Episode 5: Why You're Waking Up at 3 a.m. — and What Actually Fixes It

If you're between 35 and 55 and your sleep has changed — you can't fall asleep, or you're waking up at 3 a.m. wide awake for no reason — your hormones may be the cause, and it's treatable.

In this episode, Dr. Steven Youngblood and Crystal Burke, NP, co-founders of the Menopause Clinic, explain:

• Why progesterone decline makes it hard to fall asleep
• Why low estrogen and rising FSH cause the 3 a.m. wake-up
• Why Ambien, Benadryl, and melatonin often stop working
• What hormone replacement actually does for sleep, and how fast it works
• Crystal's own experience with months of four-hour nights

An important note from Dr. Youngblood: Hormones can fix a lot of perimenopausal sleep issues, but they don't fix everything. If you snore loudly, your partner notices you stop breathing or gasp at night, you wake up with morning headaches, or your sleep doesn't improve with hormone treatment, please ask your provider about a sleep study. Sleep apnea is significantly underdiagnosed in women and tends to worsen in perimenopause as estrogen — which helps keep the airway open at night — declines. It's a separate, treatable condition, and missing it has real cardiovascular consequences.

Have a question you want answered on the show? info@menopauselouisiana.com

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Transcript

SPEAKER_01 0:00

You are listening to Perry Menopause Explain. This show is about Perimenopause. The years before menopause, when things start changing, also before anyone calls it menopause.

SPEAKER_00 0:11

Each episode is real talk from real questions to explain what's going on in your body. No hype, no minimizing, just straight answers and honest conversation.

SPEAKER_01 0:20

If something feels off and you haven't gotten clear explanations yet.

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This podcast is for you.

SPEAKER_01 0:25

You know that feeling when you wake up at 3 a.m. and your brain is just on and you can't go back to sleep. You lie there for one hour, two hours, and you don't know why. And then you spend the whole next day exhausted. This has been happening for months. It's not stress and it's not aging. We're gonna talk about what changed in this episode.

SPEAKER_00 0:49

Hi, I'm Steven Youngblood, internist, physician, co-founder of the menopause clinic.

SPEAKER_01 0:54

I'm Crystal Burke, neurospractitioner and menopause specialist, co-founder of the menopause clinic.

SPEAKER_00 0:59

So if you've been told your sleep problems are from stress, you might be right. But if you're in your late 30s or 40s and something has shifted and you're waking up at 3 a.m. wide awake for no reason, which I remember you doing a lot of times.

SPEAKER_01 1:11

I did a lot.

SPEAKER_00 1:13

Well, you can't fall asleep no matter how hard you try, which trying to fall asleep is kind of oxymoron. Stress probably isn't the whole answer. And we're going to talk a little bit about how perimenopause affects sleep. Tristan, why don't you just give a like a quick overview of what happens and how that affects sleep from a hormonal perspective?

SPEAKER_01 1:33

So the first thing that happens is progesterone declines. So progesterone is a calming, it's a calming common. So a lot of women will realize then, in the beginning, that they can't fall asleep. Unfortunately, sometimes that leads to anxiety because I know I I need to go to work tomorrow. I can't fall asleep. Now I'm anxious about going to sleep, which that that happened to me. It's very common. But not everyone will feel that. But that is one of the things that can happen because progesterone declines. But also, then after progesterone starts to decline, estrogen is going up and down. But in the periods of low estrogen, estrogen gain is low, FSH goes high, all of this affects cortisol. And so you can have cortisol spikes. So then that's when you wake up at 3 a.m. and your brain thinks that it should be awake. That's one of the hardest things is your body and your brain are awake, just out of the blue. There's no reason. And it can happen. It can happen for a week at a time and then then get better and then happen again. During parameters, it can be so variable, which is conf which can be confusing. But it's because estrogen is estrogen itself is so variable that this is a huge problem. This is one of the things I see the most. And one of the things that women get the worst answers about. They'll go to C providers and and they really the only answers they get is it's stress, it's anxiety, it's aging, it's normal, it's a part of what happens now. But that's there, there's definitely treatment and help for that. Okay.

SPEAKER_00 3:06

So so a woman goes to the doctor, she says it's stress. What didn't you? They usually prescribe some sleep behavioral things, make sure you don't do screen time, etc. Uh, you know, make sure the room is cold, various other things, sleep hygiene, effective, not effective, semi-effective, good ideas, but doesn't really work. Like, where would you put that?

