You finished the shift. You’re so tired your eyes burn.
And at 11 p.m., your brain is still running through tomorrow’s list- the inbox, the next monitoring appointment, the dishes in the sink.
And even once you’ve finally fallen asleep, you’re back at it at 4am… anxious, wired, and unable to sleep.
Dr. Funke Afolabi-Brown is back on the podcast this week. She’s a triple board certified sleep physician, founder of Restful Sleep MD, bestselling author, and coach for high achieving women who are done treating sleep as optional. If you caught our first conversation, you know how practical she is.
This time we went deeper- into the hormonal roller coaster of fertility treatment, the reality of call and night shifts, and something I talk about with clients all the time: surrender. The harder you hustle toward sleep, the more it slips away. Sound familiar?
Here’s what we get into:
What restorative sleep actually means and why your Oura ring doesn’t get to decide
The 15 to 20 minutes before bed as protected time, and how to give yourself permission to leave the task list until morning
The treatment hormone roller coaster: soaring estrogen, the progesterone crash, and what each does to your sleep
Conditioned arousal: when your brain learns the bed is a place to be awake, and how CBTI helps retrain it
Shift work sleep disorder is a real diagnosis, plus practical strategies for nights: a nap before your shift, sunglasses on the drive home, and where melatonin actually fits
The OB/GYN client who realized she didn’t have to keep doing 24 hour shifts and what changed when she switched to twelves
Find Dr. Funke at therestfulsleepplace.com and on Instagram at @restfulsleepmd. Her course, The Sleep Recovery Method™, walks through CBTI step by step.
You can’t hustle your way into sleep. Some things only arrive once you stop chasing them. 💜
With Love and Science,
💜 Dr. Erica
P.S. If you’re running on empty and carrying a fertility journey on top of everything else, you don’t have to sort through it alone. A Private Fertility Consult is a working session where we look at your full picture together and map the next step. Book a consult here. I’d love to connect.
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Erica Bove, MD (00:02)
Hello, my loves, and welcome back to the Love and Science Podcast. I have an amazing guest today. She is a friend, she's a colleague. Her name is Dr. Funke Aphola B Brown. I actually had her on the podcast a couple of years ago, and we were just talking before we started recording about, you know, yes, some things are the same, but we have both evolved so much since then that we are bringing to you a wealth of information about sleep and hormones and female physicians.
That really was just in the beginning two years ago, and we have so much more to offer you today. So let me introduce her. She, her name is Dr. Funke Aphola B. Brown. She is a triple board certified sleep physician. She's also the founder of Restful Sleep MD. She's a best-selling author, and she's also a coach for those people who are not rooted in Pennsylvania. She helps high-achieving women prioritize sleep, achieve optimal health, thrive, and live to their fullest potential. So
I I have learned so much personally from Dr. Funke. I have read her book. I've reread her book. And today I'm so grateful that she's on our podcast to really enlighten us all about the complexity of fertility treatment and sleep and hormones. Thank you, Dr. Funke. Thank you so much for being here.
Funke Afolabi-Brown, MD (01:16)
thank you so much, Dr. Erica. It's so good to see you. Look at us matching. I mean, for those who might see the video, I love it.
Erica Bove, MD (01:20)
I know, I know, like you guys will see in the reels that we're like wearing the same like beautiful
pink color. So it's meant to be. Okay. So I hear all the time from my patients and my clients, I'm exhausted, right? And I'm
Funke Afolabi-Brown, MD (01:34)
Mm.
Erica Bove, MD (01:35)
I'm a fertility specialist. I'm not a sleep specialist like you.
Funke Afolabi-Brown, MD (01:38)
Yeah.
Erica Bove, MD (01:39)
And so I I guess I wanted to start off by asking you the question, what does it mean to get restorative sleep? What does that mean?
Funke Afolabi-Brown, MD (01:48)
That's a great way to start, a great place to start.
Erica Bove, MD (01:50)
Yeah.
Funke Afolabi-Brown, MD (01:50)
And that bone exhaustion is something that a lot of people, a lot of people that I work with, struggle with, right? and so as such, restorative sleep is that sleep that frees you of that exhaustion. It's really what we talk about restful sleep, where you wake up, you feel relieved, you feel ready to take on your day. And you know, when I think about it, it is not
It is not an objective description. It is very subjective. And this is why you don't make that decision of whether your sleep was restorative or restful based on what your data for those on video I'm wearing an aura ring. It's not based on what your data shows you. It's really based on how you feel and your ability to navigate your day and to show up as the best version of yourself. That's really what I would say.
Think of when you wake up and you just feel like singing, right? Yeah, that's it. That's the sign.
Erica Bove, MD (02:53)
So that's so interesting. So
that happened to me the other day. And then what do you recommend when people experience that? To be like, okay, what what was the context? When did I go to bed? How many hours did I sleep? What did I do before bed? You know, like, I don't know.
Funke Afolabi-Brown, MD (03:06)
Yeah.
Erica Bove, MD (03:07)
Sometimes I feel like we might hit upon it like almost by accident. And and you know, I mean I I think it can be intentional, but I I'm thinking
Funke Afolabi-Brown, MD (03:09)
Hm. wow. Yeah. Yeah. Yeah.
Erica Bove, MD (03:15)
about, you know, my my c my clients and my patients, they often live at least an hour away from their fertility clinic.
Funke Afolabi-Brown, MD (03:21)
Mm,
Erica Bove, MD (03:22)
So they're waking up
Funke Afolabi-Brown, MD (03:22)
mm.
Erica Bove, MD (03:23)
early, they're trying to fit in their monitoring before they go to their physician
Funke Afolabi-Brown, MD (03:26)
Mm.
Erica Bove, MD (03:26)
job or their other high achieving, high power job. They're driving some some somebody told me the other day that they their office is 50 miles from their home, which and then like there's
Funke Afolabi-Brown, MD (03:37)
Wow.
Erica Bove, MD (03:37)
options, you know, in both directions. So but sometimes she drives 50 miles in one direction and a hundred miles in the other direction. And I just I I was tired just like listening to what she was talking about,
Funke Afolabi-Brown, MD (03:47)
Wow.
Erica Bove, MD (03:48)
you know.
Funke Afolabi-Brown, MD (03:48)
Yeah.
Erica Bove, MD (03:49)
Because
fertility care is is is somewhat specialized. And if you live on the
Funke Afolabi-Brown, MD (03:52)
Yeah.
Erica Bove, MD (03:53)
East Coast and there's offices, you know, pretty close and a high density, but if you're in the West or the Midwest or the South,
Funke Afolabi-Brown, MD (03:59)
Yeah.
Erica Bove, MD (04:00)
people really often do have to travel a long time. Or even if you're in New Jersey and you're traveling 45 minutes, I mean that still cuts into your day and your sleep. So
Funke Afolabi-Brown, MD (04:06)
It's still yeah.
Erica Bove, MD (04:09)
so how do you recommend that people begin to start
Funke Afolabi-Brown, MD (04:12)
Mm.
Erica Bove, MD (04:14)
thinking about restorative sleep? What like what what
Funke Afolabi-Brown, MD (04:16)
Yeah.
Erica Bove, MD (04:16)
what do you do to help people with that?
Funke Afolabi-Brown, MD (04:19)
Yeah, I mean, when we think about why you're tired, it's exactly what you're describing. There are elements of this that are related to sleep, but then there's so many elements of this that's related to stress and life and that fertility journey, right? So there
Erica Bove, MD (04:35)
Mm-hmm.
Funke Afolabi-Brown, MD (04:35)
are many pieces to it. And at the end of the day, there will be things that are within our control, and there will be things that are way out of our control. And it it just is what it is. So
What I would say is don't go crazy if you have that night where you slept really, really well. The goal is not for it to be a hit or miss. The goal is that waking up refreshed is predictable. It becomes a pattern, not like a one off. But I would say maybe an observation instead of like saying, okay, what did I do? How did I position my arm? What kind of pillow did I sleep on? Like now you're gonna get anxious, right? Because now you're trying to repeat it. But just really say, okay.
What what what maybe what limits? What did I say yes to? What did
Erica Bove, MD (05:15)
Mm.
Funke Afolabi-Brown, MD (05:16)
I say no to? what was when did I eat? You know, just some just observe, right? Observe. And and that doesn't necessarily mean it's gonna replicate right away. But I think as you gather that data, you can now start to see, well, hmm, I notice a trend. When I go on social media just before bed, it seems like, you know, my heart rate's a little higher. It seems like it's a little bit harder to settle down. Or
I was so exhausted and I had some, you know, a quick diet coke with dinner because I just could hardly push through till bedtime. It seems like I'm noticing a trend here. And so then you start to lean in gently into those things that you feel are serving you. And and then from there you can now start to make this more of a habit, knowing too that there are other things that you're doing during the day which we would need to work on as well to.
