Hormones, Perimenopause & Sleep

A Conversation with Dr. Shelby Harris, Behavioral Sleep Medicine Specialist

Guest: Dr. Shelby Harris — Clinical Psychologist, Behavioral Sleep Medicine

Host: Natalie Walton — GM, BetterSleep

Topic: Why women's sleep shifts in their 30s, 40s, and 50s — and what actually helps

Introduction

Natalie: Hello, and welcome back to our series on all things sleep. Today we're talking about a topic that affects millions of women: how hormones and perimenopause impact sleep. I'm your host, Natalie Walton, GM of BetterSleep. And with me is someone who brings a wealth of clinical expertise to this conversation — Dr. Shelby Harris. Welcome to the show, Dr. Shelby. Can you please tell us a little bit about yourself?

Dr. Harris: Thank you for having me, Natalie — it's really a pleasure to be here. I'm a clinical psychologist by training, with subspecialty board certification in behavioral sleep medicine. That means I use evidence-based treatments to help people improve their sleep. I work in private practice now, I'm on faculty at Einstein Medical School, and I worked in sleep centers for a long time here in New York City. I work specifically with women — that's my main area of practice. I wrote The Women's Guide to Overcoming Insomnia, which came out in 2019. That's really what I'm mostly known for when it comes to working with patients.

Natalie: Dr. Shelby, I'm really excited because you're not just an expert on this topic — you're also an adviser to BetterSleep, and we're so grateful to have your perspective helping guide the app. What initially drew you to BetterSleep, and what made you want to come on as an adviser?

Dr. Harris: I think there's not enough out there to really target people who are struggling with their sleep. What I love about what you're doing at BetterSleep is wanting to work with professionals in the field who've seen a lot of different types of sleep problems — using meditation, using programs to help the person who has an occasional sleep problem, and also doing a deep dive into figuring out how we can all improve our sleep. I like that mission overall.

A Personal Sleep Story

Natalie: Thank you, I so appreciate that. I first learned about you many years ago. Just as a woman, my sleep struggles have been so severe — it's like my Mount Everest. For the five or six years after my son was born, I kept waking up in the middle of the night. I've gone to so many doctors. One of my doctors told me the solution was that I needed to eat more potato chips, because I have low blood pressure. Can you believe that?

Dr. Harris: In the 25-plus years I've been practicing, I've never heard that one as a sleep solution.

Natalie: Oh my god. It turns out that this summer I discovered, through using Function Health, that I was anemic — and that's why I kept waking up every morning at 3 a.m.

Dr. Harris: Oh, you're anemic! Oh my gosh. So the potato chips weren't exactly solving the problem.

Natalie: They weren't solving the problem. I did an iron infusion, and within a couple of weeks, I had a whole new lease on life at age 40.

Dr. Harris: It makes a big difference. I have restless legs myself and low iron — I supplement, and I've tried iron infusions, and they really can make a big difference for a lot of people.

Natalie: That's why I'm grateful for people like yourself. We need specialists on board like Dr. Shelby who can actually speak to women and aren't prescribing potato chips.

Dr. Harris: I'm not going to look at potato chips the same way ever again, that's for sure. I didn't know they came with a prescription.

Common Sleep Patterns in Women, 30s to 50s

Natalie: So many of our listeners are struggling with similar challenges — this is a really pervasive problem. What's one sleep pattern you see over and over again in women in their late 30s, 40s, and even 50s?

Dr. Harris: The late 30s is an interesting time frame. A lot of women — myself included — are having kids later, sometimes in their 40s or even later. At that time, you can still have a baby, but you can also be going through perimenopause symptoms as well. It's a real storm.

Dr. Harris: What I see: some people in their 30s starting to go through perimenopause, or they're postpartum, and they're noticing their sleep is becoming lighter. I hear it every day — "why is it I always wake up at 3 in the morning?" It's a 2 or 3 a.m. issue. Some people notice they just can't turn their brain off at the beginning of the night — that's another really big one, and I see it get worse over time.

Dr. Harris: When you move into your 40s and 50s, there can be more middle-of-the-night awakenings and struggling to get back to sleep, or early-morning awakenings. You have more risk of hot flashes, and night sweats can be a really big issue. Especially in the 40s and 50s, we also see snoring — even very mild, you might not even notice it — and pauses in breathing. We see an increase in sleep apnea very commonly with hormonal shifts. Because of hormonal changes and anemia, we also see a lot of restless leg issues. Many women say, "I'm really antsy, I can't calm my body down, my legs are moving so much at bedtime." It's often restless leg.

Natalie: That's so insightful. I can relate to all of that. I had sleep apnea in pregnancy, and my doctor said there's really nothing you can do about it — by the time you can get treated, it's too late.

