Tag: Articles

The one phrase that could save your patient’s life (and your license)

Posted on September 12, 2025 by IntraBalance - Sleep Health

We hear a lot about drunk driving, but not nearly enough about drowsy driving.

We live in a sleep-deprived society, and, when driving, I often find myself wondering how many sleepy drivers are out on the road.

Ironically, during my sleep medicine fellowship, one of my co-fellows nodded off at the wheel after an overnight shift in the sleep lab…with all of us in the car. He startled awake just in time, and thankfully we avoided what could have been a disaster.

The reality is sobering: drowsy driving contributes to about 18% of fatal car crashes in the U.S. (1)

That’s why, during my sleep medicine elective in psych residency at Henry Ford Hospital, one of my attendings drilled this phrase into us to always include in the chart:

“Patient was counseled on the risks of excessive daytime sleepiness and advised not to drive or operate heavy machinery when drowsy, sleepy, or tired.”

At first it felt like overkill, but here’s why it matters:

✓ It protects your patient. Excessive sleepiness is a real safety risk. Documenting it reinforces the counseling and underscores its importance.

✓ It protects you. If there’s ever an accident or legal review, your note shows you addressed the risk.

✓ It saves you time. Once you create a dot phrase or template, you can drop it in every time.

Because of that early training, I’ve made it a standard in my own charting whenever a patient reports sleep issues.

I recommend you “steal” this phrase for your own notes.

If you struggle with getting your charts done on time, Dr. Junaid Niazi MD, a board-certified internist, pediatrician, and physician coach joined me on YouTube to share some tips. https://www.youtube.com/watch?v=4YDjhcds0E0

He helps clinicians chart more efficiently so you can leave your work at work and get your evenings (and sleep) back.

Dr. Niazi shares:

✓ Why charting has become such a burden for clinicians

✓ The connection between charting and sleep

✓ His best tips to reclaim your time and reduce charting overwhelm

Plus, he’s offering a free training, “Leave Your Work at Work” on September 10 at 5pm PT. Sign up here. https://www.chartingconquered.com/a/2148159050/jwtkLbaD

P.S. We’re opening doors to our next round of Effortless Sleep in 6 Weeks soon – our signature program for adults with insomnia. Stay tuned for the details.

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. Tefft, B.C. (2024). Drowsy Driving in Fatal Crashes, United States, 2017–2021 (Research Brief). Washington, D.C.: AAA Foundation for Traffic Safety.

Does Magnesium Work for Sleep Issues?

Posted on August 19, 2025 by IntraBalance - Sleep Health

If you spend enough time on Instagram or in supplement aisles, you’ve noticed that magnesium is touted as a cure-all.

It’s said to alleviate cramps, fix constipation, cure sleep issues, do your taxes, help you look good in bangs…it’s a miracle!

But when we strip away the hype and look at the data on magnesium for insomnia and sleep disturbances, it’s not as magical as it’s made out to be.

The Evidence at a Glance

Observational studies have shown that higher dietary magnesium intake is linked to better reported sleep quality and longer duration [1,2,6].

But remember that correlation does not equal causation…and the link might be explained by healthier overall diets and lifestyles.

When it comes to sleep, there are some randomized controlled trials (RCTs). Small, mostly short-term studies in older adults and specific populations (e.g., diabetes) show:

‣ Sleep onset latency improved by ~17 minutes on average [3,4]
‣ Modest reductions in insomnia severity [3]

As for combination supplements (magnesium + melatonin ± zinc) often show better results, but the benefit can’t be attributed to magnesium alone [5].

The bottom line is that the evidence for magnesium on sleep is limited and results are inconsistent.

However, that doesn’t mean I don’t recommend magnesium supplements. In fact, I take them myself and recommend them to most of my patients, because of the fact that most adults aren’t getting sufficient Mg from diet alone.

How does it work?
Magnesium may support sleep through multiple pathways.