You know, minimize that stress.
Erica Bove, MD (06:13)
Yeah, that makes so much sense. And so I think
Funke Afolabi-Brown, MD (06:15)
Mm.
Erica Bove, MD (06:16)
I think, you know, for me I have a very full schedule. And I think, I mean, just
Funke Afolabi-Brown, MD (06:19)
Mm.
Erica Bove, MD (06:19)
because I'm like this great example of this like typeway female physician who like, my gosh, I hit upon it. What do I do? Like, ooh.
Funke Afolabi-Brown, MD (06:24)
Ha ha ha.
Erica Bove, MD (06:26)
I think my thought was, okay, it's possible to wake up feeling this way. Right. And like I think maybe that possibility thinking, okay,
Funke Afolabi-Brown, MD (06:33)
Mm.
Erica Bove, MD (06:33)
it doesn't have to be this way every night, but there are some nights that I can start to wake up feeling rested. For me, that's like a great
Funke Afolabi-Brown, MD (06:39)
Hm.
Erica Bove, MD (06:40)
entry point because it's gentle, it's kind, it's self-compassionate.
Funke Afolabi-Brown, MD (06:42)
Yes.
Erica Bove, MD (06:43)
And then it's like, okay, I think I want more of this. Like I think I can
Funke Afolabi-Brown, MD (06:46)
Hmm.
Erica Bove, MD (06:47)
lean into more of this. and I think this this conversation we're gonna have is gonna help with some of that too, in terms of like what you find for many women, high achieving
Funke Afolabi-Brown, MD (06:57)
Mm.
Erica Bove, MD (06:57)
women, what helps them to, you know, to experience that. So so what do you think about the person who wakes up feeling like tense in their muscles? Like they're like, okay, I did sleep for seven or eight hours, but I know
Like my jaw's tight, my muscles are tight, my like you know, my upper neck
Funke Afolabi-Brown, MD (07:13)
Yeah. Hmm.
Erica Bove, MD (07:15)
and I do you know, body scans with people all the time and I feel like it's often just like the shoulders are on the ears with tension. What do you think about
Funke Afolabi-Brown, MD (07:22)
Hmm mm.
Erica Bove, MD (07:23)
that?
Funke Afolabi-Brown, MD (07:24)
That is that is a that is a very common experience actually with a lot of women. I I would say the first thing to to to do is really assess and say where is this coming from, especially that jaw tension. Many of us, again, high-achieving women, hold tension in our jaw and also in our shoulders. And so
I would say start from the beginning of the night. Like how, what's that transition from wakefulness to sleep? What does that look like for you? This is something that I think is so powerful. Just that bedtime routine, that sacred time, 15-20 minutes before you ease into bed. What are you doing? That would be a good time to do some stretches. That would be a good time to incorporate things like journaling, reflection, maybe breathing exercises. That would be a good time to let go.
Of things that you really don't have much control of at that moment. Because we have this non-stop lives that we're living. And many times because you're putting out fires, you're leading teams, you're make organizing and fixing the whole world, you've not necessarily had time to check in with yourself to figure out, let me think about what I'm thinking about. So then you want to create such time for you to say, okay, this is how I'm feeling.
and some of those things you can manage right on the spot. Some of that may lead to, okay, I think I'm gonna need some help, some coaching, maybe talk to a therapist
Erica Bove, MD (08:54)
Mm-hmm.
Funke Afolabi-Brown, MD (08:55)
tomorrow. I'm not gonna be able to fix it today. So that will be something that you wanna pay attention to. That's one thing. That really is around sort of the cognitive psychological part of this. We do know that as we get older, this is just it just comes with the territory, the risk of sleep disordered breathing comes in. I have a lot of women who have.
TMDs, so temporal mandibular joint dysfunction, you know, the jaw clenching, the teeth grinding. There's a whole space that talks about lifestyle, you know, you know, managing stress, all of that. But there's another area of this that also talks about sleep disorders. So especially
Erica Bove, MD (09:32)
Mm-hmm.
Funke Afolabi-Brown, MD (09:33)
if you're doing the the basic things, not so basic, but you're realizing there's this persistent clenching, teeth grinding. It might be time to get evaluated for sleep apnea, for instance.
Erica Bove, MD (09:46)
Mm-hmm. That's really interesting. You know, I think when we when we talked before a couple years ago, you had mentioned like the bedtime routine, almost like we have a morning routine, like a wind down routine. And I will say that is something I really struggle with personally is to say, okay, it's X time, like 9 p.m. or whatever, or 8 PM, like I'm turning it off because the to-do list is so long.
Funke Afolabi-Brown, MD (10:07)
Mm.
Erica Bove, MD (10:07)
And there's so many things to do. And so how do you help people like me who are like go, go, go all the time and
Funke Afolabi-Brown, MD (10:14)
Yeah.
Erica Bove, MD (10:16)
you we want to do it, but it's like so hard to give the permission to be like, okay, you've done enough today and you can let those things go on the to-do list. I mean, yes, you're
Funke Afolabi-Brown, MD (10:25)
Yeah.
Erica Bove, MD (10:25)
right. There is a component of the stress in the journaling where people I think if they journal about the fertility journey and the stress related to those things, that is very useful. But then there's this whole other hat of like, okay, this bill that needs to be paid, or this
Funke Afolabi-Brown, MD (10:37)
Hm.
Erica Bove, MD (10:38)
all these emails I didn't get a chance to, you know, answer during the day, or like that's that constant feeling of being behind, I
think
Funke Afolabi-Brown, MD (10:45)
Yeah.
Erica Bove, MD (10:45)
truly that that's behind a lot of it for for people. And so how
Funke Afolabi-Brown, MD (10:48)
Yeah. Hmm.
Erica Bove, MD (10:49)
do you help high achieving people slow down in the evenings to give themselves permission to let things be unfinished to start that wind down
Funke Afolabi-Brown, MD (10:57)
Yeah.
Erica Bove, MD (10:57)
routine?
Funke Afolabi-Brown, MD (10:58)
Yeah, it's it's a mindset. That's that's key. I'm gonna say something funny. Get a puppy. I just got one, and he's he slowed me down tremendously
Erica Bove, MD (11:07)
Ha ha!
Funke Afolabi-Brown, MD (11:08)
because he's like, I need to go to the bathroom, I don't know what you're talking about, and so you gotta put everything away, right? But
Erica Bove, MD (11:14)
I love it.
Funke Afolabi-Brown, MD (11:15)
reality, I would say it's really around one doing the best you can to create some
non-negotiables in your in
Erica Bove, MD (11:28)
Mm-hmm.
Funke Afolabi-Brown, MD (11:28)
your life, right? And so, and that's why I said it starts with the mindset. When you think about what sleep does in the human body, the miracle that is sleep, right? How foundational it is in our fertility journey, in our ability to make those high quality decisions, in improving our executive function, in helping us heal and recover and all the good things, then it starts to look like this
Eight hour pill or six hour pill or seven hour pill, whatever your your your number of hours of sleep is that we have to take. And so the same way we're working towards eating healthy, the same way we're working towards fitness and exercise, this is what I do. And then from there you you you kind of count backwards. Say for instance, you have to wake up at you know X amount of time, right? 6 a.m. or something. Okay, well, 6 a.m. maybe I need to get
Maybe seven hours of sleep. That means I have
Erica Bove, MD (12:24)
Mm-hmm.
Funke Afolabi-Brown, MD (12:24)
to be in bed by 11 p.m. And then do that work to say, well, what do I need to do to make seven hours in bed a reality for me? And we we
Erica Bove, MD (12:34)
Mm.
Funke Afolabi-Brown, MD (12:35)
really have to have that conversation with ourselves. Well, to do that, I'm not gonna stop everything at 11 pm. That means I gotta drop it all, maybe 10 30, maybe 10, depending on how long your bedtime routine takes. And then the next question is, well, what do I need to do?
To ensure that I can give myself that permission. Then that comes, you know, back to what you're saying, the question around well, boundary setting. What do I need to delegate? What do I need to automate? What do I need to
Erica Bove, MD (13:02)
Mm-hmm.
