249: Emily Sadri, NP, Women’s Health Expert: Estrogen Loss Is Ruining Your Nights

 Welcome to the Sleep As a Skill podcast. My name is Mollie Eastman. I am the founder of Sleep as A Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world. Thinks about sleep.

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Each week I'll be interviewing world-class experts, ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness.

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And I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health and by extension, allowing you to sleep and live better than ever before.

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Welcome back to The Sleep is a Scale podcast. Today's episode has been a long time coming because the moment I met today's guest. Today's guest is Emily Sadri, the nurse practitioner. I knew we had to have this conversation. We actually met on the floor of a conference and within minutes it was just clear we had to go in deeper.

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She started discussing. Women's hormones and sleep and things that she's seeing on the ground in her practice. So I think you're gonna really enjoy this conversation. So Emily is a former nurse midwife and women's health nurse practitioner who lived years of disrupted rhythms on call nights, constant hyper vigilance and the quiet normalization of burnout until her body finally pushed back in a very real way.

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Many of us can relate to that, and here's where this episode takes a turn, most people don't expect, what if the hormone that you've been told is the sleep hormone Isn't the one actually running the circadian show? In this conversation, Emily explains why estrogen may be a primary driver of circadian rhythm, how perimenopause often shows up first as.

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Sleep and stress intolerance long before hot flashes. And why? Blanket, progesterone prescriptions can sometimes worsen sleep instead of fixing it. If you're over 35, waking at three to 4:00 AM feeling tired, but wired or doing all the right sleep things with no payoff, this episode may completely change how you understand what's happening in your body.

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So we're gonna jump right into this episode, but first, a few words from our sponsors. As we head into the fall and vacation season, winds down IEA time when late nights irregular eating habits and indulgence tend to become the norm. It's time to get back on track with our health and of course our sleep.

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Just a quick, interesting fact about sleep to mention drinking more than two servings of alcohol per day for men and more than one serving per day for women. Can decrease sleep quality by 39.2%. A sleep foundation survey reports not even mentioning all the indulgent food and late night effects that often come along with it.

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And as we know, sleep is the key to your body's rejuvenation and repair process. It controls hunger and weight loss hormones, boost energy levels, and impacts countless other functions. A good night's. Sleep will improve your wellbeing much more than just about anything else I can possibly think of on the planet.

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Uh, you know, I'm biased, but gotta say that. And sleep is your major to focus on as we head into the fall season and hopefully beyond. And that's why I recommend that if you're going to start taking some supplements on your sleep often, magnesium is a great place to begin, but not just any magnesium supplement.

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I do recommend getting the Magnesium Breakthrough by Bio Optimizers. Magnesium Breakthrough contains also. Seven forms of magnesium designed to help you fall asleep, stay asleep, and wake up refreshed, which isn't that what we're all looking to do. The sleep benefits are really remarkable. I use it every night, and once your sleep is optimized, you'll find it much easier to tackle all the other major aspects of your health.

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And trust me, it is a game changer. To test it out, visit mag breakthrough.com/sleep. Skill, you can enter code. Sleep is a skill for 10% off for any order. This special offer is only available@magbreakthrough.com 

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slash sleep is a skill. I will also include this in the show notes as well. 

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Welcome to the Sleep is a Skill podcast.

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This has been an episode a long time. In the coming, we were having different possibilities of could we do this live, you know, 'cause just such immediate connection right outta the gate. I believe we met at another conference that we were chatting on the floors and immediately knew that we had to have this episode be recorded.

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So thank you so much, Emily, for taking the time to be here. 

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I'm so excited to be here and to dive into this topic. 

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Yes, absolutely. 

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As I jealously look at you with your, uh, gleaming sun on your face. 

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I know. And hair everywhere. Oh my gosh. It's really crazy. This is the perils of Circadian Line Life's. Style, you know, it's not always the most comfortable as it'll be different temperatures and whatever 

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poised.

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It's 

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not 

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always the most poised. 

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That's that's the word. Exactly. But you know, we roll with it over here, so thank you for that. Appreciate it. And having said you got that knowledge of circadian aligned lifestyles and the benefits of that, how in the world did you find yourself as such an expert in your field, and how does that relate to sleep?

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Yeah. Well, I mean, speaking of circadian aligned lifestyle, my first, um, my first major professional career was as a midwife. Um, so my background is, um, as a, I was a dually certified as a nurse midwife and women's health nurse practitioner, and I started my career. Over 10 years ago, and I had two little kids.

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I actually was pregnant with my third when I finally started my career. And I was one in four midwives at a small practice, meaning that 25% of the time I was on call. And that's morning, night, weekend, you know what have you. And moving into that phase of my career. And I had done nights, you know, in various capacities as a nurse and as a doula and a birth assistant and you know, sort of through all of my training even prior to that.

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But, um. As we, as I moved, like deeper into my career and it became, um, even, uh, there were less periods of time for recovery. Um, I had. I really suffered from metabolic fall apart, secondary to, um, my disrupted circadian rhythm. Um, you know, and it wasn't just that I was up frequently at night, it was that, you know, I rarely got sunshine.

