HeraSphere #28: Conquer the 2am wakeup

Hi friends,

Happy Year of the Fire Horse! Its a a year that arrives once every 60 years, galloping in with extraordinary energy, ambition, and momentum. The ancient wisdom here is worth noting: the Fire Horse is also the year most prone to burnout, which makes what you're about to read feel especially well-timed.

For most of my career, I wore my ability to function on a few hours of sleep like a badge of honor. Late nights, early mornings, red eye flights right into morning meetings — I was proud of my ability to work on limited rest. Then I learned about the connection between sleep deprivation and Alzheimer's disease, and something shifted permanently. I realized that rather than a superpower, sleep deprivation is the beginning of a precipitous decline.

At the YPO Women's Wellness Summit, Dr. Wendy Troxel — one of the country's leading sleep researchers — reframed it for me in a way that actually stuck: treat your sleep like a dear friend. Prioritize it, pay attention to what supports and undermines it, and don't abandon it when things get busy. She also said something I've been thinking about ever since: chasing perfect sleep creates its own stress. The goal isn't perfection. It's consistency and care.

60% of women have trouble sleeping during the menopausal transition. It’s not a character flaw, just physiology. That puts a lot of 2 a.m. wake-ups in a completely different light.

In a previous issue on the Science of Sleep, I covered the sleep stages and why deep sleep is critical for brain health. This issue is more practical. After researching Dr. Michael Breus (aka The Sleep Doctor), a clinical psychologist and sleep specialist with 26 years in practice, I captured his most actionable guidance on sleep.

TL;DR — the DL on Practical Sleep Tips

• You were born with a genetic sleep type (chronotype) that determines your optimal sleep and wake times — and most people are living against it

• 75% of insomnia is caused by anxiety, not a broken sleep system — and women in perimenopause are disproportionately affected

• 1 in 7 adults has sleep apnea; 80–90% are undiagnosed; women's symptoms look nothing like men's

• Adenosine makes you sleepy; caffeine blocks it; most people are using both wrong

• You need a heart rate below 60 bpm and a dropping core temperature to fall asleep — everything else flows from that

• The 4-7-8 breathing technique is the most reliable tool for middle-of-the-night wake-ups

• Alcohol destroys your deepest, most brain-protective sleep stages — but timing and sequencing fixes most of the damage

• Melatonin is a hormone, not a sleep aid — most people are taking 10–40x the correct dose

• Magnesium and vitamin D deficiencies are behind more sleep problems than most people realize

You were born with a sleep chronotype

• Your sleep chronotype is a genetic blueprint that determines when your body releases melatonin, cortisol, adrenaline, and dopamine. It's written into your genes.

• Lions (10–15% of people) are wired for 5–6 a.m. wake-ups and peak before noon. Their melatonin switches off early and cortisol kicks in fast — which is why they're emailing at 6 a.m. and struggling to stay engaged by 2 p.m. Dinner and a movie is genuinely hard for them.

• Bears are the majority of the population — and the 9-to-5 world was basically built around them. They hit peak focus from mid-morning to early afternoon, and their sleep schedule aligns naturally with most social norms.

• Wolves are night owls: creatives, risk-takers, the people who get their best ideas at 2 a.m. They don't hate mornings out of laziness — it's biological. Many of the most innovative thinkers in tech and the arts are wolves who finally stopped apologizing for their schedule.

• Dolphins are the fourth type — highly intelligent, detail-oriented, slightly anxious, and chronically frustrated by sleep that doesn't come easily. They crave deep sleep but can't seem to land there.

• Chronotypes shift with age. Around 45–50, melatonin production begins to slow and sleep quality — not just quantity — starts to erode. Knowing your type helps you stop fighting your biology and start working with it. Take the four-minute quiz at chronoquiz.com to find yours.

