Why You Wake 1 To 3 A.M.

Dr Kirstey Holland 0:00

Why you wake between 1 and 3 a.m.? The liver, your hormones, your blood, and your nervous system in the small hours of the morning, and what I do about it in the clinic. Okay, let's get started. If you wake often or almost every night, between 1 and 3 in the morning, tired to your bones and yet wide awake, I want you to know that there is a reason, and usually there is more than one. This is one of the things I'm asked about most in the clinic, and the answer is rarely a single thing. It's extremely nuanced. It can be your liver, liver chi stagnation, your hormones, cortisol and melatonin, your blood, blood deficiency in TCM, your nervous system, your HPA axis, your HPO axis for that matter, or blood glucose dysregulation, and the early hours of the morning are when each of them can pull you out of that beautiful deep sleep. In Chinese medicine we pay really close attention to which hours a woman wakes because the body is not random about it. The window between 1 and 3 a.m. in the morning is liver time. The liver keeps blood and qi and your emotions moving smoothly or coursing smoothly throughout the body, and it's deeply involved with your hormones. So when the liver is overloaded or overheated or stagnant, it can wake you in the middle of the night. I want to walk you through why that happens in perimenopause and everything I do in the clinic to settle it down. Remember, this is important because when you're sleeping, it is the only time that your brain gets to take out the trash. Your lymphatic system is turned on, which is a system that allows your body to clean the brain. This sits in the repair phase, and it's really part of us kind of cleaning up all of the toxins in the body. Because sleep is where your body repairs, and everything else in your healing needs a steady foundation. We need steady sleep in order to be sustainably vital. We will also lean on test because I want you to see your cortisol and your melatonin, your iron and your hormones rather than guessing. I understand and I completely support the idea that perimenopause is a symptoms-based diagnosis, but sometimes a test is worthy. And prescribe because there is a great deal of natural medicine, or there are great there is a great deal that natural medicine can offer in this space, of course. So if you are one of the many women who wakes between one and three in the morning, exhausted yet completely alert, I want to explain what is actually happening, because it is not one thing and it is definitely not your fault. I'm going to take you through the liver, your hormones, your blood, your digestion, and your nervous system, as well as blood glucose, because any of them can wake you in the small hours, and in perimenopause they often work together, which is just a bad mocktail. Then I'm going to tell you what I actually do about each one of them in my clinic.

