unPAUSED with Dr. Mary Claire Haver - Menopause Sleep Reset: A Recovery Plan You Can Start Tonight with Dr. Kristen Holmes

Episode Date: August 14, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Kristen Holmes, Vice President of Performance Science at Whoop and author of the new book Aligned, moving from the science of circadian rhythm into a practical recovery plan a woman can start using tonight.Dr. Holmes lays out a realistic strength and cardio prescription for women who only have thirty minutes a day, and explains how sleep governs the release of growth hormone and the capacity to build and preserve muscle as we age. She introduces the idea of alignment over willpower, framing consistent habits as infrastructure built around what someone actually values rather than a matter of discipline, and connects that back to the four core psychological needs, purpose, autonomy, self efficacy, and connection, that predict anxiety and sleep quality.The conversation turns to wearables, including what to look for in a tracker, the pitfalls of obsessing over data, and simple, no cost markers like a regular menstrual cycle, resting heart rate, energy, and mood that anyone can track without one. Dr. Holmes and Dr. Haver also cover how alcohol and marijuana affect sleep architecture, when a sedative can help short term versus when it becomes a long term problem, and which supplements, like magnesium, actually have data behind them for sleep and anxiety.The episode closes with a rapid fire round on melatonin, mouth taping, cold plunging, weighted blankets, red light therapy, chronotypes, and napping, followed by the two changes Dr. Holmes would tell a woman to make first if she wants better sleep and recovery starting tonight.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

There is so much science around setting your circadian rhythm and the cascade effect that that has across every cell in your body. It will impact circadian patterned, things like insulin, for example. So you get your circadian rhythms align. You start eating during the daylight. Your insulin starts working like more effectively, right? More appropriately. Now of a sudden you have less inflammation. You start sleeping a little bit better.

So maybe it means like 10 more minutes in deeper stages of sleep, eight more minutes in deeper stages of sleep. that will have a compound effect. So it's just understanding that, you know, all these little behaviors, maybe it's, you're getting two more minutes of deep sleep here, three more minutes here. Now of a sudden, you've got 20 more minutes of deep sleep. It's going to have an incredible impact, right? You know, now maybe you're doing 15 minutes of like brisk walking and with some weights, you know, and that maybe you get two more minutes from that, right?

So while some of these little behaviors maybe elicit a small effect, but when you add them up, you add them up. They really start to compound. And this is where you start to feel less under threat. And your body and not just in your mind, you got to kind of talk yourself into a better future for a little bit, but your body actually starts to change. 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. In part one of my conversation with Dr. Kristen Holmes, Vice President of Performance Science at Woop, we talked about something I wish I'd understood much earlier in my career.

Good sleep is more than just getting eight hours. It's about timing, regularity, light exposure, circadian alignment, and what all of those things are doing to nearly every system in your body. Kristen has spent years studying what physiological data can tell us about human performance, and health. And in this episode, we go even deeper as she shares research showing that for every 45 minutes of sleep debt, executive function can drop 5 to 10% the next day. And when the leaders slept poorly, the people who work for them actually reported feeling less psychologically safe. How you sleep can change how you think, how you work, and how you show up for the people you love.

We also get practical about what women can do with this information. We talk about maintaining muscle as we age, what Kristen would prioritize if you only have 30 minutes a day to exercise, and why movement, meal timing, and morning light can have a powerful cumulative effect. We'll talk about wearables, alcohol, marijuana, magnesium, melatonin, naps, caffeine, weighted blankets, cold plunges, and even sleeping separately from your partner. We discuss why women need infrastructure, not willpower, to take care of themselves, and what it means to build a life that supports the woman you want to be decades from now. Because the goal is to have energy, strength, and health to keep showing up for the life and the people you care about for as long as possible. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner and adjunct professor of obstinate. and gynecology 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.

You've said that for every 45 minutes of sleep debt, there's a 5 to 10 percent decline in executive function the next day. Yeah. Talk about that. Okay. Yeah. So this is with a study we did McKinsey. We had 79 individuals, half women, and, you know, the other half of men. So these are really hard charging folks. And

we looked at basically just their sleep over the course of six months. And three times of week, they were kind of getting a struper and end back. So we were able to measure, objectively measure their executive function. And we saw with every 45 minutes of sleep debt, they had a five to

10 percent decrease in executive function next day. So 45 minutes seemed to be the sweet spot. We actually built in this study. So in the second year, we added psychological safety measures and wonderful scientists out of Harvard, Dr. Amy Edmondson. We used her measures, and she actually joined us on this study. And so what we did in this study is actually we looked at the direct reports. And what we saw is that the psychological safety of the direct reports was associated with the quality of sleep of the of the boss, essentially. So the more 45 minutes seem to be the sweet spot, but for every 45

minutes, the less psychologically safe, their direct reports felt. It's interesting. So basically, a direct report, like, you're reporting to your boss. So if your boss slept well, you had a better, you felt more safe. I know, which is not, and what I love about this study is that you can think about how that transfers just to like the regular, just how you're operating in the world, right? Like if you're at CVS, right? And you're sleep dead or gosh, you come home to your kids. Oh, God. I can't. After a full day of work? I was when I was working in chronic sleep debt, I was a terrible mother. They, they deserve better. I've apologized. I've found a new way to make money and, you know, support them financially. Yeah. And it's worked out better. But