Why you can't sleep: insomnia is rarely what you think it is

• 75% of insomnia cases are caused by anxiety or fear. It's not always the obvious anxiety either. Financial stress, relationship friction, a low-grade sense of dread about things you can't control... Your nervous system is still running the threat assessment while you're trying to fall asleep.

• There are two distinct types: primary and secondary insomnia. Primary insomnia means the sleep problem has no other underlying condition driving it. Secondary insomnia means something else is causing it: depression, anxiety, chronic pain, blood sugar swings, or the hormonal shifts of perimenopause.

• There are also four flavors of insomnia that women commonly experience: can't fall asleep, can't stay asleep, wake up too early, or wake up feeling completely unrefreshed even after a full night. These aren't the same problem and they don't have the same solution. If you've tried everything and nothing is working, it may be because the type hasn't been correctly identified.

• The most common "treatment" for insomnia in America is alcohol. More people drink themselves to sleep than use any other single intervention. The section on alcohol below explains why this is one of the more costly habits you can have — even when it seems to be working.

Sleep apnea: The silent sleep wrecker most women don't know they have

• One in 7 adults worldwide have obstructive sleep apnea and 80 to 90% of them are undiagnosed. Most people picture an overweight middle-aged man snoring loudly. A significant portion of them are women who've been told they have insomnia.

• Sleep apnea occurs when your airway partially collapses during sleep, briefly cutting off your breathing — sometimes hundreds of times a night. Each time it happens, your brain partially wakes to restore airflow. You almost never remember these arousals, but they prevent you from reaching and staying in the deep sleep stages your brain needs. People with untreated sleep apnea have a 45% higher risk of developing Alzheimer's disease — the same glymphatic pathway we discuss below.

• Women's symptoms look completely different from men's, which is why it gets missed so consistently. Men typically snore loudly and wake gasping. Women are more likely to report frequent waking, morning headaches, mood swings, and fatigue — symptoms that get attributed to anxiety, depression, or perimenopause. Many women with undiagnosed sleep apnea have spent years being treated for insomnia instead.

• The warning signs to watch for: frequent nighttime waking, unrefreshing sleep, morning headaches, mood that's harder to regulate, and daytime fatigue that doesn't improve no matter how much you sleep. You don't have to snore. You don't have to be overweight. Women with completely normal BMIs are diagnosed regularly, especially as estrogen — which has a protective effect on upper airway muscle tone — declines during perimenopause.

• You no longer have to sleep in a hospital lab to find out if you have it. Home sleep tests now exist — small wearable devices used for one night that measures oxygen levels, heart rate, breathing patterns, and sleep depth. The data ports directly to an app. Testing runs around $189, is often covered by insurance, and is available through sleep specialists and directly online.

Adenosine and caffeine: why most of us are wasting our coffee

Your brain runs two systems that control sleep. Understanding them changes how you think about everything from your morning routine to your afternoon crash.

• The first system is your sleep drive, powered by adenosine — a compound that accumulates in your brain every hour you're awake. Think of it like hunger: the longer you stay awake, the more it builds, and the sleepier you feel. Sleep clears it. That's one of sleep's primary jobs.

• Caffeine and adenosine are structurally one molecule apart — which is exactly why caffeine works. It slips into adenosine's receptor sites and blocks the signal that tells you you're tired. It doesn't create energy. It hides the fatigue — until the adenosine wins.

• Most of us are wasting caffeine by drinking it the moment we wake up. Your brain is already flooded with cortisol and adrenaline — the hormones that pull you out of sleep. Adding caffeine on top is like adding weak tea to someone already on an espresso. Wait 90 minutes, let cortisol taper naturally, then caffeinate — and you'll get a significantly bigger effect.

Heart rate and temperature: the two levers nobody talks about

• Your heart rate has to be at or below 60 beats per minute to fall asleep. Your glymphatic system, or the brain's "night shift worker," can only clock in once you're in deep sleep, and deep sleep only happens when your body gets the conditions right.

