Author: IntraBalance

Does Magnesium Work for Sleep Issues?

Posted on August 19, 2025 by - Sleep Health

If you spend enough time on Instagram or in supplement aisles, you’ve noticed that magnesium is touted as a cure-all.

It’s said to alleviate cramps, fix constipation, cure sleep issues, do your taxes, help you look good in bangs…it’s a miracle!

But when we strip away the hype and look at the data on magnesium for insomnia and sleep disturbances, it’s not as magical as it’s made out to be.

The Evidence at a Glance

Observational studies have shown that higher dietary magnesium intake is linked to better reported sleep quality and longer duration [1,2,6].

But remember that correlation does not equal causation…and the link might be explained by healthier overall diets and lifestyles.

When it comes to sleep, there are some randomized controlled trials (RCTs). Small, mostly short-term studies in older adults and specific populations (e.g., diabetes) show:

‣ Sleep onset latency improved by ~17 minutes on average [3,4]
‣ Modest reductions in insomnia severity [3]

As for combination supplements (magnesium + melatonin ± zinc) often show better results, but the benefit can’t be attributed to magnesium alone [5].

The bottom line is that the evidence for magnesium on sleep is limited and results are inconsistent.

However, that doesn’t mean I don’t recommend magnesium supplements. In fact, I take them myself and recommend them to most of my patients, because of the fact that most adults aren’t getting sufficient Mg from diet alone.

How does it work?
Magnesium may support sleep through multiple pathways.

It modulates neurotransmitter activity by blocking excitatory NMDA-type glutamate receptors and activating inhibitory GABA receptors, reducing neuronal excitability and promoting relaxation for sleep onset and maintenance [1,2].

Magnesium also plays a role in melatonin synthesis and possibly supports deeper, more restorative stages of sleep [1].

Safety and Dosing Pearls

‣ Examples of food sources: pumpkin seeds, chia seeds, almonds, leafy greens, dark chocolate, soy, dried beans

‣ From supplements: Generally safe, but high doses can cause diarrhea and GI upset.
Avoid excess in advanced CKD; check for drug–nutrient interactions in high-risk patients.

‣ Typical doses in trials: 320–500 mg elemental magnesium daily, often split; forms include glycinate (better tolerated), citrate (laxative effects, good for constipation), threonate (crosses blood-brain barrier) and oxide (less bioavailable).

What to tell Patients

Magnesium is safe for most people and may offer a small, gradual benefit for sleep, but it’s not a sedative and shouldn’t replace proven treatments. Think of it as a gentle support in the background rather than a quick fix.

Want to learn more about sleep supplements? I’m hosting another series of masterclasses later this month – stay tuned for the details! I’ll send an email about that in the next few days.

References:

1. Zhang, Y., et al. “Association of Magnesium Intake With Sleep Duration and Sleep Quality: Findings From the CARDIA Study.” Sleep, vol. 45, no. 4, 2022, zsab276. Oxford University Press, doi:10.1093/sleep/zsab276.

2. Arab, A., et al. “The Role of Magnesium in Sleep Health: A Systematic Review of Available Literature.” Biological Trace Element Research, vol. 201, no. 1, 2023, pp. 121–128. Springer, doi:10.1007/s12011-022-03162-1.

3. Ji, X., et al. “The Relationship Between Micronutrient Status and Sleep Patterns: A Systematic Review.” Public Health Nutrition, vol. 20, no. 4, 2017, pp. 687–701. Cambridge University Press, doi:10.1017/S1368980016002603.

4. Cao, Y., et al. “Magnesium Intake and Sleep Disorder Symptoms: Findings From the Jiangsu Nutrition Study of Chinese Adults at Five-Year Follow-Up.” Nutrients, vol. 10, no. 10, 2018, p. E1354. MDPI, doi:10.3390/nu10101354.

5. Dhillon, V. S., et al. “Low Magnesium in Conjunction With High Homocysteine and Less Sleep Accelerates Telomere Attrition in Healthy Elderly Australian.” International Journal of Molecular Sciences, vol. 24, no. 2, 2023, p. 982. MDPI, doi:10.3390/ijms24020982.