what I don't want is our shift workers and people still in those positions to feel like this is hopeless. I know. It's not hopeless. And we are doing. But I have to say, I knew none of this. So I wasn't doing all the things to protect my sleep. You weren't working out as much. Yeah. And I didn't understand the importance of exercise to my sleep. Literally, I was 120 pounds, so I was fine. Yeah. Like my whole vision of what medicine taught me healthy was was my shape, my size. And so like I'm healthy. You're skinny, so I'm good. Yeah. I'm good. And I had no idea. I was chipping away at my bone muscle, cardiovascular, furial tube risk, damage, risk. Yeah. And relationships. Yeah. And relationships. So. Yeah, we need to protect our biological sleep. And I think a lot of it starts again before we even enter, you know, before we even have that first symptom of perimenopause, right? We need to really, I think, you know, I have a daughter. I know you have daughters as well. My daughter's 17. And, you know, we are, I'm actively talking about sleep with my kids, you know, just I'm like, hey, it's like you, it's sleep is kind of a, in modern life, unfortunately, it's a skill. It doesn't just happen for us. We get pulled from these primal thresholds of nature. Oh my gosh. Okay, wait. I love.

Love you. Let's go back. Good sleep is a skill. It is, unfortunately. I would love to be able to say, oh, yeah, we'll just sleep. But access to food, access to light, like we just 24-7, it's modern life is literally sets as well to fail. It does, but I never, my patients feel like they're doing something wrong. No. They don't realize that the worlds that we build. We haven't adapted to. They do. They do. They do. And we have to. be just intentional and fight against, fight back against that. And it gets much harder in perimenopause. It's so much hard because everything else is collapsing around us. It's like this one more thing, right? So building some of that, those habits before you get to perimenopause is very, very protective. And the other thing that we see in data is that, you know, and this, you know, this is kind of hard to say. But this is very clear in the data. Higher fit individuals have better amplitude.

lower reported symptoms of paramedopause and menopause. I mean, yeah. Lower. You've known that for a long time. Okay, yeah, yeah. Lower fit. Not to say that if you, I have triathletes who are absolutely hung upside down with paramedopause.

So, but in general, the more fit you are, the less overall symptomatic you are. And I will say there is a overtraining element, too, that will have, you know, you can be, you know, I haven't say two fit, but you can be training in such a way where you're putting incredible stress in the system, a system that is already stressed during paramedopause. So I think, you know, not that we have to stop doing triathlons, but you can probably get away with training less potentially, right, and have almost better performance outcomes, right? Thinking more intentionally about recovery and preserving sleep and thinking about the circadian piece.

It's complicated, right? Unfortunately, modern life has made this really complicated. And this is why your book, and I can't wait for my daughter to read it, you know, she's obviously only 17, but I'm like, you need this, you need to have this. your brain to understand how to think about your choices, right? Because because these cumulative lifestyle exposure is going to impact, I think, the severity of how you move through this, this transition. And I, you know, I'm about five to seven years away from having that data to be able to, like, be able to say that definitively. Right. But I think how you live in your 20s

matters for this next phase of your life. Talk about growth hormone and timing of sleep. and muscle, and we see age-related muscle loss. So if a woman is not purposefully doing things to preserve her muscle mass, the aging process, and we think adding menopause on top of it, you know, perimenopause and menopause does kind of accelerate this loss. Where does sleep play into all of this? Sleep impacts our capacity to train. Okay. There's just no question about it, right? So a lot of the, you know, the conversation online will just lift.

Well, you know what? I'm too damn tired. So I think that they're, because she's really mad right now. You know, I think it's obviously getting our sleep right and getting our behaviors during the day that are going to facilitate the best possible sleep where we're releasing, you know, all the things that are restorative that are happening during sleep, like the release of humor growth hormone, for example, and all the other genes that are turning on and off during the day, during the night.

We need to try to create conditions during the day that, that in let that, that enable that to happen. So that's kind of the first order of business. And then when you do that, you then have more capacity to train. You can train more intensely. You can train for longer, right? And you have the ability to then, you know, improve the quality of your muscle tissue. And I think there's, you know, there's a really important metabolic component to that, right? When we have poor muscle quality or we don't have enough muscle tissue that glucose just ends up going into the bloodstream, right? And that's when all the problems happen. So, you know, we want to preserve a muscle as much as possible. Again, you know, it's never too late, right? So if a woman had 30 minutes a day

that she could, you know, this is what my patients tell me, like, I've got 30 minutes, what should I be doing? Yep. I think a portion of that lift, so maybe lift for 20 minutes, try to hit, you know, three or four body parts. Does she have, can she do 30 minutes every day? Yeah. Okay, yeah. I do a combination of lifting and I would do some high intensity work. So I would do 30 seconds on, 30 seconds off five or six times, a minute on, minute off. If you're from- High intensity meaning like, so you want to go, yeah, 80 to 90 percent of your maximum heart rate. So you're really out of breath like you're really pushing yourself. You can do, you know, some days I'm like, you know, I just, I don't really feel like I'm not really feeling it. I do 15 seconds on,

45 seconds off times eight or something, you know, but I really try to three times a week get my heart rate up as high as I can go. So I would say prioritize that. We know that again, thinking about this principle of amplitude, that is a great way to increase that amplitude. And then obviously lifting weights for the other 25 minutes, right? And what I just described will take four or five minutes, right, to do that high intensity work four or five times. And then maybe on a day where, you know, maybe you do that three times a week and then another day you go for a really nice long zone too, right? And maybe that's, if your modality is a swim, it could be a swim for some people, it could be a bike, you know, it could even be on the rower, you know, whatever your medium is that you

really enjoy that you can consistently do, do it. But that would be my take, you know, don't overthink it. And I would say if you have resources, you know, it's great to get a trainer just to learn how to do the basics, right? And it doesn't, you don't have to have loads of variety. That doesn't really matter. You just want to, you know, work the big muscle groups, right? And then, yeah, And then once you get, you know, you build that efficacy and the skills in the gym, then you can maybe start to be a little more creative. What I'm trying to talk to my daughters about is we're socializing women in this country that, you know, you can have it all.

