[00:00:00] Dr. Jessica Singh: Welcome to the Holistic Physician Coaching Podcast. I'm your host, Dr. Jessica Singh. This podcast explores physician health, wellbeing, and fulfillment, embracing all aspects of the human experience. Just as in medicine where a single interaction can transform a life, this podcast is grounded on the belief that each coaching conversation has the power to inspire, heal, and bring about meaningful change. 

[00:00:35] Dr. Nishi Bhopal is board certified in psychiatry, sleep medicine, and integrative holistic medicine. She's the founder and medical director of Pacific Integrative Psychiatry, an online practice where patients receive a whole person approach to anxiety and insomnia, including sleep coaching and integrative psychiatry.

[00:00:58] In addition to her private practice, Dr. Bhopal is the founder of IntraBalance, an educational platform that includes a YouTube channel and online courses on integrative sleep medicine for healthcare practitioners, her passion is making sleep, easy to understand and acceptable to all. Welcome so much Nishi.

[00:01:19] Dr. Nishi Bhopal: Thank you so much for having me.

[00:01:21] Dr. Jessica Singh: It is such a gift to be here with you and to talk about sleep health, especially in a context of physicians and our schedules and residency, and also motherhood. And so to begin, I'd love to just begin by asking, can you share what led you into psychiatry, sleep medicine, and ultimately integrative holistic medicine?

[00:01:44] Dr. Nishi Bhopal: Yeah. Well, thank you so much for having me and opening up this conversation because I think it's an area that we don't talk about enough in medicine. So how I got into sleep medicine was accidental. I didn't know that sleep medicine was a specialty when I went into medical school and even residency.

[00:02:03] And I actually started my residency in internal medicine (IM) and I did my medical school training in Ireland and I came to the US for my residency in IM, and I quickly started to realize that it wasn't quite the right fit for me. It was different than what I had expected. The medical system in Ireland, Europe, I grew up in Canada, like it's just a little different. So I got into my IM residency and I got burned out pretty quickly and I was always interested in psychiatry. That was like the other specialty I was considering. And I decided after a couple months in my intern year that I wanted to switch into psych.

[00:02:41] So I ended up switching into a psychiatry residency. And so for any residents who are listening, it's possible to pivot, right? Like you're not stuck. And I think that's just a really important point for people to realize, or even as you progress in your career, we're not stuck as physicians.

[00:02:57] So I ended up switching and during that time, one of my senior residents was going into a sleep fellowship. She was an IM resident, and I didn't know that was a thing. I was like, "Oh! That's interesting. Tell me about that. What's that all about?" And it turned out that where I was doing my residency at Henry Ford Hospital in Detroit, Michigan, they have quite a well established, world renowned sleep center. And I started doing rotations with them. I did some electives and I really loved it because sleep is really the intersection of psychology, psychiatry, medicine, pulmonary neurology. It's truly like a bio-psychosocial sort of specialty. And it was just a great fit for me. I just loved it. And I also struggled with my own sleep issues going into residency, during my training, we can talk about that as well. And so for me it was just this area of medicine that I thought was really fascinating and is truly the foundation of health because in my psych residency I was seeing lots of patients with sleep issues, like, you know, up to about like 90% of patients that you're gonna see in the psych clinic are gonna be struggling with sleep in some form at some point and I felt like I wasn't getting a good foundation, how to really help them more holistically. So I ended up doing my sleep fellowship after my psych residency and here we are. And so now I have a whole platform teaching sleep medicine to clinicians.

[00:04:15] Dr. Jessica Singh: I love the fact that it was guided by your own desire to wanna practice medicine in a way that holistically aligned with your values. Also sounds like it was there to help with what you went through in residency and to help your patients. What do you find were some of the most important gaps that were filled by your fellowship or what we aren't taught well enough in medical school?

[00:04:35] Dr. Nishi Bhopal: Yeah, so you know, most medical schools only provide about an hour or two of sleep education in training, and even thinking back to when I was doing my IM residency, well, I only did my intern year in Im, but I remember getting one lecture on like obstructive sleep apnea and one lecture on obesity hypoventilation. And then in my psychiatry residency, I think we got like a lecture on restless leg syndrome, one on obstructive sleep apnea, and then a lot of like training on psychopharmacology for insomnia and a little bit of CBTI. And that was basically it.

