144: Dr. Nishi Bhopal, Integrative Psychiatrist, Sleep Doctor, & Founder of Intrabalance: Educating Physicians, Therapists, & Patients On All Things Sleep!

Welcome to the sleep as a skill podcast. My name is Mollie Eastman. I am the founder of sleep as a skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world thinks about.

sleep. Each week, I'll be interviewing world class experts ranging from researchers, doctors, innovators and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness, and I'm committed to keep Keeping you up to date on all the things that you can do today to transform your circadian health and by extension, allowing you to sleep and live better than ever before.

Welcome to the sleep as a skill podcast. Does it concern you that your average primary care doctor has had about two hours of training in the area of sleep? The thing that we do a third of our lives on average, 26 years of our lives spent asleep and yet has only had about two hours of training. Does that concern you?

Well, if it does, you're going to love my guest who is making it her mission to educate physicians and health practitioners in the. area of sleep. So Nishi Bhopal, MD is board certified in psychiatry, sleep medicine, and integrative holistic medicine. She is the founder and medical director of Pacific Integrative Psychiatry, an online practice in California, where patients receive a whole person approach to anxiety, depression, and sleep disorders, including nutrition.

Mindset coaching, psychotherapy, yoga, and meditation, and integrative and functional medicine. In addition to her private practice, she's the founder of intrabalance, an educational platform that includes a YouTube channel for physicians and therapists, where she teaches evidence based. integrative tools to optimize sleep and mental health along with online courses on sleep for both patients and healthcare practitioners.

Her passion is making mental wellness and the science of sleep easy to understand and accessible to all. Now I know you're going to really love today's episode, but first a few words from our sponsors. Here at the Sleep is a Skill podcast, we're all about enhancing your sleep. And a cornerstone of that journey often revolves around stabilizing your blood sugar levels.

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sleep to mention drinking more than two servings of alcohol per day for men and more than one serving per day for women can decrease sleep quality by 39. 2%. A sleep foundation survey reports, not even mentioning all the indulgent food and late night effects that often come along with it. And as we know, sleep is the key to your body's rejuvenation and repair process.

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This special offer is only available at mag breakthrough. com forward slash sleep is a skill. I will also include this in the show notes as well. And welcome to the sleep is a skill podcast. Thank you so much for taking the time to be here I know we're gonna have a ton of topics to dive into but just first off my gratitude for you taking the time out of your busy schedule and You got launches and you got all kinds of things happening  It means a lot.

Oh, thank you so much for having me. I'm really excited for this conversation I know we've been talking about it for a while. So yeah, it's exciting to finally make this happen  Yay, this is going to be really, really great. And I know I've been so, so much of a fan of the work that you've been doing. And thanks to social media, the things that we get to stay abreast of, it's just so, so helpful to see what people are working on and the difference that I'm clear you're making and out to make for so many practitioners that are looking to support people in their sleep.

Or maybe you just have a total blind spot that sleep could really make a marked difference in people's wellness journey and the fact that you're bringing this to the forefront is so huge, but to begin, how did this come to be? How did you even find yourself kind of in this role and really taking a stand for sleep?

Yeah. Yeah. Thanks so much. So it's, it's interesting. I've always struggled with sleep, but not in the way that most people think of, like when we hear about people struggling with sleep, we usually think about insomnia. Sure. Right. But for me, it was the opposite. I was sleepy all the time, tired all the time as a teenager.

I was the teenager who could not get up in time for school. When I was in university, I would schedule my classes for later in the morning because I just could not make it on time. And I couldn't get a handle on it. And I didn't really understand what was going on. And then when I went to medical school and I got into residency, I really struggled, right?

Because sleep deprivation is such a big aspect of medical. Training and I remember one morning I was getting ready for, um, going to my rotation and we would start our work day at like 6 a. m. or 6 30 a. m. We'd start rounds and I was so fatigued that I was just crying in the shower, like, like, so, like, just from sheer exhaustion, right?

And sleep, it was sleep deprivation. And for me, as someone who was maybe a little bit on that delayed. Sleep phase schedule that I didn't understand when I was a teenager  and someone who's very sensitive to sleep deprivation. It was, it was just really, really difficult. And so when I was in medical training, I actually encountered a senior resident who was a couple of years ahead of me and she was going into sleep medicine fellowship.

And I was like, what is that? I've never heard of that. I didn't know that was a thing. This was like over 10 years ago now. And I was like, sleep medicine, what's that all about? That's a thing you can study. And so that kind of kicked off my interest in learning more about sleep medicine and how it affects our health.

