How This Breakthrough Menopause App Can Help You Get Better Sleep•
Posted on March 10 2023
Many women experience changes to their sleep quality starting in perimenopause as the result of many different factors. In honor of World Sleep Week, we checked in with Ann Garnier and Massimiliano de Zambotti, co-founders of the Midday Menopause App developed in partnership with Mayo Clinic, for their insights and advice. Here, Ann & Max share insights they’ve discovered along with why their app might just be the key to helping improve sleep quality in menopause and beyond.
Q: So, Ann, before launching Midday you had spent 25+ years developing cutting-edge tech-enabled healthcare products including for high-risk pregnancy and pre-term birth. What made you decide to launch a menopause app?
Ironically, it was my own menopause experience. At the age of 51, I reached menopause with zero symptoms. I assumed I was one of the lucky ‘fifteen percenters’ that breeze through perimenopause unscathed. I was wrong. One day, a switch flipped, and the symptoms piled on.
Like most women, I made a beeline to my doctor. She was sympathetic but not helpful. Not surprising after learning that few physicians are trained in menopausal care. Also, like most women, I went online but found sources like Google and Facebook confusing. So, I leveraged everything I had learned in my career, diving into scientific literature, talking to leading experts and experimenting with different treatments. Within a few weeks, I noticed several symptoms had disappeared or significantly reduced.
The whole experience showed me what a huge unmet need there was in providing women with access to science-backed support so that they could make more empowered decisions about their care and have access to gold-standard care in the palm of their hands. I felt called to help lead the revolution. My mission was first and foremost to make midlife women visible, eliminate the shame and silence, and leverage technology to transform the menopause life stage. Every woman – all 3.8B worldwide – deserves a menopause journey personalized to her. A journey that illuminates what’s happening physically and emotionally and delivers science-backed relief, access to menopause specialists, and information she can trust.
Q: Max, aside from being the co-founder of Midday, you are an internationally recognized neuroscientist, sleep expert, and principal scientist for SRI International. What are some of the insights you can share about how menopause impacts sleep quality in women?
Let me start by saying that sleep in midlife women can be deeply challenged due to a multitude of biopsychosocial factors. Menopause-specific factors like vasomotor symptoms (hot flashes and night sweats), decreasing estrogen, as well as more general factors like stress and poor sleep hygiene, each contribute to the poor sleep women experience going through menopause.
Among these factors, there is no doubt that hot flashes should be considered among the key contributors to poor sleep. For example, my research team and I investigated and precisely calculated the amount of wake time associated with each hot flash women have at night. This work led to the conclusion that hot flashes directly and strongly impact sleep. Specifically, we highlighted that about 70% of physiological hot flashes were associated with awakenings, accounting for about a third of the total wake time at night. Striking results also indicated that in some women, hot flashes accounted for almost all their disturbed sleep.
Symptoms of sleep disorders that menopausal women complain about include falling asleep, frequent awakening and/or early morning awakening. Sleep disturbances such as insomnia are extremely common, especially in women after menopause. According to data from the National Institutes of Health, sleep disturbance varies from 16% to 42% before menopause, from 39% to 47% during perimenopause, and from 35% to 60% after menopause.
Insomnia in menopause is a real deal and goes beyond a woman’s perception of poor sleep! Insomnia in women going through menopause has a detrimental impact on their health, being associated with profound objective sleep alterations. My team and I showed that having insomnia in menopause translates to greater than 40 minutes of less sleep a night on average, with almost 50% of the menopause insomnia sample we studied having less than six hours of sleep per night. You can imagine how hard it is for women to cope with the next day's activities!
Q: Ann and Max, how did both of your expertise and subsequent research into the area of menopause and sleep quality translate into the features you built into the Midday app?
Max: Both our backgrounds have centered around developing novel approaches and technologies to improve people’s health and well-being. I have specific expertise in wearable technology in the sleep space including how wearable devices can be used to monitor sleep and physiology, and improve sleep.
One of the things that sets Midday apart is our wearable integration. We currently integrate FitBit and Apple Watch, with plans to roll out additional wearables this year. Wearables can provide passive tracking of objective sleep data over time. The data from wearable devices can help women in several ways, including longitudinal mapping of women’s habitual sleep and recognition of deviating sleep patterns to target personalized behavioral interventions.
Ann: It was important to us to be able to offer women a wide range of science-backed options, from natural, holistic treatments to virtual care with a menopause specialist and prescription options.
