Author: IntraBalance

Exploring Cannabis in Medicine: Insights with an Internal Medicine Doctor

Posted on June 10, 2025 by - Sleep Health

Exploring Cannabis in Medicine: Insights with an Internal Medicine Doctor

Join us for an eye-opening conversation with Dr. Janice Makela as we dive deep into the medical use of cannabis. Dr. Makela shares her extensive knowledge on the benefits, risks, and applications of cannabis for sleep, pain, and anxiety management. Discover the science behind the endocannabinoid system, the differences between THC and CBD, and explore how cannabis can be integrated into medical practice. Perfect for doctors and healthcare professionals looking to expand their understanding of this increasingly relevant topic.

Unlocking Shift Work Success: Sleep Strategies with the Director of the Oak Health Sleep Program

Posted on May 19, 2025 by - Sleep Health

Join us on this informative episode where Dr. Alison Kole dives deep into the challenges of shift work and offers evidence-based strategies to improve sleep and health outcomes for shift workers.

Join us on this informative episode where Dr. Alison Kole dives deep into the challenges of shift work and offers evidence-based strategies to improve sleep and health outcomes for shift workers. Learn about the differences between shift work and shift work disorder, the acute and chronic health impacts, and practical tips to prepare for and recover from shifts. Dr. Kole shares her expertise on optimizing performance, utilizing light exposure, managing schedule rotations, and even using nutrition and stimulants effectively. Whether you are a physician supporting patients or a shift worker yourself, this masterclass is packed with valuable insights. Subscribe and enhance your understanding of clinical sleep medicine to improve quality of life and health outcomes.

Sleep Strategies for Shift Workers: Clinical Insights for Healthcare Providers

Posted on May 19, 2025 by - Sleep Health

Sleep Strategies for Shift Workers: Clinical Insights for Healthcare Providers

I was in elementary school when the Exxon Valdez oil spill made headlines. The images of oil-drenched wildlife and thick, syrupy water are etched in my memory. We even discussed it in class.

What I didn’t learn at the time, though, is that the worst oil spill in U.S. history was also a sleep-related disaster.
The person responsible had reportedly been awake for 22 hours before the incident. At that point, the brain functions as if you’ve been drinking alcohol…equivalent to a blood alcohol level of 0.08%.

In other words, sleep deprivation isn’t just a health issue, it’s a public safety problem, especially for those working shifts.

Shift Work and Sleep Deprivation: A Growing Public Health Concern

If you’re a doctor, nurse, or healthcare provider who works shifts or manages patients who do, you understand the toll shift work can take on sleep and overall health. But the impact goes beyond just feeling tired.

The consequences of chronic sleep deprivation in shift workers, whether in healthcare or other industries, can lead to burnout, poor decision-making, and serious safety risks.

This week, I’m joined by Dr. Alison Kole MD, a pulmonary, critical care, and sleep medicine physician who understands the brutal reality of shift work from experience.

After burning out working ICU shifts during the COVID-19 pandemic, Dr. Kole pivoted and is now the host of the Sleep Is My Waking Passion Podcast. In this masterclass, Dr. Kole shares her experience and evidence-based strategies to help shift workers manage their sleep better.

Watch Dr. Kole’s Masterclass on Shift Work and Sleep

Watch on YouTube

Here’s what you’ll learn in this shift work sleep masterclass:

  • What qualifies as shift work and why it’s not just night shifts
  • The real-world impact of sleep deprivation on decision-making and public safety
  • Evidence-based sleep strategies for managing sleep during shifts, including the role of anchor sleep, naps, and sleep banking
  • How to strategically use caffeine and follow the jet lag diet to improve alertness and recovery
  • Practical advice for healthcare professionals to avoid burnout and sleep deprivation-related accidents

Start Building Your Clinical Sleep Medicine Knowledge with My Free Course

If you’re a healthcare professional working with patients, it’s crucial to have a strong foundation in clinical sleep medicine.

