Tag: Articles

Hormone Therapy for Mental Health

Posted on December 19, 2025 by - Sleep Health

Hormone Therapy for Mental Health

I once did an informal survey on Facebook asking people their biggest sleep concerns. The majority of respondents were women in their 30s and above, and their number 1 concern was this:

→ Difficulty staying asleep

It wasn’t surprising, because hormones do have a known impact on sleep.

Lower levels of estradiol and higher levels of FSH during perimenopause are associated with sleep disturbances, independent of vasomotor symptoms and mood changes. (1)

As for progesterone, it’s known to have sedative properties, thought to act as a GABA-agonist. It also stimulates breathing via acting centrally on brainstem respiratory control centers, and by peripherally affecting upper airway patency. Thus, we see higher rates of sleep when progesterone levels drop in perimenopause and menopause. (2)

Now, whether hormone therapy (HT) is helpful is a bit more complex.

I’ve seen patients experience an initial improvement with HT, but then develop sleep issues again. So why might that be?

This week, we’re digging into hormonal shifts, mental health, and sleep changes with Harita Raja MD.

Dr. Raja is a reproductive psychiatrist specializing in hormone therapy for mental health. If you’re not already following her on Instagram, I highly recommend that you do.

In this interview, Dr. Raja shares:

  • How hormones affect psychiatric conditions
  • When to consider HT in women with mental health or sleep issues
  • Why HT is often not enough to overcome symptoms
  • The role of lab testing
  • Whether psychiatrists should be prescribing hormones
  • How to get trained in hormone therapy
  • And much more

Click here to watch the interview and don’t forget to claim your CE credits using the Learner+ link below. https://www.youtube.com/watch?v=rboinFa38SA

References:
(1) Coborn J, de Wit A, Crawford S, Nathan M, Rahman S, Finkelstein L, Wiley A, Joffe H. Disruption of Sleep Continuity During the Perimenopause: Associations with Female Reproductive Hormone Profiles. J Clin Endocrinol Metab. 2022 Sep 28;107(10):e4144-e4153. doi: 10.1210/clinem/dgac447. PMID: 35878624; PMCID: PMC9516110.

(2) Boukari R, Laouafa S, Ribon-Demars A, Bairam A, Joseph V. Ovarian steroids act as respiratory stimulant and antioxidant against the causes and consequences of sleep-apnea in women. Respir Physiol Neurobiol. 2017 May;239:46-54. doi: 10.1016/j.resp.2017.01.013. Epub 2017 Feb 9. PMID: 28189710.

Bright light therapy

Posted on December 5, 2025 by - Sleep Health

Bright Light Therapy

I met a friend for a later-than-usual dinner a couple of weeks ago and we were laughing at how incredibly sleepy we both were given that it now becomes pitch black by 5pm in the Bay Area.

The short winter days can make for sleepier evenings, lethargic days, and even Seasonal Affective Disorder (SAD) in patients prone to it.
Bright light therapy, medications, and other conventional treatments are effective for SAD.

But one of the missing pieces is embracing seasonal shifts.
In our modern world, we expect ourselves to maintain the same productivity, energy, and sleep patterns all year round.

Meanwhile, nature does the opposite, as trees become bare, animals hibernate, and the stars come out to say hello in the early evening hours.
I love embracing the Scandinavian concept of “hygge”, with cozy evenings, twinkle lights, homemade soups, a good book and a soft blanket.

Pair that with a purposeful dose of daytime bright light by going for a walk outside, preferably out in nature, my favourite being a brisk midday stroll on the beach.

It often does more than people expect.

But, back to bright light therapy which is one of the most underutilized tools in the clinical toolbox.

Bright light therapy (BLT) is:

  • Also called phototherapy
  • It’s a non-pharmacologic treatment for sleep and depressive disorders
  • It involves daily exposure to bright light and is typically administered with a light therapy device (light box, wearable, or dawn simulator)

Bright light therapy was originally used to treat seasonal affective disorder (SAD). Now it’s also used in the treatment of non-seasonal depression, bipolar depression, fatigue, insomnia, and circadian rhythm disorders.

