This is the tenth edition of The 2 Susans, a monthly LinkedIn newsletter produced by Dr. Susan Baumgaertel and Dr. Susan Vogler.
We are two doctors who are curious about aging. Our newsletter embraces conversations about aging from many different perspectives—medical, psychological, societal and even personal. Of course we’ll have a lot of content that pertains to peri/menopause and beyond.
To read the January edition, click here. To read this new edition on LinkedIn, click here.
Enjoy the reprint below!
Sleep is NOT Overrated!
Do you wake up feeling refreshed? This month we cover great info on sleep. Susan V shares how sleep is integral to many body systems, and what happens to our sleep cycles as we age. Susan B reviews sleep hygiene and circadian rhythms, and provides tips on how to improve sleep quality and quantity. You deserve better sleep!
Susan V:
Dreaming of Good Night Sleep
Good quality sleep is associated with consecutive, uninterrupted sleep that refreshes and energizes you. Sleep is essential for maintaining health and well-being, yet it is frequently overlooked in our busy, fast-paced lives. Optimal sleep, defined as 7 to 9 hours of quality rest per night, offers many health benefits beyond mere tiredness alleviation.
Quality sleep supports immune function, helps regulate hormones, and promotes cardiovascular health. During sleep, the body repairs tissues, builds muscle and synthesizes proteins crucial for recovery and growth. Adequate sleep is essential for mental processes, including memory consolidation, learning, and problem-solving. It enhances concentration and creativity, allowing individuals to perform better academically and professionally. Inadequate sleep significantly impacts mental health and can lead to irritability, anxiety, and depression. On the other hand, optimal sleep promotes emotional resilience and boosts mood and overall emotional well-being. Influencing the hormones that control appetite, sleep deprivation can increase hunger and elevate the risk of obesity.
The duration and quality of sleep change throughout our lifetime. The amount of time we spend each day sleeping declines as we age. Newborns need more than twice the amount compared to adults. Although older adults still require 8 hours of sleep daily, the quality of their sleep and the ability to stay asleep declines, making it difficult for some people to get an adequate amount.
Regardless of age, most people typically don’t get enough sleep. We live in a fast-paced society brimming with demands that often lead to burning the candle at both ends. Many individuals frequently spend their nights completing work tasks or handling household responsibilities. The nagging sense of needing to finish a project or tackle another load of laundry prevents us from getting a solid eight hours. Furthermore, daily stress often exacerbates sleep issues as we are preoccupied with planning for the next day.
To enhance sleep quality, consider the following strategies: regular daily exercise, maintain a consistent sleep schedule, establish a comfortable environment, and steer clear of stimulants such as laptop screens, alcohol, and caffeine before bedtime.
The National Sleep Foundation focuses on the vital link between sleep and overall health and well-being every year. In 2025, March 9-15 will highlight the significance of achieving optimal sleep for maintaining good health. Visit thenfs.org to learn more.
A Winter Morning in New England. Photo credit: Dr. Susan Vogler
Susan B:
Sleep Disruption *
Two o’clock star walk,
I become menopausal cat,
searching in the dark.
—Haiku by Susan S. Scott, PhD, psychotherapist, writer, artist (Langley, Washington)
The term “sleep hygiene” has become almost ubiquitous in our culture for many reasons. I know many people who can recite from memory the salient points: Don’t use the bed except for sleep or sex; keep the bedroom at a cool temperature; avoid electronic screens for one to two hours before bed; keep the room dark; avoid vigorous exercise just before bed; and so on. Yet many of us have trouble with the quality and quantity of our sleep. This impacts so many different aspects of life.
Our circadian rhythms and sleep patterns naturally change as we age and may also distinctly shift during menopause. Regardless of origin, a change in sleep habits can be unwelcome, as we are often creatures of habit. We can usually rebound from one bad night. However, when a good night’s sleep seems like a distant memory, there is a problem.
It can be helpful to identify if sleep initiation (falling asleep) is the main issue, or if waking up during the night more than once is the bigger concern—or both. Can you not fall back asleep easily? Do you wake up more than once? Do you wake up very early and never fall asleep again? Does your brain just not turn off?
Let’s consider these scenarios individually.
1. Trouble falling asleep
I am a big fan of bedtime rituals. We often think about this in the context of kids—bath, bedtime story, snuggle time, lights out—but it is just as valid for adults, especially as we age. Some of these rituals overlap with sleep hygiene fundamentals.