[00:05:12] An elective in sleep medicine, most of that is going to be focused on obstructive sleep apnea. And you'll get some exposure to insomnia, CBTI, maybe parasomnias, hypersomnia and things like that show up. There's a little bit of training on that. But what I have found through my clinical education work, 'cause I do a lot of ground rounds for different residency programs, I have my own platform where I teach; I teach inside some integrative psychiatry and in integrative medicine programs. What I've found is that most clinicians aren't getting a good foundation in how sleep works. So even basic things like the two process model, process C and process S, that's essentially how we fall asleep. A lot of physicians are not getting trained in just those basic mechanics of sleep.

[00:05:55] Sleep is much more than insomnia and sleep apnea and depending on what framework you use or what classification system you use, there's over 80 different sleep disorders. So there's so much more, and even in my fellowship, I feel like we barely scratched the surface.

[00:06:10] Like I'm still learning. I'm over a decade out of fellowship now and I'm still learning. And even through a holistic lens, a lot of that work is additional coursework that I did after my training.

[00:06:21] Jessica Singh: I can't even imagine because there's also, on top of this education gap, this feeling of when you're in medical school, in residency or fellowship, at least from the point of a physician is " what control do I have over this? I have to work I regular hours or I have to be on call, or I have to work night shifts."

[00:06:38] And as you know in certain specialties that doesn't end after training. It just continues. And so I am so curious if you have any advice or how you've seen, been able to help people manage that.

[00:06:51] Dr. Nishi Bhopal: Yeah, I think that's a really important point. So I think about it in terms of like medical training and then after your medical training. So when you're in training, so when you're in medical school, residency, fellowship, we really don't have a lot of control over those schedules. And that's something that I really struggled with. I remember being in my IM intern year and coming off like a weekend call and then going in for rounds, waking up at 4:30 AM or 5:00 AM whatever it was, and feeling so bone tired like I was just sobbing in the shower just from sheer exhaustion. And these are the things that we don't have a lot of control over. Like we just have to go with that schedule. After training then we might have a little bit more agency over it, but it can still be a struggle.

[00:07:37] There are some things though, that we can do to mitigate the impact of shift work 'cause essentially shift work is working a non-traditional schedule that's misaligned with your body clock. But I think one of the distinguishing features with medical residency and training is that we're not just dealing with shift work, we're also dealing with chronic sleep deprivation because our sleep hours aren't really protected in training.

[00:08:02] So we've got like a double whammy, the circadian dysregulation and then the sleep deprivation aspect. In terms of just overall health impacts of shift work, there are long-term impacts. We know that there's a higher risk of accidents. So even things like you think about like the Exxon Valdez oil spill or the Challenger explosion, for anyone who remembers that. Those were caused by sleep deprivation in shift work. So there are very significant impacts, not only on the individual, but public health, workplace accidents, safety. There is a higher risk of cardiometabolic disease, cardiovascular disease, cancer. I think there's like a 20 to 35% increased risk in those various diseases.

[00:08:48] So it's not just about being tired, but there are real significant downstream impacts. So what can we do about that? Yeah.

[00:08:56] So what we can do about that is one, if you do have control over your schedule, so if you're an attending and you have some control over your schedule, then one, just take a moment to assess how it's impacting you. This is actually something I talk to my brother about a lot because he's a neonatologist. He works in the nicu. So he's years out of fellowship training as well, and he's still doing these long, crazy shifts and I see the toll it's taking on him now in his forties. And so we talk about this a lot. "Like, what can you do about this? And is this something that's gonna be sustainable for you long term?" For me, I design my schedule in such a way that I don't do those types of shifts anymore 'cause I know they. They don't align for me, like I don't feel well. So I'll sometimes even write, like if I'm working with a physician or someone in healthcare or someone who does shifts and I can see the tolts having on them from a physical or mental health standpoint, I'll sometimes even write them medical notes saying that they should not be doing shifts.

[00:09:52] So that's one thing to consider, but if you can't do that, then forward rotating shifts are healthier. They can help you adjust better. What that means is that instead of like going back and forth with like different schedules, trying to make it so that your shifts are just going later and later kind of around the clock when you're in residency, you don't have a lot of control over that. So other things you can do are using bright light therapy. So what that looks like is you can use a bright light therapy device before your shift and stain bright light during your shift. So you could use a visor, you could use a light therapy box and then just make sure you're staying in bright light during your shift.

[00:10:30] And then when you're off your shift, dark glasses when you are done and when you're driving home, when you get home. Strategic napping is also a useful tool and so studies do show that a two hour nap can increase vigilance. And that's been compared to sleep hygiene. So sleep hygiene education is actually not that helpful for shift work. But taking that strategic two hour nap before your shift is helpful.

