Subscribe
Share
Share
Embed
What if midlife isn't the beginning of getting old—but the beginning of something we haven't quite figured out yet?
Welcome to Second Opinion, where science meets real life in midlife.
Because the second half of life deserves a second opinion.
Hosted by Rosemarie Beltz—a cardiovascular perfusionist, Columbia-trained journalist, and former broadcast medical reporter with more than three decades inside operating rooms and high-stakes medicine.
Second Opinion brings together a career spent practicing medicine and reporting on it to explore health, longevity, reinvention, and the wonderfully complicated reality of being somewhere in the middle.
Because midlife is strange.
Some days you feel 25—curious, ambitious, optimistic, and convinced there's still so much ahead.
Other days? About 105. You're tired. Your body feels different. Your parents are getting older. Your career may not fit quite the way it once did. Relationships change. The future suddenly feels both incredibly exciting and a little more finite.
And somehow, all of those things can be true at the same time.
We're also living through an extraordinary moment. Medical discoveries, emerging technologies, and changing ideas about aging are reshaping what's possible in our 40s, 50s, 60s, and beyond.
We're talking about healthspan, hormones, metabolic health, strength, sleep, brain health, longevity, artificial intelligence, and treatments that barely existed a generation ago.
But more information doesn't always mean better answers and solutions.
After more than three decades working in medicine, Rosemarie has seen firsthand how asking another question, considering another perspective, or seeking a second opinion can change an outcome.
One expert doesn't have every answer. One approach doesn't work for everyone. And sometimes, the most important thing we can do is challenge what we've been told.
That's the philosophy behind Second Opinion.
We look beyond headlines, health trends, quick fixes, and conventional wisdom to explore what the evidence actually supports, where uncertainty remains, and what different choices might mean in real life.
And here's an even bigger question:
We may be living longer—but what are we going to do with all that extra life?
That's where the conversation gets really interesting.
Because midlife isn't just about our physical health. It's about our relationships, financial well-being, emotional health, careers, environments, changing priorities, and the lives we're still living and creating.
Through candid conversations with physicians, researchers, scientists, innovators, authors, and people with something meaningful to teach us, we explore the science, stories, decisions, and unexpected possibilities of midlife.
And sometimes Rosemarie turns the microphone on herself—sharing what she's learning from medicine, journalism, starting over, building something from scratch, and discovering that you don't necessarily become less curious about life as you get older.
Sometimes you become more curious.
What we're exploring:
- Health & longevity: Perimenopause, menopause, hormones, cardiovascular health, metabolic health, GLP-1s, sleep, strength, brain health, preventive medicine, and navigating healthcare.
- Relationships & connection: Dating after 40 and 50, love, sex, intimacy, friendships, family, and the relationships that shape our lives.
- Money, work & reinvention: Financial well-being, career transitions, entrepreneurship, confidence, changing priorities, and finding new purpose.
- Life beyond medicine: Mental and emotional well-being, beauty, technology, travel, our environments, personal growth, and finding more joy in everyday life.
This isn't about trying to be 25 again.
We can't go back. And maybe we don't want to.
We've lived. We've learned. We're not starting from scratch. We're starting with experience.
It's about taking everything we've learned, everything science is learning, and everything we still don't know—and exploring what might be possible from here.
Call it Midlife 2.0.
No perfect roadmap. No pretending we have it all figured out. Just smart conversations, good science, lived experience, a healthy dose of curiosity, and a willingness to look at things from another angle.
Because health matters. But being healthy isn't the whole point of living.
🌍 Independently created and produced in New York City, Second Opinion has reached audiences in more than 90 countries. A growing conversation for curious women and men who believe there's still so much more to discover.
And yes, Rosemarie is still figuring out what she wants to be when she grows up.
Real science. Real life. The bigger picture.
Second Opinion isn't here to tell you what to think. It's here to give you something worth thinking about!