6. Mah, J., and T. Pitre. “Oral Magnesium Supplementation for Insomnia in Older Adults: A Systematic Review & Meta-Analysis.” BMC Complementary Medicine and Therapies, vol. 21, no. 1, 2021, p. 125. BioMed Central, doi:10.1186/s12906-021-03297-z.

Sleep changes in Menopause

Posted on August 11, 2025 by - Sleep Health

Sleep changes in Menopause

Have you seen those videos on social media showing nostalgic clips from the ’80s and ’90s, like old Nintendo controllers, He-Man action figures, cartoon character lunchboxes with matching thermoses, and bustling malls?

(Btw – Orange Julius was my favorite at the mall foodcourt…I’ll share my homemade recipe sometime.)
Anyway, those videos always transport me back to simpler times.

If you’re old enough to remember those things, you might also be nostalgic for something else: the days when you could sleep straight through the night without interruption.
I know I am.

I used to be one of those kids who could sleep through the night like a rock.

But as I’ve aged, nighttime awakenings have become common and expected. And that’s true for a lot of midlife women.

Sleep disturbance affects up to 60% of women during the menopausal transition, and nighttime awakenings are the most common sleep complaint during perimenopause and menopause.

One study found that 30% of postmenopausal women report poor sleep quality (Pittsburgh Sleep Quality Index >5), compared to 14% of premenopausal women [Kim et al.].

The American Heart Association notes that sleep complaints, especially frequent awakenings, increase significantly during perimenopause, often in tandem with hot flashes, temperature swings, hormonal shifts, and psychosocial stressors.

As Dr. Andrea Matsumura MD says, “With the reduction of estrogen, you have a lot of middle of the night awakenings – that’s really because estrogen plays a role in calibrating your temperature, and when you lose that, sleep gets disrupted.”

If you’re seeing midlife women in your practice, you’re seeing sleep disruption.

To help you support these patients (or yourself), I sat down with Dr. Andrea Matsumura, “The Sleep Goddess,” for a deep dive into menopause, hormones, and sleep.

She shares practical, evidence-based strategies you can use right away.

In this episode, you’ll learn:

Why sleep fragmentation is often the first sign of perimenopause

  • When to consider melatonin, HRT, and sleep aids
  • How to screen for sleep apnea in women (and why home tests often miss it)
  • Dr. Matsumura’s DREAM method for holistic sleep care
  • What every clinician should ask about sleep (and the question that changed her practice)
  • Why “Sleep is the CEO of health” and how to help your patients reclaim it
  • And much more…

Quick clinical pearls to get you started:

‣ Don’t dismiss “I’ve always been a bad sleeper” as normal aging. Look under the hood to see what might be going on.


‣ Ask, “How many hours of sleep do you think you’re getting?” instead of “Are you sleeping well?”. It’s a subtle difference, but can reveal useful info.

‣ For women with midlife sleep issues, consider hormone therapy, but don’t forget about screening for other sleep disorders like sleep apnea.


‣ CBT-I is a powerful tool for menopause-related sleep disruption and can help with vasomotor symptoms like hot flashes.


If you’re ready to help your patients (and maybe yourself) get better sleep through menopause and beyond, don’t miss this conversation.


References:
1. Baker FC. Optimizing sleep across the menopausal transition. Climacteric. 2023

Jun;26(3):198-205. doi: 10.1080/13697137.2023.2173569. Epub 2023 Apr 3. PMID: 37011660; PMCID: PMC10416747.

2. Carmona NE, Solomon NL, Adams KE. Sleep disturbance and menopause. Curr Opin Obstet Gynecol. 2025 Apr 1;37(2):75-82. doi: 10.1097/GCO.0000000000001012. Epub 2025 Jan 17. PMID: 39820156.

3. Kim MJ, Yim G, Park HY. Vasomotor and physical menopausal symptoms are associated with sleep quality. PLoS One. 2018 Feb 20;13(2):e0192934. doi: 10.1371/journal.pone.0192934. PMID: 29462162; PMCID: PMC5819793.

4. Maki PM, Panay N, Simon JA. Sleep disturbance associated with the menopause. Menopause. 2024 Aug 1;31(8):724-733. doi: 10.1097/GME.0000000000002386. Epub 2024 Jun 25. PMID: 38916279.

