Bedtime starts at breakfast: Kate Mikhail on sleep and the menopause

Psychotherapist, sleep coach and author Kate Mikhail on morning light, wool and the menopause years.

18 October is World Menopause Day.

Kate Mikhail opens every curtain in the house before she does anything else. Then she takes her first cup of tea outside, even in winter. It's the first step of her bedtime routine.

Kate is an integrative psychotherapist, a sleep coach and the author of Teach Yourself to Sleep. She joined us at our Wool Month evening at The Conran Shop. She also lived with insomnia for decades.

We asked her what changed, why the menopause years are so hard on sleep, and what a good night makes possible the next day.

One page in a family book

You said insomnia started decades before you sorted it out. What was the turning point?

“The turning point for me came when I was reading a book by my great-great-uncle Richard Waters, who was a pioneer in cognitive behavioural therapy and audio therapy.

He wrote a page about insomnia and the connection between our thoughts & mindset, our physiology and our sleep. I’d never thought of sleep that way, so I began to research sleep from this perspective and to explore the science behind what my uncle was doing, and the latest science of sleep.

I also recorded a brief sleep script that he had written that I listened to every day, which I now understand acts as a powerful sleep habit cue.”

The menopause years

Why does menopause disrupt sleep so much? Is it mainly hot flushes and night sweats, or is more going on?

“The hormonal drop that comes with the perimenopause and menopause can really disrupt your sleep. Before this, oestrogen works to keep you cool but when your oestrogen levels suddenly drop, your internal thermostat goes slightly haywire, causing hot flushes and night sweats. And night sweats are the biggest culprit for ruining sleep during the menopause years.

On top of this, progesterone has a calming effect, so with less progesterone in your body, you can experience heightened anxiety, which can also disrupt your sleep.

Unfortunately, daytime stress from other menopause symptoms, such as brain fog, low moods and fatigue etc can also spike your stress hormones, making it harder to go to sleep easily, or to have deep, refreshing sleep. This creates a vicious cycle, as the worse your sleep is, the worse your menopause symptoms are. But this cycle can be broken. I’m publishing Substack articles about menopause and sleep, and how members can break the sleepless-menopause loop.”

Light first

You said your bedtime routine starts when you wake up. What are the first things you do in the morning?

“The first thing I do is to open all curtains and blinds to let the daylight in. Our biological body clocks need a daily re-sync, and they need daylight to do this.

I go for early morning walks as much as possible, and will often wrap up in the winter to have my first cup of tea in the garden, to give myself those morning light signals.

I also do some full-body stretches and resistance exercises, as movement is so important in building a strong sleep drive.”

A minute or two

What does "shifting down" during the day look like for someone with a busy job?

“Downshifting during the day is about finding pockets of time when you can pause for a moment, so that your central nervous system can take a break from the demands and stimulation of life.

If your day is hectic, a minute or two of controlled deep breathing is very effective, as is listening to a short therapeutic relaxation audio.

When you don’t give yourself time to downshift, you can end up what’s called “hyperaroused”, in a state of mild fight or flight, with too much cortisol in your system. And this tends to make it harder to go to sleep, stay asleep, or to have deep, restorative sleep.”

A cooler night

Why does core body temperature need to drop before we sleep, and what helps it along?

“Your body temperature is circadian, that is to say it fluctuates in a regular pattern, over the 24-hour day. When your core body temperature drops at night, this acts as a circadian sleep cue for your brain, to initiate the physiological downshift that’s needed for sleep. In other words, it lets your brain know that it’s time to launch the physical chain reaction you need to sleep, for example, by releasing the sleep hormone melatonin.

Some of the things that help to maintain this natural drop in body temperature is to not exercise just before bed, or eat a large meal too late and to have a cool bedroom.

Once you’re in bed, natural fibres in your bedding and bed clothes will help to stop you sweating and your temperature from rising, which is likely to wake you up. Wool, of course, is excellent for this, as it is thermoregulating, so helps maintain an even body temperature – and it is also moisture wicking, which helps to keep your skin dry and comfortable.”

All Floks wool bedding (duvets, pillows, toppers) is filled with British Wool. You can read more about the temperature-regulating benefits of wool here.

Small changes, lasting habits

You're a sleep coach. How hard or easy is it to build better sleep habits?

“It is very straightforward to transform your sleep quality, once you know what’s causing your sleep to be the way it is, as small habit changes can have a big impact on your sleep quality.

I use the science of habits in my work, as this makes it much easier to build new habits that will actually last.

I look at my clients’ 24-hour day, to work out what’s disrupting their sleep, whether that’s behavioural, biological, environmental, psychophysiological... And the bottom line is that once you understand what shapes your sleep – just the basic biology is enough – you can work with this, instead of working against it, which people often do without even realising it.”

The day after

What does a good night's sleep make possible for you now that wasn't possible before?

“I wake up with far more energy and emotional resilience than I did when I was sleep deprived.

When I was a chronic insomniac, I had to accept that I would have burnout days, when I wouldn’t be able to function, and I would just have to go to bed during the day for a few hours (not that easy when I had three young children). Thankfully that doesn’t happen any more and I have plenty of energy for whatever I want or need to do.

I’m also able to take long-haul flights without suffering extreme sleep deprivation, which happened in the past, due to jet lag further disrupting my insomnia.”

Where to start

Your best sleep resources?

“I don’t use any sleep podcasts etc but I can recommend my Substack SleepHealthy+.

This is a library of sleep-related articles and resources, based on my method. It includes therapeutic relaxation and sleep audios I’ve created to reduce stress & anxiety, and to help members be sleep-ready in mind & body at night.”

Find Kate

• Substack: SleepHealthy+
• Website: katemikhail.com
• Book: Teach Yourself to Sleep