Dr. Barone - 00:00:04:
Welcome to Second Opinion. I'm Rosemarie. If you've ever wanted a second opinion on some of the hottest topics in medicine, health, and wellness, you're in the right place. Each episode, I sit down with experts, innovators, and even a few disruptors to bring you fresh perspectives on the issues that could change your life from age rejuvenation and brain health to the weight loss drug revolution and how to reinvent your career. Together, we'll dig into the latest research, question what's hype and what's real, and give you the insight you need to make your own choices about health and wellness. So if you're ready for a second opinion that's engaging, enlightening, and maybe even a little unexpected, let's get started. Today, I'm talking with Dr. Daniel Barone about sleep medicine as it relates to midlife and menopause. Dr. Barone is the Associate Medical Director at the Weill Cornell Center for Sleep Medicine, an Associate Professor of Clinical Neurology at Weill Cornell Medical College, and an attending neurologist at New York Presbyterian Weill Cornell Medical Center, board certified in neurology and sleep medicine, Dr. Barone specializes in diagnosing and treating sleep disorders, including insomnia, sleep apnea, restless leg syndrome. And narcolepsy. He is also the author of two books, Let's Talk About Sleep and The Story of Sleep: From A to Zzzz, has published multiple peer-reviewed articles on a variety of topics in sleep medicine, and has been a contributor for both CNN and CBS News. Dr. Barone, thank you so much for being one of our first guests on this podcast.
Rosemarie - 00:01:52:
Very happy to be here. Thank you for having me, Rosemarie.
Dr. Barone - 00:01:55:
Great. So I was reading some things instead of sleeping. So no pun intended. I was drifting and I read some numbers which were quite interesting. So according to the Department of Health and Human Services. Insomnia is one of the most commonly reported sleep problems. About one in seven adults suffer this. And what I also thought was interesting, although that number is high, but we spend about a third of our life sleeping. Is that accurate? Okay. So if we're not getting sleep and we're supposed to be steady, that seems like that could be a pretty significant, that could be concerning.
Rosemarie - 00:02:37:
Correct. And I always, when I talk to my patients about this, I always bring up the notion of evolution, right? So. When we think about our ancestors from 30,000, 40,000 years ago, right? They would be in a situation where They're in the jungle or they're in the wild and sleeping, the act of sleeping, of being recumbent or lying down for eight hours at a time would put them at an increased risk for being eaten by a bear or by a tiger or whatever. They didn't have the luxuries that we have now. So there must be something so important going on in sleep. Otherwise, evolution would have weeded it out of us, right? We would kind of have evolved to not need it. Yet we do. And we need as much sleep as we did back then. So it just goes to show basically how important sleep is for kind of normal functioning and normal health.
Dr. Barone - 00:03:30:
Wow, that's interesting. Some of our chiefs or bosses, they could be seen to be perceived just like a band. Related to modern day life. So I feel like, you know, we've heard a lot about sleep and it's, you know, but I feel like maybe broad stroking what actually goes on the science and then we can connect it to then what goes on in midlife. So people could understand why, you know, maybe why this is happening.
Rosemarie - 00:04:02:
Right. So, so when we go to sleep, when our brain goes to sleep, it's not like a light switch where we just shut it off and the brain goes into another form of consciousness. Sleep itself is actually very, very complicated. We know that there's different forms of sleep, so you may have heard of non-REM and REM. So REM is when we tend to dream. What we're doing in sleep, though, again, nobody really knows the full answer, but there's different theories. So one of them is for memory consolidation, right?
Dr. Barone - 00:04:31:
Right.
Rosemarie - 00:04:33:
Sleep not only in the short term. But chronically helps us to remember things and also staves off things like dementia. It allows the body to repair itself, right? When we're going to sleep, naturally, our blood pressure comes down. A heart rate comes down. And these are things which don't really matter on a night-to-night basis, but if we look at over years and decades, this kind of thing helps us for our body to repair itself. So these are the kind of things that happen when we sleep. The answer as to why we sleep, though, has kind of been an age-old question. Like, what is the need for sleep? And one of the theories is that the brain actually uses sleep to get rid of toxins that would otherwise build up. So all these things kind of factor in. To the fact that house sleep is so important for us, and unfortunately, with stress. You know, the rigors of daily life. And other medical problems that may creep in when we get to midlife, sometimes sleep becomes a challenge.
Dr. Barone - 00:05:36:
So with that, could you go? Zero in even more with midlife, maybe what could be going on that could be causing these issues.
Rosemarie - 00:05:47:
Right. So during midlife, and this is not me saying this, this is the medical literature, there's increased risk for depression, there's increased risk for loneliness, there's increased risk for anxiety, particularly during these times now. Out of the pandemic, thankfully. But, you know, people are still reporting those issues, right? There's more medical conditions that happen when we get to midlife. Chronic pains, right? Arthritic pains. Uh, process using men, which will make them I have to go in the bathroom. Um, certain medications that are needed to treat. Chronic problems like diabetes or hypertension can cause disruptions in sleep. So you factor in all these things. Plus, we're exposed to computer screens and iPads and iPhones. All these things together. I think is what is what is what. Makes going into midlife. Makes sleep more challenging.
