Sleep Wake

This is a transcript of our recent radio broadcast focusing on the relationship between sleep and sexual health.

Dr. Amy Lazar: Welcome back to Health Dimensions. I'm your host, Dr. Amy Lazar. Today's guest is, Dr. Debra Fetherston, a practicing internist who is here to talk to us about women's health, sleep, and sexuality.

 

Good morning Dr. Fetherston.

 

Dr. Debra Fetherston: Yeah, hi there guys. Were you able to hear me, because I was [inaudible]?

 

Dr. Schiesser: Yes, I think we were able to hear you.

 

Dr. Lazar: We're working, and we're able to hear you.

 

Dr. Schiesser: We were afraid you couldn't hear us. I want to remind listeners...

 

Dr. Fetherston: Oh, OK.

 

Dr. Schiesser:... if they didn't think they could hear you, they can go to creeksidemedicine.com, and listen to the segment again.

 

Dr. Fetherston: OK good, cause I was having a little technical difficulties there, so I think we have that straightened out.

 

Dr. Schiesser: Well we were excited about what you were saying about "Intimacy, and Sex," and excited to hear more about that this morning.

 

Dr. Fetherston: Oh great, great! Well yeah, what I really wanted to share is that it's such an important part of our health in our relationship. So many studies have shown that couple that share regular sexual intimacy, they form deeper emotional bonds--an attachment to each other.

 

So, in the stresses in our lives today, with everything that's being thrown at us, it really helps our experience, makes us much more healthier. I think we have longer lives because of it, because we're able to share those stresses with our partners.

 

So, but there's definitely differences between the sexes, and their perception of what's important in a relationship. I think if we think about women, intimate relationships are really at the center of their lives. They usually are the nurturers, and the caregiver of the family--often that's extended to other members of the family. So women are usually caretakers for their moms, or mother in-laws, or children.

 

So, certainly that can be a problem with stress, and day to day care, and also sexual activity, and even sleep. There's a lot of worries surrounding that. But for women particularly, communication, and talk intimacy is very important to them. Women really need to be touched. So being touched, and feeling protected, and loved is really paramount to their overall look on their relationship.

 

Men are a little different. I mean, I think men overall feel the same way, but men tend to be much more visually stimulated. So many of the ladies out there, many of the wives they notice their husband's taking those occasional "side-ways glances." They see those passing beauties, or those 20 something walking down the street.

 

But, I think men just can't help themselves, there's a part of their brain that just takes over.

 

Dr. Lazar: Debra, I'd like to ask you...

 

Dr. Fetherston: Sure.

 

Dr. Lazar:... if you could talk a little bit about the stressors in today's world with our busy lives, and our busy schedules...

 

Dr. Fetherston: Sure, oh certainly.

 

Dr. Lazar:... and women's reproductive cycle? How that effects...

 

Dr. Fetherston: Plays a role?

 

Dr. Lazar:... and the goal of sleep?

 

Dr. Fetherston: Yeah, it's certainly true. I mean for younger women in their reproductive years with young children; childbearing, getting up in the middle of the night, caring for young ones, certainly that's a big stress. It adds particular stress to their lives.

 

So many women today too, are returning back to work. So not only are they caring for young children, but then they have the stress of daycare. Getting kids ready, dropping them off, and then that feeling of separation between being a mother, and wanting to be nurturing and being with their child--but then the obligations of having to go to work to bring in that second income.

 

So, it's an incredible stress for women particularly who have that nurturing bond with their family.

 

Dr. Lazar: I'd like if you could discuss a little bit for us, regarding the reproductive cycle, from adolescence on through post-menopause in women, and the various stages. What might be interfering with sleep, and sexuality for women? What might be some benefits to help?

 

Dr. Fetherston: Sure. For women, we have changing hormonal cycles, and so that's something that is always going on throughout our life.

 

With younger women it takes a while for our cycles to regulate. So, it's not uncommon when we first begin our cycles in adolescence, to be really somewhat irregular with our periods. That can be somewhat stressful.

 

With fluctuation in hormone levels, our bodies change. So, our breasts become more tender, we hold on to a bit more water, our bodies feel a little bit more uncomfortable, and our cycles our irregular.

 

Sometimes too during those times, menstrual cycles because of that can be much more painful. So there can be a lot more cramping, and those feelings of feeling uncomfortable, particularly when we're first starting out in our cycles--so that's something that's present.

 

For younger women in their 20's, certainly a lot of times we're dealing with fertility issues. So, we're thinking about becoming pregnant. We may choose to be on birth control pills, or not be, because we're trying to become pregnant.

 

Certainly those also cause a lot of changes in our mood, and in our cycle-- particularly in the premenstrual phase, which is usually about 10-14 days into a woman's cycle after she has her first bleeding episode, the first part of the period.

 

There's a surge of estrogen, and that estrogen surge can cause a lot of breast tenderness, and water retention. If that falls off--progesterone rises. Progesterone can for some women who are sensitive, cause a little bit of a mood disorder--make you feel tired, make you feel a little bit sad, and also there's a lot of food cravings at that time.

 

Dr. Schiesser: Debra, I'm going to jump in real quick here.

 

Dr. Fetherston: Oh, sure.

 

Dr. Schiesser: Because I hard some things that you said earlier, that intrigued me, and were kind of focusing on the bed as a "nest, " and because we're relating a lot of this to sleep. But you sort of... I think your distinction between sex as an intimate act, and sex as something that might have some negative emotions attached to it--can you help us like outline that distinction a little bit further?

 

Dr. Fetherston: Sure. By negative emotion--just maybe partners not being in sync with one another. Is that what you're referring to, Dr. Schiesser?

