Tag: Articles

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

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.

Pink, Brown, and White Noise for Sleep

Posted on April 21, 2025 by IntraBalance - 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.