How To Fight Sleep Issues And Improve Sleep Quality With Dr. Nishi Bhopal

How To Fight Sleep Issues And Improve Sleep Quality With Dr. Nishi Bhopal

OYM Nishi Bhopal, MD | Improve Sleep Quality

Fighting sleep issues isn’t as easy as counting sheep at night. As Dr. Nishi Bhopal, a board-certified in psychiatry and sleep medicine shares with Timothy J. Hayes, most of the time, what helps improve our sleep quality has more to do with our lifestyle during the day than what we do during nighttime. Dr. Nishi highlights 3 important elements that are integral in creating better quality sleep and also touches on the subject of using sleeping pills, their effects, what they do, and how they could actually do more harm than good. Find out how you can improve your quality of sleep at night by digging deeper into the factors that affect sleep.  

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How To Fight Sleep Issues And Improve Sleep Quality With Dr. Nishi Bhopal

Dr. Nishi Bhopal is a triple board-certified in psychiatry, sleep medicine and integrative holistic medicine. She graduated from the University College Cork School of Medicine, completed her psychiatric residency at Henry Ford Health System and a fellowship in Sleep Medicine at Harvard Medical School. She also received training through the Maharishi Ayurveda Association of America and the Integrative Psychiatry Institute. 

Dr. Bhopal, thank you for being here again. It’s a delight to have you back and I’m anxious to know about your Sleep Program and this specialty that you have within the integrative psychiatry practice that you do. 

Thank you for having me back. It’s a delight to be here. I’m excited to talk about one of my favorite subjects, which is sleep. 

Tell us about this. Did you say it’s a four-week program? 

Improving and enhancing sleep quality at night start during the day. Click To Tweet

Yes. I have a four-week online holistic sleep optimization program and it consists of four modules where I walk people through the different elements of their day to optimize sleep at night. Improving and enhancing your sleep quality at night does start during the day. 

I never would have thought of that. How is that? 

There are three prongs that I like to focus on when looking at sleep quality and when working on enhancing your sleep. These three things are the circadian rhythm, the sleep drive or also known as the homeostatic sleep drive, and also your mindset and nervous system. If you can get those three things into alignment, and getting those three things into alignment starts during the day, you’ll be well on your way to achieving good quality sleep. 

How do you assess things like the circadian rhythm? 

I’ll explain a little bit about the circadian rhythm. I find the circadian rhythm incredibly fascinating because it’s our connection to the planetary rhythms. Our circadian rhythm as humans is trained to or aligned with the day-night cycle or the light-dark cycle. It’s approximately 24 hours. The human circadian rhythm is slightly longer than 24 hours but when you line it up with the natural day-night cycle, it then becomes a 24-hour rhythm. A lot of people know about the circadian rhythm in relation to sleep. It helps to regulate our sleep-wake cycles, but it does much more than that. It also regulates our levels of alertness. It regulates hormone secretion and metabolism. When we get hungry, it also regulates our body temperature and so many other functions. Our brain has a little tiny clock in it, which is our master clock and that’s the line to the day-night cycle. All the cells in our body and the organs in our bodies have their own little clocks in them that keep things running on time. It keeps our body running on a schedule. 

What happens if one of my little tiny clocks is off a little bit from another one? Do I have a crisis internally? 

It’s not necessarily a crisis per se. How do you know if you have a circadian rhythm misalignment or issue? I don’t like to call them circadian rhythm disorders. In the DSM we call them delayed sleep phase disorder, shift work disorder and so forth. Some of us are slightly on the delayed side. We might be a little bit more of a night owl. Some of us are more on the advanced side where you might be a bit more of a morning lark as we call it. These are variations in the circadian rhythm.  

There are clock genes that determine this so there is a genetic and a social basis to this so your body clock is going to adapt somewhat to your daily social obligations, your work schedule, school schedule and so forth. There are ways however to tell if your circadian rhythm is misaligned. One way to tell that is if you’re having a lot of trouble falling asleep at night but once you fall asleep, you stay asleep through the night and it’s hard to wake up the next morning.  