Some of the most popular features to help women get better sleep are:
- Guided Journeys: Midday’s guided journey feature guides you to everything you need to know about a particular symptom and your options for management. Knowledge is the first step toward taking control and getting relief and most women are not aware of all of the therapeutic options available as they are not readily accessible to the majority of people. Now, women not only can make informed decisions about what to do for their symptoms, but usually, they can access the treatment options right in the Midday app. We are adding coaching to the app, and your coach can also help you make treatment decisions and support you in reaching your goal.
- Mindfulness and Meditation Programs: We offer a wide range of programs, but for sleep, our immersive sleep meditation programs that Max designed to help you fall asleep and stay asleep are particularly good as they can induce a deep sense of relaxation, a key requirement to a good night’s sleep.
- Meno-Marketplace: Midday’s product marketplace is quite popular. We heard from women that they want a one-stop shop for all their menopause and healthy aging needs, and they trust Midday’s curated selection of science-backed and high-quality solutions. Become Clothing is a great example. We know that many women suffer from hot flashes while sleeping and wake up drenched in sweat, and Become Clothing cooling pajamas use advanced technology to help you stay cool and dry and get a better night’s rest.
- Virtual care Access to Mayo Clinic Menopause Specialists: There are occasions when menopause symptoms are very severe and holistic options don’t work. Rather than continuing to suffer, in some cases women suffer for years, consulting with a specialist can put you on the fast track to relief. In the case of sleep disturbance, it may not be hot flash related. It could be chronic insomnia or sleep apnea, both of which have serious long-term health consequences. A specialist can help identify the root cause.
Q: What are some of your top tips for helping women over 40 get a better night's sleep?
There are several options women have to improve their sleep, and these options are related to the nature of why they are sleeping poorly and the magnitude of the issue. Also, it is important to consider that one size does not fit all.
On a high level, sleep hygiene is a good place to start. Maintaining a quiet sleep environment, going easy with coffee, and maintaining a regular sleep schedule, are among the factors to consider. Some of these tips are particularly useful for women going through menopause. For example, we know from the literature that sleeping in a cool environment reduces the likelihood of experiencing hot flashes, and thus a simple adjustment of the bedroom environment may make a big difference in the sleep of some women. It still surprises me how small sleep hygiene tips can make a big difference.
However, the story is more complex and that is why at Midday we are using a data-driven approach to investigate which specific factors and/or the synergy effect across multiple factors affect women's sleep. Getting at the root cause of trouble sleeping should always be the first step!
Stress and anxiety are also big factors impacting the capability of women to get to sleep and maintain sleep, and bedtime relaxation strategies may work well for some. Cognitive behavioral therapy and pharmacologic interventions may also be options to evaluate, for more severe cases.
Women’s preferences and adherence to the interventions are also factors to consider when planning any interventions. Thus, personalization and multiple intervention strategies are part of what we are focused on at Midday.
Q: Do time changes influence sleep (we 'Spring ahead' on March 12th), or do you have any tips that might include the time/light change as a factor that might affect sleep?
On March 12th, we Spring ahead by one hour. Shifting the clock one hour forward may catch you unprepared. The risk is to lose sleep, and even one hour of sleep loss can lead to severe impairments. The pattern of daylight exposure is also altered, which can impact your circadian rhythms.
Among some easy tips you can follow, gradually adjust your sleep schedule. Start by going to bed 10-15 min earlier each night in the week(s) before March 12th. Daily activities should also be adjusted accordingly. Also, be sure to sleep well the weeks before Daylight saving time. You do not want to reach that day already sleep-deprived!
Remember that the time change is scheduled for 2 am! Luckily, nowadays, most of our digital clocks automatically adjust the time. Thus, you can sleep soundly and all your electronics should be ready when you wake up! But if you are still in the analog era, you can set your clocks before bed to have peace of mind.
In the days after March 12, be sure to have enough daylight exposure which can help re-adjust your body clock. Finally, always remember to eat healthy and exercise, that always helps!
Q: Thank you both so much for your time today. Are there any last thoughts you want to share with the Become Community before you go?
Don’t buy into the belief that having the ability to operate on very little sleep is a badge of honor, or that there is nothing you can do about sleep disturbance. Getting insufficient and poor sleep has serious and wide-reaching health consequences. Take your sleep health seriously, and give Midday a try for science-backed support that is designed specifically for women in midlife.
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