Liver Time And Sleep Disruption

Dr Kirstey Holland 3:03

The liver and the 1 to 3 a.m. window. So let me begin with the liver because in Chinese medicine the window between 1 and 3 a.m. in the morning does belong to the liver. And it is this time that I'm actually asked about most. The liver keeps blood, qi and emotion moving smoothly through the body, and it is deeply involved in your hormones. When liver qi stagnates, it generates heat, and that heat rises and disturbs your sleep. So it matters a great deal that the liver is happy, cool, and free-flowing. One of the classical formulas I reach for here is either Shao Ya San or Zhaoi Shao Ya San. Its cooling version is the Jia We Xiao Ya San, so I generally use the second for a lot of perimenopausal women, which translates to the free and easy wanderer. Because that is exactly what we want the liver to be, free and easy. We don't want the liver to be stagnant and hot. The liver can also wake you in these hours when it is overloaded and needs to detoxify. So this is really important. And in the repair phase of the hierarchy of healing, we really do kind of weed out the gastrointestinal tract, we you know get rid of all those weeds, we create some beautiful fertile ground, and then we plant the roses so that it's really easy for us to actually detoxify our endogenous hormones. And I'm looking at estrogen here really. This is one of the strongest reasons I ask you to stay away from alcohol in perimenopause, and again, particularly in the repair phase of the program. Alcohol has the tendency to heat us up and it does disrupt our sleep architecture. It is not your friend, it is certainly not your brain's friend in perimenopause, unfortunately. So your sleep architecture in perimenopause is already compromised, and this can also relate to the blood glucose dysregulation which so many of us experience because we're actually unfortunately in a more insulin-resistant state at this time. So when blood glucose is dysregulated, or when blood glucose is high, or when stress hormones are higher overnight, unfortunately there can spike cortisol, which then again spikes insulin, which can actually cause you to put on weight while you sleep, as opposed to being in a state where you can sleep yourself skinny, which is actually what we want. And just as I say sleep yourself self skinny, I say it because it sounds fun, but it's actually more about being lean and strong. So please remember that. It's easier to remember sleep yourself skinny. So let's go with sleep ourselves lean and strong, but you you understand what I'm trying to say. Muscle is absolutely so important. It is literally your huge lever when it comes to glucose, blood glucose regulation. So I'm all about perimenopausal women to have, you know, about us having as much muscle as we possibly can. It's a real sponge for blood glucose and therefore helps us regulate our glucose and our insulin and therefore keeps us away from type 2 diabetes or metabolic syndrome or pre-diabetes, um, etc. So, um yeah, so this is really important. There's something deeper going on too. Your body will always prioritize a toxin that comes in through the mouth. This is evolutionary biology at its best. The moment you take in an alcoholic drink, your liver actually stops what it is doing and it prioritizes clearing the oral toxin. So it clears that alcohol first. And here's why that matters so much for you right now. Perimenopause is often a high estrogen state. Your own internal estrogen can run two to three times higher than in your younger fertile years. So many of us are in an estrogen dominant state. That means we need to be clearing estrogen properly through the gut and the estrobilome, as well as the liver. So estrogen detoxification part of the gut is called the estrobilome, and that estrobilome is inside of the microbiome, and of course through the liver. This is why healing, sealing, and repairing your gastrointestinal tract is actually supportive of hormonal balance. You can't really separate the gut from hormonal balancing. And look, I completely understand that online there's so much controversy around, you know, saying the word, I'm going to be balancing your hormones, because of course hormones are always fluctuating. But I say this and I use those terms because these are actually the terms that the beautiful woman that I take care of come into my clinic using. So there's no point in me using, you know, crazy biochemical names and terminology if the lay person that I'm helping doesn't understand what I'm saying. So if there are any scientists listening to this, please forgive me. I do say balance hormones, although I completely understand that, you know, it's a little controversial, and there are lots of people out there on social media that don't like that terminology, but I also don't think it's helpful to completely confuse, bamboozle, and lose people. So that's my piece on balancing hormones. When alcohol is in the way, the liver prioritizes the alcohol over the estrogen. Estrogen clearance suffers, and your estrogen dominance or your potential estrogen dominance relative to your progesterone levels, which are generally lower in perimenopause, get worse. So the alcohol is not only heating you up and breaking your sleep in the moment, it is standing in the way of the very detoxification you need most. So whenever I found myself having an alcoholic drink in perimenopause, which I have done extremely little of because I just found it so torturous, I would literally wake in the middle of the night with a dry throat, dry tongue that felt like sandpaper, and I'd be really hot and it would increase the hot flushes and night sweats. So not much fun. So there you have it. Alcohol is not friendly to your brain or your liver or your sleep in perimenopause.

