The Menopause Sleep Solution: Expert Strategies Beyond Hot Flashes with Dr Nishi Bhopal

THE SLEEP SOLUTION YOU HAVEN'T TRIED: BEYOND THE BASICS WITH DR. NISHI BHOPAL

Is sleep your Achilles' heel despite doing "all the right things"? In this eye-opening episode of Fit and Fabulous, Dr. Orlena welcomes sleep medicine expert Dr. Nishi Bhopal to explore the emotional and cognitive dimensions of sleep that most experts never discuss.

Discover why sleep quality matters more than hours logged, with fascinating insights into how sleep continuity affects your entire day—even when your tracker says you got "enough" sleep. Dr. Bhopal shares powerful, practical techniques like scheduled worry time and mindful reframing that tackle the racing thoughts keeping you awake at 3 AM.

Women listeners will especially benefit from Dr. Bhopal's expertise on how sleep issues manifest uniquely in women's bodies. Learn why perimenopausal and menopausal sleep problems are often misdiagnosed, how subtle symptoms of sleep disorders differ between genders, and the specific nutritional, hormonal, and mindset approaches that can transform your sleep.

Whether you're struggling with nighttime anxiety, midlife sleep changes, or simply want to optimize your rest for better energy and health, this episode offers expert solutions beyond the standard sleep hygiene advice. Don't miss these transformative strategies that could finally deliver the restorative sleep you deserve.

Connect with Dr Nishi Bhopal:

Website: https://pacificintegrativepsych.com/

Youtube: https://www.youtube.com/@IntraBalance

IG: https://www.instagram.com/pacificintegrativepsych/ 

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Join the free community and enter the competition: https://www.drorlena.com/offers/DeQiSXZp/checkout 

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Looking for support? Book a free call with Dr Orlena: https://bookme.name/drorlena/positively-healthy-chat-with-dr-orlena-fb

Transcript

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[00:00:00] 

Dr Orlena : hello, hello, hello. Welcome to Fit and Fabulous with me, Dr. Orlena. I am super excited today because we are talking about pillar three. So for those of you who don't know, there are four pillars, nutrition, exercise, that lights you up, sleep and emotional wellness. And Pillar three tends to get a little bit neglected, I have to confess.

But we have an expert today who is going to help us all about sleep. I'm Dr. Nishi Bhopall. am a psychiatrist. I am also an integrative sleep medicine physician. I'm based in the San Francisco Bay Area.

Perfect. Now we have decided today that we're gonna talk about. The extra things. So we are not covering the basics today. If anybody wants to go back, there is a podcast that I did with a wonderful lady called Dr. Zin Morgan, and we really covered the basics of sleep, like routine [00:01:00] and exercise and light and all of those things.

So today I'm really excited to talk to you about emotions and thoughts and stress and all of those things that keep us up at night, even if we are doing like all the other things correctly. So what do you, where do we start? How do we unravel this?

Dr Nishi Bhopal: Okay. Okay, so I, I love talking about sleep. This is my favorite topic because it is so foundational to health and I think. Often when we think about sleep, people immediately jump to insomnia issues. But sleep is such a big umbrella. There's so many other things that are going on with sleep. There's so many different types of sleep disorders that affect women, so I think that's a good place to start.

It's just understanding that, okay, there's lots of different things that can be going on with my sleep. If you're struggling with sleep, there's. Over 40 different sleep disorders that are described in the ICSD three, which is the international classification of sleep disorders. So it's isn't always just insomnia, so you don't wanna take that at face value.

And I can explain more about what that means, but I think [00:02:00] that's just a good starting point to understand that if you are struggling with sleep, you wanna look under the hood to see what else might be going on.

Dr Orlena : Yeah, and I think one of the things that I see is people don't consider themselves ready to have a sleep disorder, but when you talk to them, they're like I sleep badly because my dog keeps me up, or because I'm at that time of stage in my life, or I get hot flushes and that stops me from sleeping or.

My husband snoring stops me from all so many different things that it feels like I'm totally normal, but I would sleep much better if.dot. And I think that's a big group of people. And really the knock on effect of that is absolutely huge in terms of energy levels, weight loss, if you're trying to lose weight, but also long-term health as well.

So perhaps we should start there. Perhaps we should just start with, why do we want to optimize our sleep?

