312: Sleephoria Unleashed: Embracing Menopause and Conquering Insomnia for Empowered Women | Dr. Valerie Cacho

Join us for an in-depth conversation with integrative sleep medicine specialist Dr. Valerie Cacho, as we explore the fascinating world of sleep health and wellness for women. From the impact of hormones on sleep to debunking common sleep myths, Dr. Cacho shares her expertise on diagnosing and treating medical sleep disorders, promoting mind-body approaches to insomnia, and empowering women to prioritize their sleep health through self-compassion and holistic practices. Discover the secrets to a good night's sleep and unlock the energy, clarity, and drive you need to change the world.

Key takeaways:

• She uses various techniques to support patients with sleep disorders, including mind-body practices, breathing exercises, journaling, and meditation.
• Mindfulness-based stress reduction and self-compassion courses are effective practices that can aid in supporting sleep.
• The differences between integrative, lifestyle, and functional medicine and how they take whole systems approach to healthcare.
• Role of behavioral changes in improving health and quality of life. By embracing a holistic approach that addresses physical, mental, and emotional well-being, individuals can make meaningful shifts in their behaviors and achieve lasting improvements in their overall health and quality of life.

Meet Dr. Valerie Cacho:
Dr. Valerie Cacho is an integrative sleep medicine specialist who diagnoses and treats medical sleep disorders. She is particularly interested in women's sleep concerns, mind-body approaches to insomnia, and promoting sleep health and wellness. She is the president and founder of Sleep Life Med, a tele-sleep practice in Hawaii and California. Additionally, Dr. Cacho is the CEO of Sleephoria, an online educational and sleep wellness company for women.


Dr. Valerie Cacho’s Links: 

• Linkedin: https://www.linkedin.com/in/valeriecacho/
• Instagram: https://www.instagram.com/drvalsleepgal/?igshid=YmMyMTA2M2Y%3D
• Website: https://www.sleephoria.health/

Resources/Links: 

• Website: https://sleephoria.com/
• Instagram: https://www.instagram.com/sleephoria.health/
• Sleep Life Medicine: https://www.sleeplifemed.com/
• Free checklist of questions to ask the doctor if you are chronically 
• exhausted: https://www.sleephoria.health/f/exhaustion-checklist

Transcript

00:00:00 Dr. Valerie Cacho: Your mind is really fixated on that one thing. And so, like, I can be asking them something, and it's almost like they're ignoring me, but they're not really ignoring me, is that their brain is just so laser focused on that one thing. And so when you work with someone who is a practitioner of clinical hypnotherapy, it's therapeutic, right? Clinical hypnotherapy as opposed to hypnosis. You know, stage hypnosis is a lot different from what we do in a practice 'cause I do in terms of supporting their sleep. Typically, insomnia or people who have obstructive sleep apnea have a hard time using the mask because it's uncomfortable for them.

00:00:34 Maya: This is the Healthy Lifestyle Solutions Podcast. And I'm your host Maya Acosta, if you're willing to go with me. Together, we can discover how simple lifestyle choices can help improve our quality of life. Let's get started. 

00:00:49 Maya: All right, friends, welcome back to another episode. I'm your host, Maya Acosta. Very excited about this episode because we're speaking about supporting women in sleep. And so, my next guest is an expert in  that supports women that are perimenopausal, menopausal, and just really, really struggling with insomnia. Valerie Cacho MD is an integrative sleep medicine specialist. Her interests and expertise include diagnosing and treating medical sleep disorders, women's sleep concerns, mind-body approaches to insomnia, self-compassion training, clinical hypnotherapy, and promoting sleep, health and wellness. She's the president and founder of Sleep Life Med, a telesleep practice in Hawaii, in California. Additionally, Dr. Cacho is the CEO of Sleephoria, a wellness brand. Founded on the belief that a well-rested woman has the energy, clarity, and drive to change the world. As always, my friends, the full bio and the links for my guests are found on the website healthylifestylesolutions.org. And I wanna make sure that you click on the link. We'll talk about it as we interview her, but she has a special link for you to find out what are those? It's sort of like a checklist of questions to ask your doctor if you are chronically exhausted. So, welcome Dr. Cacho.

00:02:14 Dr. Valerie Cacho: Thank you, Maya. So happy to be here. Thanks for having me.

00:02:17 Maya: It's an honor to have you as a sleep  specialist.  I don't know what the percentage is of women who struggle with sleep, but you'll probably tell us a little bit about that. Before we talk about your specialty,  you know, sleep disorders, I'd love for my listeners to learn more about you.  When I started to learn a little bit about you and heard that you went to Loma Linda, you specialized in integrative medicine, and then I saw that you did training through Dr. Andrew Weil, who is from UA or Arizona. I was very excited. I've been a fan of his for a long time, and I recently told my husband, I'm not a... obviously a practitioner, I'm not a health professional, but I first started with integrative medicine as my interests, and then I moved on to functional medicine, and now I'm in lifestyle medicine. So I told my husband I'm about to get my medical degree. 

00:03:13 Dr. Valerie Cacho: You are.

00:03:15 Maya: I'm playing around with it. I just love all that all of you do. So please tell our listeners,  how you got started, why sleep disorders, and then now more specifically, why working with women?

