not just about flushes. And people can think, “Oh menopause. Oh, you just a bit more warm.” And in fact, the flush itself that has a very interesting physiology as well that’s just sort of pre-drawn to the flush, they can feel very anxious. They can have palpitations. They know what’s coming on. They think people are looking at them. And that can be this very sort of exhausted intense experience that can last 5 minutes or so. And that can happen hundreds of times per week for the women who are most severely affected.

Dr. David Cunnington: I saw someone today who is describing hot flushes and wondering what I might be doing to sleep and she is about to have a sleep study. I said to her, “There is a signature physiologically that we can see in a sleep study, if we look at heart rate, you see there are variations in heart rate, there’s increasing sympathetic activity that precedes the awakening from the hot flush. So it’s not just that feeling of heat. There is this whole sympathetic activity that underpins that. That’s going to give rise to those anxiety symptoms and other symptoms of dysregulation that occur as part of it.

Dr. Sonia Davison: There is definitely a sympathetic link to all of this. But we haven’t out – there is lots and lots and lots of research being done where we haven’t actually totally worked this out. We know there is something central and we know that the sympathetic nervous system is involved and we know that the symptoms do start to happen at night. So for example, in perimenopause, when estrogen levels are starting to bottom out of this as you head towards menopause, women can start to get flushes and sweats even though they might be having regular menstrual cycles. But that can happen when their estrogen levels start to get low just before the menses start.

Dr. David Cunnington: So we talked a bit about hot flushes. One of the things I find hard to tease out in sort of women in their 40s and 50s is how much is just the natural progression of sleep getting lighter as all of us age versus the changes in sleep from reduction in hormone levels. Have you got the secret formula on how I can tease those things apart?

Dr. Sonia Davison: I think some people are just terrible sleepers. And you see them. I see the hormonal ones and trying to fix the hormones. But some women definitely say, “I slept well before.” And with all the hormonal changes at perimenopause or when they’ve got to menopause, it was like a light was switched. The light switch was turned and they just couldn’t sleep anymore.

So I think there are lots – the other thing is women around menopause – well, the age of menopause in Australia at least is 51 to 52 years. So at that sort of age, most people are working. Most people have parents who are getting older and most people will have probably still dependent children or children in their 20s, et cetera, who they worry about because they go out at night partying or they come home at 3 in the morning.

So I think there is a lot more that can impact sleep. There’s the aging process. There are the hormonal changes. There are other health concerns as well that can happen around this time too. But there is also the life situation. And women are doing a lot. We have never used to do so much but now, we are doing all of those different roles and that’s great. But something unravels and often, the quality of life will unravel with women during sleep.

Dr. David Cunnington: Yeah, it’s a really good point. I absolutely agree with you, this stage of life for high risk for insomnia is all of those factors; busyness, busyness in the professional world, busyness at home, responsibilities, caring for both parents and kids. And so at the same time, women are trying to negotiate menopause, it is that phase of life where they are at the highest risk of insomnia. And one of the risk factors for acute insomnia turning into chronic insomnia and getting anxious about sleep is the ability to regulate emotion and deal with anxiety. And if that’s the phase of the menopause too that makes that a little bit more challenging. It’s just this milieu that’s going to develop an anxiety about sleep and fuel an insomnia.

Dr. Sonia Davison: Some women don’t have the flushes and sweats but may have terrible anxiety around menopause and perimenopause or low mood and a lot of crankiness as well and also, the sleep disturbance. Some women will come to me around this age because the GP has cleverly referred, I’m thinking, “Well, I think this is hormonal.” And some of those women really will respond extremely well to hormone therapy. So that is a really good option for helping both the anxiety, flushes and sweats if they have them, and also the sleep disturbance.

Some of my ladies don’t have a mood disturbance, don’t really flushes and sweats but their sleep is terrible and they are purely on hormone therapy because it helps them to sleep.

Dr. David Cunnington: I agree. And I think for those – exactly like you said where there’s that step wise change in sleep that coincides with menopause and it’s not necessarily driven by hot flushes, just this reduction in sleep lengths, sleep quality, sleep continuity, and you add back in, hormonal replacement therapy. And it seems to be a panacea for sleep and help for sleep.

Dr. Sonia Davison: It’s certainly can be really useful for some women. Not all women. It’s not suitable for everyone. Some women can’t have hormone therapy but when women come and sit down in my consulting room after being on their hormone therapy for the first three months and when they say, “I feel normal and I can manage again. I can sleep.” The three words I feel normal. They are so important. You don’t realize that those words are really important until really, you don’t feel normal anymore.