That’s why I’ve created a free sleep mini-course focused on the foundations of clinical sleep medicine. This course is specifically for doctors and healthcare providers who want to understand the science of sleep and gain practical tools for treating sleep issues in their patients.

Click here to get immediate access to the free course

Why Sleep is Crucial for Doctors and Healthcare Providers

As a doctor or healthcare provider, your ability to provide excellent care depends on how well-rested you are. Shift work sleep issues are more than just inconvenient—they can seriously impact your performance and decision-making. Sleep deprivation can lead to mistakes that affect patient care and safety.

By learning the fundamentals of clinical sleep medicine, you can not only improve your own understanding of sleep but also provide better care for your patients, especially those working irregular hours.

Bottom Line: Sleep is Essential for Shift Workers

Sleep isn’t a luxury for shift workers. It’s a health necessity…and it’s something you can learn to treat more effectively with the right clinical sleep strategies.

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

Can the Oura Ring Improve Sleep Insights for Your Patients?

Posted on May 14, 2025 by - Sleep Health

Can the Oura Ring Improve Sleep Insights for Your Patients?

As a sleep physician and psychiatrist, I’ve found the Oura Ring to be a surprisingly useful tool, both personally and clinically.

I’ve worn my Oura Ring for years and regularly use it to track sleep trends in relation to lifestyle factors like late-night screen time, stress, and diet. While I’ve always known I sleep better after a nature hike or worse after a late dinner, having objective sleep data makes these patterns undeniable.

It turns out my HRV tanks after evening laptop use or meals close to bedtime—exactly what I counsel patients about. Tools like this can be a valuable addition to our clinical sleep toolkit…when used wisely.

How Clinicians Can Use the Oura Ring in Practice

Here are 3 practical ways doctors can integrate the Oura Ring into clinical conversations about sleep health:

1. Monitor HR and HRV as Stress Biomarkers

The Oura Ring performs well in capturing nocturnal heart rate and HRV (heart rate variability). Several validation studies have shown a high correlation with ECG overnight HRV readings [1–3].

‣ Use Case: For patients dealing with burnout or ANS dysregulation, these metrics offer a non-invasive way to measure recovery, especially in response to interventions like mindfulness or behavioral and lifestyle changes.

2. Track Sleep, But Focus on Trends, Not Sleep Stages or Single Nights

While the Oura Ring does a decent job estimating total sleep time, its sleep staging accuracy doesn’t match polysomnography (PSG) [4].

‣ Tip: Encourage patients to look at sleep trends over time rather than individual nights or specific stages. Emphasize that we’re not diagnosing, we’re pattern-tracking.

3. Support Lifestyle Interventions with Wearable Feedback

A recent 12-month study showed that pairing the Oura Ring with guided health coaching improved sleep, activity, and metabolic health markers [5].

I’ve seen this play out in real life. When patients visualize how meditation or limiting alcohol affects their HRV and sleep quality, they’re more likely to stick with healthy behaviors.

How Patients Can Share Oura Ring Sleep Data with You

Patients can now easily export their sleep data using the “Shareable Sleep Reports” feature. Just go to the top-left menu, > “Shareable Reports” > “Sleep Reports” > Choose your time frame > Download the PDF.

3 Common Pitfalls of Sleep Wearables

While wearables can be helpful, they come with limitations. Here’s what to watch for:

1. Orthosomnia or obsessive behaviors:
Some patients develop sleep-related anxiety or obsessive behaviors around sleep and activity tracking, fixating on their scores instead of tuning into their body.

In those cases, I recommend taking a break for a few weeks or months, and shifting attention to how they feel.

2. Over-Reliance on Metrics:
Data is not the whole picture. Patients may feel fine but score “poorly”, or vice versa. Teach them to listen to their body first.

