Brittany:

Hello everybody, welcome to our live webinar with Thrivelab, Brittany Nurse Practitioner. It is such a pleasure. We are gonna dive into all things sleep habits, hormone related, answer questions as we go and I have the amazing Manda with me today. It is such a pleasure to be on here with you. I always find this is like the coolest part of my week because it's like a girl talk, but with everyone else online. And so it's super fun. So I'll go ahead and let you introduce yourself and go over some of your background working with Thrive.

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Amanda Shetler; DPC:

Thank you so much. My name is Amanda Shetler. I am director of patient care here at Thrive Lab, which gives me the opportunity to talk to patients every day who are struggling with perimenopause and menopause and other conditions that are associated with hormonal deficiencies. And a lot of them have sleep disturbances. So I also was a very early menopause adopter. I completed menopause at age 38. So I've had my own hormone journey. I have been a Thrive Lab patient for over two years and I have worked for the company for over the lab, a little bit longer than a year. So I live the nightmare of not being able to sleep when your hormones are deficient and have come out on the other side. And I'm here to tell you it does get better and it can get better. You just need to follow the right steps. So, I'm so happy to be here. And I feel like we should start off with talking about what really good high quality sleep actually looks like, because I think Americans particularly really don't have an idea, we don't have a good representation of what that looks like.

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Brittany:

I think that's a great start because when I think of our sleep qualities, I think of, so you mean no cell phone, no TV in bed, and I can't just like be on screens for hours and hours and not expect to fall asleep. So I really like that bridge because I find that and the day of the world with all the technology and all the apps and everything that we have open on our screens, it can really affect our sleep quality, which then can affect our hormones. And the goal with any kind of plan with Thrive, as you may know, whether you're a patient or not, you're just here to educate yourself, is really getting to the root issue, right? And really digging in deep and not putting band-aid on things. And so... If we look at the four pillars, just kind of briefly looking at that, we wanna ensure that sleep has the biggest impact on our life. We have to function, we have to work. And then just some backside to that is, really experts have a big effect on what they believe sleep to look like when it comes to it. It's crucial for healthy living, and it has a big effect on our emotional stability, even our hormones. And so we really wanna be sure that the basics of sleep is being done because that helps set the foundation for the next day and for our lives. So what would you kind of say, Amanda, for the four pillars going in order what that looks like for sleep health?

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Amanda Shetler; DPC:

So I think part of aging, and whether it's perimenopause or whatever, you're having aging, and wellness, attention to wellness becomes more important. So we definitely want to pay attention to nutrition and exercise and stress management, and then sleeping the fourth pillar, the final frontier, if you will, and not just actually sleeping. It's not... it's all of the architecture of the sleeping. So you wanna get REM, you wanna have non-REM, you wanna have all the different phases and you want those phases in the appropriate amount of time. So when we have hormonal fluctuations or hormonal deficiencies, those things start to decrease. So whether it's having difficulty falling asleep or latent sleep onset. Waking up multiple times during the night is more associated with also a hormone fluctuation. What happens? I used to tell people, if you wake me up after 3 a.m., if anything wakes me up after 3 a.m., I'm up for the rest of the morning. And then conversely, if you don't get that quality sleep, it messes with your hormones and it messes with your health and your wellbeing. So I think all of those things need to be in place and I feel like we just don't really understand what that looks like in real terms. So everybody says they are overwhelmed and tired, but how do you know if you're overwhelmed and tired because you just had a really rough weekend or you're overwhelmed and tired because you haven't slept well for years?

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Brittany:

Absolutely. And I like that you mentioned the hormone aspect of that when it comes to sleep, because there's really so many different variations of what that looks like with men and women, with the different fluctuations of hormones. So let's start off with puberty, right? For men and women, when you have those fluctuations in your hormones, a female going through puberty is having their hormones rise and fall in a course in this day and age of technology, you're having estrogen rise, preparing for that menstrual cycle and then drop off around day 14 with progesterone spiking and you can start to become a little bit sluggish and tired. So estrogen is an energizer hormone, but whenever you have those cycles with those puberty patients, especially men as well, there's already some insomnia and sleep concerns. Hence why. Those in middle school and high school can definitely stay up way later than myself. So, they have a lot more stamina going on. And even when it comes to you know progesterone and pregnancy, right, we kind of briefly discussed that, you know, pregnancy is a relaxing calming aspect of what progesterone does, but that third trimester right women have pregnancy insomnia, hi!

So it definitely is because of those hormone fluctuations. And then if we fast forward to the next phase of life, when we're in this perimenopause menopause state where the cycles are becoming a little bit less frequent or a little bit not as monthly as they were before, you're having these rises and falls of when the ovaries, which is our machine for producing our hormones, is not being well regulated. Or with men, their testosterone, their energizer hormone is now being depleted and they can't sleep that night, right? So there's really a lot of different variations of what that looks like, but I love what you said when you said, are you tired because you had a long weekend or are you tired monthly and weekly and you're getting good sleep habits and you're having certain sleep regimens in place, which we will review. But a lot of it can be what phase of life are you in and what other factors are affecting that. So what are your thoughts on that? You speak to so many patients throughout the day and throughout the week. Are you kind of getting that feedback from patients as well?