Dr. Barone - 00:06:47:
Okay. So they're the outside factors. So how about some of the things maybe that might be going on? Internally without getting too caught up in science, but maybe some basic science for some people out there who, who would really, maybe that would help them connect the dots a little bit.
Rosemarie - 00:07:04:
I would say the best example of this is when a woman goes through menopause. So in menopause, what happens is estrogen and progesterone are no longer produced. And they have, those hormones have many effects on the human body. Estrogen gives women a different fat distribution than men. So if estrogen is no longer there, what tends to happen is there may be fat deposits in the neck region. Okay. And not grossly, but I mean, more kind of, you know, microscopically. It can make the airway a little bit tighter. Progesterone is a respiratory stimulant amongst its many effects. So when that's no longer produced, women may not be breathing essentially as deeply. During the night. Both of these things together increase the risk for obstructive sleep apnea. Which you may have heard me. This is a condition where people essentially stop breathing throughout the night. And particularly with, with women. The risk of sleep apnea when they go through menopause. Shoot way up. Doesn't reach that of men, but it does go much higher. And what can happen is these women will come to me and they'll say, look, I've been the same way I've been my whole life. I look the same as I have my whole life. But now my bed partner notices I'm snoring. And guess what? I'm waking up a lot of times now to go to the bathroom or to... I'm just waking up for no unclear reasons. And it's because of sleep apnea. So I would say that probably, and especially in midlife, that was probably the number one thing I would say people come to me complaining of. And it's something we should be cognizant of.
Dr. Barone - 00:08:37:
Oh, wow, that's interesting. And you said that. Was it affect women? We were talking about weight. So they were the same weight. So were they say maybe average weight or I'm just curious because if you're just say maybe a a woman that is going into menopause that's, say, maybe a little more fit than... Right. You know. Life things happen. I'm just, that's just interesting to me.
Rosemarie - 00:09:03:
Yeah. Well, it's just the point I'm trying to make here is not that everybody who wakes up has sleep apnea and everybody who. Who had, you know, not everybody who goes through menopause, developed sleep apnea. But the point is just to think about these things, you know. Sleep apnea is not necessarily a condition where, um, you know, people are, have to be overweight. You can, you've seen it in people who are thin. You know, who are otherwise perfectly healthy. But it's just structurally the way the airway is constructed, where the tongue sits. That that tongue may actually be falling backwards throughout the night and closing off their airway, which is what the problem is.
Dr. Barone - 00:09:38:
Oh, wow. That's interesting. I wasn't even going there with that when I was, when I was doing it.
Rosemarie - 00:09:43:
So that's one example, but I'm just saying that there are, there are many examples where you said. You know, internally what's going on. That is a major one that people tend to overlook. But also too, the hormone the hormone changes of menopause can cause people can cause women to wake up so um, you know, something else to think about.
Dr. Barone - 00:10:03:
So that's interesting because I even have a lot of friends. I am focusing on women. There are some guys that I'm going through this, but focusing on women is that even, so they're experiencing this, but then even with say hormone replacement therapies and stuff, now they still might, is this maybe just because they're. Maybe not at the right level of Medic- Or whatever they're doing to remedy that situation. Because I found that interesting.
Rosemarie - 00:10:35:
Right. So, yeah, hormone replacement therapy can help. That's something you definitely want to talk to your OBGYN about, but it's not right for every person. Every woman. But, but then, yeah, if the hormones are right, then you may want to think about, all right, so, could this person be, you know, their mind is just not shutting off when they go to sleep, right? Could there be increased risk of... You know, anxiety or stress or, things of that nature. You know, unfortunately those go up as we get older. These are all things which can cause people to cause women to wake up regardless of the hormones.
Dr. Barone - 00:11:08:
Regardless of the hormones. Okay. Thank you. I like to blame everything on hormones.
Rosemarie - 00:11:12:
Well, I mean, it does play a role. Yeah, it plays a role.
Dr. Barone - 00:11:17:
Okay. So we talked about the hormones, right? That's a separate conversation, but there's also a lot of discussion about sleep hygiene. Can you share some realistic tips for somebody struggling with during these transitions?