Dr Nishi Bhopal: Yeah. Great. And that's such a great point because I think so many of us live with. Suboptimal quality sleep. It's normalized in our modern [00:03:00] society. And even the CDC has declared that insufficient sleep is a public health crisis because so many of us are living with that. So I like to think about this in two main categories.

We've got the sort of the sleep deprived people who just aren't getting enough sleep for whatever reason. Maybe there's lots of disturbances as you were describing. And then we've got the sleep disorders. So I like to separate out those two camps. when it comes to long-term issues with sleep again, I'd like to break this down into what's happening to you short term. The next day or the next few days, and then what's happening after years of poor sleep. Short term, most of us can relate to this, so just not getting enough sleep, feeling more cranky, more irritable. Maybe you're snapping at your partner, maybe you're making mistakes at work. It's harder to stay focused.

You've got typos in your emails or you're missing things. These kinds of things happen with short-term sleep deprivation. Even a higher risk of motor vehicle accidents is associated with this. That's where the public health aspect comes in as well. So these are the [00:04:00] short term things.

Longer term though, we do see a higher risk of cardiovascular disease, higher risk of stroke atrial fibrillation. I'm a psychiatrist, so I see higher rates of depression. There's a bidirectional relationship as well between mental health and sleep. So higher risk of anxiety worsening of other psychiatric symptoms. Elevated blood pressure, the list goes on, right? 'cause sleep is essentially the time where our body and brain are able to repair and restore itself. So if we don't have enough time to do that at night, it's going to translate into health issues during the day.

Dr Orlena : That's really interesting. And you were talking about not getting enough sleep. And I wonder as well, just from my own personal experience whether the pattern of sleep when it's d disrupted. So for example, here I live in beautiful Spain and it's quite touristy here. I. But it's like beaches and family.

But we do have a disco in town now. The disco is only on in the summer because it's really only for the tourists. It's really for the sort of teenagers [00:05:00] who come with their parents and because it's just been Easter. We've had a four day break and they had the disco on for two nights, and the disco wakes me up in the middle of the night.

But even when I look at my watch, it says, yeah, you've got like over eight hours sleep. But in the morning, I just feel so awful. As opposed to a different night when I might have got less hours sleep. 'cause I've been to bed a little bit late, but I've had more hours consecutively and somehow I feel better.

And I don't know if that's just me or is that supported by science as well? I.

dr--nishi-bhopal_1_04-23-2025_090517: That's a great question because sleep quality isn't just about the duration of sleep. It also relates to the continuity to how, if you're getting all of your sleep stages, your sleep architecture, if that's preserved. The timing of sleep also matters. So having a consistent sleep schedule, meaning waking up around the same time every day also has makes a difference.

For example, if someone's getting eight hours of sleep every night, but they're waking up at different times every day. So one day they're waking up at 6:00 AM another day, 9:00 AM they're not [00:06:00] gonna feel as rested even though they're getting the same amount of sleep. So yes, that

Dr Orlena : That's interesting.

dr--nishi-bhopal_1_04-23-2025_090517: yeah, the disruption, the timing the regularity of getting enough sleep on a regular basis, all of these things do have an impact.

Dr Orlena : So what's the ideal, if you could hand it to somebody and say, look, this is the best thing that you could do. What would you advise people to do?

dr--nishi-bhopal_1_04-23-2025_090517: Yeah, so the number one thing is to get up around the same time every single day. This is something that I hammer home with all of my patients and clients that I work with, getting up around the same time every day and getting bright light in the morning that serves as an anchor for your circadian rhythm and it sets your internal clock. Anyone who has a pet, if you have a dog, you know that they're on a clock. They're not looking at their watch or looking at the clock on, on the wall. They know exactly when it's time to get up, when it's time to go for a walk, when it's time to have their dinner. We also have that internal clock, but so many of us have lost touch with that. So resetting your clock with that consistent wake time. And I know this is not possible for everybody depending on your work schedule or [00:07:00] if you have kids that need to get up early for, soccer and things like this during the weekends and whatnot. It might not be possible, but as much as you can. Sticking to that consistent wake time really serves as an anchor and helps to improve sleep quality. I.

Dr Orlena : Perfect. And I will say from my own personal experience that I have been prioritizing sleep for several years now since I read. Matt Walker's book, why We Sleep, and when I read that book, it was eye opening and since then I really have made an effort to have a consistent bedtime and a consistent getting up time.