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Amanda Shetler; DPC:

I am. One of the things that I find interesting though is I tell people, like I often will say well how are you sleeping? It's one of the main questions I ask before we get into like other things and they say some people say I sleep all the time. I want to sleep all the time. I sleep all the time. And so they're actually having sleep disturbances. They, but they don't perceive it as a sleep disturbance because they want to sleep all the time. Well, you want to sleep 12 hours, more than 12 hours, because the sleep quality isn't there. So your body is trying its hardest to get all of those pillars of the sleep architecture captured and it's not happening. So you're having disoriented sleep, disrupted sleep, some people will sleep, try to sleep all night, get up in the morning, go back to bed, take naps, and all of those things are messing with your hormone levels. They're also confusing your body about when it's time to sleep and when it's not time to sleep. So that goes into the more of the sleep hygiene aspect of it. So if you get up and you're exhausted and you take the kids to school and then you come home and climb back in bed, and like sleep again and then get up, pick up this kids from school and go back to bed or take a nap, your brain subconsciously is starting to think like they're not, it doesn't make that strong association that the bed is for sleep. It's for everything. You watch TV in bed, you do all these things in bed, you need to stop doing that because your brain is subconsciously like, we do all kinds of fun things in bed. So you need to stop that process. So I know when I was a young kid, like Sunday mornings, we would stay in bed and read and cut, like all pile into my parents' bed and hang out in their bedroom, all of us talking about different things early Sunday morning before going to church. And that was okay, but it wasn't, you know, like that wasn't an ideal thing for sleep hygiene for my parents at all.

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Brittany:

Right, right. No, that's a really good point. And even you know, we kind of we touched base on the hormone aspect of what it does for men and women cortisol, especially, right? Cortisol is not a horrible thing, you know, Katie Jo mentioned weeks before, and I loved her verbiage for it was it actually is helpful with this, our everyday lives, but that actually, you know, like we discussed earlier, it rises in the morning, it gets our body prepared for the day. And if we're getting our body and our cortisol rising and then, you know, we're going back to bed or we're not sleeping well at night, it just really throws off the cortisol level, but also our circadian rhythm, right? And our circadian rhythm is really that biological clock per se of, of how our body functions with behaviors, physical, mental, all of that. And it helps process the lightness and the dark and, you know, affects, you know, even animals and plants. I mean, there's really circadian rhythms throughout everyone. And so ideally what we like to see with the healthy sleep habit is seven to nine hours of sleep every night consistently. And so that really will play a big effect into melatonin. And so we'll touch base on melatonin, but as you can, I'm sure grasping with this discussion as it plays more effect into other things throughout the body than, well, I just can't sleep. It's almost a cascade of events of how your body reacts to that hormonally, emotionally, and then it just unfortunately snowballs, which could possibly be into more of a big concern. So, you know, with that being said, Amanda, I kind of want to touch base too on the ages that we see men and women kind of face this. And I know personally, just starting off with men in general, I see it in their 30s. They're already having some sleep disturbances. Women as well, I would say the 30s was when it gets kind of interesting. And at this time, most already have children by then. So I do wanna say if we do a deep dive into their life events of work and family and just different roles in the family dynamic of the household, there are events that take place. One patient comes to mind, he works night, his wife works days, he's in school, he's the breadwinner trying to support family and he has horrible insomnia. Well, yes, there are hormones that can be affected with the stress of all those things, but... Ideally, 30s is when things get a little bit funky for both men and women. And I find that the biggest culprit of what makes them kind of what's going on is really sleep. They feel something is off and they don't feel well rested. I'm not sure what do you see when you speak to patients? What's really feedback on this age group for you?

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Amanda Shetler; DPC:

So it's interesting. I certainly started having sleep disturbances after having kids, right? Like you bring home a newborn, they don't sleep, you really don't sleep. And I feel like women particularly, but it isn't, I'm not, you know, the primary caregiver for the children, whoever that is, you sort of get into this habit of one eye open and one eye shut at all times because you're kind of on hyper vigilance. And then you're also losing hormones, like on top of that. So you're in hyper vigilance, you're trying to be there for your kids and be aware of your surroundings because now you're not just worried about your own safety or a bump in the night, you're worried about everybody's safety. Are my teenagers on the stairs sneaking out, you know, like am I hearing the creak on the stairs or am I hearing the creak in the stairs because they didn't make it home in time for curfew? So all of those kinds of things are going on as well. But it's interesting once people correct the hormonal aspect and start sleeping better again, the first people to notice are usually the kids who say, mom, you're so much nicer now in the morning, like you're not so grumpy. And the person's like, what? Like, I've been killing myself for you. Everyday, like I do so much for you, and you think that you're doing a great job. But when you don't sleep well, you're snappier. Like you don't have the patience, especially first thing in the morning, especially if you've woken up multiple times in the night or you had that 3 a.m. I'm never going back to sleep phase. And then your kids, when they're young, they sleep so well. So they wake up like well rested and energized. We used to say bright-eyed and bushy-tailed and they're like, mom, mom, mom or dad, dad! And meanwhile, you feel like you've just been through a hurricane and you're like, coffee, I need air, you know, and they're there in your face. And so you're not even aware that you're being short with them. Or it could be your spouse or your coworkers, everybody like, you know, oh, she needs three cups of coffee before we can talk to her. I've even seen the mugs, they're like, not yet, not yet, not yet. Now you can talk to me now that I've had like so much coffee. If I could get in her vein is coffee, I'm sure they would, people would be doing it because they're so exhausted. So I feel like that was one of the most telling signs is that people don't realize how their behavior has changed when they're exhausted. Because they don't see it, they're not outside of their house. And then when it gets corrected, the people closest to them notice. And they're like, well, I never wanted to say something but you're really grouchy in the morning, but now that you're not grouchy, I'm gonna like compliment you on it. And the person's like, but I didn't even know that I was grouchy. I didn't know that I was, it's not that you're hurting your kids or you're hurting your spouse, but you're not being your best. And it's not because you don't want to, but you can't be. And so that's really one of the things that I thought for myself and for many patients that I talked to was like one of the most eye-opening aspects of correcting the problem was I've been doing, you know, I started with Thrivelab hormones and after six weeks, my kids were like, you are so much more pleasant in the morning. And I was like, what do you mean? I’ve always been pleasant! Ha ha!

