Brain Power with Dr. Eko

Ep. 18 | Discovering the Three Pillars for Better Sleep with Dr. Bhopal

• Dr. Hokehe Eko • Season 1 • Episode 18

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Unlock the secrets to rejuvenating sleep with Dr. Bhopal from Pacific Integrative Psychiatry, who gracefully dissects the intricate dance between sleep and mental health. Our enlightening chat navigates through her holistic approach to well-being, targeting nutrition, gut health, and mind-body practices. Dr. Bhopal unveils her three pillars of sleep—circadian rhythm, sleep drive, and the nervous system—and sheds light on actionable advice to sync our body clocks. She emphasizes the transformative effect of light exposure on our alertness and overall health. For stressed parents and restless souls, this episode is a haven of insight, offering practical tips and a guiding hand towards the restful embrace of sleep that has long eluded them.

As we wade through the waters of daily habits that can significantly augment sleep quality, Dr. Bhopal serves up a platter of knowledge—ranging from the benefits of high-fiber snacks to the science of adenosine buildup in our brains. Discover why caffeine should say goodnight well before you do and learn about alternatives that can lull you into a peaceful slumber. Explore the calming practices of journaling and scheduled worry time to soothe your mind before bed. For those who have tried seemingly everything, this episode could very well be the lighthouse in your search for nocturnal serenity. To continue your journey to better sleep and mental clarity, follow Dr. Bhopal's ongoing work at Pacific Integrative Psychiatry and her YouTube channel, Intra Balance.

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Dr. Hokehe Eko:

Hello parents, welcome to another episode of Brain Power with Dr. Eko. So glad to be with you today. I have an amazing guest with me, Dr. Bhopal, and I'm gonna let her introduce herself. But she's a powerhouse and I can't wait to share all her wisdom with you. So welcome, Dr. Bhopal, to the podcast.

Dr. Nishi Bhopal:

Oh, thank you, Dr. Eko, for having me on.

Dr. Hokehe Eko:

Yes, my pleasure, so please tell our listeners about the amazing work that you do in your practice.

Dr. Nishi Bhopal:

Oh, thank you. So, yeah, I have a private practice. It's called Pacific Integrative Psychiatry, and we see patients all across California and Washington state as well, and we support them with a whole body approach to mental health. So what that means is that, while we might use medications when appropriate, we can also support people with nutrition, gut health, mind-body practices, using supplements and even minimizing their reliance on medication for anxiety, depression and sleep issues. So my background is I'm an integrative psychiatrist and a sleep medicine physician, and then I also have a platform teaching clinicians so physicians, therapists and coaches about integrative approaches to sleep.

Dr. Hokehe Eko:

Which we all need. Every single person needs that. You should expand to dentists and everybody else. Yes, All you professionals get in here and listen.

Dr. Nishi Bhopal:

Well, absolutely, because you know, most physicians only get two hours of sleep education during medical school. Every single patient has to sleep. We ourselves have to sleep, right, even as a patient, we have to sleep, and it's something that all of us have to do and it's so fundamental to health. Yet we get so little training in it as physicians and therapists. And then now we have this pandemic, or epidemic, of people who are struggling with insomnia and being prescribed sleep aids, when there are so many other things that we can do to optimize sleep quality.

Dr. Hokehe Eko:

Yes, and I know you're an adult psychiatrist, but yes, we see that as an integrated pediatrician with kids, they're getting prescribed meds for sleeping at three, four, and I'm like there has to be a better way to do this. So I'm so glad we're having this conversation, even though we're going to be addressing parents. But yes, we start with parents so that you can help your kids.

Dr. Nishi Bhopal:

Absolutely. A well-rested parent can be like a superhero.

Dr. Nishi Bhopal:

Right, I'd be like they are superheroes, they are superheroes, superheroes. Yeah, and I remember a patient of mine who had a couple of little ones at home and he was burning the candle at both ends, staying up late, waking up early to go to work and so we just focused on optimizing his sleep and after two weeks he was like I feel like superman. I can do so many more things now, and it's crazy because even though I'm sleeping more, I feel like I have more hours in the day.