Menopause is normal. Perimenopause is normal. And people sort of say, “Why are you medicalizing this? Why are you trying to give treatments for a normal part of life?” But is it normal to be having dependent children, to be working, to have aging parents and caring for them into the busy world where you are always stuck in queues in traffic. Everything is monitored by a device. We are not meant to be living like this. That’s where definitely, we need to check in whatever we can to help women at this time.

Dr. David Cunnington: Give us a look under the hood. Give us an idea of when you are going to counsel someone, it’s “OK, hang in there,” versus, “OK, you’ve crossed threshold that I’m going to look at prescribing hormone replacement therapy.”

How do you pick that gradation and where do you draw that line?

Dr. Sonia Davison: It’s about managing. I go through all of the – there’s a beautiful symptom score on the Australasian Menopause Society website that looks at typical menopausal symptoms. I often go through something like that where you get them to do it and they come back the next time. And it’s looking at typical menopausal symptoms and I go through each symptom and I think, well, do they have it? Do they not have it? Is it severe?

And the things that are really bothersome are the mood instability, the sleep disturbance, and the drenching of sweat at night. If a woman says, “I can do this. I’m all right. Thank for telling me about this normal process. I think I’m OK.” Well, that’s all good. But if she is sitting in a chair with me crying and she says, “I’ve got all of that and I can’t go on anymore,” then that’s definitely when I start to talk about hormone therapy. And there’s a lot – it’s a minefield. To talk about hormone therapy, a woman instantly thinks HRT, equals breast cancer, and that’s not quite right.

So there’s a lot of important counseling. And again, women want to be natural. They want to be normal. They want to feel well. Menopause can sort of unravel that and hormone therapy is a very important part at least for someone who came to me frightened. Some health practitioners are also frightened about prescribing hormone therapy. We used to be very good at it in the ‘90s and early 2000s and then the newer generation of GPs I think are not as good as – not as comfortable as prescribing hormone therapy around this time.

Dr. David Cunnington: As you say, it’s complex area and there’s a literature around risks and benefits. Someone, an expert like you said, well-versed in having that discussion with people but may not be as easy for a non-expert.

Dr. Moira Junge: It’s harder. Every new study is another piece of evidence that I know because I do this all day long and it’s what I do. But for a GP sitting there who has to know everything about everyone from 8 to 99-year-olds. You can’t know it all.

I think if really general practitioners don’t get that area or know, well, I think hormone therapy might help. That’s when referring off is totally appropriate. Like for you with sleep, when someone doesn’t sleep and the GPs reached the end of what they’re comfortable with and what they know, it’s appropriate to refer off.

Dr. Sonia Davison: And there’s some great information out there. The Australasian Menopause Society has 30 different information sheets about things like sleep, hormone therapy, other body changes that happen around menopause, osteoporosis, et cetera. And Jean Hailes, For Women’s Health, has a really good website really aimed at informing people but there are also some webinars and things to help professionals. Again, looking at anything about women’s health but also with a good focus on menopause, hormone therapy, and I think there might be a little bit of sleep stuff here but I’m going to check that.

Dr. David Cunnington: Happy to help you with that if you need to. I had a look at those resources as part of preparing for these, and you’re right. Great resources so I’ll put links to those in the notes.

Give me an idea about the decision’s made. OK. We are going to start hormone replacement therapy. What does that mean in terms of length? Is that – we are going to bridge across a certain period of time. Or is it indefinite treatment. What does that look like for somebody?

Dr. Sonia Davison: It’s like a piece of string, David, 20% of women get severe symptoms, 20% of women get no symptoms, and 20% of women have symptoms that last for more than 5 years. So it can be a very intense burst of symptoms around the time of menopause and that can leave very quickly. But I had a 59-year-old lady just yesterday actually saying, “When is this going to stop?” And I’ve also had women in their mid-60s saying, “When are these flushes and sweats and sleep disturbances, et cetera, going to stop?”

So the hormone therapy is useful for when symptoms are bothersome. I try and reduce the dose of hormone therapy at some point and say, “Well, we’ve done this for now. We’ve got through that. Let’s find and review the situation. Let’s try and reduce your dose now and see what happens with symptoms. Always do it really slowly so that there is not that sort of cold turkey instantaneous. I’ve got no hormones and then these symptoms are I think are at risk of usually increasing after that.

Dr. David Cunnington: So we’ve spoken about hormone replacement therapy. What else outside of hormone replacement therapy, what other therapies or strategies out there?