Funke Afolabi-Brown, MD (13:03)
let go of? Because this situation, fortunately, at least for most people, this is not like ICU level stuff. It doesn't, it's like life does not depend on you paying that bill at 9:30, right? And so
Being able to sort of walk your way backwards, I think it's really important. And then another thing I would say that you have to absolutely do during during the day, especially as a fast-paced, high-achieving woman, is create breaks for yourself. You might need to, I have an alarm that goes off that says, just chill, like stop. And that gives me an opportunity. And whether I just take my eyes off the screen, whether I just take a quick walk, five-minute walk.
It just allows me to not feel like I'm carrying all this energy all the way to bedtime. Because when I
Erica Bove, MD (13:48)
Mm-hmm.
Funke Afolabi-Brown, MD (13:49)
carry all that energy to bedtime, that's when everything feels like a crisis. I need to do it, do it, do it, do it, do it. But when you sort of pause or stop, as they say, to to smell the flowers, right? That's when you start to realize, okay, we got this. Even if we don't have to do it all at once, we'll get to it.
Erica Bove, MD (14:08)
I think there is so much brilliance in everything that you just said. And I I also think
Funke Afolabi-Brown, MD (14:12)
Mm.
Erica Bove, MD (14:14)
stopping normalizing like start starting how to say this, we need to stop normalizing the fact that we can be like sleep deprived, running around
Funke Afolabi-Brown, MD (14:24)
Mm.
Erica Bove, MD (14:24)
on coffee caffeine. I think a lot of people see it as a badge of honor, like, look how tough
Funke Afolabi-Brown, MD (14:28)
Yeah.
Erica Bove, MD (14:29)
I am. I only slept this many hours and I
Funke Afolabi-Brown, MD (14:31)
Mm.
Erica Bove, MD (14:31)
did all these things and and it's like
you know, nobody's looking for a a hero. Like maybe maybe
Funke Afolabi-Brown, MD (14:37)
Yeah.
Erica Bove, MD (14:38)
the heroic thing is actually to reset what we're hoping for and maybe the the new normal is, my goodness, you know, I'm the hero if I can get seven to eight hours of sleep and wake up. And
Funke Afolabi-Brown, MD (14:49)
Yep. Yeah.
Erica Bove, MD (14:50)
I I mean, I'm sure you know this 'cause you do this day in day out, but I think so much better when I'm rested. My brain is faster. I make better decisions.
Funke Afolabi-Brown, MD (14:56)
Mm-hmm. Yep.
Erica Bove, MD (14:58)
I don't second guess myself.
And so the reality
Funke Afolabi-Brown, MD (15:00)
Mm-hmm.
Erica Bove, MD (15:01)
is I'm actually gonna be more functional when I get the sleep. I
Funke Afolabi-Brown, MD (15:03)
Mm-hmm. Yep.
Erica Bove, MD (15:05)
just need to set those boundaries. Like you said, you said boundary setting, what can I delegate, what can I automate, what can I let go of? I think that is so brilliant. So thank you for sharing
Funke Afolabi-Brown, MD (15:10)
Yeah, yeah, yeah.
Erica Bove, MD (15:14)
all of that. I think it's gonna help so many people.
Funke Afolabi-Brown, MD (15:16)
absolutely. And then the other thing I want to say that you had mentioned is giving giving permit giving yourself permission. I it sounds cliche, but it is so real. Give yourself permission to leave the dishes in the sink. Like literally, that kind of la that level.
Erica Bove, MD (15:29)
Yes. Yes.
Funke Afolabi-Brown, MD (15:32)
Like you do not have to be score an A plus and have this perfect home, perfect life. Life is messy. So give yourself permission. That extra five minutes that you would have spent or ten minutes loading those dishes, like.
If it's eating into that time, that boundary you've set around sleep, let it go for tonight. Because guess
Erica Bove, MD (15:52)
Yeah.
Funke Afolabi-Brown, MD (15:52)
what? Now tomorrow you'll be like, Okay, well maybe I need to work things in such a way that I get it done earlier or I get somebody else to do it. Right. So
Erica Bove, MD (16:00)
Yeah.
Funke Afolabi-Brown, MD (16:00)
I think that's a big piece.
Erica Bove, MD (16:02)
That's so beautiful. Okay, so let's shift to talking a little bit about hormones and sleep. And I I think there's more and more coming out about this that, you know, s the menstrual cycle in general. Sometimes
Funke Afolabi-Brown, MD (16:14)
Yeah.
Erica Bove, MD (16:15)
our sleep can vary over the course of the menstrual cycle. I will say the fertility journey is is a time of a lot of hormonal roller coasters, right? So IVF,
Funke Afolabi-Brown, MD (16:23)
Yeah.
Erica Bove, MD (16:24)
the estrogen levels are sky high.
You know, if if we're lucky, right? If somebody has the capability,
Funke Afolabi-Brown, MD (16:26)
Yeah. Hmm.
Erica Bove, MD (16:29)
the potential of getting a lot of follicles, a lot of eggs, and then, you know, then we shift to the progesterone phase, and
Funke Afolabi-Brown, MD (16:35)
Yeah.
Erica Bove, MD (16:35)
then there's this crash of the hormones. And I wanted to ask, you know, what you see about the connection between hormones and sleep. And I mean, yeah, we talk about perimenopause and sleep, but I don't think we talk about these huge hormonal
Funke Afolabi-Brown, MD (16:47)
Yeah. Enough. Hmm.
Erica Bove, MD (16:50)
shifts in the context of fertility treatment and how
Funke Afolabi-Brown, MD (16:52)
Yeah.
Erica Bove, MD (16:52)
we might be able to mitigate some of those struggles.
Funke Afolabi-Brown, MD (16:55)
Yeah. Yeah, I would say I think this is so powerful because and I was talking to somebody recently about this. The same way when you start to have you know periods and you start to go through your your menstrual cycles, you see a sort of tumultuous experience sometimes with sleep, right? PMDD, all of that fatigue, excessive sleepiness at certain times. Also, towards the tail end, when you stop having your cycles, i.e. perimenopause.
You start to
Erica Bove, MD (17:24)
Right.
Funke Afolabi-Brown, MD (17:24)
see those changes. But every single month in between, there are, and some people are just more sensitive to these changes than others. So we know that progesterone, because I say I talk about progesterone more because it there's a tighter connection relatively when it comes to sleep, because it has this gabarurgic properties. it tends to provide this relaxation, slight sedation, and so we will notice that.
you know, mainly in that lureal phase as the progesterone starts to rise, you may start to feel a little bit more tired, more sleepy. Then once you know your spirits start, you start to get this whole crash, and this is where you know the insomnia may set in, and
Erica Bove, MD (18:08)
Mm.
Funke Afolabi-Brown, MD (18:09)
difficulty sleeping, maintaining or initiating sleep. And this is a pattern I see in a lot of women. The issue, however, because that's you know
You may have a few, maybe five to seven days where it's really challenging and most times things stabilize. But where we start to get into issues is not actually with the specific hormonal changes. It's over time what now happens. When you start to predict that your brain starts to predict,
Erica Bove, MD (18:35)
Mm.
Funke Afolabi-Brown, MD (18:36)
my goodness, it's about to start again. We're not gonna sleep, it's gonna be horrible. And then and then what you develop is what we call conditioned arousal.
I had this with a lot of with a lot of my patients. It may have started with, yeah, I would have, you know, changes with my sleep, with my cycle, but now, even when I'm not in my cycle, I'm still struggling. And so that now becomes the thing that we start to work towards. But knowing that, I think the understanding that your sleep might change. And we don't, not everybody has the same experience. Some people are just more sensitive than others. And we really don't know what really puts some more people at risk than others. I would say
folks with it's not PCOS now, it's PMOS, I assume, right? Though
Erica Bove, MD (19:18)
Yeah.
Funke Afolabi-Brown, MD (19:19)
they tend to have a a a little bit of a tougher time. But I think what you do need to know is when that if that's a a situation you notice about yourself, that's data. And it's important that you you take some action on that and say, okay, well, at this certain period of time in the month, it tends to be a little bit ch more challenging.
And so everything you and I just talked about, right onto up until this moment, you actually take it even more intentionally. After
Erica Bove, MD (19:45)
Mm-hmm. Yeah.
Funke Afolabi-Brown, MD (19:48)
that, whatever, do you do you? But in that situation, this would be more important to set those boundaries to have that bedtime routine. Your bedtime routine may need to be a little bit longer because again, you're you're it's it's you're just more sensitive and it just it's it makes it makes it a little bit harder for you to initiate sleep. So you may need a longer window. You may need to drop that
Room temperature a little bit more. You may really, really need to take that warm shower or bath before you go to bed. So that intentionality and planning around it is important. And per adventure, you now get into a situation where it has become this habitual conditioned awakening or dreading of sleep. Then we really start to talk through what cognitive behavioral strategies that we would need to implement.