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Brittany:

Right! And I think a beautiful part of sleep is we need it.

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Amanda Shetler; DPC:

Right, restorative.

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Brittany:

Technically when we are asleep, those garbage cans that are in our brain come and take out all the junk that we don't need to rid our body of things that is not needed. And as sleep does not happen, that gets worse and worse and worse. And there's even research that show there's a correlation between insomnia and Alzheimer's and dementia. It has such a big effect on the brain. But if we dial it back a little bit and get to the root issue, and we'll touch base on sleep medication, right, like prescription medications. I think if we don't look at so much of the surface, but dig deep, we can really see the cause of this. And, you know, you mentioned these, you know, parents, right, dealing with children. What about that next phase of perimenopause and menopause? Right? Children are out of the house, retirement is in the future, hot flashes, night sweats, insomnia, insomnia. And it's unfortunate, but I even spoke to one of my other patients in my practice, and she said, these are my labs. I always have patients who will wanna show me their hormones. Like, hey, look at this.

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Amanda Shetler; DPC:

What does it mean?!

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Brittany:

And she’s in menopause and she has hot flashes and night sweats and I'm not sleeping and her provider he she her verbiage was old school said you're going through menopause and you're not sleeping just get through it you'll get on the other side of it. Get through it? For what years and years and not have sleep? You need the sleep. So that's a huge big effect when it comes to those hormone imbalances as a whole. So we have the puberty aspect and then having your kids and going through that and then going through the menopause. So as those time goes on those years and years and years add up and my god, you need sleep before all of that to help function, right?

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Amanda Shetler; DPC:

Right. And then even as we look beyond, as people start to get past, so you know, we think of 0 to 20 as the developmental phase and then 20 to 30 ish is the wellness phase and then we start entering the morbidity phase at age 30, which is when we start to develop health conditions and things like that. And then the mortality phase. And we know that people who are in the mortality phase or the end stage of morbidity don't sleep very well at all. Like you go to, when I used to work in nursing homes, like those patients, we called them sundowners. They were awake all night long and then they would be sleeping during the day. So their circadian rhythm and their hormones were all off and they had very low levels of hormones. So, you know, that was a huge, that's a huge problem for them. And then that's adding to dementia and all those other comorbid conditions associated with poor sleep. And we know that The older you get, the less sleep, they used to say the less sleep you require, but it's just the less sleep you're able to get. So it's putting you closer to the end stage of life or the end, but really robbing you of quality of life and making you sicker by not getting that sleep. And the more that continues on over years and decades, the worse it becomes for you.

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Brittany:

So true because if we think about it, you know someone who can't sleep, you're stressed because of that internally which then affects your blood pressure. Right blood pressure goes up. Okay. Here's a blood pressure med. Ah, you can't sleep. Here's a sleep aid. Oh my gosh, you're not working out because you can't sleep because you're on the sleep aid and you're too tired because the sleep aid has side effects and then you're not working out you know what, let's go ahead and put you on a weight loss medication. The cascade of the band aids keep rolling and rolling and rolling. But if we just dial it back a little bit and start at the foundation, I think outcomes can be more cost effective, and also longevity for your life. So I love that aspect of what you mentioned, even with the blood pressure, the comorbidities, because it just goes on and on and on. And I can proudly say when I treat a patient and they tell me I'm off this med now on this med, I'm like, heck yes, of course the overseeing physician who has prescribed those okayed it to come off, but it's a huge win for me because we're now not putting band-aids on things, right? But of course, consult with your primary care who is managing those conditions. But as you can see, those conditions can progress if we don't start with square one. Right? And so with that being said, I feel like too, we kind of, you know, briefly mentioned melatonin being released in the evening cortisol being released in the morning. What kind of you know, with melatonin and I have some literature, you know, it's, you know, produced by the penal gland, which is in the brain and that actually decreases with age, right? And so as we get older, melatonin kind of decreases, but melatonin is actually a beautiful a replacement mechanism for health overall and what that looks like. I find that some patients are like, if I take melatonin, I can become addicted, it can become harmful, but it has a lot of good, helpful benefits to it, on what it does. And even just looking at, because I was looking at a research article again, that it actually can help protect against cancer because it has a potent antioxidant effect. Especially in the mitochondria. And so it really just helps with a lot of destructive, free radical matter throughout the body. And so that our body does naturally have this, but there is supplementation to amplify it. What is your take on melatonin? Are you a, are you pro melatonin or what are your thoughts on that?