It modulates neurotransmitter activity by blocking excitatory NMDA-type glutamate receptors and activating inhibitory GABA receptors, reducing neuronal excitability and promoting relaxation for sleep onset and maintenance [1,2].

Magnesium also plays a role in melatonin synthesis and possibly supports deeper, more restorative stages of sleep [1].

Safety and Dosing Pearls

‣ Examples of food sources: pumpkin seeds, chia seeds, almonds, leafy greens, dark chocolate, soy, dried beans

‣ From supplements: Generally safe, but high doses can cause diarrhea and GI upset.
Avoid excess in advanced CKD; check for drug–nutrient interactions in high-risk patients.

‣ Typical doses in trials: 320–500 mg elemental magnesium daily, often split; forms include glycinate (better tolerated), citrate (laxative effects, good for constipation), threonate (crosses blood-brain barrier) and oxide (less bioavailable).

What to tell Patients

Magnesium is safe for most people and may offer a small, gradual benefit for sleep, but it’s not a sedative and shouldn’t replace proven treatments. Think of it as a gentle support in the background rather than a quick fix.

Want to learn more about sleep supplements? I’m hosting another series of masterclasses later this month – stay tuned for the details! I’ll send an email about that in the next few days.

References:

1. Zhang, Y., et al. “Association of Magnesium Intake With Sleep Duration and Sleep Quality: Findings From the CARDIA Study.” Sleep, vol. 45, no. 4, 2022, zsab276. Oxford University Press, doi:10.1093/sleep/zsab276.

2. Arab, A., et al. “The Role of Magnesium in Sleep Health: A Systematic Review of Available Literature.” Biological Trace Element Research, vol. 201, no. 1, 2023, pp. 121–128. Springer, doi:10.1007/s12011-022-03162-1.

3. Ji, X., et al. “The Relationship Between Micronutrient Status and Sleep Patterns: A Systematic Review.” Public Health Nutrition, vol. 20, no. 4, 2017, pp. 687–701. Cambridge University Press, doi:10.1017/S1368980016002603.

4. Cao, Y., et al. “Magnesium Intake and Sleep Disorder Symptoms: Findings From the Jiangsu Nutrition Study of Chinese Adults at Five-Year Follow-Up.” Nutrients, vol. 10, no. 10, 2018, p. E1354. MDPI, doi:10.3390/nu10101354.

5. Dhillon, V. S., et al. “Low Magnesium in Conjunction With High Homocysteine and Less Sleep Accelerates Telomere Attrition in Healthy Elderly Australian.” International Journal of Molecular Sciences, vol. 24, no. 2, 2023, p. 982. MDPI, doi:10.3390/ijms24020982.

6. Mah, J., and T. Pitre. “Oral Magnesium Supplementation for Insomnia in Older Adults: A Systematic Review & Meta-Analysis.” BMC Complementary Medicine and Therapies, vol. 21, no. 1, 2021, p. 125. BioMed Central, doi:10.1186/s12906-021-03297-z.

Sleep changes in Menopause

Posted on August 11, 2025 by IntraBalance - Sleep Health

Have you seen those videos on social media showing nostalgic clips from the ’80s and ’90s, like old Nintendo controllers, He-Man action figures, cartoon character lunchboxes with matching thermoses, and bustling malls?

(Btw – Orange Julius was my favorite at the mall foodcourt…I’ll share my homemade recipe sometime.)
Anyway, those videos always transport me back to simpler times.

If you’re old enough to remember those things, you might also be nostalgic for something else: the days when you could sleep straight through the night without interruption.
I know I am.

I used to be one of those kids who could sleep through the night like a rock.

But as I’ve aged, nighttime awakenings have become common and expected. And that’s true for a lot of midlife women.

Sleep disturbance affects up to 60% of women during the menopausal transition, and nighttime awakenings are the most common sleep complaint during perimenopause and menopause.