Rosemarie - 00:11:34:
Sure. So we have now, unfortunately, with the devices that we have, the computer, the TV, the smartphone. Smart devices. We're exposed to what's called blue light. Okay, so blue frequency light, you may have heard about. What that is, is the light that comes from screens. Okay. It's in a certain range. And what happens with blue light is the brain. Recognizes that light. And thinks to itself, okay, the sun is out right now. So therefore, I must not need to go to sleep. Okay, that's the simplest way. What happens is when we're exposed to blue light, these type of devices. Our brain shuts off melatonin. Melatonin is normally made when the sun goes down and that tells us it's time to fall asleep. When we're exposed to blue light, especially before bed. The shutoff of melatonin can make it harder for us to, to essentially go to sleep. Okay, so. So what happens nowadays is we have what's called social jet lag. Right? So it's like we're kind of up late. Our eyes are exposed to this blue light and that can kind of make. Shift our schedule later than what we want. Okay, so. When we talk about sleep hygiene and good sleep habits, know sleep hygiene doesn't mean the bed is clean it means the habits are clean right So we recommend is people take at least. A half an hour before bed. To kind of give their eyes a rest. So what you can do instead of using a screen would be to listen to soft music or a podcast like this.
Dr. Barone - 00:13:08:
Right.
Rosemarie - 00:13:09:
Or meditation is one of my favorite things, or read on paper. Okay, like we used to. These are all things that you can do to kind of give your eyes a rest, give your brain a rest and tell your brain that it's time to go to sleep. I would say that's probably the biggest thing.
Dr. Barone - 00:13:27:
That we're really suffering with today, in today's day and age. Actually, I had a personal question too, because during the day, so say people who tend to get up early, they'll have coffee in the morning and they don't necessarily maybe drink it all day, but later in the day, say if they want to hit the gym or something after work. And so they need something just to get them through. Let's face it. It's low in calorie. It's, you know, it's, it's kind of like the good go-to if you don't really have the time to eat a meal and so forth, grab a cup of coffee. So is that, cause I've read many different things from all different doctors, you know, about what time to stop drinking that, um, as opposed to eating a snack before going to bed, all these different things are, but basically the whole caffeine. Is it, if you say drink a cup of coffee late in the day, but say you do use that to go to the gym or you do burn that off, what are your thoughts on that as far as sleep?
Rosemarie - 00:14:27:
So it's a great question. And honestly, the answer is more individualizing, I think. So, caffeine can have a half-life up to five hours in some people. So what a half-life is, is, you know, After that period of time is over, half of the substance is left behind in the body. Okay. So if that means if somebody has, let's say, a cup of coffee at 5 p.m. And they're doing something good for, you know, they're going to the gym, they're working out, which is great. The problem though, is when they try to go to bed at nighttime, it's possible. The caffeine is still in their system. Even though they don't necessarily feel the burst of energy. The brain recognizes caffeine is still present. And that can be enough. To make it harder for them to fall asleep at night. So what I usually recommend, and again, this kind of depends on the person, but I would say if anyone has any trouble sleeping at night, I would probably say by 1 to 2 o'clock. Caffeine should be the latest.
Dr. Barone - 00:15:20:
Should be the latest.
Rosemarie - 00:15:22:
Okay.
Dr. Barone - 00:15:22:
Yeah. Cause you know, a lot of people, coffee's an experience too, you know?
Rosemarie - 00:15:26:
Right. Exactly.
Dr. Barone - 00:15:28:
Right. So it's just, and a lot of people I know that was like a question for them.
Rosemarie - 00:15:33:
Sure.
Dr. Barone - 00:15:33:
As well.
Rosemarie - 00:15:34:
But let me just, I just want to qualify that for one thing. So, so, so even decaf coffee has a little bit of caffeine in it. So you got to be careful about that. I know I've made that mistake myself. Unless it says caffeine free. I would say one, two o'clock.
Dr. Barone - 00:15:47:
Great. Thank you. How about even if you say get hungry before you go to bed? Because I've read that it's, you know, have some protein or something before you go to sleep, but then that could also disrupt your sleep.
Rosemarie - 00:16:00:
So the rule with that is you kind of want to, Go to bed not too hungry, right? So you don't want to be starving. We have hunger pangs. But you also don't want to go to bed with, um, with your belly full of food, okay? Because both of those situations will wake you up. What we'll usually recommend is if you are hungry before bed, maybe a little snack. You know, like... Little bit of protein like maybe peanut butter or so a little bit of carbs and protein a cracker with peanut butter would be fine. Those are the kind of things. But again, it's kind of a delicate balance. You don't want to gourd yourself, of course.
Dr. Barone - 00:16:33:
Right, too much.
Rosemarie - 00:16:34:
Right.
Dr. Barone - 00:16:35:
Thank you.
