unPAUSED with Dr. Mary Claire Haver - Menopause and the 3AM Wake Up: What Light, Meal Timing and Hormones Do with Dr. Kristen Holmes

Episode Date: August 11, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Kristen Holmes, Vice President of Performance Science at Whoop and author of the new book Aligned, to unpack why sleep and circadian rhythm matter as much as hormones when it comes to the symptoms women feel in perimenopause and menopause.Dr. Holmes explains the concept of circadian amplitude, the contrast between activity and rest, light and dark, and fed and fasted states that keeps every system in the body running on time, and why women with lower amplitude tend to report more frequent and more severe symptoms. She walks through why morning light exposure is one of the most powerful and underused tools available, how getting outside within the first part of the day sets the timing for melatonin release that night, and why a window is not a substitute for actual daylight.The conversation moves into meal timing, including why the body is more insulin sensitive earlier in the day and how consolidating calories into a shorter window can support better sleep and metabolic health. Dr. Holmes also covers where movement fits, including the specific role of zone two training in recovery, why late night intense exercise can work against sleep, and how alcohol affects women differently than men at the same dose.Dr. Holmes and Dr. Haver also dig into what actually drives a 3am wake up, tracing it back to progesterone, GABA signaling, and the loss of hormonal stability that comes with perimenopause, and why sedatives can mask the problem without improving sleep architecture. The conversation ends with a look at the data connecting circadian misalignment to shift work, mental health, and long term health risk, and what a woman can start doing tonight to build back that rhythm.Guest links:Dr. Kristen Holmes (Instagram)Dr. Kristen Holmes, PhD (LinkedIn)The Line with Dr. Kristen Holmes (Apple Podcasts)Books“The New Perimenopause,” by Dr. Mary Claire Haver“The New Menopause,"⁠ by Dr. Mary Claire Haver“Aligned: The Data-driven Guide to Performance, Recovery, and Human Potential,”by Kristen Holmes

Because there was so much to cover with Dr. Kristen Holmes, we have broken this episode into two parts. This is part one, and we will publish part two later this week. When you've got the regular Jane and Joe actually starting to adopt some of these behaviors that we know really impact these markers of health and performance, it's transformational. And that's what surprised me the most. I get emotional when I think about it because there's so many people who have come onto our platform really struggling. and they adopt, you know, what are quite frankly very simple behaviors and it transforms their life. The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials

are intended to be a substitute for professional medical advice, diagnosis, or treatment. I want to tell you something that took me an embarrassingly long time to put together. I've been treating menopause patients for years. I understand the hormonal mechanism. I know what declining estrogen does to sleep architecture, why night sweats can fragment sleep, why three in the morning anxiety is a hallmark of the perimenopause transition, and I've been treating the symptom. What I was not doing was treating this system. What I did not fully understand until I started looking at the circadian research is that menopause and sleep disruption are not just occurring simultaneously. They are amplifying each other in a loop that most women and most

of their physicians don't recognize. The hot flash might wake her up. The disrupted sleep destabilizes her circadian rhythm. The destabilized circadian rhythm makes the hypothalamus, which is already under hormonal siege, more dysregulated, which makes the hot flash is worse, which disrupts the sleep more, around and around. here's the part I was missing in my clinical conversations. When she sleeps matters as much as how long she sleeps. The regularity of her sleep timing may be as powerful a predictor of her health outcomes as the duration. A UK study of 60,000 people across 10 million nights of sleep found that sleep regularity predicted mortality, independent of how many hours a person slept.

We may have been measuring the wrong thing. My guest today has spent her career at the intersection of elite athletic performance, behavioral science, and one of the largest human physiological data sets ever assembled. Dr. Kristen Holmes is vice president of performance science at Woop, a three-time All-American athlete, a former Team USA field hockey player, and one of the most decorated coaches in Ivy League history. She has access to what the human body actually does under pressure, at scale, across hundreds of thousands of people, and she has spent years asking what the data means for women specifically. What Kristen is going to tell you today is going to be uncomfortable in some places. It challenged assumptions I held for years, but this conversation will also give you practical things that you can change tonight. I'm Dr. Mary Claire Haver, a board-certified

obstetrician and gynecologist and certified menopause practitioner, an adjunct professor at the University of Texas Medical Branch. Welcome to Unpaused, where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Our schedules are packed, our brains are carrying a mental load, and the last thing we need is more friction in our daily routines, especially when it comes to finding the right thing to listen to on a morning commute, a neighborhood walk, or even when tackling household chores. That's where the Amazon music app comes in. With Amazon Music Unlimited, you can listen to all your favorite music, podcasts, and now audiobooks, all in one app. No need for multiple places to clutter up your phone, and you can

find something to match your current mood. So whether you're listening to your favorite playlist, catching up on a podcast, or getting lost in a great audiobook, it's all right there with the Amazon Music app. Amazon Music, Podcasts, Audiobooks, All in One App. This episode of Unpaused with Dr. Mary Claire Haver is brought to you by Alloy Health. One question I hear all the time is, why hasn't my skin changed so much? And if you've been wondering the same thing, you're not alone. As estrogen declines during menopause, we lose collagen more rapidly. That can leave our skin feeling thinner, drier, and less elastic.

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Your menopause specialized doctor will tailor your skin care to your needs, plus you get $0 unlimited messaging with your doctor. Head to M-Y-A-L-L-O-Y dot com and use the code M-C-H-20 to get $20 off your first order. All right, Dr. Kristen Holmes. Welcome to Unpause. I'm very excited about this conversation. I know, me too. Our listeners are not sleeping. I know. So, and you are the world's expert in the architecture of sleep and really understanding what's happening to women. But before we get there, tell me a little bit about what your PhD is in, you know, and how you went from a very elite athlete, you know, walk me through the path to get to where you are now at Woop. Well, I started out, I played two sports in the Big Ten at the University of Iowa. I played basketball and field hockey. And I just played one year. of basketball. I walked onto the team, so Feel Like It was my primary sport. And then I went on and played for the U.S. national team for seven years. I made the team in my sophomore year of college. So I was kind of playing throughout and then and then kind of revamped my career in my early 30s and played another

year of international hockey. And I coached at My Alamata for three years and at Princeton University. I was the head feel like a coach for 13 seasons. And while I was at Princeton, I got really into data as a way to foster human performance to help keep my athletes safe and healthy to compete. And so that was really when I started developing my own technology, which is what led me to whoop, which is a, you know, a risk worn wearable that I monitor physiology. And really my leap from collegiate coaching and kind of teaching at Princeton was really this idea of being able to scale this notion of recovery that I was seeing in my environment was so correlated with every marker of mental, physical, and emotional health. And so I just got

really into data and just this promise of being able to scale recovery really is what it kind of came down to. And I've been at WOOP for 10 years leading the science that underpins a lot of our coaching and our algorithms and it's been a wild ride. For our listeners who don't know what a WOOP does or what WOOP measures, can you walk us through that? Yeah. It's a 24-7 physiological monitoring device, and it is kind of meant to be worn 24-7, so you can wear it while you're sleeping, while you're working out, while you're showering, while you're saunneling, while you're cold plunge, really anything your body can do, who can do too. So it gives you this really holistic picture in terms of how you're responding and adapting