One study found that 30% of postmenopausal women report poor sleep quality (Pittsburgh Sleep Quality Index >5), compared to 14% of premenopausal women [Kim et al.].

The American Heart Association notes that sleep complaints, especially frequent awakenings, increase significantly during perimenopause, often in tandem with hot flashes, temperature swings, hormonal shifts, and psychosocial stressors.

As Dr. Andrea Matsumura MD says, “With the reduction of estrogen, you have a lot of middle of the night awakenings – that’s really because estrogen plays a role in calibrating your temperature, and when you lose that, sleep gets disrupted.”

If you’re seeing midlife women in your practice, you’re seeing sleep disruption.

To help you support these patients (or yourself), I sat down with Dr. Andrea Matsumura, “The Sleep Goddess,” for a deep dive into menopause, hormones, and sleep.

She shares practical, evidence-based strategies you can use right away.

In this episode, you’ll learn:

Why sleep fragmentation is often the first sign of perimenopause

When to consider melatonin, HRT, and sleep aids
How to screen for sleep apnea in women (and why home tests often miss it)
Dr. Matsumura’s DREAM method for holistic sleep care
What every clinician should ask about sleep (and the question that changed her practice)
Why “Sleep is the CEO of health” and how to help your patients reclaim it
And much more…

Quick clinical pearls to get you started:

‣ Don’t dismiss “I’ve always been a bad sleeper” as normal aging. Look under the hood to see what might be going on.

‣ Ask, “How many hours of sleep do you think you’re getting?” instead of “Are you sleeping well?”. It’s a subtle difference, but can reveal useful info.

‣ For women with midlife sleep issues, consider hormone therapy, but don’t forget about screening for other sleep disorders like sleep apnea.

‣ CBT-I is a powerful tool for menopause-related sleep disruption and can help with vasomotor symptoms like hot flashes.

If you’re ready to help your patients (and maybe yourself) get better sleep through menopause and beyond, don’t miss this conversation.

References:
1. Baker FC. Optimizing sleep across the menopausal transition. Climacteric. 2023

Jun;26(3):198-205. doi: 10.1080/13697137.2023.2173569. Epub 2023 Apr 3. PMID: 37011660; PMCID: PMC10416747.

2. Carmona NE, Solomon NL, Adams KE. Sleep disturbance and menopause. Curr Opin Obstet Gynecol. 2025 Apr 1;37(2):75-82. doi: 10.1097/GCO.0000000000001012. Epub 2025 Jan 17. PMID: 39820156.

3. Kim MJ, Yim G, Park HY. Vasomotor and physical menopausal symptoms are associated with sleep quality. PLoS One. 2018 Feb 20;13(2):e0192934. doi: 10.1371/journal.pone.0192934. PMID: 29462162; PMCID: PMC5819793.

4. Maki PM, Panay N, Simon JA. Sleep disturbance associated with the menopause. Menopause. 2024 Aug 1;31(8):724-733. doi: 10.1097/GME.0000000000002386. Epub 2024 Jun 25. PMID: 38916279.

A new option for CBT-i

Posted on August 11, 2025 by IntraBalance - Sleep Health

I was recently working with a woman in her 30s who’d been dealing with insomnia since her teenage years.

After so many years of struggling, she didn’t just have insomnia, she was insomnia.

“I’m a bad sleeper,” she told me.

And just like that, it had become part of her identity.

When people label themselves this way, it becomes a self-fulfilling prophecy.

As James Clear says in the above quote, holding on to an identity keeps people stuck in unconscious patterns.

It’s not just the behavior that needs to change, it’s also the identity underneath.

If you’re a clinician helping folks with sleep issues, start by getting curious about how your patients see themselves.

And if you’re personally struggling with sleep, ask yourself: What identity have I adopted around sleep?

To dig deeper into this, I interviewed Dr. Noelle Smith, PhD, VP of Clinical Care at Moona Health, an online CBT-i (cognitive behavioral therapy for insomnia) clinic.

