S1 E4 Medical Series: Hot Flashes, Anxiety, Insomnia:The Menopause Sleep Crisis with Dr. Caitlin Chasser

Narcolepsy Navigators launches its Medical Series focused on the medical side of narcolepsy and common comorbidities. Host Fred (currently undiagnosed sleep disorder) and co-host Bernadette (narcolepsy type 1) interview Dr. Caitlin Chasser, a family doctor turned sleep and menopause specialist, who describes her own insomnia linked to premature menopause and the lack of sleep education in medical training. The discussion covers how menopause and perimenopause commonly disrupt sleep (estimated 60–80% experience sleep disturbance), and how sleep affects appetite, hormones, weight, repair, memory, mood, and daily functioning. Dr. Caitlin explains the role of stress and the sympathetic nervous system in blocking sleep, and emphasizes holistic and behavioral approaches including wind-down routines, meditation alternatives (coloring, knitting), breathwork, and body-scan techniques. She outlines practical sleep strategies for menopause-related insomnia: optimizing the sleep environment (darkness, quiet/white noise), regular exercise (with resistance training noted as beneficial with age), reducing alcohol, limiting naps (with a note that narcolepsy may require naps), and going to bed only when truly sleepy to build sleep pressure. Melatonin use is discussed as not a simple solution; it may help for jet lag, shift work, some children with ADHD/autism, and older adults, but should follow sleep basics and professional guidance, with caution about unregulated supplement dosing. Physical sleep disruptors are addressed, including hot flushes/night sweats, restless leg syndrome (often linked to iron deficiency from heavy periods), and obstructive sleep apnea (more common and underdiagnosed after menopause); she advises formal evaluation and targeted treatments, including iron supplementation when low. The episode also addresses libido changes during menopause, vaginal dryness and pain, topical estrogen or lubricants, the impact of poor sleep on desire and mood, and options such as HRT or testosterone therapy when appropriate, alongside emotional connection. Dr. Caitlin highlights cognitive behavioral therapy for insomnia (CBTI) as the gold-standard treatment, describes hyperarousal and normal sleep cycles, and notes significant improvements can be achieved. She introduces The Sleep Project, a group of clinicians formed after COVID to address rising sleep problems, offering online resources, consultations, and CBTI programs at www.thesleepproject.life. The episode closes with Narcolepsy Navigators announcements about Patreon, merch, Discord access, a shout-out to first patron Jane Powell, and information about Naps for Life CIC, ways to donate, and how to share stories via narcolepsynavigators@gmail.com.
About The Guest
Dr Caitlin Chasser is a GP and Sleep Consultant with a special interest in women’s health, particularly how sleep is affected by menopause.
She is a co-founder of The Sleep Project, a doctor-led organisation helping people of all ages improve their sleep through practical, science-backed programmes. Caitlin has over 20 years of experience supporting women to feel better, sleep better and take back control of their health.
She specialises in Cognitive Behavioural Therapy for Insomnia (CBT-I), the most effective treatment for long-term sleep difficulties, and takes a holistic, compassionate approach to sleep and wellbeing.
Caitlin is passionate about making good sleep accessible to all — especially during life stages like menopause when sleep can often suffer. 

Transcript

Dr_ Caitlin Chasser - menopause - Medical Series
[00:00:00] 
Medical Series Kickoff
Speaker: Welcome to the brand new Medical Series on the Narcolepsy Navigators Podcast, where real stories meet expert insight in this special series where diving deeper into the medical side of Narco. Not just the condition itself, but the often overlooked comorbidities that many of us face from sleep apnea and heart disease to high blood pressure, and even dementia.
We'll be unpacking how these conditions interact with narcolepsy and what it means for our daily lives. We'll be sitting down with leaving x. Where it's the odds, the questions that matter. How can we prepare for these challenges before they catch us off guard? What tools and treatments can help us manage them effectively?
And most importantly, what can we do to slow down the progression and protect our long-term health? Whether you're a newly diagnosed, a long-term warrior, or supporting someone you love, this [00:01:00] series is here to empower you with knowledge, clarity, and practical advice for the journey ahead. So grab a cup of tea, settle in, and let's explore the full pitch of narcolepsy together.
Meet the Hosts and Guest
fred: Hi welcome to Narcolepsy Navigators. I'm Fred. I'll be your host for today. And I have a currently undiagnosed sleep disorder and we're here with my co-host, Bernadette.
bernette: Hello Narcolepsy type one.
fred: So today we're here with Dr. Caitlin and she is an expert on sleep, health and menopause and how those two things relate. And she's here with us today for our bonus series, which is our medical series. So hi Dr. Caitlin
dr chasser: Really nice to be here and delighted to be part of your medical series and excited to, to be talking about menopause and sleep.
fred: Alright, well we're glad to have you. So this is our new medical series. I believe you're our [00:02:00] second episode in this series, so we're super excited to have you as well. And I know that you mentioned that your specialty is menopause as it relates to sleep, but you don't necessarily do specifically with narcolepsy, that you tend to refer those out. But Bernadette and I were talking earlier about how a lot of the issues that you see with menopause and sleep you were talking about like insomnia and sleep apnea, those are very common in narcolepsy as well and in central disorders of hypersomnolence. So we would love to hear about that.
dr chasser: Would it be helpful for me to give just a little bit of background
fred: yes. That would be wonderful. Some background about yourself. 
dr chasser: Super. 