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We also moved to a part of the country that had, that was very overcast. Um, uh, and just the amount of stress in that kind of position. The amount of work demand, having little kids at home, um. And it's amazing what can happen when you're deeply passionate about something, how, how far you're willing to go in terms of betraying your body and its needs.

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Mm. Yeah, 

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especially when your community is, you know, congratulating you for being so, um, disavowing of your own physiologic needs. Mm. Like you're con, you know, you're just celebrated if you've been up for 36 hours or, you know, in service of someone else. Um, and, you know, I, I still feel like a midwife into my soul.

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It was, you know, most definitely a calling. I had all four of my own babies at home, um, and really believe in the power of. Birth and the power of positive birth support, um, and the power of supporting normal physiology whenever possible. Um, and we have just set that system up to be one that it, you know, becomes impossible for people to stay healthy.

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And when I was looking around at my colleagues, no one was maintaining. Positive health. Everyone was metabolically broken. Um, many midwives were ending up divorced and, you know, miserable. And it, it just wasn't, I was never gonna be able to find any way to hack my way through that career. 

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Sure. 

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Um, and I really, really hit home during COVID when I was, I was actually pregnant with my fourth baby and, um, because I was pregnant and more high risk and, um, it was early in COVID and, you know, people were nervous.

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I, I took over most of the outpatient visits and I did them all virtually from home. And my colleagues were gracious enough to take all the call for me. So I had this magical two, three month period in the middle of my pregnancy where I started sleeping at night. 

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Hmm. 

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And in my third pregnancy, I was diabetic for the first time.

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Secondary, you know, now upon retrospect to this massive, you know, circadian rhythm, disruption, stress levels, you know, for all the things. Um, and I was diabetic again in my fourth pregnancy, and I noticed a, a real causal relationship between, um, not just sleeping at night and sleeping well, but also doing like.

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Very intentional nervous system practices before bed and change my fasting blood sugar, and nothing else would change my blood sugar except. These very specific circadian practices and nervous system practices. Even like the way that I ate, like counting carbs was just not that fruitful for me. And I'm not a body that responds well to severe carb restriction, like a keto style diet didn't really work well for me, um, and didn't.

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It, it didn't, it was not anti-inflammatory for me, and thus it was not po. A po did not have a positive effect on my, on my fasting blood sugar. 

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Sure. 

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Um, and so I, I, it just sort of put this idea in the back of my head, I don't think I fully understood it yet. I knew that like this is what was working for me, but I didn't have the space bandwidth time, um, connections yet to really like get that.

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Um, but I did know that, like when I went back, um. Toward the end of my pregnancy that. It, it, I, I was, it was a, it was just a, a trade off that like, I couldn't, I could no longer make, um, that I became a different person. Um, as soon as like, that was stripped away from me. Um, just the, just the ability to be rhythmic and to reliably know that you were gonna go to bed and not be woken up.

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Because for five years, almost five years of my life, I didn't reliably know that I wouldn't be woken up. 

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Mm. 

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Also having little children and, you know, whatever. Yeah. And so you become, you're in this just hyper aware, hypervigilant state all the time because you're so used to. Um, you know, being disturbed at all times.

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Sure. 

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So that, that was sort of my like initial, like a path and experience. And then I, I was postpartum in COVID and two days before I was supposed to return to work, I resigned 

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really 

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like as a type A very, uh, you know, high achieving person. Yes. Living in a part of the country where there aren't a million jobs for midwives, not knowing what I would do next.

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Um, for the first time in, oh well over a decade, I just said like, I just can't do it. I just can't go back. Um. I just can't sacrifice like my wellbeing at this time. And, you know, yes, all my kids were home. They were homeschooling. It was COVID. There was so many things going on. 

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Yeah. 

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And so I opened my practice really just because I, I liked to continue to, to do the work.

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And I had been studying, you know, integrative and functional medicine for a few years before I left. With the idea that I would do something with that and go somewhere. Um, but no one wanted to hire me. So, which is a, was a total blessing. So I, I hung up a shingle and opened a little women's health practice, um, with an integrative focus.

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And, you know, I just, I learned by, I learned by trial and fire that, um, you know. Sort of what was, what, what worked from a functional medicine model and what didn't? 

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Hmm. 

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Um, and predominantly most of the women that came through my doors were bet, you know, between 35 and 55 years old, simply because of who I was and my connections to the community and how old I was.

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Um, and I just found, uh, that I, I became a hormone person sort of by default because Hmm. Most of these women needed intense hormone support. And of course I had a background in, you know, conventional hormone science. I understood all of the basic things that a good, you know, functional hormone person would understand.

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But I, I quickly discovered kind of where those things fell short. 

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Hmm. 

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Specifically related to the way that, um, you know, we, we bifurcated, um, at the time, the WHI came out in early two thousands and conventional medicine had their sort of way of demonizing estrogen and then integrated medicine had its own way and they were really the same two things.