You can work and you can be a mom and you can do all these things. But that comes out of sacrifice to ourselves. Our physical health, our mental health, our taking care of ourselves becomes very low on that totem pole. Because, you know, I saw this cute video the other day where, Men are like, my hands are full and they have a cup in each hand and women will put the cups all under each arm and pick up a bag and sling something over their shoulder. Oh, my God, that's so true. Yeah. And if you don't prioritize these things, if you don't build your life where you are first and you are prioritizing these amplitudes.

So your nutrition, when you're eating, how you're eating, the quality of your exercise, your nutrition, your sleep, your stress reduction. And then you, when we start layering on all these other things, you are going to break. And if no other message gets to my kids, it is you have to preserve these things. Yeah. You know, and build that before you start adding. And those stay a priority. Yeah. And I mean, they're seeing a beautiful example in you, you know.

Well, I didn't do it very well for a long time. Yeah. I know. And, you know, I had kind of the same moment. You know, fortunately, it was like 17 years ago. But, you know, I fell asleep at the wheel with my babies in the car. Yeah. Okay.

My grandma had just entered hospice. My mom had, she died of sorts of the liver when she was, you know, in her 40s. And so it was just me to kind of take care of my, my grandma. She had a few months to live. I just gave birth to my daughter. I had an 18-month-old son. And I was going back and forth. And this is, again, you know, not asking for help.

And this was me, you know, just thinking I could do it all. You know, I could have my babies in the car and I could drive up to my grandma in Massachusetts. I was living in Jersey at the time. And, yeah, I literally clapped. And that was kind of the moment that that really did change my life. You know, I was like, I, I can't keep up this pace. Like, what do I think I'm doing? You know, and I literally almost killed my family, you know. And so that's when I started prioritizing sleep. And I started, you know, because I worked in a culture where, you know, the president of the university wore a t-shirt, jokingly, sleep is for the week, you know, but that was literally the reality on the campus of first university. And I love Princeton. And, you know, it's just a local coffee shop. They make these shirts. But. sleep was a sign of weakness if you slept, right? I mean, that was just, you know, and my athletes fought that as well. And so I became this annoying human on campus where I was just like the sleep evangelizer. Like I was just like, and this is what got me off on this path of like researching

sleep and circadian rhythms as I started to see. I'm like, holy shit, this is a huge advantage. So I started doubling down and I had a very successful team at Princeton. And a lot of it was because we slept. Like, we just, we didn't get injured. And it's going to go back to this point about doing it all when it comes to just the people around you. Like, I realized that, you know, once I started sleeping, once I started taking care of myself, I was absolutely a better mom, but I was a better coach. I was a better role model. I felt just so much better about my life. I had the energy to train. And when I think about like what I endured as a kid, you know, there wasn't a day in my life that didn't worry about my mom. You know, she was depressed her whole entire life.

You know, she was a non-functional alcoholic. And, you know, there wasn't a day that went by that I didn't pray that she was healthy. And I was like, I am going down a path where my kids are going to have to take care about. They're going to have to worry about me. So when I zoom out and think about this, I'm like, I want them to know a healthy, thriving mama, you know? And I deserve that. And they deserve that. And so when they see me taking care of myself, they know it's because I love them. And I want to show up for them every single day for as long as possible. And I don't want them to have to, you know, take care of me when I'm 60 years old, right? Like, I want to be in my 80s where I'm playing with my grandkids. That is, when my patients come to clinic, once we put out the fire of metabolic, right? And get them. Yeah, you're going to deal with the immediate. Like the immediate, you know, and they're functional. Then the next conversation, and this is the thing I love best about taking care of this population, is they're like, okay, I'm taking care of my mom or my grandmother or my aunts or I'm watching this and this is my own story saying my mother my grandmother dimensioned frailty so both of them and I just thought this was inevitable for me yeah and I did not

learn until maybe the last five years that there are so many behaviors that I can change their trajectory we don't have the ape oe gene we checked right so there's no genetic component to this other than it happened to both of them and that sleep is part of this yeah They just changed the cardiovascular risk factor scoring system and sleep is a part of it. So is gynecologic history for the first time in the world. You know, but this cultural like rewarding of busyness, rewarding of hustle culture. I grew up in medicine. I mean, like, you sleep when you die.

Yeah. It was the thing and like we're killing ourselves. Yeah. But the women in my clinic are saying, I want to be a benefactor and not a burden. Oh, I love that. That's so good. I do not want to burden my children with my care for a short of time as possible. Same. Yeah. That's my why. And that has become my why. Yeah. I love that. So I run the cancer

gauntlet, which I also was big in my family, but so far so good. Same. Yeah. I'm going to outlive all three of my brothers who died this year. Sorry. So I am determined that it's called my nursing home prevention program. I love that. I know. It's exactly right. It's critical to that. It is. Scrating alignment, sleep is just is the foundation, you know. What do you say to the woman who's been handed a bottle of Ambien from her doctor, well-meaning physician who doesn't know anything about this because this is not taught in medical school. Oh, God. It's so hard because I know when people are just like so desperate to feel like they're sleeping. I mean, is it okay for a few days? I would say, do all these other things. Get your circadian rhythm as aligned as humanly possible.