Dr. Hokehe Eko:

Oh yes, Because there's such a link between sleep and our behavior, sleep and the way our brains function, and if you don't sleep, your brain won't function and therefore you wouldn't be able to function. So it's absolutely fundamental. So I know you have three pillars of sleep that you like to discuss. Would you like to share those with us?

Dr. Nishi Bhopal:

Yes, so there are three pillars that I recommend people to focus on to optimize sleep quality. These three pillars are the circadian rhythm, the sleep drive and the nervous system, and we can unpack each of those and talk about what they mean and different ways to optimize them, but what I really want to emphasize is that there is a formula to sleep better, because often when people are struggling with sleep whether it's insomnia or excessive daytime sleepiness, fatigue or irregular sleep patterns it can feel kind of out of control, like it's kind of slippery, it's kind of murky, it's like it's hard to get a handle on it. And even I personally, when I was in med school residency, I struggled so much with sleep and I just didn't understand how to, how to get it under control, and so using this formula with these three pillars is a really tangible way to start to work on sleep optimization. I'm taking notes. I hope you are OK. Let's go Great, ok.

Dr. Nishi Bhopal:

So let's start with the first one, which is the circadian rhythm. The circadian rhythm is essentially the body clock right, and often when people think about the circadian rhythm, they're thinking in terms of their sleep cycle, which is absolutely true. It regulates our sleep-wake cycle, but it also affects so many other things. It affects hormone secretion, it affects our metabolism, it affects when you get hungry, it affects body temperature regulation, and the list goes on right. So the circadian rhythm is basically our internal clock that tells our body when to do different functions. Even alertness, brain function, their ability to focus All of that is impacted by our body clock. So there is three main things that we can do to regulate the body clock. So these are three external cues that you can really focus on.

Dr. Nishi Bhopal:

The first, most powerful cue is light, exposure to light and exposure to darkness. So how you can incorporate this into your daily routine is to get really bright light exposure in the morning. You can see if people are able to see the video, I'm in this bright room, right, and so what we do in the morning is open up all the curtains, blinds, whatever window coverings you have, let the light stream in, and the best thing to do is actually to go outdoors and get natural sunlight. So if you can go outside and get natural sunlight without your sunglasses and get that bright intensity, even for five or ten minutes, it doesn't have to be this, you know, prolonged session, even just going outdoors for a few minutes. Maybe, you know, even taking your dog for a walk or something. If you have an opportunity to do that. It gives you a bit of exercise too.

Dr. Nishi Bhopal:

And why it's so important is that light exposure suppresses the brain's production of melatonin in the morning, so it's going to help you feel more awake, more alert right, it's going to give you more energy. And why it's important to go outside is because on a bright, sunny day, when there's no clouds in the sky, we're getting about 100,000 lux of light intensity, and you can see this room that I'm sitting in here. It's quite bright. We have large windows, but even in here it's probably about 800 to 1,000 lux versus 100,000 lux.

Dr. Nishi Bhopal:

If I were to go outside and get quite a bit of light intensity, that way but you can also consider using a light therapy box and I can explain later if we have time. You know how that works or people can check out my YouTube channel for information on that. But light therapy is really important. And then, on the flip side of that, it's getting darkness at night, so exaggerating exposure to darkness in the evening. So dimming the lights, closing the blinds, even dimming screen brightness. That helps to promote your brain's production of melatonin in the evening, to help with sleep onset and promote good quality sleep. So I'll just pause there. So that was the first.

Dr. Hokehe Eko:

I have all these questions in my head. I'm thinking well, of course it's the pediatrician. So for thinking, of course, as a pediatrician. So for kids, instead of waiting. So this whole thing about we're watching TV before we go to bed is actually not good for the kids' brains to start shutting down. We need to reverse it right Watch TV further away from bedtime, right, okay?

Dr. Nishi Bhopal:

Yeah, that's a really great question because this is a routine that a lot of people do.