Um, I was in psychiatry residency. So of course, when you're working with patients who are struggling with mental health, sleep is a huge part of that, right? Because there's such a bi directional relationship between sleep. and mental health.  And so I wanted to learn more about, um, one, how to, you know, fix my own sleep issues, but also how to better serve the patients that I was working with.

And so that sort of started this whole journey of exploring sleep as a foundation of physical health and mental health. And then how I got into talking specifically to practitioners about sleep is I started a YouTube channel during the pandemic because so many of my patients were struggling with sleep issues.

They're asking me the same questions over and over again, right? And  so I thought, well, I can. Probably make some videos about this and just put it online and maybe other people would find it helpful.  And then what I found was that the people who are really asking questions were my colleagues. So I was getting emails and DMs and messages from other psychiatrists from primary care doctors about their patients sleep issues.

And so I actually kind of pivoted a little bit. And so now I've got an online course for practitioners teaching them about sleep medicine and also integrative approaches to sleep. And why is that that there's such a need I've gotten the sense that we're so aligned on our some of our concerns around just the stats that are out there and just the lack of training.

So why is this such a problem? Why has this not already been addressed? What's the systemic kind of breakdown of what a lot of these practitioners that you're working with, what do they know? And why is this such a problem? Why is this a missing? It's such an interesting thing when you look at it, because, you know, as you and I both know, sleep is the foundation of health.

It's really hard to have good health without, you know, proper sleep or good quality sleep.  But most physicians only get about two hours of training in medical school about Sleep, right? And this was a study out of Harvard. And so even at Harvard Medical School, they found that their medical school curriculum had less than two hours of formal education on sleep.

Most medical schools in the U. S. Have devote only two to four hours of sleep education. As part of their curriculum, that's less than 1 percent of their total classroom education is 0. 06 percent of  their lives like  wild. Okay, everyone has to sleep, right? Every like every practitioner who's working with a patient.

Um, like all your patients have to sleep. It's not like all your patients have diabetes, you know, like some of your patients might not have that or they might not have anxiety or issues. So you don't need to know about everything. But sleep is one of those things that every practitioner needs to know about.

And, um, just one more statistics. There was a global study looking at  409 medical schools across 12 countries, and they did a survey of how much are they training their students in sleep, and they found that globally, the average amount is is about the same as in the U. S. About 2 to 2. 5 hours.  And there are some schools that have no education in sleep at all in medical school.

And then when it comes to pediatrics, Which is even, you know, less understood pediatric sleep. And I know you had Dr. Funke on your sure podcast recently. She's amazing. She's amazing. So passionate.  Yeah, she's so good. And I learned so much from her about pediatrics, but most medical schools only cover pediatric sleep for 17 minutes out of two hours of sleep education.

Maddening. And so for people, maybe if people are listening like, well, is it that big of a deal? If I really have a problem with sleep, I'll go see a sleep. I'll see a, a physician that's practicing specifically in sleep or a practitioner that that's what they do. So not that much of a problem. Why is that kind of flawed logic?

Yeah. So the challenge there is that there are very few. Doctors and therapists who are trained specifically in sleep medicine. So in 2017,  um, there was a survey showing that there's only about 7, 500 sleep medicine doctors in the United States.  And when we think about the population, you know, hundreds of millions of people in the U.

S., that's a ratio of 43, 000 patients to one sleep trained doctor.  Right? So it's not like you can just go to a sleep clinic. Like, I'm here in the San Francisco Bay Area. The sleep clinics here have a wait list of like six months. Eight months, right? It's not that easy to get into a sleep clinic. And if you do, um, get into a sleep clinic, oftentimes the treatments that will be offered are either CBTI, which is cognitive behavioral therapy for insomnia, which is very effective.

Um, but they'll offer that. Or you might get a sleep study,  and then maybe you're treated for sleep disordered breathing, some form of sleep apnea, or some other form of sleep disordered breathing, and that's about it. And then, and then what? Like, what else can you do, right? And so that's why in our practice, um, so I have a practice called Pacific Integrative Psychiatry in California, um, we get people coming to us.

With that question of, well, what else can I do? What else is there to improve sleep? And this is also why I'm so passionate about about training and helping other practitioners learn these methods because there's so few people who understand, you know, so few practitioners who understand sleep,  but people are really hungry for this information.

Absolutely. And not to mention the fact that so many people have no clue that they're even dealing with a sleep issue. And if our primary care doctor isn't spotting those red flags for us, uh, and not for their, and certainly not from a malicious place, just systemically that they're just haven't gotten the training so might not know what to look for.