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Amanda Shetler; DPC:

I love melatonin. I think the key is the correct dosage and not the over dosage, which some people are, you know, it's my favorite nursing analogy. Like if one's great, five are better,

right? Five isn't too much, right? And then also the anti-inflammatory, the chronic inflammation. Poor sleep is linked to chronic inflammation. if you're getting poor, if you're having poor sleep, you're having poor melatonin, you're also having poor other hormone optimization or death deficiencies, which is also decreasing your ability to manage inflammation. And that chronic inflammation is the precursor for pretty much all morbidities or chronic conditions that can lead to death, but they make us feel sicker or they always have patients with a high blood pressure, the high cholesterol, all of those things. Interestingly, a lot of people go on statins and that affects their sleep because it's you know, it's destroying the hormones that help sleep. And so, you know, it's like when we talk to patients and I'm like, what medications are you taking? And I'm writing that list. And for some of our patients, there are it's quite a list. And, you know, I'm certainly not going to tell them like, you know, you don't want to take the statin. You know, like that's not helping. Let's see how we can maybe get you off the statin. And if we can control the inflammation, maybe that will be something that you'll be able to discontinue obviously at the behest of your primary care or cardiologist in that case, if that's the case.. And improving your dense, your nutrition density is also really important, but the inflammatory aspects of all of the things that we're talking about, also it really takes its toll. And the longer it goes on, the more it takes its toll. I feel like COVID was a great example or science experiment in the sense of what they wanted to say was, if you have poor inflammatory markers, specifically cytokines, if you've elevated cytokines, you're more susceptible to disease. And cytokine is a type of inflammatory marker. But that got lost in translation when we were getting tidbits of when it first came out. But what did they say? If you're old, you're going to be more susceptible to serious disease. And what they should have said is, if you don't have sex hormones managing your inflammation, you're going to be more, after you go through transition, whether it's andropause or menopause, you're going to have really bad inflammation control. And that's going to lead to more serious disease.

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Brittany:

Absolutely, no. And that's even, of course, seen in menopause because hormones at that time are at a big halt, right? But even in the perimenopause or even clinically too, I mean, women with PCOS have big concerns with sleep. And even looking at just like hormones in general, because I have a good outline, I kind of want to be sure I touch base on it, especially with our audience. Because I know there's so many different age groups that are watching, but like PCOS, you have irregular periods. And so then you have higher levels of testosterone, which then causes the irregularities of the hormone, which then affects sleep disturbances. Or even women who are in menopause, they have lack of estrogen, which causes hot flashes and night sweats, and then causes insomnia, because you can't sleep. And so it just becomes a cascade, but melatonin is really known as a sleep hormone. And so it's produced by the gland, but it also helps you know, be influenced by the sun and all of that as well. And so what we find in this day and age of technology is we're also not getting outside and absorbing the sun and having our melatonin levels be affected either. So again, this kind of cascade of events how it just goes one into the other and to the other. And I think that's what's so important too about our consults with patients is, you know, how is stress, what do you do for work? How are these other things because it's not always so black and white. There's other alternatives to our life and what we decide to do throughout the day that can really affect our sleep, right? And with that even being said, I think it's important to even touch on sleep habits and see what would be good and to touch base on the audience of that. So like we kind of even discussed before, right? Just kind of just brainstorming on all the different things to cover because sleep in general is such a broad topic because it affects many different aspects chemically within your brain, hormonally throughout your body, men, women, different phases. But to keep it just raw and simple, I find that we can dive into sleep habits and kind of look at, well, okay, do I have a sleeping problem or is it my sleep habits? Is it my hormones? What does this look like? Because, you know, for someone who's on their screen all night long, drinking caffeine at 7pm, working out right before that and doing energy drinks and they can't go to bed, it's like, oh my god, do I have a hormone problem? Let's kind of dial it back and start with step one of sleep habits. So, you know, of course I agree with no screens before bed. How many hours before bed do you have the no screen goal?

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Amanda Shetler; DPC:

I feel like we tell, or I would tell patients that you need to make sleep an appointment on your daily, like you have to be at work at what time, you have to be at sleep at what time. And that's a consistent thing every night. Like you pencil it in. I'm gonna sleep at, I'm gonna go to sleep at 10 o'clock and I'm gonna get up at six o'clock. And so if I'm gonna go to sleep at 10 o'clock, I need to power down at least an hour before. So no phones, no digital, no blue light after nine o'clock. And I'm not going to have caffeine or stimulant things, there are other things that are stimulating besides caffeine, six hours before 10 o'clock. So then, you know, like I'm going to, my last coffee cannot be after four o'clock, right? So I need to eat dinner and it needs to be digested before eight o'clock. Like, so if you, if you started the whole process of looking at your sleep hygiene and starting with like this is when I'm going to sleep. So let's count back from when I'm going to sleep. And this is when I'm waking up. So let's count forward. So obviously the caffeine. And then if you get in bed at 10 o'clock and you still can't fall asleep after 20 minutes, get out of bed. Don't stay there and toss and turn. You're confusing your brain. Your brain, you want your brain to associate the bed with sleep and intimacy. So you can use the bed for both of those things. Hopefully you use it for both of those things on a regular basis. But you will, like I try not to even be in my bedroom after I get up in the morning. Obviously I have to sometimes go in there and get things, but the idea is like, this is a sacred space reserved for sleep. You don't eat your breakfast in your bathtub, hopefully. Because the bathroom is a reserve space for things that are related to the bathroom, showering, whatever. So you need to take that same sanctity and apply it to your bedroom. And if you can't sleep, getting out of bed, leaving your bedroom and forcing yourself to read an actual book as opposed to your phone, which does not have blue light and does have that back and forth motion which should make you sleepy. but you can't keep telling yourself, I'm doing this so I get sleepy. You're like, I'm just gonna catch up on my reading. I'm not sleeping, so I'm gonna just catch up on my reading, whatever you have handy, and do that until you get sleepy, then try again.