SPEAKER_01 3:27

Sleep and can make you more comfortable when you're when you're trying to sleep, but actually going to sleep and doing those things that's hormonally based.

SPEAKER_00 3:35

Gotcha. And so what are it specifically is, which would you say, like, for example, is you see more common waking up at 3 a.m. or having trouble initiating sleep? Like which of the two things? Or they're about eating.

SPEAKER_01 3:48

So most of the time I see the waking up at 3 a.m. I'm a little biased because the falling asleep was the problem for me. So that's one of the things I go to. But overall, most commonly I see women waking up at two between two and four a.m. And they've tried they've tried sleeping pills, those don't work. Or maybe sometimes they worked a little or then they or maybe they did work and they stopped working. But on the long term, what I see most commonly is the waking up at 3 a.m.

SPEAKER_00 4:14

So what are some of the things I could probably answer this a little bit more, but like some of the things that people are normally prescribed for sleep disuse, especially as they get older, right? So we have a tendency to use antihistamines, spinadry. I think that's like sold over the counter, melatonin, trazodone, trazodone, and sometimes and you know, not too distant past. We were given things like Valium Xanax.

SPEAKER_01 4:38

I have I have a few patients on Xanax.

SPEAKER_00 4:41

So talk to me about how useful those medicines are routinely in this scenario. I mean, versus just repleting the hormones. Give me a little background on that.

SPEAKER_01 4:52

So, I mean, doing that is treating the is treating the symptom, but not the cause, right? For some women, some women say, yeah, it helps a little bit in the beginning and then it's and then it stopped. Some people say it never worked. And the thing is, is that when estrogen is low and FSH is going up and it's trying the whole point of that cycle is the brain trying to get more estrogen from the ovaries. And that's not going to happen.

SPEAKER_00 5:17

Yeah.

SPEAKER_01 5:18

So Ambient and Xanax and all those things are not going to fix that cycle. So it it's not, it's not usually helpful.

SPEAKER_00 5:26

There's a um, and interestingly, you know, the use of those medications has been linked to multiple other problems, you know, cognition issues, falls, variety of other things, you know, and you know, in infants and young children, it can, you know, cause issues. And as we get older, it can cause issues. And chronic use over time is that when you're using something like a benadryl to help you sleep once every great so often, probably not gonna cause much, but definitely over time can cause some issues.

SPEAKER_01 5:55

Yeah. The thing is, is that at some point everyone is going to need something, right? Like so like here or there, because there's so many reasons to have sleek issues. But if you're between 35 and 55 and then and it's more of a constant thing, even if it's variable, right? But it's an ongoing chronic thing that might get better for a week here or a week there, but it but in the course of a month you are take you're taking ambient several times a month and it's not working, then the then the problem is different. But taking something every once in a while is one thing. And everyone's getting dictatorial. But yeah, a lot of times it's all that women had as an option before they know that this is paranopause related.

SPEAKER_00 6:38

So tell me a little bit about what some of the other things that happens to a woman's general health as they're having trouble sleeping. Affecting the immune system and all those other elements.

SPEAKER_01 6:48

So yes, any anytime you're not getting them right around asleep, it's gonna affect your immune system. It's going to affect it affects everything. It's gonna affect your job, your work, your health, all of those things. So sleep is one of the biggest, it's the most common things and the thing that uh affects the most.

SPEAKER_00 7:06

So and you personally you went through you know, you had issues with sleeping. I mean, how did it affect you? I would just wake up and you wouldn't be there. And you'd be out in the in the dining room painting something or drawing or Yeah. Yeah. Yeah. I mean, I was like, wow, she's really not sleeping. She's getting a lot done, kind of jealous. Who knows? But like how did it affect you and your your day-to-day at that time period, if you remember?

SPEAKER_01 7:29

It was miserable. It was miserable. And I I had actually just started a new job. Well, I no, I had changed. I had gone and and I was working with all new people and and it was a group I I was working with a group that uh were very friendly and and very open. And I was like, Yeah, like on my first day there, I was like, I can't sleep, y'all. I can't sleep, I don't know why. And two of them had the same problem, which is is now that we know all this, right? Like we were the same age, two of them had the same problem. When I used to, I was up at 3 a.m. I as uh my other friends, I would chat with one of our other friends on Facebook because she was She didn't sleep. So now looking back at that, clearly that's there's something going on with women in our age group.