to external stress, which is a really, I think, valuable source of insight. You know, when we don't know what is causing or how we're adapting to the load, the life load, we don't necessarily know where to apply our effort to fix things. And because of the way modernity has kind of pulled us, which we'll talk about later, I think pulled us from a lot of these primal thresholds. We have, our body is really confused a lot of the time, right? Because we're getting mixed signals that our body doesn't know what to do, right, with those mixed signals. So it creates some confusion. So it creates a lot of variability in how we respond and adapt to stress. And that's one of the things that we measure with a metric called heart rate variability. Okay. That is one of the most

confusing metrics. I cannot figure out. So please, for the love of God, or those of us who are wearing wearables, like, what is heart rate variability? Why is it important? How do you measure it? Yeah, yeah. So we measure it via PPG. So, you know, for whoop and there's other, obviously, there's rings and there's lots of different form factors, which is great. You know, I'm a huge fan of, obviously, of learning your body and understanding these signals, right? They can really, I think help you understand how to better apply your effort, right? So back to HRV, heart rate variability is quite simply the time interval between heartbeats. So it's a measure of an interval of time, the measure of time. And you want that measure of time to be more variable.

So the more variable, which if we were kind of giving you a measure of hearty variability, that would mean a higher hearty variability is a proxy measure for how well you're adapting to stress. So higher heart variability would be you're adapting, adapting positively to stress, generally speaking. There's a lot of nuance there that we could get into. A lower heart rate variability, relative to your own baseline, of course, means that you might not be responding and adapting to stress in as functional a way as you could. And what's great, but also really confusing about heart rate variability is there are, it's super sensitive to not just physiological inputs, but also psychological inputs.

It's a psychophysiological mirror, which makes it really powerful, right? So this gentleman posted on Reddit, I think, was basically a screenshot of his HRV over the course of six months, and it showed him beating depression. And it showed his HRV rising from, I think, a 30 millisecond to almost a 90 millisecond,

right, over the course of six months. I feel like if I hit 30, I'm winning. I know, I know. So, and again, it's very individual to the person, But I think that's a really good illustration that it is not just kind of a mirror of how you're training, right? It's not just about your training load. It's so much more than that. And when I was at Princeton, we were tracking heart rate variability.

And that's when I really started getting deep into this metric. And what I love about whoop and aura is that we're actually measuring it during sleep, which is, you know, we're able to minimize a lot of these confounders and get like a very stable baseline. So it does give you a nice understanding, again, of how you're responding and adapting to stress, which HRV is a good proxy measure of. That's amazing. So you started with elite athletes, so the fittest people in the world. And then you're, then you started collecting data on like mere mortals like myself. You know, what were things that really were surprising you through all of this?

What surprised me is that we're, we're very much the same in terms of the principles. the foundations that move around these metrics that we have visibility into that we are able to observe, right? You know, when someone who's relatively sedentary starts working out, their heart rate variability improves. They start to look, the profile morphs into what would be more akin to an elite athlete profile. There's things that, I think with elite athletes that are already, who are already close to their performance ceiling, we're talking about margins, right? We're talking about just 14 more minutes of sleep, you know, a reduction of, you know, 20 minutes of less sleep wake variability. We're talking about the timing of a cold plunge.

You know, a lot of these things get at the margins for elite athletes. And when they're doing it, it does impact performance outcomes. But when you've got the regular Jane and Joe actually starting to adopt some of these behaviors that we know really impact these markers of health and performance, it's transformational. And that's what surprised me the most. I get emotional when I think about it because there's so many people who have come onto our platform really struggling. And they adopt what are quite frankly very simple behaviors and it transforms their life. I think that's what's really rewarding about being in this space, which is your space too. So what else does it measure?

So we talked about her variability. Yeah, herring variability. Resting heart rate 24-7. We look at respiratory rate, blood oxygen saturation. We measure obviously sleep architecture, strain. which is a measure of your cardiovascular load. Recovery, so we have algorithms. We basically take these data, for example, our recovery algorithm, you know, or is a readiness

algorithm, our recovery algorithm takes into account your heart variability, your resting heart rate, your sleep performance, and your respiratory rate, and, you know, weights them differently and kind of gives you this measure of readiness, which is just a simple way to, you know, for you on a day, on the daily basis, just to kind of see how you're responding and adapting. It's a snapshot. I think looking at that over the course of a, you know, of a week or just looking at trends is more helpful than just the acute one night a day. Yeah, yeah. What I'm really excited about

right now is we also, you know, we're tracking basically second to second data. So the engineers in December were able to pull the second to second data for me. So I've been really looking at the amplitude of different metrics that we track like heart rate, heart rate, heart rate, variability, respiratory rate. They all kind of follow this rhythm, right? And so that's kind of like the next ridgeline of research is what does circadian amplitude specifically, does that predict some of these outcomes that we're really interested in? And that's something I'm really eager to talk to you about. What were you seeing in women specifically that really stood out when you, and you worked with women mostly when you're at Princeton? And so now you go and you have to

look at boys too at Wu. But talk to me about women and data. Yeah. So yeah, what was really amazing at WOOP. And one of the non-negotiables when I began research at WOOP is that I'm, I'm not going to just do WOOP research on men for every perspective study, every, you know, study that we do, we're going to be looking at women too. And the CEO, Well, Amon, has been so, I think, supportive of that effort. So we've done lots and lots of research over the course of the 10 years. And I think one of the things... How many, how much data are we talking about? I mean, billions and billions and billions of lines of code. It's just, it's, it's, it's, It is an overwhelming amount of data.

And then not just to mention all of the physiological data, we have all the behavioral data as well. We have questionnaires, you know, health history questionnaires. We have surveys. Yeah. So it is, we are able to do incredible research with very, very large data sets. Wow. Yeah. Okay, so back to the world.

Yeah. You know, there's a couple different, I think, interesting observations at various stages. So one of our partners is the Wussai Human Performance Alliance. Scott Delp runs that lab along with Jen Nixon. And Clara Wussai is this incredible philanthropist. And I think she owns one of the women's basketball teams. And anyway, she has put in huge amounts of money to basically study female physiology. And so we partnered with Wussai.

And one of the papers that we just published is looking at the menstrual cycle. And what we're trying to understand is, are there any metrics, anything about about the metrics that predict cycle regularity and cycle length. And one of the things that we saw, just probably not surprising, but the more variability that exists, and I know this is confusing because you just said variability is good and amplitude is good, but when we have, when we look at the coefficient of variation, so when we're looking at, you know, the day-to-day variability in heart rate and heart rate, respiratory rate, coefficient of variation, that day-to-day variability is not so good, right? The more data-to-day variability, you know, the more

day-to-day variability, the more unstable your overall physiological profile, the more that predicts irregular period in women. I thought that was really interesting, right? So we need stress, obviously, with training, and that's good. But when we start to layer on hormonal changes, hormonal changes, right? Now we start to get more variability. So the more your lifestyle is in chaos, right, the more obviously you're going to see variability in these other metrics. And what that leads to is, of course, irregular, you know, in timing and length. And we've talked on this podcast before that your period is a vital sign. For sure. And if you're not having predictable, regular monthly cycles that don't wake you up in the middle of the night, that don't have you

changing pads more than, you know, like, if you have to disrupt your life for your period, this is a problem. And if your periods aren't coming regularly, this is a problem. So you're saying we can predict this outside of menstrual cycle tracking. Yeah. And where this becomes helpful is, is you can just kind of not in a freakish way, but just observe your data, right? And most importantly, observe your lifestyle, right? There are very clear behaviors that lead to cycle predictability. Like, for example. Alcohol. Yep.