We see this a lot in adolescents and young adults. That could be a sign that you have what we call delayed sleep phase syndrome. That’s a delayed body clock. On the other hand, if it’s hard to stay up at night and you’re falling asleep around 7:00, 8:00 or 9:00 PM and you’re waking up early, around 4:00 AM or sometimes even earlier, that could also be a sign that it’s a circadian rhythm issue. That would indicate something called advanced sleep phase syndrome. These are not necessarily disorders. They’re simply variations in your body clock. They become problematic when your body clock is misaligned with your social obligation. 

I have kids I have to attend to. They’re going to go to sleep at 8:00 or 9:00 PM and I want to fall asleep at 7:00 PM. That’s a social obligation that’s going to create a problem. With your work, have you discovered ways to help people shift whether they have an early or late alignment phase? How do you address that? 

OYM Nishi Bhopal, MD | Improve Sleep Quality
Improve Sleep Quality: Sleep deprivation become problematic when your body clock is misaligned with your social obligations.

The circadian rhythm is aligned with the day-night cycle or the light-dark cycle. You can use that to your advantage when you’re trying to shift your body clock. In my practice, I mostly see people who are on the delayed side. I work with a lot of young adults in their 20s and 30s. About 16% of adolescents have what we call delayed sleep phase syndrome but that can carry over into adulthood. I see a lot of these folks in my practice. What we do is leverage the power of light to line up their body clock with their work schedule and their work demands. 

How we do this is either by using bright natural light in the morning by going outside in a prescriptive way or we’ll use a sunrise alarm or a lightbox. There are devices that emit bright light that we can use to help to shift the circadian rhythm. On the nighttime end of things, we leverage the power of darkness. An environment of darkness helps to promote the body’s natural production of melatonin. Sometimes I will use exogenous low dose melatonin to help pull the sleep a little bit earlier, and then light to shift that sleep time earlier. It’s a way to shift that whole cycle.  

We’ll do this in a strategic way, gradually over time. The mistake that I see a lot of people are making is that if they’re on the delayed side and they’re naturally waking up let’s say at 9:00 or 10:00 AM, and they have to get up at 6:00 AM on a weekday for work. They will try to shift their schedule drastically or abruptly. What happens is it’s like pulling a rubber band, it snaps back in the opposite direction and it’s hard to maintain. I do it in a gradual, prescriptive, strategic way so that it’s sustainable. 

You’re working with a little melatonin to help them get to sleep a little earlier, the brightness to help make sure they wake up in the morning, and the darkness at night. The things that I’ve been trying to talk about is sleep hygiene. All of these different things related to preparing myself for sleep. The environment I’m going to be in, the sound, the light, what I’m going to put in my body in preparation for sleep so I’m not going to eat a great big meal and lay down. I’m assuming that in this four-week program you have, there are all kinds of aspects including that preparation for sleep at night. What do you do with somebody who can’t get to sleep and it’s 12:00, 1:00 and 2:00 at night? 

That is such a common issue. Sleep hygiene is important. Setting up your schedule in the evening is incredibly important to lay the foundation but what we do know is that sleep hygiene alone does not work. It’s not enough. This is where people start to get frustrated because they feel they’ve tried all the things, they’ve read all the articles online, they’ve done it and it hasn’t worked. This is where refocusing on those three prongs that I mentioned so circadian rhythm, sleep drive, but then the mindset and reducing the nervous system’s hyperarousal response is important. 

For that person who is going to bed and cannot fall asleep, what you want to do is get out of bed and don’t get back into the bed until you’re sleepy and tired. What happens is that when you’re in your bed awake, frustrated or tossing and turning, you’re training your brain to do that when you’re in the bed. Your brain starts to associate the bed with the place that you’re awake and alert. We want to break that association by getting out of bed and only getting back into bed when you are sleepy. How do you know when you’re sleepy? It’s when your eyes are heavy and your head is nodding. It’s hard to stay awake. That is when you want to get into bed if you are someone who is having trouble with sleep.  