Move during the day. Very, very important, right? Because your movement during the day, is also correlated with the depth of your sleep, right? Like we see people who are sedentary just don't sleep as well. They actually sleep longer, but less quality, right? And lots of, lots of folks in our data set. So we know that movement during the day is very, very important for every single age and is correlated with quality of sleep. So I would say to that woman, we need to get these behaviors, these circadian behaviors

firing on all cylinders. That's the start. Okay. And maybe in parallel, but I would start to wean, see if we can wean off the Ambien. But, and again, I'm not a medical doctor, just to be very clear. They do have to wean because it's addictive. Totally, right. So, yeah.

They'll have withdrawal symptoms. Completely. So I think doubling down on these circadian behaviors, you know, picking, you know, I think the timer should eat, I think, like, working out is so empowering. And I would say if that woman who's taking Ambien isn't working out, like, let's start training. Okay. You know, I just feel like that changes your outlook. We know that it has, it impacts serotonin, impacts your mood, right? Like you get this little high after you work out. And you feel like you're,

you feel more in control, right, of your life and the trajectory of your health. So yeah, I mean, I would really try to encourage that woman just even if it's 20 minutes, say, 10 minutes a day, five minutes a day, just start moving intentionally and make that promise yourself and just keep it every day. and then weeding off the ambient. Okay. That's not a, that is not a long-term strategy. Yeah. And I think long-term benzodiazepine use is linked to dementia.

It is, it is, yeah. 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. So if your skin care routine isn't working like it used to, it's not because you're doing anything wrong, your skin needs have changed. That's one of the reasons I'm excited about M4 skin care from Allo.

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And the best part, women in all 50 states can access personalized care, and it's almost always covered by insurance. So yes, I'm glad menopause is finally getting attention, but don't settle for noise. Get care from clinicians who are in this with you for the long haul. Book your virtual visit today at join midi.com. That's join midi.com. You talk a lot about, you know, willpower versus infrastructure. So what does that mean? So we need things to be automatic, right? Or we don't do them. So you need to create muscle memory and patterns in your life that you anticipate and expect and feel good to you. So I think when it comes to, you know, willpower, I say it's alignment, not willpower, right? And it's figuring out, you know, who do I actually want to be in the world? You know, I want to be a mom, you know, who can be present with my kids, you know, and show up with energy for the work that I love to do, right? And so when I think about this idea of joy, energy, and peace, those are the things that I deeply value. How do I back into that? How do I need to live my day?

And that's infrastructure. It's not willpower. It's alignment, not willpower, right? It's practicing being the person I say I want to be. And then when you start proving that to be true, you create a beautiful flywheel. But you have to name it. You have to say it. Who do I actually want to be in the world?

What are the things that I really value? If you value peace but you're raging all day, like how is that aligned, right? And so it's thinking, okay, how do I have to design my life in order to, in order to live these values that I say are important to me? I think it takes just a little bit of introspection, you know, to figure out, like, how do I want to show up? And what does that mean about my life? What does that mean about the people I surround myself with? And it's kind of you have to sit down and, like, audit things more intentionally. I find that our menopausal patients do, like, they're realizing this, right?

They never thought about this in their 30s. The 40s is just this chaos. And then when they kind of come through and they get to that stable end after, you know, perimenopause, they are like, oh, I don't need this person in my life. Like, I need to focus on this. I'm like, suddenly they realize they need to circle the wagons. Because they're not going to be okay. Yeah. Do you find this in the data as well? There is really good data around our core psychological needs we have as human beings. One is perfect. One is autonomy, self-affecacy, and control. And, sorry, in connection. And connection is, of course, psychological need. And when we are connected to people, places, and things that don't support our values, we start to feel a lot of internal dissonance. And I think what you're talking about is an inflection point into life where you are like, I know who I am.

I know what I want. Like, all that is starting to become clear. And your capacity for bullshit decreases. Yeah. is just, I think, the real big moment feeling that need. A menopausal superpower, you know? I mean, it is. It is.

Like, I think we need to kind of lean into it. And it's because, like, you recognize, like, the time is fine. You know, we don't have, you know, we're not going to be on this point of forever. Yeah. It is. And for me, like, perimenopause, I lost two brothers in the middle of my perimenopause, you know. So then this whole, like, I may not live as long as I think I'm going to, you know, like if I don't make different choices than they did or.