SPEAKER_00 8:13

Right.

SPEAKER_01 8:14

Clearly, clearly. But anyway, so yeah, I was sleeping a lot of times no more than four hours and had to get up and go to work at 6 a.m. It was miserable. No wonder I had brain fog, though. Brain fog is a real other thing, but on top of that, when you're sleeping four hours a night for months, I really don't know how I was functioning.

SPEAKER_00 8:36

Right. Well, exactly. And it because it's not like you sit four hours and you wake up rusted. You can't sleep and you're exhausted.

SPEAKER_01 8:43

Right. Right. Absolutely.

SPEAKER_00 8:45

Yeah, as I remember way back, I used to say, I'm too tired to go to bed. Like I'm so exhausted, I just I can't do anything. Yeah.

SPEAKER_01 8:52

Yeah. And then every once in a while I would I would hit a wall and I would I would sleep. And then that made me think, oh, it's better now, it's gonna go away.

SPEAKER_00 8:59

You know, cycle road mutes. So from a general health standpoint, we know that, you know, reduced sleep causes lots and lots of problems, right? Waiting, you know, the pe people who are exercising the the rebuilding of muscle requires sleep, right? So you if you have weight training, you're the theory is you're creating micro tears in your muscles, and part of that healing process creates more more muscle. So that's how people build muscle over time. Sleep is crucial to that. There's actually been very good studies that show if you deprive, if you give people the same amount of exercise, the same amount of calories, and you deprive one of them of sleep, they don't build muscle is the one that has unlimited, you know, they're getting the full eight hours.

SPEAKER_01 9:43

And this is this is as our testosterone is going down. So we're not like it really if you think about how it affects all of the other symptoms, right? So mood, energy, focus, not having sleep effects, all those, plus muscle as testosterone going down.

SPEAKER_00 9:58

And there's been a fairly recent study, if remember serves me correctly. I think it was pretty recent, that women who are on weight loss medications like GLP1s lose more weight if they're getting hormones replaced. Yeah. Which probably one of the mechanisms of that, because no one really knows what the mechanism of that is, could be that if you just improve their sleep. And so now their you know, GLP one has a chance to work.

SPEAKER_01 10:24

Yeah.

SPEAKER_00 10:24

Right, right. It makes sense.

SPEAKER_01 10:26

Yeah. There are some women that it happened to me, and there and we know a couple of others, and this was before we knew about carimenopause, that we knew that there were some women that GLP1s didn't work. And then because you see all these people taking GLP1s that were losing weight quick, and it didn't happen like that for me. And it we have a really good friend that didn't happen like that for her either. And had no idea then, but now we know that HRG has a huge effect on that.

SPEAKER_00 10:56

Yeah, from yeah. I mean, definitely if you if you're trying to lose weight over the GLP one, you gotta make sure everything else is on point. Maybe your thyroid's on point, you're going through perimenopause, get replacement, because it's sleep.

SPEAKER_01 11:08

I mean, you're right. Sleep probably has a lot to do with that.

SPEAKER_00 11:11

So the so we keep saying waking up at 3 a.m. That is something you kind of see on you know social media, and for some reason 3 a.m. seems to be the number that everyone's picked is when they wake up. Is there any biological reason behind the 3 a.m.?

SPEAKER_01 11:26

So yes. So when FSH rises, um, it affects the cortisol, it just chef's cortisol. So cortisol is supposed to be um lowest at night and slowly rise in the morning. When that cycle is disrupted, brain and your body, your brain thinks that it's morning at 3 a.m. Because the FSH has disrupted the cortisol.

SPEAKER_00 11:47

Right. So you're not waking up because something is wrong with you per se. You're waking up because your hormones got hijacked, right?

SPEAKER_01 11:56

Mm-hmm. Yes.

SPEAKER_00 11:58

And it's fixable.

SPEAKER_01 11:59

Absolutely fixable.

SPEAKER_00 12:00

So let's talk about a little bit of the fix specifically for the 3 a.m. wake up. What would be like the fix you would you'd first go to kind of walk us through the steps that are involved in that? Yeah.

