And so I’m here to tell you that, for example, I’m just gonna be upfront. Because that’s kind of what this podcast is about, sharing stories, my stories, other stories, practitioners being willing to be vulnerable and share their stories and go, hey, this is how I struggled. And only from the benefit and privilege of being educated in this and being an expert in the field, were they able to overcome. And that’s a similar story for me.

And that’s why I’m doing this podcast is to help you guys and people, guys means everyone to me, sorry. I’m not trying to gender sway things one way or the other, but it is a gender neutral me and my use of guys. But that’s the reason I’m doing this podcast is because I don’t want the struggles that I have gone through and the benefit that I got from going through them, the strength, the wisdom, the knowledge that I got, to just only go to my patients and people who can afford to access it, right? So that’s not fair. 

So why not share it with everyone? And so that’s what this podcast is about. So I wanted to do this episode on sleep and sex because it’s like fundamental. It’s the base of Maslow’s hierarchy of needs, right? Food, shelter, sleep, sex, like belonging, connection, right? Basic human touch. 

Everybody wants to have that. Like it’s right up there at the top. So let’s talk about sleep lifestyle medicine for better pelvic health, essentially. And what’s my story in this? Well, I’ve learned a lot over the years about it. I’ll be 51 this year. If you’re watching the YouTube, you can see my, you know, sparkle hands or whatever, my jazz hands in the air because it’s been a great transition for me.

I’m on the other side of the menopause experience. It’s fantastic. I love being here. I’m super free with everything. I can do anything I want. I’m not hemmed in by biology anymore. And it’s pretty awesome. But that is not usually the case for most women. It’s usually some kind of inferno, like literal inferno and special hell. And I’ll be the first to say that if I didn’t do what I did for a living, it would be a special hell. It would be an inferno. And I also won’t lie because I had to experience some of the symptoms first to know, okay, well, it’s time to take care of it because now I’m fully entering into that fantastic transition where I get to spend a third of my life or so, maybe even more than that, completely free of biology. 

So some of the early symptoms that I felt were sleep issues. I mean, awful sleep issues where you would wake up drenched or you really couldn’t get to sleep at all or you’d go to sleep because you were dead dog tired. I’m not sure where that phrase came from. No offense to any dogs.

And then you’d wake up at 2AM. You know, like a prairie dog popping its head out of the hole. Hey, what’s up? There’s no, you know, sleep going on here. And I have done so much work in the mindfulness field just for myself, which has definitely made me a better therapist and teacher. But I used to be the kind of person that when I would wake up at 2 AM. Forget about it. I’m up the rest of the night.

And I don’t want that to happen to you. Because I spent a good part of a decade, I think, with that experience because here’s the thing that people don’t tell you, it’s not in the prenatal brochure. Postpartum can be just like perimenopause. They look the same, y ‘all. So I don’t care if you’re 22 and you’ve had your first or you’re 32 or 42 and you’ve had your first. Get ready because you’re gonna feel postpartum with a brand new human being to take care of.

And if you live in a country like the US, just to talk policy for a second, you are existing without the basic Maslow’s hierarchy of needs support that you need. So unless you have an absolutely fantastic partner who is going to share that load equally of work with you, and I guess they exist, then you are going to have a rough time.

You don’t have to have a rough time because you should be able to treat at least these perimenopausal symptoms that you’re experiencing during postpartum. So really, again, this podcast is for everyone. Because even if you are in the prime of your life having babies and loving it, you’re still gonna have interrupted sleep and sex because you’re either in that postpartum kind of perimenopause type time. Or your flipping kids are getting you up all the time, right? 

So we need to know how to get back to sleep again. And you need to go, need to know how to get to sleep. So I’m gonna give you some tips, never fear. Now, on the sex side of things, frankly, you’re not gonna feel like having any if you’re not sleeping well, right? So do I need to explain the correlation there? Or the relationship rather?

I don’t really need to explain it because you just don’t have time for anything else if you’re not sleeping. So let’s talk about getting the sleep right first. And then if you still have some sexual dysfunction that’s outside of that, it could be very much hormonally driven or pelvic floor driven. And both of those things I actually love to talk about and treat every single day. 

So let’s start with sleep first. Now, sleep and sex are two of those big pillars that make up the base part of the Maslow’s hierarchy of needs. Beyond housing and food, sleep and sex are top notch elements to survive for most of us. All of us for sleep, okay? Maybe sex is optional for some people. So you get to decide. Sleep and sex allow us to get to the point where we can move past just surviving and move towards thriving. So what can we do to improve sleep? All right, y ‘all, first we need to know what’s normal.

Seven to nine hours of sleep, but not nine hours of sleep every night. You’re gonna lean more towards the eight, solid eight. You can get away with seven sometimes, but not all the time. You can get away with nine sometimes, but not all the time. Less than seven and forget about it. I remember stories about Ruth Bader Ginsburg saying she didn’t need sleep and that she could stay up writing all these briefs and stuff.