The getting up time's kind of easy because you know you have to get up, but the nighttime I find really interesting that to begin with, I had to force myself to go to bed a little bit, whereas now years later on. I really find that I just, my body says to me, it's time to go to bed. It's and I'll be reading a book going, I want to read the book, but my brain is falling asleep.

And I'm like, okay, I need to stop reading the book. It's time for you to go to sleep. And it's really interesting that, I think that pendulum, that flow really gets stronger and [00:08:00] stronger the more you do it.

dr--nishi-bhopal_1_04-23-2025_090517: That's exactly right. That's and that's how our body rhythms work. And so when you're really in tune with that and you're fostering that. do fall into place, sleep falls into place, but also energy levels start to improve during the day. Your circadian rhythm is more robust. You might notice that your hunger patterns are also more on a clock so that you're not grazing and snacking as much during the day because you're having a proper meal. So all of these things do start to fall into place with just some

Dr Orlena : Yeah,

dr--nishi-bhopal_1_04-23-2025_090517: techniques like we were talking about.

Dr Orlena : perfect. And it's really interesting. I was talking to one of my clients today who's recently decided that she's getting back on track and she's stopped eating out all the time and she's now cooking for herself and she says it's amazing. I'm sleeping so much better. By doing simple things that you wouldn't think would really have a big impact.

But I think one of the things that I see has a really big impact on a lot of people is stress and those thoughts that wake us up in the middle of the night. [00:09:00] And sometimes I think it's not even a particular thing that wakes us up, it's just this ongoing stress. We live in a life that's so full of stress, whether it is being mundane, stuff, being stuck in traffic or more.

Let's say important stuff like paying the mortgage or having unwell parents or relatives and things like that. And it may not be that you wake up in the middle of the night thinking, oh my goodness, I'm worried about the mortgage. But you wake up thinking about something and I think that's all related.

So could we move on and talk a little bit about stress and how we can change some of the ways that we think about things?

dr--nishi-bhopal_1_04-23-2025_090517: Yeah I'm glad that you brought that up because this is a common thing and the first thing I'll say about this is that is the brain's natural response to stress. It's a protective mechanism, one thing that I coach people on when I'm working with them around, stress related sleep issues, or they may have a diagnosis of insomnia, which I can share more about shortly. Is reminding yourself that, okay, my brain is actually protecting me. [00:10:00] Because your brain experiences any type of a threat, if it perceives a threat, it doesn't matter what that threat is. Thousands of years ago, maybe it was a tiger attacking the village, right? Now it's not a, it's a proverbial tiger.

You're thinking about the mortgage, but your brain perceives that the same way. So it's going to wake you up or keep you awake at night to surveil your environment to make

Dr Orlena : Oh,

dr--nishi-bhopal_1_04-23-2025_090517: under attack.

Dr Orlena : Yeah.

dr--nishi-bhopal_1_04-23-2025_090517: so I do encourage people to just to remind themselves not to try to fight your brain in the middle of the night.

If you're waking up and you're thinking, 'cause that creates anxiety for people. Oh my God, why is my mind racing? I'm never gonna get back to sleep. I have to wake up in three hours. I'm gonna be wrecked tomorrow. just feeds the cycle. Shifting your attention to, okay, thank you brain. Thank you for showing me that there's something that I need to address. I'm gonna. Put this in the box for tomorrow, and I can share more tools about how to do that, but that's the first mindset shift that I recommend tuning into.

Dr Orlena : That's really interesting and I hadn't considered it like that. And I think particularly for women [00:11:00] mothers, it becomes a habit as well because when you've got young kids. You're on call the whole time in the middle of the night. You know you're waiting for them when they're little to wake up and they need feeding.

And then as they get a little bit older you are just on that sort of alert as to, are they gonna call out in the middle of the night? And then obviously they grow up. My children are much older and they've slept through the night for absolutely years now. But I think there's still that kind of habit of you're absolutely right.

Just is everything okay in the house? Is everything safe and secure? Yeah, we would totally love some tips and tricks on how to change all of this.

dr--nishi-bhopal_1_04-23-2025_090517: Okay, great. So again, I wanna distinguish between people who have chronic insomnia versus this sort of occasional stress related sleep issue. Chronic insomnia is when people have trouble falling asleep or staying asleep, or waking up too early, at least three nights a week for three months or longer. And it's associated with daytime distress or daytime impairment. [00:12:00] That's chronic insomnia. So having these types of sleep issues from time to time, it's totally normal and it's expected we all have it, right? That's just part of being human. So first, just recognizing that when you're in a state like that, okay, just having that self-compassion, this is okay, this is normal.