If you see patients with insomnia, depression, or fatigue, it’s a good idea to learn how to prescribe bright light therapy. See my video here for an in-depth tutorial:

Some clinical pearls to get you started:

  • 10,000 lux for about 30 minutes in the morning is still the gold standard. You’ll also see older protocols using 2,500 lux for 2 hours, also effective but less convenient. (1)
  • Blue light devices can work at much lower intensities, and newer studies show green light may help too, but white light still comes out on top in meta-analyses. Red light is shown to be ineffective for SAD. Ensure the device has a UV filter.
  • Light therapy is most effective first thing in the morning. It needs to hit the retina (not the skin), so position the device at eye level.
  • Traditional light boxes have the longest and strongest evidence base, but the wearable visors/glasses can be just as effective for people who need portability. The ReTimers here are an example. (Disclosure: This is an affiliate link.) https://shareasale-analytics.com/r.cfm?b=2448501&u=3028033&m=148943&urllink=&afftrack=&shrsl_analytics_sscid=81k8%5Fo0ome&shrsl_analytics_sstid=81k8%5F1we5t
  • Most people start to feel better within one week, and response rates can reach ~80% when the protocol is followed correctly. Side effects are usually mild (eye strain, headache, nausea).

I still recommend that my patients go outside for a dose of natural sunlight in the morning and midday hours, while integrating bright light therapy devices into the treatment plan.

References
Galima SV, Vogel SR, Kowalski AW. Seasonal Affective Disorder: Common Questions and Answers. Am Fam Physician. 2020 Dec 1;102(11):668-672. PMID: 33252911.

Simple sleep tip

Posted on November 26, 2025 by - Sleep Health

Simple sleep tip

One of the most common concerns I hear from my patients is that they can’t shut off their mind at night.

They climb into bed and suddenly the mental floodgates open: to-do lists, work problems, holiday logistics, the awkward comment from 2003, existential dread…all of it shows up like clockwork.

These are often the patients asking for a sedative or an anxiolytic to quiet the noise.

While medication can be appropriate in select cases, it rarely solves the underlying issue.

You might suggest relaxation techniques or meditation, but for those with chronic insomnia, those tools often backfire because they increase “sleep effort”, amplifying frustration.

Plus, the mind is doing exactly what it’s designed to do: think. Expecting patients to “turn it off” sets them up for more pressure and disappointment.

So here’s a more effective entry point:

Shift the focus to pre-sleep cognitions. (1)
Pre-sleep cognitions are the mental activities that occur in the window before sleep onset, like rumination, planning, worry, mental rehearsal, intrusive thoughts, and problem-solving.

In chronic insomnia, these thoughts tend to be more intense, more negative, and more sticky than in what I call “effortless sleepers.”

Research consistently shows this cognitive arousal is associated with:

  • Longer sleep latency
  • Decreased sleep efficiency
  • Worse subjective sleep quality

So how can you help patients meaningfully shift their pre-sleep cognition patterns?

Use a tool that’s free, simple, low-risk, and clinically supported: Gratitude.

It’s a timely topic with Thanksgiving in the US this week, but is relevant year-round

Gratitude practices have been shown to:

  • Reduce pre-sleep worry and rumination
  • Lower cognitive arousal at bedtime
  • Improve subjective sleep quality
  • Support emotional regulation and mood

It’s underused, especially in insomnia care, yet quite easy for patients to do.

Here’s how I coach my patients to start practicing gratitude:

What to do

Choose one specific thing you’re grateful for each day. Keep it concrete, like “I’m grateful for the warm coffee I had this morning.”

How to do it:
Say it out loud, write it in a journal, or drop it on a post-it note into a “gratitude jar.”

When to do it:
Begin in the evening. With daily practice, it starts to happen spontaneously throughout the day.

Why it matters:
It builds “emotional fitness,” improves pre-sleep cognitions, and improves sleep quality over time.

As clinicians, it’s important that we practice what we preach. Gratitude takes only a few seconds but compounds quickly.

With that said, I’m grateful you’re here and letting me be part of your sleep education journey.

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

References:
(1) Lemyre A, Belzile F, Landry M, Bastien CH, Beaudoin LP. Pre-sleep cognitive activity in adults: A systematic review. Sleep Med Rev. 2020 Apr;50:101253. doi: 10.1016/j.smrv.2019.101253. Epub 2019 Dec 17. PMID: 31918338.

Melatonin for Menopause

Posted on November 11, 2025 by - Psychiatry

Melatonin for Menopause

Did you learn about menopause care in med school or clinical training?

I didn’t. Not much anyway.

But menopause is finally having a moment.

For years, women were told to “just deal with it”… the hot flashes, the mood shifts, the weight changes, and the sleepless nights.