00:03:28 Dr. Valerie Cacho: Yeah. Thank you so much, Maya. So, let's see. I'd say it probably has to go back to my childhood and how I was raised. It was brought up in the faith,  Seventh Day Adventist, and we have the health message. And so the health message is basically, you know, eat lots of fruits and vegetables, avoid smoking, avoid drinking, and going to church. And so, you know, fast forward several years, lo and behold, Adventist, especially on Loma Linda or the Blue Zone. So there's something to that sort of health message that we live by and also share with others. Coupled with that, going to La Melinda, learning a lot about healthy living spirituality. I've always, I don't know, maybe like yourself, been drawn to sort of the teachings of Dr. Andrew Weil. We read a couple of his books and it just made sense to me in the aspect of when you go through medical school, really what you're trained to do is talk to a patient, do a bunch of blood work, diagnostic testing, imaging, and then, put 'em in a box per se, right? Okay, you have high blood pressure, right? You have depression, and then match a pill or a surgery to that diagnosis. 

00:04:41 Dr. Valerie Cacho: What I like with the world of integrative medicine, lifestyle medicine, functional medicine, it takes more of a whole systems approach. And I like to think of integrative medicine as more of umbrella term. And then with that falls, things like lifestyle medicine, energy medicine, AIC medicine, Chinese medicine, so different systems. And the best way I like to describe it is all the things I did learn in med school that can help someone heal. And so it just gives me extra tools to really help someone improve their sleep, their wellness. And I'm sort of branding it now as whole living, moving away from wellness. Because sometimes when you think of wellness, you think of things like supplements. You think of sort of like hacks.

00:05:24 Dr. Valerie Cacho: And I'm sure, hopefully you agree with Maya, is that your health is not a hack. You know, it's behavioral changes. If you can link it down to your core values, it's the decisions that you make on a regular basis that can really improve the quality of your life, the quality of your health, the quality of your relationships, the quality of your sleep. And then going to your question about why women, and being a woman myself, but working, I mean, in a field where a lot of women are biased in medicine, and we just know that from research, there's just not a lot of research from women across the fields, but specifically within sleep medicine, you know, a woman can go to their doctor feeling tired,  maybe being a little overweight, maybe being over 50, going through menopause. And guess what? She doesn't get sleep study. She gets a referral to see a therapist, maybe some blood work for a thyroid and an antidepressant. And that sort of it, versus a man with similar symptoms, oh, you must have sleep apnea, let's go get you diagnosed and treated. So really spreading the word on how women certainly can have medical sleep conditions. 

00:06:28 Dr. Valerie Cacho: And at the same time to take a look at medical education, there's only about two hours or less spent on medical education during medical school. And same thing about perimenopause. I don't even think we know, we knew about the word perimenopause back then, it was just menopause. So about two hours so it's just not a lot of education. So I always like to encourage your listeners, if you do have a practitioner or physician nurse practitioner, physician assistant who isn't quite in tune to your symptoms, please keep looking. There are definitely specialists out there who are willing and ready to help, but sometimes it does take a little bit of digging to find someone who really listens to you and understands how you know what you're going through.

00:07:11 Maya: Absolutely. And thank you for saying that because that's one of the things that I've been sort of working on even on my end. So this platform, the podcast, I feel like is a tool to encourage listeners to have a voice when they're having that conversation with their physician. And you talked about bias, and I've also learned through some, some of the literature associated with [inaudible] medicine, but I think it's anywhere, is that sometimes women are gaslighted by their own physicians. And when I talk about these topics, it's not finger pointing. We don't wanna attack our physicians, our providers, but basically sometimes we're dismissed, just like what you said, you said we're dismissed in terms of, "Oh, it's psychological." "Oh, it's not really there." And rather than why is it that men are taken more seriously and that sleep studies are ordered for them, do they think we're not compliant?

00:08:07 Dr. Valerie Cacho: No, and that's a good question, Maya. You know, what it comes down to is a presentation is a little bit different. So part of my training and I trained in internal medicine, I used to work in the hospital. This is sort of my favorite example to give. So when a man comes in with a heart attack and they have the classic symptoms, elephants sitting on my chest, I'm sweating, pain goes to my left arm, sort of a slam dunk heart attack. You know, I've had several women who would come in, nauseous, dizzy, and good thing the ER doctor checked, and did a heart test and she was having a heart attack. So the presentation can be different, I wouldn't say a little bit different, but that was sort of greatly different.

00:08:46 Dr. Valerie Cacho: Sometimes the symptoms for women are a lot more subtle, and the results can still be the same. You know, the biggest killer in the US for women is still cardiac disease. And then when you take a look at sleep in something like obstructive sleep apnea, which is a medical sleep condition, where the muscles of the upper airway, typically it's the tongue that falls back and closes off the airway. You know, classic symptoms are snoring, gasping, choking, stopping breathing, waking up tired or feeling tired. For women, sometimes the symptoms are morning headaches, mood changes, right? Unrefreshed, sleep fatigue. And you don't actually have to snore to have sleep apnea. And so it's almost no wonder when you speak to a provider or a physician, your practitioner, they may not be attuned to pick that up because they honestly just may not know that you don't have to snort to have sleep apnea now.

00:09:36 Dr. Valerie Cacho: And I like to think because women's brains are smarter or, or just a little bit more sensitive. So when the airway can partially collapse right when the tongue is coming back, your brain can wake you up before it collapses. And so with that said, you may not have the gasping or choking, but the end or the sort of the resulting symptoms are the headache, feeling tired as we go through perimenopause and menopause, when we lose the estrogen progesterone, it actually makes our airways more floppy. So the rates of sleep apnea actually double to triple pre perimenopause, postmenopause, menopause has premenopause. So, you know, I always think everybody should get sleep apnea test and you can do that at home and they're so easy to do, especially if you're tired and you're not really sure what's going on. 

00:10:20 Maya: Yeah. You just likely touched on some of those sleep disorders, but I'd like to go back a little bit and ask Sure. In terms of, when we're going through that change, as I myself, am entering that and feel very unprepared because no one gave me a checklist of what I'm gonna go through. But you hear of  the vaginal dryness and how flashes that you experience as a woman going through menopause or, or perimenopausal, sleep disorders or having insomnia during that time. I didn't expect anxiety. I've heard of anxiety as well. And you lightly touched a little bit of what's happening as we're going through the change.  can you kind of go back a little bit and explain some of those medical disorders, sleep disorders that women are affected by? 