And I know it's like it's tough, right? Because, you know, I think society has really normalized alcohol and it's a part of the fabric of our society in some ways, right? And it kind of is like if you're not drinking alcohol, you're not fun. And, you know, so it comes with a lot of, I think, baggage, right? But there is no question in our data. Apart from altitude and fever, that is the number one disruptor of sleep. And every physiological metric we track, it's. it correlates with low mood and we know that when you drink you move more you move less the next day

that's you know so it distraised every aspect of your life unfortunately and there is a dose response relationship yeah of course right um and we're able to measure all of these things for the people who track it so for women and this is the other uh study that we just published and and we can link to it in the show notes um and this is not great news for women young women across all the phases but young women in particular are highly vulnerable to alcohol. In what way? It's in terms of its impact on her resting physiology. So hurry variability, resting heart rate take a bigger dive than a man, for example. And is this, you know, if we dose her according to her weight versus a man at the same weight. She's still going to be great. She's more vulnerable. Yes, it's a beautiful question. With the same amount.

Exactly. And that's what I think women just need to be aware of, right? When you are not, when you're of the age of, you know, where you can. have a child, right? Your body's just scanning for safety, right? So when we put toxins in it, of course it's going to reject it more forcefully, right? And so I think we just have to be aware of that. And I think the other thing is when we think about this cumulative lifetime exposure of, for example, alcohol, that is going to impact amplitude later in life. And that's the other finding that we have is that circadian amplitude. Okay, the magnitude. What does circadian mean and what is circadian amplitude? Okay, so circadian rhythms are mental, behavioral, and physical...

Biosyncho social. Exactly. Patterns that are happening over the course of the 24-hour period. And you have exogenous kind of factors that are photic, so light source and non-light source, that are entraning the circadian system, okay? The strongest signal, of course, is light. That's why, you know, and we'll talk about this more, but... We see that, you know, the more light you're getting during the day and the more darkness at night, the more contrast that exists, the higher amplitude you have.

So we're really going for amplitude. Okay. Okay. And we'll get back to the data point around paramedal metapause and metapause related to amplitude in a second. But just a quick primer on circadian rhythm. So we've got the light. And basically what happens is as soon as the light hits the retina, it's not the light on the skin, it's light in the retina. Okay. And this is why it's so vital that you're getting light in the morning.

because your body is desperate for that signal. You've got intrinsically photosensitive retinal ganglion cells, okay? These cells in the eyeballs. Okay. That then sends a signal to the superchaismatic nucleus, which is located in the hypothalamus. Okay. The SCN itself has 20,000 neurons that have clocks inside them that go to different regions of the hypothalamus and then send signals to your body.

So when you're not getting this signal at the intensity that it needs, you create less amplitude in your body. So what kind of light is that? So outdoor natural light, ideally, a lot of us get up before the sun comes up, right? So bathe yourselves in artificial light. If you want to fall asleep 16 hours after that time frame, 12 to 16 hours after that moment, you want to bathe yourselves in artificial light. And then once the sun comes out, do everything you can to get outside and how long? You know, for five, if it's really sunny out, five, 10 minutes, 20 minutes. There's a lot of, there isn't great consensus in the literature and among sleep and circadian scientists of exactly how long you need to be. But I think 20 minutes is certainly, I think, safe. Five minutes

is probably enough of just making sure that you're exposing yourself to this natural light. What that does is it sets your circadian rhythm, right? It tells all these clocks in the body what it needs to be doing, right? And what you're doing is you are helping preserve that amplitude. That is so critical across the life cycle, right? But particularly, when you are vulnerable, that is when your hormones are shifting and declining, we need to preserve that amplitude the best that we can. So light is really powerful. So that's one of the, that's the non-photic, right? And then we've got non-photic, psychkeepers, time givers, right? That also inform our clocks. Okay. Feeding, time assured to eating. I want to get into that too, because this is an

underutilized lever for women in midlife. And I really want to hammer this. So time ratio to eating. and insulin doesn't have, it's a hormone, of course. It doesn't have a circadian rhythm per se, but it's circadian patterned in the sense that it responds to the timing of your food. We are more insulin sensitive in the morning. We get more insulin resistant out the days goes on. Okay. Right. So eating later in the day.

Yeah. This is the first I hear this. Let's go back. Okay. We are more insulin sensitive in the morning. So if I did a home I are first thing in the morning when we're fasting and it looks great, but I repeated that. Fasting in the evening, it would change.

Yes, yes. I know. There's some really good settings. So how should we be eating? Well, we want to bias our calories. We want to distribute our macronutrients across the day. Yeah. Right?

And I think we want to fuel. And this is something I talk about in my book in terms of just a mindset around food. We want to fuel for activity, right? We want to make sure that we have enough calories to eat. engage in the activities that we're taking on throughout the day. And so when we know from the data that, you know, in the morning and you want to eat like a princess and a queen, I'm going to use the women versions for breakfast and lunch, and then a pauper at night. Okay. Please explain what that means. Okay. So we want to eat a most nutrient dense, you know, as most, the most calories,

you know, that we can earlier in the day because we're more primed and metabolize that food. So fasting in the morning is not is not, no, not for men or women. Yeah, men or women, no one, right? Because we're more insulin sensitive in the morning. So prior to 3 p.m., right, we want to be eating a bulk of our calories. Okay. Okay.

And there's really good, there's a great study that literally did this exact experiment. They looked at people who were preferentially eating a bulk of their calories, Mediterranean diet, both groups. One was eating before 3 p.m. The other group, and this is quite a big study. We'll link to it in the notes. and then the other group was eating after 3 p.m. And the earlier eaters had better metabolic outcomes, better sleep, every parameter they were

measuring was better. And it just is the reality of the situation. It gets more egregious as we age, right? We become less sensitive, insulin sensitive at night, right? As we age. And menopause takes another chunk out of it. Exactly does. And that's why this notion of aligning our circadian rhythms, aligning our behavior with

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shapewear on the market. Use our exclusive link to save 20% off Honeylove at Honeylove.com slash unpaused. That's honeylove.com slash unpaused. After you check out, they'll ask you where you heard about them. Please support our show and tell them we sent you. Experience the new standard and comfort and support with HoneyLove. I for 10 years fasted in the morning based on the early intermittent fasting data. I know, I know, I know. I would do that completely. You know, I know better now. I've read. But at the time, that was kind of what the prevailing data said. And now I break my fast almost, you know, I know I get to the gym by eight or nine. And so I know I want to get at least 10 grams of protein in before I start lifting. Yeah. And so I make my shake. Yeah. Yeah. Which is a lot of

calories, a lot of protein, a lot of fiber, a lot of stuff. And I start drinking it and I try to get, you know, a good 20% of it down. And I take it to the gym and I sip at it for the next three hours. Yeah. And so that's great. And I think we know that it's okay to train fast it. That's okay, right? as long as you're getting food at some point relatively soon after your training, right? Like that seems clear in the data that because we have glycogen stored in our muscles, it's okay to, if you prefer to train on an empty stomach, you can do that. You just want to make sure that you're getting a nice hearty meal in the morning when we are most prime to utilize those nutrients and you likely need those nutrients.