The more you try to sleep, the more elusive sleep becomes. Click To Tweet

The second thing I would recommend for that person who’s struggling to fall asleep is to stop focusing on trying to sleep. I know this is easier said than done but the more we try to sleep, the more elusive sleep becomes. The harder it is to fall asleep because you’re reinforcing that hyperarousal response where you’re getting anxious and frustrated. What you want to do is instead of trying to sleep, shift your attention to relaxation. Do things that you find enjoyable. Maybe it’s watching a television show that you like or reading a book that you enjoy. Nothing too stimulating like the latest Stephen King novel or something that’s going to keep you up all night but something relaxing. Maybe you do some yoga, have a warm shower, something like that. It doesn’t necessarily matter exactly what the activity is as long as it’s not too stimulating. Shift your focus to something that’s relaxing rather than focusing on trying to sleep. 

That’s been a big thing with a lot of peopleIt’s like those people who decide they want to meditate. They’ve got this idea and they buy a program that tells them what to do to meditate, clear their thoughts and make sure no thoughts intrude. Every time a thought intrudes, they get furious and it’s counterproductive. The same thing happens if people say, “I’ve got to get to sleep. It’s 12:30. It’s 12:45. I’m never going to be able to get up for work in the morning.” That cycle of obsessive, anxious-inducing thought is itself the thing that will keep most people from slipping into that lovely thing we call sleep. 

The people who sleep well don’t think about it. If you sleep well, you already think about sleep, you’re not going online researching it. You’re not going on Facebook groups trying to figure out what’s going to work for you and what isn’t. I hesitate to use the terms good sleeper and bad sleeper because there’s no such thing. Everyone’s a good sleeper. We are all capable of sleeping. Our bodies want to sleep. It’s a physiological process that we all do and we all can do well. If you’re someone who has trouble sleeping, what often happens is that you’re thinking about it 24/7 and that feeds into the problem. 

What do you suggest for people like that? I have several in my caseload now whether they’re in their 40s or 70s. As you know because you specialize in this, when you’re dealing with somebody who’s having difficulty sleeping, they get to feel like this is panic-inducing. 

We want to start to break that panic response, that hyperarousal response. There are several ways to approach this. One is to start examining the thoughts that we’re having about sleep. This is part of the Cognitive Behavioral Therapy for Insomnia protocol or CBT-I protocol. It’s identifying what are the thoughts that you’re having about sleep. How are those thoughts serving you? How true are those thoughts? How can we reframe them? For example, many people believe that we have to get eight hours of solid sleep every night and if you’re not getting that, then you’re a bad sleeper. That’s simply not the case. Sleep varies from night to night. It’s normal to have some good nights and some bad nights. Some nights you get a little bit more and some nights you get a little bit less. That’s normal. Addressing those thoughts, deconstructing them and seeing how much validity there is to them is the first step. 

Along those lines, it’s important to understand how sleep works. For these folks who have trouble sleeping and who have developed a panic response around it, oftentimes what you’ll see is they’ll start spending more and more time in bed hoping that they’re going to get more sleep, and trying to get more sleep. They’ll go to bed 2 or 3 hours earlier than they normally would or they’ll stay in bed until the late hours in the morning as late as they can, hoping that they’re going to get a few hours here and there. That becomes counterproductive. It trains your brain to be awake in the bed. Another technique we use in CBT-I is called Sleep Restriction where we restrict the amount of time in bed closer to the amount of time that you’re sleeping to help increase what we call sleep efficiency. It’s the proportion of time you’re asleep while you’re in bed. 

OYM Nishi Bhopal, MD | Improve Sleep Quality
Improve Sleep Quality: Identify the trauma and be willing to work on resolving the effects of the trauma.

You’re going to use the Cognitive Behavioral protocol for inducing sleep. You’re going to work a little bit with melatonin but definitely with light. You mentioned breaking this cycle of panic-inducing thoughts that lead to this heightened neurologic state. There’s a lot of talk about hyperarousal and the amygdala. How common is it for you that when you begin working with peoplethey’re already taking these over the counter or prescription sleep aids and they’re still not sleeping? 

It’s incredibly common and this is what I see a lot of in my practice. People will come to me for sleep issues but they also want help in getting off of these sleeping pills. I’ll see people who are on prescription sleeping pills, things like Ambien or even benzodiazepines like Klonopin and Ativan that they take every night for sleep. They may even be taking over-the-counter sleeping pills like Tylenol PM or Benadryl-based products. It’s interesting because they’ll come with the complaint that they can’t sleep, yet they’re stuck on these pills.  