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Right. It's just that integrative medicine was like. Really talking about estrogen dominance and you know, all these, and estrogen detoxification, and that was their way of kind of interpreting this global understanding around estrogen. And then conventional medicine had its own framework and. I, I, I just sort of, I, I had this moment where I had to kind of rectify both worlds and say like, this is not actually practically working for people.

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Yes. And from a, from a, and, and for myself as well. Yes. Like from the point of view of being, you know, I was postpartum in 40 years old when I had my last child. And so recovering my metabolism and recovering my. Ian Rhythm. You know, my, my menstrual rhythm, um, postpartum was, was a real challenge and a really different experience than doing it three and a half years prior with my third child.

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So that's sort of the very long version. 

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No, 

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it's perfect. How did I get here? 

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Yeah. 

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And how did I become interested in what I do now and what I really specialize in now, which is a, a more precision or physiologic based approach to hormone replacement therapy. That is very distinct from sort of what is done in conventional medicine, which is a very low dose static therapy using commercial products that were truly developed for symptom management of hot flashes and not for optimization.

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And so when I'm looking at restoring someone's, uh, physiologic reproductive hormones, right? I'm thinking of it at the, in the same way that I'm thinking about thyroid hormone, right? We would never go, you know, you have a lot of thyroid insufficiency because imagine if we all went through thyroid th thyroid menopause.

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Like imagine that that was just mm-hmm. A reality and we all, you know, suddenly woke up at 43 years old with a TSH of 15. We would never say like, why don't you just start with like five micrograms of Synthroid and that should be enough so that like you can wake up every day. Hmm. You know what I mean? So true.

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Like we have this very, um, we have these boxes of like how we treat different systems and we're not applying that same principle. Um, whereas we, we, we state pretty openly, um, not with a lot of clarity and management, but we state pretty openly that women who go through menopause before age 40, it's pri premature ovarian insufficiency, and it's emergent.

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And you should replace hormones like as close to physiology as possible because we know that those women have such higher risks for osteoporosis, cardiovascular disease, et cetera. Um, but why isn't it an emergency at 42 or 47? 

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Mm. 

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Like why does it suddenly change at age 40? 

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Yeah. 

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And so by doing this. One thing that I learned, and this is our connection point and sort of what brought us together, because I am an Enneagram eight and I will just insert myself into any conversation, for better or worse, 

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please keep it coming.

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Yeah, exactly. 

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Basically, the reason that we're doing this podcast and you know, is that that we had this interaction on the, the floret, the at this. Conference in Austin and Yeah. Yeah. I said, you know, one of the things that shocked me and that I learned doing a, doing a physiologic approach to hormone replacement was yes.

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And something that I learned is that estrogen is really the primary driver of circadian rhythm, not progesterone. Yet everybody thinks about progesterone as the sleep hormone. And so what I hope that we can do today and the, uh, information that we can share with listeners is really how both of those hormones work differently in the brain.

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Yes. 

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And why? If you have sleep disorders over the age of 35 or 40, and you think that they're hormonally related. What you should really be thinking about looking at testing for and considering with regards to treatment and how those things act differently for repairing your sleep patterns. 

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Yes. Oh, that's perfect.

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That's a perfect place to begin on this conversation, and I remember vividly our interaction of you sharing just some of the nuance. Is that maybe are just glossed over or not even considered in some of this conventional sort of blanket approaches to, oh, struggle with sleeve. Here's some progesterone.

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And you, I believe, if I'm recalling this correctly, had pointed to certain cases where you're working with people and they're almost having a more cortisol inducing effect by bringing in this progesterone. So anyway, yes. So if you could kind of explain how should we be thinking about this as you introduce us to this estrogen, potentially as a dominant hormone, and how can we think differently about this?

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And some of those, you know, maybe contraindications or things that can go wrong if we just take the normal path. 

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Yeah. Well, I think it's important to start with what's happening in an optimal body prior to. The beginning of ovarian senescence. Sure. So, you know, really ovarian senescence are like sort of aging and cellular death in the ovaries starts to kick off with more fervor after age 35.

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And thus, the secretion of estrogen and progesterone, which is governed by the pituitary hypothalamus in the brain, can become more unsteady. And people will often say, well, progesterone declines first. People are hopefully not in their head as they hear me say that. 

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Yeah. 

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Which never made any sense to me because it's one gland.

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The whole gland is aging. Yeah. So if there's a problem with progesterone, mind you, progesterone's behavior and activity is governed by estrogen. Mm-hmm. So what do you mean progesterone declines first? Like the ovaries selectively makes a, a poorer corpus lutetium and estrogen's perfectly fine. Mm. Like that makes absolutely no sense.

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Yeah. So I think it's, it's helpful to understand the cycle physiology, which is that in short, and I can explain this really quickly. 

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Yeah, please 

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do you know starting on day one of your cycle, if you're a menstruating woman. Your hormones are at a low level following like the shedding of your uterus. You know, you're, you're in your period, your hormones are at a low level around day four, five.