00:11:11 Maya: And you mentioned sleep apnea and that we're more, more likely to now enter that as we're going through menopause. Tell us, if you could just tell us a little bit more in detail, what other things does survive sleep? I know that for me, is that busy mind, the worrying, I don't know. I am a night owl. I don't know if I stay up because it's a quieter, soothing time for me or if there's something going on because of my hormones.

00:11:39 Dr. Valerie Cacho: Yeah. And the actress probably, yes, both and multiple factors. And so when you take a look at women in this time of our life or midlife, right? You know, let's break it down. So from a medical sleep standpoint, I mentioned obstructive sleep apnea, also women can have higher rates of restless leg syndrome, and that's an uncomfortable sensation in your legs. A creepy colleague can keep you from falling asleep. It certainly can run in the family. And it's associated with low iron. It can happen more frequently around pregnancy. So that's a time, right. You know, if we're losing blood, especially, diet can play a role too, right? If you're not eating a lot of green leafy vegetables, right? If you have lower iron stores that can affect your symptoms of the restless leg. Yeah. So that's definitely one of 'em.

00:12:28 Dr. Valerie Cacho: And we talked about sleep apnea.  insomnia is definitely big. And it's really interesting because if you talk to a psychologist or even a psychiatrist, sometimes they think of insomnia as a symptom of depression or anxiety. But in sleep medicine, we consider it its own standalone condition, right? Because you don't necessarily have to have anxiety or depression to have insomnia, right? You know, the insomnia could come from perimenopause where you have fluctuating levels of hormones, you have hot flashes, and then a little bit more anxiety, and that can keep you from either falling asleep or staying asleep. And I would say those are probably the main underlying medical sleep conditions. But what also can happen to a woman during midlife to disrupt their sleep? Well, right? The busy mind, women do have higher rates of depression and anxiety and mood disturbances and sleep disturbances go hand in hand. It's a two-way street.

00:13:19 Dr. Valerie Cacho: So if you're not getting enough sleep, right, you know, that affects your energy levels, then that can lead to not wanting to do things. Your motivation is down. And so depression. But also if you have a lot of anxiety and your mind has a hard time settling down, you have a really high arousal state. You know, sleep happens when your brain may slow down. And if there's just a lot going on in your life, which certainly can be in midlife, we have our own medical health conditions, our parents are getting older. Oftentimes women are the caregivers for their own parents if and their their children. And so it's being in that sandwich generation can be part of it. And then if you take a look at maybe things of like the soul, your purpose, sometimes when you get into your late forties, fifties and sixties, maybe you've been in the same career for a long time and you're starting to think, what else is available for me? Is this it? You know, maybe you're thinking about starting a new career or a new passion project. And so sometimes that can weigh on people's minds. So it goes beyond, I would say, the physical, the way I like to approach patients. It's the whole mind, body and soul approach. And so what's going on between sort of that triad and how can we support your sleep by looking at the different parts?

00:14:36 Maya: Yes. I've heard you say that. And it's very interesting that most of us, when we struggle with sleep, the first thing we think about is taking melatonin or having some sort of prescription medicine to help us with sleep. But you've said that sleep specialists, actually, that's not the first thing that you do. What are some of those techniques that you use?

00:14:56 Dr. Valerie Cacho: Yeah, one of my favorite things to talk about are mind body practices. And this is coming from my training with Dr. Weil, if you think about the stress response and the relaxation response, and then from a neuroscience speak, it's your autonomic nervous system. So you have your sympathetic drive, which is really important to have, right? You know, you have a deadline at work, you're standing on the street corner and a bus is coming at you. You wanna have that drive to be like, okay, you know, I'm gonna get out of the way, right? I know what I need to do. This is important versus the rest and digest, which is a relaxation or the parasympathetic. And I don't think it's unique to the way we live now, but I just think that there's so much inputs, there's so much stimulation, there's so much distraction, and we tend to really hyper schedule our lives.

00:15:48 Dr. Valerie Cacho: And so with that said, if we're going through our day and we're constantly on, and you know, the minute we put our head on the pillow, we expect to fall asleep and we don't fall asleep, then we start to think that something's wrong. I'm deficient in something, I need to take something. But really, if you think about it, when you go to the gym, and exercise, do you start just lifting the heaviest weights or do a warmup? Do you do some stretching? And that's sort of like, "Okay, the last hour of your day, can you mold it just for you?" Can you get to the point where you're doing some kind of ritual, some kind of relaxation technique, whether it be journaling is one of my favorite things to do. Prayer, meditation, art, listening to soft music and just really find a practice that turns up that relaxation response. And it's really unique, just like exercise, you know, when some patients ask me, "Okay, what's the best form of exercise?" And honestly, it's the one that you'll do. 

00:16:46 Dr. Valerie Cacho: So the same with with mind body practices. I like breathing exercises because right. We always have our breath with us. We don't need any sort of external objects to help with us. And honestly, when you take a look at the science behind it, when you can slow down the respiratory rate to less than six breaths per minute, really focus on holding the breath and slowing down the exhale, you switch from the stress response to the relaxation response. And it's the quickest thing to do. You know, I have two young kids and I see that they're upset. Guess what? They're hyperventilating. They can barely breathe. And so counting slowly to them, helping them slow down their breath and then that, that helps them change their emotional state.