But when it turns into this ongoing problem, then there are specific strategies we can use to address that, because. When it becomes an ongoing thing. Now the anxiety is about the sleep itself.

Dr Orlena : Yeah.

dr--nishi-bhopal_1_04-23-2025_090517: about the mortgage anymore. Now it's about, my God I'm never gonna sleep again or. And I'm a bad sleeper, right?

And so these kinds of thoughts just feed into that perpetuating cycle of insomnia. So some strategies. One strategy that I really love that is simple is called scheduled worry time. this is a strategy from CBT or cognitive behavioral therapy. And all it involves is setting aside about 10 or 15 minutes. During the day, not right before you go to bed, but sometime during the day, I recommend at the end of the work day. [00:13:00] So that's usually a good time as you're transitioning from work into your evening hours and taking a piece of paper and a pen and just writing out all those thoughts that tend to swirl around in your brain at night. Get them out on paper during the day. And this does a few things. One is it allows your mind that time to focus on it. Because the reason we have those thoughts at night is because there's nothing else. Pulling pulling our attention away. So during the day, we're busy, we're caught up in all kinds of activities, and at night it's quiet so our mind can go there. So let's give your mind the opportunity to do that during the day. There is something about that physical act of using a pen and paper rather than typing it on a. Electronic document, but using a pen and paper, almost like transmits that thought, that motor action of physically writing slows you down and it helps you process those thoughts. Then look at what you're writing. It can be anything. Do it uncensored. No one's gonna read it, right? So don't worry about that. You can tear it up and throw it away after if you want or shred [00:14:00] it. But look at what's been written. And then you can come up with an action plan. So for example, okay, yeah, it's a mortgage related thing okay, what's our action plan to deal with that? And that just gives your brain that that reassurance that, okay, we're addressing this problem. So that's a tool that I recommend. I'll pause there and see if you have any questions about that.

Dr Orlena : Yeah. No, it's great. And also just thinking sometimes, I dunno, I'm a, I'm an action person and sometimes I think my brain does making plans and action is a stress response actually, and that sometimes I just have to go, no, it's okay. Just accept it. It's fine. Like this is the situation and that's okay.

As opposed to trying to fix it. So I guess it depends where you are in that scheme of things. If you are a chronic doer, then perhaps not creating a list is an action plan is not necessarily a good thing. If you need to, then obviously that's a great idea.

dr--nishi-bhopal_1_04-23-2025_090517: Yeah. And okay, let me just qualify this a bit more. So if you're a chronic doer, this is still a great technique because it's not just about [00:15:00] creating the action plan, but also allowing yourself to write out whatever the feelings are behind that. So going a little bit deeper Hey, wait, what is going on?

What is this anxiety? What are the fears? What are the concerns or worries that are coming up for me? I also like to, at the end, especially if you are someone who falls into that sort of chronic doer sort of pattern, I also like to tie this up with a bow at the end of gratitude and writing out two or three things that you're grateful for so that you're not just, ending your worry time and now you've got this.

Big to-do list. And that's even more anxiety provoking, but right. So tying it up with little bit of gratitude, maybe setting an intention tonight I wanna go through my life with peace, and I wanna bring in intention of peace into everything that I do for the rest of the day. then set that timer.

And so when the timer's up for your scheduled worry time, you close the notebook or whatever you're using and put it away. And if your brain starts going back into, oh yeah, my to-do list, I've gotta follow up on that email. Nope. That's [00:16:00] in my worry time. I'm gonna visualize myself putting it back in that box again at night.

If it's the middle of the night and you're waking up and you're having those thoughts, you can have a pen and paper at your bedside and just jot it down and just tell your brain, okay, it's done. Or say to your brain, this is going in my worry time tomorrow. You can leave me alone for now. So these are just little tricks that people can try.

Dr Orlena : Perfect. That sounds awesome. Okay. And you had another trick that you were gonna talk to us about as well.

dr--nishi-bhopal_1_04-23-2025_090517: Okay, so this is something that you can use if you tend to wake up in the middle of the night, which is really common for women. It can happen to everyone, but this especially. Perimenopause and beyond. Waking up through the night is the most common complaint that women have about their sleep. This can start to cause more anxiety because then you can start to worry, oh my gosh, am I gonna get sleep? Am I gonna stay asleep tonight? Am I gonna have that 3:00 AM awakening again? And then that can perpetuate the whole cycle of worrying. first is just knowing that waking [00:17:00] up at night is normal.

