Category: Sleep Health

Sleep Doctor Explains Restless Leg Syndrome Treatment and what NOT to do

Posted on February 4, 2025 by - Sleep Health

In this episode, Dr. Nishi Bhopal MD, an integrative psychiatrist and sleep medicine physician, interviews Dr. Andrew Spector, a sleep neurologist specializing in Restless Leg Syndrome (RLS). They discuss the latest in RLS diagnosis, clinical triggers, and treatment guidelines. Topics covered include the role of iron levels, medication strategies, and non-pharmaceutical interventions for RLS. Dr. Spector shares his approach to patient care, the importance of addressing underlying causes, and new advancements in RLS therapies like dipyridamole and Nidra devices. Learn how to optimize RLS management and improve patient outcomes with practical tips and strategies from this engaging conversation. Dr. Spector also discusses his book, ‘Navigating Life with Restless Leg Syndrome,’ a valuable resource for both patients and clinicians. To delve deeper into sleep medicine or connect with Dr. Spector, visit andrewspectormd.com.

Sleep doctor explains the best time to take melatonin

Posted on January 28, 2025 by - Sleep Health

What Time to Take Melatonin

In this episode, Dr. Nishi Bhopal explores the most effective times to take melatonin and get light exposure based on the phase response curve (PRC). Discover why timing is critical for melatonin efficacy and learn the optimal times for bright light exposure to manage circadian rhythms. Dr. Nishi Bhopal also provides a free melatonin brand guide for physicians, which includes high-quality, third-party tested supplements used in her practice. Obtain actionable insights to guide your patients in improving their sleep and mood disorders through accurate melatonin and light therapy timing. Access the free guide at intrabalance.com/melatonin and gain further knowledge from a video on prescribing bright light therapy. Disclaimer: This video provides information only and is not medical advice.

The RISE-UP protocol

Posted on January 21, 2025 by - Sleep Health

The RISE-UP protocol

Over the Christmas break, I found this gem of a book at my mum’s house: The Book of Negroes by Lawrence Hill.

It won a ton of awards including the CBC Radio’s Canada Reads competition and the Commonwealth Prize for Best Book.

It came out in 2007 but somehow I hadn’t read it until now. It’s a story about a virtually unknown chapter of history…and so compelling. There are also loads of quotes about sleep. Highly recommended.

Now, I found myself staying up to read way past my bedtime for a few nights…leading to heavy sleep inertia in the morning.

Sleep inertia is the groggy, disoriented feeling people may experience after waking up, making it hard to feel alert and get going.

Whenever patients struggle with sleep inertia, I recommend they try the RISE-UP protocol.

The RISE-UP protocol is a behavioral intervention designed to reduce the duration and severity of sleep inertia, especially in people with insomnia and bipolar disorder (1).

Here’s what it stands for:

R = Refrain from snoozing: Avoid the use of the snooze button to prevent fragmented sleep
I = Increase activity: Engage in physical activity within an hour of waking to boost alertness
S = Shower or splash your face and hands with cold water
E = Expose yourself to sunlight: Get morning bright light with sunshine or a light therapy device
U = Upbeat music: listen to upbeat music, a podcast or audiobook while moving around
P = Phone a friend: any kind of social contact counts, even a chat with your housemate

I share this protocol with patients all the time, as so many of them struggle with sleep inertia and irregular wake up times.

You don’t have to do all the things in the protocol, but pick a few to try out…and, if you struggle with sleep inertia yourself, let me know how it goes.

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

References
Kaplan KA, Talavera DC, Harvey AG. Rise and shine: A treatment experiment testing a morning routine to decrease subjective sleep inertia in insomnia and bipolar disorder. Behav Res Ther. 2018 Dec;111:106-112. doi: 10.1016/j.brat.2018.10.009. Epub 2018 Oct 27. PMID: 30399503.

Charting for Physicians: How to Chart Faster

Posted on January 16, 2025 by - Sleep Health

How to Chart Faster

In this episode, Dr. Nishi Bhopal, an integrative psychiatrist and sleep medicine physician, hosts Dr. Junaid Niazi, founder of Prosperous Life MD, to discuss how physicians can improve their charting efficiency to reclaim personal time and enhance their well-being. Dr. Niazi, a primary care physician and life coach, shares insights on the importance of mindset in managing clinical workflows and offers practical tips for integrating efficient charting practices. They also explore the relationship between charting, physician burnout, and sleep deprivation. Dr. Niazi introduces his free ‘Leave Your Work at Work’ workshop and other resources to help physicians enhance their practice management.