[00:10:52] You can also use caffeine. So the caf nap or the cap, the nap pacino where you're using caffeine before your shift or during your shift. All of those things can help.

[00:11:04] Dr. Jessica Singh: It is such great advice. When you said you were bone tired, I had a visceral reaction. It brought up so many memories and it's wonderful that you're able to share this insight so that way we can help advocate for ourselves. I still feel like someone could put a huge sign to medical administrators in the way they're designing shift work because it's a system that is designing these shifts the way they are, and essentially making it not sustainable for those.

[00:11:30] There's more and more research coming out right about a lack of health protection that physicians get over others. And so it's important to know that it's a hard reality to swallow as a physician, right? Because we go through all of this and then there's this you put on this face, this professional face to show up to work, put the patient first.

[00:11:47] If you do all of these things, it's hard to accept that just inherently we might get sick by our own lifestyle that's imposed on us from the system that we are giving our lives for. And it's a really hard reality to swallow.

[00:12:01] Dr. Nishi Bhopal: Yes. 

[00:12:01] And I think that's such a great point. And also when we look back to how was this system designed in the first place? It was designed by somebody who, in the 1800s was using cocaine to stay awake. Right. William Halsted. And he was using drugs and that's how he was doing these really long shifts. And so the culture of medicine that we have stems from that person's experience. That's where it comes from. And so it really is a cultural thing. And so I think you've hit on something really important, which is shifting that culture of medical training, like that is the secret ingredient and making protected sleep mandatory and really understanding the importance of that. Because at the end of the day, it's about patient safety, right? So if you've got a doctor who is sleep deprived and is more prone to medical errors, that's gonna have an effect on outcomes and for them too.

[00:12:54] Like I remember like in sleep fellowship we used to go to the sleep lab once a month and we would do an overnight shift in the lab. So we'll be in the clinic during the day and then we'll go to the lab at night and we'll be there with the techs. And it was great training, great experience 'cause we got to be there in the trenches with the techs, with our attending all the fellows, like doing titrations and managing complex sleep apnea and all these things. It was a great training, but this was what, like 24 hours of work, right? And we were driving home, we'd all carpooled together, all of us fellows. 'cause the lab that we went to for this was about 20 minutes away from our main hospital. And we all fell asleep in the car, including the driver. And it was a really close call and we were the sleep fellows driving home and thankfully nothing happened.

[00:13:35] My co-fellow woke up in time and we were all just like, oh my God. Like this is so dangerous. But it's just baked into the culture and what could we do? Like if you're an attending and you are in a leadership role are there ways that you can keep your people safe by protecting sleep?

[00:13:53] Dr. Jessica Singh: If we were in a live room right now, and I know with all the talks you give, you ask the question, how many people know a physician who's fallen asleep or got into an accident from sleep deprivation? I bet you have a room full of hands. Yeah. It's interesting that you brought up cocaine because obviously drug use is an issue in medicine, and arguably some substances are more higher abused in medicine compared to other fields. But what's not commonly taught about in such common part of culture is using Benadryl or drinking alcohol to go to sleep or having, like you mentioned, caffeine or Adderall or certain things.

[00:14:27] And so I think there's also a lot of lack of education too in these common sleep aids or staying up aids that I'm sure you learned a lot more about in your fellowship as well.

[00:14:38] Dr. Nishi Bhopal: Yeah. 

[00:14:39] Okay. So I think that's a really great topic to explore. And the first thing I would say there is, what are you trying to treat with that? So shift work is one area and there is a role sometimes for like, for caffeine sometimes for melatonin or sleep aids or wake enhancing agents like stimulants or modafinil, things like that for shift work sleep disorder. But even those aren't shown to be not as effective as the strategic napping, the bright light therapy, the protected sleep time, the rotating shifts and things like that. But But I see those agents be used a lot for insomnia as well. So even outside of shift work for someone who's working like a standard schedule that's aligned with their circadian rhythm. So the question is what are you trying to treat? Because one of the gaps that I see in sleep treatment in medicine is we often skip the workup. An analogy that I use is like, if you're treating someone for a fever, the patient comes to you with a fever, you're not just gonna say like, here, try this Tylenol and see if that helps. And then come back for a follow up, you're gonna try to figure out what's driving that. Like what's going on? Is this viral infection? Is this bacterial infection? Like what is happening here? And you might use the Tylenol as a supportive treatment, but you're gonna do a workup to see what's going on.