SPEAKER_01 12:10

So for that, so this is different than when the when it talk about waking up at 3 a.m., the fix is gonna be different than the trouble falling asleep. But there is a fix for that too. But the trouble with waking up at 3 a.m. is that the first thing that happens to all of that is that estrogen is low. Because in perimenopause, it's going from low to high. When the estrogen is high, it's not gonna do the same thing. But when it's low, that's when the brain is looking for for your ovaries to make estrogen, not some FSH thing happens. So replacing the estrogen is what helps sleep. Helps that part of sleep. And it helps your brain to move through the sleep cycles better because all of that gets disrupted when the estrogen is lost. So replacing the estrogen is what helps the most.

SPEAKER_00 12:59

So a sleep aid is such as benadryl and ambience, forcing the brain to go to sleep through an unrelated system. Yes. Back to normal where it can function in a way that it's supposed to, so you can get the rest you're supposed to.

SPEAKER_01 13:17

You're repl you're replacing what the body naturally makes and is missing. You're just giving it back.

SPEAKER_00 13:24

So you know, it's kind of like the idea of we're we're uh helping the wound to heal versus just putting a band-aid on. Right, right. Right.

SPEAKER_01 13:31

Yes, that's exactly it. Yeah.

SPEAKER_00 13:34

So I know we talked about the 3 a.m. wake up. Let's talk a little bit about the w the ones that are having trouble going to sleep. And you may have mentioned that a little bit, but let's just kind of put that as a separate topic. What's causing that? What's the fix? How do you progress through it?

SPEAKER_01 13:47

So that is because of lack of progesterone. So you're so the fix for that, which that that not always, but typically will happen as one of the first things as you lose progesterone first. Some women will notice that. So that's gonna be replacing the progesterone. And progesterone is it's a capsule, it's bioidentical, it's exactly what your body makes. It's the simplest, it's most fixable thing.

SPEAKER_00 14:10

How do you how do you tell people normally take it? Obviously, then I take it in the morning, I don't think.

SPEAKER_01 14:14

No. Take it at bedtime. I tell them to take it at bedtime and then after a week or two weeks, experiment and just kind of see do you want to take it earlier? Plus, for some for some women, it doesn't make them sleepy right away. It might take a couple hours, but some women say it really helps them to feel calm. And so some people may take it like between six and eight and have the evenings feeling calm.

SPEAKER_00 14:39

Lack of racing thoughts, yeah, quiet, you know. I can I can read the book.

SPEAKER_01 14:44

Yeah.

SPEAKER_00 14:44

I can, you know, watch the television show.

SPEAKER_01 14:47

When I think back on it, that was one of the first things that I didn't notice but was happening was I just started having trouble winding down. That's actually pretty common. But we don't realize that. We think, oh, it's just stress, anxiety. Uh yeah. My job. My job, my job.

SPEAKER_00 15:01

I got a couple more things to do. Let me go do them. I can't turn the brain off.

SPEAKER_01 15:04

We gaslight ourselves.

SPEAKER_00 15:05

Right, right. You know, that's what it is. I just need to get these things done, and then I I'll be able to wind down, which really doesn't matter if you know whatever something was going to keep you wound up because you're gonna just be wound up.

SPEAKER_01 15:18

Yeah, because because of the hormones and not anything else. So to give those hormones back, I've I've I've noticed some women will will notice on their own that yeah, I'm just I feel much better when I take it earlier. Definitely not in the morning, but in the evening. So yeah, I tell people take it, take it evening or at bedtime, whatever works for them. Because for some women though, they take it at bedtime and they take it too late, or if they take it too late, they go to bed late and take it too late, they'll still feel a little groggy in the morning. So taking it earlier can help with that.

unknown 15:49

Yeah.

SPEAKER_00 15:50

Day one to symptom relief, how long does it take for like progesterone to work?

SPEAKER_01 15:54

Progesterone. Sometimes some some women notice it day one. For some, it can take a couple days to up to two weeks. And then and then it can be adjusted. So there's there's a couple of different doses of progesterone. But for the most part, it's gonna be within two weeks to see it.

SPEAKER_00 16:10

And then like for the 3 a.m. wake up, which is mostly estrogen mediated, that's what you said. How long does that take before you see results?

SPEAKER_01 16:18

Some for some women it can take. I've got mess I've gotten messages that said I'm singing better than I ever have within five days. But in general, it's gonna be maybe I'd say eight weeks to see the flow effect of that.