Whether you’re a clinician looking for referral options, or someone trying to fix your own sleep, you’ll come away with practical takeaways, including Dr. Noelle’s #1 sleep tip.

In this episode, we cover

The science behind CBT-i and how it changes physiological biomarkers
Why CBT-i works when sleep hygiene alone doesn’t
How it’s adapted for pregnancy, PTSD, menopause, and more
What to know about sleep meds and CBT-i
…and more.

👉Quick refresher:

What is CBT-i and why should you care?
Cognitive Behavioral Therapy for Insomnia (CBT-i) is not just about avoiding caffeine or keeping your bedroom cool. That’s sleep hygiene, and while it matters, it’s not enough.

CBT-i is the first-line, gold standard treatment for chronic insomnia. It helps people unlearn the habits, thoughts, and behaviors that are keeping them awake…also known as the perpetuating factors of insomnia.

How long does it take?
Most people start to see improvements in 2 to 3 weeks. A full course is typically 6to 8 sessions. Unlike meds, the benefits last long after treatment ends.

Do you have to stop sleeping pills to start CBT-i?
No, people can start while still on medications. Many people choose to taper later as their sleep improves.

Is CBT-i right for your patient (or you)?
It’s effective for most people with chronic insomnia, including those with anxiety, depression, trauma, or menopause-related sleep issues. It can even be tailored for pregnancy or PTSD.

For clinicians:
If your patient has insomnia that’s interfering with their life, CBT-i should be your first-line referral.

Thanks to telehealth and digital tools, access is easier than ever, especially compared to when I was doing my sleep fellowship.

Bipolar, burnout, and 2 hours of sleep a night: How Bill found peace

Posted on July 24, 2025 by IntraBalance - Sleep Health

I just read The Borrowed Life of Frederick Fife. Have you read it?

Such a fun and heartwarming novel. It was written by Anna Johnston, a physician who worked in a nursing home, and was inspired by her grandparents.

I won’t spoil it, but I loved the above quote on sleep.
Sleep disturbances are a core feature of many medical conditions, including bipolar disorder.

It’s the “S” in the DIGFAST mnemonic for mania.*

Sleep issues in bipolar disorder aren’t limited to acute episodes of mania, hypomania, or depression.

You can also see persistent sleep issues during euthymic (interepisode) periods, showing up in a variety of ways, including chronic insomnia, hypersomnia, or irregular sleep-wake patterns.

Circadian rhythm disturbances, including delayed sleep phase, are also common, and are associated with greater mood instability and functional impairment.

That’s why stabilizing sleep is a key preventive strategy in bipolar disorder.

This week, I have a video for you that’s a little different.
It’s an interview with Bill Fitzgerald, also known as The Accidental Life Coach, and a patient with bipolar disorder in Ireland.

He shares his raw and inspiring journey of living with bipolar disorder and trauma, overcoming chronic insomnia, and rebuilding his life from the inside out.

Bill and I share an Irish connection, as we’re both UCC (University College Cork)alums – I went to med school in Cork, Ireland.

Here are some tips to get you started:

During mania or hypomania, the hallmark sleep change is a reduced need for sleep (not insomnia). People sleep significantly less without feeling tired.

During depression, you can see insomnia or hypersomnia. Hypersomnia is more common in bipolar depression than in unipolar depression. That’s a diagnostic pearl most people miss.

PSG (polysomnogram) and actigraphy show increased sleep onset latency (time to fall asleep) and increased REM density across all illness stages.

We also see more obstructive sleep apnea, restless leg syndrome in people with bipolar disorder…yet these may go undiagnosed.

Sleep changes are often early warning signs.

Trouble falling asleep or sleeping too much can show up weeks to months before a depressive episode.

Decreased need for sleep often precedes mania.

If you’re treating bipolar disorder, or managing it yourself or with a loved one, addressing sleep is vital.