[00:15:52] But for some reason, with sleep issues, I see that workup often skipped. So the patient comes in with trouble falling asleep, staying asleep, waking up too early, and now they're prescribed a treatment, whether it's something OTC, like your, Benadryl, your diphenhydramine, or your prescription Z drug or Trazodone, or maybe that you're recommending a supplement or something like that. And the workup is missed.

[00:16:17] Going back to what I was saying earlier, there's so many different sleep disorder. So this could be sleep apnea, it could be restless leg syndrome, it could be a circadian rhythm misalignment, it could be a shift work issue, it could be hormonal fluctuations. It could be a normal variant depending on what that patient is experiencing. So there's so many things that we have to consider. And then you mentioned other substances like alcohol, which is a sleep disruptor, and so it might help people fall asleep initially, but then over the night, it causes more (rapid eye movement) REM disruption more difficulty with sleep, maintenance, fatigue the next day. So now the patient or the person might be using more caffeine to get through the day 'cause they're hung over when they can't sleep at night, and it becomes a vicious cycle. But what I would really encourage people to do and to take away from this is if you do one thing, just take a step back and ask: why is this patient not sleeping? Or why am I not sleeping (if you're the one who's struggling)?

[00:17:10] Dr. Jessica Singh: As such great advice and a really humble reminder for everyone.

[00:17:14] One of the things I also appreciate about the advice, and I would not recommend this to anybody listening, but when I was a resident, we would drink coffee, whatever it was. There were times where my heart rate would be in the one forties, one fifties, and I just refused to get checked out. I didn't wanna take the time off of work. I was like, they're gonna look at me. I'm a South Asian female. They're gonna, I know what the workup's gonna be. I don't even wanna go there. But I spoke with one of my friends who is in, I don't know what year of his surgical residency, and he just casually mentioned he didn't do caffeine.

[00:17:40] And I was like, if he's not doing caffeine and working 80 to a hundred plus hours a week, maybe I don't have to either. And so I, I don't know if you've seen this or if there's like evidence basis for this. All I have is an N of one, but somewhere in my third year of residency I stopped drinking caffeine, switched it for water, and not sugary beverages, but more natural beverages. And I also, even though my shifts were at night, they're swing shifts. They're all over the place. As you remember, I aligned my dietary habits with the sun. So like if it was a night shift, eating before night shift and eating enough so I wouldn't munch during night shift and then eating breakfast, and I felt like, I wish, it seems simple and again, I don't know the evidence basis or the studies for this.

[00:18:24] I know you know so much about circadian rhythm and rhythm disruption, and I'm wondering if you've seen that with shift work, if you can try to align as much as possible to the natural rhythm, It helps bring balance even if the system is disrupting the balance.

[00:18:38] Dr. Nishi Bhopal: Yeah. Okay. I love that. And it's that's a very like, Ayurvedic approach, right? So for anyone who's not familiar, like Ayurveda is a traditional system of healing from India, and it's very much about aligning with the sun and the day/night cycle.

[00:18:52] So you hit on a few things there. I think one is minimizing sleep disruptors. So caffeine can be a useful tool, but if it's causing tachycardia, if it's making you anxious and feeling wired and jittery, then yeah, it's probably a good idea to take a break from that and or at least scale down. So it really comes down to tuning into your body. Listening to what your body is telling you 'cause it's telling you what you need. So that's one: minimizing sleep disruptors.

[00:19:20] When it comes to food, one of the really unfortunate things is that in hospitals at night you usually don't have very healthy food options. Like when I was doing my training, the only thing open at night was Little Caesars.

[00:19:32] And so like all you could get was like a greasy cheese pizza and crazy bread. And you okay? Like it tastes really good at like two o'clock in the morning when you're hungry and you're working these long shifts, but metabolically it is not good for you that fat load, that carbohydrate load and it's gonna cause a crash.

[00:19:50] So the more that you can incorporate unprocessed foods foods that are nourishing for your system, even bringing food with you, and then aligning the timing to whatever works for you as well. Some people need to eat during their shift to keep their energy levels up and keep going. So focusing on that fiber, that protein intake, but for other people eating it before the shift gives them more energy.

[00:20:14] So there's no one size fits all approach to this. I'm really an advocate of tuning into yourself and experimenting. You don't have to, we don't have to fall into patterns of perfectionism, like experiment, try different things and see what works for you.