Rosemarie - 00:16:36:
Yeah.
Dr. Barone - 00:16:36:
See, so. Okay. So what would you say, so in your books, both of your books. You do talk about disorders, insomnia, sleep apnea.
Rosemarie - 00:16:52:
That's right.
Dr. Barone - 00:16:53:
What would you say to somebody who might suspect that they have a sleep disorder, but they're not sure?
Rosemarie - 00:17:01:
Sure. I think the bar these days should be pretty low. You know, you definitely want to talk to your primary care doctor and see if there's something that's, you know. Low-hanging fruit that you can improve upon. For example, you know, If somebody's waking up frequently to go to the bathroom, something as simple as... Okay, well, maybe stop drinking liquids an hour or two before bed. That may be all they need. Right. But if you do all the quote right stuff and are still having trouble. I think you want to go get yourself at least tested. And These days, we have home sleep tests, which are pretty, pretty benign. You know, really, it's just the one that we use here is we just have basically a device that goes on the wrist. A person wears it for two nights. And while it's not 100% accurate, it gives us a sense of, is this person having sleep apnea or not?
Dr. Barone - 00:17:52:
Interesting. So you're suggesting they start with their healthcare provider first. Because I know there's a lot of information that circles the internet too that might not necessarily, because I've even seen like patches and all these different things. Right. So just start with your doctor and then for, I guess, do the appropriate testing to see them what tests, how to move forward.
Rosemarie - 00:18:16:
So, I mean, you know, there are, there are gradations to how severe a sleep problem is, right? So, so if somebody in his bed partner says, Hey, listen, I hear you choking throughout the night. That I think would be, all right, look, this could be sleep apnea, go get tested. As soon as possible. Whereas if it's occasional difficulty, you know, initiating sleep. I think reading a book, such as mine. It might be helpful to, but yeah. To get some good tips and that may be all they need. But I think if they do all the kind of right stuff first. And none of that is working, then I think you want to talk to your provider.
Dr. Barone - 00:18:53:
Okay, great. Thank you. So is there anything coming down the line as far as new research or any kind of treatments that you're excited about that we might not know about yet?
Rosemarie - 00:19:09:
Right. So for, um, For the classic... Obstructive sleep apnea and insomnia. Those are constantly in the public awareness because there is always new things that people are at least, um, purporting to to investigate. Um, Sleep apnea, the kind of gold standard is as a CPAP machine. And what that is, is kind of a mask that people wear over the nose or the nose and the mouth. You know, sometimes they call it a Darth Vader mask. But basically what the CPAP does is it blows pressurized air into the airway. Which then forces the airway open with pressurized air. It does won't, but people, you know don't like it necessarily in some cases because they feel claustrophobic or they feel anxious So there are people, there are companies and investigators trying to figure out ways to treat sleep apnea. Without. Without a CPAP machine. As it is right now, we have dental devices, which... Pull the lower jaw forward. Those can work. You may have heard about the Inspire device. Which is a nerve stimulator that gets implanted into the chest. And what that does, it sends a signal for the tongue. To stay stiff throughout the night so it can't fall backwards and close off the airway. Oh, wow. Yeah, but there are people working on medications now. Believe it or not, a pill to take at nighttime. Which may reduce the likelihood of sleep apnea. So I would say this is a pretty exciting time in sleep because people are, investigators are really trying to hone in on the biggest. Biggest problems there are which are insomnia and sleep apnea which are rampant in this country So I think we're heading in the right direction.
Dr. Barone - 00:20:54:
Yeah. Well, even, you know, it's like. Just working in healthcare and things like that. And just, we have these conversations all the time too, you know, cause we, quality versus quantity, you know, it's like, ideally you're getting quality and quantity sleep, but where, I mean, and I guess one would affect the other, I guess, essentially, but. What could we do better or where are we going? I mean, you said the blue light, where are we going wrong, but what could we maybe start doing today to maybe improve the quality of our sleep or what are your thoughts on that quality versus quantity?