Dr. Harris: That's a problem with the system. It takes so long to get evaluated and treated. It would be good if we could actually catch this early in women and help them get better sleep for everyone all around. But yeah — it's a problem in our society.

The Frustrations Women Don't Often Talk About

Natalie: What are some of the most common nighttime frustrations you hear — the ones women don't often talk about? I didn't really want to talk about my sleep apnea in my third trimester.

Dr. Harris: So common, right? That's one that people don't ever really talk about, and as a result, it gets missed all the time. There's something about women talking about their sleep problems — a lot of women do it, but in a way where it's like, "Oh, I wake up at 3 in the morning and I just can't turn my brain off." Women will talk about that together because it's a common issue.

Dr. Harris: But sometimes one of the reasons people have lighter sleep or broken sleep is snoring, and people don't talk about that — or not even snoring, just apnea, however it's presenting. With women, it's that feeling of being tired but not necessarily sleepy.

Dr. Harris: There's also this idea in our society that we don't talk about enough: "Well, this is just what life's going to look like when you hit perimenopause and menopause. You're going to be tired, you're not going to have good sleep." I challenge people — maybe it doesn't have to be that way. Maybe there are things we can do to target whatever is going on with your sleep.

Dr. Harris: Restless leg, apnea, and also the feeling of being very lonely at night — women don't talk about that enough either. They're stressed and feeling really lonely. Sometimes people are doing a lot of things in the middle of the night — taking care of whatever has to be done at home, chores, work, whatever — because there's no other time in the day. Women are stressed, and it's impacting their sleep in many areas.

What's Happening Inside the Body

Natalie: Can you help me understand — what's a simple, relatable way to describe what's happening inside the body during these nighttime disruptions?

Dr. Harris: Even in adolescence or as a younger adult, when you're about to get your period, there are sharp drops in estrogen. In postpartum, there are a lot of fluctuating hormones — things aren't leveling out for a while. Especially in perimenopause, that phase of transition, there are sharp drops in estrogen and progesterone.

Dr. Harris: Estrogen is really important for sleep in general, but also for body temperature regulation and sleep timing regulation. It helps mitigate hot flashes. If your body isn't able to regulate its temperature well, you can start having hot flashes — all because of drops in estrogen.

Dr. Harris: Progesterone is the other one that changes. Progesterone itself is a very calming, sleep-inducing hormone — so it actually helps people sleep. That's why, before women are about to get their period and there are drops, some will say, "I have horrible insomnia before I get my period, and then it gets better once I get my period." Same thing with perimenopause.

Natalie: Does it ever get better? At what point do we have anything to look forward to?

Dr. Harris: That's a great question. There are things we can do to improve it. If you're not happy with the quality of your sleep, talk with a specialist. Look into apps that can help. Are there doctors you need to talk with about hormones or whatever it might be? There are things that can be done.

Dr. Harris: Some women notice that once they hit menopause — the clinical definition is not having their period for a full year — things even out. It doesn't always happen, so it's hard to say yes or no. But for many people, it starts evening out.

Tired but Wired: The Perfect Storm

Natalie: For me — maybe this is where I am in life, I have a five-year-old, I'm running a company, feel like I'm taking out the trash — my brain and body suddenly feel wired but tired, even on nights when I'm completely exhausted. It's very complex. If this almost feels like a sudden shift, like it did for me a couple of years ago, do you have any thoughts on why that is?

Dr. Harris: It's a perfect storm of three different areas. First, the hormonal shifts we just talked about — sometimes you have less of the calming hormone from progesterone. Second, we find that women often have more anxiety and stress. And third — the big one that doesn't get talked about enough — the social demands.

Dr. Harris: Women are having babies later in life. They're further along in their career. They have parents who are aging. And when you get home from work, you don't stop — everything's on a phone, nothing stops.

Dr. Harris: There's a difference between fatigue and sleepiness. Fatigue is the feeling of "I have no energy, I'm exhausted" — which is what I'd argue many women, including myself, feel a lot of the time. Sleepiness, though, is the irrepressible need for sleep. What most people are responding to when they're going to bed is that tired-but-wired feeling. You have no energy, but you're not necessarily sleepy, because you're revved up from all the other stuff — stress, anxiety, your hormones not helping you calm down.

A Bedtime Ritual That Actually Helps

Natalie: Let's talk about the fix, because I think that's why people are tuning in. What's a small bedtime ritual that helps calm the nervous system and supports sleep during hormonal changes?

Dr. Harris: One of the best things people can do is create a buffer between day and night. That can be hard. I took a lot to get there myself, and I'm not perfect with it every day by any means. For a long time, I had to have everything wrapped up in a bow before I could go to bed. I use the example in my book: the dishes. It used to drive me mad if the dishes were in the sink when I went to bed.

