Author: IntraBalance

Is AI going to replace clinicians?

Posted on January 5, 2026 by - Sleep Health

Is AI going to replace sleep clinicians?

As we wind down the year, I’ve been reflecting on changes in my medical practice. Things are so different from when I finished my training over a decade ago.

2025 was the year of AI and I’ve seen a lot of concern from clinicians about whether AI will replace us. What do you think?

In collaboration with VuMedi, I’m sharing a 2025 year in review about AI in sleep medicine.

In this video, I’m sharing:

  • AASM guidelines on AI in clinical practice
  • How AI is creating more anxiety in my patients
  • The one tool that changed my workflow
  • A change in my practice in 2025 that I’m excited about
  • Whether AI will replace you
  • And more

Click to watch the video and don’t forget to claim your CME credits using the Learner+ link below.

Wishing you a joyful and prosperous 2026!

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

Do sleeping pills work?

Posted on December 30, 2025 by - Sleep Health

Do Sleeping Pills Work

A psychiatrist in my Clinical Sleep Kit (CSK) program for practitioners recently asked how I use prescription sleep aids in my practice.

By the time many patients reach my clinic, they’ve already cycled through nearly every sleep aid on the market. Because of that, my approach to insomnia is primarily non-pharmacological.

That said, sleep medications do have a role when they’re used thoughtfully and strategically.

Short-term, intermittent use can be appropriate for select patients.

But here’s the part many clinicians don’t realize:

→ The actual impact of most sleeping pills on sleep latency and wake after sleep onset is only a few minutes.

The gap between expectation and reality is often where prescribing challenges begin.
This week, I’m sharing a short tutorial on best practices for prescribing sleep aids and how to talk with patients in a way that prevents the loop of trialing of one medication after.

In this video, we cover:

  • AASM recommendations for the use of sleeping pills
  • When sleeping pills help and when they don’t
  • My personal prescribing practices
  • Word-for-word patient dialogues (steal these for your clinical practice)
  • And more

Click to watch the tutorial and don’t forget to claim your CME credits using the Learner+ link below.

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals. https://champions.learner.plus/?champion=Dr%20Nishi%20Bhopal

References:
(1) Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017 Feb 15;13(2):307-349. doi: 10.5664/jcsm.6470. PMID: 27998379; PMCID: PMC5263087.

Hormone Therapy for Mental Health

Posted on December 19, 2025 by - Sleep Health

Hormone Therapy for Mental Health

I once did an informal survey on Facebook asking people their biggest sleep concerns. The majority of respondents were women in their 30s and above, and their number 1 concern was this:

→ Difficulty staying asleep

It wasn’t surprising, because hormones do have a known impact on sleep.

Lower levels of estradiol and higher levels of FSH during perimenopause are associated with sleep disturbances, independent of vasomotor symptoms and mood changes. (1)

As for progesterone, it’s known to have sedative properties, thought to act as a GABA-agonist. It also stimulates breathing via acting centrally on brainstem respiratory control centers, and by peripherally affecting upper airway patency. Thus, we see higher rates of sleep when progesterone levels drop in perimenopause and menopause. (2)

Now, whether hormone therapy (HT) is helpful is a bit more complex.

I’ve seen patients experience an initial improvement with HT, but then develop sleep issues again. So why might that be?

This week, we’re digging into hormonal shifts, mental health, and sleep changes with Harita Raja MD.

Dr. Raja is a reproductive psychiatrist specializing in hormone therapy for mental health. If you’re not already following her on Instagram, I highly recommend that you do.

In this interview, Dr. Raja shares:

  • How hormones affect psychiatric conditions
  • When to consider HT in women with mental health or sleep issues
  • Why HT is often not enough to overcome symptoms
  • The role of lab testing
  • Whether psychiatrists should be prescribing hormones
  • How to get trained in hormone therapy
  • And much more

Click here to watch the interview and don’t forget to claim your CE credits using the Learner+ link below. https://www.youtube.com/watch?v=rboinFa38SA

References:
(1) Coborn J, de Wit A, Crawford S, Nathan M, Rahman S, Finkelstein L, Wiley A, Joffe H. Disruption of Sleep Continuity During the Perimenopause: Associations with Female Reproductive Hormone Profiles. J Clin Endocrinol Metab. 2022 Sep 28;107(10):e4144-e4153. doi: 10.1210/clinem/dgac447. PMID: 35878624; PMCID: PMC9516110.