Dr Caitlin Origin Story
dr chasser: So, as you said, Fred, I'm an expert in sleep, but my background is, I started off as a, family doctor. So working with the whole family for lots of different reasons. And then actually about just over a decade ago I developed insomnia myself and was finding that I was awake in the middle of the night, [00:03:00] really struggling to sleep. Finding that I was tossing and turning them, waking up the next day and not being able to function and feel my best. And I kind of went back to my own medical training thinking I'm a doctor. Must know about sleep conditions. And actually nobody has really taught me about sleep in medical school. It's mainly missed off the curriculum. Both in the UK and, and actually across the world. They tend to teach about obstructive sleep disorders, like obstructive sleep apnea and about sleeping tablets. But a lot of the time your kind of general doctors haven't been taught about sleep. So I, I, I recognized that there was a real gap in my knowledge. And as it turned out, actually I was going through a premature menopause which took a little while , to figure that all out. What happened was I then went on to this huge journey of discovery about what are the triggers for sleep? What are the hormone balances that are needed? What are the different treatments both from psychology, psychiatry sleep [00:04:00] medicine and, but also eastern medicine. All of those things that come together to really help and support sleep. And to cut long the story short, I managed to fix my sleep. I'm now a really good sleeper, but it was such a, a kind of life changing journey for me that I then have kind of dedicated my medical career to, helping people sleep better, particularly during menopause and menopause transition, which is a real hot point for sleep problems.
Holistic Sleep Foundations
bernette: So how much, if at all, do you incorporate or elicit information about holistics, like meditation and therapies of massage therapy, acupuncture, acupressure, et cetera? 
dr chasser: For me, particularly related to sleep, it's really core to, to what I do. Because I guess the, a good way to explain it is if you think back to our hunter gatherer caveman times and you were wandering around out in the open you haven't made it back to the cave before, it turns dark and you are alone [00:05:00] and you are vulnerable, are you going to sleep well? And the answer is no. You're probably not gonna fall asleep. And if you do sleep. It's gonna be in fits and starts. And that's because our biological mechanisms that keep us alive that've been evolved over millions of years are designed to not let us sleep when we feel unsafe or in a place of danger. And that's because our sympathetic nervous system that the fight or flight or stress response is designed to inhibit sleep. Because having a nap while there's danger around you is not a good idea. When you are in sleep, particularly deep sleep, you are, you are very vulnerable because you're not aware of the environment around you. When you're dreaming, your, muscles are paralyzed to stop you from acting out your dreams. And so sleep is a really vulnerable time. And so we've evolved mechanisms that when we're stressed, when we're anxious. We don't sleep. And if we do sleep, we don't sleep as well. But we're currently in a situation [00:06:00] where there's lots of triggers within the environment around us. Modern living emails, stressful work, always on culture that actually are preventing us from switching into that relaxation mode and helping facilitating sleep happening and allowing good quality sleep that actually training our minds to switch off at the end of the day with whichever method works for us, is really key to getting good quality sleep. And for some people that's meditation. For others, it's breath work. And often it's about finding that key. To help switch off your mind in association with lots of other behavioral things that are needed to establish good sleeping patterns. And that often when we're sleeping poorly, , we might change what we do, how we think and how we behave. That actually can be a bit counterproductive to getting good sleep. 
Exercise and Sleep Quality
bernette: Have you found any correlations that work with the [00:07:00] disrupted sleep patterns of menopause and of sleep disorders associated with exercise or extreme, you know, extreme sports or doing any kind of cardiovascular or anything like that to try to bring yourself to that place? Where does it help or does it actually hinder it when you actually are in this kind of state? 
dr chasser: Yeah, it's a great question. And in general exercise sport is really good for sleep. And it almost doesn't matter which type of exercise? Almost all of them are good for sleep, and it's about finding exercises that you enjoy and can do consistently. As you get older, it seems that resistant training or or weight training is probably the best type for improving sleep quality. But actually as long as you're moving your body consistently and regularly that will help improve your sleep, particularly the deep sleep. And deep sleep is really important for feeling refreshed the next day.
fred: [00:08:00] So how did your journey go from GP to having insomnia and that got you interested in sleep problems and insomnia and, and fixing that. How did you kind of merge into the specialty with menopause? 
dr chasser: So I'd actually always been a menopause specialist. As a family doctor. I tended to see a lot of women and within the uk gynecology is not necessarily separated , from general practice. There, there's specialists, but the, the main core of women's health , is dealt with by family doctors. And so I sub-specialized in, in women's health and I've always been really interested in kind of menstrual cycles, normal cycles periods kind of the menopause transition. But. Then there's not very many people who put those two things together, the interest in women's health and sleep. And as anyone who's, who's had a period or been through the menopause knows the two are very intrinsically [00:09:00] linked. If your hormones are all over the place, then you're probably gonna be sleeping poorly. 
fred: Okay. 
Menopause Sleep Changes
fred: So what are some things that you should expect when you go through perimenopause and menopause to change with your sleeping habits?
dr chasser: Okay. Now sleep issues are really common during menopause transition. So that's when you're still having cycles, but you might have some menopause symptoms to when you go through the menopause, which is 12 months without a period. And it's estimated that between 60 to 80% of women will have some sort of sleep disturbance during that time. So that makes it one of the most common. Symptoms of menopause, but it also is one that impacts our lives considerably because all of our menopause symptoms feel worse after a bad night's sleep. But also, sleep is so fundamental for pretty much every function in your body. Whether it's your appetite control, your hormone control, your weight control, [00:10:00] your repair and regeneration, your memory, your emotional stability, and your interaction with others. All of those are really key aspects that are controlled by sleep. And so whether you're sleeping poorly, having somnia, poor sleep quality, whatever happens during that menopause transition time it's gonna have a profound impact on how you feel and function during the day and the severity of pretty much all your menopause symptoms.