3. Skipping Medical Evaluations:
A good score doesn’t rule out sleep apnea, mood disorders, or circadian rhythm issues. Wearables complement, not replace, your clinical judgment.

3 Sleep Coaching Tips for Doctors Using Oura Ring Data

Track Trends, Not Single Nights
Two weeks of data gives a clearer picture than a single off-night.

Use Data to Build Insight
Let patients discover how lifestyle impacts sleep…especially caffeine, alcohol, and late screen use.

Watch for Tracking Burnout
If the ring is causing more stress than clarity, press pause. Help patients reconnect with body cues, lifestyle changes, mindfulness, and what I like to call Vitamin J (Joy).

Final Word: The Oura Ring Is Like a Stethoscope for Sleep

The Oura Ring is not a diagnostic device, but it’s a powerful adjunct when paired with clinical insight. Think of it as a modern stethoscope for sleep and recovery…helpful for gathering clues, but not the whole story.

Want More Clinical Sleep Tips for Healthcare Professionals?

Check out our Sleep Medicine Pearls Course for Clinicians

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. Kinnunen H, Rantanen A, Kenttä T, Koskimäki H. Feasible assessment of recovery and cardiovascular health: accuracy of nocturnal HR and HRV assessed via ring PPG in comparison to medical grade ECG. Physiol Meas. 2020 May 7;41(4):04NT01. doi: 10.1088/1361-6579/ab840a. PMID: 32217820.

2. Cao R, Azimi I, Sarhaddi F, Niela-Vilen H, Axelin A, Liljeberg P, Rahmani AM. Accuracy Assessment of Oura Ring Nocturnal Heart Rate and Heart Rate Variability in Comparison With Electrocardiography in Time and Frequency Domains: Comprehensive Analysis. J Med Internet Res. 2022 Jan 18;24(1):e27487. doi: 10.2196/27487. PMID: 35040799; PMCID: PMC8808342.

3. Herberger S, Aurnhammer C, Bauerfeind S, Bothe T, Penzel T, Fietze I. Performance of wearable finger ring trackers for diagnostic sleep measurement in the clinical context. Sci Rep. 2025 Mar 19;15(1):9461. doi: 10.1038/s41598-025-93774-z. PMID: 40108409; PMCID: PMC11923143.

4. Robbins R, Weaver MD, Sullivan JP, Quan SF, Gilmore K, Shaw S, Benz A, Qadri S, Barger LK, Czeisler CA, Duffy JF. Accuracy of Three Commercial Wearable Devices for Sleep Tracking in Healthy Adults. Sensors (Basel). 2024 Oct 10;24(20):6532. doi: 10.3390/s24206532. PMID: 39460013; PMCID: PMC11511193.

5. Browne JD, Boland DM, Baum JT, Ikemiya K, Harris Q, Phillips M, Neufeld EV, Gomez D, Goldman P, Dolezal BA. Lifestyle Modification Using a Wearable Biometric Ring and Guided Feedback Improve Sleep and Exercise Behaviors: A 12-Month Randomized, Placebo-Controlled Study. Front Physiol. 2021 Nov 25;12:777874. doi: 10.3389/fphys.2021.777874. PMID: 34899398; PMCID: PMC8656237.

Why Single-Night Sleep Studies Miss the Full Picture

Posted on May 6, 2025 by - Sleep Health

Multi-Night Sleep Testing

Join Dr. Nishi Bhopal, MD and Dr. Sahil Chopra, MD as they dive deep into the evolving field of sleep medicine. They discuss the critical insights into sleep apnea, debunk common myths, and explore the latest advancements in longitudinal sleep testing. Learn how Empower Sleep is transforming the diagnosis and treatment of sleep disorders with cutting-edge technology and personalized care. This episode is packed with valuable information for healthcare practitioners looking to enhance their understanding and approach to sleep-related health issues. Don’t miss out on practical tips for improving patient care and future trends in sleep medicine!