Yeah. And one was cancer. was HIV and hepatitis. So Bob died of liver failure. And like, you know, like, I have a couple brothers left, but like, it's, it's, I'm going to outlive them. So I get it, you know, combined with watching how the women in my family age. Yeah. You know, it's not selfish, you know. It's, um, it's being around people who bring out the best in you, you know, and, and allow you to live your values. I think there's probably nothing more important than that. And we know that's associated with longer, healthier life. Right. So I think.

think sometimes that that can create a hard conversation, but what's harder is living with that dissonance. Yeah. You know, and because that dissonance doesn't just manifest psychologically, it manifests physiologically as well. When you don't feel like you have control over the people, places, places and things in your life, like that all of a sudden, your autonomic nervous system, low HRV, higher resting heart rate, you become more inflamed. Like I, you know, it just, it starts to manifest physiologically where now all of a sudden it wasn't just not just up here it's it's actually it's actually making you sick right so people matter yeah and getting that right really matters so let's talk about wearables yeah and what should a woman if she's curious if she's not wearing one right now what should she look for in a wearable yeah i mean i think accuracy really matters um no they don't need to be perfect but i think establishing a baseline is really valuable you know because then you kind of know if there's a big deviation maybe something is going on and I can talk to my primary care physician. And I think I would say medical doctors,

primary care physicians are becoming way more, they have wearables themselves. So yeah, so exactly. So I think we're all kind of like, ah, all right, the science is good. The data is good. It's accurate enough. So now let's all kind of embrace this idea of being a little bit more data-centric, using it as just an extra layer of support to be able to have a clearer conversation. Right. And that's I mean, I've heard it called a bad boyfriend. You know, it can be a bad boyfriend. So like, what are the pitfalls of a wearable? Pitfalls, I would say, obsessing over the data and kind of overtaking your life. There's no, generally speaking, you know, no reason why your data today should tell you not to train. Right. Now, for five days of data where your heart rate is, you know, 17% above your baseline, then, okay, that's, you know, an indicator that you're just not adapting well to something, right? It could be a combination of factors. But that's when you want to step back and audit. All right, what's going on here? I think where it goes wrong is, is like you're using it to kind of manage your day or it's giving you anxiety around

your sleep, you know, those are real that can happen, right? But I think going into it with a perspective of, all right, I'm just going to learn about my body, right? I'm curious about my body. And this is a great way to understand what inputs support me, what inputs don't support me. And I think it's the individual, and now I'm talking about all the positives and not the pitfalls, but I think we all have very unique physiology, right? And that's, and all that these are calibrated to you, right? So you get this like, end of one experiment. And you can see the impact of altitude, right? And how that changes my respiratory, right? home in Colorado at 9,000 feet.

Okay. So your respiratory rate goes crazy, right? And my HRV tanks temporarily, you know, so what about the person who seems to be, their mental health is negatively affected by a tracker? And they are kind of consumed by it. Yeah. I mean, that's taken a break is obviously the path. You know, it should just be a tool, to your point, it's a tool in the toolkit.

It's just to help you learn your body. But if it's becoming, you know, I think we call it. it this orthosomnia, orthorexia, right? Like there's some sort of equivalent for a tracker, I'm sure. Orthotracking. But or they're tracking. Yeah, yeah. Anything in your life that is negatively impacting or creating anxiety. Step back. My daughter's, one of my daughter's best friends operates at a really high level. You know, she's pre-med and runs triathlons and just, you know, she had to take her smart watch off. Yeah, yeah. Because it was leading to more.

anxiety and she can't manage, she wasn't able to manage. Exactly. And there's a lot of folks like that, you know, and that happens to me with a glucose monitor. I can't do it. I was actually like eating less. Like I lost a lot of weight when I was wearing a glucose monitor. So yeah, I didn't help me. Yeah. So I definitely, I think that's a really important question. And it's one, you can only answer for yourself, you know, and it's, and I would say, you know, it's healthy. Just take a break every now and again, you know. You don't need to be wearing it all the time, you know, to take it. off for a couple weeks and come back to it. And I think anything that is, is creating anxiety is, is, you know, is worth pausing. What about competition? My husband and I, oh, yeah, will get up in the

morning and like pull up our phones and what'd you get? Oh, yeah. I, according to the ring, I am a better sleeper than him. Okay. But according to our mattresses, he's probably a better sleeper. So it's just funny. It's like a joke between us. It doesn't, it touch our relationship, but it's funny. I mean, I think as long as it's lighthearted and it's just fun. Yeah, there's no, no harm in that. I will say that a lot of the metrics and the algorithms are really tuned to yourself. So comparing doesn't make a lot of sense. Like, I think on our platform, a lot of folks compare strain, which is strain is basically a function of how fit you are. So if you're really fit and I say, let's say you're super, super fit, you run a mile and you get a strain of 14 running that mile. I am really unfit and I run that mile. I might get an 18 strain,

right? So your fitness, how efficient your heart works will impact your strain. So a lot of the algorithm, like, so you can't, we can't, people can't compare a strain, for example, but we have all the time people online are like comparing their strain. I'm like, no, no, no, no, it's not how it works. But yeah, and same with HRV. It's another one. You cannot compare your HRV with anyone else. So I think as a rule, it's great just to use it for yourself and not really use it in a competitive scenario. But if it can help you like think about, all right, let's see who can have the least amount of sleep awake variability. Like that would be a good competition. So what if you can't afford the trackers or don't have access? What are things that you can measure at home? That would be

markers of, you know, how you're doing. I love that. I talk about this in the book as well. I mean, your menstrual cycle, morning wood. an amazing signal. A morning erection. Yeah, morning erection. Yeah, sorry. Yeah, that was very non-technical. So they're like, what?

I'm really sorry. So morning erection is healthy. Morning erection is very healthy. Yeah. So those two are the best signals. So a regular menstrual cycle and, yeah, morning erection are really good signals that things are generally probably really like are doing well. What about a resting heart rate?