Melatonin Myths and Uses
bernette: I have seen lately. That. Now being that I have this sleep disorder and I've had it for a very long time, I was diagnosed in 99. I was always told, do not take melatonin because it will only substitute the little bit of the, the sleep hormones that you need, and then it can make you sleep even worse, basically.
dr chasser: Mm-hmm. 
bernette: But today I see a lot of people that are actually being prescribed or being told to give pretty high doses of [00:11:00] melatonin to their children to get them to sleep. And I don't, I, it's like red flags, just B, b, b, you know, to me. And I tell all my friends and the people that come to me with the melatonin questions because I have a sleep problem, I tell them, don't be giving your kids Mela. Send ' em outside, you know, run 'em around in circles. I don't know, do something but don't start getting them hooked on melatonin. Do you actually suggest melatonin to normal people or do you actually look at other avenues rather than substituting that? 
dr chasser: It, it's a great question and, and it doesn't have a simple answer. I would say in the vast majority of people, whether they're children or adults. There are simple solutions, particularly around kind of behaviors and bedtimes and the, our relationship with sleep and whether we're feeling being anxious before we go to sleep, that if we work on those things, we can solve the vast majority of sleep problems without using melatonin. Melatonin is a [00:12:00] hormone of the circadian rhythm, so our 24 hour cycle and, and how it controls night and day and it's secreted overnight to help support our sleep. There are some conditions. Where it is very helpful and there's good evidence for, so if you're a shift worker or if you have jet lag, it's very useful for moving our kind of timings. For some children with A DHD or autism, it can be helpful for supporting sleep, but I would say in the vast, and, and actually in the older adults, so over 55, there's some evidence that melatonin can be helpful in supporting sleep, but it's not a silver bullet. It's not likely to solve things on its own outside of those conditions. And actually the behavior and supportive things that we can do. Both with kids and adults can completely change our relationship with sleep without the need of, of melatonin. And anyone who is thinking of, of using melatonin is really important to [00:13:00] first talk to, a healthcare professional, particularly a sleep expert, because there's a, really good chance that we can fix their sleep without needing melatonin. That's not to say that melatonin is dangerous, but why beyond something? Sometimes for, years if it's not needed, and often particularly in the the States, but in other countries too, it's, it's licensed as a supplement. Mm-hmm. And so when you buy it from the, the pharmacy, the dose that you're getting isn't always completely regulated. And so you, you just need to be a little bit careful. 
bernette: Yeah. My next question would be basic, almost. Inline is it, that it should be used as a temporary and never as a long-term fix? Like you said that when people get into it and are using it for a year, year and a half, it should really be a momentary fix for when you have a bad night, or is it something that you could take long-term without wrecking your system's ability to make it on its own or to give off [00:14:00] those sleep hormones on their own?
dr chasser: Yeah. So it shouldn't have an impact on, on the kind of intrinsic hormones that we produce. But it's one of those things where I would always recommend the behavioral and the, the kind of the, the sleep treatments first. Because if, for example, there's a lot of sleep anxiety in a child or, or bedtime anxiety, or actually there, there's other things going on in the lives or the bedtime's too early and they're spending too much time in bed or having too many naps. If you don't get those things right, then you are never gonna be able to fix the problem with melatonin. And so first get the, the sleep basics, right. And if it's not working, then melatonin might be something that's the answer. And for some people they are on it longer term, but I would never say that they're on it longer term without it being advised by an expert, particularly an expert in sleep.
Menopause Sleep Changes
fred: If you had a kind of quick list of what thing, well it might not [00:15:00] be quick of what things people can do to make sure to improve their sleep habits and that sort of thing, what do you generally recommend as a course of action for someone who is experiencing insomnia?
dr chasser: Particularly related to menopause, or anyone. 
fred: Well let's stick to the, the menopause topic because it seems like what you were describing earlier, basically is a major system dysregulation from this, and that is very similar to what people would experience with narcolepsy. A lot of us in the community talk about how it makes dysregulations, you know, in your body temperature and just in your fight or flight and everything throughout your body. It causes this dysregulation, which is just a general lack of sleep, does that as well, which even though they're, they're different conditions, but they have the same result. What is the method that you would recommend to deal with the insomnia, especially in menopause?
