Dispelling Common Misconceptions About Sleep Medicine

Nishi Bhopal, MD, founder and medical director of telepsychiatry practice Pacific Integrative Psychiatry, clarifies 5 misconceptions about sleep and offers practical clinical guidance for mental health care professionals who encounter patients with sleep issues in their practices.

Missed the first part of this interview? Find it here: The Importance of Sleep Education for Mental Health Clinicians.

For more expert insights for your practice, visit our Sleep Disorders Excellence Forum.

Psych Congress Network: Which misconceptions on the topic of sleep medicine within psychiatry would you like to clarify for our audience?

Nishi Bhopal, MD: First, insomnia isn't always insomnia. When patients present with insomnia, it could actually be a symptom of something else that's going on. It could be obstructive sleep apnea, it could be circadian rhythm disorders, it could be restless leg syndrome, it could be a thyroid disorder, it could be anxiety or depression. There's a whole host of other things that it could be. We don't want to be taking that complaint of insomnia at face value. We really want to look under the hood to see what is happening.

The second thing is that sleep issues are highly treatable. I think sleep often feels very murky, both to the physician and to the patient—like, how do you help somebody sleep? Additionally as a clinician, if we don't get enough training in it, it can feel very overwhelming and it can be hard to know where to start. Same for the patient. But sleep issues are highly treatable, especially now with telehealth. There are lots of resources available. There are sleep clinics that are available online now. Sleep testing can be done at home. There are lots of different apps available to support patients with sleep. I have an online sleep program for clinicians where I train them in different aspects of sleep optimization, so there are lots of resources out there.

The third thing is to not forget about doing labs. Sometimes basic blood work can give you a lot of information about what's going on. For example, I pick up on a lot of low iron and ferritin in my practice, and we know that when patients have a ferritin less than 75, it can predispose them to restless leg syndrome, but also just restless sleep in general. So those are simple things you can test for. Also, test vitamin D levels and vitamin B12 levels. When they're suboptimal, it can impact the patient's energy, their sleep quality, and their circadian rhythm. So, don't forget about those basic blood tests that we can easily do in a clinic.

Fourth is to use a framework that I call the CSH framework. It stands for “circadian rhythm, sleep drive, and hyperarousal.” These are just 3 prongs that you can go through whenever a patient comes to you with sleep issues, so you can ask them about their circadian rhythm and do a little evaluation on that. You can look at their sleep drive on their sleep schedule. Are they taking naps? Are they using caffeine? Regarding hyperarousal, is there anything that's activating their nervous system, whether it's stress or maybe a medical condition? So that's just a nice framework that people can use to start kind of thinking through sleep issues.

Finally, take care of your own sleep as the clinician. Make rest a priority, and sleep is one form of rest. Rest is the basis of all activity. So, when you as the clinician, when you're not well-rested, if you're sleep deprived, if you're burning the candle at both ends, you're not going to be as present with your patients, right? To be of the best service to the patients that you're taking care of, you need to take care of yourself.

Interested readers can explore Dr Bhopal's YouTube Channel here.

Nishi Bhopal, MD, is board-certified in psychiatry, sleep medicine, and integrative holistic medicine. She graduated from the University College Cork School of Medicine, completed her psychiatric residency at Henry Ford Health System, and a fellowship in sleep medicine at Harvard Medical School. She is the founder and medical director of Pacific Integrative Psychiatry, an online practice in California where patients receive a whole-person approach to anxiety, depression, and sleep disorders, including nutrition, psychotherapy, and integrative and functional medicine. In addition to her private practice, Dr Bhopal is the founder of IntraBalance, an educational platform for physicians and therapists that includes a YouTube channel and online courses on clinical sleep medicine for healthcare practitioners. Her passion is making clinical sleep medicine easy to understand and accessible to all.