SPEAKER_00 16:31

Which means like a lot of the other issues that come with lack of sleep, rainfall, they're gonna be after that, right? Like you gotta have to get the sleep part right before the brain fog, libido, and other, you know, anxieties probably get better. They'll get better as the sleep improves. But you know, when you've been at a sleep deficit for four years, it's kind of like you know, when you when you go a week of burning the midnight oil because you got a paper to do or a thing presentation, the weekend hits, it's over, and you sleep for twelve hours. Because you're like, the deficit has to be made up. You can't just, you know, sleep eight and you're good again, right?

SPEAKER_01 17:08

Yeah, and this is this is typically been happening for so long. It's a whole process.

SPEAKER_00 17:12

I bet. So what other like key things would you just want people to know about? Hormones, perimenopause.

SPEAKER_01 17:19

Sleep is one of the most treatable symptoms there is. It is it is one of the the ones that absolutely can be fixed.

SPEAKER_00 17:28

And it's a big it's a big thing.

SPEAKER_01 17:29

Huge.

SPEAKER_00 17:30

Huge thing. Huge huge, especially if you're going through it.

SPEAKER_01 17:32

Mood focus sleep, mo mood focus, energy, health, relationships, work, all of those things.

SPEAKER_00 17:39

And and from like and and to your knowledge, are there any other medicines out there that are FDA approved to help any do perimetaboles induce sleep issues?

SPEAKER_01 17:50

No, no.

SPEAKER_00 17:51

A lot of them are used, but they're not approved for it.

SPEAKER_01 17:54

Yeah, they're not approved for it. And and most of them are not gonna work on the long term like the hormones will work. Yeah.

SPEAKER_00 18:01

Um let's go to a couple of rapid fire questions. Will my sleep go back to normal?

SPEAKER_01 18:06

Yes. Sure, the most likely. If it's a hormone, so that's the thing, is there's lots of different reasons for sleep problems. If it's related to hormones, which if you're between the ages of 35 and 55 and this it started in this time frame, most likely, yeah.

SPEAKER_00 18:20

But it may not. There is yes, this is where it may not be. Um, how long before treatment helps sleep?

SPEAKER_01 18:26

It can be a couple of days to four to six to eight weeks, but usually it's going to be between within nighttime prior.

SPEAKER_00 18:33

Is it safe to take progesterone every night long term?

SPEAKER_01 18:36

Yes. It's bioidentical, it's what your body makes. It is safe. You might hear sometimes things about synthetic progesterones, but it doesn't have the same safety performance. It doesn't have the same rest. It's it's safe.

SPEAKER_00 18:47

So biodental and synthetic are really two different progesterones.

SPEAKER_01 18:52

Absolutely two different things. Um, and the safety profile is very different. We use both. I prescribe both, but progesterone is safe after.

SPEAKER_00 19:02

What if I tried everything and nothing works? I think the question means, what if I tried everything that is not a removal and nothing works?

SPEAKER_01 19:09

Consider a forma.

SPEAKER_00 19:10

Consider opa.

SPEAKER_01 19:11

Consider it, yeah. Because the thing is, is is it worth a trial and error? Because a lot of times we don't know. A lot of times a lot of women will have these patterns, right? So my moor, my libida, like all of the common things. But if sleep is the only only thing and you've tried everything else and you're you're in that age range, it might is it if it's worth a trial, it's something to consider.

SPEAKER_00 19:33

What's the one thing you wish women knew about sleep and perimenopause?

SPEAKER_01 19:36

That it's common. It's not just aging or stress or something to deal with. It's treatable.

SPEAKER_00 19:43

And that they go hand in hand. They really do. They really do. So if you haven't f fallen asleep in a while, your hormones might be the cause. And that has an answer.

SPEAKER_01 19:52

The sleep problem is very treatable. You can get better with this, and it is not just aging or stress.

SPEAKER_00 19:58

You have any quick take-home points before we end the show?

SPEAKER_01 20:01

Just that absolutely sleep can affect everything. So consider all of your options.

SPEAKER_00 20:07

And don't just take Benadryl. I'm Steven Youngblood. Um, this is the co founder of the Menopause Clinic.

SPEAKER_01 20:12

I'm Crystal Burr, Neospertin's menopause specialist and co founder of the menopause clinic.

SPEAKER_00 20:16

This has been Perimenopause Explained.

SPEAKER_01 20:18

Thanks for listening. You are listening to Perimenopause Explained.