Histamine Heavy Bleeding And Iron

Dr Kirstey Holland 9:05

Heavy bleeding, mast cells and your blood. Now I want to talk about your blood because this is where several perimenopausal symptoms actually come together. Heavy bleeding is extremely common in perimenopause, and one of the things that can drive it is mast cell activation and high histamine in the body. So your mast cells release histamine and inflammatory chemicals, and as progesterone declines, you lose its natural mast cell stabilizing effect while fluctuating estrogen can set the mast cells off. To bring the histamine and the inflammation down, I ask you to either take either no dairy or A2 dairy. The reason is the protein, the A1 casein in most cows' dairy breaks down into a compound called beta-casomorphine 7, which is inflammatory and has opioid-like effects, whereas A2 dairy does not contain that same A1 protein, so it is far gentler on the system. Heavy bleeding leads somewhere else too, and that is unfortunately iron deficiency anemia. And this is such a chicken and egg situation because heavy bleeding causes iron deficiency anemia, and unfortunately, iron deficiency anemia can cause heavy bleeding. Estrogen excess causes heavy bleeding, or a lot of estrogen causes heavy bleeding, and estrogen increases histamine in the gastrointestinal tract. And unfortunately, believe it or not, but more histamine in the gastrointestinal tract actually increases estrogen. So it's another chicken and egg going in the wrong direction. It's bad, it's a really bad mock tail. In Chinese medicine, we call iron deficiency anemia or something that looks very similar. We call this blood deficiency. And it has a beautiful, precise meaning. There is not enough material substance for the spirit to rest. And that means in the body, right? The traditional Chinese medicine talks about the fact that there isn't enough material substance in the body, and it isn't cool enough when there isn't enough because there's too little, so it heats up too quickly. So the spirit can't rest at night, so you don't have a beautiful, restful sleep. So when the blood is deficient, the spirit, what we call the shen, has nowhere to settle, so it becomes flighty and wakes easily. Blood deficiency insomnia has a particular picture. There's often incessant dreaming, feeling too hot, waking through the night. During the day you can actually feel really dizzy and out of it, and you just generally feel very anxious and ungrounded. You can actually startle really easily and get a fright when people come around the corner. Yeah, it's an awful way to feel. I really, really, really, really, really feel for my blood deficiency patients because you feel so ungrounded. So one of my focuses in clinic is to make sure that these patients really strengthen their stomachs and spleens, take in enough animal protein so that we can build up that iron again so that they can really get lead in their boots and feel very grounded. The ancient texts say the heart needs to be cool for the spirit to be settled, and anything to do with blood involves the liver and the heart. So when the spirit is not held within the blood and the heart, it startles and it wakes. For this pattern, there's a classical formula I love called Swansa Rentang, the sour jujubi decoction, which is used precisely for blood deficiency insomnia.

Build A Sleep-Proof Bedroom

Dr Kirstey Holland 12:39

Now, as well as all of the goodies that I've been speaking about, the sleep environment is so important. Before we go to the nervous system, I want to talk about where you sleep because your bedroom either helps you or fights against you. From a Feng Shui perspective and a building biology point of view, I want your bedroom to be clutter-free, truly dark, dark enough so that you cannot see your hand in front of your face. And if that's not possible, please wear a sleep mask. Make sure that there's no sound that can wake you. Use earplugs if your partner saw snores. Keep the room cool enough. Keep electromagnetic radiation as low as you possibly can, so no electric blankets, no extra heaters, no screens. The ancient Chinese also didn't actually like mirrors in the bedroom. They say that if the spirit sees itself in the night in the mirror, it gets a fright and pulls us out of sleep. Now I know that that's a little kooky, but I like the idea anyway. None of this is super fussy. Each one removes a reason for your sleep to be disturbed, and I cannot recommend highly enough. Your bedroom is for the two S's. It's sleep and the other one, and that's it. No work in the bedroom, no conversations about the kids or the exes in the bedroom. This is a sacred spiritual special place. Um keep the room nice and cool, and honestly, um, for perimenopausal women, I cannot say enough about natural fabrics. It's actually ideal to sleep naked, and I would highly recommend linen on linen. I bit the bullet and made the investment a couple of years ago, and I have never looked back. I cannot tell you how divine it is. Sleep naked, linen on linen. You will thank me. Okay, so the nervous system, the adrenals, and melatonin.