I listened to her autobiography, I think, and read a few books about her. And she was thriving for a very long time, but it doesn’t mean that her brain was thriving for as long as it could have. So you do need sleep. I don’t care who you are. I don’t care how smart you are. You do need sleep.

You should also fall asleep within 15 minutes of your head hitting the pillow. If not, you’ve got a delayed sleep onset that needs to be treated. That is something that a lifestyle medicine versed person can help you with, okay? It’s a big part of what I treat every single day. 

You should stay asleep all night long and not wake at all. Except if you gotta get up to go pee, which we call nocturia, getting up in the middle of the night to urinate. If you get up in the middle of the night to do that, really, I don’t want it to be more than one time. Some people say two times, I just can’t get on board with that. 

Now that may be what the evidence says, but I know if I was getting up two times a night, forget about it. It’s not working. And I think that’s true for most people and I encourage my patients to aim for the same goal, max one time a night, preferably not at all. Your bladder doesn’t, you don’t have to get up in the middle of the night, okay?

When you’re pregnant, this will be worse. You won’t have the space for the bladder to fill and you’ve got a baby kicking it and laying on top of it. So, okay. I can understand why that’s the case. I had three babies. I had to do the same thing. You’re sleep deprived anyway. Fortunately, you can recover from that. So, past the nocturia, let’s move on to the next thing. You should wake up feeling refreshed. If you don’t, something needs to be tested because maybe your cortisol and your melatonin

are having issues. They’re not getting along because you can’t have both melatonin and cortisol happening at the same time. As your melatonin levels go up, your cortisol comes down. And in the morning, your cortisol levels should naturally come up as your melatonin levels go down. There is a way to test for that within labs. And so with my patient population, I do refer out to make sure they can get those labs done and back to me and any other practitioner that needs to see them so that we can make changes in their lifestyle choices. 

So if you do not feel refreshed, that is not normal, okay? It is not normal to wake up feeling groggy. It’s not normal waking up to feel like you’ve got a hangover or you drank too much when you didn’t drink at all, for example, okay? Speaking of alcohol, we’ll get to that later, okay? And ideally, in an ideal world, when you’re well rested, you will wake up without an alarm. Yes, it’s true. 

Not if you have to catch the 4 AM  or 5 AM flight, okay? Or if you chronically get up at 5 AM and you’re not getting the appropriate eight hours of sleep at night. But otherwise, you should be able to wake up naturally and normally and feel refreshed. So ask yourself this question, are you normal? Probably not. 

Most Americans, I say that because I’m in the United States, but most Americans aren’t. But, you know, I have traveled a lot in my work life and for fun and personal travel. And I’m always talking about lifestyle medicine wherever I go. And most people have sleep problems. It’s universal. So to improve your sleep, fortunately, science is pretty straightforward. So that’s good.

First, create darkness. Now, I just came back from Scotland and two summers ago, this very same time, I was in Alaska where the sun doesn’t set. And when it does set, it’s for a very short amount of time, just a few hours, and the sun is back up. So I just came back from Scotland where at 3 AM the sun rose. And what happens when the sun rises in the natural world where I was? I was sleeping with all the windows open out in the country.

The birds start singing. Okay. You go from night noises and silent to beautiful bird song. And let me tell you, the bird song in Fife where I was, was stunning. Bird song I had never heard before in such detail, but it also meant I was awake at 3 AM. So I had to use some white noise and train myself to go back to sleep, which I have. But first you need to create darkness. So, blackout shades.

White noise. Now, some people argue against white noise, but if you have tinnitus or a noisy environment, you may not have a choice to use it. So white noise can be controversial, but again, tinnitus or noisy environment, you may not have a choice to use it. 

No TV in the bedroom, sorry, but no TV in the bedroom. It doesn’t work, any kind of blue light or noise pollution is going to impact your sleep, even if you think it doesn’t. You also want to wake up with sunlight, which can be tricky. So if you completely use blackout shades, you won’t wake up with natural light. So you need enough natural light access in your room, which I have created in my bedroom, where my drapes are completely closed. They are blacked out. So no light gets through there. 

But I do have some transoms that are like little sun lights above my windows that are shuttered. And when the sun gets high enough, it does start to peek up over those windows, right? So, you know, at first light, I might just get a very dim amount of light. Your pineal gland perceives that light. It’s super important. So figure out how you can introduce that natural sunrise light into your space so that you don’t chronically oversleep and sleep too much.

The other thing you can do if you can’t do that naturally, like I do it with my windows above my shutters, they’re not covered at all. You could do it with one of those natural sunlight globes. I love those things, those little sunlight clocks that gradually the light comes on to mimic that sunrise. You can do that. 