Rosemarie - 00:21:33:
Right. So when somebody says, you know, I want to improve my sleep, what I always say is there's actually three things. So there's quality, right, which is if there's a sleep disorder, taking care of it, like sleep apnea, I keep talking about. So there's quality, there's quantity, right? So the National Sleep Foundation has. But fourth, we need seven to nine hours. The average adult needs seven to nine hours of sleep. But also timing. So you have quality, quantity, and timing. Okay, and the timing part is important because... We talk about circadian rhythm, right? What does that mean? This is basically the brain's internal clock that tells us this is the time we're supposed to be asleep and this is the time we're supposed to be awake. And that plays a role like for somebody who works overnight. My wife works over at the hospital, every few days, every few nights. And what can happen is she comes home from work and she's exhausted, right? And she will sleep, but we know the quality of the sleep from the morning hours into the evening. Is not as good as it would be. In the evening until the morning. Right. We know that the body is not kind of. Adjusted to that. So no matter how, even if she has a great, great quantity and great quality, the timing is off. Okay. And that can, that can happen for, for people on a smaller scale as well. For example, if somebody tells me, you know, I start getting tired around 11 and, you know, I think my body wants to wake me up around 7. But I tend to stay up later than I should. I stay up later until like 1 o'clock or so playing video games or so. And I still get my seven hours, but I don't feel as good as I want to. In that case, I would say their circadian rhythm is probably telling them to go to bed earlier and wake up earlier.
Dr. Barone - 00:23:21:
Interesting. And is this true? I've read, I don't know how accurate this is, but your body, the earlier you go to better because your body is actually your sleep, that's when you start repairing yourself, whether your liver, your brain, there are certain times when that starts to happen.
Rosemarie - 00:23:38:
Well, it's not so much, oh, my liver is ready to sleep.
Dr. Barone - 00:23:41:
At 10 o'clock.
Rosemarie - 00:23:43:
It's more, I think it's a global. Signaling your body telling you, hey, you've been awake for enough now. It's time for our organs to kind of repair themselves. But it's really the brain that drives everything.
Dr. Barone - 00:23:56:
I see. So it's not necessarily better to say, go to bed by 10 or somebody is more of a night owl and they stay up till midnight. But if you get the same amount and quality, that's what's more important.
Rosemarie - 00:24:09:
Well, it's different for every person, right?
Dr. Barone - 00:24:11:
Different for every person. Okay.
Rosemarie - 00:24:12:
So there are some people who their clock is literally set later. So instead of, let's say, 11 to 7, their body really is telling them. 12 to 8 or 1 to 9. Now, if they were able to kind of exist. With a job or with school in that paradigm, then that's great. A lot of times people are kind of fighting against that. In which case, you know, they kind of get misdiagnosed as insomnia. When in reality, it's just their body's clock is telling them this is the time to sleep. It kind of depends on the person, the situation.
Dr. Barone - 00:24:47:
Okay. And then with that, some of my midlife friends from work, both in news and in the hospital, they had two burning questions. One was, well, one you sort of answered with the time and their brain function. A lot of them are just all concerned about keeping their faculties as long as they can. And also, which I didn't think about was their microbiome, if that's connected to your sleep.
Rosemarie - 00:25:16:
Right. So the microbiome question is super interesting, and I think that will be answered in the coming years. You know, we definitely know the gut and the brain are connected. If you look at. Was just really interesting. There's more nerve cells in the gut than there is in the central nervous system, which is a fascinating finding. So, where that kind of lies with sleep and how what we eat and all that. We don't really know the answers yet. But I think in time that will definitely be, be parceled out. Both how we sleep, how it relates to our, how it affects the gut biome and how the biome affects our ability to sleep and vice versa. We don't know that, but it is definitely coming.
Dr. Barone - 00:26:04:
Oh, wow. So could that be something that people could even so in midlife as we get older and our, you know, microbiome has kind of been through it? Would that be something, I guess, maybe overall sleep and just overall health that that could possibly help? Or is that a stretch to say?
Rosemarie - 00:26:23:
Yeah, but it's it kind of goes back to the question we were asking before. Right. Which is like, what is the point of sleep? Right. We started this. We said, what was the point of sleep? It's must be something that's so important that the body is kind of repairing itself. Um, I think we're going to find that sleep. And brain health are so closely tied to not only the gut biome, but the entire The entire body. You know, the entire body. Mind and spirit, you know, I mean, for lack of a better term. You know, I, I, we don't have the answer yet, but I think we will in time.
Dr. Barone - 00:26:55:
It's funny, like to circle it back around to midlife, we've realized it's just all over all health, you know, just like our weight, our sleep, our, you know, our diet. It's just not to be, you know, thin or, you know, be able to lift so much. It's just all work, how it's so interesting, how it all comes together. Like you might do one thing, but if you're not doing this other thing, right. You know, like I feel like sometimes sleep anymore. Like I wish I knew this in college. You know, I'm sure you in medical school, like we stayed up and even like women who might be, you know, trying to stay up late to get things done. You know, you're dealing with, you know, your kids or aging parents or heck you might be back in school at 40 or 50. You never know. And it's like, you know, at the end of the day, like now I know I'm like, I'm just going to bed. Nothing's going. You know, it's like I'll function. It's not, you know, I can't read anymore. I can't prepare anymore. Or I can't, you know, just go to bed.