Yeah, resting heart rate. And you can just take that, you know, one minute pulse here on the wrist. And how you feel when you wake up, right? Absolutely. Your energy level during the day. You know, do you feel like you need stimulants to carry you through the day? Can you fall asleep and stay asleep? Another great signal, right?

If you're struggling to fall asleep, if you're struggling to stay asleep, obviously that's when you're like, okay, something probably isn't right. Do you have energy to work out? You know, are you able to complete your workouts in a way that feels good to you? Yeah. I mean, those are a few, you know, signals that you can just kind of pay attention to. But I think energy levels is just a big one, you know, and your mood. Do I feel, you know, generally, it's okay to be in a bad mood.

Like, that's a normal part of the human experience. So it's not like you have to be positive all the time and happy all the time. But mood is another great thing to monitor. Mood, energy level. Yeah, and then just some of these physiological signals can be super helpful. Yeah, if you're, if you feel like your heart is racing when it shouldn't be, that's a sign that, you know, you're, you're probably sympathetic dominant, you know, your autonomic nervous system.

So even though you don't have hearty variability, but if you feel, find yourself unable to control your state, kind of wind down when you want to wind down, wind up when you want to wind up, that's a sign that, you know, you might be off, you know, your autonomic nervous system might be, you know, not functioning properly. I think the biggest thing I've learned from this is the impact of alcohol. Yeah. And, you know, I come from a very big culture of alcohol as being part of socializing culture and whatever.

And, like, I just didn't realize how much it was affecting my sleep. It's wild. And I tell my people now, you know, if I do choose to drink and I do drink occasionally, I am potentially choosing not to sleep. Yes. And that's why I just stop drinking altogether, you know, is, yeah, it's like the cost of it is just not worth it. August is National Dog Poop Month, which, yes, is apparently a real thing. And while that might sound a little ridiculous, if you're a dog owner, you know your dog's digestion can actually tell you a lot about their overall. health. That's one of the reasons my daughter started feeding her dog Rex, Ali's fresh dog food.

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Go to OG.com slash unpaused and use code unpaused for 20% off. That's OGE.e.com slash unpaused and enter code unpause. to get 20% off. Just curious, what about the effects of other drugs on sleep? Yeah, so we have a paper actually in review right now on tobacco and marijuana. So a lot of women are using marijuana medicinally off label. There's no label. Well, in some states for the treatment of their menopause, especially sleep disruption.

Yeah. And I would say it does impact sleep architecture negatively. Okay. Yeah. So you're not going to get into the depth of sleep that you would typically. You know, it's one of those things again, like, gosh, I just, you know, I just wish there's other thing. You know, I think a magnesium, DNA, like, there's maybe other things that we can use. So what?

So say, okay, she doesn't want to go to the dispensary and get her marijuana to help sleep. Yeah. You know, and she's, you know, HRT is on the table, off the table, whatever. What supplements actually help? And why? Magnesium is not soporific, but, like, it's not going to make you sleepy. But what does it do? It does reduce anxiety.

Okay. You know, which I think for people who are struggling falling asleep who might be using marijuana, it's usually to address the anxiety. Okay. Now, I'd want to back up and be like, let's address the anxiety, you know. And there's obviously lots of reasons an individual can feel anxious. But it's generally speaking tied to our feelings of control. You know, I kind of mentioned the core psychological needs. We have a person who.

has lots of purpose in their life, generally is not anxious. A person who has high self-efficacy, they feel like they have the skills and resources to do what's asked of them, generally speaking, not anxious. An individual who feels like they are in control and have agency over their health and their schedule, generally not anxious. Positive connections, generally not anxious.

So I went through this kind of framework, these four core psychological needs that we have. When those are in place, generally we're not anxious, right? So look there first. Like what, what, which one of these is not happening in my life? What can I do in my current circumstance? What are the things that I can move around or change that can help me design a life where I am building in these core for psychological needs? So cognitive behavioral therapy, like talk therapy.

I mean, therapy is really great, right, to help manage anxiety. So I would say let's back up and really try to think about how can we build more meaning into our life. What are some little things that we can do? And working with a therapist can be really helpful. And we see one of the studies that we published in Emotion last year looked at challenge versus threat. And this is another, I think, important point for women who are struggling to sleep. It might be related to your feelings of threat during the day. And when our body is doing wazoo shit, we feel under attack.

We feel threatened, right? We feel, and what this threat taps is feeling like you have the skills and resources to manage your day. So if you're under threat and that is not framing your life as challenging, we actually see it impair sleep quality. There was nothing really changing in markers of like blood pressure, cardiovascular indices. Like none of that really changed. if you're praising your day is threatening or challenging, the only thing it changes is your sleep architecture.

So it's like a double whammy for women who are like, what the fuck is happening with my body? Challenge versus threat. Yeah. It's, I know. What is the difference? So, you know, and this is something I thought about in my environment as a coach all the time, right? I'm trying to get my athletes in a challenging state so they can produce appropriate levels of energy for the task, right? So mental, physical, emotional, spiritual, right?

We want to be in a situation where we are able to modulate all of that in a way that allows us to Positive adaptation. Right, right. Adapt positively to whatever it is that we're doing. When we are under threat, all of that is off, right? And we could just be, let's say we're just not prepared for a presentation we have to give in front of 100 people. And you can just, the anxiety that comes with that, right? Like we feel like we perceive the day as threatening.