Dr. Sonia Davison: It’s about good health. Menopause is a really good time for me to look at someone who is about 50 which is midlife, see what her symptoms are because that’s what has brought her to sit with me, try and address those symptoms and then also plan for the rest of her health life which is I’m really worried about her health from the age of menopausal and I’m also worried about cardiovascular disease because that’s the killer of 33% of women in Australia at least.

There are lots of treatments for different symptoms. There are pelvic floor exercises for example to help in urinary or vaginal symptoms. There is vaginal moisturizer if there’s vaginal dryness. There is vaginal estrogen which doesn’t give systemic symptoms that can help vaginal symptoms which is one of the common things that women have around menopause.

A healthy lifestyle, so not being overweight. When you’ve got more insulation, you’re going to get more flushes and sweats. So reducing fatness, and that’s also going to improve health. And if you do a lot of exercise, I think at the right time of day of course, David, you’re more likely to be tired at night and then I think you will sleep better as well. But I’m not sure …

Dr. David Cunnington: Those studies on evening exercise, a bit overstated actually of the many effects of those in exercise.

Dr. Sonia Davison: Oh, that’s good. I’m glad.

Dr. David Cunnington: And actually, any exercise anytime is better than none. So I’ll settle for some evening exercise.

Dr. Sonia Davison: You know what? Some of my ladies get up at 6 o’clock. They get everything ready for the family. They are driving in traffic. They are stuck there. They go to work. They do it all day. And then they drive home again, it’s 7:00, 7:30. After doing the dinners, have to do everything else, Dad. They are exhausted. How can you exercise in all of it? It’s just not pragmatic for the average working normal woman to actually – and it’s cool to say, “Oh, you should be doing 30 minutes of exercise a day. It’s just very difficult for women to do it. So I try and just get them to do whatever they can do for their lifestyle.

There are lots of others. So some women will come with anxiety around the time of menopause and perimenopause but aren’t suitable for hormone therapy because they’ve had breast cancer or they’ve had stroke or heart disease or whatever. So the SRRI group of medications very useful for control of anxiety and depression. But again, women have this stigma, “Oh, you’re handing me an antidepressant for symptoms that I’m having because I’m appearing menopausal.” So some women don’t like to take that as well.

There are lots of other things. So in terms of body and health, we want to make sure they are having enough vitamin D. We want to make sure there is enough calcium in their diet. It really will depend on the individual symptom that is bothering a woman the most.

Dr. David Cunnington: So often for sleep, we think of insomnia as it will have that biological basis. And then often, there’s changed thinking and behavior around sleep that can amplify and perpetuate symptoms. So that’s part of the role of CBT for example with insomnia.

Is there a similar role for menopausal symptoms? There are the biological symptoms but then maybe there is some amplification of the response in terms of how people might respond psychologically. Do you ever use CBT or psychology-based strategies?

Dr. Sonia Davison: Those strategies are very useful. And there is a lovely book by Myra Hunter who is based in the UK who looked at cognitive behavioral therapy for menopause. And I’ve reviewed this book because I thought, “How can CBT actually help change a physiological flush or a sweat?” Well of course it doesn’t but it helps how the women deal with that and how they process it, how they respond to it.

And after reviewing this book, I thought, this is a really good strategy. Women can do this. We can do this but we can’t use hormone therapy and that would be a really, really good approach. Of course, it’s finding someone who can do it. That’s the other issue. And finding the time. But there are self-help cognitive behavior or therapy books out there for women and some online as well, which can be targeted for menopausal symptoms but also at absolutely for sleep. And that’s very important.

And counseling just in general. If a woman has anxiety around the time of perimenopause and menopause or depression or crankiness and relationships are struggling because of that, absolutely seeing someone who has a focus, a background in sort of psychological counseling in this situation, that can be extremely useful just to know if this normal, knowing the strategies that can work and having just that support I think can be extremely beneficial to women.

Dr. David Cunnington: Thanks very much for your help, Sonia. I think that has really helped clarify a lot of the underpinnings of menopause and some strategies that woman can use.

Dr. Sonia Davison: Oh, delightful. Thank you very much.

Dr. Moira Junge: Thanks so much for that interview. Thanks, Sonia too. That’s really, really useful. I think that’s long overdue as I said. Sort of the take-home I guess, what would – on the basis of your discussion with Sonia, what would you do differently now? Or does it change anything with your approach?

Dr. David Cunnington: So it does change my approach Recognizing that yes, if we are managing someone with sleep problems around the menopause, there is the psychological components and behavioral components that I want to target with CBT. But there’s also a biological component too. And you we have to be cognizant of that and have an understanding of that. I’ve got a better understanding now having spoken to Sonia and recognize that that’s a part of it. The same way as in someone outside of the menopause, I think of insomnia as being multifaceted and I want to change somebody’s thinking around sleep, their behavior around sleep, their thinking styles and characteristics.