It's likely that we're missing all kinds of important signs. I know Project Sleep has, you know, been screaming from the rooftops of being, you know, misdiagnoses are for things like narcolepsy and certain things that can take years for many people to even realize they're dealing with something. So they might not even know to get on any wait lists.

So anyway, love what you're doing.  That's so important. And so to go in a little bit deeper, I love that you also pointed to, this is another big talking point for myself as well, is that for, you know, many of the paths that we see is CBT I, and not to, you know, take away from the incredible value that can be there, but CBT I, Or and or a sleep lab.

But beyond that, good luck. So what do you see? How can we expand the aperture of what's possible for people outside of those two paths? Yeah, it's, it's such a great question. And you know, sleep is so personalized, right? Everybody is so different. We all have different lifestyles, different schedules, different jobs.

So the way that I think about it is how can we create a plan that is tailored to The specific individual that's in front of us, but there's a lot of, um, similarities between some of the foundational practices that we can introduce. And so when I think about, um, helping someone optimize their sleep, the framework that I use is, um, basically three pillars.

So we're looking at their circadian rhythm, their sleep drive, and then their nervous system and hyper arousal. And so those three pillars I think of as falling under this bigger umbrella of what's the root cause. Right? So if someone isn't sleeping well, maybe they have insomnia, maybe they have hypersomnia, they're getting enough sleep, you know, quote unquote, like according to the number of hours, they're still really during the day.

Maybe they just want to optimize their sleep and they feel like their sleep isn't as good as it could be. The question always says, well, what's the root cause or the root causes and how can we address those? So I like to use those three pillars, circadian rhythm, sleep drive, and hyper arousal or the nervous system.

Okay.  For practitioners, there's a five step process that I recommend a practice. So if there's any practitioners listening, the five steps that I recommend going through are basically, um, it's five T's. So first talk to the patient, get a history. Right. That's always the first step. Yes. Um, and in, in the program, um, for practitioners that I have, um, you know, we have a whole checklist of questions to ask, and I know with primary care physicians, you're, they're so busy.

Right. So it's no fault of their own that they're not investigating sleep is the right time. Right. So you can even do this as a questionnaire for your patients so they can do it before they come to clinic or after your visit. You don't have to spend your visit going through all of these questions, but talk to the patient is the first step doing some testing.

And so we'll look at that and what that could entail  tracking their sleep. And the outcomes and their, um, uh, response to treatment,  um, implementing the treatments based on what you've ascertained so far. And then the last step is to tune up. So that's where you can make adjustments in the treatment plan.

Again, referring back to those three pillars as your roadmap.  Oh, absolutely. I love that. And so out of those now in your day to day practices, people are coming your way and also with all the people that work within your practice. Now, are there certain things that you're seeing time and time again? So for the listener that's coming in and they're struggling and you know, they're whether they're really just dealing with an immediacy like an acute issue with their sleep or ongoing chronic things.

What are some kind of first steps for them to take if they're, they're hearing this and I go, geez, so my primary care doesn't know how to help me and I might be on a waiting list for ages. Like what are some things that they can do to make a difference now? Yeah, that's such a great question. Okay. So the first thing that I recommend to everybody is to work on your circadian rhythm, like work on your daily routines, right?

Because most of us have a deficiency of light exposure during the day. And then we've got an excess of light exposure at night. And that's a really simple thing that we can manage, right? Because oftentimes when people are struggling with sleep issues, it can feel so out of control. Yeah. It can feel like, Oh my God, I don't know where to start.

I don't know how to get a handle on this and you can't control how many hours of sleep you're getting each night. Like when I go to bed tonight, I don't know how many hours I'm going to sleep. But roughly I have an idea, but I don't know what my ring is going to say exactly tomorrow. Right.  But I can control light exposure, dark exposure and daily routines.

So that's a really simple thing for people to start with. And that's just as simple as maximizing your light exposure in the morning, staying in bright light throughout the day. And then really exaggerating exposure to darkness at night. So dimming your lights and then staying on a routine with meals.

This is one that I often see people are surprised about in our practice. Like, I'll ask them, what time do you eat your lunch? What time do you eat your dinner? I'm like, Oh, I don't know. Like whenever I have time or maybe I'll get in the car or I'm like checking email and I'll just grab something, you know, in between meetings.

And that is, is not good for your circadian rhythm because our body raves regularity. Right. So that's even a simple thing that people can do.  And it's not about.  Being like a Swiss train, you know, you don't have to be perfect. Exactly. Yes. Within about an hour, you know, keeping things aligned within about an hour every single day.