[00:20:27] Dr. Jessica Singh: That's such a beautiful reminder because then it allows everyone to just accept what is, without trying to feel like they have to do something perfectly. My next question is, so you've gone over shift work, challenges that doctors face and how they can help each other or how we can help ourselves. For physician moms, I'll start with what are things that we aren't really taught about pregnancy and sleep health?

[00:20:50] Dr. Nishi Bhopal: Yeah. Okay, great. Another thing I'll just add about shift work is that Dr. Allison Kole, she is a sleep doctor and my friend who's the host of Sleep is my Waking Passion podcast.

[00:21:01] She came on my YouTube channel and she did a whole lecture on shift work for healthcare practitioners. She is someone who used to be an ICU doc and because of her own burnout working shifts, she ended up leaving and changing her career, like pivoting in her career. She still does sleep in a different way.

[00:21:18] So if you want a deeper dive into shift work, I highly recommend checking out that lecture that she has on my YouTube channel, and I can send you the link, Jessica, and then you can post that.

[00:21:27] Dr. Jessica Singh: Yeah, I would love to share that. And for anyone listening to this, just look at the show notes and you'll find a link to all the resources that Nishi is mentioning.

[00:21:34] Dr. Nishi Bhopal: Great. Okay, so pregnancy and postpartum. So I think one thing that's important to note is that pregnancy changes your sleep physiology, right? In very significant ways. And when I'm working with patients who are early in their pregnancy, like they're in their first trimester, we have to normalize the fatigue because I think we live in a culture where we're expected to be on all the time, no matter what season of life you're in. And nature just does not work that way. And so working with your system rather than against your system is really important, especially during pregnancy.

[00:22:10] We also need to remember that some sleep disorders are more common during pregnancy, like restless leg syndrome and obstructive sleep apnea. You don't have to live with those. Like those are treatable. So if you do notice that you're having those types of symptoms, now with all the online sleep clinics that are out there it's just much more easy to get into see a sleep doctor for evaluation and potential treatment, if that's appropriate. So I'm just looking out for some of those things like feeling restless, feeling like you need to get up and walk around or having those obstructive sleep apnea symptoms.

[00:22:42] But I think, just taking a step back, it's about prioritizing your self-care. I see so many patients in my practice who put everyone first especially the moms and particularly physician moms, they're putting everyone else first. Their patients come first, their kids, their partner, their parents, and their own needs are put on the back burner. And that's a recipe for burnout. And often the first thing to go is sleep. We're staying up late working on things. We're getting up early to get a head start on whatever it is that you wanna do. And rest is not a priority.

[00:23:22] Rest is more than just sleep, So I think looking at your schedule, seeing what you can delegate. Whatever means you have available to you, planning ahead of time. Being proactive. So if you're pregnant and you're about to deliver, I talk to my patients a lot about, okay, what's the plan? How are we gonna protect your sleep once the baby comes? What support do you have? Whether it's from a partner, family hired help, whatever they have access to we create a plan around that.

[00:23:51] I've seen this time and again. I have a patient of mine who is a medical student actually and she had a baby last year and her sleep become, we talked about it, but it became extremely disrupted and it led to a quite significant flare up of mood symptoms. And once we were able to regulate her sleep and get those supports in place and really rally the troops, she was able to get back on track.

[00:24:15] And in that case we used medication support in addition to other psychosocial support. And so looking at it through this kind of broad bio-psychosocial framework is helpful. Making sure you're addressing all of those different pieces. She also turned out to have iron deficiency and wasn't eating well, and all of the different pieces of the puzzle were addressed.

[00:24:35] Dr. Jessica Singh: It must have just been such a gift for her to work with you and for providers like you who are so driven, because I feel like this is how you practice sleep medicine authentically by practicing through Western medicine, with all the evidence basis, and then integrating all the complimentary medicine, because then it's like you can go to a provider and find everything in one place. The care you're gonna give them, how you're gonna treat them, rather than that one person having to go to different provider, different provider, different provider, and never get the same kind of, and maybe they will or maybe they would never get that same depth of care, the same healing response. And the fact that you were able to work with her during residency, which was one of the most challenging times in life to get better is such an inspiration.

[00:25:18] Dr. Nishi Bhopal: Oh, thank you. Yeah, and I think, it's really important again to advocate for yourself. So if you are struggling with sleep issues, there are sleep doctors out there who do take this more holistic approach and, if it's okay if I talk about sleep medicine training a little bit, there's a cohort of sleep doctors who were grandfathered in before sleep became a fellowship.