The extra bit to add around the menopause is OK, where are they biologically with the menopause and how might that be an additional factor that’s modulating their symptoms?

Dr. Moira Junge: Absolutely. I mean it should be part of everyone’s first appointment really especially a woman in their 40s and 50s. It should be like, “Where were you at with menopause?”

Dr. David Cunnington: So if people are looking for more information about menopause and its impact on sleep, the Australasian Menopause Society has some really great videos about menopause in general that are matched by some handouts and resources for health professionals.

So we took advantage of the fact that Sonia was with us to get a clinical tip for health professionals working with women across the menopause.

Dr. Sonia Davison: Just to be aware that women in their mid-40s and maybe early 40s and around the time they’re 50, will be having hormonal fluctuations and will probably be nearing perimenopause or menopause. Some of them will have bothersome symptoms. There are strategies that can help them. There are a number of resources out there. Just be mindful that it’s not all about sleep but it may be about flushes, sweats, quality of life and mood.

Finding a women’s health expert I think is the best option for these women. And then targeting their treatment to the symptoms that bother them.

Dr. Moira Junge: It’s the pick of the month. What’s your pick of the month, Dave?

Dr. David Cunnington: So my pick of the month is sort of – it’s something I came across in trying to work up some future podcast episode. I’m still struggling with this food and sleep. So, they are coming these episodes. As part of doing background grading, I bought the book, Brain Changer by Professor Felice Jacka.

Dr. Moira Junge: The Deakin Food & Mood Centre?

Dr. David Cunnington: Exactly. Felice is the Director of the Food & Mood Center at Deakin University. And her book, Brain Changer, talks about how foods have an impact on anxiety and depression. So not sleep specifically but things to do with mental health as you would expect from a professor and someone who sort of learned and respect it. It’s well-written. It’s easy to follow. And I find it a really interesting book.

What about for you, Moira?

Dr. Moira Junge: Well, mine is a book too. And it’s a little book published by Penguin, a little paperback. I felt competitive thinking, “I wonder whether Dave has actually read this one.” And I bet you have, have you?

Dr. David Cunnington: No.

Dr. Moira Junge: For one, from what I’ve learned from the book because it’s only published this year. And it’s by a guy called Darian Leader who I didn’t know and he is British psychoanalyst and it’s called Why Can’t We Sleep?and it delved into the history of sleep in a really interesting way. Actually, it covers dream analysis. He is quote in the book as saying, “I’m an excellent sleeper.” Oh, that’s interesting. You’re going to love it. It’s very sleep geeky, but history. It talks about dream analysis, talks about the whole pre-industrial relation of the two, they talk about basic sleep. Just a really good read. But it probably poses more questions than provides answers.

But I think that’s quite good because that’s really – it’s probably a true reflection of where we’re at in the sleep field anyway. And it does conclude, he asks, “If we got so many experts now, so many apps, so many books, so many high-tech matrices, you name it. Why Can’t We Sleep?”

And he concludes that perhaps there is no such thing as normal sleep.

Dr. David Cunnington: Oh nice! I like that.

Dr. Moira Junge: And I thought, “I think that’s probably the conclusion of many of our episodes.

Dr. David Cunnington: Yeah.

Dr. Moira Junge: Would align with that as well.

Dr. David Cunnington: Chasing an expectation that is driven by these unrealistic beliefs obviously.

Dr. Moira Junge: Yes. Yeah. So yeah, so check it out.

Dr. David Cunnington: So look out for the next two episodes where we are finally going to get to food and sleep and how these things interact. One of the episodes will be about the effect of timing, so when we eat and how that relates both to sleep, energy, and health. And the other episode will be about foods that may impact on sleep. So keep an eye up for those.

Dr. Moira Junge: I look forward to those food ones that are also overdue. They are very, very interesting. So thanks everyone for listening. It’s a pleasure to have your company. Please keep sending us suggestions at email address at podcast@SleepHub.com.au. And if you like the podcast, review us on iTunes or subscribe to the podcast.

Also, remember that we are now on Spotify. You can find us there. And have a great month and we will talk to you soon.

Dr. David Cunnington: Thanks a lot.

Outro:This podcast is not intended as a substitute for your own independent health professional’s advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with any questions you may have regarding a medical condition.

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from SleepHub https://sleephub.com.au/podcast-39/

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