Dr. Nishi Bhopal:

Right, it's like you watch TV in the evening, and so there's a little bit of nuances with this one. And so what I tell people is that actually TV in the evening is not bad if it helps you wind down. And TV is better than something like watching something on the iPad or your phone because it's less interactive, so it's a bit more passive, it's not as stimulating to the brain. You can actually dim the brightness on the TV screen. It's not in your face Like it's not just inches from your eyes, it's several feet away. So it's actually not as bad. And if it does help you calm down and just get your mind off of things in the evening so that you can fall asleep, I'm not opposed to that right. So there is some nuance there to figure out, like, what actually works for you. On the flip side, if you find that your kids or even yourself, you're getting revved up in the evening because you're watching a show and you want to keep watching, then it's time to reconsider that habit.

Dr. Hokehe Eko:

Yeah, because I was thinking maybe how lots of kids will do, maybe a lot of kids will take a shower and then they'll watch TV and then sleep. So maybe if we just reverse that to watch TV, take a shower and then bedtime that will give them more time to wind down and bedtime will help wind them down even more and then they're ready for bed. I think that's what I'm going to start teaching Because it makes sense, because we're priming the brain to like OK. So things are slowing down.

Dr. Nishi Bhopal:

Yeah, absolutely. And the whole idea here is to create a little bit of a runway before you go to sleep, because sleep isn't like flipping a switch like you're awake and then you're asleep, it's more like it's not like on off, it's more of a dimmer switch. So we need to start dimming our activity in the evening, like physically dimming the lights, literally, and then, you know, figuratively dimming our activity in the evening, so that we're winding down our nervous system, so we can have this nice slope into sleep.

Dr. Hokehe Eko:

Yeah, I love that. I like the runway analogy.

Dr. Nishi Bhopal:

So I'll just quickly share the other two pillars under circadian rhythm. So we're still talking about the body clock, so the most important cue is light. The second cue is activity, meaning exercise, physical activity and movement. So, again, we want to create a little bit of a runway in the evening where we're not doing very vigorous activity right before going to bed. Right before going to bed and I know this can be tough for parents, because you're busy all day the kids go to bed. Maybe now you want to fit in your workout or something like that, so you want to avoid very vigorous workouts at least an hour before bed.

Dr. Nishi Bhopal:

Studies actually show that doing vigorous activity an hour before bed negatively impacts sleep quality, and it can, you know, make it just harder to fall asleep and stay asleep. So vigorous activity means any type of exercise where it's hard to talk. So imagine if you're, you know, sprinting or something it's hard to talk to anyone else. So light to moderate exercise is okay in the evening, but the key here, though, is regularity with the circadian rhythm. Regularity is king when it comes to the circadian rhythm, so what this means is regularity with that light and dark exposure, and then regularity with your physical activity and exercise, so making sure that you're kind of on a routine.

Dr. Nishi Bhopal:

And then the third cue is the timing of meals. So often we're thinking about what are we eating and you know the nutrients and all of that. But the time that you eat also has an impact on sleep and circadian rhythm. So having meals at regular times every single day, you know within an hour or so, wherever possible, having your larger meal at lunchtime, midday, a lighter meal in the evening, finishing your meal three hours before bed and then, for people who wake up hungry in the evening or they might have a little bit of a meal in the evening, finishing your meal three hours before bed. And then, for people who wake up hungry in the evening or they might have a little bit of a drop in blood sugar and it's harder to maintain sleep, then having a high fiber snack about an hour before bed can be helpful. But again, the regularity is so important for the circadian rhythm.

Dr. Hokehe Eko:

Yeah, I like that you pointed out the times of eating, because most people have that flipped right they eat a big dinner and not so big lunch, and then three hours before bed. That, too is important. Okay, so what kind of high fiber snack? What's an example of that?

Dr. Nishi Bhopal:

Yeah, so something like this could be a piece of fruit with nut butter, so maybe like an apple with nut butter, it could be something like a handful nut butter. It could be something like a handful of berries, it could be roasted vegetables and hummus, something like this. So again, it should be nourishing, like the idea here with sleep. Sleep should be nourishing and enjoyable and same with food. So it shouldn't be something where you're like, oh, I have to eat this like high fiber, disgusting sweet, you know like I already does it yeah, it's like that's just not gonna help you.