So that's a simple one. Absolutely. Yeah. And then I know you mentioned the Out of your teas, you mentioned the, the term, the tracking term, and certainly from your vantage point and the things that you see people dealing with, who are the people that you think that on their own accord might be served to track, I know you mentioned the ORA ring, and who are the people that might be better served to leave that aside or think of it another way?

Yeah. So the people who would benefit from tracking are the sleep optimizers as I, as I thought. Yeah. So people who are not really anxious about their sleep, they're not worried or preoccupied with their sleep, but they're just wanting to get a better handle on how to be healthier, you know, to see if, you know, these, their light exposure, changing their mealtimes to see how that impacts their sleep quality.

So for people who are sleep curious, yeah.

And also if you're working on your stress management, um, maybe tracking your HRV, your heart rate variability can be really helpful. The people who should not be tracking are the people who are struggling with insomnia where it is causing distress because. The more focus for people with insomnia, the more focus you put on sleep,  it makes sleep more elusive, right?

It creates more anxiety. It becomes this vicious cycle where you're tracking and then you're more anxious about the results.  There was, um, this term called orthosomnia, or there's a term called orthosomnia  coined by researchers at the University of Chicago, where they saw people coming in who were really anxious about their wearable data.

Yes. So for people who are struggling with that, I recommend taking a break from tracking  sometimes with patients who have insomnia. We will track just for a week or two just to see what's going on, but then we'll stop right and take the emphasis away from tracking and back onto well, what are the things that we can control?

during the day.  The other thing I'll, I'll mention in the tracking category that, um, many practitioners might not think of is actually tracking basic screening labs. So this is something that we do with all of our patients coming in to the practice, whether they're coming to see us for Anxiety or depression or mental health issues or they're coming to see us for sleep issues  is we do get a set of baseline labs.

Um, so just basic blood work essentially. And this includes things like micronutrients. So we like to look at their iron and ferritin levels, their vitamin D levels and their vitamin B 12 levels. Um, and so on. There's other markers that we look at as well.  But these are some simple things that people for anyone who's listening, people can go and get these checked at your doctor's office.

And  So frequently, we find vitamin D deficiency or insufficiency. In our patients. Yes, there is data showing that. So there was a meta analysis  in 2018 showing that people who had vitamin D deficiency had a higher risk of sleep disorders. They had poor sleep quality, shorter sleep duration and more sleepiness during the day.

So that's a really simple blood test that you can check and then you can start supplements according to what your needs are and then track the outcomes after a few months. So again, these are just simple things that people can do and have a conversation with your doctor about. Yes, and can you break down more too on the connection with vitamin D and how that links up with melatonin and serotonin and how we can think about that for people that are pausing on, well, what does that have to do with sleep so that we can really prioritize that?

Yeah, absolutely. So when you think about nutrients, nutrients are cofactors for the synthesis of neurotransmitters.  So Vitamin D is a micronutrient. It's a type of nutrient. We get it from the sun, right? So it's involved in circadian regulation. So when sunlight hits our skin, um, our body is unable to, you know, convert that into vitamin D, which then has downstream effects on inflammation.

It impacts gut health. Um, it's it's helps to support melatonin synthesis. There's so many things that vitamin D does and actually the full spectrum of what it does with regards to sleep hasn't been elucidated yet. Okay. Exactly. Yeah, we do know that. Yeah, but we do know that these micronutrients, including the other ones that I mentioned, like B vitamins, ferritin, magnesium, I didn't talk about yet, but all of these things are important, not just for sleep, because oftentimes when we talk to patients about, um, using nutrition for sleep, The way that people think about it is, okay, if I take magnesium, I'm going to fall asleep faster, right?

Or something. Yeah. Yeah. Like it's not, we're not using these things as sedatives or sleep aids. We're actually using them as fuel for your brain. And for your body to synthesize the neurotransmitters that are involved in sleep regulation. So, you know, if we think about the production of melatonin, for example,  tryptophan is an amino acid that we get from food.

Tryptophan is then converted to serotonin, which is then converted to melatonin. And for that conversion process to happen, we need a bunch of micronutrients. They're cofactors, the enzymes involved in the production of these things, right? So those micronutrients are those things I just mentioned, like magnesium, B vitamins, zinc, copper, vitamin D, all of these things are so crucial.

Absolutely. And sometimes I think when people hear, okay, well, the nutrition, like they have a problem, they're not sleeping so well. And then they hear nutrition and then they say, okay, well, what are the foods that I should be eating for sleep? One, do you have an answer for that? Or two, is it not that simple?