Rituals can re-train our brains. Think about driving back home on a long road trip where you pass a certain landmark on the highway, and you instinctively know that home is about 20 minutes away. Well, if you train your brain to anticipate sleep after certain rituals, it can have the same effect.
I discourage any important household discussions close to my bedtime. You know, finances, downsizing, buying a car, world events, and so on. I know that these topics will get my brain fired up, and I won’t be able to settle down to sleep.
I like to play a word game on my mobile phone (with the screen set on yellow with low-level brightness and sound off), which is just stimulating enough to keep my focus at first, but eventually becomes repetitive or downright boring, and I get quite sleepy after a short period of time. There is now a huge industry of apps catering to bedtime rituals that help calm the brain and prepare for slumber.
I do keep a small notepad and pen on my nightstand just in case something important jumps into my thoughts (like ideas for this book). I make a very short note to myself and then mentally dismiss it as “done” so I don’t have to continue thinking about it.
2. Waking up during the night and trouble falling back asleep
Have you played this game yet? I woke up because I have to pee. I woke up and, now that I’m awake, I should go pee. Which one is it? Or is it both?
Many of us live in environments where noise can be a factor (ambulance siren, loud party at a neighbor’s, barking dog, etc.), so waking up can sometimes be inevitable. We then might feel anxious about personal safety (recent home break-in down the street), have concern for a loved one (older teen not yet home from a party, past curfew), or feel that our brains are bent on reliving all the unresolved issues of the past few decades (for real?!).
There are many techniques to learn to try and return our minds and bodies back to a state of slumber, which are best discussed with a sleep specialist. I would also be remiss in my medical duties if I wasn’t quick to point out that there are some significant medical disorders (such as sleep apnea) that often need to be ruled out before assuming that disrupted sleep is not pathologic.
3. Waking up early and trouble going back to sleep
This is a tough one. As we age, often our body’s need for sleep changes. Some who always needed nine hours now find that seven hours is fine. Others now need 10 hours. Frankly, if you feel rested and do not have trouble with daytime fatigue, then you are likely getting good sleep—both quality and quantity.
One temptation if you are tired during the day is to take a nap, often in the mid-afternoon. Naps are neither good nor bad, but they can definitely impact the 24-hour circadian rhythm and sleep quality. For those who are frustrated by not being able to fall asleep or by waking up very early, naps are not advisable.
It should not be understated that substance use can be linked to all types of sleep disruption. You may think that a glass or two of wine makes you drowsy and, therefore, believe that you sleep soundly, but scientific evidence disagrees. Some of us are also very sensitive to caffeine, even in small amounts and even when consumed long before bedtime. Nicotine, cannabinoids, and other drugs significantly impact sleep cycles. Although cannabinoids (THC and CBD) can help some people with sleep disruption, the downside is often habituation, which only leads to significant sleep disturbance and insomnia during withdrawal when stopped.
By no means is this a comprehensive how-to guide for solving sleep issues. Working with a sleep specialist can often be of great help, especially when considering cognitive behavioral therapy for insomnia (CBTI). This is a specific approach that involves the principles of stimulus control and sleep restriction (following a precise schedule) with relaxation training and biofeedback. It also uses psychotherapy and cognitive control, in addition to sleep hygiene training.
One final point for those who struggle with sleep: Aim for quality first, then quantity. It is far better to work on sleep quality, and then gradually increase the amount of time you spend asleep. If you can achieve success with both, then you’ll have won the game!
* from The Menopause Menu, chapter 3, Sleep Disruption (hyperlinks added)
Looking out over Puget Sound from a high bluff in Discovery Park, Seattle, WA. Photo credit: Dr. Susan Baumgaertel
🗓️ Our March edition will focus on thyroid function and nodules.
📝💬 The 2 Susans would love to hear from you!
Let us know the aging topics YOU are curious about. Please also share this newsletter in your network and tag us—we are so grateful.
Susan B: susan@mymdadvocate.com
LinkedIn, myMDadvocate, MenopauseMenu, The Menopause Menu book
Susan V: susan@voglermedical.com
The 2 Susans newsletter is for informational purposes only. It does not represent medical advice and is not intended as a substitute for professional advice, diagnosis, or treatment. Always consult with your private physician.