Category: Sleep Health

Mastering Benzodiazepine Tapering: Insights from ASAM Guidelines

Posted on July 14, 2025 by IntraBalance - Sleep Health

In this episode, we dive deep into the intricacies of tapering patients off benzodiazepines with Dr. Nishi Bhopal and a special guest, a board-certified psychiatrist Harvinder Singh MD. Learn about the latest guidelines from the American Society of Addiction Medicine (ASAM), risk-benefit assessments, patient-centered approaches, and the pitfalls and best practices for successful tapering. This video is packed with valuable information for healthcare providers, offering both practical advice and theoretical knowledge to optimize patient care in the realm of benzodiazepine tapering. Watch to gain insights into managing dependency, withdrawal, and ensuring patient collaboration through evidence-based strategies.

How Sleep Issues Cause Glaucoma, Dry Eyes & More

Posted on July 9, 2025 by IntraBalance - Sleep Health

Join host and optometrist Dr. Neda Gioia in this insightful episode as she delves into the interconnections between sleep and eye health. Discover the pillars of eye health from a functional medicine perspective, addressing modifiable risk factors like nutrition, stress management, exercise, and sleep. Learn about the impact of sleep disorders, particularly obstructive sleep apnea, on eye conditions such as dry eye and glaucoma. Dr. Gioia also provides valuable insights into functional medicine, nutritional advice, and the importance of personalized patient care. This episode is essential for healthcare professionals looking to enhance their understanding of holistic eye care and its systemic interactions.

How sleep affects your eye health

Posted on July 9, 2025 by IntraBalance - Sleep Health

I was getting my hair and makeup done at the Psychiatric Times studio in New Jersey before filming a segment on narcolepsy, when the makeup artist asked, “Wow, you have amazing lashes! Do you use a serum?”

I laughed, “Well… it’s just my glaucoma medicine.”

Because of a family history of glaucoma, I’m on latanoprost eye drops to keep my eye pressures down, and the main side effect is excessive eyelash growth.

Fun fact: it has similar ingredients to Latisse, the eyelash growth serum.

When my intraocular pressure started creeping up, I also got myself tested for sleep apnea.

As a sleep doc, I know the link between sleep apnea and glaucoma…but unfortunately, sleep apnea screening isn’t yet routine in glaucoma care.

We don’t usually connect sleep and eye health. But we should.
In this week’s conversation, I spoke with Dr. Neda Gioia (pronounced “Joya”), optometrist and functional medicine practitioner, about the surprising and under-discussed link between sleep quality and vision.

It turns out your sleep habits may play a much bigger role in eye disease than we realize.

How Sleep Affects Eye Health

Poor sleep increases oxidative stress and systemic inflammation, both of which are risk factors for:

- Dry eye disease
- Glaucoma
- Retinal degeneration

Untreated sleep issues like sleep apnea can worsen eye health. Yet, there isn’t enough collaboration between eye doctors and sleep specialists.
The eye’s tiny blood vessels are vulnerable to inflammation, acting like a “canary in the coal mine” for systemic problems.

Dr. Gioia takes a functional medicine approach to eye care…getting curious about nutrition, sleep, stress, and even trauma.

She’s not just treating symptoms; she’s looking under the hood to see why inflammation is there in the first place, and addressing it with her 5 Pillars of Eye Health.

It’s a refreshing and fascinating expansion of the current model of eye care – certainly not one that I’ve experienced in my personal healthcare journey.

What You Can Do Right Now

For clinicians:

Ask about sleep duration, timing, and quality
Consider sleep evaluations for patients with chronic eye conditions
Remind your patients to get regular eye exams

For you:

Get your yearly eye exam…and consider a sleep study if you have high eye pressures
Prioritize sleep just as you would your blood pressure or diet…it’s all connected

Dr. Gioia explains:

- The link between sleep apnea and glaucoma
- The impact of blue light on eye health
- Specific nutrition tips for the eyes (I’m definitely going to start incorporating these)
- Pillars of Eye Health
- The dry eye and sleep connection
- Insomnia, shift work, and eye health

And a lot more…

Yoga Nidra for Sleep

Posted on June 26, 2025 by IntraBalance - Sleep Health

You may have heard the buzz around Non-Sleep Deep Rest (NSDR), popularized recently by neurobiology professor Andrew Huberman.

While he’s not a sleep specialist, there is evidence for NSDR which is rooted in an ancient yogic practice called Yoga Nidra, often described as “aware sleep.”

Yoga Nidra is a guided, supine practice that induces delta brainwave activity, seen in deep sleep (stage 3 sleep), while you stay awake.