00:17:26 Dr. Valerie Cacho: And same thing for adults. You know, we're wired a little bit the same, so if we can slow down our breathing, that would be like definitely excellent. So that's one of my favorite things to do. Journaling. And now this is out there on... probably a lot of news articles and pop media, but journaling is so helpful, especially folks who have the busy mind. And you know, sometimes people ask, well, what do I write about? And it's just like, well, whatever you're thinking about. And if you think of journaling as sometimes people call the thought download or paper thinking all the stuff that's swirling in your head. When you put it on the paper, it actually distances yourself from that.

00:18:04 Dr. Valerie Cacho: And you can look at it a lot more objectively. And you don't have to repeat the thought cycle, because when it's on the paper, it's almost like, okay, now I've put it somewhere. And it doesn't have to keep spinning and spinning around in your mind. And sometimes I like to say with my patients, you know, what do you do with all the mail that you get and you don't use it anymore? You know, do you just leave it on your table or do you throw it away? So same thing with the thoughts, you can write them down if you don't like that thought, if it doesn't serve you, if it's not your to-do list, you can just throw it away. And the more you practice this, right? I like to also think of it at night. If you have those busy thoughts coming in, also think of it like a unwanted solicitor.

00:18:44 Dr. Valerie Cacho: You know, someone's coming to your door or marketer or trying to sell you something. Can you just be like, "Nope, I'm not letting you in. It's one o'clock in the morning. What are you doing here?" But like physically tell your brain or have practices around that so that your brain knows it's time to sleep. And there's something about darkness and the quietness, I think that you mentioned that it is, I think, a good time to be with our own thoughts, but at the same time, if your brain, for whatever reason, you know, going through perimenopause, if you're just hyper aroused from a project at work the next day, and it doesn't necessarily have to be a negative event, sometimes I have a hard time winding down if I'm going on a vacation because I get excited. So just having a practice on a regular basis where your brain knows, okay, work life, family is done, this is the time for me to wind down and so get me in the right state to be able to go to sleep.

00:19:38 Maya: Yeah. Yes. Yes. So the busyness of what you were referring to of those thoughts and putting them on hold, a couple of other things that can affect sleep.  sure. I know that you talk about metabolism and also alcohol.

00:19:51 Dr. Valerie Cacho: Yeah. Yeah. So alcohol's really interesting.  Yeah, I actually don't drink anymore myself. Things have just happened as I've gotten older, as I've had my second kid, and I just feel like I don't metabolize it the same. And so it just makes me feel really, really sick. So I just really avoid it. But yeah, in terms of sleep, it's really interesting. And it's also a little bit of dose dependent. You know, alcohol does have some sedating effects certainly in the first half of the night. But when sort of the, the products break down and something like wine or something like a mixed drink actually also has a lot of sugars in it. And so sugars actually can cause more arousal. So it's the alcohol itself, but also the sugar content that can disrupt your sleep. And it actually can disrupt different stages of sleep. 

00:20:39 Dr. Valerie Cacho: You know, like your REM sleep, it can, you know, sort of suppress REM give you REM at different times. So in terms of using alcohol to help you sleep better, I definitely don't recommend it. I do know some folks who have an insomnia and that's the only thing that works, but it's almost like, because they haven't learned about these other sort of things. So there are definitely other tools out there, beyond alcohol Yeah, that can really disrupt your sleep. So yes, if you are someone who is gonna drink, I always recommend it earlier in the day, more of a brunch type situation, not a nightcap situation. Yeah.

00:21:14 Maya: Right. And what about foods? How do they affect us in terms of like metabolism? Are there certain foods that are easier and better for us to sleep,  consume in the evening so that we can sleep better?

00:21:26 Dr. Valerie Cacho: Yeah, this is such a good topic, so I can break it down in terms of food that contain things like tryptophan, which are the building box for melatonin, so tart cherry, certain actually cheeses and even kiwi fruit. So there was a research study in Taiwan where they actually gave people a kiwi to eat an hour before their bedtime and they actually fell asleep faster or reported better sleep quality. So it was pretty amazing. And I sort of mentioned that to some my patients and anecdotally,  it actually makes 'em feel a lot sleepier at night.  Cherries as well because they have tryptophan, which can also lead to melatonin so you can drink it rather than eat it. What else? And in terms of if you think of like macronutrients type, you really wanna avoid, and this is sort of true for I think a lot of health now is the simple carbohydrates, right? You wanna have more plant-based, whole fiber type foods, things with higher fiber. Because what happens if you eat a lot of simple carbohydrates, it can affect your insulin levels, right? And so if you have like a huge [inaudible], insulin levels can rise and that can sort of cause arousals. 

00:21:26 Dr. Valerie Cacho: So in terms of snacks to eat, if you are hungry before you go to bed, avoiding the milk and cookies, right? You know, that extra sugar, but maybe more something like hummus or cucumber, right? Something with higher fiber content. And I would say that with protein, I don't think we have enough evidence to see protein at night is helpful. I know some people who are more in the body building world really focus on protein. And certainly I think women don't have enough protein in their diet as a whole. But in terms of sleep, I think the verdict is still a little bit out on do you need to have protein right before you sleep? 

00:23:14 Maya: Right. And I was just gonna say, when I was thinking of the simple carbohydrates of how that can actually, and we're talking about what I... when I think of simple carbohydrates, I think of heavily processed foods or packaged foods that can cause a spike in your blood sugars. So that would probably affect your sleep as well because of-- 

00:23:35 Dr. Valerie Cacho: Yeah. Definitely. But it's interesting though, because if you don't get enough sleep, and they've studied know sort of nurses who work night shift or even slept high college students, when you lack sleep, your body wants that quick fuel, which are the simple carbohydrates. So if you get less than six hours of sleep, and it's not a willpower thing, it's almost like your body's craving the junk foods, right? And so when they slip, deprive these kids and what they see these students, they're grabbing more of the sweets, they're grabbing more of the potato chips, the French fries, right? And it's just your body craving that quick fuel, whereas you just really need to get sleep because sleep is also fuel.