Rosemarie - 00:27:59:
Right. Well, you know, it's one of those things where we're designed to be able to do that occasionally, right? That's not a bad thing. We look at, in terms of sleep, we look at things, you know, long term. Right? So night here or night there, of course, sleep here. It means nothing in the grand scheme of things. But we're looking at more kind of over the years and decades. People always ask me, I want to stave off dementia, right? What's what I can do? Quality sleep. Quantity sleep. Timing, right? And exercise. I think that's kind of as easy as it sounds. That really is kind of what we know. Um, you know, Poor sleep can affect memory short term. But if we don't get good sleep over years and decades, the theory goes that. The brain is not able to kind of get rid of those toxic. Byproducts that get left behind. And that can lead to neurodegenerative diseases. Um, you know, that's kind of... I would say the crocs of everything right
Dr. Barone - 00:28:58:
now. Right. So clearly it's best to try to make these changes, you know, as early as possible.
Rosemarie - 00:29:05:
Definitely.
Dr. Barone - 00:29:06:
But is it too late? Like say if you are, you know, midlife and so forth, I mean, is there still a shot if you start taking, you know, making better choices now that you can help chronic disease and things like that?
Rosemarie - 00:29:23:
Undoubtedly. And actually there's, there's, data being put forth, you know, practice parameters and guidelines for both providers and for patients that in midlife, you know, if you can start really making good changes. The risks are mitigated down the road. You know, so dementia, chronic diseases, all the things we talked about. So it's definitely not to rate. And, you know, if you're someone who's thinking, okay, I should be tested or should be evaluated for a sleep disorder, absolutely do it. I don't think there's any other time than now.
Dr. Barone - 00:29:54:
Okay. Well, and just a few more things before we wrap up, because I, I I'm interested as well. You touched on supplements a little bit and then you kind of went off of it, but I feel like there's just so much out there, right. Even just with melatonin and there's this L-theanine and, you know, I have something, something sitting in front of me that I take, you know, with a bunch of different, you know, I take magnesium at night, you know, for multiple things. What are your thoughts on supplements and how should people approach that? Because what if melatonin is not even the issue? I don't know. It's like, you could be taking melatonin and. Yeah. If you would like to share a punt with that.
Rosemarie - 00:30:36:
So no, I have no problem with supplements and I think that in the right situation, they're, they're perfect. Um, What you hear though about is people say, oh, you shouldn't take melatonin for this long time or... I would say this. The rule that I have is You don't want to use any supplement as a band-aid, right? So if somebody, let's say, is waking up many times throughout the night, The bed partner hears I'm snoring. There's a high risk of sleep apnea. I would not be popping melatonin in that case to try to stay asleep. Go get it tested and get evaluated for sleep apnea. But in the right case where somebody has informed their doctor and everybody's on the same page, Sure. Trying melatonin can be very, very useful. In fact, if a patient of mine comes to me and they haven't tried anything yet, and they don't want to go the route of medications just yet. Let's try melatonin. You know, I usually say if it's trouble falling asleep. Immediate release melatonin, a few, you know, up to maybe five milligrams. If they have trouble staying asleep, then time release or extended release melatonin can it can be a great. You know, a great option or even a, you know, a complimentary. by approved. So melatonin is by far and away my most recommended, but I also recommend magnesium. You know, magnesium has been shown to. Reduce central nervous system activation that can help people be more a little bit more relaxed before sleep. You know, but Those are just two. There's many others. You know, there's Valerian, there's Elphianian, as you mentioned. Some people use actual ganda. You know? I mean, The important thing is you just got to tell your provider what you're doing. And make sure that you're not overdoing it. You know, with melatonin specifically. I really wouldn't go above 10 milligrams.
Dr. Barone - 00:32:20:
Really? Okay. Because they make the gummies and they make it very easy. Don't take more than 10.
Rosemarie - 00:32:28:
Right.
Dr. Barone - 00:32:28:
Okay. So with that, a lot of people, if you fall asleep and say you wake up at say, you know, you go to bed at like. 10, and then you wake up at say one, two, or even midnight. Sometimes you might only sleep two hours, especially in midlife. What is something that people can do to maybe fall back to sleep?