Erica Bove, MD (20:36)
Yeah, that makes so much sense. I mean, I I guess the question that's coming up for me is like, how do you start to disentangle? What is the effect of stress?
Funke Afolabi-Brown, MD (20:42)
Mm.
Erica Bove, MD (20:44)
What is the effect of hormones? What is
Funke Afolabi-Brown, MD (20:46)
Yes.
Erica Bove, MD (20:46)
some like you said, like what is when do you need more evaluation from somebody like yourself and some cognitive behavioral things? Like, how do
Funke Afolabi-Brown, MD (20:50)
Absolutely. Mm-hmm. Yeah.
Erica Bove, MD (20:54)
you think about all of that?
Funke Afolabi-Brown, MD (20:56)
fantastic question.
And the answer is, is it the hormones? Is it stress? Is it insomnia? Is it another sleep disorder? And the answer is yes. For most for most,
Erica Bove, MD (21:06)
Yeah.
Funke Afolabi-Brown, MD (21:08)
it's yes, right? Because at the end of the day, you know what we talk about, the chicken or the egg. The situation
Erica Bove, MD (21:14)
Right.
Funke Afolabi-Brown, MD (21:14)
is it's here now. So what do we do? And and when people
Erica Bove, MD (21:16)
Exactly.
Funke Afolabi-Brown, MD (21:17)
and I I feel like for women, we've been gas leap for so long, they'll say, Yeah, just
Stop stress, manage stress. What does that even mean? How on earth do we manage this thing that feels
Erica Bove, MD (21:27)
Right.
Funke Afolabi-Brown, MD (21:27)
unmanageable, right? Because at the end, you know, whatever the case, eventually it feeds into our sleep. Sometimes, even when the stress itself, it might be acute stress, even when the stress is not so intense, it's left
Erica Bove, MD (21:41)
Mm-hmm.
Funke Afolabi-Brown, MD (21:42)
footprints. So, regardless of what's going on, these things would still stay true.
Now, here are situations where you do realize this is most likely a comorbid underlying sleep disorder. Snoring, waking up with your very dry mouth, teeth grinding, you know, very restless sleep, you know, you know, drowsy driving, those you need to get evaluated. I don't know, I don't care if it's the hormones or stress or everything else, that needs a medical
Erica Bove, MD (22:15)
Yeah.
Funke Afolabi-Brown, MD (22:16)
evaluation, right?
Or maybe you're somebody who has worked on this enough where you've done all the sleep hygiene, you've practiced delegating, setting boundaries, and for the life of you, you just still wake up at 3 a.m. and you're still not able to go to sleep. And I would say it's been going on for a few, maybe weeks to months. You've tried supplements,
Erica Bove, MD (22:35)
Mm-hmm.
Funke Afolabi-Brown, MD (22:36)
you've tried the melatonin, you've done all the yoga, the mindfulness, and nothing seems to be working. We need to we need you evaluate it because that is the actual definition of.
Chronic insomnia. And while I do not want to put anybody under pressure, because this is the other thing that I would say for especially for a lot of your clients, is you know, maybe you're on that journey of, you know, trying to get pregnant, and now the pressure lies on you. You've now listened and they said sleep is the hallmark of everything. And now you put yourself under pressure to say, I gotta sleep now so that it doesn't ruin my my chances, right? So I think there's a very, very fine balance with that. So
That in and of itself kind of feeds into all that stress which might end up contributing to to wake ups.
Erica Bove, MD (23:22)
I I think that's a fab those are fabulous guidelines.
Funke Afolabi-Brown, MD (23:24)
Mm.
Erica Bove, MD (23:24)
And you know, I'll add that with this PCOS PMOS, even people
Funke Afolabi-Brown, MD (23:28)
Mm.
Erica Bove, MD (23:28)
with lean PMOS have higher rates of sleep apnea. And so I see it all the time when I'm doing an egg retrieval on somebody and they're under
Funke Afolabi-Brown, MD (23:32)
Yeah. Yeah.
Erica Bove, MD (23:34)
anesthesia and they're like snoring away and I'm like, my goodness, like this is probably like let's talk to your partner 'cause this is you probably have sleep apnea and and and like
Funke Afolabi-Brown, MD (23:37)
Yeah.
Erica Bove, MD (23:43)
Eggs actually like energy like oxygen, right? Like just like other tissues in the body. So that's that's something
Funke Afolabi-Brown, MD (23:46)
Yes. Yeah.
Erica Bove, MD (23:49)
I always say, what's in our control and what's out of our control. So like looking at
Funke Afolabi-Brown, MD (23:52)
Mm. Yeah.
Erica Bove, MD (23:53)
those things, getting a sleep evaluation, that's definitely in our control if we have any of those things going on. And then the stress, you know, I think that sometimes we just say, and you know, this treatment's inherently distressful and that is what it is, and I'm just gonna, you know, get my grit and get my resilience and power through.
Funke Afolabi-Brown, MD (24:08)
Mm.
Erica Bove, MD (24:09)
And it doesn't have to be that way. Like there's so many tools of, you know, we do a lot of like mindfulness meditation and affirmations and journaling and yoga,
Funke Afolabi-Brown, MD (24:19)
Mm.
Erica Bove, MD (24:19)
moving the body and really listening to like what the body needs. And so we've
Funke Afolabi-Brown, MD (24:23)
Mm.
Erica Bove, MD (24:23)
talked about this before. I think if there is a stress component and then we start
Funke Afolabi-Brown, MD (24:27)
Hm.
Erica Bove, MD (24:28)
to process it during the day, you know, when we have that space for mindfulness, we have to create the space in the first place because a lot of us don't do that.
Funke Afolabi-Brown, MD (24:34)
Yes, mm-hmm.
Erica Bove, MD (24:36)
But when we
can really even give a little bit of attention to that, then it's not that really loud voice at four AM, the panic attacks, like, you know,
Funke Afolabi-Brown, MD (24:44)
Yeah. Hmm.
Erica Bove, MD (24:46)
is this treatment gonna work? I only have two embryos left. And if not that, then, you
Funke Afolabi-Brown, MD (24:48)
Hmm.
Erica Bove, MD (24:49)
know, like projecting ahead. Well what if I need a gestational carrier and we have to spend over a hundred thousand dollars? I mean, like our brains just are these like trains at four AM and if we can get ahead of it by processing some of that stress in a structured way, I find that that people
Funke Afolabi-Brown, MD (25:03)
A really protect.
Erica Bove, MD (25:04)
start to sleep a lot better.
Funke Afolabi-Brown, MD (25:06)
That is huge. That is and there's
Erica Bove, MD (25:07)
Yeah.
Funke Afolabi-Brown, MD (25:08)
actually an element of when we deal with chronic insomnia where we talk about acceptance commitment therapy, which is really it's that act, that that surrender, right? And we've talked about this. I feel like this is nostalgia.
Erica Bove, MD (25:20)
We've talked about surrender.
I'll I'll put our conversation from two years ago. That really was a lot of what we talked about then was how surrendering
Funke Afolabi-Brown, MD (25:24)
Yeah, yeah. It was powerful. Yeah.
Erica Bove, MD (25:28)
to the sleep process, surrendering to the fertility journey, it's all one and the same thing. But it's
Funke Afolabi-Brown, MD (25:30)
Yeah. Yeah. Yeah.
Erica Bove, MD (25:33)
it's it's really hard, you know, we don't surrender naturally. Our our instinct is to fight or to flight or to freeze.
Funke Afolabi-Brown, MD (25:37)
Hm, yeah, yeah.
Erica Bove, MD (25:41)
It's not to turn it over because I think a lot of us when we're used to control, control, control,
work harder, you'll
Funke Afolabi-Brown, MD (25:46)
Hm,
Erica Bove, MD (25:47)
get your outcome.
It's it's a foreign
Funke Afolabi-Brown, MD (25:48)
yeah.
Erica Bove, MD (25:49)
concept where it feels vulnerable, it feels scary, it feels
Funke Afolabi-Brown, MD (25:51)
Hm.
Erica Bove, MD (25:52)
like if we're not working harder then we're, you know, giving up or we're like letting ourselves
Funke Afolabi-Brown, MD (25:57)
Yeah.
Erica Bove, MD (25:57)
down. but I think but what how do you think of surrender and sleep? 'Cause let's talk about this again, 'cause it's such a such a rich concept.
Funke Afolabi-Brown, MD (26:03)
Yeah, it is
and it it's so funny because this was not intentional, but one way or the other it made its way in. We were gonna go all scient.