A new option for CBT-i

Posted on August 11, 2025 by - Sleep Health

A new option for CBT-i

I was recently working with a woman in her 30s who’d been dealing with insomnia since her teenage years.

After so many years of struggling, she didn’t just have insomnia, she was insomnia.

“I’m a bad sleeper,” she told me.

And just like that, it had become part of her identity.

When people label themselves this way, it becomes a self-fulfilling prophecy.

As James Clear says in the above quote, holding on to an identity keeps people stuck in unconscious patterns.

It’s not just the behavior that needs to change, it’s also the identity underneath.

If you’re a clinician helping folks with sleep issues, start by getting curious about how your patients see themselves.

And if you’re personally struggling with sleep, ask yourself: What identity have I adopted around sleep?

To dig deeper into this, I interviewed Dr. Noelle Smith, PhD, VP of Clinical Care at Moona Health, an online CBT-i (cognitive behavioral therapy for insomnia) clinic.

Whether you’re a clinician looking for referral options, or someone trying to fix your own sleep, you’ll come away with practical takeaways, including Dr. Noelle’s #1 sleep tip.

In this episode, we cover

  •  The science behind CBT-i and how it changes physiological biomarkers
  • Why CBT-i works when sleep hygiene alone doesn’t
  • How it’s adapted for pregnancy, PTSD, menopause, and more
  • What to know about sleep meds and CBT-i
    …and more.

👉Quick refresher:

What is CBT-i and why should you care?
Cognitive Behavioral Therapy for Insomnia (CBT-i) is not just about avoiding caffeine or keeping your bedroom cool. That’s sleep hygiene, and while it matters, it’s not enough.

CBT-i is the first-line, gold standard treatment for chronic insomnia. It helps people unlearn the habits, thoughts, and behaviors that are keeping them awake…also known as the perpetuating factors of insomnia.

How long does it take?
Most people start to see improvements in 2 to 3 weeks. A full course is typically 6to 8 sessions. Unlike meds, the benefits last long after treatment ends.

Do you have to stop sleeping pills to start CBT-i?
No, people can start while still on medications. Many people choose to taper later as their sleep improves.


Is CBT-i right for your patient (or you)?
It’s effective for most people with chronic insomnia, including those with anxiety, depression, trauma, or menopause-related sleep issues. It can even be tailored for pregnancy or PTSD.

For clinicians:
If your patient has insomnia that’s interfering with their life, CBT-i should be your first-line referral.

Thanks to telehealth and digital tools, access is easier than ever, especially compared to when I was doing my sleep fellowship.

This Is Why You’re Not Sleeping During Menopause | Sleep Doctor Explains

Posted on August 9, 2025 by - Sleep Health

Sleep changes in Menopause

Join Dr. Andrea Matsumura, known as the ‘Sleep Goddess,’ as she unveils her journey into sleep medicine, focusing on sleep issues related to menopause. Hear about her transition from internal medicine to sleep medicine and discover her holistic DREAM method for sleep improvement. Learn about common sleep issues in perimenopause and menopause, including the role of hormones like estrogen and progesterone. Get practical advice on hormone replacement therapy (HRT), melatonin use, and the importance of diagnosing sleep apnea. Perfect for clinicians, this episode offers actionable insights into sleep health, insomnia treatments, and much more. Don’t miss out on improving your patients’ quality of life!

INSOMNIA CURED WITHOUT MEDS?! CBT-i Is the Secret Weapon No One’s Using

Posted on August 9, 2025 by - Sleep Health

A new option for CBT-i

In this episode, Dr. Noelle Smith, a psychologist and Vice President of Clinical Care at Moona Health, discusses Cognitive Behavioral Therapy for Insomnia (CBTI). Dr. Smith explains the differences between CBTI and sleep hygiene, the core components of CBTI, and the benefits of using telehealth to make this therapy more accessible. She also addresses common misconceptions, shares patient success stories, and provides insights on modifying CBTI for specific populations like those with pregnancy, PTSD, and menopause. Additionally, tips on how clinicians can refer patients, the efficacy of telehealth, and maintaining consistent wake times are covered. Don’t miss this comprehensive exploration of how CBTI can change lives for those suffering from chronic insomnia. Visit Moona Health for more information and additional resources.