And I think for women who are really hungry before bed, you know, generally that generally means you haven't probably eat enough calories during the daylight hours. Okay. Right. But there's something really powerful about this 12 on 12 off, 11 on, you know, 13 off. So we don't need to do 16 hours? No, I don't think so. I think I naturally do 12 without trying.

Yeah, I think we are designed to have a consolidated fasting period. And that's really what time restricted eating is, is a consolidated fasting period where you're biasing a majority of your calories during the daylight hours. once the sun goes down, you know, it's your body is ready to just wind down. Okay, so what did the Princess Queen and Popper mean? Yeah. So they'd say eat like a Prince and a King in, you know, the morning and lunch. So I just kind of, you know, use the female versions. So Princess for breakfast. A Queen. Queen. So have a big, yeah, nice hearty meal with all your, you know, Microoose. Yeah, Queen at lunch. And then, yeah, and then a Popper, you know, just a lighter meal at

at night. Again, making sure that you're getting in total, like the amount of calories you need relative to your resting metabolic rate to make sure that, you know, you're obviously not in a deficit unless, of course, you're trying to lose weight. But yeah, that's one of the other nonphotic time givers. That's really powerful and an important lever. And then just your activity patterns. Okay. You know, you really, again.

I'm like terrified. Okay, when should I be working out? I know. No, I know. And, you know, it's not, you know, over, you know, overthink it too much. But there is, you know, there's really good. And like, let's preface this, what all exercise is good. all exercise is good. There's no question about it. Nothing's better than, nothing's worse than sedentary.

Yeah. But if you have all the time in the day to exercise for your security and rhythm, what would be the best times? I think after the sun goes down, and there's really, and actually our team at Wou published a beautiful paper, and I think nature comms, that basically showed the closer you exercise to bed and the higher intensity, the more it compromise your sleep architecture. I can see that. Which seems obvious, right? But I think it's just a good reminder. you know, that's an inactive phase of our circadian rhythm. So if we're applying a lot of intensity and effort, it just makes us wired, right? And we are basically flooding our system with all sorts of, yeah, yeah, adrenaline and, you know, cortisol. And so it just makes it harder to wind down and fall asleep and potentially stay asleep. So, and that's what we see in the data. Zone two appears to not have an impact. So the lower thresholds, you know. So your walk after dinner is fine. Oh, that encouraged.

That is, I think, a beautiful strategy, especially if you've had a bigger meal or a carb, you know, a carb heavy meal potentially. That's a great way to just kind of get your blood sugar back under control. And there's lots of good data around that as well. But yeah, activity, we want to, again, try to be active during the day. And the other thing that we see in the data is this activity rest pattern. And again, following this logic of amplitude, we want a lot of activity during the day, during the daylight hours. That is when we're primed to take on load, mental, physical, emotional, right? As the day goes on, we get less primed.

And so once we move from the active phase of our circadian rhythm, which is essentially when the sun is up to the inactive phase when the sun is down, our body expects to be winding down. So when we go against that, we, again, we confuse those cells in our body. And I think it's important to say that the confusion, the cellular confusion, is the basis of aging and disease to be clear. Right. Right. So we want to create as much synchronicity, as much beautiful communication internally as possible.

And a big piece of that puzzle is maintaining this synchrony with the natural light, dark cycle. Okay. So time period eating and then sleep wake timing. So sleep wake consistency or sleep break regularity. Yeah. Another, you know, well known in trainer, right? And so when we have really high, like lots of variability in our sleepway consistency. And what she means is like going to bed at a certain time, waking up at a certain time and being as consistent as possible.

Exactly. Yeah. Yeah. So we want to try to maintain sleep consistency as much as we can. And I think one of the things that's important about sleep consistency and Andrea, your amazing sleep scientist, you know, touched on in her episode. But I want to double down on it. Sure.

Because I think we talk about the lead up to bed, right? And we talk about hygiene, both very important. And Andrea covered that beautifully, right? So we want to make sure that we're winding down. We want to make sure that we leave a nice two to three hour buffer between our last calorie when we intend to sleep, cold, dark, quiet, very important. But sleep consistency, and I see this in the data, okay, the path to sleep consistency actually starts the moment you wake up.

Okay. If I were to tell women to stabilize one thing, it would be sleep awake timing, sleep awake consistency. Really? Yes. Okay. And this is, again, being inside the data that I am, it bubbles up in every single piece of research as being predictive. And this was my PhD thesis with circadian alignment. Sleepway consistency is a proxy for circadian alignment,

predicted both physiological and psychological resilience in humans. Okay. This is the... What does that look like? But it's not easy, exactly. So when we look at... If I'm going to maximize my circadian rhythm and stop waking up at 3 in the morning, you know, without hot flight, like take a minute upon, I'm 25.

Yes. And so for my best chance to have the absolute recovery during sleep, nutrition, what does that look like? Yep. Time restricted eating. We want to eat. eat a bulk of our calories during the daylight hours and give ourselves a nice big buffer. At least a three-hour window. I think it's from last-neil to three-hour window to your head on the pillow.

Yep. If women find themselves really hungry or maybe didn't get the calories that they needed during the day and gosh, they're hungry before sleep, a yogurt, 130-calorie yogurt is going to be just fine. Right. So I wouldn't stress about that. It's what we don't want to be eating is like three donuts and, you know, a cup of coffee or something, right? Like, that's not good.

So time-rich-e eating is one way to help. And I saw this in a study that I published called Core 4, published last May, I basically ran this challenge where I looked at these kind of four core circadian behaviors. And I just wanted to see if people engaged in these behaviors, what would happen to these metrics? And these circadian behaviors actually stabilize sleepway consistency. And one of those behaviors that stabilized sleep with sleep with consistency was time restricted eating. Okay. That also actually had a direct effect on cardiorespiratory fitness. So cardiorespiratory fitness improved, but it was mediated through sleepway consistency.

So basically engaging in these circadian behaviors, people stabilize their sleepway consistency, which then improved markers of cardiovascular fitness, which is so cool. All right. But yeah, time is you eating. All right. Now movement. When does she be doing her exercise? I'm going to do what, okay.

Let me talk about light first because this is really, so then we'll go to movement. In this challenge that we were able to publish, light behavior was the. second. So I encouraged that big bolus of morning light. So I gave them a little protocol, very simple. And they just reported whether they did. What was the protocol quickly? It's just basically 20 minutes of morning light. Okay. Go outside. Go outside. Is the window okay? No, the window actually cuts down a lot of that photon energy. So you want to get outside. All right. It's raining. It's cloudy. Go outside. And even uncloudy skies, it's not going to have the same lux, that same intensity of light. but it still is going to tell your system that it's daytime and it's going to tell it what it needs to do.

Okay. So there's nothing more powerful than the sky in terms of entraining our circadian system. Do we have substitutes for that? Like can I go buy like what you put in the lizards cage or whatever, the UV? I have, yeah, I have a circadian lamp. So Amazon, I think I get it for 30 bucks or whatever. Amazon sells these and definitely the winter. I use kind of a sad lamp, seasonal affect disorder lamp.