Have your melatonin and cortisol levels checked. You can do that as well. Manage both of them. Don’t mega dose on melatonin. I am not your practitioner, so I cannot prescribe melatonin doses over a podcast, but I can only tell you what the literature says. Microdosing is going to be better. So three milligrams and under, sometimes one milligram and under. That’s like a pediatric dose. It’s a small dose, that one milligram dose. 

If you are older, you may need a slow release formula melatonin. Not just the standard melatonin off the shelf. And I would just beg you, just…can you avoid buying it at some drugstore chain where it sits on the shelf? Lord knows how long it sits on the shelf. And it’s all mega doses. 10 milligrams and up. We don’t need elephant gun, you know, equivalent of melatonin. So let’s not do that. And let’s do what the literature tells us to do. 

Also, you could consider a form of magnesium, not citrate or citrate. That’s a laxative. If you want to stay up all night emptying your bowels, sure, go for it. But not citrate, some people call it citrate, however you want to identify it. 

Magnesium glycinate and malate are two that are commonly used because they do not have a laxative effect. The dosing, you’ll have to consult with your provider on. Again, I can’t prescribe that to you. I know what I discuss with my patients because many of them are magnesium deficient. You are not going to sleep well. You’re not even going to exercise well. You’re not going to have good pelvic or orthopedic function if you’re low in magnesium. All right. 

So the other element that you could consider adding, this is not a laundry list, right? Because this is just a 20 minute podcast today. Is L -theanine. It’s an amino acid and that can be used for calm, not just for sleep, but just for calming and mood regulation.

All right, so let’s move on. The second piece, sex. So you’re gonna implement all of these things and your sleep is going to improve drastically. Now there are other things. That is not the only thing for sleep, but I cannot go through all the sleep science, okay? So consult your local practitioner who is certified in lifestyle medicine.

That could be an MD, a DO, mental health, a physical therapist, even a nutritionist and a health coach. All those people could discuss your sleep lifestyle medicine. So moving on to sex, all right? If your sleep’s improved, then your pelvic health is going to improve, your inflammation is going to go down and your sexual function will improve. The shocker is there are no norms for frequency. I can’t say one time, or three times or whatever is normal per week. 

But one thing is for certain, sex should never be painful. That’s a pathology. And pelvic PT or OT, a pelvic practitioner, that is a therapist, specialty trained in pelvic health. I’m not talking about a GYN here. They look at something completely different. If you think, or GYNs think, or anyone thinks we’re ever in competition with GYNs, we are not. We do completely different things.

We work together synergistically, but we’re not the same. So you need a pelvic PT or OT. That is your first stop because they need to diagnose why you’re having sexual dysfunction. Now, painful sex for men can look like painful ejaculation, what’s called a hard flaccid syndrome or situation, painful erection, premature ejaculation, and overall ED or erectile dysfunction. All treatable.

You do not have to suffer with that. Not one more second, not one more day. So go and find your local friendly, helpful pelvic PT or OT. And if they have actual extra additional training in sex therapy, fantastic. So for women or people that identify as women, what does painful sex look like? Attempted penetration or penetration that’s painful. 

It’s not just penetration and sex is not just penetration. Let’s get past that y ‘all. It can mean many other things. Just that stimulation around the vulvar area can be classified as sexual dysfunction without penetration ever actually happening. And then any rebound pain or what I call rebound pain after penetrative intercourse or non -penetrative intercourse. You shouldn’t have pain the day after two hours later or 48 hours later.

And a lot of women will come in and say, you know, it was fine during, but holy cow, afterwards, not so much. And now I don’t want to do it anymore. Okay, we need to address that. It’s all treatable. And then the other thing that’s common with women is not just having superficial pain or deep aching type pain in the pelvis, but having UTI type symptoms. And it’s not that you have a UTI. So again, don’t abuse the antibiotics. Go back to my previous episode, episode seven on gut health and sexual and pelvic health to learn about that. 

But overall here, you guys, all this is treatable. And of course, I can’t give you all the solutions. All of these issues are too complex for simple solutions. But a major culprit in sexual dysfunction is going to be a dysfunctional pelvic floor. The muscles, there are many, will be too tight, non -functioning, you know, a number of things and they also connect directly into the hip as well. 

So a good pelvic PT or OT will fully evaluate the entire pelvic girdle, the low back, the SI joints and the hip. So the only people who are really experts in evaluation of that sexual dysfunction, pelvic floor dysfunction are gonna be pelvic PTs and OTs. So there will be a link in the show notes to find a pelvic health therapist. 

Also know that it might be good to have in your back pocket, a sex therapist as well because they are going to also be very synergistic in treating these issues too. So I hope this has been a helpful episode about sleep and sex. Leave me a comment, leave me a positive feedback and if you’ve got questions, just leave them in the comments or reach out at our website or wherever you find and listen to your podcasts. Thank you guys.