Erica Bove, MD (26:07)
No. It did make its way in.
Funke Afolabi-Brown, MD (26:11)
We were gonna go all scientific. But you can see this is critical. If we don't get this piece, then everything else is you know, it's it's just whatever. So I would say one thing, like you said, I wanna lean into is that piece of surrender, that fight you're having, that fight to let go, because it almost feels like it's feels like a fight to let go.
It's really hard for you to do it effectively in the middle of the night at 3 a.m. It's challenging if you've never practiced it. So I love the work you already do with your clients and your patients, which is really working on mindfulness-based practices during the day. Because I have patients who are now trying to learn a whole breathing technique at 3 a.m. And they're like, wait, is it the right nostril first or the left nostril?
Do I breathe 546 or 444 or 478? Now you're now now, you know, and you're type A, and so now you're spiraling because you can't even breathe right, right? So so I would say to start, in at the in the moment, yes, you will push through, you will get through. Sometimes getting out of bed and just doing something else. If you're struggling, you're noticing you're spiraling, the thoughts are racing, the worries are coming, you're
You're doing some math about how many more hours you have in bed before it's time to wake up. Those things are not sleep-related activities. So at that time, you may need to just lean in and say, Well, I'm gonna take a break from this and just sit in a chair, maybe listen to a calming podcast or music, or do some breathing out of that bed situation. And then once you start to feel a bit more relaxed, you get back into bed. But
The following day or a couple of days after I want you to start to build it in. How is what can I do if I have just five minutes to just breathe? What can I do if I just get to write what's going on? Check in with me, check in with myself, right? Those are practices that you want to incorporate right there. and then
Erica Bove, MD (28:06)
Right.
Funke Afolabi-Brown, MD (28:06)
at bedtime, some of the things is again another check-in to say, well, what's lingering? What are the thoughts and the worries that might be lingering? and maybe maybe I'll say maybe I'll write one thing that I could do about it.
tomorrow, not tonight. I'm not, I'm gonna go to sleep tonight. But maybe I need to check in with my doctor tomorrow. Maybe I need to ask for help. Maybe I need to send an email. Well, I will not be doing this at 10 p.m. I will do it tomorrow. And the mind is such a powerful thing, but still that amygdala, that primitive portion, just doesn't know the difference. That you
Erica Bove, MD (28:39)
Yep.
Funke Afolabi-Brown, MD (28:40)
writing down that to-do list or whatever it is that's cluttering your mind, it almost feels like you already dealt with it. So those are things.
And then that ability to say, well, these are the things that are worry that are worrisome. These are the thoughts, the many thoughts I have. These are things I could do. One thing I could do about the ones that I can actually do something about. And these are the ones that are completely with out of my control. And I choose to make that decision to let go. Because there's nothing I can do if I worry, if I hustle, it doesn't change the outcome. So I just
Erica Bove, MD (29:15)
Mm.
Funke Afolabi-Brown, MD (29:16)
let go of it. And so
That conscious practice, and it's gonna feel weird the first couple of times you do it, but then it will become a process that you over time will start looking forward to. And when the thought and the invitation comes as you lay in the dark, trying to you know falling asleep, when the invitation to bring to take those worries on comes back again, you could just murmur to yourself and say, I let go, that's done, I'm done. We'll we're we're gonna address this tomorrow, right? And so.
Those are some practical ways that I would say you can actually let go. And and of that effort, right? there's here's one thing I always tell my patients. We talk a lot about, and I think the wellness industry is just screwing people over, right? It's like take the next supplement and the next the next sleep hack and make your room, you know, 65 degrees and everything will be fixed. Well, it turns out there's really nothing similar to to pregnancy, right? There's really nothing.
You can do to make sleep come. Sleep just comes. It comes. And so the
Erica Bove, MD (30:19)
Right. Right.
Funke Afolabi-Brown, MD (30:22)
more, the harder you try to hustle up and try to get to sleep, the harder it is. It will elude you. Imagine: are
Erica Bove, MD (30:29)
Mm.
Funke Afolabi-Brown, MD (30:29)
we there yet? Are we asleep yet? Are we asleep yet? The more you start to ask yourself that question, the harder it is because you become it you become very conscious and very aware. So
Erica Bove, MD (30:38)
Mm-hmm.
Funke Afolabi-Brown, MD (30:39)
really that practice of
of being able to let go is is really critical to to being able to get that sleep.
Erica Bove, MD (30:47)
Yeah, it's so beautiful. And there's there's actually like meditations that where you actually like vis as you know this, you visualize
Funke Afolabi-Brown, MD (30:52)
Mm. Mm.
Erica Bove, MD (30:54)
like whatever it is that you're worried about and you like watch it go down the river, or maybe sometimes it's a balloon and you like see it float away. I
Funke Afolabi-Brown, MD (30:59)
Mm. Mm. Yep.
Erica Bove, MD (31:03)
also think that it sometimes what makes it really hard for my people to let go is that most of them are female physicians, they're responsible
Funke Afolabi-Brown, MD (31:07)
Mm.
Erica Bove, MD (31:10)
for everybody's care, and so they think if I'm not the hypervigilant one, then who is going to be
Funke Afolabi-Brown, MD (31:15)
Yes,
Erica Bove, MD (31:15)
that? And so
Funke Afolabi-Brown, MD (31:16)
we
Erica Bove, MD (31:17)
What so I I I get at this in a couple ways and I th I find that it helps with the surrender process. And you know, one of one of the things that we do is we cultivate authentic hope, which is is what I call it's hope grounded in science. And so for
Funke Afolabi-Brown, MD (31:32)
Mm.
Erica Bove, MD (31:33)
every single person I work with, I identify why it makes sense for them to keep going on their journey. And, you know, maybe it's that they are 32.
And they have good egg reserve and good quality. Maybe they have had a baby before and we know their uterus has been so so the the list goes on, but but I always am reminding people because we have such a negativity bias. I'm reminding
Funke Afolabi-Brown, MD (31:53)
Hm.
Erica Bove, MD (31:54)
people why I, as an experienced REI, believe in them and then help them transmit that belief to their so themselves.
Funke Afolabi-Brown, MD (32:00)
Mm.
Erica Bove, MD (32:01)
And I think that that that defuses that feeling of threat. That threat.
Funke Afolabi-Brown, MD (32:06)
Hm,
Erica Bove, MD (32:07)
And then I
Funke Afolabi-Brown, MD (32:07)
yeah.
Erica Bove, MD (32:07)
think that truly helps the subconscious when it does come to three or four AM. You know, people can remind themselves like Coach Erica believes in me, my REI believes in
Funke Afolabi-Brown, MD (32:16)
Yeah.
Erica Bove, MD (32:16)
me, these are the reasons I can believe in my own journey and that this is ultimately gonna be successful because we talked about this last time, like it really is going to be okay. But if we
Funke Afolabi-Brown, MD (32:25)
Mm.
Erica Bove, MD (32:26)
can't believe that, then our hyper vigilance is gonna keep trying to protect ourselves. And so
Funke Afolabi-Brown, MD (32:33)
Yeah.
Erica Bove, MD (32:33)
that's what I think
we need to drop into is like, I'm not gonna fix this now. I have a thoughtful plan, you know, I I really can turn this over because it is gonna be okay. So I I kind of
Funke Afolabi-Brown, MD (32:46)
Yeah.
Erica Bove, MD (32:46)
look at what's the skill of surrender and then how can I help people in the other ways to start that process of belief that it actually is gonna work out. And I find that really helpful.
Funke Afolabi-Brown, MD (32:57)
That's so, so powerful. I love it. And and I think that's
Erica Bove, MD (33:00)
Yeah.
Funke Afolabi-Brown, MD (33:00)
it's it aligns so well with that that's why the work we do aligns really, really well. Both
Erica Bove, MD (33:05)
It does. And I
don't I don't know too much about CBTI, but but I would
Funke Afolabi-Brown, MD (33:09)
Yeah.
Erica Bove, MD (33:10)
imagine there's some parallels here. So, you know, we we
Funke Afolabi-Brown, MD (33:12)
yeah.
Erica Bove, MD (33:13)
do a lot with mantras and you know,
Funke Afolabi-Brown, MD (33:15)
Hm.
Erica Bove, MD (33:15)
mantras are basically the thoughts that we think over and over again that induce a certain feeling in us that then allow us to take empowered actions or, you know, inactions, whatever it is that we need to be doing, and then then to generate the results that we're hoping to get. And so it's sometimes it's we don't even realize those thoughts that are running under the surface that are so
harmful to ourselves and then when we can bring those to light and and realize that a lot of those thoughts aren't true and and and because a lot of it's like those monsters under the bed. They're just in our
Funke Afolabi-Brown, MD (33:45)
Yeah.