How, how are you thinking about nutrition and sleep? Yeah. So it is simple and it's not. Yes. Yes. Well said.  Yeah. So this, I'm all about simplicity, right? Like I was actually just talking with one of my, my patients yesterday and we were talking, he was, we were talking about like all the fancy gadgets and technology that's out there and  it can get overwhelming for people.

So what I tell people is let's just go back to basics.  And so when it comes to diet. We know that a Mediterranean diet is shown to help improve sleep quality. Yeah. Right. It helps people fall asleep faster. It helps people stay asleep. And again, it's not a quick fix. It's not like, okay, today I'm gonna go eat a Greek salad and, and I'm done.

Yeah. And I'm done. Right. Exactly. It's, it's a lifestyle.  So you can think about that.  Think about traditional diets as well. So it doesn't have to be specifically a Mediterranean diet, it's actually been shown that traditional diets help to reduce anxiety levels, they help to calm the nervous system.

Traditional diets are the types of foods your ancestors might have eaten. So, my family is originally from India, so I would think about, okay, what are the types of foods that my ancestors might have eaten? So like lentils, and different kinds of vegetables. Usually traditional diets. Whether it's a traditional diet from like Norway or India or Japan or, um, Peru, they're, they're all different types of foods, but there are certain things they have in common like lots of plants.

So fresh fruits and vegetables, whole greens, healthy fats. There's usually some kind of fermented food in there, which is really good for the gut. And then there's minimal processing, right, so that's just a really simple way to think about it.  Um, but there's also some research on the specific impact of foods on Sleep, which I can go into if we have time.

Sure. Yeah. Um, yeah. Why don't we jump in there too? That could be interesting to hear a little bit about that. Sure. So when we think about nutrition, you can think about the micronutrients that we just talked about, the vitamins and then the macronutrients. So carbohydrates, proteins, and fats.  I'll just preface this by saying that the research on nutrition and sleep is emerging.

So, you know, we, we need a lot more data to really understand like what the connection is, but, um, when it comes to carbohydrates specifically, so it's been shown that high glycemic diets so that you can think of things that high glycemic foods are. Um, they spike your blood sugar really fast and often these are processed foods.

Yeah. Um, low fiber generally. Um, so it leads to rapid increases in blood glucose which can affect sleep and there are studies suggesting that high glycemic index diets can shorten sleep onset latency so it can. Make it longer for you to fall asleep, basically,  and maybe associated with a higher risk of insomnia.

And there was a Women's Health Initiative study, which looked at like 70, 000 women over a number of years in the U. S. And they found that in postmenopausal women, a high glycemic index diet was associated with a higher rate of developing insomnia over three years.  Right? Um, and they found that a higher...

fiber diet was associated with a lower incidence of insomnia.  So again, correlation is not always causation. Sure. But the takeaway here is, again, think about traditional diets, foods that are minimally processed, foods that are higher in fiber. And what I recommend to patients is to help keep your blood sugar stable because fluctuations in blood sugar, like we just saw, are associated with, um, sleep issues.

You can think about introducing, like, just a little snack before you go to bed, um, not a huge heavy meal, but maybe an hour before bed, something that is high in fiber, um, that maybe is, um, you know, something like a banana with nut butter, or hummus with veggies, or a handful of nuts, or something like this, just to keep your blood sugar and your cortisol levels stable.

Yeah, absolutely. And on the tech front, since we work with so many people with certain kind of the gamification leaning, we'll see that clear correlation when we have them wearing continuous glucose monitors and they're tanking in the middle of the night and those wake ups for so long. I mean, I've had so many people that speak to, they're like, you know, well, unfortunately, can't do much for wake ups except maybe some breath work in the middle of the night and what have you.

And that may be an element, but there are things we can do, like for one, what you just spoke to, of the importance of just even there alone, let alone many other things that we can do to be aware of. One is, can we get to a bit more of the root cause of some of those wake ups, not to villainize wake ups every so often, we certainly have those.

I'm curious, while we're on the topic, and then we'll switch to how you're managing your own sleep, but wake ups, given that you have such an incredible training and you're working with so many people, and how to think about these things. One of the things we hear all the time is people waking up and not knowing how to think about that and how to manage that from a psychological perspective.

And so just would be curious to get your thoughts there. Yeah. Absolutely. That's such a common thing. Right.  Yeah.  Yeah. So, yeah. So, you know, I feel your pain for anyone who's experiencing that. Right. Yeah. Yeah. But what you said, like you just said something that's really important, which is that everyone experiences these wake ups from time to time.