• Everything that keeps your heart rate elevated — food, sugar, alcohol, stress — is working against sleep. Digestion keeps heart rate up, which is why three hours between your last meal and bedtime isn't arbitrary. Sugar is a double hit: it raises heart rate and actively suppresses melatonin production.

• Core body temperature has to drop simultaneously with heart rate, which is why a cool bedroom helps. For women in the menopausal transition, this is especially high-stakes. Hot flashes are disrupting the exact thermal conditions your body needs to move into and stay in deep sleep.

• Dr. Troxel described deep sleep as the brain's "full Marie Kondo" — the nightly clearing of tau protein and amyloid beta, the compounds linked to Alzheimer's disease. The glymphatic system does this work on the night shift, but only during those deepest sleep stages. Anything that fragments or suppresses deep sleep is interrupting critical brain maintenance.

• Anything that drops your heart rate and quiets mental noise is working with your biology. I finally understand why my Renpho eye massager helps me fall asleep — it works like focused meditation, giving my nervous system something specific and calming to attend to, which brings my heart rate down. Same principle as breathwork, progressive muscle relaxation, or any wind-down ritual that actually works.

• Wake time (not bedtime) is the master control for your entire sleep system. When morning light hits your eye, melanopsin cells fire a signal that shuts off melatonin and sets a 14-hour countdown to when it turns back on. Sleep in two hours on Saturday and you've pushed your whole cycle two hours later. Consistency at wake time is the single highest-return sleep habit.

When you wake up at 2 a.m.: a step-by-step protocol

• Everyone on earth wakes briefly between 1 and 3 a.m. Your core temperature reverses course at that point to prevent hypothermia, and the shift can briefly surface you from sleep. Most people roll over and fall back in 30 seconds. Here is what not to do.

• Don't check the time. The moment you see 3:17 a.m., your brain calculates hours until your alarm, tomorrow's first meeting, how exhausted you'll be — and your heart rate climbs. You've just made it physiologically harder to fall back asleep.

• Don't automatically get up to use the bathroom. Standing spikes your heart rate above 60, and now you're fighting to get back under the threshold. If you sleep on your side, try lying flat on your back for 25 seconds first — a lot of what feels like bladder pressure is simply compression from your position. If you still need to go, use a nightlight rather than overhead lights; bright light signals morning and shuts off melatonin production.

• Use 4-7-8 breathing, developed by Harvard physician Dr. Andrew Weil originally for military stress situations. Inhale through your nose for four counts, hold for seven, exhale through your mouth for eight. Do 20 cycles, visualizing each number as you count. The extended exhale activates your parasympathetic nervous system, your heart rate drops, and you cannot count and catastrophize at the same time. I'm testing this the next time I wake up at 2 a.m.

• If you're still awake and anxiety is building, give yourself permission to just lie there. Research on yoga nidra (non-sleep deep rest) shows that lying relaxed and still for an hour delivers roughly the equivalent of 20 minutes of sleep. Here is my go to yoga nidra meditation for going back to sleep.

Alcohol is hurting your deepest sleep — here's how to keep both

• Alcohol knocks out stage 3 and 4 sleep. The glymphatic system can't clear tau protein and amyloid beta if you never get there. You might fall asleep faster after a glass of wine, but you're trading your most protective sleep hours to do it.

• Timing and hydration are the key. Finish your last drink by 7:30 p.m. and alternate each glass with water. Three hours between your last drink and bedtime gives your body enough runway to process the alcohol before sleep architecture is affected.

• Water does two things: it slows your drinking and offsets the magnesium depletion alcohol triggers. Wine acts as a diuretic, pulling water, magnesium, and B vitamins out of your system — which compounds both sleep quality and next-day impact. A small amount of coconut water before bed can help restore what's been lost.

• Your body metabolizes alcohol most efficiently between 4 and 8 p.m. This is when your liver produces peak levels of alcohol dehydrogenase, the enzyme that breaks it down. Happy hour is, biologically, the right time to drink. Earlier really is better.