Erica Bove, MD (33:45)
brains. So how can we look at those, shine a light on those during the day like we talked about, and then and then those lose a lot of their power at
Funke Afolabi-Brown, MD (33:53)
Yeah.
Erica Bove, MD (33:53)
night because we we recognize, right, we talked about that. That's actually not true. I know my brain's offering
Funke Afolabi-Brown, MD (33:58)
Yeah.
Erica Bove, MD (33:58)
me that but I'm just gonna set that aside because I you know it it's just a monster under my bed.
Funke Afolabi-Brown, MD (34:03)
Yeah.
Erica Bove, MD (34:04)
That doesn't exist.
Funke Afolabi-Brown, MD (34:04)
Yeah.
Erica Bove, MD (34:05)
And so that's that's another piece of it too. Can you tell us can you say a little bit about C
Funke Afolabi-Brown, MD (34:08)
Absolutely.
Erica Bove, MD (34:09)
BTI?
Funke Afolabi-Brown, MD (34:10)
yeah, absolutely. And that's it really the key. So when we talk about cognitive behavioral therapy for insomnia, it's the the behaviors, the habits, and the thoughts that we have around sleep, right? And so we start off with fundamentals. There are about five, you know, pillars of CBTI. The first is psychoeducation. That's what we're having right now. You learn about sleep hygiene. The bedroom needs to be cool. How does sleep work?
Your sleep drive, your circadian rhythm, all of that stuff, which is important because some of the habits, the the healthy habits we try to build really are found, it's foundation, it's based on those pillars. and then the other piece that's really, really important actually, it's even independent of all the other pillars, it single-handedly can help address your insomnia is stimulus control. So here's what happens.
We have this, like I said, conditioned hyperarousal, where because you've had difficulties falling asleep for a while, your brain now has associated the bed with a place of wakefulness. People tell
Erica Bove, MD (35:17)
Mm.
Funke Afolabi-Brown, MD (35:17)
me, I'm dog tired, I'm bone tired. As soon as my head hits the pillow, I'm awake, right? And the thoughts start flying. And so that right there is sleep-related anxiety, is worry.
And that's not a sleep-related activity. So what we do with stimulus control is limit the amount of time we spend awake in bed. So when you're
Erica Bove, MD (35:38)
Mm-hmm. Mm-hmm.
Funke Afolabi-Brown, MD (35:40)
noticing a a deluge of strong, intense emotions, a lot of worries and things like that, the same way you wouldn't have dinner in bed, hopefully. The same way you shouldn't be watching TV in bed, the same way you shouldn't, you know, the it's not the same way you shouldn't be doing your office work in bed.
You shouldn't be worrying and trying how to sleep in bed. It's not a sleep-related
Erica Bove, MD (36:04)
Mm-hmm.
Funke Afolabi-Brown, MD (36:05)
activity. So when you take that, that means that as soon as I get into bed, if I'm noticing a lot of worries or I'm in bed tossing and turning and it's been a while, get out of bed. Let's do something else. Let's just take a bit a break from trying. That is so helpful. Because with that, you're retraining those neurons that have come to associate the bed as a place of wakefulness to learn. Well, if you're not gonna sleep, we're gonna do something else, right?
Erica Bove, MD (36:29)
Sure.
Funke Afolabi-Brown, MD (36:29)
And then
once you start to feel sleepy, you get back into bed. So that's stimulus control again, super important. And then we have other things like what we call bedtime restriction because some people go to bed at and stay in bed for 12 hours with hopes
Erica Bove, MD (36:42)
Mm.
Funke Afolabi-Brown, MD (36:42)
that they'll get six hours of sleep. That dilutes your sleep drive significantly. So you want to narrow, you want to have a sleep window, and we usually will work with a sleep diary and things like that. And then the the last one I would say, or the last two, is the cognitive restructuring.
Pretty much everything you just talked about, we just plug it into sleep, right? Catastrophic thinking. The same way you're wondering, will I only have two more eggs retrieved? What is gonna happen? What if, what if, what if? There's a lot of what ifs around sleep. What if I don't sleep? I'm gonna have an accident, I'm not gonna have a a good cycle, it's gonna be the worst, I'm gonna end up under the I'm gonna lose my job. You know, all those catastrophic
Erica Bove, MD (37:18)
Right.
Funke Afolabi-Brown, MD (37:19)
thoughts.
We're gonna now become thought detectives. And so we do what
Erica Bove, MD (37:21)
Mm.
Funke Afolabi-Brown, MD (37:22)
we call cognit cognitive restructuring. So I I'm sure you can see the semblance. So it's taking those thoughts and saying, well, what is the alternative to this thought that I will get into a train wreck because I had one night of poor sleep or two nights of poor sleep, right? What is the likelihood? Well, I've been driving for over 21 years and we've been good. So the likelihood I'm gonna have an accident tomorrow, it's minimal. So okay, what is an alternative I can give to that thought?
That is so catastrophic. Well, even if I don't get a good night of sleep, I've had some pretty bad nights, and but I'm still pretty badass. I'm still doing the things, I'm still crushing goals, I'm still helping people. So you provide gentler kind of alternatives to those
Erica Bove, MD (38:03)
Yeah.
Funke Afolabi-Brown, MD (38:04)
very intrusive thoughts. And essentially, like what you said, you're bringing those thoughts to light and you're offering
Erica Bove, MD (38:09)
Mm-hmm.
Funke Afolabi-Brown, MD (38:10)
alternatives with it. So, and this you're doing along with what we call, of course, relaxation strategies, whether it's a mantra.
Whether it's breathing exercises, whether it's affirmations, whether it's the body scan, progressive muscle relaxation, visual imagery, there's so many tools out there.
Erica Bove, MD (38:28)
Mm-hmm. Mm-hmm. That is so beautiful. And so does if somebody's gonna do C BTI, do they work with somebody like you who knows all these things and yeah.
Funke Afolabi-Brown, MD (38:37)
Yeah, so it's a six to eight week typical program where you'll have with setting so everything I just told told you about takes a while, right? It it's it's many layers of the onion with peeling off. So it usually takes a period of time working with a sleep trained, C BTI trained professional. So either a sleep psychologist, a sleep physician, C BTI trained coaches, all of that. there's some apps, there's
Erica Bove, MD (39:01)
Got it. Yeah.
Funke Afolabi-Brown, MD (39:04)
self-paced programs. I have a course on it. So
They're different resources. So some people need that kind of hand holding. While some people
Erica Bove, MD (39:10)
Yeah.
Funke Afolabi-Brown, MD (39:11)
with, you know, especially with someone, people that work with you already, you're familiar with that letting go acceptance commitments. it really lends itself well to the tools that you get from CBTI.
Erica Bove, MD (39:24)
That's so beautiful. So what I'm gonna say is if this sounds like something that could help you, go check out Dr. Dr. Funk's resources, her course, her services. Just wanna say this is something that a lot of my people struggle with. And we do know that, you know, as as much as we try to walk that line of self-compassion, eggs
Funke Afolabi-Brown, MD (39:40)
Yeah.
Erica Bove, MD (39:40)
do like good sleep. You know, uterine,
Funke Afolabi-Brown, MD (39:42)
Yeah.
Erica Bove, MD (39:43)
you know, receptivity, i we do better on the fertility journey when we are sleeping well. And so I just
Funke Afolabi-Brown, MD (39:49)
Yeah.
Erica Bove, MD (39:50)
wanted to put in that plug.
If sleep is something that you're struggling with, please do look at Dr. Funke's materials because she's amazing. Okay. I'm gonna transition and ask something I really, really we never talked about last time, which is physicians who have particular obligations, and I put that
Funke Afolabi-Brown, MD (40:09)
Mm-hmm.
Erica Bove, MD (40:09)
in some of my air quotes because we can set boundaries, but you know, particular sleep schedules. And so this is gonna be published right following this series that I've done on, you know, most of my clients are female physicians, but
What does it mean to be an OBGYN struggling with fertility? How is that different from a pediatrician struggling? How is that different from a trauma surgeon? There's some core elements that are similar, but there's actually a lot of differences among these different areas. And so what I am trying to do is see the various people with
Funke Afolabi-Brown, MD (40:40)
Mm.
Erica Bove, MD (40:41)
their subspecialties and really help. And the thing that keeps coming up over and over again is altered sleep schedules.
And
circadian
Funke Afolabi-Brown, MD (40:48)
Mm.