Dr. Nishi Bhopal:

So it should be something that you enjoy, but just take into account that you don't want it to be like something really salty, sugary that's gonna like impact your your blood sugar regulation, so you can think about what works for you. But usually some kind of fruit or vegetables with a little bit of like you know a nut butter or a yogurt or something like that can be helpful.

Dr. Nishi Bhopal:

So the second pillar is the sleep drive. Okay, so the first one is the body clock and just staying on a schedule and being regular. The second pillar is the sleep drive, and what this refers to is the pressure to fall asleep in the evening. So the longer we're awake, the more our brain builds up a neurotransmitter called adenosine. And the more adenosine you have in your system, the sleepier you're going to feel. So when you sleep, your brain washes out this adenosine and then you're more awake in the morning and then the longer you're awake, the more adenosine builds up. So how we can enhance this so that by the time you go to bed, you're sleepy and tired right, because I hear from a lot of people they're like they go to bed and like I'm not even sleepy yet. So there's ways to increase your sleep drive. So one is to get more activity and movement throughout the day. So that can be going for walks, it could be even just like doing some light stretching, squats, things like this just little activity throughout the day, instead of being sedentary all day, and then maybe there's like one hour where you go to the gym or you, you know, do your exercise or whatnot, so thinking about how you can get more movement throughout the day.

Dr. Nishi Bhopal:

The other thing to think about with the sleep drive is caffeine, because caffeine actually blocks that adenosine receptor in the brain. So adenosine isn't able to tell your brain that you're sleepy if you have caffeine, because caffeine is blocking that action. Right, but the adenosine is still building up in the background even though caffeine is blocking your brain from receiving that signal that you're sleepy. So this is why you'll see people lining up outside of Starbucks at 2 pm because that adenosine is building up. So they need another caffeine hit to block that signal.

Dr. Nishi Bhopal:

Right, and so, yeah, so you want to be mindful of how caffeine might be impacting your brain's ability to even know that you're sleepy. You might notice you get a crash in the afternoon and then. So you want to minimize caffeine use at least six to eight hours before bedtime, because that's about the half-life of caffeine and for some people it's even longer than that. So just, you have to notice, right? So a lot of this is just noticing yourself, tuning into your own body, noticing how different things affect you. What works for your partner might not be the same for you. So really getting a sense of how caffeine affects you, how all of these different activities affect you, so that you can increase your sleep drive.

Dr. Hokehe Eko:

Oh my goodness, I hear all the coffee drinkers say what that means. Limit yourself to one cup, because caffeine also narrows your blood vessels that go to your brain. So please.

Dr. Nishi Bhopal:

Yes, that's exactly right.

Dr. Nishi Bhopal:

And then people might say like, oh, I can drink caffeine in the evening and it doesn't affect me, and it might just be because you're used to getting bad sleep.

Dr. Nishi Bhopal:

You might not even know that it's affecting you, and so you can actually study show like if someone has caffeine in the evening, you can see the impact on their sleep quality throughout the night and more awakenings throughout the night on a sleep study. So, again, we don't want this to be an exercise in deprivation of like oh, now I have to eat fiber, fiber snack and I have calcium in the evening Right, or in the evening right, or in the afternoon. And so think about how you can maybe bring in other nourishing habits that feel really good to you, that aren't going to be harmful to your sleep and to your brain health. So what that might mean is, instead of your afternoon espresso, maybe swap that out with, like, a really delicious herbal tea that you love to drink. Or maybe it's like something refreshing, like sparkling water with cucumber in it, or you know something like this, and making it a fun experiment to see what's going on, or a smoothie, or whatever.

Dr. Hokehe Eko:

Right. So thank you for sharing the alternative to what they could do like instead of drinking caffeine so good. So what's the third pillar?

Dr. Nishi Bhopal:

OK, so the third pillar is the nervous system. So this is the big umbrella here. This can refer to things like stress, anxiety, depression. There's a bidirectional relationship between sleep and mental health, so there's that aspect. But this also can refer to nutrition, gut health, anything that's going to have your nervous system kind of out of whack right. And so this is where you might know that there's something off with the nervous system is if you feel like you're stressed out all day but you're tired, but you're still wired at the end of the day right, so these are the people who are like I'm so tired but I just can't get to sleep.