It's part of the normal sleep schedule. If you look at sleep architecture, you'll see multiple awakenings throughout the night. It's protective so that we can get, wake up, look at our environment, okay, we're safe. Go back to sleep. So if you're awake and you're starting to feel anxious, the traditional recommendation is to get out of bed and go do something else. I'm not someone who wants to get out of bed I'm warm and cozy. No, I don't wanna do that. And that's usually what's recommended. And sure it does help some people. It's one of the tenets of CBTI, which is cognitive behavioral therapy for insomnia, however, it's called stimulus control. However, if you're not wanting to get out of bed, then you can practice some mindfulness and what that looks like is really paying attention to how the pillow feels. comfortable it is paying attention to the blankets. Oh, they're so soft, they're so cozy. There's no one emailing me or trying to call me. Right now. It's 2:00 AM. Thank goodness for that. I can just have this time to myself. So reframing that wakefulness. Almost inviting [00:18:00] it. Oh yeah, okay, I can just be here and no one's gonna bother me.

So shifting the relationship with the wakefulness is really helpful. There is a, there are different breathing techniques that people can try. One of them is simply just exhaling for twice as long as you inhale. And that's calming to the nervous system. So if you do find you're starting to get a little bit anxious, just shift to focusing on that. Long exhalation. Maybe you inhale for a count of four, hold it for a few seconds, and then exhale for the, for a count of eight. And so again, that mindset reframe and then just regulating the breathing, that can help with some of those nighttime awakenings.

Dr Orlena : Perfect. And that's exactly what I do. I didn't realize I did what you called it, but I feel my fingers, I put them underneath my pillow and my sheet and I like focus on my fingers and the sensation of my fingers. And then also I. Imagine myself feeling heavy, do you know what I mean? On my sheets, and then feeling myself sinking into the sheets.

So those are all perfect [00:19:00] tips to help us. And I think another thing, just to add is that I think when people are in that place where they think, oh my goodness, this is such a big problem, and it feels like nothing will work. They've tried things and tried things, but actually quite often people are very close to the solution.

It's just that they haven't. It, they perhaps haven't tried it for long enough and that these things are worth trying because they do work. That, that definitely works for me. I've been using it for years and actually I started doing it a few years ago when my son was really unwell, and my brain would just spiral into that.

What if in the middle of the night? And another part of my brain was going, this is not helpful. This is not helpful thinking. You need to stop thinking. And that was my way of basically stopping my brain from thinking, was to focus on my fingers and stop myself from doing that. So thank you for all of those things.

Bit about menopause and why is it that when we've got all of this stuff going on. We have [00:20:00] hormones going up and stress levels going up, and it just feels like this melting pot of everything. Just shifting a little bit. And one thing that happens to a lot of people is sleep, partly because of temperature regulation.

I don't know if there's any other reasons, but it can really feel like it's just the cherry on top that makes everything a little bit unbearable.

dr--nishi-bhopal_1_04-23-2025_090517: Yes. No that's exactly right. And and again, sleep issues are the most common complaint that women have during perimenopause and menopause. And there are a few reasons for that. One of them is the temperature dysregulation that you just mentioned. Just, it's. flashes and all of those kinds of things, those vasomotor symptoms can certainly disrupt sleep.

But that's not the only thing. We've talked a little bit about stress. So often in this time of life, women are taking care of their parents, they're taking care of their children, they're working full-time. There's all of these things going on depending on a person's life situation. So there's a lot more pressure and stress as well at that time of life. But [00:21:00] other things to consider are specific sleep disorders. So women are have a higher likelihood of having sleep disorders, specifically insomnia that we were just talking about. But during perimenopause and menopause rates of sleep apnea increase in women, before menopause and menopause perimenopause men are more likely to have sleep apnea than women. This is not to say that a woman can't have sleep apnea. Before she gets into her forties, they absolutely can. Anyone can have sleep apnea. It's not just weight related or related to gender or things like this. Anyone can have it any shape and size. But during menopause because of the hormonal changes, the airway becomes more susceptible to collapse.