Pink, Brown, and White Noise for Sleep

Posted on April 21, 2025 by - Sleep Health

As always, it's essential to make personalized recommendations and to “look under the hood” to see what else might be going on with your patient’s sleep.

This question came up twice this week – once in my insomnia group program, and again in a patient visit:

“Does white noise help with sleep?”

During sleep, the auditory system remains active and the brain continues to process environmental sounds.

When I was living in downtown Chicago, there was constant background noise, which can disrupt sleep.

Nowadays there are tons of apps, YouTube videos, noise machines, and other devices providing auditory stimulation (like white, pink, and brown noise, binaural tones, etc.)
to block noise and promote sleep.

First of all, what are white, pink, and brown noise?

White noise is often used to mask sounds in the environment. Examples include radio static or a whirring fan.

Pink noise is thought to be more pleasant than white noise. Examples include steady rainfall or gentle ocean waves.

Brown noise involves lower frequencies than white or pink noise. Examples include thunder or crashing waves.

Do they help with sleep?

White noise is quite popular – in fact, I have a white noise machine on right now while I’m working. However studies on sleep show mixed results.

Less than a third of research on white noise demonstrates positive effects on sleep quality. (1)

Some studies even suggest white noise could potentially have negative effects on brain function and cognition, more evidence is needed.

Pink noise has been suggested as a potentially more effective alternative to white noise, though research is still limited.
It may improve sleep quality for some individuals, but, like white noise, the rigor of studies on pink noise remains weak.
Brown noise has also gained attention as a sleep aid. While it’s less studied than white and pink noise, some people report that the deeper tones of brown noise help them sleep more soundly.

As with the other types, more research is needed to conclusively determine its effectiveness.

It’s also possible that listening to the same thing each night can trigger a conditioned response, where people associate the noise with falling asleep.

Interestingly, hospital settings have begun experimenting with audio interventions to improve sleep for patients.

When I was in residency, they used to play classical music on the general medical floor and I found it calming as a sleep-deprived resident. But it was only played during the day.
Given the noise-sensitive environments in many hospitals, noise reduction strategies paired with audio interventions may help improve sleep quality in these settings.

Is it safe?

There’s no strong evidence to suggest that audio interventions like white, pink, or brown noise are harmful when used short-term.

In fact, they may be a good option for patients struggling to sleep in noisy environments.
A small study done in NYC found that white noise significantly improved sleep latency and reduced wake after sleep onset (WASO) in people exposed to high levels of environmental noise. (2)

However, like a Pavlovian response, people may inadvertently condition themselves to rely on the sounds, potentially making it difficult for them to sleep without them.

There are also potential concerns about not allowing the auditory system to switch off, rest, and repair overnight.

Continuous exposure to high levels of white noise could potentially lead to hearing damage. White noise machines can sometimes hit unsafe noise levels, especially if they’re turned up too loud. (3)

Another study indicated that prolonged exposure to white noise can induce maladaptive changes in the brain, potentially impacting neurological health and cognition. (4)

Back to sleep, some studies suggest that continuous noise may actually disrupt sleep. (1)

Bottom line

The evidence is still inconclusive, but this area of sleep science is evolving.

If patients ask you about this, here are considerations:

  • Mixed Effectiveness: Research on white, pink, and brown noise for sleep shows mixed results, with some studies reporting benefits and others showing limited or no effect.
  • Conditioned Response: Regular use of noise for sleep may create a dependency, making it harder to sleep without it.
  • Safety Concerns: Long-term exposure to high volumes of background noise may cause hearing damage.

How I guide my patients: I wouldn’t recommend using white, pink, or brown noise continuously.

However, if it helps them wind down and fall asleep, using it for a set time at night could be helpful. And of course, be mindful of the volume and risks of hearing loss.

As always, it’s essential to make personalized recommendations and to “look under the hood” to see what else might be going on with your patient’s sleep.