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Brittany:

Reading a book, right? Not a Kindle.

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Amanda Shetler; DPC:

Right, absolutely not a Kindle. It could be a magazine. Probably something boring would be better. Like there are certain books that I just get like so absorbed in. So you probably wouldn't wanna like start a thriller. I had one patient tell me, she's like, I read chapters of the Bible when I can't sleep. She's like, I figure it's gonna, it'll help me have better knowledge and better whatever, understand. So, and I was like, well, you know, those, there are some chatters in that Bible where it's like, he was the son of her, the, you know, like goes on and on in generations. So not that that's boring, but it's very repetitive information. So something like that would be helpful. And then if you wake up in the middle of the night, do the same thing. Don't keep a digital clock that glows all night long in your bedroom. Yes, you may need to look at a clock, but it should be blacked out. And like if you wake up in the morning and you have 15 minutes to first sleep, you might look at your clock then to see like how much time do I have before I have to get up. But you should get, do not go back to sleep if you wake up at, if you're supposed to get up at seven, don't go back to sleep at 6:45. If you wake up at 6:45, get out of bed.

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Brittany:

Your brain is going to be so confused. And you know, talking about clocks, one clock we have is, you know, the clock where it's dark at night, but as you get closer to your alarm going off the light shines. And when the light shines, your body senses that light to wake up and starts, you know, all of that rising, right. And so there's such fascinating technology out there that helps kind of get us back on track, but it's also bittersweet because then there's a lot of technology, Kindles and iPads and all the things where it can really just throw off your sleep. But yeah, those are, that's really good insight for those sleep habits.

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Amanda Shetler; DPC:

I think, you know, if you think back to people, original colonists and things like that, they, when the sun went down, they went to bed because they didn't have electricity and the roosters woke them up. That was their alarm clock. They weren't looking at a clock clock. They had one, but usually it was, they were rising and falling like with the tides almost, or, you know, the moon phases and getting back to that. really does enhance the circadian rhythm. So not that I'm advocating everybody go out and buy a rooster, which might not like him very much, but especially on a Saturday morning, but that concept of like having a natural wake and the light, I love those, those clocks that get brighter. I've used those with teenagers. It's an amazing thing to get for teenagers who really want to sleep all the time.

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Brittany:

It's more common.

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Amanda Shetler; DPC:

And almost like you startle them when you wake them up in the morning, right? They've like, they've been up and down and they're, they're finally in a deep restorative sleep and you're waking them up and they're like, you know, so those clocks are fantastic for that.

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Brittany:

Right, no, I love the clock. I'm a huge advocate for it, especially with the slow progression of how one may wake up. I'm like, give me all those clocks, please. But you know, I think there is also, with that being said, like when you have poor habits in place, especially with like screen time and, you know, reading the iPad in bed and watching, you know, TV, having a TV in your room. I personally don't have one in our room. It's nice, although there's times I'm like, oh, I just want to watch this show, you know, but it's great because I don't have this bright TV shining on my face, but how that can really, if you have all those factors in place, how it can have triggers chemically and biologically, especially as time goes on, I mean, I even see this younger generation of elementary school just on the phone and watching movies in bed and just all the technology and blue screen that's involved. And, you know, even with social media, right? I mean, when we're on these social media platforms and sometimes the bitterness or sweetness that can come with it, great check-ins, but also the TikToks and the comparison and all of that, which can rise stress and cause even more worsening hormonal effects from it, especially we're on PMS or all the things. So again, just all the different avenues it can affect, but. What I see that there are some natural medications that can help with sleep, which is what we wanna advocate for. What is your body lacking that we can replace? And I love the way Bimisa, Dr. B said it, two weeks ago was we're not here to take away, we're here to add in. And that stuck with me because clinically. You know, you are having melatonin in your body. So let's do more melatonin. You are having magnesium in your body. Let's give magnesium before bed, right? So really let's give your body what it already has and not, you know, just kind of lay a blanket over it. And with that being said too, I find too with women, whether they're, you know, young women going through PCOS or, you know, infertility, there's already some underlying rooted hormonal, you know, imbalances there. And since we're talking on sleep, I always encourage melatonin, magnesium glycinate. I think those are both really good hand-in-hand things that can help hormonally. Of course, there's a hormonal aspect of treatment and all of that as well, but going into the medications of sleep, I find that to be helpful. Of course, if we wanna talk about the PCOS patient, polycystic ovarian syndrome, where their testosterone, as Katie Jo said weeks ago, they're like, on raging of the testosterone and not enough progesterone. It's like, I tell my patients it's a seesaw. We want those energizer and relaxing hormones balanced. You're ideally lacking progesterone, which is that calming, sleepy hormone that a lot of women with young women, they're not experiencing that. Add on birth control, it's even worse. So going away from all the details of what those clinical diagnoses can look at if we just scoot back to what we can help with just baseline sleep medication or helping your body sleep, magnesium and melatonin.