But now there’s a quorum of us female physicians going through perimenopause and menopause ourselves…

Which is leading to a movement of clinicians getting trained in menopause care and women demanding better solutions.

When I spoke with Dr. Andrea Matsumura MD, a sleep medicine physician and women’s health expert, we both agreed: this new era of menopause care is long overdue.

We’re seeing more open conversations, better research, and a growing recognition that sleep disruption during this stage of life isn’t just hormonal, it’s multifactorial.

This week’s video rounds out our 3-part series on melatonin with a focus on menopause.

In this 6-minute episode, I’m sharing:

  • How melatonin can help restore circadian rhythm and sleep continuity in midlife women
  • When to use immediate vs. extended-release formulations
  • What the data show on melatonin for menopausal insomnia
  • Dosing and timing strategies for different sleep presentations
  • Melatonin isn’t a cure-all for sleep issues, but it’s an important piece of the puzzle, with emerging research suggesting it can improve sleep quality and timing when used correctly.If you’re helping patients navigate menopause (or navigating it yourself), this short episode will give you practical, evidence-based tools to use right away.

Watch the full video here.

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

References:
Caretto M, Giannini A, Simoncini T. An integrated approach to diagnosing and managing sleep disorders in menopausal women. Maturitas. 2019 Oct;128:1-3. doi: 10.1016/j.maturitas.2019.06.008. Epub 2019 Jun 28. PMID: 31561815.

Jeon GH. Insomnia in Postmenopausal Women: How to Approach and Treat It? J Clin Med. 2024 Jan 12;13(2):428. doi: 10.3390/jcm13020428. PMID: 38256562; PMCID: PMC10816958.

Why melatonin doesn’t work

Posted on November 2, 2025 by - Sleep Health

Melatonin doesn't work

We’ve all heard this from our patients:

“Melatonin doesn’t work for me.”

And to be honest, it often doesn’t work…at least not in the way most people are using it.

Melatonin isn’t a sedative. It’s a chronobiotic.

It’s a biological time cue that tells your body what time it is and helps regulate the sleep-wake cycle.

So when a patient says melatonin failed, the problem usually isn’t that melatonin doesn’t work.

It’s usually one of these 3 things:

  • Wrong timing
  • Wrong indication
  • Poor quality supplement

This week, I’m breaking down why melatonin doesn’t work and what to do about it.

In this 8-minute episode (Part 2 of my 3-part series on melatonin) I share two real clinical cases that illustrate how to make melatonin work for the right patient at the right time:

  • A 32-year-old who was misdiagnosed with insomnia and cycled through multiple hypnotics without relief
  • A man in his 60s with early-morning awakenings who tried melatonin without success, until he learned how to use it strategically

I’m also sharing:

  • How to time melatonin supplements relative to DLMO (dim light melatonin onset) instead of clock time
  • The optimal melatonin dose for circadian realignment
  • When to choose extended-release formulations
  • Why melatonin rarely works in isolation and how to use it most effectively

If you’ve ever wondered how to handle “melatonin doesn’t work” complaints in clinic, this episode will give you a roadmap.

Well worth the 8 minutes of your time.

Watch the full video here.

Then, stay tuned for Part 3, where we’ll explore melatonin use in perimenopause and menopause.

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

Is Melatonin Safe?

Posted on October 24, 2025 by - Sleep Health

Is Melatonin Safe?

A 2023 research letter in JAMA (Journal of The American Medical Association) and 2017 study in JCSM (Journal of Clinical Sleep Medicine) highlighted serious issues with over-the-counter melatonin quality*.

One melatonin gummy was found to contain 347% more melatonin than what the label claimed.

That’s enough to make anyone pause.

It has definitely changed the way I recommend melatonin to patients.

But as I explain in this week’s video, the full story is more nuanced, and perhaps not quite as alarming, as the headlines suggest.

In this 10-minute episode (Part 1 of a 3-part series on melatonin), I unpack what every clinician needs to know about melatonin safety, including:

  • Why melatonin isn’t a sedative
  • What the JAMA and JCSM studies actually found
  • How to interpret dose variability and brand differences
  • What the research says about short, moderate, and long-term safety
  • My clinical take on when to use it…and when to rethink it

I also share a patient story that illustrates how melatonin, when used correctly, can retrain the circadian rhythm instead of becoming a nightly crutch.