If I am, you know, there are so many times as a parent where I'm like, I don't have the skills and resources like to do to be an effective parent right now. You know, like, I mean, you'd imagine anyone who has teenagers goes through that at some point where you're just like, okay, I need, I need some help here. And so that can manifest in sleep. So there's a gazillion things that you can appraise as threatening. But I think the skill here is how do I shift from threat to challenge? Yeah. that's the reframe right we need to reframe in some and it might be getting building skills and resources right my body feels under attack right now what what do i need and this is the crux of your work is

helping women feel more in control by educating them right and and so perimenopause for a significant percentage of women they their whole world becomes a threat it's a literative literal and figurative state of threat. And the only thing different in their world is their hormones. Right. And that is making them feel like the world is threatening. And so that has to be contributing to sleep because we see it in the data. Yeah.

We see it in the data. When you appraise the day is threatening, you have lower quality sleep. So women need to know this, understand that, okay, this is actually what's happening. I'm under threat hormonally, right? which is then making me perceive the day and perceive the tasks as more threatening, right? So you have to actively reframe. You have to just slow down and get yourself under control and make a plan. And what would that plan be?

Because everyone's taking notes right now. I mean, it's just different for everyone. It just depends on what's going on, right? I mean, it could be, all right, I know that a few of the things that are going to help me feel more in control is actually to create the circadian alignment. Okay. Where am I going to start? I'm going to start with waking up every single day at the same time and viewing morning

sunlight. And I'm going to make that plan. How much of a percentage of a change will that make? Like, what are we talking about? Okay. So it's meaningful enough, meaning that I'm talking about it. So I can't give you a percentage. There's a lot of individual variability.

But there is so much science around setting your circadian rhythm and the cascade effect that that has across every cell in your body. It will impact circadian patterned, things like insulin, for example. So you get your circadian rhythms line. You start eating during the daylight. Your insulin starts working more effectively, right? More appropriately. Now of a sudden, you have less inflammation.

You start sleeping a little bit better. So maybe it means like 10 more minutes in deeper stages of sleep, eight more minutes in deeper stages of sleep. That will have a compound effect. So it's just understanding that, you know, all these little behaviors, maybe you're getting two more minutes of deep sleep here, three more minutes here. Now of a sudden, you've got 20 more minutes of deep sleep. It's going to have an incredible impact, right? You know, now maybe you're doing 15 minutes of like brisk walking and with some weights, you know, and that maybe you get two

more minutes from that, right? So while some of these little behaviors may be elicit a small effect, but when you add them up, they really start to compound. And this is where you start to feel less under threat. And your body, and not just in your mind, you got to kind of talk yourself into a better future for a little bit, but your body actually starts to change. So we usually do this for social content before we wrap up. Okay. Hyper hope. Okay, I'm going to call out some stuff. It's like rapid fire. Okay, got it, got it. Okay. Hyper hope. And you can say like one sentence if you feel like compelled. Okay, got it, got it. All right. I'll try to be succinct and brief. All right. Here we go. Hyper hope. Okay. Sleep timing regularity matters more than sleep direct.

for most people. Hope and there are good studies to back this up. Okay. Yeah. Melatonin supplements? When traveling. Okay. Go into that a little bit more. Again, I'm not a physician. So I say this with, you know, just a lot of caveats in that melatonin over the counter is usually at super physiological levels. Right. You've probably heard this, right? Yeah. So Andrea talks about this as well. And she really breaks it down. And if you're going to go on melatonin, and you, and you are, are a woman in midlife trying to get your sleep in order, work with a professional. Like, and don't just go over the counter and get melatonin. Like, you want all of this, like, because they have interaction effects, you know, if you're estrogen, predestrian, melatonin, you know, like, you just want, you want to be able to understand what's working, what isn't working. So if you're just doing all sorts of random stuff to your body, you can't, you don't know what is actually working, what is it. And so, I think working with a provider is so,

so important or going to a clinic like you have like you know it just like we can't wing it and i i remember at the health conversation i started i was like we we can't afford to wing it like we have to be more intentional and that is just the cross that we bear okay but yeah what magnesium glycinator you know magnesium for sleep hope okay mouth taping so i have just some data like we haven't published any of these data but math taping during the day hope because it gets you you breathing through your, like I, you know, I, I write about this in my book. I just integrity, lung integrity and breathing mechanics are so, so important for, for sleep, for anxiety, for feeling in control when we have inefficient breathing patterns that impacts us at a

systemic level. So we want to try to get breathing right. Mouth taping can actually start to help you retrain and getting you breathing through your nose or maybe help you identify, wow, my breathing patterns really do, aren't great, and I need to get some help. Okay. Cold plunge before bed. Hype. Okay. Cold plunge at all.

Hope. Okay. For women who really love it. Okay. I hate being cold. There's no way. You have to, like, lower me with a change. I know.

I really, I like cold funding, but yeah. Weighted blankets? Hope. Big hope. Okay. Love it. Where do you buy a good weighted blanket? What do you looking for?

That is actually a great question. You know, I don't use one, but I definitely am like a, I'm a, I'm definitely fully covered up when I sleep. But that's a good question. Okay. We might, there's a little business opportunity for us right here. So red light therapy for circadian alignment. Hype.

Hype. Okay. Sleep divorce, separating beds or rooms from your partner. I think there's some hope in that, you know, like you just have to preserve your sleep. So if your partner's like snoring and waking you up and that's just tough. What about, and we didn't talk too much about, but. what if you have different chronotypes meeting you wake up and go to bed at this?