What we do know is sleeping pills are meant to be used short-term only. They’re not meant to be used for more than two weeks. They were never designed for long-term use. They should be used at the lowest doses possible for the shortest period of time required. It’s usually for acute situational stressors. Maybe if someone is going through a tough time, they’re going through a loss of a job, a divorce or something like that, they may need a little bit of support from a sleeping pill.  

What happens long-term is that these pills can start to cause what we call tolerance. It stopped working and you need higher doses to get an effect from it. They can also cause rebound insomnia. When you try to stop the pill, insomnia gets worse. What people often attribute this to is saying, “I can’t sleep without the pill.” They’re thinking that they need the pill to sleep but what’s happening is that it’s rebound insomnia. Tapering it off slowly, while implementing some of these other strategies that I mentioned will help the person be able to restore their sleep naturally and sleep better without medication. 

That’s the goal. There are a number of people that end up walking into my office who are already on 2, 3, 4 or 5 medications. What I say to them is, “That’s good if the medications are helping you. If they’re helping you so much, why do you need therapy?” What comes out is the medications may have worked for a little bit early on in taking them and now they’re not working. Maybe they’ve increased the dose 2 or 3 times and now it’s not working again. Hopefully, you’re going to branch out and do more than just sleep. You’re going to have a program for this and the other thing. Let’s come back to your sleep program. We’rgetting to sleep a little earlier gradually. Making sure that I wake up watching the light, watching the obsessive thoughts and focusing more on relaxation as a goal rather than focusing on, “I have to sleep.” What else is in this program? What other kinds of factors do you direct people to look at or work with? 

Another thing that I recommend people look at is the underlying cause or causes for sleep issues because this is often forgotten or missed as well. All of these things that I mentioned, circadian rhythm, sleep drive and hyperarousal, it’s important to address those three things. If there’s something that’s contributing to the underlying sleep issue, just focusing on those three things isn’t going to be enough. Examples of underlying causes would be things obstructive sleep apnea. This is commonly seen in the psychotherapist’s office or the psychiatrist’s office because about 20% of people with depression have obstructive sleep apnea.  

It’s important that if you’re a healthcare provider in the mental health space, that you’re screening your patients for this or have been talking to their doctor about it. Signs of obstructive sleep apnea would be things like snoring, waking up gasping or choking at night, your partner might notice that sometimes you stop breathing at night or you wake up with a little choke or little snorts. Sometimes waking up with a dry mouth or a headache, feeling excessively sleepy during the day, tired or feeling unrefreshed in the morning. Also having trouble falling asleep and maintaining sleep can be signs of sleep apnea.  

I’ve had a lot of people whose experience is they sleep a lot and yet they’re always tired. That’s one of the things I tell them, “You should check this out.” Unfortunately for a lot of people, they get prescribed a CPAP machine and they’ve got all kinds of problems with it. They’re like, “I can’t have that thing on my face. It’s too noisy,” or whatever. What do you prescribe for people or how do you help people who might have obstructive sleep apnea if they can’t tolerate the CPAP machines? 

It’s a common problem because who wants to sleep with a mask on their face and being hooked up to a machine? Many people do find CPAP to be life-changing. When you get the right mask, pressure, settings, humidity and all of that stuff, it’s like day and night. No pun intended, but they can be life-changing for people. What I recommend to people is that if you have a CPAP machine and you’re not comfortable with it, don’t be afraid to go talk to your doctor about trying different masks. You can go to the clinic. You can do mask fittings. You can find the configuration. Talk to them about your settings. There are different ways you can play around with the settings that have to be prescribed by your doctor. They can make adjustments to that to make it as comfortable as possible for you.  

You need to experience a sense of safety in order to fall asleep. Click To Tweet

Finding the mask is like finding a well-fitting pair of shoes. It might feel comfortable in the store but then when you start wearing them outside and walking around, you might realize, “They’re pinching in the heel or my toes are pressing up against the front,” or whatever. You may have not noticed that when you’re in the store so finding a mask is like that. It might feel okay during that one overnight sleep study or whatnot. When you start using it at home, you might realize it’s not quite the right fit so don’t be afraid to troubleshoot that.  