Erica Bove, MD (40:48)
rhythms and 24-hour calls and having to work the next day post call. And so what can you say about people with these demanding sleep-altering jobs? And and what
Funke Afolabi-Brown, MD (41:00)
Yeah, well
Erica Bove, MD (41:00)
can we do? What boundaries need to s do we need to set? Like, what is your suggestion to female physicians with infertility with these various
Funke Afolabi-Brown, MD (41:08)
Yeah.
Erica Bove, MD (41:09)
commitments?
Funke Afolabi-Brown, MD (41:10)
I think the hardest is shift work, honestly. I mean there's a h an entire sleep disorder known as shift work sleep disorders. Now,
Erica Bove, MD (41:19)
Wow, I didn't know that.
Funke Afolabi-Brown, MD (41:20)
yeah, it's an ICD like a full disorder that you need treatment for. Exactly. And
Erica Bove, MD (41:23)
Wow.
Funke Afolabi-Brown, MD (41:26)
higher risk of so many like diabetes, high blood pressure, heart issues.
Erica Bove, MD (41:28)
Yeah. Wow.
Funke Afolabi-Brown, MD (41:31)
So
We understand also that we have a lot when we're younger, there's a there's a lot more resilience and capacity and reserve to handle those circadian misalignment episodes. Every single night you're sleeping out of alignment with your with your circadian rhythm is is tell it's telling a story and the body keeps score. So I am just gonna be out there flat out tell you the sooner you can navigate out of
Shift work that does not align with your circadian rhythm. And so watch my words carefully, the better for your health on the long term. That's it. I
Erica Bove, MD (42:10)
I see.
Funke Afolabi-Brown, MD (42:11)
put it out there. I said it. Now, when I said aligned, we do have people who are night owls, right? And we have people who are morning larks, right? You're a night owl meaning that you are just the most productive. That's your chronotype late at night. So maybe a shift work would work for you. Perfect. Keep going.
It's good. Just make sure you get enough sleep during the day, right? But if you're a completely misaligned where you could barely see straight during your shift and you're wide awake and unable to fall asleep during the day, then we really need to start to advocate for ourselves. And this would be my dream. I work with some organizations, hospital systems, actually, and training institutions to really talk about how do we create schedules while honoring certain people's.
Circadian rhythms. I think that would be a dream to have as you're filling out your application to say, I'm a night owl, I'm a shit. You know, imagine because the work will be done. It will be done. But how can we do it in a way that people are the healthiest? And I think that's it. And I'm getting off my soapbox. So let's get on to
Erica Bove, MD (43:13)
Ooh No no this is so
good. This is so good.
Funke Afolabi-Brown, MD (43:18)
Yeah, so let's just practically here's what I would say. if you are somebody who does work shifts, I think the issue is again your brain, right? The your your super your S C N, your superchiasmatic nucleus, really is sending those signals to secrete melatonin, you know, at a time that's opposed, right? So at night your s your your melatonin is meant to be high,
Erica Bove, MD (43:44)
Mm-hmm.
Funke Afolabi-Brown, MD (43:44)
but
And you're supposed to be sleeping, and so now you're outside exposed to blue light, all of that. And so in the morning it's hard. So here's what I would say: this is what I say practically. If you know you're gonna work a shift, you do want to take a pre-shift nap. I think that is important. That is not a should I have, that is an absolute, right? And so you want to take a pre-shift nap. I usually will recommend probably an hour or so before you go onto your shift. So if for instance, maybe you do a seven to seven or eight to eight or something.
and that's where again boundaries come in. Somebody's gotta keep an eye on the kids. You can't do it all and then go straight to work, sleep deprived, right? And then when you get to work, you do need a lot of blue light. So go to the places where the light is brightest. Because again, we're working opposite our circadian rhythm. As you start to, as the night continues to progress, and it's maybe the latter half of the night. you may want to start avoiding those.
Very brightly lit areas. you wanna if you if you were gonna take caffeine, you wanted to take it earlier in the night. You're not taking a 5 a.m. caffeine. No, we're not doing that. Again, we're trying to now wind down. And
Erica Bove, MD (44:55)
Mm-hmm.
Funke Afolabi-Brown, MD (44:56)
so once you're done with your shift, wear sunglasses. This is what I recommend. Wear sunglasses because we want to try to avoid as much blue light in the morning as possible. Go home, don't do groceries, don't pick anything on the way, don't talk to anybody.
Take a warm shower, get into bed as soon as possible. For some women, you may need to take a low dose melatonin. That's actually one of the few conditions where melatonin is actually indicated shift work, sleep disorder, circadian rhythm issues, jet lag, things like that. And then you
Erica Bove, MD (45:31)
Hm.
Funke Afolabi-Brown, MD (45:31)
want to have that room as cool, dark, all of that as possible. So those are practical ways to try to get as much sleep as possible. And we do know, you know, studies have shown it.
The total amount of sleep that somebody who's a shift worker gets is absolutely much less. I think almost by one to two
Erica Bove, MD (45:48)
Yeah.
Funke Afolabi-Brown, MD (45:49)
hours than you know typical scheduled person. So those are things. And then when it comes to and then this lines itself also to boundaries, these are the places where nothing noisy, nothing deeps anywhere around you. Because even those subtle, those subtle interruptions will be very disruptive to your sleep. And as soon as you get, even if you just started the job, it's fine.
As soon as you get to a certain level of of in your in your within your job or your employee position, you wanna start to advocate for a job that's that has a more suitable shift. It just has to happen.
Erica Bove, MD (46:23)
Yeah, no, I think you're right. I think a lot of this does have to happen on the healthcare level. I mean, I will tell you I take
Funke Afolabi-Brown, MD (46:29)
Yes.
Erica Bove, MD (46:29)
call for like a week at a time and my
Funke Afolabi-Brown, MD (46:32)
Mm.
Erica Bove, MD (46:32)
you know, you have to keep your phone on, but then do you have the apps that let in some notifications if it's the hospital, but like leave out the other ones and like I think we can be smart about those sorts of things. But I think
Funke Afolabi-Brown, MD (46:38)
Mm, yeah. Yeah. Yeah.
Erica Bove, MD (46:43)
you're absolutely right. Those are great suggestions for people who work the shifts. Do we ever catch up? Like do we ever can we ever like catch up on a weekend or you know, or is that just like a myth?
Funke Afolabi-Brown, MD (46:54)
If you are, if you're somebody so typical, we don't encourage that mindset of, I'm just gonna sleep five hours and I'm gonna catch up on the weekend. That should not be your your MO. But if you work shifts, you will need to, because there is gonna be some level of sleep restriction. you will not be able to fully catch up. Because if you do the math, I mean, by the time you're done by the end of the week, you're probably owing maybe 12 hours of sleep. Like, when are you gonna be able to?
Get back. Get back. Right. So
Erica Bove, MD (47:23)
Right, right, right. Yeah, yeah.
Funke Afolabi-Brown, MD (47:25)
there's some degree. And if we think about even athletes, they do. They they they catch up. They're traveling. They're, you know, they're playing their games. They may have a whole day where they're just playing catch up on in terms of their sleep and their rest. So there is a role for that, but not so much that it becomes our lifestyle.
Erica Bove, MD (47:44)
Totally. And I I think too we
Funke Afolabi-Brown, MD (47:45)
Okay.
Erica Bove, MD (47:45)
talked about healthcare system changes, but I even had a client recently who said, you know, I'm an OBGYN. I am scheduled to do all these twenty four hour shifts, but I'm really worried about the impact on my body and my fertility outcome, et cetera. And I said, Well, do you have to do the twenty-four hour shifts? And she
Funke Afolabi-Brown, MD (47:59)
Yeah. Yeah.
Erica Bove, MD (48:01)
said, I actually don't think I do. I'll disappoint some people, but I can pick up some twelves and I'll still make the same amount of money. And
Funke Afolabi-Brown, MD (48:03)
Yeah, yeah, yeah.
Erica Bove, MD (48:08)
she's like, as as she as you saw her, as I saw her over Zoom, I just saw her whole body relax, like
Okay, that's the thing I need to do. And so he
Funke Afolabi-Brown, MD (48:14)
Yeah.
Erica Bove, MD (48:14)
or she is sometimes it's our own selves and our own ceiling of our beliefs. I can't do that. Really? You know, I've had
Funke Afolabi-Brown, MD (48:16)
Mm, mm, yeah, yeah, yeah.
Erica Bove, MD (48:22)
I've had so many people once they cross the bridge to pregnancy say, guess what? I'm not operating in my third trimester, or I'm I'm I'm not doing cases. And
Funke Afolabi-Brown, MD (48:30)
Yeah.