If you’ve ever had a patient ask whether melatonin is “safe,” or wondered how to approach it in your own prescribing, invest 10 minutes of your time in this high yield video.

Click here to watch it.

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

*References:
Cohen PA, Avula B, Wang YH, Katragunta K, Khan I. Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US. JAMA. 2023 Apr 25;329(16):1401-1402. doi: 10.1001/jama.2023.2296. PMID: 37097362; PMCID: PMC10130950.

Erland LA, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 2017 Feb 15;13(2):275-281. doi: 10.5664/jcsm.6462. PMID: 27855744; PMCID: PMC5263083.

CBT-i Only Works If You Do This

Posted on October 21, 2025 by - Sleep Health

CBT-i Only Works If You Do This

We all see patients struggling with insomnia, but implementing CBT-I (cognitive behavioral therapy for insomnia) in real-world practice can feel daunting, especially when you’re not a sleep specialist.
I remember my first time recommending “sleep restriction” to a patient.

The look of panic on her face made me question if I was helping or just adding to their anxiety.
In fact, sleep restriction is often the thing that scares people away from CBT-i or leads to non-adherence with treatment.

This is where the art of clinical practice comes in: meeting patients where they are.
This week, I sat down with Dr. Parky Lau PhD, a sleep psychologist at Stanford, to talk about how to make CBT-I practical, flexible, and patient-centered, even for clinicians who don’t do this every day.

In this episode, Dr. Lau shares:

  • How to build a case formulation for insomnia (and why it matters)
  • How to practically implement time in bed restriction (and why he prefers that term over “sleep restriction”)
  • Practical analogies (like pizza dough and finger trap) to help patients understand sleep
  • How to adapt CBT-I for menopause and bipolar disorder
  • Tips for supporting patients who are anxious, perfectionistic, or dependent on sleep aids
  • How to build flexibility and empathy into a successful treatment plan
  • And more…

When your next patient mentions insomnia, you’ll have practical tools from this video to guide your clinical thinking.

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

References:
Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klin Spec Psihol. 2022;11(2):123-137. doi: 10.17759/cpse.2022110208. PMID: 36908717; PMCID: PMC10002474.

3 Steps to End Sleep Anxiety

Posted on September 25, 2025 by - Sleep Health

One of the most common misconceptions about insomnia is that it’s just a matter of bad sleep hygiene.

But many of your patients with chronic insomnia have better sleep hygiene than anyone you know…and they’re still lying awake.

Here’s why: insomnia isn’t all about bad habits.

It’s more like a phobia.

The brain has learned to fear the very experience of being awake at night.

So people end up cycling through one sleeping pill or supplement after another, or trying gadgets and all the “sleep hacks” they heard about on podcasts, but it doesn’t get any better.

The paradox is that the harder patients try to “fix” it, the worse it gets.

In my new video, I share how I explain sleep anxiety to patients, plus 3 strategies that work far better than piling on more rules about caffeine and blue light.

It’s less than 5 minutes, designed for both clinicians and patients, and part 2 of a short series I’m creating on insomnia.

Feel free to share it directly with anyone in your care who’s caught in the cycle of sleep anxiety.

And if you (or your patients) want to go deeper, I’m teaching a free masterclass on how to quiet racing thoughts and sleep through the night.

It’s a deeper dive with tools you can use right away. You (and your patients) are welcome.

Register here. 

How to quiet your mind at night

Posted on September 23, 2025 by - Sleep Health

Stop Waking Up at Night

One of the most common things I hear from patients is this:

“My brain just won’t shut off at night.”

Do you hear that in your clinic too?

And most of them have already tried the usual fixes like meditation apps, relaxing harder, melatonin, sleep hygiene checklists, and so on.

The problem is: When you try to force the brain to relax, it’s like chasing a dog with the zoomies.

The more you try to contain it, the zoomier it gets.

In my new video, I explain why racing thoughts at night are so persistent, and three steps to redirect that energy so your patients can actually fall asleep and stay asleep. 

This video is part of a short series I’m creating for both clinicians and patients.

It’s less than 5 minutes but jam packed with the same info I share with my patients 1:1.

Feel free to share it directly with your patients and colleagues.
And if you (or your patients) want to go deeper, I’m teaching a free masterclass next week on how to quiet racing thoughts and sleep through the night.

You and your patients are welcome to attend that too.
Sign up here. 

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

Posted on September 12, 2025 by - Sleep Health

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

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.