Bipolar, burnout, and 2 hours of sleep a night: How Bill found peace

Posted on July 24, 2025 by - Sleep Health

I just read The Borrowed Life of Frederick Fife. Have you read it?

Such a fun and heartwarming novel. It was written by Anna Johnston, a physician who worked in a nursing home, and was inspired by her grandparents.

I won’t spoil it, but I loved the above quote on sleep.
Sleep disturbances are a core feature of many medical conditions, including bipolar disorder.

It’s the “S” in the DIGFAST mnemonic for mania.*

Sleep issues in bipolar disorder aren’t limited to acute episodes of mania, hypomania, or depression.

You can also see persistent sleep issues during euthymic (interepisode) periods, showing up in a variety of ways, including chronic insomnia, hypersomnia, or irregular sleep-wake patterns.

Circadian rhythm disturbances, including delayed sleep phase, are also common, and are associated with greater mood instability and functional impairment.

That’s why stabilizing sleep is a key preventive strategy in bipolar disorder.

This week, I have a video for you that’s a little different.
It’s an interview with Bill Fitzgerald, also known as The Accidental Life Coach, and a patient with bipolar disorder in Ireland.

He shares his raw and inspiring journey of living with bipolar disorder and trauma, overcoming chronic insomnia, and rebuilding his life from the inside out.

Bill and I share an Irish connection, as we’re both UCC (University College Cork)alums – I went to med school in Cork, Ireland.

Here are some tips to get you started:

During mania or hypomania, the hallmark sleep change is a reduced need for sleep (not insomnia). People sleep significantly less without feeling tired.

During depression, you can see insomnia or hypersomnia. Hypersomnia is more common in bipolar depression than in unipolar depression. That’s a diagnostic pearl most people miss.

PSG (polysomnogram) and actigraphy show increased sleep onset latency (time to fall asleep) and increased REM density across all illness stages.

We also see more obstructive sleep apnea, restless leg syndrome in people with bipolar disorder…yet these may go undiagnosed.

Sleep changes are often early warning signs.

Trouble falling asleep or sleeping too much can show up weeks to months before a depressive episode.

Decreased need for sleep often precedes mania.

If you’re treating bipolar disorder, or managing it yourself or with a loved one, addressing sleep is vital.

It’s one of the most powerful tools we have for preventing relapse and protecting stability.

To see what that looks like in real life, listen to Bill’s story here.

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals. 

P.S. DIGFAST is a mnemonic to remember the symptoms of mania. It stands for: Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity increased, Sleep decreased, and Talkativeness

References:
1. Kaplan KA. Sleep and sleep treatments in bipolar disorder. Curr Opin Psychol. 2020 Aug;34:117-122. doi: 10.1016/j.copsyc.2020.02.001. Epub 2020 Feb 13. PMID: 32203912.

2. Lewis KJS, Richards A, Karlsson R, et al. Comparison of Genetic Liability for Sleep Traits Among Individuals With Bipolar Disorder I or II and Control Participants. JAMA Psychiatry. 2020;77(3):303–310. doi:10.1001/jamapsychiatry.2019.4079

3. Palagini L, Miniati M, Caruso D, Massa L, Novi M, Pardini F, Salarpi G, Pini S, Marazziti D, Etain B, Riemann D. Association between affective temperaments and mood features in bipolar disorder II: The role of insomnia and chronobiological rhythms desynchronization. J Affect Disord. 2020 Apr 1;266:263-272. doi: 10.1016/j.jad.2020.01.134. Epub 2020 Jan 22. PMID: 32056887.

What It’s REALLY Like to Have Bipolar Insomnia (and Come Out the Other Side)

Posted on July 22, 2025 by - Sleep Health

In this episode, join Dr. Nishi Bhopal as she interviews Bill Fitzgerald, the ‘Accidental Life Coach,’ who shares his powerful journey of overcoming bipolar disorder. Bill provides an in-depth account of his experiences with panic attacks, insomnia, and being diagnosed with bipolar one. He talks about the various therapies and modalities that have aided him, from EMDR and reiki to grounding techniques and meditation. Bill emphasizes the importance of holistic approaches in mental health treatment, and offers valuable advice for health practitioners and individuals dealing with mental health crises. Don’t miss this inspiring and informative story that sheds light on the vast array of tools available for mental wellness.