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Um, the brain is responding to the fact that that low level exists and it starts to pump out more follicle stimulating hormone. From the pituitary and follicle stimulating hormone increases the secretion of estrogen. And from about day five to, let's say around day 12 in a, you know, this could be different for every woman, but relatively in a 28 day cycle, we get a peak of estradiol, the highest peak of the entire cycle, right?

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Mm-hmm. That peak can be three, four, or five, even 600, right? For in a, in a cycling woman. And that peak is very important. It governs many processes in the body, and it is like this, this momentary regulator. In, in our, sort of, in our cycle of the month, it recycles our blood vessels. Right? So it turns over the intima, the innermost lining of our blood vessels.

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It, um, in increases stem cell production. Right. And it also sort of fires up all of the receptors around the body and there are estrogen receptors on every cell and surface in the body except for red blood cells. So basically everywhere. 

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Mm-hmm. 

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One thing that's bathed in. Estrogen receptors is the SCN in the brain, the schematic nucleus.

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Right. The master regulator of the circadian rhythm. So when we peak that estrogen, it, it's like a, it's like an on button in the whole body. Mm. Right. And the other thing that estrogen does when it peaks like that, is that it triggers the brain that it's time to secrete a hormone called luteinizing hormone.

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Lh, right? Luteinizing hormone should peak quickly, and that triggers the ovary to release an egg, a follicle. Follicles released, and right when LH Peaks, estrogen drops, it has like a nadier moment to kind of give lh its time in the sun, and then we ovulate a follicle. And what's left behind in the ovary is called the Corpus Lutetium, which is a temporary endocrine gland that secretes progesterone for, you know, 12 to 14 days in a, in a robustly healthy cycling woman.

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So then progesterone begins to rise. Estrogen rises again, and progesterone has its own, you know, series of things that it does. They both rise. If there's no pregnancy around day 21, 22, we start to see the, the fall of those hormones. And then as they get low enough, that triggers the release of the uterine lining and we start all over again.

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So if you are having sort of dysfunctionality poorer production in ovarian cells, if the, if the ovaries are aging faster than the rest of the body ages, which I think is a really important concept, that's, that was probably an evolutionary thing. Not all mammals have menopausal. People, creatures in their, in their, in their kingdoms, um, that we do.

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And it's, you know, it's probably helpful for, at some point for women not to continue to have babies so they can help other mothers, right? 

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Mm-hmm. 

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Um, but it does happen and it's like, it's kind of a phenomenon, right? Like other animals don't do this. We do. Um, well then we would expect that that rise of estrogen, it's like the beginning of a rollercoaster.

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Mm-hmm. You know, like you're, you feel vertical and it's going all the way up the hill. It's very important that you get all the way up the mountain. Otherwise, the rest of the rollercoaster won't work. Right. You won't have that momentum. 

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Sure. That's a good analogy. I like that. 

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So we need that momentum. But if you have ovaries and cells in your ovaries that are also right, we are also under tremendous stress.

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We have oxidative damage, we have poor nutrition. So there's a million other reasons that their aging has accelerated, right? That there's other things going on. If you were a smoker or used. Drink a lot of alcohol. This process of aging might have happened even sooner for you. Or you know, you could have poor ovarian function really early in life, right.

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As well. Mm. But we're talking about perimenopause so that that move up the mountain is extremely difficult now. 

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Mm. 

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Because it requires like very productive cells that are responding really well to a signal. The signal from the brain. And so instead what we see besides this nice up curve is kind of like cha chink, cha chin.

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Up, down, up, down, up, down, up, down. And so this can do a couple of different things. It might, you know, delay ovulation, right? It, we see a lot of times a woman with a 28 day cycle and when we start to actually monitor her cycle with like a Mira monitor for example, will see that she doesn't ovulate until like day 20 because her estrogen just can't get it together.

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Interesting. Yeah. 

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And then she has this little blip of ovulation. She gets good progesterone for three or four days, and then it's like, shit hits the fan, and then she's bleeding on day 28. Oh, you have a day, you have a 28 day cycle. Well, no, it's highly dysfunctional, but it all began with estrogen, right?

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Hmm. So if you're being told that in perimenopause, progesterone declines first, that just makes no physiologic sense. 

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Right. 

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It may be true that you respond well to a progesterone only intervention first, but just because a therapy works, therapy doesn't always explain physiology. 

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Yeah, absolutely. 

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And I think it's really important to understand that.

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And so if our goal is to. Recreate physiology or preserve physiology. And you can see now the connection between my love of birth and physiologic birth. 

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Yes. 

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And my like diehard obsession with the cycle and how important it's for the body because I just have such a reverence for Yeah. Our rhythms, our physiology.

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The artist in me also just loves that, like how it has this whole life cycle, right? Mm-hmm. That just does this thing and we should really respect that, right? Yeah. And when we respect that. Everything works well. 