There are other ways to address sleep apnea beyond CPAPs. There are things called oral appliances or dental devices, which are calibrated by a dentist that gently pull the jaw forward so it opens up the airway space and that can help with sleep apnea. That’s something to consider as well. Sometimes it’s weight-related. Working on a weight loss plan, while you’re using a CPAP machine or an oral appliance could be a long-term solution as well. If there are significant obstructions in the airway, sometimes those can be treated surgically. 

I know a number of people who have had a weight reduction and that’s the solution for them. They learned they have to keep their weight below a certain level or the extra weight is enough to bring on that disruptive snoring pattern or the sleep apnea. I’ve had several people who’ve had good results with the dental appliance and several people who haven’t. You have to keep working with something until you find something that will work for you. A couple of people went to a dentist who specializes in this. They got measured, they bring the thing home and they’re using it and it’s too painful for whatever reason. Whether it’s a mental issue or there’s physical pain, they’ve gone back for several fittings and it doesn’t work. It’s good to hear you say there are these other options and that you can go back and retry the multiple attempts at a mask and adjusting settings with your prescribing doctor for the CPAP machine. What level of psychological involvement, if any, do you find with people who are having sleep problems? 

In my practice, I’m a psychiatrist so I see people who have anxiety, depression and other psychiatric conditions as well. There is a bidirectional relationship between mood disorders and sleep disorders. We know that when people have anxiety and depression, they’re at a higher risk of having sleep disorders. There are many different sleep disorders, we’re talking a lot about insomnia but there are other sleep disorders as well. Hypersomnia is another condition we see with depression. When we’re looking at insomnia, specifically, we see that there’s a high prevalence of insomnia in patients who have anxiety and depression but also vice versa. When people have insomnia, even if they don’t have underlying anxiety or depression, they’re more likely to develop anxiety or depression down the line if the sleep issue is left untreated. I’ll mention that people who have insomnia are more than twice as likely to develop an anxiety disorder. 

You said that there’s that bidirectional relationship. I’ve had a number of people who had a trauma-based anxiety issue and it was devastating to their sleep. It had been for either months or years. The only solution was to identify and help them resolve the effects of past trauma. Lo and behold, the natural system takes over and it’s okay to sleep again. There was one person who had this absolute belief that if they fell asleep, they weren’t going to wake up. It came seemingly out of nowhere after years of being a relatively good sleeper. Until they uncovered what was the root of that false belief that was feeding this terror, there was no solution in all of the sleep aids and the drugs that were going to get them past that. They had to identify the trauma and be willing to work on resolving the effects of that trauma. 

That’s such an important point because you need to experience a sense of safety to fall asleep. Our bodies have evolved to have this hyperarousal response that we’ve been speaking about. It’s a safety mechanism. Way back when, when we were living out in the forest or whatnot, our bodies evolved to respond to sound or changes in the environment and external threats or potential threats by waking up at night. That’s what kept us safe. If there was any perceived stressor, that would keep us up all night. That’s how the brain has evolved. Even if there isn’t an immediate external threat or stressor, our brain still follows that pattern of staying awake when you don’t experience a sense of safety or if you experience your environment as unsafe. That’s how trauma feeds into this perpetuating cycle of insomnia. 

It can be debilitating. I remember working with one woman. The pattern began when she had read about sudden infant death syndrome. Within a few weeks of hearing about that and having her child, she walked in and found her baby blue from oxygen depletion and went into a panic. Fortunately, her baby survived and everything worked out. After that, she developed the pattern of if the baby was sleeping, she had to be awake. If the baby was awake and somebody else was with the baby then she could sleep. Here’s the kid 3, 4, 5 years old and we’re past the point where sudden infant death syndrome might be an issue, she still has a disruption in her sleep problems. Until she got at the root of that and did some trauma work around it, she wasn’t able to sleep. 