00:24:14 Maya: Yeah. It's amazing. All the gadgets and distractions that we have in our homes that take away from that quality of sleep. And when I am in nature, it could be on a sailboat, it could be in a van camping or just in a tent camping. I tend to sleep earlier and wake up earlier and feeling more refreshed. And because I'm in nature, I want to eat healthier. So you use other techniques that I'm really interested in this whole idea of self-compassion training and then of course hypnotherapy. But what is self-compassion? I mean, self-compassion training?

00:24:49 Dr. Valerie Cacho: Yeah. So Dr. Kris Neff and Chris Germer created this workbook and it's called the Self-Compassion Workbook. And I continue the link later and it's just phenomenal. So I first started off with a book and I'm more of a person that needs to be in a group setting. You know, I, I read a couple chapters, but I didn't really do the exercises. And then I saw that they had an online training through a place in San Diego, and it was just online, I think it was 10 weeks. We would sit together, learn about the different topics, meditate together. And really what self-compassion is learning to be kind to yourself. Part of it is meditation, and part of it is, is knowing common humanity, like what you're going through with sleep in your health journey, right?

00:25:35 Dr. Valerie Cacho: There are other women across the globe are going through, take a look at the rates of difficulty sleeping during midlife. It's 40 to 60%. And so when you have that mindset, because sometimes when you get into the state where you're sort of stress levels aren't high, you think you're isolated, you're alone, and you're the only one who's going through this. So part of self-compassion is understanding that common humanity and really speaking kindly to yourself and giving you that voice that you would talk to a daughter or a son that you'd have or a loved one, because a lot of us are really harsh to ourselves, right? You know, I hear a lot of patients that come in, no, I'm a bad sleeper. I've been a bad sleeper my whole life, and you mentioned being a little bit more of a night owl, and I was letting you know this one patient.

00:26:21 Dr. Valerie Cacho: And I was like, no, you're not, not a bad sleeper. Your clock has just shifted. You know, if you had a job where you would work like 10:00 PM to eight hours later, it would be perfect. Like it wouldn't be an issue at all. But it's sometimes sort of, we've been acculturated to sleep between eight hours. And if you don't, then something's wrong with you. And then you create this mindset where they have to take something and the pharma industry is so strong, there's these pills and if these pills don't work, something else is wrong. And then you have a doctor sending you to a therapist or psychiatrist, and it sort of feeds into that. Whereas if you maybe just take a look back, understand the science asleep, right? You do have biological rhythms within you, right? That help support your sleep, your circadian clock, you know, your homeostatic sleep drive. And then, you know, coming to a point where, okay, now how do we decrease that arousal state? And so really being kind to yourself through this process and understanding that you're not alone, and there's different practices that are also involved. So it's a little bit similar to the mindfulness-based stress reduction program where they do body scans. 

00:27:28 Dr. Valerie Cacho: But what's a little bit different with the self-compassion course is that extra layer or other layer of gratitude where when you're doing a body scan, instead of just thinking about the different parts of your body, it's can I send my feet a level of fix and appreciation for all that they've done through me? Can I send my knees, if they're bothering me, can I send them, some words of comfort and some words of support? And that's a little bit different from the regular mindfulness meditation practice where you're just noticing it. So it's bringing in that other layer of self-love, self-kindness,  self-compassion. And how it relates

00:28:06 Maya: Yeah. Yes. Self-care aspect.

00:28:07 Dr. Valerie Cacho: That's self-care. Exactly. And it's the way you talk to yourself, so some of my patients have pretty bad anxiety and it can keep them from being able to sleep. And going back to a self-compassion practice,  if your daughter was going through something like this, what would you say to her versus the way you talk to yourself I'm such a bad sleeper, there's something wrong with me, I need to get a stronger medication versus what I'm going through is what 40 to 60% of people are going through, right? I'm not alone. And so it's really taking a look at the thoughts that you have and speaking to yourself with care and support. 

 00:28:48 Maya: Absolutely. 

 00:28:49 Dr. Valerie Cacho: Having your own back.

00:28:50 Maya: Now, do you practice hypnotherapy or do you have someone you partner with for your patients?

00:28:56 Dr. Valerie Cacho: Yeah, so I'm actually trained in it  through the American Society of Clinical Hypnotherapy, where they train practitioners, dentist physicians, counselors, psychologists in it.  And it's phenomenal. So the way I describe clinical hypnotherapy, and it's similar to meditation in a lot of ways. But I don't know if you've ever, if you have children and I have young kids, so two and five, and if they're watching a show, they're basically in a trance. So trance state is basically when your mind is really fixated on that one thing. And so, like, I can be asking them something, and it's almost like they're ignoring me, but they're not really ignoring me, is that their brain is just so laser focused on that one thing. And so when you work with someone who is a practitioner of clinical hypnotherapy, it's therapeutic, right?

00:29:46 Dr. Valerie Cacho: Clinical hypnotherapy as opposed to hypnosis, stage hypnosis is a lot different from what we do in a practice.  Cause I do, in terms of supporting their sleep, typically insomnia or people who have obstructive sleep apnea have a hard time using the mask because it's uncomfortable for them. So now all hypnosis is self-hypnosis. So it's really working on that parasympathetic, that relaxation response. So helping someone relax to the point where they're in trance, and once they're in trance, basically add post-hypnotic suggestions, which are you're a great sleeper. You can, you know, it's words of self-compassion, words of gratitude, words of support. You can sleep anytime you want. And there's different imagery that when you bring in, I like to have someone come up with their perfect day, and then when we come up with their perfect day, whether it be they're on a vacation, they're home with their family,  and then at the end of the day, you're so tired because all the activities you did were so relaxing. 

