Q&A: insomnia; lowering cardiac calcium; exercises for achy joints; & taking an osteoporosis meds "holiday"
TGIF!
ICYMI 👉
Today’s LIVE Q&A is about AGING & BRAIN HEALTH 🧠 : Practical Tips for Cognitive Wellbeing. Join me HERE TODAY at 5/9 at 3 pm ET!
Paid subscribers can submit their questions for me to answer live, right here!
In this week’s reader-submitted Q&A, we’re tackling these questions:
How can I combat sleeplessness?
Can I lower my cardiac calcium score?
What exercises are safe for someone with achy joints?
Should I take a break from my osteoporosis medicine?
📣 Send me your questions for future Q&As! Click here to write me. ✍️
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: SLEEPLESSNESS
Hi Dr. McBride, sleep has become a disaster. I fall asleep fine but wake up at 2 or 3 a.m. with racing thoughts. I’m functioning, but barely. I’ve tried magnesium, melatonin, better sleep hygiene… nothing sticks. What do you recommend when everything should be working but isn’t?
- Kim
Kim,
You are describing what I call “the 3 a.m. mind.” You’re not alone. Waking up in the middle of the night with racing thoughts is one of the most common sleep complaints I hear—especially from women in midlife. You’re doing all the “right” things, and yet you’re still exhausted. It’s deeply frustrating—and also incredibly human.
First, let’s acknowledge that waking up during the night isn’t always pathological. Our ancestors likely slept in two phases. But if you’re waking up and not getting back to sleep—and spending those early hours tangled in anxious thoughts—that’s where the problem lies.
You mentioned trying magnesium, melatonin, and solid sleep hygiene—and I’m glad you’ve covered those basics. Sometimes they help. But when they don’t, I often turn to a different framework: What’s happening in your nervous system?
That middle-of-the-night wake-up is often less about melatonin and more about cortisol—your brain flipping into high alert mode just as your body is trying to rest. This can be from chronic stress, perimenopause (hi, hormones), anxiety, or even unprocessed mental clutter that has no time to surface during the day. And once you're up, your brain spins with everything from tomorrow’s to-do list to that thing you said in 2003.
Here’s what I often recommend:
Get out of bed. Seriously. If you’re lying there for more than 20–30 minutes, get up, keep the lights low, and do something boring (like reading a slow novel or folding laundry). Then return to bed when you feel sleepy again.
Keep a “worry journal” by the bed. Jot it all down—no judgment, just a brain dump. You can deal with it in the morning.
Try guided imagery, meditation, or breathwork. The Calm, Insight Timer, or Headspace apps have middle-of-the-night tracks specifically for this.
Check in with your doctor about hormonal shifts. Especially if you’re in perimenopause or postmenopause—this is prime time for sleep disruptions, and sometimes low-dose hormone therapy can help.
Zoom out. If your mind is always running, it might be time to look at the bigger picture: are you overextended? Burnt out? Anxious in a way that might benefit from therapy—or even a short course of an SSRI?
You’re not broken—and you’re not doing anything wrong. Sometimes the body is telling us it’s not just about sleep. It’s about what’s happening beneath the surface—emotionally, hormonally, and neurologically.
Remember: the goal isn’t perfect sleep. It’s “good enough” sleep, most nights, without anxiety becoming the dominant bedtime companion. This is a process, not a quick fix. But there are paths forward—and you don’t have to figure it out alone.
QUESTION #2: LOWERING YOUR CORONARY CALCIUM SCORE
My calcium score was higher than I expected and now I’m panicking. Can you lower your score once you have plaque—or is it more about preventing it from getting worse?
- Daniel
Daniel,
I totally get the instinct to panic—getting a higher-than-expected calcium score can feel like an alarm bell. But let’s reframe it: your calcium score is information, not a guarantee of disaster. And there’s a lot you can do with that information to protect your heart.
A coronary artery calcium (CAC) score is a specialized CT scan that helps detect calcified cholesterol plaque in the coronary arteries—the vessels that feed the heart muscle. The presence of plaque is called coronary artery disease (CAD), and while it’s common (especially with age or certain risk factors), it doesn’t automatically mean you’re on the verge of a heart attack.
The goal of the calcium scan isn’t to give you a “perfect” number—it’s to help stratify your risk. It tells us who might benefit from more aggressive prevention. For example, someone at intermediate risk—not obviously high-risk, but not clearly low-risk either—might use their CAC score to decide whether to start a statin, tighten up lifestyle habits, or adjust their approach to blood pressure or blood sugar.
As for whether you can lower your score? The answer is: not really. Once calcium is laid down, it tends to stay. But here’s the key: it can be stabilized. And stable plaque is far less likely to rupture or cause symptoms. So we focus not on reversing the score, but on preventing progression and reducing your overall cardiovascular risk.