Menopause Insomnia Playbook
dr chasser: Okay, so particularly with menopause, it's really important to take a [00:16:00] really wide look at everything that's going on. So most people go through the menopause around the age of 50, but on average, the symptoms associated with the menopause can, can start 10 years earlier. So if you're in your early forties and you're starting to maybe have poor quality sleep, maybe you're having some mood changes, maybe you're feeling more hot or sweaty, particularly at night, but could be any time of the day, then it's possible that that's related to perimenopause. And so take a, a step back. First have a look at what the different symptoms that are, are happening during your life and think about each of them in turn. I would say if you're getting very significant. Menopause type symptoms. So sort of hot flushes or mood changes or struggling with kind of day-to-day activities. It may be that you want to consider hormone replacement therapy, but that's not for everyone, and it's not something that you, you have to do because there's good solutions [00:17:00] even without it. The next thing is to think about the sleep environment. So making sure that your room is as dark as possible. It should be so dark that if you waved your hand in front of your face, you wouldn't be able to see it. And if it's not that dark, add in an eye mask because actually darkness helps increase our melatonin production and improves our deep sleep. Next, make sure your environment is quiet, so if it's not naturally quiet, consider earplugs or adding in white noise. Next, think about exercise. We've mentioned exercise being really important. The next one would be alcohol. Alcohol has its significant impact on sleep, particularly during the menopause. What it does is it's a sedative, so it feels like it gets you off to sleep quicker. Many people use it as a crutch to get them to sleep, but actually it can be really detrimental to sleep quality. It inhibits our dream sleep and it makes our sleep much more fragmented and broken. So if you're someone who's having [00:18:00] sleep problems associated with the menapose. Quite often you wake up at two, three in the morning and find it very difficult to get back to sleep. You might be bouncing in and outta sleep and actually if you have alcohol, that will be much worse. It will also make hot flushes much worse. And the hot flushes are associated with more wake up in the, the, the, the night. So trying to cut out alcohol and replace it with a non-alcoholic alternative is likely to be a, a really important factor. If menopause symptoms sleep and hot flushes are part of the picture. The, the next thing is to, to think about your behavior during the day. So making sure that you're not having too many naps. And obviously that may be a little bit different if you're, you're suffering with narcolepsy, where you, you might need those to get through the day, but for most people, you wanna try and keep your naps short if you have them less than 20 minutes. And. Try and keep them earlier during the day if possible. And then next is think about your, your bedtime [00:19:00] routine. So preparing your body and mind for sleep. Ideally, setting aside at least half an hour, if not an hour before bed, where you're starting to wind down and switch your nervous system from that kind of daytime busyness to the sleep mode. And that will involve dimming the lights, having a hot bath or shower, which helps. Drop our body temperature, which is needed for instigating sleep. It ideally would involve a little bit of breath work, so that's breathing where you are controlling your breath, particularly extending your outbreath, which has been shown to decrease anxiety and, and help the onset and quality of sleep. And you might continue consider something like the body scan, which is a kind of meditation relaxation that you can do before bed to help improve sleep. So developing your own bedtime routines really important. And then the next one is making sure that you only go to sleep when you are really tired. So the point where you can't stay awake often with people. When they have [00:20:00] insomnia, they start bringing their bedtime forward. So they say, oh, I'll go to sleep at eight o'clock because I'm just so exhausted. And then they fall asleep for a couple hours and then they're wide awake. Often if you're having difficulty with your sleep, actually you need to push your bedtime a little bit back till you're absolutely exhausted so that you can improve your sleep quality overnight. That's because when you sleep, there's something called your sleep pressure, which builds up over the day. And the more sleep pressure you have, the easier it is to stay asleep through the night.
bernette: When I finally decided to take the advice of the doctor because I was very in denial and very rebellious about it in the beginning was when I took strictly into consideration my sleep hygiene. The way my room was, how comfortable it was, how uncomfortable it was, where the position of my bed was, my pillows, everything became a deal. You know, the sheets on my bed, I got very snooty and bougie about my sheets for a while there. So it was very real though, the change that took [00:21:00] place when I finally got everything in line the way that I wanted it to be and felt good about it, it changed everything for me. So even if my house is destroyed, which so many of us with sleep problems, and especially menopause in conjunction with, we'll have your house is an array because there's just too much. The focus just isn't there. But my sleep space, oh yeah, yeah. You know, it is dialed in. I have it straight because I just, can't, not anymore. 
Sleep Safety and Hyperarousal
bernette: I used to be able to, but not now that I've been able to get my sleep hygiene and my, my sleep schedule in line that I don't, as you recommended for, and I don't know if you find this with people with that are suffering with severe insomnia, with the emotional issues that come with menopause and the night sweats, which can wake you up, ready to peel the wallpaper off the walls is that with the night terrors that come along with it, the horrible nightmares, the [00:22:00] Bibi dreams that will not leave you and the fear that comes with it, that is of course tied to the emotion of the hormonal imbalances, but. I don't know, especially if you're a mom or if you even live alone or you have pets, whatever. Just security overall becomes such a heightened issue. Is the door locked? Are all the windows shut? Was that somebody in my driveway? What did I just hear? I mean, it's just so escalated that for me, I have claustrophobia too though. That's not a good thing. But for the complete darkness, if I wake and it's completely dark and I cannot see, I flip. I completely go into panic mode and I have to talk myself out of it. So with the combination of the nightmares and all that, I keep sound in my room real low, but something that can keep me attached to the reality to keep me from that complete anxious panic that I could go into 
dr chasser: And I think you make a really good point there, Benette. These are general guidance. And each of [00:23:00] these things will, need to be personalized to your own situation. And as you say, one of the most important things with sleep is feeling safe and secure and making sure that your nest, your room environment is that feels safe. That's why when, for example, we go sleep at a hotel or someone else's house. We don't sleep as well. That's because our, our brain is aware that it's something different. We don't feel as safe as we do in our own environment, so we don't sleep as well. So creating that perfect sleep environment's really important. And if that involves having a little nightlight on but perhaps putting an eye mask on or having some sound there in the background. Lots of people like to listen to radio on low and that kind of just gives them that little bit of security find the things that work for you. And I think you make a really good point as well. You were very aware of the environment around you. This is very common with insomnia. What we get is a hyper aroused state. So this is where everything [00:24:00] around you, you can, the bedding around you, you can feel, you can hear the bins being rattled by the cat or whatever happens, and all of those things you suddenly have a very heightened response to. And part of what we do, so one of the therapies that works best for insomnia, whether it's caused by menopause or otherwise, is cognitive behavioral therapy for insomnia. And that's about turning down the, the kind of dial on that hyper aroused state at night so that when you are able, when you go to bed, you're able to fall asleep more easily, stay asleep through the night and wake up refreshed at the right time, rather than kind of feeling all kind of on edge and frazzled throughout the night and waking up constantly. We go through. Sleep cycles. So 90 minute sleep cycles where we go through these different stages of sleep and in between each one we wake up briefly check the environment around us, whether that's consciously or subconsciously before going back to sleep again. And if when we [00:25:00] wake up, we don't feel safe, we don't go into those deeper stages of sleep. Mm-hmm. Or we might be delayed to, to getting to that next stage. And so a lot of what we do is work on people being able to get back into good quality sleep and turn down that hyper arou state where we're absolutely aware of everything and fearful and reacting in a, with our kind of full fight or flight response. As soon as something disturbs that environment, 
Wind Down and Mind Quieting
bernette: the 30 minute to hour wind down. Is also one of the things that has helped my sleep, even with having specifically narcolepsy that has really helped is definitely the wind down. And when my mind is particularly lit up, 'cause so many of us are, we do suffer with some sort of almost OCD or attention deficit disorder of some sort. And whether that's in, caused by all the sleep deprivation or whatever the case may be. [00:26:00] Nonetheless, it's like having 17 screens open on your computer and they're all running at the same time. And so in order to reel my mind in, I very literally, I, I have children's coloring books and I have crayons and I sit down and I make myself just color and it begins to. Draw my mind to kind of slow it down and reel myself back into a time when my brain, my body, my reactions didn't have anything to do with all of the responsibilities and the chaos that today's life as an adult, an adulting person has to do. And it kind of just, I don't know. It calms me. It reels me in and it quiets all that noise so that I can, yeah.