That is such a terrifying thing. I can’t imagine how scary that must have been for her. You have to get to the root cause of the sleep issue whether it’s trauma or some other condition. That’s why the sleeping pills don’t work long-term because they don’t get to the root cause. They’re sedating without providing any long-term relief or providing any long-term solution. That’s also why when people stop these pills, the sleeping issues come back because you haven’t addressed the root cause in the first place. 

That and the rebound because the brain is trying to work to reach homeostasis and when you pull that very strong and active substance out, your brain’s got to compensate in some way. That rebound effect can mean you might have to go off of it very slowly, and then you’ve got to find out what the original cause of the disruption was. 

When I’m helping people taper off of these sleeping pills, sometimes it will take a year to taper off. There’s no rush, especially if people have been taking them for a long time. I’ll have patients come to me who have been taking something like Clonazepam or Klonopin for ten years. They’ve also developed this belief that they need it to function and sleep. Part of the process of tapering is unraveling and untangling those thoughts associated with the medication. I’ll have patients take 6 to 12 months, sometimes even a little bit longer to taper off. We’ll do it very slowly and gradually, almost to the point where they don’t even notice it while we’re implementing all of these other strategies. Inevitably, what people tell me is that after they’ve tapered off and been off for a few weeks or a few months is that they have more energy, they feel less anxious, they’re sleeping better, they feel they’ve gotten their lives back and they’re functioning better. This is what I hear almost every single time after tapering someone off these types of medications. 

It’s rewarding when you can hear that from somebody. All of a sudden, I was thinking about the gut biome and whether or not how powerful that is to interact with the hormone system and the endocrine system, etc. Do you do any work with that? I know as an integrative psychiatrist, it’s all open possibility. Do you find a lot of connection between the gut biome and the hormone cycle with sleep disruption? 

OYM Nishi Bhopal, MD | Improve Sleep Quality
Improve Sleep Quality: Our bodies evolve to respond to sound or changes in the environment.

This area I find so fascinating and there’s emerging research coming out on the link between the gut microbiome, sleep and the circadian rhythm. We know that when people have sleep apnea, they show signs of dysbiosis or alterations in the gut microbiome. Maybe not dysbiosis per se but we know that there’s a difference in the composition of their gut microbiome. One thing I talked to all of my patients about whether or not they have sleep issues is gut health and nutrition, and with sleep specifically. It’s shown that diets that are high in fat and high in sugar are associated with more awakenings at night and less restorative sleep versus diets that are high in fiber, which of course are good for the gut microbiome. High fiber diets are shown to improve sleep duration, sleep quality, and also help to restore that slow-wave deep sleep stage that’s important for restoration and brain health. There is a link between the two.  

It’s interesting because I was looking at some of the research for another project that I’m doing on the gut microbiome and sleep. There’s a study that showed increased diversity in the microbiome is associated with increased sleep efficiency and total sleep time. This is an early area of research so we need a lot more studies to fully understand the implications of this but it’s interesting. One of the reasons they think that this is the case is because the microbiome or the bacteria in the gut produce by-products including short-chain fatty acids. These byproducts help to reduce inflammation but they also influenced the clock genes or the circadian rhythm genes. There is an interaction between the gut microbiome composition and our internal body clock. That’s fascinating and it’s also been shown that people who have dysbiosis are more likely to exhibit signs of sleep fragmentation and short sleep patterns. 

What is dysbiosis? 

You can think of it as an overgrowth of unhealthy bacteria in the guts. When you think about the microbiome, you want to think about a lush rainforest where you’ve got lots of diversity. There are different species in the rainforest. You’ve got different plants, trees and animals. You want to think of your gut microbiome in that way. You don’t want a Saharan Desert where it’s homogenous. When there’s dysbiosis, there are too much of usually 1 or 2 strains that take over and it reduces that microbial diversity. That’s shown to have multiple downstream effects on sleep but other health-related conditions. 

Eating healthy should feel nourishing and not stressful. Click To Tweet

What’s the standard way to address dysbiosis? Do you work with prebiotics and probiotics? Do you vary the diet and decreased sugar? 