00:30:42 Dr. Valerie Cacho: When you go to your room and you see your bed, it's just so comfortable, right? And it just being imagery around that where sometimes they're yawning during the sessions, sometimes they feel like they almost fell asleep. And it's recorded. And I encourage them to listen to that because that's the reprogramming of their brain in a sense where hearing my voice, allowing someone to use the power of their own imagination to elicit that relaxation response is what can help them fall asleep. And it works pretty cool. It's awesome.

00:31:14 Maya: I love hypnotherapy. I'm familiar. 

00:31:16 Dr. Valerie Cacho: Oh, okay. 

00:31:17 Maya: I've had a couple of hypnotherapists in the past. 

00:31:20 Dr. Valerie Cacho: Oh, nice. 

00:31:21 Maya: You also have touched on relaxation response, and I recently had someone on the show that really went deep in discussing what that looks like. So I'm glad that you're touching on that as well. So I'm wondering if we can touch on a couple of sleep myths just–

00:31:35 Dr. Valerie Cacho: Sure. 

00:31:35 Maya: For listeners to kind of learn about those, but, or these ideas that we have about sleep, like.

00:31:41 Dr. Valerie Cacho: Right. 

00:31:41 Maya: And I don't know if this is so much a myth, but I've always believed that as we age, we're more likely to wake up earlier and sleep earlier. Is that true?

00:31:51 Dr. Valerie Cacho: Yeah. I mean, there is a percentage of population that have more what we call advanced sleep. So when you think of your internal clock or your circadian rhythm through puberty, it starts to be a little bit delayed. So high school, college, if you have kids of that age, right? Then they're taking the later and later class, they're staying up all night. Some of it has to do with the social impact of living in dorm, being an apartment. But then as we age and get older, there is a percent of the population that tends to sleep a little bit earlier. And then we call that phase advance. If you go to a restaurant and maybe at five o'clock, six o'clock, the people that visit it are a little bit older or folks like myself or the young kids than the people who come in at like seven or eight, right, or even later. So, yeah. But there is an age-related change in the quality of our sleep, our sleep stages. So as we get older, we actually have less deep sleep, and that's the restore dose sleep and then less rem sleep. And that's sort of gifts of father time, mother nature changes. Yeah. So our sleep stages and our circadian rhythm may shift a little bit. But at the end of the day, we still need, you know, adults between seven to nine hours of sleep. Yeah.

00:33:04 Maya: Okay. Well, it'll be a miracle if I ever wake up at five in the morning just to socialize. I've always been, since high school, I've been a night owl. It's just soothing for me to be awake. 

00:33:17 Dr. Valerie Cacho: Yeah. 

00:33:17 Maya: And it's also a time where I'm not running around. 

00:33:20 Dr. Valerie Cacho: Yeah. 

00:33:20 Maya: I'm not running errands at 11, 12 o'clock at night. I'm–

00:33:24 Dr. Valerie Cacho: Yeah. No, that's good.

00:33:25 Maya: Relaxing. What are other myths that people have, you know, maybe even some idea that this is the way it is and not having quality sleep is like their destiny.

00:33:37 Dr. Valerie Cacho: Yeah. I'm glad you brought that up. And I was just speaking to someone recently and she was so thankful sort of for the work that I was doing, not to sort of to my own horn, but just in the fact that from a medical sleep standpoint, if you snore, you potentially have sleep apnea, like, you potentially have a problem. But then there's another subgroup of women who maybe all their friends are tired. Right. They're working, they have kids, so they have their own health issues. And so the whole idea is that we're all tired, and that's just normal. And I think what I'd like to encourage people to think about, right, through the checklist that I have is, that's not actually normal, right? Maybe we're overscheduled, but you don't have to feel tired all the time.

00:34:26 Dr. Valerie Cacho: You know, feel like you're craving caffeine, that there are treatment options available. Take a look at your vitamins, take a look at your blood levels to see if you have anemia. Take a look at your thyroid, right? Take a look at your hormones. There may be a reason beyond saying, I'm just getting older, and it's just the way life is. Because if you sort of have that as your mindset, it's almost like, well then there's nothing that we can do to make it better. But there are so many options that I really wanna encourage your listeners to know that you don't have to feel tired. And if you are tired and it's really disrupting your life, even though all the… your social group has these same sort of symptoms, it doesn't mean that it can't get better. And there always is hope out there. Yeah.

00:35:15 Maya: Yes. That's why these conversations are so important. When I was in my mid 30s, I felt like I was 50 years old and I didn't know it at the time. I had hypothyroidism and adrenal fatigue, associated with, who knows. But mercury poisoning was one of the things that I battled with and–

00:35:32 Dr. Valerie Cacho: Oh, yeah.

00:35:33 Maya: My energy has changed since I've made lifestyle changes. 

00:35:37 Dr. Valerie Cacho: Yeah. 

00:35:37 Maya: But sometimes we just think that that's just the way our destiny is. Like this is until you learn. And I also agree that I don't necessarily like using the word hack or right now you hear it a lot on podcasts and other things that people are biohacking. But it's amazing with simple changes, seeing an endocrinologist, getting some of these tests done, that those simple changes can improve your energy levels, eating the right foods, feeding our healthy gut bacteria, those simple thing, and I say simple, but you first need to know what's going on with you. Right. So that you can… so tell us more, you just slightly touched on it, but you have a free checklist that listeners can click on to see if they're chronically… if they're experiencing chronic exhaustion, they can ask these questions for the doctors and say, hey, is this what's going on with me?