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Yeah, and I love the language that you bring to this. So in the spirit of respecting that, how do you look at this different?

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Granted there's, I know this is very generalities, but if someone is coming your way and struggling in particular with sleep, how are you thinking about this differently than the standard course? 

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Yeah, so I think a lot of women start perimenopause with reduced tolerance to stress. And sleep disturbances.

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Mm-hmm. Those are, that's like, or anxiety, you know. Um, those are a lot of times, not always, but in my experience, early forties. Yeah. Those are really common symptoms. 

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Sure. 

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And so they might be offered progesterone, which again is not the wrong intervention, but again, it's not going back and really looking at like, well, what is estrogen functionality?

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So my first course of of action would be to really. If I can assess what's happening with the first half of the cycle in physiology and I do like to use the mirror or a needle monitor for that. 

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Okay. 

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Um, and we'll give you a link for that as well. Yes, please. Which, um, I think it's just such a useful tool.

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You know, we used to have to do Dutch cycle mapping on everyone. Yes. And it would take a month and it cost $500, then we had to wait for it to come back. And Yes. Now we get this real-time data and patients can share it with us. Much like A CGM. Exactly. It's like, it's like a cgm. Mm-hmm. But for your hormones, it's incredible.

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Yeah. So you can really see that pattern. I don't rely on it entirely for just sufficiency or response to hormone therapy. Mm-hmm. But in terms of pattern, yeah. It's the, it's the best. And to me it's the gold standard. 

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Sure. 

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Um, so I would wanna assess what's going on there and then, you know, I would recommend intervening, um, potentially, again, this is aside from like all of the other counseling and we can talk about changes to the vagus nerve system 

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Sure.

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As well under the influence of like cycle fall apart, which is kind of how I like to conceptualize what happens in perimenopause. Okay. It's not just hormone decline, it's cycle fall apart, and the loss of rhythm is just as important as the loss of hormone sufficiency, right? Mm-hmm. So I would look at that first half of the cycle.

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And I would wanna know, are you like the person I just mentioned who took until day 20 to ovulate? Mm-hmm. Um, are you ovulating just fine, but you're having 24, 25 day cycles because your progesterone's low? Like, where's the problem and how do you feel like what's going on during that time? Right. And have we, have we done the low hanging fruit things?

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Have we done, have we, you know, are you eating well? Are you, you know, doing the basic lifestyle stuff that like we would, we would want and expect for a person to be doing? And can we make any headway with that lifestyle stuff? Many times when people come to us, they've already done a lot of that. 

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Mm-hmm.

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Um, sometimes they haven't, they can use some support, but you know, there are certainly places where we can optimize that cycle. With an herbal intervention, with just working on, you know, the other pieces, the other input points like circadian rhythm, retraining, those kinds of things. And then there's situations where like no matter how healthy you are, like where I was when I was 42 and started hormone therapy, it, it just, you know, we just go in and we replace the rhythm and we replace the insufficiency.

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And it's really that simple. And so we, we will use oftentimes a compounded transdermal cream because it allows for dose adjusting. Right. So we use a toppy click, which I will show you when we talk about what's on my nightstand later. 

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Yes. 

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Perfect. 

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Okay, 

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great. We use a top click device that provides, um, half a milligram per click.

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Um, so that we can provide, say, you know, 1, 2, 1 or two milligrams, um, days, one through five of the cycle, and then maybe we bump that up days six through eight, seven through 9, 10, 11, 12. We're going up to mimic that rollercoaster. 

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Mm. 

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And for many women who are in early mid perimenopause, that will actually help them ovulate in a more, more robust way.

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Absolutely. 

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It's almost like giving Clomid, right? Which essentially does that Sure. Boot bolsters FSH and LH and helps you make more estrogen. So it's, it's really quite fascinating and I find that, um, it works so much better than a low dose approach in perimenopause because those bodies, those brains at between 38 and 48 years old, even depending on kind of where you are.

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Sure. They are used to robust levels of hormones, right? Yeah. We're not talking about, you know, Millie, who's three years post-menopausal and hasn't had hormone exposure, and we're just trying to protect her bones and get her 

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up 

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to an estradiol level of 80 every day. Like that's a different scenario and there's a time and place.

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But you know, we, we really find that that works well, especially for those women with sensitive nervous systems. They feel the shift in estradiol. 

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Mm. 

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Because it's such a master regulator for the vagus nerve system. 

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Got it. Okay. And then I love your. Walking us through the ways in which you'll get this information you're testing routinely.

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How long does this, and I'm sure of course this varies by the person, but is there a generalized expectation of the length of time that you might be testing and then maybe retesting to see what the kind of curvature and look of that hormone monthly cycle is looking like and ways to kind of course correct along the way to find that perfect kind of solution for the individual?

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Totally. So I usually have someone use some type of, um, cycle tracking app. Sure. Um, just to, you know, I use natural cycles. I open it up and I like click my symptoms. Um, so there's that piece. And then for the first year or so, we're measuring every 12 weeks. So every third cycle where we'd make a dose adjustment.