How to taper off benzodiazepines

Posted on July 22, 2025 by - Sleep Health

How to taper off benzodiazepines

During med school, I lived by my “First Aid for the USMLE” book series.

Over a decade later, I still use some of the acronyms and mnemonics…10 points to Gryffindor if you remember SIGECAPS.* 🙂

Dr. Harvinder Singh MD, founder of Psychiatry Education Forum, joined me on YouTube this week and reminded me of this one: Out The Liver (OLT).

Do you know that one?

Here’s a refresher: All benzodiazepines are metabolized by the liver, and the metabolites are eliminated by the kidneys.

Some benzos don’t have active metabolites, and take a simpler route through the liver…they skip the usual oxidative metabolism and go straight to glucuronidation. 👇

Those are the “OLT” (Out The Liver) benzos:
‣ Oxazepam
‣ Lorazepam
‣ Temazepam

Why does this matter? Because this pathway doesn’t rely heavily on liver function, making these meds safer choices for older adults or people with liver issues (Peng et al, 2022). Plus, they don’t produce active metabolites, so they’re gentler on the kidneys too.

I don’t recommend long-term use of benzodiazepines because of the side effects including a high potential for misuse and physical dependence.

So how do you safely come off of them? Dr. Singh provided us with a masterclass on benzodiazepine tapering this week, based on the 2025 ASAM (American Society of Addiction Medicine) guidelines.

If you’re a clinician it’s a must watch, I learned so much from it. If you’re not a clinician, but are taking benzodiazepines or know somebody who is, this is must-have information.

This talk is jam-packed with high yield information, including:
‣ How long it takes to become dependent on benzos (it happens much faster than you think!)
‣ How to assess withdrawal risk
‣ The number 1 mistake people make with tapering
‣ Dr. Singh’s first step in tapering – it will change how you think about benzo tapers
‣ A tapering table to help you decide how to taper
‣ When you should switch to a long acting benzo, which 3 long acting benzos to choose, and who should NOT be switched to long acting
‣ Tapering pace and how to start
‣ The 2 adjuncts recommended by the ASAM guidelines to support a taper
‣ Managing sleep disturbances during a taper

And so much more…

Watch it here and bookmark the link, because you’ll want to refer back to it again and again. https://www.youtube.com/watch?v=eCzUoh5Cx_A&t=1s

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals.

References:
1. Peng L, Morford KL, Levander XA. Benzodiazepines and Related Sedatives. Med Clin North Am. 2022 Jan;106(1):113-129. doi: 10.1016/j.mcna.2021.08.012. PMID: 34823725.

Mastering Benzodiazepine Tapering: Insights from ASAM Guidelines

Posted on July 14, 2025 by - Sleep Health

Mastering Benzodiazepine Tapering: Insights from ASAM Guidelines

In this episode, we dive deep into the intricacies of tapering patients off benzodiazepines with Dr. Nishi Bhopal and a special guest, a board-certified psychiatrist Harvinder Singh MD. Learn about the latest guidelines from the American Society of Addiction Medicine (ASAM), risk-benefit assessments, patient-centered approaches, and the pitfalls and best practices for successful tapering. This video is packed with valuable information for healthcare providers, offering both practical advice and theoretical knowledge to optimize patient care in the realm of benzodiazepine tapering. Watch to gain insights into managing dependency, withdrawal, and ensuring patient collaboration through evidence-based strategies.

How Sleep Issues Cause Glaucoma, Dry Eyes & More

Posted on July 9, 2025 by - Sleep Health

How Sleep Issues Cause Glaucoma, Dry Eyes & More

Join host and optometrist Dr. Neda Gioia in this insightful episode as she delves into the interconnections between sleep and eye health. Discover the pillars of eye health from a functional medicine perspective, addressing modifiable risk factors like nutrition, stress management, exercise, and sleep. Learn about the impact of sleep disorders, particularly obstructive sleep apnea, on eye conditions such as dry eye and glaucoma. Dr. Gioia also provides valuable insights into functional medicine, nutritional advice, and the importance of personalized patient care. This episode is essential for healthcare professionals looking to enhance their understanding of holistic eye care and its systemic interactions.