References

(1) Riedy SM, Smith MG, Rocha S, Basner M. Noise as a sleep aid: A systematic review. Sleep Med Rev. 2021 Feb;55:101385. doi: 10.1016/j.smrv.2020.101385. Epub 2020 Sep 9. PMID: 33007706.

(2) Ebben MR, Yan P, Krieger AC. The effects of white noise on sleep and duration in individuals living in a high noise environment in New York City. Sleep Med. 2021 Jul;83:256-259. doi: 10.1016/j.sleep.2021.03.031. Epub 2021 Apr 6. PMID: 34049045.

(3) De Jong RW, Davis GS, Chelf CJ, Marinelli JP, Erbele ID, Bowe SN. Continuous white noise exposure during sleep and childhood development: A scoping review. Sleep Med. 2024 Jul;119:88-94. doi: 10.1016/j.sleep.2024.04.006. Epub 2024 Apr 16. PMID: 38663282.

(4) Attarha M, Bigelow J, Merzenich MM. Unintended Consequences of White Noise Therapy for Tinnitus-Otolaryngology’s Cobra Effect: A Review. JAMA Otolaryngol Head Neck Surg. 2018 Oct 1;144(10):938-943. doi: 10.1001/jamaoto.2018.1856. PMID: 30178067.

Hypnosis for Sleep: Science-Backed Tool or Hype?

Posted on April 15, 2025 by - Sleep Health

Sleep Hypnosis Legit or Pseudoscience

In this episode, Dr. Nishi Bhopal interviews Lara Kassir, a certified clinical hypnotherapist and brainspotting practitioner, about the transformative role of hypnotherapy in treating sleep disorders. Lara delves into her professional background and how hypnotherapy can address chronic insomnia, anxiety, and other sleep-related issues. She explains the difference between therapeutic hypnotherapy and common misconceptions tied to stage hypnosis. The conversation further explores the applications of brainspotting for trauma and how hypnotherapy can be a potent adjunct to cognitive behavioral therapy for insomnia (CBTI). Lara also touches on the importance of a holistic approach, combining mind and body, in effective sleep treatment. This episode is a must-watch for physicians and health practitioners looking to incorporate hypnotherapy into their clinical practice.

Can Electrolytes Improve Sleep? We Asked the Doctor Who Created Dr. Raindrop

Posted on April 8, 2025 by - Sleep Health

Can Electrolytes Improve Sleep? We Asked the Doctor Who Created Dr. Raindrop

Join us in an enlightening conversation with Dr. Sandhu, a nephrologist, as we dive deep into the relationship between hydration, electrolytes, and sleep. Discover why supplements can be essential, even with a balanced diet, and learn about Dr. Sandhu’s journey in creating Dr. Raindrop, an effective electrolyte powder. We also touch on common deficiencies, the impact of modern lifestyle factors, and practical tips on optimizing both your hydration and sleep patterns. Perfect for doctors and health practitioners looking to enhance their clinical practice with practical sleep medicine knowledge. Don’t miss out on the insights and expert advice in this episode. Check out more information in the description below!

Mastering the CPAP Adjustment: Here’s what works.

Posted on April 3, 2025 by - Sleep Health

Mastering the CPAP Adjustment: Here's what works. Expert Tips from a Behavioral Sleep Psychologist

In this episode, we dive into the challenges patients face when adjusting to CPAP therapy with Dr. Sarah Silverman MD, a behavioral sleep psychologist. Discover actionable strategies to help patients overcome issues like claustrophobia and insomnia, and learn about the importance of personalized approaches and follow-ups. Dr. Silverman also discusses the significance of ensuring the right mask fit and how daytime acclimation can ease the adjustment process. This conversation highlights the efficacy of CBT for CPAP adherence and provides essential resources for healthcare professionals to support their patients. Tune in for valuable insights into improving CPAP compliance and enhancing patient care in clinical sleep medicine.