Sure. Um, there's kind of this idea that once you fall asleep, we should be in the state of oblivion until we wake up the next morning and it's just not how it works.  So like, you know, if you look at a sleep study, you'll see that people have these little awakenings across the night. And if you have an aura ring, like we both have an aura ring or someone's using another wearable, you'll see that like, you'll have these little awakenings throughout the night and that's totally normal.

It's part of our normal sleep cycle. So the first thing is. Don't worry about it. It's, it's okay. Totally. Yeah. Yeah. So important.  Then the next thing is, okay, well, when is it problematic? So if they're happening frequently across the night, then that could be a sign that there's something else going on. So maybe that's a time to look into sleep apnea, or is there some kind of issue with periodic limb movement disorder or something like this?

And, you know, just kind of tying back a little bit to what we were saying about it. lack of sleep training in medical school. Yeah. I often ask doctors this pop quiz question when I give presentations, which is how many sleep disorders are there?  So good. Yes. Okay. Right. And then the answers I'll get vary from like, 17, 5,  150, you know, like I'll get right all over the place.

Yeah.  And so the answer is there's over 80 sleep disorders described in the ICSD 3, which is the International Association of Sleep Disorders. The reason I bring this up is that if someone is having frequent nighttime awakenings and they can't get a handle on them or their prolonged awakenings, and they're not really sure what to do about them, there may be some other kind of sleep disorder that's contributing.

In addition to the lifestyle factors that we've spoken about, right? So that is a reason to maybe go talk to a sleep doctor or someone who understands sleep to get some guidance on on how to handle it. But a few other things that can be helpful in the interim. One is actually a little bit of sleep compression.

Yeah.  I often find that people are spending too much time in bed. Yeah. And when you're spending too much time in bed. Your sleep is going to become a little bit more fragmented, so by slightly reducing the amount of time you're spending in bed, you're actually more likely to consolidate that sleep.  And then the other aspect of it is, if you wake up in the middle of the night, and maybe your mind's racing a little bit, or you're a little bit worried about it, that's where some of these integrative mind body practices can be helpful.

Sure. Like a mindfulness or breathwork practice, or something like this, just to calm the nervous system. So well said. Ah, well, that actually perfectly brings us to learning about how you're managing your own sleep so we can kind of take some, uh, or glean some new insights on how you're thinking about things.

So our first question that we do ask everyone is what is your current nightly sleep routine look like right now? So I'm all about visual cues. So I like to create cues for my brain. So then my brain knows it's time to wind down. Yeah, because I have the type of personality where I could just keep going on my computer.

Yeah, right. Yeah. So like, I need to create cues for myself to create a separation from my workday and my Non work life,  especially since I work remotely, right? I work from home. So how I create visual cues. One is by regulating light exposure. So in our house, we have everything on dimmers  and we have everything timed.

So after seven p. m. the lights just go.  Really low. Yeah. And like my family makes fun of me because they're like, it's so dark in your house. I'm like, yes. Yes. It should be in yours. By design. Yes. By design. Um, so that's one thing that I do. Um, so we dim our lights. The other thing is I have a warm shower. In the evening, and then change into my cotton PJs, so natural fiber.

And that's another visual cue for me. Once I have my PJs on, I'm done with work. It's over.  So good. Yeah.

Yeah. So that's basically the evening. And then I just have a cutoff time. So. No computer after that, once my pajamas are on. I love that. No work.  Such a good role. Yeah. Right? And so that just makes it really simple. It's a simple separation.  Especially for for people who work from home and then my husband and I, we've just recently started doing this little like ritual where we both do wordle and then we do the mini crossword.

It's a  little bit of screen time, but we turn our brightness down on our screens. We both do it together. On the couch and it's just like a cute fun little bonding thing that we do. Oh, that's so fun that you are the first person to say that. So I love that.  Amazing. Love a good novel evening routine. Okay.

Amazing. Okay. So you've got, so it sounds like some really great vibes as you, as It relates to your evening routine. And then how might we think about your morning sleep routine? We put in air quotes with the emphasis that how we start our day can impact our results at night. So what might we see there?

Yeah. So for the morning, um, it's kind of the opposite. So instead of dimmer lights, I'm maximizing light exposure. And you know, as I mentioned at the beginning of our conversation, um, mornings have always been a challenge for me.  Listen, I mean, I work with a lot of high stakes poker players and part of my story was one of being an extreme night owl.

It was how I kind of managed life and so the fact that now I love mornings is insane because for so long it would be so the opposite. So I get Everything you're saying and more. Yes.  Absolutely. And it's amazing, right? Our circadian rhythm is so adjustable. Yes. Right. So what I do is in the morning, as soon as I wake up, I actually open the, we have the blackout blinds.

