Interview with Dr. Shelby Harris, Behavioral Sleep Medicine Specialist and Author on Women’s Insomnia

Table of Contents

• Why sleep matters — especially for women
• About Dr. Shelby Harris
• Interview: questions and answers
• Practical: a one-week plan to get started
• Key takeaways we can act on today
• FAQ
• Resources and next steps
• Where to find more from Dr. Harris

Why sleep matters — especially for women

We live in a culture that celebrates productivity and downplays rest. Yet for many women, sleep is not optional — it is essential medicine that gets interrupted by biology, life responsibilities, and anxiety. Dr. Thais Aliabadi and Mary Alice Haney sit down with Dr. Shelby Harris, a board-certified behavioral sleep medicine specialist, to translate evidence-based approaches into practical strategies. Dr. Harris blends clinical rigor with a compassionate, realistic approach that fits into our busy lives. Below, we walk through who needs what kind of sleep, when to get help, and how to recover nights without relying first on medication.

About Dr. Shelby Harris 

Dr. Shelby Harris is a licensed clinical psychologist and one of the few board-certified behavioral sleep medicine specialists in the United States. She treats patients across the lifespan, from infants to older adults, and is the author of The Women’s Guide to Overcoming Insomnia. Her work centers on behavioral interventions like cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and targeted approaches for conditions such as sleep apnea and restless legs.

Interview: questions and answers

How did you end up specializing in sleep medicine?

My interest began early: I was a sleepwalker as a child, and that curiosity stuck with me. After college, I spent a year in research and landed on a study examining sleep interventions for people early in alcohol recovery. The result was striking — people who slept better early in recovery had lower relapse rates. That finding reframed sleep from a passive state to an active therapeutic target. Since then, I’ve focused on how sleep intersects with psychology and health.

What exactly is behavioral sleep medicine?

Behavioral sleep medicine, or BSM, is a subspecialty that uses evidence-based psychological and behavioral strategies to treat sleep disorders. Many BSM clinicians are psychologists, but the specialty is interdisciplinary. We treat insomnia, but also use non-medication approaches for sleep apnea, narcolepsy, idiopathic hypersomnia, and restless legs. The emphasis is on changing behaviors and thoughts that interfere with restorative sleep, rather than defaulting straight to pills.

What is restless legs syndrome, and how do we approach it?

Restless legs is a sensory-motor condition where limbs — commonly legs, but sometimes arms or the trunk — feel restless as night approaches. People describe an irresistible need to move. It often worsens in the evening and can mimic insomnia because it makes falling asleep difficult. Women, particularly during pregnancy and perimenopause, are more likely to experience it. First steps include reviewing sleep hygiene (less caffeine and alcohol) and checking iron stores because iron deficiency can drive symptoms. If those measures don’t help, there are effective medications to try.

How much sleep do different people need? Is there a one-size-fits-all number?

The commonly cited “eight hours” is shorthand for the midpoint of a range: seven to nine hours is the range where most adults feel refreshed and functional. There are outliers on both sides, but if someone truly gets two hours per night and functions poorly, that is a medical problem that needs attention. The best way to find your personal need is practical: give your body permission to sleep on its natural schedule for about a week — go to sleep when sleepy, wake without an alarm — then average days four through seven. That gives you a realistic baseline of your sleep need and biological timing.

What are the signs of too much sleep or too little sleep?

If you sleep longer yet wake unrefreshed, it may reflect nonrestorative sleep from a condition like sleep apnea or fragmented sleep. Too much “time in bed” compared to actual sleep can perpetuate wakefulness and lighter, less consolidated sleep. On the other hand, daytime sleepiness, difficulty concentrating, mood changes, and reliance on naps are clear signs of insufficient sleep.

Are naps helpful or harmful?

Naps are a tool, not a universal fix. A single 20-minute nap roughly eight hours before bedtime can boost alertness without disrupting night sleep for many people. But long or late naps can fragment the night, particularly if you already struggle with insomnia. If you need multiple naps to get through the day, that’s a sign to address the underlying cause. For those with chronic insomnia, we usually try to eliminate naps to restore nighttime sleep drive.

How do we distinguish insomnia from sleep disturbance caused by life stages — pregnancy, menopause, parenting?

Insomnia is defined by three core problems: difficulty falling asleep, staying asleep, or waking earlier than desired, combined with daytime impairment. If these symptoms occur at least three nights per week for a month (short-term) or three months (chronic), it meets diagnostic criteria. Importantly, insomnia can coexist with pregnancy, perimenopause, PCOS, or other conditions; it is not required to be secondary to them. Our clinical approach treats the insomnia, whether or not another condition is present, while coordinating with specialists for hormonal or medical management when relevant.

Do women with PCOS have more sleep problems?

Yes. Research shows higher rates of insomnia and sleep apnea in people with PCOS, and a modest increase in restless legs as well. The apnea in PCOS is not always explained by weight alone; hormonal and metabolic factors may contribute. Treatment follows the same behavioral framework as for other patients, but we often coordinate care with gynecologists or endocrinologists to address hormonal contributors.

When someone walks into your clinic with insomnia, what is the standard treatment plan?

The first-line treatment is cognitive behavioral therapy for insomnia, or CBT-I. This is a short-term, structured therapy that typically takes two to eight sessions. It goes well beyond sleep hygiene. Sleep hygiene is helpful, but not curative — it is like brushing and flossing. If a cavity forms, you need more than brushing. CBT-I includes:

• Time in bed restriction to consolidate sleep and increase sleep pressure.
• Stimulus control to strengthen the bed-sleep association (e.g., get out of bed when unable to sleep).
• Cognitive therapy to challenge catastrophic thoughts about sleep and daytime consequences.
• Relaxation and mindfulness practices to calm the racing mind.
• Practical middle-of-the-night strategies so wakefulness does not become entrenched.

The goal is to get measurable daytime improvement without relying primarily on medication.

What is the “three-hour rule” and practical bedtime hygiene to implement tonight?

The “three-hour rule” Dr. Harris recommends refers to limiting alcohol, vigorous exercise, and large fluid intake within three hours of bed. Alcohol may help you fall asleep, but fragments sleep later in the night. Caffeine should be limited to around eight hours before bedtime, because it can linger and reduce sleep quality. Other core hygiene tips:

• Keep the bedroom quiet, dark, cool, and comfortable.
• Wind down for at least 30 to 90 minutes before bedtime; include low-stimulation activities and brief mindfulness.
• Avoid scrolling on the phone or consuming stimulating content right before bed.
• Try to keep wake time consistent each morning, even on weekends, within about an hour and a half.

What exactly is a time in bed restriction, and how could it help someone who lies awake from 12 to 3 a.m.?

Time in bed restriction can sound counterintuitive, but for people who spend long nights awake in bed, it helps consolidate sleep. If you currently go to bed at 10 p.m. and get only six hours of sleep, we might shift bedtime later so wake time stays fixed. For example, move bedtime to 11 p.m. or 11:30 p.m. and maintain the same morning wake time. Over a week or two, this increases sleep efficiency — the percentage of time in bed spent asleep — and reduces nighttime wakefulness.

Is it okay to read in bed? What about baths, temperature, and timing?

Reading can be fine; the rigid rule of only sex and sleep in bed is sometimes too strict. The key is that the activity should be quiet, calming, and not arousing or anxiety-provoking. Regarding baths and temperature:

• Warm baths help, but timing matters. Aim to bathe about 90 minutes to two hours before bedtime. This supports the natural drop in core body temperature that promotes melatonin release.
• Keep the bedroom cool, ideally in the mid to upper 60s Fahrenheit. Cooler temperatures help you fall and stay asleep.

What should we do when we wake up at night with a racing mind?

The instinct to lie very still and force sleep is usually the opposite of what helps. If you notice frustration, attempts to force sleep, or racing thoughts, get out of bed and do a quiet, calming activity until you feel sleepy again. The objective is to avoid pairing the bed with wakefulness. If you’re awake for shorter periods and not frustrated, you can stay in bed. If wakefulness continues beyond a reasonable threshold and causes frustration, get up.

Are sleep trackers useful or harmful?

Wearables can be helpful for people who do not prioritize sleep; they reveal inconsistent schedules, late nights, or large amounts of alcohol and caffeine. However, if you are actively trying to improve your sleep, hyper-focusing on a tracker can worsen sleep anxiety — a phenomenon called orthosomnia. Trackers estimate total sleep fairly well, but staging (deep vs REM vs light) is less reliable. Use them as an awareness tool briefly; if they increase worry, set them aside and focus on how you feel during the day.

Can you walk us through the stages of sleep and what each does?

Sleep unfolds in cycles. Briefly:

• Stage 1: The twilight phase between wakefulness and sleep.
• Stage 2: Light sleep that occupies about 60 to 65 percent of the night for many adults. Stage 2 is key for memory consolidation and energy restoration. Trackers often underemphasize stage 2, but it is biologically important.
• Stage 3 (deep sleep): The restorative slow-wave sleep when growth hormone is released, and physical repair happens. It predominates in the first part of the night.
• REM sleep: The dreaming stage that increases in the latter third of the night and supports emotional processing and certain types of memory consolidation.

There is limited ability to intentionally increase specific stages. Rather than chasing “more deep sleep” numbers, focus on behaviors that improve overall sleep quality and daytime functioning.

When is medication appropriate, and which medications are commonly used?

Medication can be a helpful adjunct, particularly when CBT-I alone is not producing sufficient gains. We generally try behavioral strategies first, then consider medication if a patient remains significantly impaired after several weeks or months. Some commonly used medications include:

• Trazodone (used at low doses for its sedating effect).
• Non-benzodiazepine hypnotics such as zolpidem (Ambien) and eszopiclone (Lunesta).
• Suvorexant and lemborexant, orexin receptor antagonists that inhibit wake-promoting circuits.

Medication choice depends on age, fall risk, cognitive side effects, comorbid conditions, and patient preference. We weigh risks and benefits and consider using medication for a limited time while working on behavioral skills.

Do supplements help? What about melatonin and magnesium?

Supplements have nuanced roles. Melatonin is most useful as a timing agent rather than a sedative. In clinical practice, we often use very low doses — 0.5 to 1 milligram — given several hours before the desired bedtime to shift the circadian clock for night owls, jet lag, or shift workers. The large over-the-counter doses commonly sold (3 to 10 milligrams) exceed physiological needs and may cause daytime sleepiness or vivid dreaming for some people.

Magnesium can “calm” people and reduce arousal, but is not a direct sleep stage enhancer. It may be helpful for people who feel physically tense. Be mindful of gastrointestinal side effects, and choose formulations that fit your tolerance.

What about vivid dreams and nightmares — can they be treated?

Nightmares can be distressing and persistent. A powerful behavioral technique is imagery rehearsal therapy. During the day, you intentionally rewrite a disturbing dream to a non-threatening ending and visualize that new script repeatedly (often twice a day). Over time, this reduces nightmare frequency and intensity. Night terrors are different — they occur in deep sleep, usually in the first third of the night, and the person often has little recall. If night terrors are frequent or severe, we may evaluate medically and use behavioral or targeted medical strategies.

How does sleep change across the lifespan? Do older adults need less sleep?

Misconception alert: older adults do not need less sleep dramatically. Age-related decreases are modest — perhaps a half hour to an hour for some people. What changes more is the distribution of sleep — older adults nap more and may get the same 24-hour total as in younger years. Listen to your body; if your doctor tells you you simply need “less sleep” without assessing symptoms, seek another opinion.

What do you advise new parents about sleep planning before and after the baby arrives?

Plan ahead. If you are pregnant, report any new sleep issues and any new snoring to your provider because significant sleep disruptions during pregnancy can affect birth outcomes, gestational diabetes risk, and mood. Before the baby comes, plan who will help during night wakings and how you will protect at least four hours of continuous sleep, ideally six, to reduce postpartum mood risk. Think about the feeding strategy, pumping vs. bottle feeding, and which caregiver can reliably handle some night shifts.

Why does perimenopause feel like a perfect storm for sleep problems?

There are three converging forces:

1. Hormonal fluctuations — dropping estrogen and progesterone can disrupt sleep architecture and increase night sweats.
2. Life demands — midlife often means caregiving for children and aging parents, more work responsibilities, and less clearly defined day-night boundaries.
3. Mental health — higher rates of anxiety and depression during this period compound sleep problems and vice versa.

We therefore use a multimodal approach: CBT-I, hormonal therapy when appropriate with gynecology input, mindfulness or relaxation practices, and targeted strategies for night sweats and hot flashes.

How do you treat a 40-something woman who is juggling career, caregiving, and poor sleep?

Start with the fundamentals: assess sleep hygiene and make adjustments (timing of fluids, alcohol, and exercise), track sleep in a simple diary rather than obsessing over a wearable, and apply CBT-I techniques such as time-in-bed restriction and stimulus control. Add a short daily mindfulness practice to manage a busy brain and schedule “worry time” earlier in the day so nighttime rumination is less likely. If those measures are insufficient, coordinate with colleagues for hormonal evaluation and consider short-term medications as a bridge while working on behavioral change.

What are the non-negotiables for better sleep?

Dr. Harris lists these essentials:

• Quiet, dark, cool, and comfortable sleeping environment.
• Consistent wake time every morning to anchor circadian rhythm.
• Allow time to wind down before bed; whatever calms your brain is better than screen-based stimulation.
• Do not normalize disrupted sleep as an unavoidable part of aging — effective interventions exist.
• Do not ignore snoring or pauses in breathing; evaluate for sleep apnea.

What should we absolutely avoid close to bedtime?

Limit alcohol within three hours of bedtime and caffeine within about eight hours. Avoid turning the thermostat too high in the evening. Put your phone away; falling asleep with a phone in your hand or checking the clock at midnight often worsens anxiety and sleep fragmentation. Keep lighting low and use bedside alarms that do not pull you into browsing.

How should parents manage teen sleep schedules?

Teen biology shifts later at puberty; their circadian clocks naturally favor later bedtimes and wake times. The problem is early school start times. If a teen must wake early, aim for a realistic bedtime that allows for up to 9.5 hours of sleep. If schools start early, advocate for later start times, reduce late-night screen exposure, reduce overscheduling, and try to keep weekend sleep-ins modest so Sunday nights don’t become a battle.

What are simple middle-of-the-night tactics when you just cannot fall back asleep?

Avoid looking at the clock or your phone. If you are alert, do a brief, low-stimulus task. One cognitive trick is “cognitive shuffling”—mentally name a neutral item for each letter of the alphabet, like animals or objects. It is engaging but boring, which helps the brain drift back to sleep. If you become frustrated or remain awake for prolonged periods, get up and do something calm until you feel sleepy.

Where should someone start if they don’t know how to fix their sleep?

Implement consistent sleep hygiene for two weeks: set a steady wake time, limit caffeine and alcohol, and wind down before bed. If improvements are minimal, consult your primary care provider for a referral to a sleep specialist. For insomnia, look for clinicians trained in CBT-I — it is the most effective non-medication approach and often yields durable results.

Practical: a one-week plan to get started

Use this simple, practical starting plan to move from overwhelm to momentum:

1. Choose a fixed wake time and commit to it every day.
2. Set a target sleep window that yields 7 to 9 hours based on your current sleep need. If you currently go to bed earlier but sleep poorly, shift bedtime 30 minutes later and keep wake time fixed for one week.
3. Schedule a wind-down period 60 to 90 minutes before lights out — low light, relaxing activity, and no alcohol or intense exercise within three hours.
4. Try a short daily mindfulness practice (2 to 5 minutes) at a convenient time to build the skill of noticing a wandering mind and bringing it back.
5. Avoid naps for the first two weeks unless you cannot function; use a 20-minute nap early in the day only if needed.
6. If snoring or breathing pauses are present, arrange for a sleep evaluation or home sleep test with your provider.

Key takeaways we can act on today

• CBT-I is the gold standard for chronic insomnia and works across life stages, including perimenopause.
• Track a sleep diary rather than obsessing over tracker stage data; how you feel during the day is the best metric.
• Time baths and evening routines to support natural temperature rhythms — take a warm bath 90 to 120 minutes before bed.
• Melatonin is a timing tool, not a sedative; use low doses at the right time for circadian shifts.
• If you snore or have pauses in breathing, get evaluated — sleep apnea is common and treatable in women of all sizes.

FAQs

How do I know if I have chronic insomnia?

Chronic insomnia is defined by difficulty falling or staying asleep, or waking earlier than desired, that occurs at least three nights per week for three months and causes daytime impairment. If your sleep problems are frequent and impair your function, seek evaluation and consider CBT-I.

Can sleep problems during perimenopause be treated without hormones?

Yes. Behavioral strategies like CBT-I, mindfulness, and targeted sleep-hygiene changes help many women. Hormone therapy can be beneficial for hot flashes and night sweats and is worth discussing with a gynecologist. Treatment is individualized.

Is it true that older adults need a lot less sleep?

No. Older adults may need slightly less sleep — perhaps a half hour to an hour — but substantial reductions are not normal. If sleep is poor, it should be evaluated rather than accepted as inevitable.

Are wearable sleep trackers accurate?

Wearables do a decent job of estimating total sleep time but are less reliable for staging. They are most useful for spotting large behavior patterns. If they increase sleep anxiety, stop using them for a while.

When should I consider medication for insomnia?

Medication is considered when behavioral treatments have been tried and are insufficient or as a short-term bridge while skills are learned. Choice depends on age, safety, comorbidities, and patient preference. Discuss benefits and risks with a clinician.

Do melatonin and magnesium help?

Melatonin can shift the timing of sleep when used in low doses (0.5 to 1 mg) at the right time. High OTC doses are often unnecessary and can cause vivid dreams or daytime sleepiness. Magnesium may relax the nervous system for some people, but it can cause GI upset.

Resources and next steps

If you want to dig deeper, seek a clinician trained in CBT-I or a board-certified behavioral sleep medicine specialist. Start a sleep diary, set a consistent wake time, and give behavioral changes two weeks to show initial effects. If you experience loud snoring, observed apneas, or excessive daytime sleepiness, ask for a sleep evaluation.

Where to find more from Dr. Harris

Dr. Harris shares practical resources and has written guidebooks for adults and parents. Look for clinicians who specialize in CBT-I or behavioral sleep medicine and prioritize daytime functioning as a measure of success.

Sleep is not a luxury. It is central to brain and body repair, mood regulation, memory, and resilience. With targeted behavioral approaches, practical planning, and judicious use of medicine when needed, most women can reclaim much of the sleep they’ve lost to life’s demands.

This article was created from the video Dr. Shelby Harris Reveals Sleep Secrets On Women’s Insomnia | SHE MD for Dr. Thais Aliabadi’s website.