So, you know, I have that on my desk. And so, yeah, I'm trying to, again, preserve the amplitude, create as much contrast between my day and my night. So yeah, I really try to bathe myself in light throughout the day. But specifically in the morning prior to 10 a.m., that light is particularly impactful on our circadian system. After that, there's less of a circadian impact. Red light therapy does not, that light does not change. It's neutral, right? It's not bad. but it's not going to shift your circadian rhythm. Got it. And that's why it can be useful at night and actually kind of make you a little lethargic, which is good for sleep. So I do red light at night, but that won't help you in the morning, I guess, as well. Okay. So, but some of these other lights that have these really super heavy blue rich light can help wake up the system

and be a good, you know, fail safe if you can't get outside in the way that you want to. Okay. But that morning pulse of light is just, I can't underscore it enough, is so, so critical to basically, because basically that tells your system 12, 14 hours later, it's time to produce melatonin. Yeah. Right. So all of this is just orchestrated super, super tightly. And these cues are basically telling the system when to do what it needs to do.

So we just want to be mindful, you know, of ensuring that we're building in these behaviors intentionally so we can create this really high amplitude during the day. Okay. Third. Okay. And then movement. Okay. And I think just the other thing.

in our study, we tested zone two, which doesn't sound like a circadian behavior, but my, I, the thesis was, based on all the other data that I've seen, zone two is highly recovery promoting. What is zone two for our listeners who don't know? Yeah, so zone two is basically, the best way to do it, the simplest way, if you don't have any technology or whatever, is just literally to walk briskly or for some people it's jogging briskly on a treadmill, oh, you can be on a bike, whatever, where you can comfortably talk. So if you're with a girlfriend, you're just kind of talking,

it's not like perfectly comfortable, but it's, you could talk easily. It's a little bit of a struggle. Yeah, a little bit of a struggle. Yeah, zone, it's basically a heart rate, basically. Yeah, it's basically a heart rate zone. So, you know, 60% of your max heart rate

is usually kind of in that zone two threshold. And what we see in the data is that when we control for all these other recovery detractors and sleep detractors, okay, like alcohol and irregular sleepway consistency, all of that, we see that zone two actually helps you with markers of recovery. So you will have a better chance of maximizing your recovery and potential for sleep when you engage in zone two. Okay. Think how much,

how long? Yeah. So really 30 minutes to an hour in this kind of zone two seems to be really protective for recovery or really help facilitate recovery. And I think that's where a lot of the conversations out there about zone two. I get a little frustrated because I'm gosh, I see the data and I'm like, wow, for men and women across the entire lifespan, zone two is so recovery supportive and sleep enhancing. So, and that's what we saw in terms of movement, that zone two helped stabilize sleepway consistency, which then again, improved cardiorespiratory fitness. So I love zone two. Obviously, we need to be training at intensity a couple times a week. We need to be strength training. I'm not saying we're not, we should be doing those things. But zone two is really.

recovery enhancing. And in my book, I kind of put it more in the recovery bucket than I do the training bucket because of just what I've observed in the data. I like thinking of it that way. This is going to enhance recovery and sleep. This is not, you know, I'm not training my heart to like grow old. I'm not training my muscles and bones to be strong. No. I am literally recovering. Yes. So. Yeah. With zone two. Yeah. And you just, you know, get your podcast on, whatever it is, you know, go with your girlfriends, like your partner, like whatever it is. I think it's just a different way of thinking about moving your body, right? And then side benefit, it helps with your sleepway consistency, right?

Okay. Kind of this idea that how do we back into a stable sleep wake time, zone two promotes it? And then breathwork was the fourth one, yeah. I've learned how to do that finally, but walk our listeners through. I know. I did it last night when I woke up. Oh, my God, I love it. It puts me right back down.

And I will say you mentioned in your podcast with Andrea that you suffered trauma as a child. Yeah, same. I know, I know. And I think it's, I think for trauma survivors, regaining control of the autonomic nervous system, I devote a whole chapter on this in my book because it can keep you from living a life of joy and energy and it can keep you from sleeping. And one of a beautiful path to regaining control of your autonomic nervous system is through the breath. And I think a path to sleep is learning how to breathe, which I also talk about in my book. You know, really, understanding how to breathe properly, how to breathe through the nose, and putting resources into that, I think, is really important. So, so walk, how do you practice this? So I do a couple different types of breathing techniques. I do tumo, which is super oxygenated breathing. Never heard of it. Okay. Yeah. And then I do a physiological sigh. So I kind of toggle between these two. Physiological sigh I engage in during the day, just a few times. I do it without thinking. Well, that's good. Yeah. I mean, that's,

It's a natural reflex. Why are you huffing? I'm like, it just happens. I'm like, I just call it this autonomic cleansing breath. I cannot help it. Oh, I love that. And I just, I cleansed breath all day. I used to sit in a small office with Jesse, if you're listening.

I love you. A nurse I worked with, you know, for years in clinic. And we became incommonant deep breathers, you know. And she's like, are you okay? I'm like, I'm fine. I'm just taking my cleansing breath. And then she would start doing it. I love that.

Yeah, it's so good. And I didn't know I was doing it. you know. And we definitely know there's a really a great study published in 2023 at a Stanford that looked at the physiological sigh against some other breathing modalities and meditation as well. Sorry, mindfulness meditation. So there are four different modalities. And the physiological sigh emerged as the most efficacious and reducing anxiety, not just in the moment, but five hours after the session. Wow. And it was just a five minute. And this is the protocol that we put in the study is just a five minute slow-paced breathing, which is a little different than the

physiological side, but just this idea of a longer, more extended exhale was really as simple as we said. So just breathe through their nose and you can breathe out through your nose or your mouth and just prioritize a longer exhale than inhale. That was kind of it. It was very simple and just try to do it for five minutes a day. And the people who engaged in this modality, again, saw improved sleepway consistency. So it's one of those things where, you know, a big bulk of my background is in psychology, not in the clinical side, but just a lot of the theory and applied side of sports psychology and psychology. And, you know, there's no question that this negative stress accumulation that can happen over the course of the day is going to rear its head when we try to fall asleep

at night. We all know this, but yet we run ragged throughout the day. And we don't take these minute moments of rest. And you're taking them naturally. You've built in that muscle almost, right? Or almost just by, like, I find like I have to or I'm just going to explode, right? Like I find like I have to breathe, right? But I think for a lot of folks, it's just before attaching it to or, you know, something else that you do, like maybe lunch or breakfast. Like I always try to like breathe before and after just even a few times. You know, I'll just do some so place breathing. And it's definitely a part of when I lay in bed every night, I take one, two really big inhales, long exhale. And then I shut my mouth. I breathe in my nose. And I picture myself in a field.

holding the hand of someone I love, whether it's one of my kids, my partner, and I just feel the sunshine. I'm in a field. I'm joyful. I'm at peace. I breathe through my nose. And then before I know what I'm asleep, you're out. And that has just been my routine for just like coming to center, telling my body,

I'm safe. It's okay to sleep. And I think sometimes, like we feel like we don't deserve it almost, you know? and creating these little routines, I don't know, for me, like, makes me, I'm like, I deserve it. You know, like, I deserve this piece. Mm-hmm. You know, I deserve this beautiful, consolidated rest. A little off topic, but it just bubbled up in my head, so I can't push it back down.

