Category: Sleep Health

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.

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.