Erica Bove, MD (48:30)
sometimes we actually have more agency than we think we do, and
Funke Afolabi-Brown, MD (48:33)
Hmm. Yeah.
Erica Bove, MD (48:35)
we have to remember that. And so if that's something that you're struggling with, I love helping people find their voices within our systems.
Funke Afolabi-Brown, MD (48:40)
Yeah.
Erica Bove, MD (48:41)
Because we think it's one size fits all and
Funke Afolabi-Brown, MD (48:43)
Hmm.
Erica Bove, MD (48:43)
it may not be.
Funke Afolabi-Brown, MD (48:44)
That that is the most empowering thing. You have agency. You do. And
Erica Bove, MD (48:48)
Yeah.
Funke Afolabi-Brown, MD (48:49)
and and that's the thing. When people come to me and they say, Well, I have this shift, I ask, You're you've been in this company for 10 years. Do you really have to work this shift? Because now it's impacting your health. So if you were fine and it worked perfectly, then we don't have a conversation. And then they realize, wait, actually, no, I I don't. I can actually either get another job or find or they can
Actually work things out to work for me and you will never know until you ask.
Erica Bove, MD (49:17)
Exactly. Exactly. Okay, those those are such brilliant suggestions. So I wanted to give space, is there anything else that's on your mind that you think it's important for our listeners to hear about sleep, the fertility journey? Anything that still needs to be said?
Funke Afolabi-Brown, MD (49:34)
I think the main thing was something you said of all of this, right? A few you know weeks of not getting good sleep may not show up right away, but over time, you know, the body keeps score. and our brains, eggs, love oxygen. So if there's anything around what we've talked about that's really gonna impact this journey the most, I would say untreated sleep apnea
Erica Bove, MD (50:00)
Mm.
Funke Afolabi-Brown, MD (50:01)
is one of them.
So if and the beauty of this is now we have home sleep studies within the comfort of your own home. You could get a test done. You do not, if you don't love CPAP, you don't have to wear CPAP, although CPAP is profoundly effective in treating sleep apnea, but there's so many other treatment options that we cannot stay in the dark if we're having issues with breathing at night. So that's something I would say I always want to flag.
Erica Bove, MD (50:26)
Beautiful. And I know you do those evaluations, right? You help your patients with those all the time. And your your availability is
Funke Afolabi-Brown, MD (50:30)
yes. Absolutely, absolutely.
Erica Bove, MD (50:32)
excellent. Remind us your availability for getting people in for a sleep study, please.
Funke Afolabi-Brown, MD (50:36)
we'll
get it within one to two weeks. You will have your you have your results and Yeah. my gosh. Yeah. And then Cena. Yeah.
Erica Bove, MD (50:38)
Which is wild. I mean, in these parts it's like a nine month wait and then, you know, good luck, good luck. So I think we should all
be looking up Doctor Funke for all of her resources. Okay. please
Funke Afolabi-Brown, MD (50:51)
Yeah.
Erica Bove, MD (50:52)
tell us where we can find you.
Funke Afolabi-Brown, MD (50:54)
So I'm on I'm on social media restfulsleepmd. That's that's my that's my handle on on Instagram and on Facebook. And then my website is therestfulsleepplace.com. So the restful sleep, the kind of sleep we really want, the restfulsleepplace.com. And on there, I have a YouTube channel where I talk a lot about sleep in women. we have blogs, we have, of course, if you need to work with us, whether you're in Pennsylvania or not.
how to reach us. It's it's all there. So that would be another place I would say to check out. And also on the website is our course. It's it's called the Insomnia Reset Pro course. So it's really a self-paced course where we're talking through self-paced and self-applied DIY cognitive behavioral therapy for insomnia because a lot of people may not necessarily have access to a CBTI specialist in their area. So that's also another resource.
Erica Bove, MD (51:50)
Beautiful. And I'm gonna scan my list of questions one more time from the people. I think you answered all of them. All of them. I mean, you know, questions about bathroom breaks. Like this is this is some common sense stuff, but sometimes we don't think about it. Like,
Funke Afolabi-Brown, MD (52:02)
Mm.
Erica Bove, MD (52:03)
stop drinking liquids at a certain time
Funke Afolabi-Brown, MD (52:05)
Mm.
Erica Bove, MD (52:05)
that we're not up all night peeing. You know, you said
Funke Afolabi-Brown, MD (52:08)
Yeah.
Erica Bove, MD (52:08)
that the the melatonin was really, you know,
Funke Afolabi-Brown, MD (52:11)
Yeah.
Erica Bove, MD (52:11)
one of the things you can do, but there's a lot of supplements
Funke Afolabi-Brown, MD (52:13)
Yeah.
Erica Bove, MD (52:14)
that really have no data for them.
Funke Afolabi-Brown, MD (52:16)
Yeah.
Erica Bove, MD (52:17)
And then sleep aids, I mean, I guess that's another question. Like, do you ever recommend unison, Benadryl, any of those things?
Funke Afolabi-Brown, MD (52:20)
yeah. Yeah.
Erica Bove, MD (52:22)
Like, yeah.
Funke Afolabi-Brown, MD (52:24)
Great question. I am not crazy about Unisom or the Divinhydramine type products. On the very short term, you have stress, there's so much going on, you're not getting some sleep. I think it's okay. But on the long term, with all the effects that we know
Erica Bove, MD (52:42)
Yeah.
Funke Afolabi-Brown, MD (52:43)
that divinhydramine has, it's really not my go-to. In terms of supplements, a few
Have been studied, you know, magnesium glycinate, you know, some data around that. I would say if you're having sleep troubles, if you're having insomnia, you're struggling to sleep, and you've given yourself about two to three weeks on these supplements, it's time to get evaluated. If it's going to work, it should have worked by then. And then the other piece with melatonin is a lot of people do lean into melatonin, but most people take too high a dose. So typically.
Especially for women, I don't go above five milligrams. I know people on 10 milligrams, 20 milligrams. The lower the better. So if you tried
Erica Bove, MD (53:24)
Beautiful.
Funke Afolabi-Brown, MD (53:24)
a low dose and it doesn't work, doing more may not necessarily help. It may end up really causing what we call parasomnia, sleep talking, sleep walking, sleep eating, all of that. So we want to avoid avoid that. The other supplements are shuaganda, L Pianin, it's it's a splattering of.
stuff like there's the data is so limited in terms of the
Erica Bove, MD (53:47)
Yeah.
Funke Afolabi-Brown, MD (53:47)
efficacy. And then another thing I would say for women I wanted to mention is another thing we do in our practice, which is different, it's a little bit unique, is we look at your micronutrients as well. So when we think of ferritin, your vitamin
Erica Bove, MD (54:00)
Mm-hmm.
Funke Afolabi-Brown, MD (54:01)
D, zinc, magnesium, when those
micronutrients, if they're deficient, sometimes we see that it impacts the quality as well. So that's something that you want to just pay attention to. And especially
Erica Bove, MD (54:08)
that's interesting. Yeah.
Funke Afolabi-Brown, MD (54:10)
for ferritin, a lot of times, if you're having periods, sometimes it's low. So that might be something that we may need to help boost and help you feel better when it comes to complaints of exhaustion. Mm-hmm. Hmm.
Erica Bove, MD (54:19)
Yeah. There's there's some data about ferritin and and fertility outcomes. There's also did you know this, Dr.
Funkey May I you may know that's it, but maybe I can teach you something today. There's melatonin
Funke Afolabi-Brown, MD (54:28)
Mm.
Erica Bove, MD (54:29)
in the ovarian follicles. You you you didn't you knew that, isn't that crazy? I know, so okay, you already knew that. Anyway, we we we could
Funke Afolabi-Brown, MD (54:31)
Yes. Isn't that crazy? Yeah. But yeah, I know it's okay for a reminder.
Erica Bove, MD (54:37)
talk for hours about this. it is such a joy to know you. It is such a joy to know what work you're
Funke Afolabi-Brown, MD (54:42)
Mm-hmm.
Erica Bove, MD (54:43)
doing in the world, how you're helping individuals, couples, families, people on the fertility journey.
You know, live their best lives, have their best fertility outcomes, all of those things. And so thank you for coming on and sharing your wisdom. Thank you for your continued evolution. And I cannot wait to continue to collaborate with you.
Funke Afolabi-Brown, MD (55:00)
thank you so much for having me. You're amazing and thank you for the work you do.
Erica Bove, MD (55:04)
Anytime. And to my listeners, you know how much I love you. Bye.