What about the position we sleep in? Oh, interesting. I am a stomach sleeper. Oh, yeah. And side sleeper. Okay. It's very hard for me to sleep on my back, I think, because I feel vulnerable, because I was, I had so much sexual trauma. And I can't sleep without underwear.

on, you know, because I don't feel safe. And it took me years to figure that out. Like, you know, like after intimacy, I will go put my underwear back on because it's hard for me to sleep. And I'm like, why would this be? I'm totally safe in my house. You know, whatever, my husband is next to me. I know. And that's the only thing that makes sense to me. Like, is the position important? Is it means something? It is. It's communicating to your nervous system. Trauma is an injury to the nervous system. It an embeds. It an embed. every fiber in cell in your body. Wow.

So, okay. Yeah. So we have a paper that's in review right now that looked at individuals who say they have sleep anxiety. We looked at all the different modalities that they tried. And this is a huge sample size. So they're doing all sorts of different types of things like melatonin and a weighted blanket. Weighted blanket for people with sleep anxiety.

And again, trauma, sleep anxiety, highly, highly linked, right, associated. Weighted blanket was the number one. modality. I don't know if you've ever tried that. My daughter has one and she swears by it. Wow. Yeah. I mean, people who have suffered trauma really love the weighted blanket. I don't know if you've ever tried it. I haven't tried it yet. I mean, I always sleep with a blanket. Yeah. She does not enough. I need. The weighted might allow you, if you want to try to sleep on your back, that might help you feel more cocooned and safer. Interesting. Let's talk about makeup for a second. Have you noticed that what worked for your skin, five or ten?

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visit today at join midi.com. That's join midI.com. You know, as a former shift worker. So I was OBGYN. I was delivering babies. I loved that part of my job. Yeah. Like talk about the most, one of the most beautiful moments to be present with people, you know, at this incredible. And then you get this present and then you get to hand the present to the parents, you know, and their loved one. Oh my God. But Jesus God, can they just come between eight and five? I know. I know. It's not going to happen. I was rapidly losing my resilience in my 40s. Now I know it was perimenopause. I did fine. I could compensate. Like I was, you know, doing it, no problem. I signed up for this. This was my job. You know, I did this on purpose. And I'm not a napper. So I have napped, but I cannot nap on command. And my husband can sleep anyway. I know. Every movie, every plane, I was realizing I was playing games with sleep. I was like negotiating my sleep with myself over all of this call and being up late at night and just not being. So my 50th birthday present to myself was to give up that part of my medical practice. Because I knew I was shaving years off of my life. I didn't know the data. I didn't know the science. I didn't know the research. But I knew I cannot continue like this because I am not a human that is going to be able to stay married or be the mom that I need to be, you know, and negotiate this life that I built if I keep doing. When I read the data around shift workers,

I was shocked. Cercadian misalignment. So let's talk about that. Yeah. So when you are operating outside the natural light, dark cycle, one of the consequences of shift work is you end up with really misaligned circadian rhythms. And this is kind of everything that we're talking about, right? We're trying to get back to a place where we're engaging in behaviors that align our circadian rhythms, right? Well, shift workers don't have that luxury, right? It's, almost like I feel like we owe it to the shift workers to do everything that we can to like be as robust for society so we can help them through it right but yeah so circadian misalignment when we look at the shift work data I've done a lot of research with frontline health care physicians published a paper in annals of surgery in 2023 with doctors Mitch Cohen and and Jamie Coleman both acute care surgeons 27 different centers across the country 270 acute care surgeons we observed them over the course of a year lots of really good demographic information. We did burnout questions. We knew when they lost patients, when they didn't lose patients. We knew exactly what their shift work looked like. The mean

age in the study was 43. Every single one of these surgeons had at least 10 years of on call, where they were on call at least two times per month. Okay, on average, some more. The resting physiology looks like that of a 60-year-old. 17 years older. And we know that shift. shift workers have a reduced lifespan of 10 years. And it's because of this circadian misalignment operating outside the natural light dark cycle. It just comes at a cost, right? A lot of, you know, one of the things that I'm studying right now is, you know, are the things that we can do to mitigate the cost of shift work, right? Definitely exercise. We have to have shift workers. We have to, right? So trying to eat a bulk of the calories while you wake up, so during when it's actually so light. So if you

wake up at 3 p.m. for your shift or 4 p.m. 5 p.m. for your 7 p.m. shift. Try to try to get a really big, your densest meal in at that point. Okay. Right. Just my daughter's going into emergency medicine. Yes. So I'm like, Catherine, take notes. I know. I know. Really thinking intentionally about when you're eating a bulk of your calories. And then while you're on shift, prioritizing, you know, just you got to eat as healthy as humanly possible. That's, I think, a non-negotiable for a health care worker. It's a cross that they bear, unfortunately. But I think that's a non-negotiable. Exercise is a non-negotiable. And I think high intensity, exercise, you know, short, intense can go a long way. Strength training. You know, one of my dear

friends, she's very thin. You know, you look at her. You'd think she's really healthy. You know, called me up. She's like, I'm pre-diabetic. I'm like, I'm like, we're going to start lifting weights, you know, had never picked her weight before in her life. Was able to reverse her pre-diabetic state within in two months of strength training. Started taking creatine, you know, still obviously on call and having to navigate that, but that went a long way.

And she literally reversed her pre-diabetic condition in two months of starting a strength training and just being more mindful of when she's eating. So that gives me hope. And we have to do some, you know, interventional, you know, randomized control trial study to really try to isolate these effects.

But given what I know of the literature, I know that that can get shift workers on a better path really quickly. Uh-huh. So light, Let's go back to light. I think you've said this, and if I'm misquoting, let me know. It's the most underestimated drug in the world. Yeah, it's so powerful. And if we think about perimenopause and menopause. And, you know, one of the things that we see in the data is this

idea of amplitude. And again, if we're going back to this principle of getting as much light during the day and getting as much darkness at night, you will increase the amplitude of heart rate, of respiratory. Every metric that we know that has a circadian rhythm is going to improve just by creating more contrast, activity, rest, light, darkness, you know, eating during the active phase of circadian rhythm, not eating during the inactive phase or estrogen rhythm. If we can just start to apply these principles, we will increase our heart rate amplitude. When we increase our heart rate amplitude, which is the magnitude of change over the course of the day, and we look at Mezzar, which is the average heart rate, okay, when we look at these two things, which help us understand

amplitude, higher amplitude, lower severity of symptom, of perimenopausal symptoms. Mm-hmm. Okay. So this idea of preserving amplitude through circadian practices, is one way, based on the data that we have, it's one way to mitigate the severity and frequency of symptoms in perimenopause. I believe it. Yeah. So we have not published these data yet, but these are kind of hot off the press. But I want to share them.

And people can judge that if they want to. But we will put these through review. We will let the audience peer review. You can talk all you want. Okay. Thank you. I appreciate it. But we're really excited about these data because I think it gives hope, right?