00:36:36 Dr. Valerie Cacho: Yeah. And so oftentimes I think when we go to see our doctors or healthcare practitioners, there's not a lot of time spent and they have their own checklist, especially if it's your annual wellness visit of things you need to go for, right. Your mammogram, or are your age for colonoscopy. How's your cholesterol? How's your blood pressure? And sleep definitely falls to the wayside, right? I mentioned doctors don't get much treating in it. But if you are one of those folks who are feeling tired or feeling exhausted, please speak up. And this checklist is sort of like a little of a roadmap where it takes a look at different things in your blood that could potentially be an issue, right? Thyroid, does that play big? Are you developing high blood sugar? Could you be developing diabetes?

00:37:23 Dr. Valerie Cacho: Diet certainly can play a role. The food that you're eating, is it nourishing or is it zapping your energy?  Talks about sleep, definitely because I'm biased cause I'm a sleep doctor, brings up things like rheumatologic conditions, right? Could there be mental health conditions? And so it really just sort of gives a nice overview of things for you to think about and then bring up with your doctor. And there's even a little note section. So if you do bring it in, you can take notes on this side. Sometimes it's better to come in prepared. Right. You know? 

00:37:55 Maya: Yeah. 

00:37:55 Dr. Valerie Cacho: I think I've heard some discussions about primary care, you really only have about seven to eight minutes face to face. And if they have their list and you have your list, and it's like, no wonder the healthcare system is the way it is, or if you can at least sort of, oh, I have these symptoms, does that mean I need to get my thyroid checked? Or I have these symptoms, maybe I do need to see a rheumatologist, for sort of my joint pain. Yeah.

00:38:21 Maya: Yeah. Yeah. Well I'm that person that will take a book or a list or anything to my doctor and say, I think this is what's going on with me. And oh my goodness, I sometimes wonder, do physicians appreciate that or do they not? I don't know. But my–

00:38:35 Dr. Valerie Cacho: I’m gonna say it doesn't matter, Maya, because it's about your health. And if you go to a physician who doesn't appreciate it, then please find someone who does. Yeah.

00:38:43 Maya: Thank you. That's very empowering. It's our choice whether we wanna see certain people or not. 

00:38:48 Dr. Valerie Cacho: Yes. 

00:38:48 Maya: All right. I really wanna cover, Dr. Cacho, your programs. So tell us about Sleephoria, which I love the name and then Sleep Life Medicine.

00:38:58 Dr. Valerie Cacho: Yeah, so I'll actually start with Sleep Life Med. So I'm… since I'm a medical doctor, we're restricted to practice in states where we're licensed. So for me that's California and Hawaii, I used to live in Hawaii, but I'm in California now. So I do integrative sleep through that. Because basically the things that we've talked about take a whole holistic mind body approach. A lot of it is diagnosing and treating obstructive sleep apnea, restless leg. And then even insomnia treatments where I do clinical hypnotherapy. I talk about mind-body practices. We come up with a plan together. So that's my traditional practice per se. And then Sleephoria is I think my third child or my passion project where folks who don't live in those states don't necessarily have access to the type of care I can provide. And I didn't necessarily wanna limit that because, as we're here today, I'm sure there's a listener who maybe listens and hears one or two things that are helpful and can improve the quality of their life.

00:39:58 Dr. Valerie Cacho: So creating Sleephoria as an educational brand where I can have high quality articles, right? I can do interviews and even have mini webinars. So right now what it looks like is Sleephoria on my website, sleephoria.com. I have different articles. A lot. It's really focused for women's health in terms of sleep, women's health, mental nutrition and exercise. And so those are sort of the categories that I talk about. And then I do free webinars and all the content I have is actually for free on YouTube where, twice a month, I come on anywhere between 10 to 30 minutes. It's live. So if you will come live, you can ask questions, but it's also all there. And I just talk about different sleep topics and anything that I think is relevant. And so I sort of get the questions from my practice and I sort of package it in a way that I think women like all across the globe can benefit from. So that's what Sleephoria is and I really wanted to keep it really free. In the past, I thought about doing coaching or charging a membership, but I think at the end of the day, I think women just need to have this information. So I'm just happy to put it out there for them.

00:41:09 Maya: Ah, well thank you so much for that. You're definitely going to be a resource for my listeners and I'm–

00:41:14 Dr. Valerie Cacho: Wonderful. Appreciate it. 

00:41:15 Maya: Going to make sure I add that in the sleep category of my website where my  episodes are held. Well, yeah, because like I said, there are few of you sleep specialists. I don't know what the percentage is of people that go into that field. 

00:41:29 Dr. Valerie Cacho: I don't know. It's so hard to categorize because there's like family doctors who go into sleep, internal medicine and then neurologists go to sleep. Psychiatrists go to sleep and not a lot I would say are 100% sleep. I know my friend who does pulmonary ICU and sleep. So I think we could take a look at how many people are board certified, but how many practitioners do 100% sleep and then really focus on women. I would say yeah, definitely. Probably a really, really small percentage. Yeah.

00:41:58 Maya: Right. A very small niche. But that's it, you know, I'm so glad that we–

00:42:03 Dr. Valerie Cacho: Yeah. 

00:42:03 Maya: We were connected. 

00:42:05 Dr. Valerie Cacho: Thank you. 

00:42:05 Maya: So you did talk about like, because I was having this conversation recently with someone else about other resources for people that may be limited and I always appreciate having that additional conversation about–

00:42:18 Dr. Valerie Cacho: Yeah. 

00:42:19 Maya: What are some of the things that people who cannot afford a coach or a specialist, what are some things that people can do to, right now, kind of improve their sleep? And I'll throw one out there for you. I've said this before on the podcast, but my husband actually has struggled with sleep for many years. It could be his field. Very demanding. So now as a result, we go to sleep to the Sound of Rain. 