[00:25:38] So there's a lot of sleep docs out there. And this is, no, I'm not trying to shame or blame anyone, but just so you know the landscape of what's available. Like there's lots of sleep doctors out there who never actually did a sleep fellowship, but they're able to practice sleep medicine. And so a lot of times they're focused on sleep apnea management and running these sleep clinics. But there's also now like a new generation, like, I think about, it's like Star Trek, the Next Generation, aging myself here, but like, the next generation of sleep doctors who have this more holistic view, like some of the colleagues I just mentioned, like Dr. Allison Kole, Dr. Funke Brown, Dr. Valerie Cacho. You can find them all on my YouTube channel, and that's why I've created this. Platform so that clinicians and patients like can come and learn about these different approaches and see who's out there and find out what the resources are and really educate yourself.

[00:26:27] Because it's not hard, like it's not rocket science, but it's about understanding all the different pieces of the puzzle that are at play. So the circadian rhythm, what does healthy sleep look like in different stages of life? Because it doesn't look the same at different stages.

[00:26:44] Understanding the role of different micronutrients, like a ferritin level, less than a hundred can cause restless sleep. Vitamin D level, less than 50 can negatively impact sleep and your daytime energy. Vitamin B12 level less than 500 can also have a negative impact on sleep and your energy levels. So optimizing those things, looking at a whole food diet increasing your fiber intake can increase deep sleep. Decreasing processed sugar also can help because processed sugar is shown to cause more sleep fragmentation.

[00:27:15] So these are simple lifestyle interventions; bright light therapy, going outside, getting sunshine, all simple things, but they're all little pieces that add up to give you better, more restful sleep.

[00:27:25] Dr. Jessica Singh: And pieces that are way often overlooked in medical education training, and then physician practice later on.

[00:27:31] Dr. Nishi Bhopal: Yes.

[00:27:32] Dr. Jessica Singh: I really appreciate your sharing the lay of the land in sleep medicine, especially, there's so many specialties that are young, like lifestyle medicine. Even though they're pioneers in the field, there're also probably people who are grandfathered in, and so the training is different.

[00:27:45] For emergency medicine, it was the same. You can practice emergency medicine without having residency in it, and so it, it really helps, especially for physicians listening to this. Who knows, maybe there'll be a resident inspired to go into sleep medicine from this 'cause just like you said really appreciate what you're gathering 'cause like you didn't know it existed until you were in residency. You put everything together so well so that it becomes accessible now to all the people that you're able to impact. So thank you so much for that.

[00:28:12] I wanted to ask you too, so you talked a bit about sleep health during pregnancy. Can you share a little bit more about postpartum? And I'll just piggyback. I remember it's hard and my background was emergency medicine, but the way maternity leave is set up unfortunately as a disability in our system, I remember seeing attendings in their third trimester stack their shifts together so they could get more time off.

[00:28:37] It'd be night shifts, whatever it was. And they were very pregnant and they just worked through, they're like powerhouses, at least they appeared to be. But I know that it obviously contributes to increased complications during childbirth and complications and it's really hard postpartum as well, because by the time you go back to residency or your job, which is six to eight weeks, I know people still go back after two. I've still heard of that, but like after c-sections, I still hear people, which is crazy to me. But like your hormones, like you mentioned, haven't even regulated yet. It's such a setup for postpartum depression and so I know you were talking about advocating for yourself, so when you think about sleep, health and advocacy in that postpartum period, just love to share what your insights would be.

[00:29:21] Dr. Nishi Bhopal: Yeah, absolutely. So you know that sleep loss, it is a biological stressor. And it increases the vulnerability to postpartum depression and anxiety. And that's something that I'm always on the lookout for as a psychiatrist. And I, something I talk to my patients about, so protecting sleep it's like not a luxury, right?

[00:29:42] Sleep is not a luxury. It is a part of recovery. And it's also really important for regulating your hormones, for regulating your mood so that you can be present for your new baby and your family. And interestingly, it affects men too. Like I saw a patient this morning who, they just had a baby. And they're both taking shifts. The two partners and we were talking about the impact of doing the night shifts on the entire family, right. So neither of them were feeling present because they were both alternating these night shifts and like everyone was struggling, but of course for the mother too, your sleep changes after having a baby because the arousal threshold is much lower, right? So like you're gonna be more on the lookout for sounds and serving, like waking up like, oh, this baby, okay. Like that's just the thing that happens to moms. And I think that never goes away, right? That you're just always aware of all the noises and everything that's going on. And then you add on top of that all of the stressors of being a new mom and if you're a physician, you're working and doing all of these things. And then the perfectionism and all the self-imposed pressure that we put on ourselves gets in the way too.