It's not, it doesn't mean that you don't need hormone replacement therapy. It does not mean that you don't need these other therapeutic strategies. Right. I talk about tools in the toolkit. Totally. This is circadian alignment is a really important foundational element to human health and functioning. And when we look at shift workers and we know that they were reduced health span of 10 years. Yeah.

We see very clearly this experiment is not working for human beings because we have not adapted to blue rich light after the sun goes down. we have not adapted to access to food 24-7. We haven't adapted to parting until 3 o'clock at night, right? We haven't adapted to this modern life. Right. So we need to be smart on average about adopting these percircuating practices. It doesn't mean about missing out and being perfect, right? But it's just like being more intentional, right?

Knowing that misalignment comes at a huge cost. There's an increased risk for cardiometabolic disease. Misalignment leads to an increased risk in cardiovascular. not to mention mental health disorders. There is not a mental health disorder that exists that doesn't have some sort of circadian disruption element to it. So when we zoom out and we look at, you know, what is the foundation of human health and functioning? Circadian alignment is a big piece of this puzzle. Okay. You sent me a graph. Yep. And here's what I love. I love so many things about this graph. And we are going to show the graph on video, but we'll have it in the show notes.

but this is a graph looking at the percent of women reporting sleep problems. And instead of age, the axis is time around the final menstrual period. So like this, you're like singing music into my ear. So we're looking at the center of the graph being menopause, and then right before it is perimenopause, and then we have postmenopause. So percentage of women with any sleep problem averages 25 to 30% in premenopause. Okay. By the time we're like T minus three years before you're fully menopausal, so you are full on perimenopausal. Yeah. That number is going to climb dramatically. It's like one and four. Cross the transition. Yeah. And then it is going to stabilize at the 45% range and it doesn't go down.

You have a new baseline. So that. that is where I'm meeting people in my clinic. So I'm taking care of perimenopause all the way through 60s 70s. And the girls are not sleeping. I know. And what I will say and what these data show is that it's happening four years to perimenopause. The four years prior to your first reported symptom, your sleep is getting worse. Well, medically, we still define perimenopause symptoms as a fucking hot flash. Okay. I know. So, but like my patients are having sleep issues well before that. They're having mental health changes well before that.

They're having brain fog well before that. To me, that is where in my new book, that's where perimenopause begins in the brain. Sleep disruption, mental health changes and brain fog, you know, cognitive decline and cognitive struggle. Yes. And so it's unbelievable. And like seeing it like, yes, this is what I'm seeing in clinic. I know. I know.

And this is what we see in the data. And so what frustrates me is I just. saw like some quotes from, I think, Wall Street Journal or something. And they interviewed people who've been kind of in the menopause space in academics for a long time. And they're, they seem to be very biased to me, where they're like, no, no, no, any sleep disruptions is simply a hot flash. If we, you know, put her on VOS and get rid of that, she should sleep fine. Well, she's not. Yeah. She's not. The data is clear. Yeah. You know, I have, I'm great at controlling hot flashes with medications. My patients are still struggling with sleep. Yeah. Why? I mean,

I think a big piece of it is this decline in amplitude. Lower amplitude affects your entire profile. And and so preserving amplitude from what I understand of the literature is a path to preserving sleep. So why don't doctors understand this? Because half of them will give this patient who is absolutely struggling. Yeah. Ambien or another sedative. Yeah. A benzodiazepine. Progesterone and estrogen is the path here. What's wrong with giving them a sedative? So a sedative is going to impact the depth of your sleep.

Just because you're passed out doesn't mean you're actually getting into deeper stages of sleep. And those data are very, very clear. Well, let's talk about that. Yeah. Because a lot of our listeners, if they haven't listened to the Matsumora-Andreya's episode, don't understand about sleep architecture. Yeah. You know, we spend a lot of time.

The internet is rife with how many hours, how many hours, how many hours are you sleeping? And not very many people are talking about the quality of your sleep. So for the listener who doesn't understand sleep architecture, what are sleep stages? Why are they important? Yes. How much time should we be spending in each of them? Great questions. And just as a reminder, one of the drivers of sleep quality is sleep consistency.

Okay. So if we back out, we look at, okay, what are the four pillars of sleep? We've got sleep sufficiency. So time in bed. And how much time you're spending in bed matters, right? Because you've got to run through the sleep cycle. So, you know, everyone is different. And that's what is important.

Not huge variability, right? In the same way that we don't have huge variability in chronotypes. We don't have huge variability in sleep need. Now, there's obviously people on the extremes for both of those. But generally speaking, it's somewhere around seven to nine hours. That said, you can be sleeping less than seven hours, but getting really high quality sleep. Right. And in the absence of sleep debt, some folks only need six hours and four, two minutes of sleep or seven hours and five minutes of sleep, right? If they're getting really high quality of sleep. So I think it's figuring out, okay, what do you need to live your values with joy and energy, right? Like that's what we're trying to figure out here. And we know that stable sleep wake time is going to help drive quality of sleep. And then the timing of sleep matters too. We know that you. Folks who are going to bed after midnight, for example, are going to wake up with a higher fasting, higher fasting glucose levels than people who go to bed prior to midnight.

So there's something about the timing of sleep that matters. We know when we look at folks who have access to no access to artificial light, fall asleep three and a half hours after the sun goes down. And if you've got a group of people on a mountain, this experiment has been done. Evening people, morning people, they all fall asleep within 30 minutes of each other. So we know that, you know, somewhere around 10, 9, 30, 10 p.m. is probably the sweet spot for sleep for most humans. So timing does matter. Consistency, sufficiency, and then quality. So when we look at stages of sleep, you've got basically four stages of sleep. Your kind of first two stages of sleep are generally light stages of sleep where your body's kind of preparing for these deeper stages of sleep. And then you drop into slow sleep. And this is where a lot of the physical restoration happens. This is where you release a bolus of the human growth hormone. And again, again, Again, this is where timing, I think, really matters, right? If you bypass your natural pressure for sleep by staying up and watching more Netflix shows or doing whatever it is that you do, when you bypass that natural pressure for sleep, you will end up releasing less, definitely

less melatonin likely, because you basically bypassed it, right? You bypass that bolus of melatonin, and now it's starting to decline because you're up and engaging in life and potentially viewing light and all of those things. And then also you compromise that third stage of sleep, which is that deep stage of sleep. So if you're not dropping into that deeper stage of sleep, then you're obviously not going to wake up as refreshed, right? And then that four stage is the REM, this is the dreaming. And you basically want to cycle through this, you know, every cycle takes about 90 minutes and you want to cycle, you know, four times-ish, you know, through these various cycles of sleep. I get the bulk of my deep sleep in the first third of my night.

Yep. Is that normal? Yeah. Yeah. Yeah. That's normal, yeah. And I'm cycling, but it's like, boom, boom, boom, boom, and then I stay in the upper. Upper ranges for the back half for most of it, yeah. Yeah, that's normal. That's normal. And are you waking up feeling refreshed? Most of the time. Okay, great. And I think that's like the danger of sleep trackers, I think, is that sometimes we're like, wait, is this, you know, and that's where it can be helpful, but also maybe harmful if we're like. Well, I have a wearable and a shareable. Wait, nearable and a wearable. So have a mattress. Oh, and I have a ring. and I just pick whichever one tells me I slept the best. Perfect.