And so we do see rates of sleep apnea double after menopause and it's often missed in women. And I see this all the time in my practice. women will have complaints of daytime fatigue, they may have headaches, they have trouble concentrating, [00:22:00] and then they're diagnosed with depression or they're diagnosed with fibromyalgia 'cause they have aches and pains that are unexplained. And then we do a sleep test and it turns out, oh, you've got sleep apnea. 

Dr Orlena : And just,

dr--nishi-bhopal_1_04-23-2025_090517: up differently.

Dr Orlena : can you only have sleep apnea if you sleep on your back, or can you have sleep apnea if you sleep on your side? Like I can't really see how happens if you sleep on.

dr--nishi-bhopal_1_04-23-2025_090517: Yes, so you can have it in any position. So in some cases, apnea is worse on the back. So we call that positional apnea. So positional therapy can be helpful for people who have positional apnea, so sleeping on their side can be, improve a therapy for them. it's not always positional.

So sometimes it has to do with the structure of the airway. Women just have, we have naturally a smaller, narrower airway. And then if there's even a little bit of weight gain, so I'm not talking, 20 pounds, but even a few pounds can create more tissue around the neck. Even the tongue can fall back. You can have just a smaller jaw palate, all of those [00:23:00] things, nasal obstruction can contribute to apnea. So it doesn't just have to do with the position that you're sleeping in. Yeah. And then in men, they often have the classic symptoms. 'cause all the sleep apnea studies have been done in men. It's it's like the symptoms that everything in medicine, right? So all the, all what we know about sleep. Most of what we know about sleep apnea is based on what the symptoms look like in men. So they have loud snoring, they have gasping arousals, their wife or spouse, notice that they're, stopping, breathing during the night.

These kinds of things. They're super sleepy during the day. in women, it can look very subtle. Like I said, it can look like depression, like fibromyalgia, like chronic fatigue. They may not snore, they may not have those gasping or choking Arousals. But it doesn't mean they, they don't have sleep apnea and treating it can be life changing for people.

Dr Orlena : And can modern watches like an Apple Watch, would it pick it up?

dr--nishi-bhopal_1_04-23-2025_090517: Yeah, that's a such a great question because that's a new feature on the Apple Watch. It can be useful for screening. Now again, I'm not [00:24:00] sure how accurate that data is for women. If, did they look at it? Did they look at

Dr Orlena : They're looking at your respiratory rate, so I'm presuming what they're looking for is pauses in your breathing. And then it, you can set it up to have an alert. Presumably if you stop breathing for a period of time where it will wake you up and say, how about you do some breathing?

dr--nishi-bhopal_1_04-23-2025_090517: Great. Yeah, no, that's great. So these tools are very helpful for. For screening. So if you are seeing that it's showing this, that you're having pauses and you're breathing at night, then it's absolutely worth going to a doctor to get that further evaluated. But it's not a replacement for a sleep

Dr Orlena : Sure.

dr--nishi-bhopal_1_04-23-2025_090517: It's just a sign that, okay, look, something's going on.

Dr Orlena : Yeah, sure. No, absolutely. I think if you're concerned, definitely go and get tested properly. But just thinking, are we more likely to pick them up if we all start wearing, I don't know if all of them do them, but I know that Apple does. And I don't know if the aura rings and things like that. Do I presume they do, but.

I don't know. Okay. So we have covered sleep apnea. What about just people who don't [00:25:00] have sleep apnea? But and going back to your point in saying it's like one of the biggest complaints in menopause. I think probably one of the big reasons, it's one of the biggest complaints is because I think we can put up with aches and pains and all of these things during the day.

We just get on with our life. And hot flushes, they're inconvenient, but. It's an inconvenience. Whereas when it affects your sleep now it's affecting your entire life. It's affecting how you're feeling, how you are performing your energy levels. It's suddenly it's taken over your life as opposed to oh, it's just this irritation that I have.