dr chasser: I think that that's absolutely perfect. And lots of people, when they think of meditation before bed, think of kind of a Buddha sat underneath the tree with their legs crossed. Actually meditation is just being present in the moment and aware of our own thoughts. Often our lives are so full with noise and disruptions [00:27:00] and draws on our, our attention that actually it's, it. We often don't have an opportunity to sit with our own minds and what might be going on. And that's why part of the. Thing that happens with insomnia is that as soon as we lie down, our brain comes, all these thoughts come, come thundering in that often are cyclical, often negative, and are difficult to control, particularly at night when our brain, particularly the kind of frontal part, the control part of our brain is feeling really sleepy. And so to give those a moment to those feelings before you go to bed to release them is really important. So you calm your mind and go into sleep with a quieter mind. And that could be coloring, it could be knitting, it could be watching a, a very calm documentary. Whatever it is that that does it for you, find your thing. Mm-hmm. 
Breathwork Sleep Hack
dr chasser: For the one I probably recommend most is, is breath work, because it's almost like a hack. Into your, your body. When if anyone's had a fright, someone popped a [00:28:00] balloon next to you, your breath becomes quick and fast. That's our, our body preparing to run in case there's danger. When we breathe slow and on the out breath extended, it's telling our body that it's, we're in a safe place. We're okay. When our breathing is calm and slow, it tells our mind that it's okay to calm down. And so it's a really easy hack that we can do to almost shortcut our brain into that, that quieter mode. So there's, there's lots of things. My, my company's called the Sleep Project, and on our YouTube chat, YouTube channel, we have lots of of breath work exercises and meditations and a body scan that you can do all before bed so that you can help switch your mind off because that's really important. 
Tools for 2AM Wakeups
dr chasser: And you can also do them in the middle of the night if you wake up, because the same thing happens if you wake up at two and you think, I'm not gonna be able to get back to sleep. You start doing calculations of how many more hours sleep you're gonna get and think about all those things. The next day I'm not gonna be [00:29:00] able to do my job. I'm gonna be late, late for work and I sleep through my alarm and start almost catastrophizing. Then sleep gets blocked. So what you need to do is have tools in that moment to switch off your mind and distract it. And breath work, meditation body scan. There's a few, lots of other tools that we use during CBTI to to switch off the mind, but you're trying to distract your mind from that pressure that you have to get to sleep. Because sleep is the one thing where if you try really hard to sleep. Actually sleep gets blocked by design because you trigger that sympathetic nervous system. And if you think back to kind of falling asleep, most people don't remember falling asleep. That's because it's an automatic process. It's one of those ones we don't have control over. So we just have to distract our minds enough to let our body do what it needs to do. 
Sports Body Scan Story
bernette: I know that previously when we were speaking, you had mentioned sports. Mm-hmm. And your connection to that as well in your, in [00:30:00] your practice. And one of the best meditations I ever learned was when I was playing sports, when I was a teenager and we were at a tournament. It was a three day tournament for state championships, and we kept winning. So we kept having to go to the next match, to the next match, and it was in basketball, so it was very. Fast moving, lots of, you know lots of exertion. And so it was getting to a point where we were about to drop it, just we weren't gonna be able to make it. And our coach, who is, shes crazy, but she took us all in this room and it was dark. It was a classroom inside of this school. And she made us all lie down. And then she did this 15 minute meditation with us, without telling us it was a meditation, you know, she's like, look, we're gonna get energized. This is how we're gonna do it. And so she did it. And to this day, I still use it. I will forever use it. It was a body flex and relaxation with breathing from your toes up, then the [00:31:00] whole body. And I don't make it past my ankles anymore. I make it as like maybe to my knees and then I'm completely out. But I have never forgotten it because it was the most, it was the most invigorating. Saying that had ever happened to me to, that I've used since that day forward, and the meditation and the breathing and the flexing and the blood flow and the constant just concentrating on the body instead of concentrating on the mind without realizing, you know, that you're working with both. It was amazing and I think it's very underutilized practice. When it comes to sleeping 
Military Body Scan Explained
dr chasser: , And I think , it sounds like that was a form of the body scan technique and it's mm-hmm. It's an excellent one as a, a kind of gateway into meditation, particularly if you're someone who finds that as soon as you are quiet and sat still, your, your mind becomes very full. This is quite a good way of, of almost directing the mind in a way that helps switch it off. In fact the body scan technique is, is one that u is used for the [00:32:00] military and is called a kind of military armor. So people in combat can use it to switch off after a day of combat and getting the, the sleep that they need to repair and to kind of prevent post-traumatic stress and, and issues that happen if you're not sleeping particularly well after a trauma.