[00:30:53] So again, I think going back to, okay, what are the resources that I have access to and how can I leverage those to get. Protected sleep time. Even if that's just, a few hours, four or five hours of uninterrupted sleep time where you have some help maybe you're pumping. If you're breastfeeding, like you have someone who can feed the baby. Maybe you have support from family. In this case that I just shared with you, or the husband and wife were both alternating.

[00:31:21] They came to the conclusion that, we need to hire some help at night, like a night nurse to help us 'cause this is just not working for us. And they have access to resources to be able to do that. So getting the help wherever you can.

[00:31:34] Dr. Jessica Singh: And. I know that was also a driving factor, so if you could share more about your platform IntraBalance and what gaps you're hoping to fill and for people looking specifically for doctors, for coaches looking to find credible resources. Obviously you figure out how to do it, if you have any insights for them to share, to be able to utilize what they have and learn more.

[00:31:56] Dr. Nishi Bhopal: Yeah, absolutely. So on my platform I've got over 200 YouTube videos on different topics related to sleep. And some of them are ones that you can share with your patients. Some of them are more clinician focused but there's a whole variety of topics on everything from insomnia to sleep apnea to parasomnias to metabolic health and sleep, CBTI, so many different topics. And so that's IntraBalance.

[00:32:19] I also have an online program which is focused on integrative sleep medicine, and that's for clinicians who want to go deeper into their sleep education. And so that's a membership model and we discuss cases every month. We have like kind of a round table where we discuss the patients that we're all seeing in our practices and how to best support them. We have expert guests who come in and teach on their areas of expertise. Like we just had a talk on yoga nidra this month and hypnosis the prior month.

[00:32:49] Coming up we've got a talk from a sleep psychiatrist on sleep testing and how to navigate that. So we've got lots of support and materials inside of that program.

[00:32:59] Dr. Jessica Singh: It is incredible. And who do you find is generally signing up for this program, this education that you're offering?

[00:33:05] Dr. Nishi Bhopal: Yeah, so we've got a whole variety of different types of clinicians. So we've got primary care doctors, lots of psychiatrists. 'Cause I'm a psychiatrist too, so I think, a lot of people in psych they appreciate that sort of approach.

[00:33:17] We've got lots of other types of practitioners like naturopaths. We have nutritionists. We've got sleep coaches as well. So for anyone who's a health coach or sleep coach, the training that is available is not as robust as it could be. And sleep coaches are gonna see a lot of, and health coaches too, you're gonna see a lot of different types of sleep issues showing up in your practice that you may not have the training to even recognize, let alone handle and know where to refer and when to refer.

[00:33:46] So we get lots of sleep coaches who come in. Oh, nurse practitioners also. So really any clinician who's working with clients or patients one-on-one who have sleep issues are all welcome.

[00:33:57] Jessica Singh: It's incredible. I guess one of the challenges sometimes that comes up for coaches, and I always get humbled by this because it's the beauty of the coaching process, how we're here to facilitate a space for the person being coached to find their own wisdom. Like you mentioned, use their own resources, but sometimes at the surface when you first meet, especially with a physician, and they're upset, understandably so, about sleep deprivation given the system and environment they're in, I get my head out of there because there's no way to, like, if you think you have to solve the answers for someone else, it won't get you anywhere.

[00:34:30] And so as you see sleep coaches or just coaches come through, or coaches working with physicians or with anyone who's in a sleep situation that's hard due to external circumstances, do you have any insight or any advice for them how they can support those looking for sleep health, meeting them where they are?

[00:34:48] Dr. Nishi Bhopal: Yeah, and I think that's such a great question. So the first thing is as the coach understanding how sleep works and just knowing like what normal sleep looks like. And so you can find information about that on my YouTube channel. So I think that was just a good foundation to have, but getting really curious about the patient or your client's relationship with sleep. There's so much messaging out there nowadays about sleep. Like when I started my training, no one was really talking about sleep. Even my attendings, when I was applying for sleep fellowship, my psychiatry attendings were like, why would you go into sleep medicine?