It’s one of the most powerful tools we have for preventing relapse and protecting stability.

To see what that looks like in real life, listen to Bill’s story here.

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

P.S. DIGFAST is a mnemonic to remember the symptoms of mania. It stands for: Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity increased, Sleep decreased, and Talkativeness

References:
1. Kaplan KA. Sleep and sleep treatments in bipolar disorder. Curr Opin Psychol. 2020 Aug;34:117-122. doi: 10.1016/j.copsyc.2020.02.001. Epub 2020 Feb 13. PMID: 32203912.

2. Lewis KJS, Richards A, Karlsson R, et al. Comparison of Genetic Liability for Sleep Traits Among Individuals With Bipolar Disorder I or II and Control Participants. JAMA Psychiatry. 2020;77(3):303–310. doi:10.1001/jamapsychiatry.2019.4079

3. Palagini L, Miniati M, Caruso D, Massa L, Novi M, Pardini F, Salarpi G, Pini S, Marazziti D, Etain B, Riemann D. Association between affective temperaments and mood features in bipolar disorder II: The role of insomnia and chronobiological rhythms desynchronization. J Affect Disord. 2020 Apr 1;266:263-272. doi: 10.1016/j.jad.2020.01.134. Epub 2020 Jan 22. PMID: 32056887.

How to taper off benzodiazepines

Posted on July 22, 2025 by IntraBalance - Sleep Health

During med school, I lived by my “First Aid for the USMLE” book series.

Over a decade later, I still use some of the acronyms and mnemonics…10 points to Gryffindor if you remember SIGECAPS.* 🙂

Dr. Harvinder Singh MD, founder of Psychiatry Education Forum, joined me on YouTube this week and reminded me of this one: Out The Liver (OLT).

Do you know that one?

Here’s a refresher: All benzodiazepines are metabolized by the liver, and the metabolites are eliminated by the kidneys.

Some benzos don’t have active metabolites, and take a simpler route through the liver…they skip the usual oxidative metabolism and go straight to glucuronidation. 👇

Those are the “OLT” (Out The Liver) benzos:
‣ Oxazepam
‣ Lorazepam
‣ Temazepam

Why does this matter? Because this pathway doesn’t rely heavily on liver function, making these meds safer choices for older adults or people with liver issues (Peng et al, 2022). Plus, they don’t produce active metabolites, so they’re gentler on the kidneys too.

I don’t recommend long-term use of benzodiazepines because of the side effects including a high potential for misuse and physical dependence.

So how do you safely come off of them? Dr. Singh provided us with a masterclass on benzodiazepine tapering this week, based on the 2025 ASAM (American Society of Addiction Medicine) guidelines.

If you’re a clinician it’s a must watch, I learned so much from it. If you’re not a clinician, but are taking benzodiazepines or know somebody who is, this is must-have information.

This talk is jam-packed with high yield information, including:
‣ How long it takes to become dependent on benzos (it happens much faster than you think!)
‣ How to assess withdrawal risk
‣ The number 1 mistake people make with tapering
‣ Dr. Singh’s first step in tapering – it will change how you think about benzo tapers
‣ A tapering table to help you decide how to taper
‣ When you should switch to a long acting benzo, which 3 long acting benzos to choose, and who should NOT be switched to long acting
‣ Tapering pace and how to start
‣ The 2 adjuncts recommended by the ASAM guidelines to support a taper
‣ Managing sleep disturbances during a taper

And so much more…

Watch it here and bookmark the link, because you’ll want to refer back to it again and again. https://www.youtube.com/watch?v=eCzUoh5Cx_A&t=1s

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

References:
1. Peng L, Morford KL, Levander XA. Benzodiazepines and Related Sedatives. Med Clin North Am. 2022 Jan;106(1):113-129. doi: 10.1016/j.mcna.2021.08.012. PMID: 34823725.

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.

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.

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