So yes, very much recommend that, and I'm very happy to, to share the link with our body scan technique with, with the group so that they can try that at home. Because I think that that's one that people will easily be able to grasp onto. 
Menopause Sleep Disruptors
fred: Yeah, that's what I was going to ask about the the combination between, you know, you talked about the mind being a big cause of the insomnia, but I find myself that anytime I'm having insomnia, it's normally body related where I have the restless leg syndrome, which I saw was also very correlated with menopause as well. So when people are having more physical symptoms than mental symptoms like restless leg syndrome or hot flashes or night sweats, that kind of stuff what do you recommend for [00:33:00] the getting past that physical discomfort so that you can relax enough to go to sleep?
dr chasser: Yeah, and I, I think I guess taking a step back , with menopause, there's probably four big. Issues that we see associated. The most common one is, poor quality sleep. So you're sleeping, but you're not sleeping as deeply and you might be waking up frequently. Then there's insomnia, which is difficulty falling asleep, staying asleep, waking too early, and having an impact on your, on your day to time function.
The third one is obstructive sleep apnea. This is where your airway blocks while you're sleeping, waking you up frequently. That becomes much more common particularly after the menopause in women and it's very much underdiagnosed and causes significant daytime sleepiness. And then you mentioned restless leg syndrome.
And restless leg syndrome is very common, particularly in the perimenopause or phase. Partly 'cause if you're having heavier periods, you're more likely to be iron deficient. And if you're iron deficient, you're much more likely to be have problems with [00:34:00] restless legs. So with obstructive sleep apnea and restless legs, those two are ones where it's worth going to see your doctor getting it formally diagnosed.
And there there's specific treatments for that. The rest is like if you have low iron, even if it's within the normal range, but the low end of normal it should be supplemented ' cause that will make a difference. Now coming back to your question about your. Feeling those physical symptoms in your body.
Hot Flashes and Temperature
dr chasser: And I think I would add in their hot flushes as one of the really common reasons why people sleep poorly during the menopause. And there's a really strong association between poor sleep and the frequency and severity of your hot flushes. So , if you're having lots of hot flushes, it will keep you awake at night.
But the, the relationship's a little bit more complex. We know that actually hot flushes can happen before you wake up, but also sometimes you can wake up and then have a hot flash. And actually the main reason for this is that [00:35:00] our temperature control is really important for maintaining sleep. And if you've ever slept in a, a hot room or, or been on a holiday where there's no air con, you probably sleep poorly because when we're hot.
We don't sleep very well, and we have to drop our body temperature to instigate and maintain sleep. So all of our hormones but particularly the progesterone, estrogen, are really closely linked to our body temperature. Our brains are full of both progesterone and estrogen receptors. So when we're going through menopause and , our hormones are all over the place and jumping up and down, or . Where they're deficient actually , our temperature control and our sleep are really impacted and those hot flushes can happen and wake us up from sleep or we wake up for other reasons and then we have a hot flush triggered by that. But , the solution to some of those physical things, this includes kind of chronic pain and joint pain or urinary symptoms sometimes is actually to try and improve the sleep quality because [00:36:00] when you are having more deep sleep, you are less likely to be woken up by those symptoms and also retraining the body to go back to sleep easily after being woken up.
' cause sometimes if you have a hot flash, if you fall back asleep afterwards, straight afterwards, it's not a big deal. What becomes problematic is when you wake up because of the hot flash and you can't get back to sleep quickly, and so it's teaching the body to then switch off afterwards. Or be in deep sleep.
So those things don't disturb you in the same way. And so when we're able to kind of calm our body and mind, but also improve our sleep quality by doing all the things that we've discussed already then even physical symptoms like hot flushes or pain in our joints or needing to go for a whee in the middle of the night are less likely to disturb us and we're more likely to sleep through.
Okay. 
Libido Sleep Connection
bernette: You know, one of the things that you, we haven't spoke about yet is one of the issues that I, myself and [00:37:00] that several other people, you know, I know other people my age that have done this, have gone through is the drastic influx in their libido. Whether they are like, are you serious? Nah. Or where do you think you're going?
Kind of thing, you know? And the, the worst part that all of us concluded to is that the one thing that will give you good sleep is good orgasm. And if you don't want it and you can't get there, or you can't even, it's not even in your wheelhouse. It's like, , how are you supposed to balance what would be normal?
You know? I mean, because your normal libido would drive you once a week, twice a week, something like that. Where, when you are in menopause, it's, huh? Hmm. You're, are you serious for a month, month and a half, and then all of a sudden you shift gears into, you think you're like 15 and you're running on I, and so
it's like a tug of war. Yeah. Because emotionally you're so connected to that as well. But so much of that [00:38:00] leaves and sleep also, just for those that aren't even in menopause that do suffer with insomnia or any other sleep disorder, including having to deal with CPAP machines, stuff like that. All that stuff's calculable in how your libido's gonna react, how your emotions are gonna react, and especially during menopause.