 

Dr. Schiesser: Yeah, cause I think that there's a listener that could take away kind of a linearity here that, "Oh, I'm not having enough sex." Yet I think that we would both agree that, there's a sex that's sort of a coming together, and there's a sex that is lifeless--at least that's my opinion. I mean, if a couple is having sex every night, it may not necessarily be as healthful as a couple that's enjoying a sense of intimacy, maybe not as often, in that context.

 

Dr. Fetherston: Yeah. I think that's very true. As I was saying before, in our very busy day-to-day lives, our timing can be off. And so we have the complexity of a woman's hormone cycles that are interfering with that, because there's mood disturbance and sleep disturbance with that. But for the male partner, there's also changes. He may be working hard. He may be coming home at different times or different shifts.

 

And I think that there can be, sometimes, different bedtimes that can occur. So if a person is tired, they might go to bed earlier. Another partner might have a different shift and stay up later, and then come in and actually wake that person up, or wants to engage in sex or feel close. And so that can cause a lot of sleep disturbance and a lot of anxiety. As I was saying, sex can just feel like a chore or a favor. And in that regard, it's not a good idea.

 

Dr. Schiesser: Can you..? Oh, I'm sorry, Amy. Go ahead.

 

Dr. Fetherston: I'm sorry. It can be a problem.

 

Dr. Lazar: You were talking about the cycles in women and the effects. And I know a lot of women get concerned in their perimenopausal years, which are years, usually, when women are working, taking care of children, have a job. Can you talk a little bit about the changes that occur, and what are some options for help and treatment for that?

 

Dr. Fetherston: Oh, sure. And that's a common misconception, as far as what's going on. The perimenopause, really, can start as early as a person's late 30s. 39 to 51 or 52 is kind of that perimenopausal time. And so, during that time, there can be fluctuations. Our ovaries are aging, our fertility is going down, and because the ovary is the major source of hormone supply for the women, those fluctuations can cause changes--as I mentioned before, changes in the breast and tenderness, but also, definitely sleep disturbance.

 

As we see in estrogen levels in the perimenopause, it's not uncommon for women to complain of not sleeping through the night. Even, there may be experiences of feeling warm, or maybe, "Did I have a hot flash? I feel like I did." Maybe having a little bit more sensitivity to alcohol. If they have a drink, they might have a hot flash. But also, there can be changes in desire and changes in lubrication. And it can be very frustrating for women, and for men as well, thinking that something's very wrong, and "What's going on?"

 

Dr. Schiesser: Deb, can I cut in there for a second..?

 

Dr. Fetherston: Sure, yeah.

 

Dr. Schiesser: Because I think another thing that could be wrong with sex is that you don't have a partner. And I want to think for a second about the person who doesn't have a life partner, and how sexuality can affect health, and how they should be listening to our comments, if we're saying, "Well, sex is important to your health." But if you don't have a partner, should they think, "Oh, gosh, something's wrong with me," or "I'm doomed," or what?

 

Dr. Fetherston: Oh, gosh, not at all. And I think it's a little bit of a challenge, because you have to be a little bit more open in your thinking. But one thing that I think is wonderful for people who are older, may have lost a partner, or maybe don't have a life partner, is just to have touch. And so massage can be a really nice way to relax and feel love and have that general relaxation in the body, so seeing a massage therapist, having regular massages, is helpful.

 

For people who are open to the idea, masturbation is a really wonderful release. And it certainly provides that same relaxation, that same health and vitality to tissues, particularly of the urinary tract, too, for women, because contractions down there are really good Kegel exercises, and strengthening of the bladder wall. And that can be very helpful.

 

Dr. Lazar: Debra, I'm going to interrupt you here, since we're going to be going close to a break.

 

Dr. Fetherston: Oh, sure.

 

Dr. Lazar: And I'd like to end towards the break. If you could talk a little bit more about contributory causes to sexual dysfunction, other than just the women's cycle--and this goes for, also, obviously, men as well--that people may not realize in their lives.

 

Dr. Fetherston: Yeah. And we did speak a lot about women, but for men, there is an aging process that goes on for men as well. And so usually, around age 50, men start to experience some changes. They have a little bit more difficulty with arousal, so getting an erection might be a little bit more of a difficulty for them.

 

Their plateau phase, or that time where it takes to go to completion, basically, to have the orgasm, is a longer period of time. And so, sometimes it's a little bit more frustrating, it takes a little bit longer period of time, and so a man might consider coming in and discussing that with his physician.

 

There are options, but also, just to know that that's normal, that it does take a little longer. And so, usually, for the couple, it's a good experience. Takes a little longer, a little bit more foreplay, and so more time together.

 

But there's also, as you know, other conditions that can cause a problem. Things that come to mind, for me, are smoking, first thing. People who smoke have less blood supply to vital organs and the pelvis, and so that can be a real problem, as can medication.

 

Dr. Schiesser: This is almost such a complex area that I appreciate the fact that we've been able to touch on so many different areas in this last segment. I'm sure we could spend three shows talking about the complexities here.

 

Dr. Fetherston: We could. [laughs]

 

Dr. Schiesser: And the great thing is that we've been able to put words on some issues that a lot of folks out there may be thinking through in their brains, but haven't really had an opportunity to put so much attention and thought and words on that we have this morning.

 

I want to invite people to go back to www.CreeksideMedicine.com, or send their friends to CreeksideMedicine.com, and listen to this podcast on the Health Dimensions page. And I appreciate that Dr. Debra Fetherston, who will be with us after break, has come on this morning to talk to us. This is Health Dimensions, on AM 1090 KPTK in Seattle.

 

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