• Having bubbly earlier and pairing each glass with water is a small shift that means I'm not trading my stage 4 sleep for a glass of wine.

The melatonin myth: why more isn't more

• Melatonin is a hormone (in the same category as estrogen and testosterone) that requires a prescription in many parts of the world. In the US, you can buy 20-milligram gummies at any pharmacy, and it is often misused.

• Melatonin tells your brain when it's time to sleep. It's a sleep regulator, not a sleep initiator. The sleepiness you feel is adenosine at work. Melatonin is the scheduler — it signals that sleep time is approaching, but it can't create the conditions for sleep on its own.

• The correct therapeutic dose is 0.5 to 1.5 milligrams — most store-bought products are 10 to 40 times that. The number one side effect of overdosing is vivid, strange dreams. A 2024 analysis of melatonin gummies found actual content ranging from 0% to 667% of the labeled amount, with some containing undisclosed CBD — none of it regulated because it's classified as a supplement, not a drug.

• Melatonin interacts with SSRIs, blood pressure medication, diabetes medication, and birth control — and almost no one is warned about this. If you're on any of these and taking melatonin regularly, it's worth a direct conversation with your doctor.

• Breus recommends melatonin in three situations only: jet lag, shift work, and melatonin deficiency, which can develop around age 50 as natural production slows.

The supplements that actually help

• Before reaching for any sleep supplement, Breus recommends blood work first. Fixing an actual deficiency such as magnesium, vitamin D, or iron is more effective than layering on products you may not need. He estimates 15% of the patients who come to him sleep better simply by correcting their deficiencies.

• GABA (gamma-aminobutyric acid) is worth knowing about if racing thoughts are your main obstacle. It's the brain's natural braking system, available as a supplement. Valerian root is a milder option that can slow thinking without affecting hormones.

• Magnesium activates GABA receptors in the brain, a "braking system" that quiets neural activity and slows racing thoughts, while also triggering a physical relaxation response in your muscles. It also helps regulate cortisol, keeping your stress response from firing at the wrong time of night. Scientists don't have the full mechanism worked out yet, but the clinical evidence is consistent: people who correct a magnesium deficiency sleep better, and most of us are deficient without knowing it.

• Vitamin D is a circadian pacemaker — it helps regulate when your body produces melatonin. Fifteen minutes of morning sunlight or daily supplementation sets the rhythm. Breus's morning protocol for every patient: 15 deep breaths outside, 15 ounces of water, 15 minutes of sun. Simple, free, and it anchors your entire sleep-wake cycle.

• For perimenopausal readers, progesterone has genuine sleep-supportive properties and is worth raising with your doctor if disrupted sleep is part of your hormonal transition. I’ve heard many friends rave about the difference its made in their sleep.

Sleep is less elusive once you understand what's actually happening behind the scenes. Adenosine building all day. Melatonin signaling the schedule. Heart rate as the threshold you have to cross. The glymphatic system waiting to start its night shift. Once you see the machinery, the fixes stop feeling random and start feeling logical.

Dr. Troxel was right: treat sleep like a dear friend, and don't chase perfection. Just show up for it consistently, understand what it needs, and get out of its way.

Are you a 2 a.m. wake-up person? Try the 4-7-8 breathing tonight and hit reply to tell me what happens. I'm testing it right alongside you.

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Note: While I love diving deep into research and sharing what I've learned about women's health and wellness, I want to be crystal clear: I'm a passionate health advocate and researcher, not a medical professional. Think of me as your well-informed friend who does extensive homework – but not your doctor.

Everything I share in HeraSphere comes from careful research and personal experience, but it's meant to inform and inspire, not to diagnose or treat any medical conditions. Your body is uniquely yours, and what works for one person might not work for another. Always consult your healthcare provider before making significant changes to your diet, exercise routine, or wellness practices, especially if you have underlying health conditions or take medications.

ICYMI, here are a few past issues that you may enjoy: