She is the CEO of a 200-person company. The youngest in the company's history. Smart, capable, three steps ahead of everyone in the room. That's how she got here.
She is doing everything right. Hormones optimized. A carefully built supplement stack with Progesterone, Phosphatidylserine, Glycine, and time-release Melatonin. She goes to bed at her usual time, around 10pm. And yet she is up every morning at 3am and cannot fall back asleep.
Her Garmin shows her body battery consistently in the 20s. Her sleep score hovers at 50. She worries about the sleep deficit she has been building but feels confident she is not struggling enough to quit. And yet… she feels the drag. About 10% reduction in energy. A slight pulling back from bigger bets, enough to make a difference. She knows it, even if no one else does.
She used to pride herself on planning for everything. But she did not anticipate this.
I am a doctor specialising in menopause and brain health. I work with midlife women who have done everything right, who arrive in my office not in crisis but carrying a load and a hesitation they cannot fully articulate.
The first thing they tell me is that their hormones are optimised. Their supplements are dialed in. Their sleep hygiene is impeccable. And still, they are waking at hours before the alarm goes off. Still, the body battery reads 22 on a Tuesday morning after eight hours in bed.
This is a nervous system problem, and it is one of the most underrecognised leadership issues of our time.
Here is how it unfolds.
Oestrogen and progesterone are regulators of the brain and nervous system. Oestrogen supports prefrontal cortex function: executive decision-making, strategic thinking, and impulse regulation. It modulates serotonin and dopamine, the neurotransmitters governing mood, motivation, and reward. Progesterone, as the natural calming agent of the nervous system, binds to GABA receptors, the same receptors targeted by sleep medications, and promotes deep, restorative sleep.
When these hormones decline, there is a unidirectional change in the quality of our sleep architecture. The nervous system loses two of its most powerful parasympathetic allies. It now runs on a higher baseline of sympathetic activation, alert, scanning, never fully at rest.
When the woman is in high-achievement mode at midlife, sleep remains fragile despite hormone optimisation and a sophisticated supplement protocol. Strengthening that sleep architecture requires you to land the plane a few times during the day to ensure you can land it at night.
At midlife, the nervous system needs deliberate parasympathetic activation not once, at the end of the day, but several times throughout it. Brief, intentional shifts out of sympathetic dominance and into vagal, or rest and relax, activation. Cortisol and adrenaline brought down from their accumulated daytime load for a few minutes, every few hours.
After enough nights of inadequate sleep, you realise that you are going to have to learn to shift your body and brain into a rest state during the day so that it can have a chance to shift into it at night. Else, the system stays in low-grade activation all day and carries that activation into the night. The body is in bed but the nervous system is still airborne. And no amount of Melatonin or Glycine will land a plane that has not been given permission to descend.
To navigate midlife sleep most successfully, you need to understand that the work of sleeping well at night begins at 10am. At 1pm. At 4pm. In the small deliberate pauses where the nervous system is invited to downregulate.
Now back to leadership.
The job of C-suite leaders is to plan. They plan for market shifts, talent gaps, succession, and disruption. They build contingencies for scenarios that haven't happened yet because they understand that preparation is precision.
And yet there is one domain where many accomplished women I know go entirely unplanned: their own midlife biology.
Perimenopause does not arrive with fanfare. It often arrives as early wakeups that don’t resolve. As words that vanish mid-sentence. As projects not undertaken that would have excited you six months ago.
Instead of seeing these as a reflection of your performance, see them as biological signals. The leader who learns to read them early, accurately, and without shame is prepared. She is doing what leaders do, positioning herself for the future.
Knowing what is coming and building your support structure before you need it is strategy for your leadership longevity. Asking for what you need before you are struggling is smart and precise. It is the difference between reacting to a crisis and being prepared for the time it comes.
The same instinct that made her the youngest CEO in her company's history, three steps ahead, that instinct applies here too. She just never imagined that doing everything right would still leave her waking at an ungodly hour.
Now you know.
The question is whether you will extend that skill of being prepared to the one domain that determines the longevity of your leadership, your own biology.
Land the plane during the day. Before predawn, before the body battery hits 20 and certainly before the bigger bets start to feel like more than you want to carry. A few minutes of breathwork, stillness, or deliberate rest is enough.
The biology is coming. The only variable is whether you meet it as a leader or as a patient.
About Manna Semby
Dr. Manna Semby is a naturopathic and functional medicine doctor specializing in menopause and brain health. She is the founder of Aruna Personalised Medicine where she works with women navigating the perimenopause transition. Dr. Manna is also the founder of Center for Cognitive Resilience where she teaches organisations about women's midlife biology which has a huge impact on workforce performance, retention, and leadership capacity. A TEDx and keynote speaker, she speaks at organisations and conferences around the country.
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