dr--nishi-bhopal_1_04-23-2025_090517: Yes, that's exactly right. 'cause it, sleep does affect everything. So things that I like to look at are nutrition. Including what time you eat. So we talked about the circadian rhythm earlier, so having a regular meal schedule, ideally with your main meal in the middle of the day, and then a lighter meal in the evening, finishing your meal three hours before you go to bed. Yes. Exactly. Yes. So [00:26:00] that actually can support the circadian rhythm. Now for people who do tend to wake up during the night. Sometimes that can be a sign of hypoglycemia. So blood sugar drop during the night and that can lead to a cortisol spike and then they feel anxious or they may have palpitations. In that case, having a high fiber snack about an hour before going to bed can stabilize the blood sugar and it can help reduce those symptoms at night. Something like some fresh fruits and vegetables, maybe a handful of nuts, this type of thing can be useful. Studies do show that people who consume more refined sugars have less deep restorative sleep, and people who consume diets higher in fiber have more deep restorative sleep. So something to keep in mind is getting enough fiber during the day as well. The other, yeah. Yeah it's really interesting and I've seen this help patients just like working on the timing of their meals, introducing more fiber, and then introducing mindful eating. Just eating more slowly and for women, a lot of us are [00:27:00] eating on the go. Maybe you're eating in your car or you're standing up and doing stuff around the house and just grazing and snacking or eating, taking some time just to sit down for a meal, chewing it properly, waiting a few minutes before you get up. It's better for your digestion. Calms the nervous system and it can do wonders for your sleep as well.

Dr Orlena : Perfect.

dr--nishi-bhopal_1_04-23-2025_090517: Yeah. And then the other thing that I recommend looking into that's often overlooked are iron levels, specifically ferritin levels. Ferritin levels less than a hundred can contribute to restless leg syndrome, which is more common in women and restless sleep. those simple blood tests, getting your iron and ferritin checked, vitamin D levels checked your B12 levels, panel. These are simple things that, that, you can do with your GP or your primary care doctor and these all, have an impact on sleep. They affect the circadian rhythm and also synthesis of neurotransmitters. So something that I do with all of our patients in our practice is we get baseline labs.[00:28:00] 

Dr Orlena : Perfect, and then presumably if nothing is working and your sleep is really disrupted because of menopause, then you can look at HRT and having some hormones that are going to help you regulate your temperature better so that you can sleep better.

dr--nishi-bhopal_1_04-23-2025_090517: Yes, HRT is helpful and also CBTI is actually shown to be an effective treatment for menopause for sleep issues during menopause and ccb. So CBTI is cognitive behavioral therapy for insomnia. And interestingly, it's also shown to reduce vasomotor symptoms.

Dr Orlena : Oh, really? That's interesting.

dr--nishi-bhopal_1_04-23-2025_090517: yes, it's really interesting. So don't forget.

So I, I encourage everyone to, not to forget about those behavioral aspects or discount them as, oh yeah, okay, fine. I already know that, because there are specific techniques that can be learned that will enhance all of these other strategies we just talked about.

Dr Orlena : And presumably that's because it's reducing your stress and then that's having a knock on effect to helping you sleep better and your cortisol levels coming down. And cortisol is such a [00:29:00] cheeky thing, isn't it?

dr--nishi-bhopal_1_04-23-2025_090517: Is,

Dr Orlena : Perfect. It's been really fascinating talking to you. Do you have any other last tips for us?

dr--nishi-bhopal_1_04-23-2025_090517: yes. Yeah. So sleep issues are highly treatable. It's not something that you have to live with and just grin and bear it. If you are struggling with sleep, then. a sleep specialist. There is a directory. You can go to the Society of Behavioral Sleep Medicine. They've got a worldwide directory, so you can look at specialists there, or if you're in the us I'm in the us, you can go to the American Academy of Sleep Medicine website. So health is available. And CBTI, cognitive behavioral therapy is the gold standard treatment for sleep. But there's all these other things that you can do as well that we just talked about.

Dr Orlena : Perfect. And I really think, like what I try and teach people is to be, do cover the basics well, so the nutrition and the exercise. Like you don't have to be. Doing it perfectly. I always say aim for 80%. A consistent 80% is far better than a rollercoaster of perfect disaster. Perfect disaster. So talking [00:30:00] about sleep specialists, where can people find you and what resources do you have for people?

I.

dr--nishi-bhopal_1_04-23-2025_090517: Oh, thank you. So people can find me on YouTube at Intra balance, I-N-T-R-A Balance. That's my YouTube channel. So I talk all about sleep on there. If you are in California and you wanna work with my team, you can find us at Pacific Integrative Psychiatry. If you just Google that, you'll find our website.

Dr Orlena : Perfect. Thank you so much.

dr--nishi-bhopal_1_04-23-2025_090517: Oh, thanks for having me.