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And of course there are times when I'll check every eight weeks. Um, we'll check a day 12 and a day 21 by serum. 

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Hmm. Got 

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it. Okay. So we're checking estradiol, possibly estro. Um, if someone's, especially someone who's kind of always running higher in estrone, we wanna see a complete picture of kind of estrogen sufficiency.

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And then day 21, we're checking a progesterone as well. Um, and then if someone is the type of person who really likes that daily feedback, yes. And. I've had a few people who have especially sensitive nervous systems, and they really love the validation of seeing that, like, while they're in this onboarding phase, like some women need to apply their cream three times a day instead of twice a day just because they, they seem to move through it really quickly.

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Mm-hmm. 

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Um, and sometimes if we apply a patch underneath that, it helps stabilize, there's lots of different techniques that we use. Sure. But they, they might be. Five, 600 on, um, their, you know, metabolite test, urine metabolite in the morning on the mirror monitor, and then by 3:00 PM they're like down in the eighties.

‍

And, and it helps them to be like, oh, that's why I feel crazy. And that's why, you know, my brain doesn't feel really good, so. 

‍

Sure. 

‍

It takes about, um, you know, anywhere from nine to 18 months to really get someone kind of to the right dose. But then you, I think it's, you throw in their perimenopause and the fact that you have ovarian decline cap quietly happening in the background and you're constantly working with that.

‍

So it really, it's not for everyone, it's for the motivated woman. 

‍

Okay. 

‍

Um, but I, I find that like when you give someone back, um, their sleep, their sanity, their clarity 

‍

Yes. 

‍

Their mitochondrial health, right. Uhhuh, it's. The trade off is like nothing, right? Yes. Um, it's entirely worth it for sort of the, the overall benefit.

‍

Oh, wow. That's fantastic. Okay, so I know this is a huge topic and I know we've only just scratched the surface, but I'm thinking maybe we can also extract some additional information as we go into how you're managing your own sleep. Mm-hmm. Since we ask everyone that does come on the podcast for questions about their sleep and what that looks like now.

‍

And of course it's dynamic and it's probably adjusting and when you're traveling and. All the things, but so far, what would you say your nightly sleep routine is looking like right now? 

‍

Hmm. Well, I have four kids. Okay. I have little kids, so I've become very flexible, like with getting my needs met in ways Yeah.

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Like, it doesn't have to be rigid. 

‍

Sure. 

‍

So, you know, one thing that I find really helpful is I, I'm, I'm, I'm pretty religious despite being. Constantly teased by my family about my blue light blockers at nighttime. 

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Love it. 

‍

And I look like a total tool walking around my house and my sweat slippers and blue light blockers.

‍

But, um, it does really help me and I find it's even, it's especially important when we, the five months of the year here in northeast Ohio, where it's very overcast. 

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Mm-hmm. 

‍

So that's a big part for me. I also often, like fall asleep. I, I co-sleep some, sometimes like 50% of the time with my, uh, little guy who's in pre-K.

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He's five years old, my last baby. Um, and I, I do think that there's a really incredible co co-regulation that happens like when you have practiced atta attachment parenting. And I don't find that it's disruptive to my sleep, um, to, to bed, share with him on occasion. Sure. 

‍

Yeah. 

‍

So oftentimes that will happen.

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Um, but I do, you know, I, I have to ap apply, I apply my hormone creams. I, you know, have a hearty supplement stack. I'm also extremely addicted to my very bougie skincare routine. Um, and I just, well, your skin is 

‍

glowing, so 

‍

whatever you're doing, thank you. Yes. It's, you know, I, I, to me, like being really high maintenance about that is like, is a way that I regulate myself.

‍

Sure. Pour into myself, and also that at a time in my life where I don't have control over lots of things. 

‍

Mm-hmm. 

‍

I get to have this kind of little mini retreat every night in the way that I take care of myself and everything smells really good and is super clean and like, it's just a, it's just a beautiful thing and I, I think my children see that like.

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You know, when you pour into yourself, it's, it sets a really positive example for them. That's so, that's very 

‍

interesting. I love that. Any favorite brands or anything 

‍

that we should know about? I'm a big fan of Monastery as of late. Okay, cool. Yeah. Yeah. Their Golden Radiance Oil is like off the chain. Um, I also like this brand, I wanna say it might be Korean.

‍

It's called Ven, VENN. Okay. And it's very like clean anti-aging, um, meets one another. Um, I also, I love oaa products, like just for very like. You know, kind of everyday casual. Sure. Especially body stuff and a couple of things that are my nights Sander o ah. Um, yeah, so those are, those are probably my tops right now.

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That's great. No, I love that you brought that in. 'cause you know, often we'll hear some of the, the standard wind down practices and what have you, and I think that is so true that that is such a demonstration of. Self care, taking time for ourselves, and I really admire that. 'cause I am really not the best at that.

‍

So I'm gonna have you in my mind to start being more thoughtful in that domain. So beautiful. 