What other recommendations have you had patients kind of take that is helpful for them? Or what are your thoughts on those two recommendations?

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Amanda Shetler; DPC:

I think they're great. What I kind of cringe at, I talk to a lot of patients who say, I take Advil PM, I take something PM, I take Benadryl to sleep. So many people take Benadryl to sleep.

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Brittany:

No allergies, just to sleep.

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Amanda Shetler; DPC:

Right. And I'm like, you are, I said, imagine that your body's a car and you're filling it up with leaded gasoline instead of high octane unleaded gasoline. Your car isn't gonna run really great, especially if it's not supposed to get leaded gasoline, unleaded gasoline. The carburetor's gonna be bad, everything's gonna be bad. You're doing the exact same thing to your body when you are filling your body up with antihistamines to help you sleep. That's not... it works and it's cheap, but it does not restore the architecture of sleep. And therefore you are now rebounding insomnia or having more difficulty with sleep because the architecture wasn't ever restored. I see that people will get a prescription for something like an Ambien or a benzodiazepine that they take every night for sleep. Again, you're degrading the sleep architecture and you're not really, you know, it's, that's not, none of those are designed to be long-term solutions anyway. And over time it erodes the sleep architecture that you've worked so hard to get to. I mean, I feel like perfect sleep architecture you see in kids pre-puberty from birth, they fall asleep and they get that deep restorative sleep. It's like they almost, they move, but they don't, they barely move. And then you see somebody, people say, I don't know how well I sleep. I'm like, well, what does your bed look like when you wake up in the morning? I had a child with a lot of angst and like the bottom sheet or the, would be the, all the covers would be everywhere all over. Like it looked like a tornado went through his bed every morning, like making his bed was like a challenge because you're like, okay, let's get the fitted sheet back on. Let's get the top sheet back on, very restless sleep. That's a key indicator of very restless sleep. Then you see the person that gets into bed and barely moves, like you, you know, almost they turn back the bed sheet, they get in bed, they sleep, they get up, and they just have to like pull it a little tight and the bed's made again. So I have had kids of both flavors, but that's what you wanna look for. What you want your bed to look like in the morning when you get up is like not disturbed. If you're in a queen size bed, you wanna see where you slept and just tighten those sheets. So that's another, it just occurred to me as another sign of poor sleep.

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Brittany:

Right. And I find too, this kind of just dawned on me, but I think why we feel so comfortable and safe with these PM over-the-counter sleep aids is because it's over-the-counter. How bad can it be? I mean, I can go and get it off the shelf and not be questioned, prescribed, nothing. I mean, this is PM and it's helping me sleep. But at the same time, we get nervous when we have clinical diagnoses of hormonal imbalances or let's add in melatonin or these different supplements or minerals because it sounds so foreign and it sounds scary it sounds like well I can't you know get that off the shelf easily or what have you and it's almost like well have we ever compared side effects um I mean my god you look at an aspirin bottle we people take it all the time my god There's a lot of side effects on that and we would not be taking it if we read them all, but it seems safe because that's what we knew was normal is it's over the counter. Take an aspirin if you have a headache or what have you. And so I find when it comes to the sleep prescriptions, it feels safe because it was prescribed, but have we ever thought of the longevity of what it can do to our system? And, you know, even trazodone, for example, that is an antidepressant, it is a sleep aid. What it actually does to men's sperm count is it decreases it and it affects your DNA and reproduction if you're wanting to reproduce. And so that's just, but do we know that, right? No, my doctor prescribed it. It helps with sleep. Now, again, you have established primary cares if you do, if you don't, what have you, but I think it's important to know both sides of the spectrum. Our goal, of course, is to educate on how hormones can be, you know, affected by lack of sleep and I do believe there are medications short term that can help with that but what is causing the insomnia I think is the biggest takeaway from this is it the screens, is it the stress, is it after childbirth right? And so I think especially for a long extended period of time prescription sleep aids can become harmful to the body because we're kind of blanketing the issue and not digging root of what, is it a melatonin deficiency? Is it a magnesium deficiency? Is there one of the medications interacting with another one that causes side effects? So it's not so black and white, but I think it's aware clinically to bring it to the forefront that it's not always just a sleep aid or like you said, Amanda, a PM, a Benadryl. I mean, it's like, whoo, okay. So what are we trying to address here, right?