[00:35:18] What is that even? Like, what is that all about now? There's so much information. Everyone's talking about it. People are tracking it. They're using aura rings and Apple watches, and there's podcasts and all kinds of things about sleep. So there's a lot of messaging out there that can be helpful, but sometimes create issues for people. It can make it more complicated than it needs to be, and so it can negatively impact a person's relationship with their sleep. So getting curious about that as the coach is a good step. Really acknowledging the reality of the constraints of the situation that physician might be in, validating that looking at what we can control and what we can't control. Sometimes we don't have control over our call schedule or rounding early in the morning or the parenting responsibilities or all of these things. So we're not aiming for perfection, but we're aiming to look at, well, what are the things that can set us up for success? And one of the paradoxical things about sleep is that the harder you try to improve it, the worst it gets. The more effort you put in, and this is so paradoxical for us as physicians, because we're used to working hard and getting results. You study harder, you do better on your exams, right? You work harder you get acknowledgement and validation for that. Hopefully. Sometimes we don't, but that's a whole other topic. But we're used to working hard and getting more output for that, right? Sleep is the opposite. The harder you work at it, the worse it gets. And so this is where letting go of perfection comes in, learning how to be okay with that, and shifting our attention away from what's happening at night.

[00:36:57] I think one of the mistakes is a lot of times people focus on what they're doing in that hour before bed and focusing on those routines and that sleep hygiene. Sleep hygiene is like dental hygiene, right? It's a way to keep your sleep healthy, but if there's a problem it's not gonna take you very far. Same with like dental hygiene. If you have a cavity, brushing your teeth isn't really gonna help. You need a specialist intervention. You need to do something different. Sleep hygiene is like that. So the mistake is people focus a lot on sleep hygiene and what happens in that hour before bed where really what we wanna focus on, it sounds so opposite, is what we do during the day. How we go through our day and how we go through our day sets us up for better sleep at night. So getting bright light in the morning, eating nutritious meals on a schedule, getting some movement, getting time for rest during the day, taking time to process whatever emotions are not being digested that might be coming up at night. So giving yourself that space, connecting to joy, connecting to your values during the day. All of those things support the nervous system, which then supports good quality sleep at night. And of course, making sure there's no sleep disorder, like sleep apnea or rest his leg or biological things that need to be addressed.

[00:38:06] The coach can help the client with those types of things. And what I like to do with patients is because there's so many different things a person could do, right? Like even those what things I just listed, like the nutrition, the exercise, the movement, the time for rest, the bright light therapy. I just ask my patient or client like, where do you wanna start? What do you think you wanna start with? And they'll tell you the answer. They know the answer, and you don't wanna do everything.

[00:38:32] Dr. Jessica Singh: It is such a beautiful approach because regardless of what the external circumstances, you mentioned so many different holistic components that contribute to sleep, that someone will find inspiration and hope because there will be one component at least, and then they'll be, oh, maybe I can impact another.

[00:38:48] And so when you start off with the allowing emotions to digest, it sounds like a key component too, is self-compassion and just acceptance. What would your takeaway message be for physicians, moms, coaches, listening to this podcast?

[00:39:02] Dr. Nishi Bhopal: Yeah, I think my takeaway would be a quote that I think you know as well by Sadhguru, which is rest is the basis of all activity and we don't need to give ourselves permission to rest. Rest is the basis of everything that we do, and we can't do what we need to do effectively without that rest. And rest is more than sleep.

[00:39:25] If you're struggling with insomnia or you're struggling with sleep in some way, put that aside for a moment and focus on how can I bring more restfulness into my day, whatever that looks like for you, whether it's going for a walk, taking your cup of herbal tea outside and just sipping that outdoors or playing with your dog or meeting a friend for lunch, whatever that looks like for you. Taking care of your rest is going to help you take care of your sleep, and that's going to trickle over into so many other aspects of your life.

[00:39:56] Jessica Singh: Thank you so much. I know we talked about credible information before and for listeners for this also one of the coaching competencies is learning how to find credible resources and it's such an honor and a gift to know you because the rigor of training you've gone through this is like a lifelong passion, let alone a job. And you can tell from the way you speak. It's so warming and you're so grounded in the science and all holistic components of it. And so really wanna say thank you for all the work that you've done. And again, we'll put all the links in the show notes, and for that way people to continue to follow up and learn more from you.

[00:40:31] Dr. Nishi Bhopal: Well, thank you so much. This was really an honor to be on your podcast and yeah, and I hope that people listening, were able to get some good pearls out of this conversation, so thank you for allowing me to share.

[00:40:42] Jessica Singh: Thank you.

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