(2) Boukari R, Laouafa S, Ribon-Demars A, Bairam A, Joseph V. Ovarian steroids act as respiratory stimulant and antioxidant against the causes and consequences of sleep-apnea in women. Respir Physiol Neurobiol. 2017 May;239:46-54. doi: 10.1016/j.resp.2017.01.013. Epub 2017 Feb 9. PMID: 28189710.

Bright light therapy

Posted on December 5, 2025 by - Sleep Health

Bright Light Therapy

I met a friend for a later-than-usual dinner a couple of weeks ago and we were laughing at how incredibly sleepy we both were given that it now becomes pitch black by 5pm in the Bay Area.

The short winter days can make for sleepier evenings, lethargic days, and even Seasonal Affective Disorder (SAD) in patients prone to it.
Bright light therapy, medications, and other conventional treatments are effective for SAD.

But one of the missing pieces is embracing seasonal shifts.
In our modern world, we expect ourselves to maintain the same productivity, energy, and sleep patterns all year round.

Meanwhile, nature does the opposite, as trees become bare, animals hibernate, and the stars come out to say hello in the early evening hours.
I love embracing the Scandinavian concept of “hygge”, with cozy evenings, twinkle lights, homemade soups, a good book and a soft blanket.

Pair that with a purposeful dose of daytime bright light by going for a walk outside, preferably out in nature, my favourite being a brisk midday stroll on the beach.

It often does more than people expect.

But, back to bright light therapy which is one of the most underutilized tools in the clinical toolbox.

Bright light therapy (BLT) is:

  • Also called phototherapy
  • It’s a non-pharmacologic treatment for sleep and depressive disorders
  • It involves daily exposure to bright light and is typically administered with a light therapy device (light box, wearable, or dawn simulator)

Bright light therapy was originally used to treat seasonal affective disorder (SAD). Now it’s also used in the treatment of non-seasonal depression, bipolar depression, fatigue, insomnia, and circadian rhythm disorders.

If you see patients with insomnia, depression, or fatigue, it’s a good idea to learn how to prescribe bright light therapy. See my video here for an in-depth tutorial:

Some clinical pearls to get you started:

  • 10,000 lux for about 30 minutes in the morning is still the gold standard. You’ll also see older protocols using 2,500 lux for 2 hours, also effective but less convenient. (1)
  • Blue light devices can work at much lower intensities, and newer studies show green light may help too, but white light still comes out on top in meta-analyses. Red light is shown to be ineffective for SAD. Ensure the device has a UV filter.
  • Light therapy is most effective first thing in the morning. It needs to hit the retina (not the skin), so position the device at eye level.
  • Traditional light boxes have the longest and strongest evidence base, but the wearable visors/glasses can be just as effective for people who need portability. The ReTimers here are an example. (Disclosure: This is an affiliate link.) https://shareasale-analytics.com/r.cfm?b=2448501&u=3028033&m=148943&urllink=&afftrack=&shrsl_analytics_sscid=81k8%5Fo0ome&shrsl_analytics_sstid=81k8%5F1we5t
  • Most people start to feel better within one week, and response rates can reach ~80% when the protocol is followed correctly. Side effects are usually mild (eye strain, headache, nausea).

I still recommend that my patients go outside for a dose of natural sunlight in the morning and midday hours, while integrating bright light therapy devices into the treatment plan.

References
Galima SV, Vogel SR, Kowalski AW. Seasonal Affective Disorder: Common Questions and Answers. Am Fam Physician. 2020 Dec 1;102(11):668-672. PMID: 33252911.

Simple sleep tip

Posted on November 26, 2025 by - Sleep Health

Simple sleep tip

One of the most common concerns I hear from my patients is that they can’t shut off their mind at night.

They climb into bed and suddenly the mental floodgates open: to-do lists, work problems, holiday logistics, the awkward comment from 2003, existential dread…all of it shows up like clockwork.

These are often the patients asking for a sedative or an anxiolytic to quiet the noise.

While medication can be appropriate in select cases, it rarely solves the underlying issue.

You might suggest relaxation techniques or meditation, but for those with chronic insomnia, those tools often backfire because they increase “sleep effort”, amplifying frustration.

Plus, the mind is doing exactly what it’s designed to do: think. Expecting patients to “turn it off” sets them up for more pressure and disappointment.

So here’s a more effective entry point:

Shift the focus to pre-sleep cognitions. (1)
Pre-sleep cognitions are the mental activities that occur in the window before sleep onset, like rumination, planning, worry, mental rehearsal, intrusive thoughts, and problem-solving.