How Dr. Saima Khan Reversed Her Narcolepsy: A Doctor’s Remarkable Journey

Posted on January 7, 2025 by - Sleep Health

How Dr. Saima Khan Reversed Her Narcolepsy: A Doctor's Remarkable Journey

In this episode, Dr. Nishi Bhopal, an integrative psychiatrist and sleep medicine physician, interviews Dr. Saima Khan, a board-certified pediatrician and toxicologist, about her journey in reversing narcolepsy using functional and integrative medicine. Dr. Khan shares her personal experiences with narcolepsy, the limitations of conventional treatments, and the multifaceted approach she took to identify and address the root causes of her condition. Gain valuable insights into the importance of diet, environmental toxins, autoimmunity, and infections in managing narcolepsy and learn practical steps for improving brain health and fatigue. Dr. Khan also discusses her virtual practice in Florida, offering guidance to both patients and practitioners interested in functional medicine. Key topics include integrative vs. functional medicine, the significance of diet changes, and how to locate Lyme and mold literate doctors. Don’t miss out on Dr. Khan’s powerful story of resilience and recovery.

The THREE biggest sleep updates of 2024 ALL doctors need to know

Posted on December 31, 2024 by - Sleep Health

Sleep Medicine, 2024 Year in Review

n this episode, Dr. Nishi Bhopal MD, a board-certified psychiatrist and sleep medicine physician, shares the top sleep medicine stories of 2024. Key updates include new restless leg syndrome guidelines, drug therapy advancements for obstructive sleep apnea with ZepBound, and FDA-approved smartwatches for sleep apnea detection. Dr. Bhopal also explores the future impact of AI in sleep medicine for the year 2025. Join us for an informative session on the latest trends and what to expect next year in sleep medicine, ensuring you’re equipped with the most current and effective treatments for your patients.

How to use melatonin ER

Posted on December 20, 2024 by - Sleep Health

How to use melatonin ER

I was recently on a podcast hosted by a physician who asked me, “Is melatonin ER (extended release) a thing? I asked in a physician Facebook group and some docs said there’s no use for it.”

I was surprised…yet not surprised.

There are so many misconceptions in the medical community about melatonin and how to use it.

That’s because most of us docs don’t learn how to prescribe it effectively.

Plus, here in the States, it’s OTC (over the counter), so loads of patients take melatonin like a daily multivitamin without really understanding how it works.

It’s now the 4th most popular natural product taken by adults and the 2nd most popular product taken by children in the US.

Melatonin is a hormone produced by the pineal gland in response to darkness.

It’s also known as “the hormone of darkness” and is involved in regulating the sleep-wake cycle.

It exerts its effects through high-affinity G-protein coupled receptors, MT1 and MT2, which are distributed in various brain regions involved in sleep regulation.

Additionally, melatonin can advance the circadian timing of sleep (i.e. help people shift their body clock to fall asleep and wake up earlier).

In fact, we use melatonin strategically in my practice mostly as a body clock regulator to modulate the circadian rhythm, rather than as a sleep aid.

While it’s not indicated for chronic insomnia, melatonin is recommended for sleep issues including but not limited to:

  • Circadian rhythm sleep disorders, like delayed sleep phase syndrome, jet lag, etc.
  • Children with neurological conditions like autism and ADHD
  • REM sleep behavior disorder

Now, what about melatonin ER (extended release)?

There’s a form of melatonin supplements called Circadin.

Circadian is a 2mg extended release melatonin formulation designed to mimic the endogenous pattern of melatonin production.

It’s primarily indicated for the treatment of primary insomnia characterized by poor sleep quality in patients aged 55 years and older.

Now, I said earlier that melatonin is not typically used for chronic insomnia.

However, endogenous melatonin secretion decreases with age, thus melatonin may be helpful in patients over 55.

Circadin is available by prescription in the UK and Australia.

If you’re in the US, you may be surprised to know that in many regions around the world, melatonin is considered a medication and is not available OTC.

In my practice, we do sometimes use extended release melatonin 2mg in our patients over the age of 55 to support sleep, taken 1-2 hours before bed.

So, my answer on the podcast was, “Yes, melatonin ER is a thing.”

But with melatonin, you have to know how to use it effectively…which includes understanding the indications, timing, dosing strategies, quality considerations, and when to stop it.

If you’re ready to use melatonin effectively in your clinical practice, register for the Melatonin Best Practices Masterclass. https://members.intrabalance.com/melatonin-masterclass

It’s a self-guided program where you’ll leave with the knowledge and tools to use melatonin strategically in your practice and enhance patient outcomes.

Sign up here. https://members.intrabalance.com/melatonin-masterclass

References:
Chua HM, Hauet Richer N, Swedrowska M, Ingham S, Tomlin S, Forbes B. Dissolution of Intact, Divided and Crushed Circadin Tablets: Prolonged vs. Immediate Release of Melatonin. Pharmaceutics. 2016 Jan 7;8(1):2. doi: 10.3390/pharmaceutics8010002. PMID: 26751472; PMCID: PMC4810078.

Lemoine P, Zisapel N. Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia. Expert Opin Pharmacother. 2012 Apr;13(6):895-905. doi: 10.1517/14656566.2012.667076. Epub 2012 Mar 19. PMID: 22429105.