I usually go back to basics and start with diet. Nutritional assessment as part of my standard practice with my patients whether or not they have sleep issues or maybe they’re coming to me for anxiety or depression. It’s getting a good sense of what the person is eating, incorporating more fruits and vegetables. One simple way to increase the diversity of your microbiome is to increase the diversity of the plants that you’re consuming.  

It’s simply eating different kinds of fruits and vegetables of different colors. Making sure there’s a wide variety in your diet across the week is important. Also increasing your intake of fiber and healthy fats. Sources of fiber would include these fruits and vegetables but also whole grains so things like millet, oats, barley, quinoa, brown rice, things like that. Increasing your intake of healthy fats is important as well. The food sources of that would be things like nuts and seeds, walnuts, pumpkin seeds and almonds. Avocados are also a great source of healthy fats.  

It’s focusing on a diverse diet. A lot of my patients will focus on trying to eat everything in one day and it becomes overwhelming and they bounce back. What I tell people is don’t worry about getting every single item in this list that I mentioned into your diet every single day. Think about it over the course of a week. When do you want to incorporate these fruits and vegetables and healthy fats? Have fun and play with them? It should feel nourishing and not stressful. 

If somebody wants to find out more about this or get access to you and your four-week program, how can they do that? 

I have a YouTube channel that I recommend to everyone. If you want to learn more about this, I share a lot of information about gut health, diet, nutrition, sleep and mental health there. My YouTube channel can be found under IntraBalance. My four-week program is closed for registration but I will be opening it up again. I have some other smaller programs in the works for people who maybe aren’t ready to commit to four full weeks. I’ve got some smaller offerings in the pipeline. 

I greatly appreciate your willingness to come back and share with us about this progress. I look forward to hearing more as you move forward and other programs you might develop. 

Thank you. 

OYM Nishi Bhopal, MD | Improve Sleep Quality
Improve Sleep Quality: Sleeping pills don’t work long term because they don’t get to the root cause of the problem.

You’re welcome and deserving. Thank you for sharing with us. I’ll be in touch as I stay plugged into your YouTube channel and see what you develop. 

It’s my pleasure. Thank you for having me. 

Take care. 

Dr. Nishi Bhopal is a triple board-certified in psychiatry, sleep medicine and integrative holistic medicine. She graduated from the University College Cork School of Medicine, completed her psychiatric residency at Henry Ford Health System and a fellowship in Sleep Medicine at Harvard Medical School. She also received training through the Maharishi Ayurveda Association of America and the Integrative Psychiatry Institute.  

Having grown up in an Indian family in Canada and lived in several different countries, Dr. Bhopal understands what it means to be multicultural and is attuned to the unique challenges faced by immigrants and expats. She’s also a meditator and brings her experiences with yoga and meditation into clinical practice, blending the best of ancient wisdom and modern medicine. Dr. Bhopal is the Founder of IntraBalance Integrative Psychiatry & Sleep in San Francisco and is a founding member of the Same Here Psych Alliance, a global initiative to reduce the stigma around mental health. Her passion is making mental wellness and the science of sleep easy to understand and accessible to all. Her website is IntraBalance.com 

Important links: 

About Nishi Bhopal, MD

OYM Nishi Bhopal, MD | Improve Sleep QualityDr. Bhopal is triple board certified in Psychiatry, Sleep Medicine, and Integrative Holistic Medicine. She graduated from the University College Cork School of Medicine, completed her Psychiatric residency at Henry Ford Health System, and a fellowship in Sleep Medicine at Harvard Medical School. She has also received training through the Maharishi Ayurveda Association of America and the Integrative Psychiatry Institute.

Having grown up in an Indian family in Canada and lived in several different countries, Dr. Bhopal understands what it means to be multicultural and is attuned to the unique challenges faced by immigrants and expats. She’s also a meditator and brings her experiences with yoga and meditation into clinical practice, blending the best of ancient wisdom and modern medicine.

Dr. Bhopal is the founder of IntraBalance Integrative Psychiatry & Sleep in San Francisco and is a founding member of the SameHere Psych Alliance, a global initiative to reduce the stigma around mental health. Her passion is making mental wellness and the science of sleep easy to understand and accessible to all.

Website: www.intrabalance.com

Free holistic sleep guide: https://www.intrabalance.com/sleepguide
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