So I just opened the blinds. Yeah. So then I'm getting light exposure in. Um, even if I'm not ready to jump out of bed, at least I'm getting that light exposure. Um, then what I do is I'll get up, stretch a little bit and I actually recently started doing oil pulling in the morning, which is nice. Yeah, sure.

Absolutely. Um, yeah, it's great for like dental health. So that's a recent thing I just started doing. So that's part of my morning.  And then I try to think about what am I excited about today?  Looking forward to today because especially again, as someone who's like, I'm so cozy in my bed and I don't want to get out of bed  framing, you know, reframing my thoughts of like, Oh, I don't want to get out of bed too.

Oh, what am I looking forward to today? What am I excited about? I'm also  just kind of raise my energy levels. Um, and then I have a morning meditation practice that I do. Um, it's essentially a Kriya yoga practice,  which is a breath work based type of yoga. And I also. You know, it's just a great reminder to think about.

Um,  things that are bigger than myself, um, having gratitude, feeling connected to a larger sense of purpose. And so that's really important for me in the morning just to get the day going.  Um, and then I go outside, um, after all of this, I go outside, bright sunlight. Um, I have this little flower garden on our deck, so I go look at the flowers and just see how they're doing and greet them, greet the day and kind of gaze out.

Love it. Outside. And so yeah, that's my morning routine. Amazing. Beautiful. Love that. And then what might we see visually in your environment? So on your nightstand or maybe if you're traveling, proverbial nightstand, so ambiance, gadgets, anything to be aware of in your space. Yeah, so I can get overwhelmed with clutter.

So I like to keep the bedroom clutter free And even my  nightstand Like and I have to be extra mindful of it because you know, we can just end up throwing that t shirt over there Yeah, you know just stuff can accumulate and um, so I try to keep our bedroom and then the nightstand, very free of clutter and minimal.

I do have a salt lamp on my nightstand. That's what I use for light. Um, so it's got this nice orange glow. Um, there may be a book there. If I'm so inclined to read something before bed, usually I  On the couch, but I feel like reading before bed. I may have a book, but it's really simple. Um, that's about it.

And then I've got my aura ring charger there as well. Sure. Yeah. Oh my goodness. Yeah. My husband, I were digital nomads for a bunch of years. So we became very minimalist.  So I love that and it is funny to out of the hundred and whatever people that have come on here. It's been interesting to hear the different approaches, but I think there's something to be said for that minimalist approach and that clean, you know, just that environment that's kind of Oasis like.

So that's amazing. Love it. And then the last question would be, what would you say has made the biggest change to how you're managing your sleep or said another way, maybe biggest aha moment in managing your own sleep? The biggest thing for me has been kind of what we talked about earlier, which is setting a cutoff time for work.

Yeah. Because I do struggle with that work creep, right? Let me just check that one email. Let me do that one more little task. Yeah. And what I noticed was that on my, or a ring, I was seeing that my HRV was decreasing. On those nights, even just objectively, I, I knew that I didn't feel as good the next day.

Um, when I was working on my computer late the night before. So that was been the, that's been the biggest aha for me is just setting a cutoff time. And actually the way that I do it now is that. I think in the morning, I think ahead to, okay, what do I have going on today and what's my cutoff time tonight?

It's, there's, it's usually the same each day, but sometimes there's different, you know, things that come up and your schedule's a bit different. So I'll think ahead of, okay, what's my cutoff time? And then I'll work backwards to plan my tasks accordingly. Oh, so good. It's wild how much of kind of time management can come into this topic of sleep.

And I think, you know, it might be like this nice afterthought or what have you, but it turns out for the consistency of the ability to fulfill on prioritizing this area, it becomes a big piece of it. So I love that. That's amazing. And I would also say, is there anything we forgot or left? out in this topic that is important to you to share?

Did we cover most things in this topic of sleep optimization, supporting people on their journey with their sleep, or the mission that you're out to accomplish? Anything we left out before we get into how people can follow you? Sure. I think the other thing is, so just a couple of quick things. Yeah. One is that we talked about CBTI cognitive behavioral therapy.

Yeah.  So that is the first line gold standard treatment for people struggling with chronic insomnia. So very, very effective. And it works in about 80 percent of people. But what about those 20 percent  of people or for people who maybe it just doesn't quite resonate with them? What else is effective? And so it has been shown that mind body practices.

So things like mindfulness based meditation, breath work, and yoga are effective. And there have been studies comparing these practices to CBTI, specifically mindfulness based, uh, practices. And they found that the outcomes are more or less. It's the same or at least very similar with long lasting durable effects over time.