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Amanda Shetler; DPC:

Exactly, exactly. And I think also, you know, we have like, oh, well, if you're over a hundred pounds, this is the correct dosage for all of those things. They're pre-populated doses. You don't have any control over the doses. And if you need a little help, like you would get from say a Benadryl, and you're taking the standard adult dose, but maybe you don't need all of that. Like, so there's also the tolerance aspect and the amount. I think a lot of people who are prescribed trazodone, trazodone doesn't come in every, it comes in multiple doses, but there aren't like a huge variety. So a lot of people think like, they're like, oh, my doctor gave me trazodone and I'm sleeping so well now. I'm like, yeah, but probably because you're getting too much. And when you wake up, you feel exhausted because you're still being sedated. It's still in your system. And your, you know, 25 milligrams may be too much for you. Especially if it's like the smaller, the person, thinner, we have, I have a lot of patients that are like five feet tall and a hundred pounds and 25 milligrams of Trazodone is going to make them tired all the time because, but they're like, it was amazing. I took, and I think also they take it the first night and they go right to sleep because it's very, like your body is like, whoa, what's this? And so then in your mind, you need it to sleep because you had that first experience. But then you say to them, well, are you still tired in the morning? Yeah, I'm exhausted in the morning. I'm like, it's almost like you have a hangover, right? Yeah, maybe that's because you're getting, you know, like it's not addressed. It's giving you something so that you're sedated, but it's sedating you too much. So, and it's not restoring the sleep architecture clearly. So that's the, but I can, you know, I remember my sister took someone's like a one night thing and she was like, that was like the best sleep I ever had in my life. And then she went to her primary care and her primary care was like, no, you're not getting that. Which was good, right? Like that person was on the ball, but yeah, it's really amazing how people, you know, none of that calculates. So when you're taking an aspirin or you're taking whatever over the counter, that may be much too high of a dose for you.

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Brittany:

Absolutely, absolutely.

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Amanda Shetler; DPC:

But you've taken it, like I figure, like you and I grew up in a time where we took Benadryl frequently growing up. Like that was the only thing they had for allergies for the longest time. So if my mom gave me Benadryl, it must be safe, right? Mom gave me Tylenol when I got sick, so it must be safe. So I don't have to worry about this. So my guard is down, even though not really. You know, like it's familiar to you. So now you aren't suspicious of it.

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Brittany:

Right. It feels, and I think that's the biggest thing, is it feels familiar, it feels safe, and our brain chemically likes safe. It likes familiar. Anything outside of that feels unsafe, and our brain's job is to keep us alive. I mean, we can go back to like the survival times. It's feeling weird or feeling off or unsure. It's like, ooh, safety, like don't go there. But I think it's important to have some education on both sides of the spectrum of, it really can look deeper and, you know, add more to you than taking away. I mean, God forbid 100 years ago, 500 years ago, whatever. Did we have trazodone back then? No, right? It was old school, like, you know, we weren't having these major chronic conditions like we are now. And of course, I think it's our environment and our food. And there's a lot of things that partake in it. But I think it's important to bring up that sleep has a big pivot on what all it can cause throughout the system. And hormones definitely are affected by sleep. Clinically, we've touched base on that, even throughout the phases of life, whether it's puberty, pregnancy, perimenopause, and then menopause, but also for men. After the age of 30, levels are already starting to decline, and as they get older, it gets worse and worse and worse. There's a lot more side effects that come to it than just lack of sleep as we know and we've discussed in many other webinars and will continue to educate on. But I think it's important to know that lack of sleep is not normal. Over the counter PM medications, they're there. You can get your hands on them, but it's definitely a blanket overlaying the root issue. And again, our goal is to educate and find you know, a fix to a root issue and not continue the bandaid. And I think it's exciting too that with Thrive, you know, not only are we throughout the US, but there's also people like ourselves that patients can talk to and, you know, and chime in on these concerns. So what kind of takeaway message you have, Amanda, when it comes to all of this in a nutshell? We've been through a lot.

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Amanda Shetler; DPC:

I think talking to a medical professional, whether it's Thrivelab or it's your primary care, if your sleep quality is not there, that is a concern that needs to be addressed. And I understand, like maybe you start with your primary care and maybe your primary care doesn't provide a complete solution, but like you're talking to them and making them part of the conversation. And then, but a lot of times you might get referred to somebody else, but to follow through with that referral or you go through, all right, well, let's make sure it's not a bunch of things. And then you can say, all right, so is it hormonal? Is it this? I feel like people who complain about poor sleep often get put in the box of, oh, you must be depressed. That's a, poor sleep is associated, depression and anxiety. A lot of people who would, depression and anxiety, have poor sleep. So maybe you need an antidepressant or an anti-anxiety. And I almost wanna say, wait, time out, time out. Maybe the poor sleep is leading to the depression and anxiety, not the other way around. So, right? So maybe if we can fix the sleep, the depression and anxiety will be eased. And that's why, you know, they say for most of those depressant, bipolar, all of those things, they're talking adolescence is the time of first onset or first episode. Yeah, that's because sleep gets disrupted at that. That's when we start to see sleep disruption. So, but you know, if you are putting the PM bandaid on your sleep problems and not talking to a healthcare provider or your healthcare provider or your healthcare team about it. And it's okay to say to your primary care, but if you're visiting your cardiologist saying, I'm not sleeping, everybody should be clued in on it. And if you are taking those over-the-counter medications, when you go in to see your provider and they ask you what medications you're taking, make sure you say that you're taking that every night. I take diphenhydramine every night. I take whatever every night, because I can't sleep. that needs to be part of the conversation. If you go to the dentist, the dentist isn't gonna help you with sleep, but tell them if you're taking diphenhydranine every night. I feel like there are interactions that can also, you know, your psychiatrist, whoever you're seeing, they should all know that you're taking, if you are using that as a sleep aid, and not to take no for an answer. So if you go to somebody and they don't offer a solution, that doesn't mean that you stop there. It's okay to keep pushing forward. If your leg was accidentally falling off instead, every few days your leg would fall off and you had to screw it back on, you probably would tell somebody or like everybody, right? So I feel like you need to have that kind of urgency and persistency that comes with this, you know, for sleep. Just as much as you would if you were having fainting spells or other seemingly important problems.