In chronic insomnia, these thoughts tend to be more intense, more negative, and more sticky than in what I call “effortless sleepers.”

Research consistently shows this cognitive arousal is associated with:

  • Longer sleep latency
  • Decreased sleep efficiency
  • Worse subjective sleep quality

So how can you help patients meaningfully shift their pre-sleep cognition patterns?

Use a tool that’s free, simple, low-risk, and clinically supported: Gratitude.

It’s a timely topic with Thanksgiving in the US this week, but is relevant year-round

Gratitude practices have been shown to:

  • Reduce pre-sleep worry and rumination
  • Lower cognitive arousal at bedtime
  • Improve subjective sleep quality
  • Support emotional regulation and mood

It’s underused, especially in insomnia care, yet quite easy for patients to do.

Here’s how I coach my patients to start practicing gratitude:

What to do

Choose one specific thing you’re grateful for each day. Keep it concrete, like “I’m grateful for the warm coffee I had this morning.”

How to do it:
Say it out loud, write it in a journal, or drop it on a post-it note into a “gratitude jar.”

When to do it:
Begin in the evening. With daily practice, it starts to happen spontaneously throughout the day.

Why it matters:
It builds “emotional fitness,” improves pre-sleep cognitions, and improves sleep quality over time.

As clinicians, it’s important that we practice what we preach. Gratitude takes only a few seconds but compounds quickly.

With that said, I’m grateful you’re here and letting me be part of your sleep education journey.

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

References:
(1) Lemyre A, Belzile F, Landry M, Bastien CH, Beaudoin LP. Pre-sleep cognitive activity in adults: A systematic review. Sleep Med Rev. 2020 Apr;50:101253. doi: 10.1016/j.smrv.2019.101253. Epub 2019 Dec 17. PMID: 31918338.

Melatonin for Menopause

Posted on November 11, 2025 by - Psychiatry

Melatonin for Menopause

Did you learn about menopause care in med school or clinical training?

I didn’t. Not much anyway.

But menopause is finally having a moment.

For years, women were told to “just deal with it”… the hot flashes, the mood shifts, the weight changes, and the sleepless nights.

But now there’s a quorum of us female physicians going through perimenopause and menopause ourselves…

Which is leading to a movement of clinicians getting trained in menopause care and women demanding better solutions.

When I spoke with Dr. Andrea Matsumura MD, a sleep medicine physician and women’s health expert, we both agreed: this new era of menopause care is long overdue.

We’re seeing more open conversations, better research, and a growing recognition that sleep disruption during this stage of life isn’t just hormonal, it’s multifactorial.

This week’s video rounds out our 3-part series on melatonin with a focus on menopause.

In this 6-minute episode, I’m sharing:

  • How melatonin can help restore circadian rhythm and sleep continuity in midlife women
  • When to use immediate vs. extended-release formulations
  • What the data show on melatonin for menopausal insomnia
  • Dosing and timing strategies for different sleep presentations
  • Melatonin isn’t a cure-all for sleep issues, but it’s an important piece of the puzzle, with emerging research suggesting it can improve sleep quality and timing when used correctly.If you’re helping patients navigate menopause (or navigating it yourself), this short episode will give you practical, evidence-based tools to use right away.

Watch the full video here.

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

References:
Caretto M, Giannini A, Simoncini T. An integrated approach to diagnosing and managing sleep disorders in menopausal women. Maturitas. 2019 Oct;128:1-3. doi: 10.1016/j.maturitas.2019.06.008. Epub 2019 Jun 28. PMID: 31561815.

Jeon GH. Insomnia in Postmenopausal Women: How to Approach and Treat It? J Clin Med. 2024 Jan 12;13(2):428. doi: 10.3390/jcm13020428. PMID: 38256562; PMCID: PMC10816958.

Melatonin’s Hidden Role in Menopause

Posted on November 3, 2025 by - Sleep Health

Melatonin's Hidden Role in Menopause

In this episode, Dr. Nishi Bhopal MD, a sleep physician and psychiatrist, shares valuable insights on using melatonin to manage sleep disorders in perimenopausal and menopausal women. Dr. Bhopal discusses how melatonin can help reset circadian rhythms and improve sleep quality, offering evidence-based dosages and tips for clinical practice. She emphasizes the importance of combining melatonin supplementation with behavioral and environmental adjustments and warns against the potential side effects of high dosages. Tune in for a detailed guide on effectively integrating melatonin into treatment plans for midlife women, along with information about an upcoming masterclass for deeper learning.