It’s especially helpful for reducing stress and improving sleep quality, with evidence supporting its use in insomnia, PTSD, and anxiety.

That’s why, in our practice, we blend CBT-I (Cognitive Behavioral Therapy for Insomnia), ACT (Acceptance and Commitment Therapy), and Yoga Nidra. This combination allows us to address both the behavioral and emotional barriers to restful sleep.

CBT-I remains the gold standard for chronic insomnia and I do recommend it.

But in real-world practice, CBT-I alone isn’t always enough. For patients with high arousal, sleep-related anxiety, or trauma histories, it can feel too rigid or triggering, sometimes leading to dropout or poor adherence.

That’s why, in our practice, we blend CBT-I, ACT (Acceptance and Commitment Therapy), and Yoga Nidra. This combination allows us to address both the behavioral and emotional barriers to restful sleep.

This week, I’m joined by Lauren Ziegler, sleep coach and yoga therapist teacher to discuss how yoga nidra works for insomnia. Click here or watch the video below.

What the Evidence Says

RCTs show Yoga Nidra improves both subjective and objective sleep parameters, including sleep latency, total sleep time, and sleep efficiency.

It helps reduce psychological and physiological arousal, two of the biggest perpetuating factors in chronic insomnia.

Early findings also suggest benefits in post-sleep refreshment, cognitive clarity, and emotional regulation…key for daytime functioning.

Who benefits?

Patients with insomnia, especially with high cognitive or physiological arousal
People who have “failed” meditation
Those tapering off sleep aids and looking for alternatives
Those who struggle with implementing CBT-i

One of the clients in our sleep program was initially skeptical, but found Yoga Nidra so effective it helped him sleep more deeply, feel calmer, and even reduce his use of sleeping pills.

How to Introduce It in Clinical Practice

You don’t need to be a yoga teacher to recommend it. Just frame it as a guided rest practice that’s low-effort, low-risk, and deeply restorative.

“You don’t have to clear your mind, just lie down and listen.”
“Even five minutes can help.”
“This isn’t about trying to sleep. It’s about letting the nervous system soften.”

Next Steps

Yoga Nidra is simple, accessible, and research-backed. For many of our patients, it’s the first time they experience what deep rest actually feels like.

Watch the YouTube conversation with Lauren to learn more.

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

References:

1. Alghosi M, Sharifi M, Namavari S, Rajamand N, Bamorovat F, Norouzi N, Alimoradi M, Konrad A. The effect of chronic yoga interventions on sleep quality in people with sleep disorders: a scoping review. Front Neurol. 2025 Apr 29;16:1566445. doi: 10.3389/fneur.2025.1566445. PMID: 40365457; PMCID: PMC12071090.

2. Datta K, Bhutambare A, V L M, Narawa Y, Srinath R, Kanitkar M. Improved sleep, cognitive processing and enhanced learning and memory task accuracy with Yoga nidra practice in novices. PLoS One. 2023 Dec 13;18(12):e0294678. doi: 10.1371/journal.pone.0294678. PMID: 38091317; PMCID: PMC10718434.

3. Sharpe E, Butler MP, Clark-Stone J, Soltanzadeh R, Jindal R, Hanes D, Bradley R. A closer look at yoga nidra- early randomized sleep lab investigations. J Psychosom Res. 2023 Mar;166:111169. doi: 10.1016/j.jpsychores.2023.111169. Epub 2023 Jan 29. PMID: 36731199; PMCID: PMC9973252.

4. Sharpe E, Tibbitts D, Wolfe B, Senders A, Bradley R. Qualitative Impressions of a Yoga Nidra Practice for Insomnia: An Exploratory Mixed-Methods Design. J Altern Complement Med. 2021 Oct;27(10):884-892. doi: 10.1089/acm.2021.0125. Epub 2021 Jul 15. PMID: 34265219; PMCID: PMC10772320.

How Yoga Nidra Can Improve Sleep

Posted on June 17, 2025 by IntraBalance - Sleep Health

In this episode, discover the secrets to falling asleep faster and reducing sleep anxiety through the transformative practice of Yoga Nidra. Join us as renowned sleep coach and Yoga Nidra specialist Lauren Ziegler explains the intricacies behind this ancient practice and its modern applications for insomnia relief. We explore the physiological benefits, differences from traditional meditation, and practical tips for implementation. Perfect for healthcare providers looking to recommend new, effective therapies to their patients or individuals seeking deeper, more restful sleep. Learn about our integrative sleep coaching program combining CBTI, ACT, and Yoga Nidra for comprehensive support. Don’t miss out on this insightful conversation that could revolutionize your approach to sleep therapy!