‍

It just, you know, when you wake up with like a well taken care of face, it just 

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Yes. Starts the day off differently, 

‍

changes everything. Plus I'm not, I'm not gonna be a bot. Girly. Like, I just know it's not gonna be a choice.

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I wanna make sure. Um, and so I do feel like it's just like everything, you know, it's a daily investment in that 

‍

I hear that my husband is a nonverbal communications expert, so the reading of faces and so he can immediately tell with all, 'cause he has all this ai facial mapping coating and so it can immediately tell if there's Botox present.

‍

So I can't certainly be the, uh, the Botox wife. It's so, 

‍

yeah, 

‍

I, I'm right there with you. So gotta, I really gotta step 

‍

up 

‍

my game. 

‍

Well if ever wanna just talk skincare, I am your girl. 

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Okay. 

‍

I'm like, I think I am very 

‍

upset. Scheduled part two. Okay. 

‍

Yes. 

‍

So good. Well, whatever you're doing is working, so, okay, love that.

‍

And then, what might we see in your morning sleep routine with the idea that how we start our day can impact our sleep? 

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Yeah. Well, I have a, I have several supplements that I do like right upon Rising, so I often do that, and I find that, um, in the summertime I like to sauna upon rising, like, early, early, early, um, just to kind of like wake my body up slowly.

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Sure. Um, in the wintertime, I don't like to sauna in the morning because I like to sleep like 20 minutes later. 

‍

Hmm. 

‍

Um, so I'll do something like a little vibration plate or just something to kind of get the blood flowing that's passive because I also think that one of the. Biggest luxuries in life is having a slower morning.

‍

Mm-hmm. Couldn't agree 

‍

more. So if there's a way that I can, even in the midst of having to get kids out the door and like, you know, we leave at seven 20 for me to drop kids off at school. Um, I, I don't want to be like trying to stack in some big health routine before that happens. It's like, I wanna just like not feel rushed.

‍

Mm-hmm. Even though I am rushed. 

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Yeah, no, I get that. 

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You know, so I tried to. Productivity. Keep it simple. I, I love to make matcha that's like very ritualistic for me and something that I just is my favorite thing in the whole world. Hmm. Um. Yeah. And in the summer the first thing I do is get, is sit on the front porch with my matcha and, and get sunlight in my eyes, like after I've hydrated and taken sort of my morning stuff and gotten my blood flowing.

‍

So 

‍

yes. I love that. Yeah. Well, if you try out that sun hug, let me know. You can make, bring the, the matcha out in the sun hug hot situation, right? Yes. I 

‍

have to 

‍

superior. You'll have to let me know if you like that. So having said that, that's beautiful kind of. I love that luxury of the slow morning, you've such a way with words.

‍

And then on your nightstand, we alluded to some of that. So what might we see there? 

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Well say I brought, I brought all my toys with me, so I have my, I have my, my blue light glasses. 

‍

Okay. Trendy nonetheless. Yes, 

‍

I have um, this oaa vagus nerve pillow mist. Have you ever used this? 

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No, I have. 

‍

Lovely. This is lovely.

‍

So funny. I have their undereye. 

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Yeah. Roller ball. That's a good one to ocean eyes. 

‍

Yes, exactly. 

‍

Yeah, I know, I know all 

‍

the things. You know, 

‍

all the things. Yeah. They also have a vagus nerve oil that I love and it's very delicate. Like it's just a nice, I don't know if it actually stimulates the vagus nerve, but, 

‍

but just even the concept, 

‍

the intentionality of it, it's so lovely.

‍

Yes. And I also have, um, this is like a, you know, I'm not even a fucking affiliate for o but I love that I have, this sound should be this body balm that I love, that I use to hydrate in the evening. And then if I have my. My hormone creams. Oh, nice. Um, so this is what a toppy click looks like, and um, I'll give you an example of like what one click is.

‍

So you just do this. Little tiny bit comes out with each click and every day you have a card and you have a slightly different dose. Um, so I do that shortly before bed, sometimes in bed, sometimes in the bathroom. Um, and then I, and when I do progesterone and I, we need to do a whole other episode on progesterone because we didn't even get into it today.

‍

But my preferred. Root for progesterone for myself, and um, I do encourage it with many of my patients is a vaginal progesterone. Oh. Um, and we'll have to have a whole episode on why that is, because it's really important and kind of how progesterone acts very differently than, um, why it's so good for sleep is not necessarily good for the brain.

‍

Sure. Um. 

‍

So I prefer to not to avoid first pass through the liver. Okay. And so I use vaginal progesterone by some these suppositories, which are like really quite lovely, well absorbed. And I do that for 15 days a month. 

‍

Oh, great. I love 

‍

that, which works amazingly, and I just like absolutely love that face.

‍

So I will grab one of those bad boys outta the fridge. Yeah. Um, before bed and then pop it by my nightstand so that when I pop, hop into bed, you know, I put it in and then, then I'll, like, if my kids come and bother me. Um, I'll be like, I can't get up. I already, you know, did my suppository tonight. 

