Author: IntraBalance

Does Clinical Hypnosis Work For Insomnia?

Posted on February 10, 2026 by - Sleep Health

Does Clinical Hypnosis Work For Insomnia?

Join Dr. Nadia Sarwar, a double board-certified pediatrician and palliative care physician, as she demystifies clinical hypnosis and its applications in treating sleep disorders and anxiety. Learn about the neurobiological effects of hypnosis, evidence-based practices, and how to tailor hypnosis for individual patients. Dr. Sarwar shares her journey into clinical hypnosis, its benefits, and practical steps for clinicians interested in integrating hypnosis into their practice. Perfect for healthcare professionals looking to expand their therapeutic toolkit.

One of the first things I do with an insomnia patient

Posted on January 26, 2026 by - Sleep Health

Are you treating patients with sleep complaints but lacking a dedicated insomnia measure? Join Dr. Nishi Bhopal MD to discover the Insomnia Severity Index (ISI), a well-validated tool designed to assess insomnia severity, distress, and daytime impact.

One of the first things I do with an insomnia patient, whether it’s in a 1:1 session or in my group program, is show them the 3P Model of Insomnia.

It’s super simple and impactful, and you can start using it in your practice as well.

Despite being foundational in behavioral sleep medicine, it often gets overlooked in medical training, which is a shame, because it explains exactly why insomnia becomes chronic, and why certain treatments work while others don’t.

The slide below visually shows how insomnia evolves from acute to chronic.

Let’s walk through how you can use this with patients.

The 3P model explained simply

The 3P model describes insomnia in terms of predisposing, precipitating, and perpetuating factors.

Predisposing factors are like dry kindling. Precipitating factors are the spark. Perpetuating factors are the oxygen that keeps the fire burning.

Even when the original spark is gone, the fire doesn’t go out if oxygen is still feeding it.

Here’s how that plays out clinically.

3P Model of Insomnia

Predisposing factors increase vulnerability to insomnia but don’t cause it on their own.

Examples: Anxiety-prone or perfectionistic traits; female sex; advancing age; chronic medical or pain conditions, etc.

Precipitating factors are the events that trigger insomnia.

Examples: illness or injury; major life transitions; grief.

For many people, sleep normalizes once the stressor resolves. But for others, insomnia persists.

Perpetuating factors are the behaviors and cognitive processes that maintain insomnia after the original trigger is gone. This is the oxygen that keeps the fire burning.

Examples: Spending too much time in bed awake; Irregular sleep schedules; Conditioned arousal in the bedroom; Worrying about sleep or trying to force sleep; Rigid beliefs about “perfect” sleep; Cycling through different types of supplements or medications

Many of these behaviors feel adaptive and protective to patients, which is why they’re so easy to miss.

Why this model matters in clinical practice

When I go over the 3P model with patients, the idea is not to fixate on why their insomnia started, but to help them see how it’s being maintained.

The 3P model helps patients see that what matters now are the perpetuating factors, because they are the oxygen that’s keeping insomnia alive.

This reframing helps to get buy-in before you introduce behavioral changes.

CBT-I (cognitive behavioral therapy for insomnia) and ACT (acceptance and commitment therapy) work because they remove the oxygen that keeps the insomnia burning.

This also helps explain why medications may provide short-term relief, but often don’t lead to durable change when the perpetuating behaviors and cognitions remain intact.

How to frame this with your patients

You can say something like: “We don’t need to figure out what started your insomnia to help it improve. We’re focused on what’s keeping it going, because that’s what we can change.”

Framing it that way tends to reduce the fear and improve adherence to behavioral treatment.

If you’re working with patients struggling with chronic insomnia, this model can be a powerful starting point and help build rapport.

Save the slide and start using it in your practice…and let me know how it goes.
Next, collect your CME for this email below, using the Learner+ link.

If you missed last week’s video on how to use the Insomnia Severity Index (ISI), watch it here:

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:
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504. PMID: 18853708; PMCID: PMC2576317.

How to use the ISI in clinical practice

Posted on January 16, 2026 by - Sleep Health

Are you treating patients with sleep complaints but lacking a dedicated insomnia measure? Join Dr. Nishi Bhopal MD to discover the Insomnia Severity Index (ISI), a well-validated tool designed to assess insomnia severity, distress, and daytime impact.

Do you use the ISI (Insomnia Severity Index) in clinical practice?

Last year, I worked with a patient whose ISI score was 24 at the start of treatment, which indicates severe clinical insomnia.

He was so worried about his sleep that he’d taken a leave from work and was terrified that he’d never be able to go back to work or be present with his young daughter.

He thought his ability to sleep was forever “broken.”
We worked together over the next few months, and by the end of treatment his ISI score was down to 6, indicating no clinically significant insomnia.

It was a huge win!

He’s now back at work and knows exactly what to do when sleep is difficult. He’s no longer afraid that a bad night means that he’ll never sleep again.
Watching his ISI scores change over time was meaningful for me as the treating physician, but it was also powerful for the patient.

It gave him a tangible way to see progress that wasn’t always obvious night to night.
If you’re not already using the ISI in your practice, I highly recommend it.

I just released a new video for clinicians on how to use it.

In this video, you’ll learn:

  • What the ISI measures
  • Which patients to administer it to
  • Scoring and interpretation guidelines
  • How often to administer it (intake → monitoring → termination)
  • Limitations of the ISI
  • How I use it in my practice
  • And more

CME is available for this video. To earn credit, watch the full video here and use the Learner+ link in the video description.

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

Is integrative sleep medicine a scam?

Posted on January 12, 2026 by - Sleep Health

As we kick off the new year, I thought we could start with some sleep medicine myth busting, starting with a look at integrative medicine.

As we kick off the new year, I thought we could start with some sleep medicine myth busting, starting with a look at integrative medicine.

A few weeks ago, I heard two comments on the same day that gave me pause.

The first one was in a physician Facebook group where a doctor wrote that integrative medicine is a scam to sell supplements, calling it a cash grab.

That same day, a clinician in my Clinical Sleep Kit education program said that integrative medicine was too expensive and asked where to find low-cost supplements for their underserved patients.

These were two very different contexts, but with the exact same assumption.

  • The assumption being that integrative medicine = supplements.

For the record, that assumption is untrue.

However, it’s problematic because that mindset limits how we care for patients with insomnia and mental health issues.

So I recorded a short video to show you what integrative sleep medicine looks like in clinical practice and to share some resources that you can start using today.

In this video, you’ll learn:

  • What integrative sleep medicine is
  • How it aligns with evidence-based care
  • 2 case studies from my clinical practice
  • How to practice integrative medicine without supplements, labs, or added cost
  • What actually comprises the heart of integrative sleep treatment and why supplements are usually peripheral
  • How to partner with patients instead of overwhelming them, using simple coaching-style phrases (steal them phrases for your practice)

If you’ve ever felt skeptical, confused, or unsure how integrative sleep medicine fits into your clinical practice, this video will bring clarity.

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

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.