Oh my God, we didn't talk about what types. I have like kind of strong opinions on this. It's so tough because once you push past, as we talked about earlier, so we all have these natural endogenous preferences for when we feel naturally sleepy. And as I said earlier, you know, based on Kenneth Wright's work from University of Colorado is I think one of the better experiments that they did where they took just a group of morning types and even types, room on a mountain, no artificial light, and they all fell asleep three and a half hours after the sun went down within 30 minutes of each other. So, and lots of the tribes that

don't have electricity that are in existence today, they don't even have a word for insomnia. Okay. And they all are falling asleep within 30 minutes. So you think, prototypes are artificial. Well, I think modern life and just even growing up in homes where there's really inconsistent, you know, lighting behavior and, um, eating behavior. And, you know, I think we have a lot of, that's one of the reasons why we're pretty unhealthy, right? Um, so yeah, so I think a lot of it is preference that there are in, in there's absolutely, we know from the data. There are evening types and morning types, but I think the very ability that we think about it as a society is, I think not true. It's not five hours, right? It's maybe an hour and a half or so. So when I was married,

You know, we, I, my partner was definitely a night owl. I'm definitely more of a morning type. And, you know, I just went to bed and he was really kind and wonderful. Like I didn't really hear him when he came into bed. So it worked out. But yeah, I mean, I think you have to honor your preference. Okay. I suppose. Yeah. And just knowing that, yeah. You need to sleep. Yeah. Napping to offset nighttime sleep. Absolutely. But try to get it in. You want to do everything you can, though, to preserve your biological sleep, your nighttime sleep. So make sure your nap doesn't interfere with that is really important. So when's the best time to nap? So prior to probably 1.30 p.m. Oh, wow. Yeah. Prior to 2 p.m. I would say. And just aim for like a 20 to 30 minute nap. For frontline healthcare who struggle napping, Yoga Nidra is has really been shown to almost mimic deep sleep in terms of its restorativeness. And oftentimes people who struggle napping, Yoga Nitra is a great gateway to that. And it basically just is a, a mind-body scan. There's lots of like scripts online that you can just follow. You just work through

your body and it's really relaxing, very recovery promoting, anxiety reducing, and can help you kind of enter into the next phase of the day with more alertness. Wow. Okay. Coffee after two in the afternoon. No. Okay. Don't do it. No. Is it true that you can recover fully from years of chronic sleep debt? I want to say yes, but that cumulative exposure takes a hit. It does take a hit. The 270 acute care surgeon studies, a good example of just this chronic exposure. And their baseline, the average HRV is below 30 for that group, right, at 43 years old. So well below, you know, the average, which would be probably around 60 for that age group, me and age 43. So there's an exposure that I think is hard to recover from. Now, can you get back on track? Absolutely. Can you

fully regain, you know, or kind of nicks out that cumulative exposure or sleep at, probably not. And then the theory that circadian disruption is the root of most chronic disease. In my estimation, based on what I understand of literature. Yes. Okay. If a woman listening right now can only do two things, two changes starting today to have better, more restorative, more, you know, better sleep and recovery. What would that be? Get your light diet in order. Okay. I just can't emphasize that enough because that is going to create conditions that allow you to fall asleep at a regular time and stay asleep.

Light is the most powerful modulator of our circadian system. And then again, what would that look like? Setting your alarm for a time that you can wake up reliably and do this experiment for yourself for a month or so. set that time, wake up, and get outside. Okay. And if, again, sun isn't up, bathe yourself in artificial light. Again, get that glass of water. Get your body moving.

Again, trying to create, okay, it's time to be awake, right? Getting that cortisol awakening response should be kind of rising. Again, the cortisol melatonin follow this amplitude. So we want nice, big rise in cortisol. Obviously, it's going to fade as the day goes on. But we want that to match what our body is. meant to do, right? So all these little things kind of help facilitate this kind of circadian robustness, right, that we know is so correlated with health and human functioning and sleep.

So yeah, that is the place to start. Set that alarm, wake up, view morning light, get yourself outside, take some deep breaths, you know, just breathe in the day, make a plan. Yeah, and then once the sun goes down, dim light. Really important, right? Set the stage for sleep. You don't have to overthink it, but when you feel sleepy, go to bed. Okay. Very important. Don't push past that pressure for sleep. Go to bed. And if you do this for three weeks or so, you'll start to get yourself into a rhythm. And you should find yourself waking up less. And you should find yourself dropping into these deeper stages of sleep. You should find yourself waking up more refreshed with more capacity to live your values with an energy, joy, and peace. Okay. So that was like that was the second one.

Yep. I would say the second one, again, low barrier to entry is time restricted eating. Start with 12 hours on where you're consolidating all your calories, bias your calories, morning, princess queen, pauper. So buy bulk of your calories in the morning and at lunch, start to, you know, kind of fade. Obviously put lots of good fuel in your body, but more think about the timing as a place to start as an entry point. So 12 on or 11 on, whatever feels good to you, with the idea that your last calorie is a few hours before you intend to sleep. Okay. So that time-street you eating is what we call it, 12-ers-on, 12-hours off.

Amazing. Yeah. Well, Dr. Holmes, thank you so much for joining us on Unpaused. Thanks for having me. We loved it. Awesome. 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. You can also find full episodes on YouTube. Unpaused is presented by Odyssey, in collaboration with Pod People.