So 
dr chasser: yeah, I, I mean , you said it all there and when we're sleeping poorly, we don't fancy having sex. Yeah. The two of them are really intrinsically linked and so sometimes it's about slowly improving those things. 
Comfort and Hormone Options
dr chasser: I would say the first thing to talk about is vaginal symptoms and making sure that you're comfortable down there.
It's very, very common to have vaginal dryness. Having soreness, finding sex is just not as much fun because it's sore. And so the first thing to do is to make sure that your vaginal symptoms are under control. Even if you don't want to take HRT hormone replacement therapy, you can use [00:39:00] topical estrogens that can help supplement the skin down there.
And if you wanna avoid them, there are other lubricants and kind of supplements that you can take topically to the vaginal area that can really help you to feel more comfortable. And so the first thing is, make sure that that feels comfortable. Then slowly try and improve your, your sleep quality.
And also think about the emotional side of things. If you're just not feeling great in yourself, you're probably not feeling your most sexy. And so often it's doing lots of little small things , to improve how you feel. Sleep is a part of it because after a bad night's sleep, you are more moody. You are less likely to connect with whoever your partner is.
You probably, your menopause symptoms are gonna be feeling worse. You're not gonna have as good libido because all of those sex hormones are controlled while you are, you're asleep at night. And so trying to tackle. As many of these little [00:40:00] things as you can. And I'm not saying it's gonna be a silver bullet and you're gonna feel like you're 18 again and wanting to shag everything, but sometimes just little by little you can start improving things.
And for some people going on hormone replacement therapy, considering testosterone therapy, if the libido's low and their testosterone is low, can be something that's, that's really helpful. But also thinking about that relationship and the connection with someone else. Because if sex has been painful, if there's been months where you haven't had sex just 'cause you haven't felt like it, it's gonna be difficult , to kind of start that process of reconnecting again.
And also remembering that there are ways to connect with your partner without sex. If sex is something that's not working for you, you don't fancy anymore. But ensuring those emotional connections is so important. 
bernette: I agree. It's just so not easy.
Menopause Surprise and Support
dr chasser: Most of the menopause symptoms, I saw a really interesting thing talking about how menopause and its impact almost comes as a [00:41:00] surprise to each new generation of women.
And I was reflecting on that because I think. Before you go through the menopause, you can't quite imagine how bad it can be and how much it will impact on every aspect of who you feel like you are, your anxiety symptoms, because anxiety is a really common symptom of menopause, but one that's probably not talked about, a huge amount about your confidence at work or in relationships about your energy. And so it undermines a lot of those things that make you feel like who you are. And so I think as women we need to talk about it and I, I think we're getting better at it and trying to help younger generations understand it, so it comes as less of a surprise. And also knowing that when you're starting to feel really bad, there are things that you can do about it and taking those steps early. It can be really beneficial. And whether that's going for hormone replacement [00:42:00] therapy, if that's what you want, or if it's that you're having poor sleep, then getting CBTI sleep therapy because that really works as well as HRT. If sleep is the, is the problem and if you're having hot flushes getting those under control, whether it's with HRT or a different medication, can really improve your, your sleep quality and your, your quality of life. So as soon as you kind of think, Hmm, this I'm not fitting right go and get help. And I think a lot of people when they first start with menopause symptoms, that kind of creeps into every day life. Kind of you're a bit more snappy with your partner or you find that , your emotions are a little bit more o all over the place or you find that you're waking up in the night, but it's not a big thing to begin with. And so sometimes it can be really difficult. To kind of pinpoint, I don't feel like me. And sometimes over a period of maybe weeks, months, years, these changes happen. And I can't tell you how many people who I've started treatment with where they suddenly [00:43:00] go, oh my gosh. I had no idea how bad I felt until I felt good again. And so just recognizing that if you don't feel right, have a conversation about it, it doesn't necessarily mean that you are gonna start treatment, but at least you're then having that dialogue and sometimes just talking about it makes a difference. 
bernette: Venting is always one of the best things that you can do. Having someone that'll just listen to you, whether you're screaming, crying, or laughing and acting a fool, it's always better to have someone that just. Lets you let it out. ' cause that way you don't take it out on other people and on yourself.
dr chasser: If those things, 
bernette: things that up 
dr chasser: in your brain and kind of you're in that kind of cyclical mode of, of thinking about stuff but not resolving it, then it's going to impact your sleep even more.
So sometimes the first step is just to say, I don't feel right and right. Have that conversation. 
bernette: The the fact that no matter what it is that is wrong with you, whether you have the flu, you broke your arm, whatever the case may be, had a heart attack, the very [00:44:00] first recommendation that a doctor makes to you is you need to get rest. Except for when so many of us in, whether it's menopause or it's a sleep disorder or whatever it is that stresses you out, causes you an emotional reaction that causes these, these instances then. You, that's the one thing you're not gonna achieve. And without achieving that, you're definitely never going to get past the first step of getting better. Yeah. 