What helps?
Lowering LDL cholesterol (often with a statin)
Managing blood pressure
Not smoking
Regular exercise
A diet rich in fiber, healthy fats, and whole foods
Managing stress, sleep, and blood sugar
And simply staying engaged in your own care
So yes—your CAC score was higher than expected. But now you have data. And data is power. With the right plan, you can absolutely shift the trajectory of your heart health.
QUESTION #3: EXERCISES FOR ACHY JOINTS
I’m 56 and used to love running, but my joints have been so achy the past year that I’ve basically stopped moving. I feel sluggish and heavier, and I’m afraid this is my “new normal.” What do you tell your patients who loved running but had to quit? I want to stay active without hurting myself. Thanks!
- Joannie
Joannie,
I hear you! What you’re describing is something I see every week in my office: someone who’s been active and vibrant for years suddenly finding that their body isn’t cooperating the way it used to. And yes, it can be frustrating. And yes, it can feel a little scary. But no—it doesn’t have to be your “new normal.”
Here’s the thing: our bodies are constantly evolving. Especially in midlife, hormones shift, connective tissues change, cartilage thins. The activities that once felt effortless—or even joyful—might now leave us feeling sore, inflamed, or even injured. That doesn’t mean movement is off the table. It just means the strategy needs to shift.
What I tell patients (and often remind myself) is this: it’s not about doing what you used to do. It’s about finding what your body can do now—and what it might grow to enjoy again.
For many of my former runners, that looks like a mix of things:
Walking—yes, it counts. Especially if it’s brisk, with good shoes, on a forgiving surface like a trail or track.
Strength training—a must in midlife. Not just for bones and muscles, but for balance, metabolism, and long-term mobility. Even twice a week makes a difference.
Swimming, biking, or elliptical—low-impact cardio can provide that same endorphin boost without the joint strain.
Yoga or Pilates—not just for flexibility, but for core strength and injury prevention.
Physical therapy—not as a last resort, but as a proactive investment in how your body moves. Think of it as your personal movement mechanic.
And most of all: grace. You don’t need to punish yourself back into shape. You don’t need to replicate your 30-year-old routine. You just need to move in ways that feel sustainable. Ways that honor the body you’re in today, not the one you used to have—or the one Instagram says you should want.
This chapter is not about shrinking or settling. It’s about adapting—and reclaiming the joy of movement on your terms.
QUESTION #4: OSTEOPOROSIS MEDICINE “HOLIDAY”
My doctor recommended a 5-year “holiday” from my osteoporosis meds. Is that standard? Will my bones just fall apart without it?
- Gail
Gail,
Great question—and one that gets at the heart of how we think about bone health as a long game.
If you've been on a bisphosphonate like Fosamax (alendronate) or Actonel (risedronate) for several years, your doctor’s suggestion of a “drug holiday” isn’t unusual. In fact, for many patients, it’s part of a thoughtful long-term plan. These medications work by slowing bone breakdown and improving bone density—but they also stick around in your bone tissue for quite a while, continuing to offer some protection even after you stop taking them.
The idea behind a drug holiday is to give your body a break from any potential long-term side effects (like rare femur fractures or jaw issues) while still maintaining some of the benefits. It’s typically considered after 3–5 years of therapy if your bone density is stable, your fracture risk is lower, and you haven’t had recent breaks.
That said, it’s not a set-it-and-forget-it situation.
During a drug holiday, your doctor should continue to monitor your bone health—usually with a DEXA scan every couple of years. If your bone density drops significantly or if you experience a fracture, it may be time to restart treatment or consider another class of medication.
And no, your bones won’t just “fall apart” without the medication—as long as you're continuing to support them with the other essentials: weight-bearing exercise, strength training, adequate protein, calcium and vitamin D, and fall prevention strategies.
Think of a drug holiday not as abandonment, but as a pause. A breather. A sign that you’ve done the hard work to build up some skeletal resilience—and that your treatment plan is evolving with you. As always, it’s about ongoing monitoring, thoughtful care, and keeping you strong, upright, and in motion for years to come.
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
ICYMI, check out my recent Q&As on:
I also highly recommend physical therapy as a preventive measure. I had been suffering with joint pain and other issues (also 56) for more than a year. What I learned working with my PT was that much of my joint pain was caused by muscular issues. Massage, mobility work, and understanding how to anticipate flare-ups (and then address them) has greatly improved my ability to exercise and recover.
Repeat from me...I learned from a pain management psychologist that the most critical part of sleep hygiene is getting up at the same time every single morning. Once I'd adjusted, I stopped the 3am wakefulness. I'm now sleeping through most nights, if IBS doesn't interrupt, for several months.