‍

Yes. Oh my God.

‍

I wonder if we're gonna have to get you, have you seen those little talk about bougie, like the mini refrigerators in your bathroom? Oh, 

‍

totally. Yeah. I, I really should. That, 

‍

that might be a Christmas or holiday gift, uh, in your future. 

‍

A 

‍

hundred percent. 

‍

It has to be super cute. Too. 

‍

Yeah, exactly. Exactly. And real quick, 'cause I completely agree the need to go in deeper on progesterone and future conversations.

‍

And just wondering, because I loved what you had said when we first had met too, about some of the surprising impact of just the experience of maybe a cortisol inducing effect, if I heard you correctly. Yeah. Where are you seeing that commonly? Is that. What do 

‍

you see? So that's a, that would be like a paradoxical reaction to progesterone.

‍

Um, we see it often with people who are sort of weird metabolizers, the women that take magnesium in the morning because it makes them more awake. Um, sometimes people who have mast cell activation will have that sort of weird reverse paradoxical reaction to progesterone. Um, so I would say that there's a.

‍

Small amounts of women who seem to have that response. But there is a relationship between, you know, cortisol and progesterone. And if you're, you have a lot of dysfunctionality in your adrenal system, um, you may respond differently to progesterone. 

‍

Sure. No, I appreciate that. Okay. So just, it's the good cliffhanger to the need to go in deeper on that topic.

‍

Yes, yes. And really to talk about. What, what difference? What? What is what? How is the body? It's a very different drug when you take progesterone orally versus vaginally versus transdermally. 

‍

Sure. 

‍

Um, and why is it making us go to sleep? It's not because it's regulating the circadian rhythm. 

‍

Yeah. Talk about that cliffhanger.

‍

Beautiful. Mm-hmm. Okay. And then well, lastly, so far to date, what would you say has made the biggest change to your sleep? Or set another way? Biggest aha moment in managing your sleep 

‍

well. But from a very personal perspective, um, changing careers. And I think, yeah. I just wanna say that because I think that sometimes we have these ideas of like, that's not for me, or that's not possible for me.

‍

Yeah. And you know, I went to an Ivy League school and spent a lot of money to become a midwife, and I'm deeply passionate about that. Yeah. But I found a way to transmute that skillset and my passion in a way that I could also support. My body and actually feel good and be well, and hopefully be around for a lot longer for my children because I've chosen a different path.

‍

Um, so I think that I, I would just say that like the biggest thing for me was realizing that my life, it's okay to make a big life change so that your health improves. 

‍

Mm-hmm. 

‍

A lot of people don't feel like they have that permission. 

‍

Yeah. 

‍

Um, and then from a, just a very practical, kind of low hanging fruit perspective, what's made the biggest um, impression On my sleep?

‍

I would say optimizing my estrogen. 

‍

Absolutely. Yeah. 

‍

Um, and a lot of the time when we have, uh, you know, insomnia postpartum, it's because it's a relative state of perimenopause really with, you know, a lot of ovarian suppression, secondary to breastfeeding and being postpartum. Um, and you know, that, that, that we always talk about the liver when we talk about like three or 4:00 AM wake up or lots of other things, cortisol, dysfunction, blood sugar, but you know, lack of estrogen is another major driver of that.

‍

That kind of wake up time. So optimizing estrogen was a, you know, completely changed my life at 42. Yeah, 

‍

so good. And I so appreciate you also discovering this for yourself and then sharing this with the people that you work with and then taking the time to share this here. So for anyone that is hearing all the things you're saying and absolutely needing and looking for that support and to work with you, follow you, be a part of your world, what are the best ways to do that?

‍

Yeah, so you can always follow me on Instagram, shoot me a message if you listen to this and have questions. Emily Sadri, np. You can also find me on my website, emily sadri.com, um, or my telehealth company. Um, we serve 12 states coming very soon to Texas. So if you're in a state, um, we're, we're coming soon to California, Texas, PA in New Jersey where we're not currently.

‍

So if you're in one of those states, you can always reach out to us and go on the wait list and we'll let you know when we're there. But we're in 12 states currently, aurelia health.com, and we do this type of precision hormone work with women. Typically ages, you know, 35 plus, um, who really want a more, um, personalized, uh, truly like nervous system focused approach to their midlife sort of recovery and repair and optimization plan.

‍

Ah, love that. Well, thank you so much, Emily, for taking the time and for all the work that you do, and looking forward to that part too. 

‍

Yeah, me too girl. Thanks so much for having me. Yay. Yes, 

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thank you. You've been listening to The Sleep Is A Skill Podcast, the top podcast for people who wanna take their sleep skills to the next level.

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Every Monday, I send out the Sleep Obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet. Fun fact, I've never missed a Monday for over five years and counting. And it contains everything that you need to know in the fascinating world of sleep. Head on over to Sleep as a skill.com/newsletter to sign up.

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