Does cannabis help sleep?

Posted on June 12, 2025 by IntraBalance - Sleep Health

Exploring Cannabis in Medicine: Insights with an Internal Medicine Doctor

Cannabis for medical issues wasn’t on the radar when I was in med school. Now it’s everywhere…the local coffee shop offers CBD shots for your morning espresso and medical cannabis has become mainstream.

Even my dog gets CBD treats PRN anxiety.

You may be getting more and more questions about cannabis in clinic…but most of us were never taught about medicinal cannabis in training.

This week I sat down with Dr. Janice Makela MD, an internal medicine and palliative care doc with training in cannabis-based care, to unpack the practical, clinical side of cannabis.

In our conversation, Dr. Makela shares what every clinician should know before saying yes or no to cannabis as part of a treatment plan.

The endocannabinoid system (ECS) helps regulate pain, sleep, metabolism, and immune response. Dr. Makela points out that we learned about the renin-angiotensin system in med school, but there’s no training on the ECS.

She makes the case that understanding the ECS is foundational, not fringe, especially if we want to evaluate cannabis objectively in modern practice.

Clinical Pearls

Chronic Pain

Cannabis can modulate pain pathways through CB1 receptors. Some patients reduce their opioid burden with its use, but it’s not one-size-fits-all.

PTSD

For some, cannabis reduces nightmare frequency and intensity. However, there isn’t enough data to recommend treating patients with it.

Dementia

Low doses may reduce agitation in geriatric populations. Dr. Makela shared some clinical pearls on dosing.

Cannabis is not benign, but it’s also not going away.

Risks and Red Flags

While anxiety and insomnia are two of the most common reasons patients turn to cannabis, the response is highly formulation- and person-dependent.

It can both help and harm. Be careful in people with underlying trauma, addiction histories, or schizophrenia-spectrum vulnerabilities.

What About Sleep?

While people feel like they sleep better, the data tells a murkier story, with increased light sleep, reduced REM, and potential disruption of architecture over time, depending on the formulation.

Patients with chronic non-cancer pain are most likely to experience benefit from cannabinoids for sleep disturbances.

Where Do We Go From Here?

Dr. Makela believes cannabis in medicine could eventually take a place like digitalis or morphine: powerful when used wisely, dangerous when not.

That’s why education matters to help clinicians think critically, communicate clearly, and meet patients where they are.

I don’t recommend medical cannabis in my practice because I don’t have adequate training in how to prescribe it appropriately. However, I’m open to having conversations with patients about it and pointing them in the right direction when they need more information.

If you’ve been curious about how to bring cannabis into the conversation with patients, or when to leave it out entirely, this interview is worth your time.

Take a listen and let me know what stood out to you.

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

References:
AminiLari M, Wang L, Neumark S, Adli T, Couban RJ, Giangregorio A, Carney CE, Busse JW. Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials. Sleep. 2022 Feb 14;45(2):zsab234. doi: 10.1093/sleep/zsab234. PMID: 34546363.

Bhagavan C, Kung S, Doppen M, John M, Vakalalabure I, Oldfield K, Braithwaite I, Newton-Howes G. Cannabinoids in the Treatment of Insomnia Disorder: A Systematic Review and Meta-Analysis. CNS Drugs. 2020 Dec;34(12):1217-1228. doi: 10.1007/s40263-020-00773-x. Epub 2020 Nov 26. PMID: 33244728.

Morin CM, Buysse DJ. Management of Insomnia. N Engl J Med. 2024 Jul 18;391(3):247-258. doi: 10.1056/NEJMcp2305655. PMID: 39018534.

Sznitman SR, Meiri D, Amit BH, Rosenberg D, Greene T. Posttraumatic stress disorder, sleep and medical cannabis treatment: A daily diary study. J Anxiety Disord. 2022 Dec;92:102632. doi: 10.1016/j.janxdis.2022.102632. Epub 2022 Sep 16. PMID: 36182689.

Velzeboer R, Malas A, Boerkoel P, Cullen K, Hawkins M, Roesler J, Lai WW. Cannabis dosing and administration for sleep: a systematic review. Sleep. 2022 Nov 9;45(11):zsac218. doi: 10.1093/sleep/zsac218. Erratum in: Sleep. 2023 Mar 9;46(3):zsad008. doi: 10.1093/sleep/zsad008. PMID: 36107800.

Exploring Cannabis in Medicine: Insights with an Internal Medicine Doctor

Posted on June 10, 2025 by IntraBalance - Sleep Health

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 IntraBalance - 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. 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 IntraBalance - Sleep Health

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

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 IntraBalance - Sleep Health

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.