CBTI Works and Next Steps
bernette: So you've got to identify the sleep. 
dr chasser: And I think if, if anyone, if takes like one thing from this listening to this is that if you're sleeping poorly during menopause, it is possible to sleep better and it shouldn't be one of those symptoms that you live with. And often it's about getting that right combination. The gold standard treatment for insomnia is CBTI, and it can have profound impacts. For example, , my last client they were sleeping less than two hours a night. I did a [00:45:00] review a couple weeks ago and I, they are now sleeping seven and a half hours consistently. And so that's an extreme, but better sleep is possible and the first step is , to say, right, this needs to change and, and get some help. And on average, most people get at least an hour of extra sleep per night with Cbti. And that's, if you take it over a week, that's almost like a whole extra night's sleep. 
bernette: Yeah. Yeah. I sleep an hour and a half. That's my. And then I'm awake, so it's intermittent. And so that's where my issues lie with my own personal sleep disorder. But definitely when I was going through menopause, it was, oh, it was about half that and it was ugly and it was not helpful to anything in my life, and at that point I was medicated. I'm no longer medicated for narcolepsy at all. Mm-hmm. I take no prescriptions for it, so I just have, you know, made my own mode of dealing with it. And I've got it way more under [00:46:00] control than I ever did when I was on medication. But I needed it at that point in my life. Medication was necessary the same as during menopause. The medication was necessary. It doesn't mean it has to be forever, you know, I mean like menopause is a very temporary stage in your life, whether it lasts a year. Or it lasts five years or even longer, depending on, you know, when the perimenopause kicks in and you actually finally identify it. 
dr chasser: Mm-hmm. 
bernette: I think it goes on a lot longer than people think because they don't identify it for so long, but just the same, you know? I mean, medication is definitely something that can help you it, especially when it comes to this kind of thing, and I think that everybody needs to for sure. Absolutely. As soon as you start noticing that you're not sleeping good, that's sign number one. I bet you'll find all the others. When you realize, you know, when you get a little bit of good sleep, you're gonna see all the other symptoms that are actually there that you've been avoiding or disguising, or not even recognizing because you have not been sleeping, so, mm-hmm.
Why the Sleep Project Started
fred: [00:47:00] Oh, earlier you mentioned the Sleep project as something that you were involved in. Did you start the Sleep project or is that a, a, a project that you work with other people about? What inspired that and what kind of impact are you hoping that it will have? 
dr chasser: So, so the Sleep Project is a collection of, of clinicians who are all dedicated to improving lives through better sleep. We came together after COVID where we saw a massive increase in sleep problems. Partly 'cause people were working in the bedrooms, exercising in the bedrooms, more stressed, more worried about everything that was going on, and has had a big consequence on, on both mental health and anxiety and sleep. And there's a really close. Interplay between anxiety, depression, and sleep. They kind of go, it's like a chicken and an egg situation where poor sleep and causes your mental health to be worse. There's a two to three times increase in anxiety and depression when you're sleeping badly, which is [00:48:00] why it's important to, to treat it. But also almost every single mental health condition has poor sleep as one of the symptoms. So we were seeing loads more sleep problems. And so we came together as a sleep project and we work with individuals with businesses and in elite sports helping to improve sleep. But we also work with healthcare organizations both doctors and with people like, like you to try and get the word out about. How people can improve their sleep. Training doctors to recognize insomnia and to treat it better and helping as many people as we can get a better night's sleep. And I guess just to, to add our, our website is www the Sleep Project Life. We've got lots of free tours, blogs information and we do one-to-one consultations or CBTI programs for anyone who's looking for support. Please do get in touch, send us an email. Would love to answer any questions if we can. And hopefully this is your first step to, better night's sleep. 
bernette: Do you [00:49:00] have any chapters or physicians in the US currently that you are partnered with or? 
dr chasser: No, but we do everything online, so anyone who's in the states, we're really happy to, work with you.
Just means that it'll have to be towards your afternoon so that we're awake. 
bernette: Yeah, definitely.
fred: All right. 
Wrap Up and Resources
fred: Well, did you have any last thoughts that you wanted to share with the listeners? I 
dr chasser: I, I think we've covered quite a lot and I'm, I'm really loved where the discussion went and all the, kind of. And, and things that came out through, through the, the discussion. So I think we've covered as much as I would like to cover, but hopefully people have taken away something that they can bring into their own lives.
fred: Alright, well thank you so much to Dr. Caitlin Chas for being here with us today for our medical series. We appreciate you very much for coming on the show.
bernette: Yes, thank you, you very much. I, I have a, a lot of comments and crazy questions, but usually it gets to a good point. So I really appreciate you taking the time to answer the [00:50:00] questions and to, to interact with us so that we can get more people aware and a little more observant of the circumstances of what's happening to them and how much their sleep is. Valuable to every aspect of their life, not just a good night's rest and a day without naps. So super. Thank you again. 
Lovely 
dr chasser: Chatting to you. Take care. Bye-bye. 
bernette: You too. Bye-bye. Bye. 
fred: Thanks. 
Patreon and Community Outro
Speaker 2: Narcolepsy Navigators is excited to announce our new Patreon and merch store. You can choose to support us monthly via Patreon and receive bonus content from our advocacy and medical series, as well as a shout out on the show. Subscribing to our Patreon will allow you to have access to narcolepsy, navigators, discord server, where you can chat with other navigators, find support, and ask questions. To be featured in future bonus episodes. Higher tier supporters can also receive Patron merch, [00:51:00] or if a monthly subscription is not in your budget, you can check out even more merch on our website, www naps four life.com. This week we would like to have a shout out to our very first patron supporter, Jane Powell. thank you very much for your support.
Speaker 3: Narcolepsy Navigators is produced by a team of volunteers working for the Naps for Life, CIC, which is a nonprofit group dedicated to improving the lives of people with sleep disorders through community action. You can help grow our podcast and join our sleep disorder support group by visiting the website www.napsforlife.com.
If you or someone you know. Has a sleep disorder and would like to share your story on [00:52:00] narcolepsy navigators. Please email us at narcolepsy navigators@gmail.com. You can also support us by donating at the websites. Happy napping everyone.
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