Adrenals Melatonin And GABA

Dr Kirstey Holland 14:22

Now to your nervous system and your adrenals, because in perimenopause, the HPA axis, the connection between your brain and your adrenal glands can become dysregulated. And then it is your nervous system that pulls you out of sleep. I support the adrenals directly so that this does not happen. Vitamin C, things like adrenotone, anxioton with carva, vitamin B5 are absolutely wonderful for adrenal support. Like I said before, Anxiotone actually contains carva, and I highly recommend swapping your evening glass of alcohol for a beautiful carva mocktail. You can get the calm without the heat and without the disruption to your sleep. See the carva mocktail recipe inside the Vitality Clinic Academy. Melatonin deficiency is also significant in perimenopause. Melatonin is your sleep hormone, and low melatonin can explain why you wake in the small hours despite feeling exhausted. I absolutely love a plant-based melatonin, and two of my favorites for supporting the nervous system and plant-based melatonin, not the stuff that's synthesized in the lab, which can actually have the opposite effect on a small percentage of women. My favorite sleep supports are plant-based melatonin and a mag calm, so beautiful magnesium glycinate with some melissa, passion flower, and glycine. Please remember that when cortisol is high at night, we actually gain weight. So balancing the nervous system overnight matters for far more than sleep alone. One of my favorite interventions for mid-sleep waking is actually GABA or pre-GABA, which supports the adrenals and the nervous system and lets the brain relax. GABA puts on the brakes so it calms and slows everything down. GABA is your brain's break. Progesterone normally supports it. And as progesterone falls in perimenopause, you lose some of that break. So your brain is kind of more excited when it shouldn't be. If you've had a stressful day or an argument, taking two pre-GABA on the way to sleep, alongside your Reduva sleep and your mad calm is a great idea. And if you wake in the middle of the night, anywhere between one and three, it's not because of fluid. And it's yeah, that's right. So if you wake anywhere in the middle of the night, anywhere between one and three a.m. And it's not because of fluid on the bladder, more on that in a moment, taking two pre-GABA on waking will usually get you back to sleep within 10 to 15 minutes at most, and you will not feel groggy the next day, so it's absolutely fine to take anywhere between 1 and 3 a.m. Now, progesterone, fluid retention, digestion, and blood glucose dysregulation.

Progesterone Fluid Digestion Glucose

Dr Kirstey Holland 17:06

This brings me to progesterone and fluid, because progesterone is actually a natural diuretic. When you are progesterone deficient, which can be the case between the ages of 35 and 55 in perimenopausal women, which is the defining feature of perimenopause, you retain too much fluid. And that fluid can actually put pressure on the bladder when you lie down and wake you in the night needing to pass urine. So one reason you wake is if it isn't your liver and it's not your nervous system, it could be a full bladder driven by low progesterone, and we don't want that either. So if you're having alcohol or sugar close to bedtime, you can really spike your blood glucose. Your blood glucose becomes spiky through the night, going really high, really low, and sometimes it's that low blood glucose drop in the middle of the night that can also wake you. So try to balance your meals. Make sure you're eating according to your N of 1 food protocol that we've established through the Heel Seal Repair Protocol inside of the Vitality Clinic. This means identifying your food triggers and eating according to the power of your plate. Make sure you've got your three cups of green, your one cup of colour, your you know, at least 200 grams of your high quality protein, enough fat and enough fiber, and also use the apple cider vinegar. Please check out the apple cider vinegar tips in the Vitality Clinic under the module about eat. And now one of the last threads, and of course, this is not, you know, this is not everything that could be keeping you up at night, but digestion is really important. If you eat too close to bedtime or have if you have silent reflux, it can be your digestion that keeps you from falling into a deep sleep. I use digestive enzymes to support digestion so that it is not the thing keeping you awake. And this is particularly for my patients who cannot change dinner time and are often eating way too close to bed. Ideally, you eat before the sun goes down because you're more insulin sensitive at that time. You have a wander around the block and you go to bed with you know your tummy not, you know, jam-packed and full. But if you can't change that, digestive enzymes are a really great workaround. So identifying your food triggers and using things like peptides to soothe and repair are really helpful if you do have reflux, and of course, the digestive enzymes if you're having difficulty shifting your last meal. So, underpinning all of this, where it is needed and where testing supports it is progesterone itself. Using 300 milligrams of oral micronized progesterone at bedtime has been shown in randomized placebo controlled trials by the beautiful Professor Pryor to improve sleep quality and reduce night sweats and perimenopause. And unlike estrogen, it causes no rebound when you stop. So this is the calm, cool, collected hormone your body has lost, given back in the right form at the right dose.