Dr. Nishi Bhopal:

I'm doing the circadian rhythm, saying I'm doing the sleep drive, saying I have those pillars, you know, totally aligned, but I still can't sleep. So this is where you might want to look at OK, what's going on with my nervous system? Am I in a revved up state all day? And so here's kind of like, the thing that I see a lot is that people will be on the go all day. They're going from meeting to meeting, they're picking up their kids, dropping them off at their activities, making dinner, like doing all the things and at the end of the day they're like, okay, let me do 10 minutes of my headspace meditation, Okay, and then let me go to sleep, and then they can't sleep right, Because what's happened is you're in the fight or flight aspect of your nervous system all day long, which is the sympathetic nervous system, and for sleep onset, the parasympathetic nervous system has to be activated in order to fall asleep and maintain sleep.

Dr. Nishi Bhopal:

That's the rest and digest aspect of the nervous system. So what we want to do here is activate that parasympathetic nervous system throughout the day as well, Because what I tell people is good. Sleep starts during the day. It's not just about what you do in that runway that one hour before bed, it's really what you do first thing in the morning, all throughout the day. That's going to impact how you sleep right. It's going to impact your sleep quality.

Dr. Nishi Bhopal:

So things to think about here.

Dr. Nishi Bhopal:

One is if there's anxiety, if there's a lot of stress, depression that you just feel like is out of your reach to get a handle on, it's worth talking to somebody about that, whether it's a therapist, seeing a psychiatrist.

Dr. Nishi Bhopal:

You know we do integrative work around that, helping people, you know, find ways to really regulate their nervous system holistically.

Dr. Nishi Bhopal:

But other things that people can do that are so easy to do are introducing what I call little micro practices throughout the day. So instead of doing your few minutes of headspace meditation or a little bit of breath work in the evening, sprinkle it as the day goes on, so maybe between each transition, so like if you're, you know seeing, you know people on Zoom, like if you're having meetings or something after each meeting, do a few deep breaths maybe, do some stretches, maybe build in a few minutes of doing your meditation before lunch or before and after meals, practicing mindful eating as well, so bringing mindful practices into your day. So mindful eating means you're sitting down, you're chewing your food thoroughly, you're noticing the aromas, the textures, the tastes and so on. Maybe you're doing mindfulness as you're washing your hands, right. So finding these like just little moments where you can bring a little bit of calm into your nervous system. That can have a really big impact on how you're able to fall asleep and stay asleep in the evening.

Dr. Hokehe Eko:

Wow, I love the statement that you made about good sleep starts during the day. I don't think we recognize that enough. So this makes sense because you know you hear a lot of people say be mindful. Maybe they don't exactly explain why, so this definitely explains why you should have the micro practices she's talking about. That was like a light bulb moment, like, hmm, good sleep starts during the day. Okay, I have lots of things to talk teaching some kids, because even for kids, I've seen people talk about mindfulness for kids and teaching them, brain breaks, which I talk about for kids, and that's a brain break. That makes sense because we're teaching, we're priming them for sleeping better.

Dr. Nishi Bhopal:

Yes, absolutely, and these are tangible things that people can do right.

Dr. Nishi Bhopal:

And so it's like again with sleep. It often feels like it's this thing, that like I'm trying to force sleep to happen and it's not happening. And it doesn't work that way. Right, sleep is like. It's like you fall asleep. You have to just let it come over you and it's going to fluctuate from night to night. That's the other important thing for people to recognize. It's like you know, you don't have to aim for this eight hours of quote unquote perfect sleep every night. For this eight hours of quote, unquote perfect sleep every night. It just doesn't work that way, so it's going to fluctuate.