00:42:42 Dr. Valerie Cacho: Oh, yes.

00:42:44 Maya: It's something he uses. It doesn't bother me. That's fine. I used to scare the heck out of my dog so he wouldn't jump on our bed. But it helps him. And we have a vibrating pad on his side of the bed that also helps sooth him. So he's using, implementing various things. What are some of the things that people can do to help sleep?

00:43:04 Dr. Valerie Cacho: Yeah, that's a great question. I would say if someone walked into my practice having a hard time sleeping, since I'm biased as the medical sleep doctor, definitely rule out obstructive sleep apnea. Cuz all the meditation and all the, sort of the gadgets won't help open up your airways. So I would say definitely talk to someone, but if you do store or stop breathing, sleeping on your side, sleeping with your torso elevated can help. I would say find a meditation practice you like and they can be low cost, 4-7-8 is what Dr. Andrew Weil recommends. You inhale for four, hold for seven, slowly exhale for eight. Get a journal. Just write down your thoughts. And really I think what it comes down to for a lot of women that I talk to is, are you prioritizing your sleep? Right?  

00:44:01 Dr. Valerie Cacho: Because if you're not getting an adequate amount of sleep, but I know you're really focused at work and you're really attentive to your family, but guess what, if you're able to get better sleep, you can… your performance at work is better, right? You have more energy, your cognitive functions work better, and you can help your family a lot better as well. So I think it comes back to your mindset about sleep and the fact that you can get good sleep now. You don't have to be tired. There are different apps, some are free. If you're someone who has insomnia through the VA, there's something called the CBT-i coach. And that basically walks through cognitive behavioral therapy. The apps like Calm and Headspace, they do and have some price to it, but there are some free memberships. Insight Timer, I think that one's actually free. So create a process, create a program, create your own prescription that'll help you turn down that stress response, improve that relaxation response, and get your brain rested and ready for sleep. Yeah.

00:45:07 Maya: Absolutely. Do you ever prescribe nature as medicine to your patients? Or walking? I know that exercise is probably somewhere in there in your program as well.

00:45:18 Dr. Valerie Cacho: Yeah, I like that. I do, in the sense that, going outside, getting that natural sunlight. So sort of thankfully or luckily a lot of my patients are in Hawaii and so being able to go to the beach on the weekend, go for a swim when it's, the weather is good. It's been really windy and rainy lately, but just going outside, getting fresh air, yeah, definitely nature as medicine and it helps support our sleep. The more sunlight we get in the morning actually can turn our clock back so we can fall asleep earlier the next day. Yes.

00:45:52 Maya: Yes. Hot Hawaii. I hate to say one of my favorite places, but that's probably what everyone says here. And then the mainland and throughout the world.

00:46:01 Dr. Valerie Cacho: It’s different: It's an island and it's paradise. But it's so interesting because I grew up in California and I first moved to Hawaii. I just had this mindset where people slept great, right? You know, what is there to be mad at? What is there to be stressed over? But like any, Honolulu is a big city.  And if you take a look at some of the research, the CDC actually showed that Hawaii is one of the most sleep deprived states. And it comes down to it's because when there's a lot more sunlight, you know, we sleep less,  there's more activities, but the end of the day it's also really expensive to live on an island. A lot of things are imported. So a lot of the people need to work two or three jobs just to feel like they're surviving. And so what happens when you're working a lot, you're taking away from your sleep. So there is sort of this, I think, dichotomy between what it looks like for us is coming in as a relaxation paradise versus like the people that live there. So yes. To support folks there.

00:46:53 Maya: Yeah. When I've been there, I've been surprised. We like to stay in a location that has a kitchen net or somewhere. Where we can cook our own food. And I've been shocked at the prices of the produce. A mango could cost like $5. I don't know, I just couldn't. And I said, how are people expected to eat healthy when they can't afford it? So  it's amazing. Is there anything else that you'd like to share with my listeners that I didn't ask about?

00:47:23  Dr. Valerie Cacho: No, I think I just wanna reiterate the fact that if you are a woman, you know, in midlife and you are feeling tired, please reach out to your peer group,  people online, right? There's a lot of great podcasts and resources available. And talk to your doctor now, be empowered. Check out that checklist because it's, you don't have to go through life feeling tired. And I think part of the platform I wanna encourage people, is that right? A well vested woman has an energy clarity and drive to change the world, and we're making the world a better place for those around us. You know what, who doesn't wanna live in that type of world? 

00:48:03 Maya: That's right. I especially like that you support women that are, again, perimenopausal, menopausal because many times, as you know,  Dr. Cacho, people sort of don't honor the changes that are happening in our own body and so it's so easy to say, oh, well it's that time you're going through the change and, and they're minimizing or not acknowledging that this is a natural phase that we're going through that takes away, can contribute to mood swings and like you said, loss of sleep and other changes that are happening, anxiety,  many things that are happening. And so the fact that you're there to support women as they're going through this change is beautiful. I love that. And I really wanna encourage my listeners to go and check out all the links will be in the show notes. But go to sleep foria.com, gotosleeplivemed.com, and of course we'll have a link for your checklist so that listeners can see if they're sleep deprived, if they're suffering from chronic exhaustion. But once again, I'd like to thank you for this time and for sharing all this knowledge with us.

 00:49:12 Dr. Valerie Cacho: Thank you, Maya. So happy to be here. Rest. Well, everyone,

00:49:16  Maya: Thank you. You've been listening to the Healthy Lifestyle Solutions podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well@ratethispodcast.com/HLS. This helps us to spread our message. And as always, thank you for being a listener.