Pulling The Patterns Together

Dr Kirstey Holland 20:02

So, pulling all of this together, you wake between 1 and 3 in the morning for reasons that usually overlap. A liver that is overloaded or overheated, especially where alcohol is in the way of clearing your estrogen, blood deficiency from heavy bleeding so that the spirit has nowhere to rest, mast cells and histamine driving inflammation and bleeding, a dysregulated nervous system and low melatonin, and low progesterone, leaving you retaining fluid and short of your natural brake system GABA. The way forward is to keep the liver free and easy, take the alcohol out of the way, use the A2 dairy or none to calm the histamine, rebuild the blood, make your bedroom dark and quiet and cool, support the adrenals and melatonin, and restore progesterone where testing shows you need it, or from of course your symptoms-based diagnosis from a decent practitioner who knows what they're doing. This week, notice which hour you wake and what your evening was like beforehand, and choose one or two of these to begin with. So I've got some questions for you that can help you bring things into focus. When you wake in the night, what time is it most often, and what is the first thing you notice in your body? Number two, what is your relationship with alcohol in the evening and have you noticed what your sleep does on the nights that you drink? Number three, do your periods feel heavy and do you feel exhausted, foggy, or easily startled in the days around them? Do you dream a great deal or wake feeling too hot? What is your bedroom like at night? How dark, how quiet, how cool, and what is plugged in near your bed? When you wake, do you need to pass urine or is your mind simply switched on? What is your evening like in the two hours before bed? And how close to bedtime do you eat? Do you notice reflux, bloating, or discomfort when you're Lie down? How wired do you feel by the end of the day, and how flat do you feel in the morning? Number 10. What have you been told about your sleep before? And did it match what your body was telling you? Number 11. If you slept through the night again, what is the first thing that would feel different in your day? Number 12. What is the one change from this week you feel ready to begin?

Simple Changes To Start Tonight

Dr Kirstey Holland 22:28

Some practical implementation tips look something like this. Take alcohol out of your evenings, it heats you up, it disrupts your sleep architecture, and it makes your liver prioritize clearing the alcohol over clearing the estrogen, which worsens estrogen dominance. Swap it for a beautiful carver mocktail using anxioton if you would like the calm without the cost. Move to A2 dairy or no dairy to bring down histamine, inflammation, and mast cell activation. The A1 casein in most cows' dairy breaks into an inflammatory compound. A2 dairy does not contain it. Make your bedroom dark, quiet, cool, and clutter-free. Dark enough that you cannot see your hand, a sleep mask if not, earplugs if your partner snores. Keep electric blankets, heaters and screens out, and keep electromagnetic radiation as low as you possibly can. The old texts also keep mirrors out of the bedroom. Support your adrenals and your melatonin so that it is not your nervous system waking you. You can use things like vitamin C, adrenotone, anxioton, and vitamin B5 for the adrenals. And remember, this is all educational. It's not, I'm not your doctor, we're not in a patient-doctor relationship, so you definitely need to speak to your treating practitioner about any of these interventions. And of course, Reduva sleep and mag calm with a plant-based melatonin for nervous system support. Keep pre-GABA by your bedside table, two on the way to sleep after a stressful day, and if you wake, two pre-GABAR in waking will usually return you sleep within 10 to 15 minutes without the grogginess the next morning. Keep your evening meal earlier and use digestive enzymes if you tend to eat late or have reflux or silent reflux so that your digestion is not what keeps you from a deep sleep. Where there is reflux, we begin the heal, seal and repair protocol and identify your trigger foods. Notice your own pattern this week, including the hour you wake and your evening beforehand. The perimenopausal symptom tracker inside the Vitality Clinic with your sleep lifestyle food and mood diaries is already there for you, so make sure that you use those to track your N of 1. If your bleeding is heavy or you feel the exhaustion and startle of blood deficiency, this is the point to test your iron and your hormones so we can rebuild the blood where you need it and restore the progesterone. Excellent.

Clinic Invites And Wrap Up

Dr Kirstey Holland 25:04

I hope that that helps. I so look forward to seeing you inside of the Vitality Clinic this week. And remember, um, Jan is taking the Tuesday a.m. call. I'm taking the Tuesday 6 p.m. call. I'll be taking the Thursday 11 a.m. call, and Jan is taking the 6 p.m. call. And if you'd like to chat with me, please book your discovery call. Otherwise, dive in and do the initial consultation. Feel free to purchase my book too. Um I've just sent out an email newsletter, and it's got all of the links to, of course, the book, the audiobook, um, and the consultations. If you're needing a little help to get a beautiful full night's sleep, beautiful. Take it easy, and I'll see you next time.