Dr. Nishi Bhopal:

But the things that you can control are like are during these brain breaks I love that term that you use Focusing on your circadian rhythm, looking at your caffeine and your sleep drive, and all of these things are things that everybody can do, right, and there's all these little things. They add up to make a big difference. And so what I would emphasize to anyone listening to this is you don't have to do all the things we just listed a whole ton of different types of practices and behavioral things to do. You don't have to do all of them. Pick one to start with, see how that goes and then maybe layer another, and layer another, and layer another and improving sleep. It's like turning around a big cruise ship, right? So it's not a speedboat where, like, you do one thing and you're turning it around and all of a sudden you know everything is better. It is like turning around a big cruise ship. So all these little changes will add up to your sleep going in a different direction and improving, but it takes. It can take weeks.

Dr. Hokehe Eko:

Yes, I always tell people, you see, how long it took you to get to where you are. It's going to take some time. There's no magic bullet, unless you want to be loaded up with some meds which may or may not work. So, yes, it's just to be patient and one step at a time, absolutely. I love that you're emphasizing that, because that's so important for people not to give up, say, oh, after one night, well, it didn't work. Exactly what are your thoughts about journaling before they go to bed, like emptying out their brain?

Dr. Nishi Bhopal:

I love journaling yeah, such a great practice. And a couple things about journaling, a couple tips. So one is if you find that it stimulates your brain or it starts you thinking about stressful things you know that are bothering you, don't do it right before bed. What I recommend to most of my patients is to actually do it at the end of the work day or the, you know, in a transitional period, in the evening, so you've kind of gone through your day and then just do a brain dump, right, because sometimes people get they get intimidated by that word journaling of like I don't know what to write and like, you know, I don't know, I don't have anything to say, and that it becomes the stressful thing. So what I tell them is like it's a brain dump, so whatever's swirling around in your head, just get it on paper.

Dr. Nishi Bhopal:

It might be things like oh, I got to go to the dentist tomorrow. I have to make sure, you know, I schedule that appointment for the cat or whatever you know. Like, whatever's in your head, just get it on paper. And then it might be things that are, you know, more things that are bothering you, that are more stressful, anxiety, or maybe you're thinking about an argument you had with a friend or a weird interaction you had with a coworker or something. So you can just get that all out and you just say what you want to say. No one's going to read it and you can even schedule it. So there's a technique called scheduled worry time, and this is a technique from cognitive behavioral therapy, no-transcript less likely to happen when you're laying in bed. So schedule five to 10 minutes and just do your brain dump.

Dr. Hokehe Eko:

Yes, I like that because it can also be like a hack to yourself Say, okay, I'm only allowed to feel bad for 10 minutes and after that we're done. Yes, one to the next, because I was I don't remember what book I was reading and they talked about giving yourself five minutes. I think it was a miracle morning giving yourself five minutes to feel bad about things and then realize, okay, what do I have control over, and go with that thought or go with the action that you have control over, instead of sitting in the down feeling. So, yeah, I've tried've tried it. I found it really helps. So what's one last brain tip you have for parents?

Dr. Nishi Bhopal:

So what I would recommend is movement. That's really one of the most effective things we can do for really all aspects of brain health, right? So, whether it's anxiety, whether it's memory and focus, whether it's sleep, getting some kind of movement and making it. Let it be fun and easy for yourself, Right? So, again, it doesn't have to be like oh, I'm going to the gym and I'm doing this workout that I hate to do If you hate doing that don't do that.

Dr. Nishi Bhopal:

So get movement into your day. Yeah, and however. However it can be, but see if there's like little ways you can build more of that into your routines.

Dr. Hokehe Eko:

Yes, it definitely moves your blood, moves the oxygen which your brain needs and helps all around. So thank you so much, Dr Nishi. Can you tell our listeners where they can find out more about you and your practice?

Dr. Nishi Bhopal:

Yes, thank you. So my practice is called Pacific Integrative Psychiatry. You can find us on our website at Pacific Integrative Psych, and, for healthcare practitioners who want to learn more about sleep, you can find me on my YouTube channel at Intra Balance. I-n-t-r-a.

Dr. Hokehe Eko:

Balance is a wealth of wisdom. As you can see, I took note. I hope you did too. So thank you again for listening to this episode and we'll see you on the next episode. Have a wonderful day and please share this with somebody in your life that needs to hear about how they can improve their sleep, because we all can improve our sleep so that we can all be the best versions of ourselves. So have a wonderful day everyone. Bye.