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Brittany:

Right. No, that's so true. And I think as time goes on, it gets worse and worse. And we live in a society where it's not too bad until it's too bad. And then we want it fixed.

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Amanda Shetler; DPC:

Yesterday.

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Brittany:

And I think when it comes to digging into the root issue of patient treatment, it takes time. It takes time to layer back those layers of years and years and years of all that just consistent band-aids or ignoring that we like, okay, enough's enough, but then it takes time to also reverse that, right? And so I love that though. I find too that all of us have, you know, that gut instinct that if you talk to a medical professional or whoever that looks like that would advocate for your care, if it doesn't sit well to get another opinion. Research shows that if you get a second opinion 80% of the time it changes. And my god, even in my other practice, I have heard way too many stories from hormones and other things and having to send another referral because that answer just didn't sit well and it's okay to find another voice that can maybe help, right? And so we know ourselves most, we know ourselves best, and I find that sleep is a huge, as I'm sure you've, you've heard us say how, how it can snowball into other things, medical comorbidities, you know, hormones in general, which is really our biggest goal to touch base on and what it does chemically within the body. But I think too, um, when it comes to, you know, just kind of final statements with this is that if any of this was of interest of you, or if you would like more information, or if you hopped on midway or at the end, this is recorded. We are live. God bless for a great Wi-Fi connection and all of the things, but you are able to rewatch this, or if you find that this video would help a family or a loved one or really helped you have some insight, it would be great if you liked it or shared it just to get the message out that you know. We don't have to suffer in silence. I think the beauty is letting light shine on these conditions and issues. And if Thrivelab is something that you're kind of interested in. There are previous webinars on there. You can always go online and make an appointment to meet with Amanda or her team along with other providers as well. And so with that being said, this is kind of a... A final wrap on our discussion with sleep and hormones. Amanda, what are your thoughts? This is fun. We're like almost an hour in.

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Amanda Shetler; DPC:

I'm so excited, I'm so pleased to be asked to participate in this. I really do believe that sleep is as important as all the other pillars of health and to remember that is the case. And persistence is the key. And I think there's also the washout, right? So if you've been doing all these things to help yourself sleep and they're not working and- now you're going to try something else, you also have to wash out of whatever you are doing, which is like taper off of it or get off of it so that you can see how this other approach is going to help you. So I feel like that is, you were just so right about that. Like it's not going to be an overnight fix. And people who start practicing good sleep hygiene, every sleep specialist I've ever dealt with, and I've dealt with a lot of them because I used to work in the sleep space, would tell you, you're gonna be really tired. This isn't, you're gonna start practicing good sleep hygiene and you aren't gonna like it at first, but it's important to stick to it. It's kind of like starting a diet. Like you're really not enjoying, like if you go on a, you need to produce your cholesterol. So you go on a low cholesterol diet. You know, everything tastes funny at first. You're like, I don't like this. I'm used to this type of milk and now I'm drinking this kind of milk. The same thing happens with sleep hygiene. So be prepared. You're not, you know, it's not for faint of heart to just like, you can't, you can do it on a whim but it's not gonna be successful unless you take it really seriously. So there is almost a little pain to get a lot of gain. And I tell people all the time, everybody hates to age. Everybody's going to get surgery to reduce wrinkles. Sleep-lack of sleep is going to age you faster than pretty much anything else.

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Brittany:

So true.

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Amanda Shetler; DPC:

So you want to be, you know, want to look good. And we look at people who have great genes and have aged gracefully throughout their life and look really good. Sleep is a big part of that. Like, you know, all of the deterioration comes from lack of sleep. So, if you want to have a great life.

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Brittany:

Absolutely. Right. No, and I love that you mentioned it's going to be painful in the beginning. I mean, even patients of ours who may be on weight loss injections, right? It's like, oh god, like, I want to finish x, y, z. I think though, to the beauty of it is to get the outcome you are, are you wanting to achieve, you got to put some skin in the game.

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Amanda Shetler; DPC:

Right, exactly.

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Brittany:

And that's really one of the things is, in a world where we can have things at our fingertips or take something and have it be fixed or order this and have it be delivered. This is more of the beautiful outcome of dialing all that back and starting with yourself with the actions that you do daily. So it's really a beautiful outcome in the end and longevity wise helps with all of that. So I love that. Well, you guys, it has been awesome. My goodness, an hour has flown by. Any questions, let us know. But yes, until next time, we will see you soon.

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Amanda Shetler; DPC:

Yes, and sleep well.

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Brittany:

Sleep well!

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Amanda Shetler; DPC:

Sleep well, and we'll see you soon.

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Brittany:

Yes. Good night.

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