Rosemarie - 00:32:49:
Well, I'm a big believer in meditation, like I said. I think having a relaxation technique, you know, going right to that would be, would be. I would also advise against looking at a clock. Okay, so if you do wake up, I know the temptation is there to see what time it is. But especially if you're hyper-focused on that, that can make it harder to get back to sleep. I would also wonder too, if somebody is going to bed at 10 and waking up at, let's say, midnight, They may be going into bed too early. Believe it or not. So it may pay for them to delay the bedtime a little bit. To maybe 11 or so and see if that plays a positive impact.
Dr. Barone - 00:33:28:
That's interesting. So here you think you're going to bed early, but that could actually be counterintuitive.
Rosemarie - 00:33:34:
It could be that the brain almost thinks of it as a nap. So, you go to bed at 10, you wake up at 12, it's a two-hour nap. And then at that point, it's impossible to get back to sleep, you know, because you've already come down a little bit gotten a little bit of sleep pressure you've already eliminated so
Dr. Barone - 00:33:53:
Oh, interesting. And I guess if that's the case later in the day, like you said, minimize the blue light. Don't go into the things that are actually going to keep you up. Just maybe do the things that are going to keep you relaxed and so forth, but stay awake. Oh, that's interesting. Thank you. That was a good, that was really helpful. And just two more things. What is, do you have a sleep routine since you're the doctor? Most people who practice don't have it.
Rosemarie - 00:34:20:
Yeah. You know, the old adage is true. You know, doctors are the worst patients. You know I'm not terrible. I mean, I do pretty good. I'm a gamer, so I do like to play my games. I have to kind of condition myself, though, to say, all right, half an hour. Let's stop it. So I'm pretty good at that. I would say, yeah, I'm okay. I think probably that's my biggest sin, though, is video games too late.
Dr. Barone - 00:34:48:
Well, and how about your wife? Would you, I mean, would you mind sharing? I don't, you know, since we are talking about women as well, like, does she have anything that maybe that people could benefit from?
Rosemarie - 00:34:59:
No, she's a very relaxed person, which I think does help her. She works in the medical field, but she's very relaxed. And I think that helps her to sleep very well.
Dr. Barone - 00:35:08:
Good, good. Well, thank you for that, for sharing that. And so lastly, how can people find your books? Are you taking patients? Are you accessible if some people are watching who are not in the New York area? So.
Rosemarie - 00:35:24:
Yeah.
Dr. Barone - 00:35:25:
Let us know.
Rosemarie - 00:35:26:
Yeah, my books, my books are on both on Amazon. Rowman & Littlefield is a publisher. Let's Talk About Sleep came out in 2018, and that's more of a kind of narrative story. You know, if somebody, let's say, wanted to read about insomnia, they would read about these different patients kind of telling their story and then me kind of interjecting. A little bit more, um, I think it's a little bit easier of a read. Whereas The Story of Sleep: From A to Zzzz, that's more of definitions. You know, again, it's written in a very... Patient-friendly style, very easy to understand. But it's more kind of like, all right, you know, I want to know about... Melatonin. So let me read the entry on melatonin. So there are two different ways of kind of, you know, reading about the same stuff. But I think both are helpful for people. So, and as far as, yes, I do take patients. I'm at Weill Cornell, in Manhattan. Uh, we have a six month wait list, I believe. So. So I have to go back. But pretty booked.
Dr. Barone - 00:36:29:
Well, that's good. That's great. And is there anything pertaining to midlife, a concern, or that I didn't ask you that maybe you wanted to make sure that you shared today?
Rosemarie - 00:36:44:
No, but I know I think we got the important points, but I don't want to belabor this point. Sleep apnea is more common than we think. 24% of men, 9% of women. So if there is, I would say that's the lowest hanging fruit, particularly as we get older, you know, into midlife, postmenopausal women, particularly, as I said, if there is any risk for that. Get out of there.
Dr. Barone - 00:37:09:
Great. Thank you so much. That's really helpful. Thank you. So, and that's a wrap for today's episode of Second Opinion. A big thank you for Dr. Daniel Barone for sharing his insights, how sleep impacts our health, especially in midlife and menopause. I hope you've walked away with some useful tips and a fresh perspective on how to improve your sleep. If you enjoyed today's conversation, don't forget to subscribe, rate, and leave a review. It helps others to find the show. And if you have a topic you'd love for us to explore, drop us a note. We're always looking for new ideas. So I'm Rosemarie Beltz. Until next time, take care of yourself and get some rest. And remember, always get a Second Opinion.