Perfect. Yeah. There's a little bit of a placebo going on there for sure. But no, I mean, I think really, before you look at your tracker, like let that, you know, when we wake up, we have that moment of, you know, maybe we wake up in a deeper stage of sleep. We maybe feel a little groggy, right? That's totally normal. Let yourself kind of take a, I have a huge glass of water. This is when I have my creatine and some of my other little, whatever, I take my huge glass of water.

And then I'm like, how do I feel? And then I kind of go on my day and then I'll look at my data a little later maybe, but I definitely try not to obsess over it. And I really try to go out how I feel. And I think that's important, you know, for most folks. So if you're feeling refreshed and you don't feel sleepy throughout the day, you don't have to hack your way through the day with stimulants, you're probably getting enough sleep. And that's you put a pin in it and you're like, all right, what did I do? And you try to replicate that as much as possible. I think one of the ways to kind of create that rhythm is definitely to set a time in the morning that you can wake up reliably. And I think for us, we travel a lot so it can be hard, right?

But on average, you want to, you know, for me, it's around 6.30 a.m. Like I try to, I always set my alarm. Sometimes I wake up a little bit before. Sometimes I want to sleep a little later. But generally speaking, I'm going to wake up at 6.30 a.m. regardless. Get my big bullets of light, have my big glass of water, you know, kind of shake off, whatever, and then I go about my day. But that allows, again, me to set my circadian rhythm and then reliably release melatonin at the same time every single night. So that is, again, how you back into that sleep consistency, which is then going to allow you to drop into those deeper, more restorative stages of sleep. You minimize the chances of that 3 a.m. wake up, right? Right. Because, again, amplitude, amplitude, right, is going to prevent that 3 a.m.

wake up. Why is the 3 am wake up happening? And it's a lack of amplitude. Such a common complaint. Now, it's a lack of contrast. My patients are feeling like they did something wrong or something's wrong with them. No one is purposely trying to sabotage their sleep, right? No one's purposely trying to sabotage their health, generally speaking, right? But I think women don't know the power of these circadian practices in setting your circadian rhythm. It's because when you don't set your circadian rhythm, you have a flat, you don't, you have a flat, there's no amplitude, right? It's flat, right? And we know if you were to look at, and we can share, this is one of the studies that I share with you, that circadian bundle study in the ICU patients. If you look at their melatonin and cortisol, it's basically like this,

you know, like, right? If you look at a healthy, robust human, it's this. Yeah. Right. So amplitude matters. Low amplitude is predictive of, this is what we see in the data. Women who have low amplitude have more severe and more frequent reported. And again, for our listeners, she's talking about amplitude being light dark, fed, not fed, exactly. Work out, not workout. Yeah. It's not hacking all of the energy, the activity, the stuff, dayline hours. To be clear. Again, as I said in the outset, these are free behaviors, right? And generally democratically available to all of us who are not shift workers. You know, obviously there's some complications when we have, you know, partners who are, you know, want to go to bed late and we have teenagers. I have two

teenagers, right? Like, so I understand that there are aspects of her life that make it more challenging, but that's where we just have to ramp up the communication. That's what I tell patients you have to triple down. You've got to triple down. You just have to talk to just be like, hey, listen, I want to be available for you and all the things that I love during the day. And this means I have, I have to do X, Y, and Z, you know. Let's talk about the curve again. Does the curve look like this for men? Yes. This is all humans. Well, I mean is seeing this acceleration. So women are going to have lower amplitude because of the hormonal changes. Okay. Yes. So menopause is that, you know, clearly here when you look at the timing of menopause and not just age, because we all go through

menopause at different ages. Menopause is associated with lower amplitude. So, okay. Done, done, done. Yeah. Does this curve look better if the woman is on estrogen plus or minus a progestogen. Yes. Okay. How powerful is progesterone here? Well, I think progesterone is particularly powerful because it puts on the break. So I think what happens with regard to the 3am wakeups is when you have low progesterone, the GABA signal is muted. Very, very important to make sure that that signaling is happening. right and that's one of the reason is that GABA that GABA signal starts to increase basically and when it shouldn't be and that's what's facilitating that 3M wake up so when you get your

levels correct I don't know if I can say back into balance that's that's not the right terminology but what would we say what's the best way to characterize well you just get these hormones the estradiol and the progesterone no longer exist you know they go right we go into a zone of chaos Right, right. Progesterone really lags in pedimentopause. Estrogen goes crazy. Right, right. It's up and down.

Up and down. It's very unpredictable. And progesterone is always just struggling to kind of keep up. So for like if I had a patient who came in and her number one symptom was sleep disruption and she was still having monthly predictable periods, I would start her on progesterone. Okay. Especially just progesterone. Starting with progesterone. Now, if it was mental health and brain fog, I would add in estrogen on the front end.

And so quite often those three things are. I have a rare patient who's just having sleep disruption without the other mental, you know, without the other brain changes. But occasionally I'll start a patient on just progesterone. And that really helps her sleep. Yeah. When a woman, when she becomes more stable hormonally and is getting treated in a way where she's able to restore sleep and is able to create more of this contrast, right? And is thinking about that intentionally, amplitude should improve. Right? Amplitude, of course, being a proxy for just general health and well-being, reduce risk of neurogenital disease, reduce risk of mental health disease, reduce risk of cardiomelibal disease, reduce that risk of heartibascular, right? So it stands to reason. And I will be able to do this research because I have health history questionnaire data that has every single permutation of hormone therapy a woman has ever been on. Of course, they're a lot. I know, I know, I know, Dr. Haver, I can't wait. And what I'm going to do is look at this amplitude, how amplitude changes over the course of, you know, a woman's life, what that looks

like with the physiology and, you know, how things help and hurt. And, you know, we'll be able to say something quite, I think, definitive and exciting that will, I think, give empower women. But I will say that this amplitude piece is huge. Women need to be taking control of these circadian practices in parallel to all the other stuff that they're doing so they can can preserve their sleep, right? Because we know that that, this is obviously the biggest complaint. And when your sleep is off, it just, everything goes south, right? We know that, right? And this is what you see in your clinic. The risk factors for chronic disease skyrocket. Right. And it's a circadian sleep thing that's happening. Unbelievable. I was surprised to read this, but it makes sense

now after talking to you that 100% of mental health conditions involves some level of circadian disruption. And in some cases, it's not correlation. It's, it's, it's, it's, it's, it's causing it. Yeah. The only evidence that we have that it's causal is in mood disorders. Okay. Yeah. And there's a good paper that it might be a review and mood disorders bubbled up as as being causal. Circadian misalignment causes mood disorders. And yeah, and I think it's it's the it's the dopamine, I think, system that's really impacted. How we seek reward during the day changes when our sleep wake timing is highly variable. So, you know, we call this social jet lag. And we know individuals who have social jet lag are more vulnerable to all sorts of mental health issues and conditions.

Wow. Okay. Dr. Holmes's new book, Aligned. The Data Driven Guide to Performance, Recovery, and Human Potential is available now wherever you buy your books. You can also find her on Instagram at Dr. Kristen Holmes and on LinkedIn at Dr. Kristen Holmes, PhD. I would love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at thepawslife.com. My new book, The New Perimenopause, is available now everywhere you buy books and through our website.

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