Dr. Harris: I've learned to let the dishes sit — to let some stuff sit — so I can prioritize five minutes at the beginning to just have a buffer. Whether it's meditating or stretching, something where I'm not going go-go-go and then so exhausted I crash into bed.

Dr. Harris: If you can't find five minutes, we need to have a bigger discussion about that. Some people say they don't have it, and I'd say: five minutes now, make it ten. If you can slowly increase the time of that buffer — to wind your body down and land the plane slowly, as opposed to just turning the switch off — it will be beneficial overall.

Reclaiming Sleep During Perimenopause

Natalie: What's one thing you want every woman to know about reclaiming her sleep during perimenopause?

Dr. Harris: There is no one-size-fits-all. Despite the messaging out there — "this is the perfect treatment, it worked amazing for me and all my patients" — there isn't one. There are different treatments with medication and without. We love to use non-medication approaches when possible. Just don't accept poor sleep as what things should be moving forward. Talk with your doctor. If your doctor isn't listening to you, find someone who will actually listen and give you the different options. You shouldn't accept feeling this way from here on in.

Natalie: Sometimes it's frustrating — you go to one doctor, then another. But in my experience of going to multiple doctors and getting my potato chip prescription, there actually is someone who will listen and can help you.

Dr. Harris: Can I ask you quickly — what did you think when they said potato chips?

Natalie: I was able to draw the connection between potato chips and low blood pressure, but I thought there had to be more. Honestly, after you go to a doctor — you find the energy, you book the time, you pay for it, and you hear an answer like that — you think, "Okay, I'm so desperate, I'll try it." But then it doesn't get better. It creates this vicious cycle of not getting any better.

Dr. Harris: Keep talking until you hit on someone who knows what they're talking about and can guide you in the right direction. No one should have to suffer.

Why Digital Tools Like BetterSleep Help

Natalie: From your perspective, what makes a digital tool like BetterSleep especially valuable for women navigating these hormonal sleep changes?

Dr. Harris: One thing we know can worsen perimenopausal insomnia — or any sleep issues — is stress and anxiety. Finding ways to help calm the brain and body can really help with calming down at night. Like I said: landing the plane. If you can do things to set the stage, to learn how to quiet your brain a little easier by putting in the practice, tools like BetterSleep can be really wonderful.

Dr. Harris: The more you can do to lower that stress — lower the overall volume going on in your brain — the better. When we think about vasomotor symptoms like hot flashes and night sweats, we know that doing meditation and some of those techniques can actually help some people reduce their hot flashes.

Natalie: Meditation has helped me tremendously, even when other things haven't.

When You've Tried Everything

Natalie: My last question: if you've tried everything and don't know where else to turn — honestly, this is me, and probably a lot of people out there — what's your advice?

Dr. Harris: I always question: what's "everything"? Is it just stuff you're hearing online? Stuff from non-specialists? I would say go to someone who is actually a board-certified sleep specialist. A lot of times, people are going to someone who specializes in apnea but doesn't really work with people who have insomnia.

Dr. Harris: Be a consumer. When you go to a doctor, ask: how often do you treat these problems? How familiar are you with it? Make sure of the specialty of the person you're seeing — not just anyone who says they're a sleep doctor.

The Road Ahead for BetterSleep

Natalie: At BetterSleep, our mission is to better serve people's needs and ultimately help them sleep better — that's exactly why we spotlight topics like this with experts like yourself. Looking ahead, where do you think BetterSleep has the greatest opportunity to grow or innovate to better support women during this phase of life?

Dr. Harris: I think innovating means thinking about how the level of demands and stress put on women during the day influences our hormones — and how our hormones then influence our sleep at night. If we can learn to bring the temperature down mentally, it can help physically with some of the changes happening, get us to sleep a bit better, and help with the cycle over a 24-hour period.

Natalie: That is my commitment to users, because as someone who has struggled like this, I don't want anyone else to struggle. If you can't sleep, you can't really live.

Closing

Natalie: Thank you so much, Dr. Shelby. This conversation has been incredibly grounding and clarifying, especially for all the women like us navigating hormonal changes and trying to make sense of their sleep. Where can listeners learn more about your work?

Dr. Harris: I'm pretty active on Instagram — you can find me at @sleepdocshelby. You can go to my website, drshelbyharris.com. Or you can pick up my book, The Women's Guide to Overcoming Insomnia. You'll find a lot of my treatment goals, techniques, and tips in there as well.

Natalie: I've read your book and found it super helpful. Thank you again. For our listeners, please be sure to follow BetterSleep for more expert-guided conversations and tools. With Dr. Harris's insight as part of our advisory team, we're continually evolving to support your sleep with compassion and evidence-based care. Until our next episode — sleep well.

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