So for people who are struggling, you, they can consider incorporating, learning some of these practices. I do recommend learning them with. Some guidance, whether it's with an app or a class, um, they can be very effective, but the important thing, the mistake that I often see people making is that they'll do their 10 minutes of headspace before they go to bed and it doesn't work.

They'll say, yeah, exactly. Mindfulness and it didn't work. Yeah, exactly. Throw it out. Yep. And it does. That's not how it works. It has to actually become a lifestyle.  So I encourage people to think about how can you build these practices into your day? So for mindfulness, a really great opportunity to practice mindfulness is when you're washing your hands,  or maybe you're washing dishes, because it's so sensory.

There's the temperature of the water, the feel of the water, the, the scent of the soap, right? The scent of the, or the, you know, the sounds that it's making. All of these things are an opportunity to practice mindfulness. So see how you can bring these moments into your day.  Same thing with breathing or even yoga.

Yoga doesn't have to mean you're twisting yourself up into a pretzel.  It can be as simple as. Um, doing a stretch. So a child's pose or even just lying on the floor. Um, and shove us in our corpse pose. Um, and doing a muscle relaxation and it doesn't have to take hours. You can even do it just for a few minutes in the middle of your work day.

So Thinking about how you can build in these little micro practices into your day to calm your nervous system. It's not only good for your sleep, but it's good for your overall health and your stress levels and your HRV and your blood pressure and all of these things. Absolutely. Oh, that's so important.

I love that you're also for the listener that they can something that they could begin to practice now and we're all doing the dishes, washing our hands and that can be a place to start. So, so good. And real quick, just tied on to that. For those people, there's certainly been many times where we hear from people saying, uh, well, I'd like to practice CBTI, but I don't have the money or I live in a rural area.

Are there like resources or steps or things that you suggest for people or apps or videos or anything that you would just throw out there? Absolutely. So there's lots of different ways to access CBTI. There are free apps available if you want to start with that. So there's two specific ones that were developed by the VA.

Um, one is called CBTI coach, the other is called insomnia coach, and those are totally free. Um, so that's a great place to start. There are CBTI programs in most hospitals, not most hospitals, but many hospitals will have some form of CBTI that's covered by insurance. Whether it's one on one with a therapist or it's with a group in a group setting.

Um, so you can look into your local resources. There's an online program called Dr. Lullaby. They take insurance and they offer CBTI all across the United States. Um, and then there's digital apps and digital CBTI delivery is as effective as doing it in person or one on one. And so there's apps like Sleepio.

is a big one. Um,  Somrist is another one. Um, so there's lots of resources and I, I think I even have a, a YouTube video on CBTI resources. So I can  share the link. Oh, that'd be great. We can put in the show notes. Perfect. Uh, so important. Wow. Okay. So for anyone listening that then is saying, all right, amazing.

And I want to learn more or I'm a practitioner and I'd like to go through the offerings that we had kind of alluded to. Can you just share what are some of the best ways for people to one, follow the work that you're doing and to participate in your programs? So people can find me on social media on Instagram at IntraBalance.

That is the platform that I use for teaching practitioners about sleep. Um, I also have an online program called the Clinical Sleep Kit for practitioners. So you can find more information on my IntraBalance  Instagram. Um, and then I also have a newsletter through IntraBalance that I send out weekly to practitioners.

So people can sign up for that. Um, as well, and then the other way is for people who want to work with my team one on one, I have a practice in California. It's called Pacific integrative psychiatry, and we see patients all across the state of California via telemedicine, and we help adults with anxiety, depression, burnout and sleep issues through an integrative and holistic lens.

So great, and sorry if you mentioned this, but I know you said the, you've done a lot of work with the YouTube offering. What was, uh, is that the same title for your YouTube, the Intrabalance as well? Yes, Intrabalance, yep, it's just at Intrabalance. We also have a YouTube for our Pacific Integrative Psychiatry, um, practice as well, and that's at Pacific Integrative Psych.

Nice. Okay. Amazing. We'll make sure of course to have all those in the show notes as well, but definitely for anyone listening, make sure to follow all of these options and be abreast of this information that is so important for us to get out into the world. So thank you so much for the work that you're doing and also just for taking the time to share your knowledge and, and also just sharing about how you're thinking about your own sleep.

I think it's so important All of us to also see that people are prioritizing this area, how they're thinking critically about it and making a lifestyle around this topic. So really, really important work. Really appreciate you. Oh, thank you so much for having me. Oh, thank you.  You've been listening to the sleep is a skill podcast, the top podcast for people who want to take their sleep.

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