Verma AK, Khan MI, Ashfaq F, Rizvi SI. Crosstalk Between Aging, Circadian Rhythm, and Melatonin. Rejuvenation Res. 2023 Dec;26(6):229-241. doi: 10.1089/rej.2023.0047. Epub 2023 Dec 4. PMID: 37847148.

Mommy Wine Culture and Sleep

Posted on December 13, 2024 by - Sleep Health

Mommy Wine Culture & Sleep

My local TJ Maxx is filled with Christmasy “word art” – for example, coffee mugs with phrases like “This is probably wine”, or throw pillows embroidered with “Mommy Needs Merlot.”

It might seem playful, but it subtly reinforces the normalization of using alcohol to cope with stress.

This is known as “mommy wine culture”…and many of your patients may unknowingly be caught in it.

As clinicians, we’re no strangers to the cultural normalization of alcohol as a stress-reliever, including for parents navigating the demands of family life.

However, it’s quite problematic on many levels.

“Mommy wine culture” normalizes unhealthy coping mechanisms and can make it harder for people to recognize the broader impact alcohol has on their mental and physical health – including issues with disrupted sleep, increased anxiety and depression, and a higher risk of dependency.

For patients struggling with chronic stress or burnout, this can perpetuate cycles of exhaustion, poor quality sleep, and poor self-care.

People sometimes ask me if alcohol is really all that bad for sleep, because they feel like it helps them relax and fall asleep more quickly.

While alcohol is sedating, its physiological effects on sleep are far from benign.

Addressing alcohol use is a crucial step in optimizing sleep health for your patients.

3 Things to Know about Alcohol and Sleep

Initial Sedation but Poor Sleep Quality:

  • Alcohol reduces sleep latency (time to fall asleep), which may seem beneficial at first, but it suppresses REM sleep.
  • Patients may report feeling unrefreshed even after a full night’s rest.

Disrupted Sleep Architecture:

  • Alcohol increases slow-wave sleep early in the night but causes a rebound in lighter sleep and awakenings in the second half.
  • This fragmentation worsens with higher doses.

Exacerbation of Sleep Disorders:

  • Alcohol can worsen conditions such as insomnia, sleep apnea, and restless leg syndrome, creating a vicious cycle.

3 Tips for Addressing Alcohol, Sleep and “Mommy Wine Culture”

Ask Targeted Questions:

  • Move beyond general alcohol use inquiries to explore timing, quantity, and the perceived relationship between alcohol and sleep. Examples: “How often do you use alcohol to wind down at night?” and “How does it impact your sleep quality and daytime energy?”

Educate with Empathy: Many people are unaware of the link between alcohol and sleep disruption. Share how even small amounts of alcohol affect sleep stages and quality.

Suggest Substitutes: Recommend alternative evening routines, such as non-alcoholic cocktails (hint – ask ChatGPT for a virgin mojito recipe), herbal teas, or activities without alcohol, to transition away from alcohol use and have other things to look forward to.

Next steps: Encourage people to experiment with reducing or eliminating alcohol for a trial period (i.e. 30 days) and track changes in their sleep using wearables or sleep diaries.
Wishing you a safe and healthy holiday season!

CBT-i Components to Cure Insomnia

Posted on October 22, 2024 by - Sleep Health

How to Cure Insomnia

Join Dr. Nishi Bhopal as she delves into Cognitive Behavioral Therapy for Insomnia (CBT-i), exploring its components and why it’s considered the gold standard treatment for chronic insomnia. Learn how to communicate the benefits and structure of CBT-i to your patients, addressing common misconceptions about sleep hygiene and treatment methods. She discusses the effectiveness of CBT-i components such as cognitive restructuring, sleep restriction, and third wave therapies like mindfulness and ACT. Dr. Bhopal also offers resources for physicians seeking CBT-i practitioners and coaches, especially with the advent of telehealth. Grab her free melatonin brand guide at intrabalance.com/melatonin and consider integrating CBT-i into your practice to enhance patient outcomes in sleep medicine. Subscribe for more insights into sleep and integrative psychiatry.

Unlocking the Gut-Brain Axis: Sleep & GI Health with Dr. Ellen Joseph

Posted on October 15, 2024 by - Sleep Health

Sleep Gut Brain

In this episode, Dr. Nishi Bhopal, an integrative psychiatrist and sleep medicine physician, interviews Dr. Ellen Joseph, a clinical health psychologist specializing in gut-brain interactions at GI Psychology in Virginia. They explore the intriguing relationship between gut health, mental health, and sleep, emphasizing the challenges patients face due to stigma and miscommunication of symptoms. Dr. Joseph shares insights on treating disorders of gut-brain interaction, highlighting gut-directed cognitive behavioral therapy and clinical hypnosis as effective solutions with an efficacy rate of about 80% for conditions like IBS. They also discuss the bi-directional relationship between gut health and sleep, with practical strategies for improving patient outcomes. Learn more about treatments and resources available for both medical practitioners and patients, and where to find specialized help.