Stop Taking Melatonin Like This — Sleep Doctor Explains Supplements

In this powerful and deeply insightful episode of Hormones & Hope, Dr. Chhaya Makhija sits down with triple-board-certified psychiatrist and sleep medicine specialist Dr. Nishi Bhopal to unpack one of the most universal yet widely misunderstood  pillars of health: sleep.

Together, they explore how sleep influences hormones, metabolism, immunity, mental health, and long-term cognitive function, and they break down the myths surrounding supplements like melatonin, magnesium, L-theanine, and ashwagandha. 

Whether you’re a clinician, a patient, or someone trying to feel better in your daily life, this episode is full of evidence-based, actionable guidance that you can start using today!

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Transcript

00:00
Number one, true or false. Good sleep starts long before bedtime and it's actually a daytime habit. True.  Number two, yes or no, is melatonin safe and effective for long-term sleep support? There's not enough information on long-term use, but in some people it can be helpful long-term. So it depends.  Number three, one supplement you think is overrated for sleep? Magnesium.  Really?  Okay. Number four,

00:29
one supplement that actually has evidence behind it.  Welcome to Hormones and Hope,  a podcast where we bridge science and wellness  to help transform your health.  I'm your host, Dr. Chhaya Makhija,  or you can call me Dr. Chhaya,  a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.  Each week we dive into the powerful intersection of clinical medicine  and real life lifestyle strategies

00:59
to help you feel stronger,  live longer,  and show up as your most vibrant self inside and out.  So let's get empowered. Hi, everyone. Welcome again to a new episode on hormones and hope.  And it is my pleasure, it's my privilege to introduce you to today's guest because today I've been interviewing a few more throughout the nation.  And I asked the other specialist.

01:26
that what is one lifestyle change that they would want their patients to learn from? And this is coming from different specialties. And everyone gave the same answer.  That was sleep. So today  I get the opportunity to actually introduce you to a triple-boarded physician specialist in psychiatry, in sleep medicine, and integrative holistic care. Like what else? What are the combination that you could think of? That's Dr. Nishibu Gopal.

01:54
She's residing in California, has a practice, a boutique practice, as well as an amazing sleep coaching program, which you also check out, and you'll learn more about it from Dr. Bhopal herself.  And it is again my delight, this is my fourth time I'm saying that, Dr. Bhopal, to have you on our podcast, and thank you for accepting the invitation. Well, thank you for having me. I'm delighted to be here as well, and really excited to talk about my favorite subject, which of course is sleep.

02:21
Yes, and I think that should be on the top list now for lifestyle intervention, especially in this era. So before we get into the nitty-gritty details of the topic today, Dr. Bhopal, can you tell us something  or anything about you, anything fun, where you're from and your passion and why sleep medicine? Okay. Well, thank you again for having me.

02:44
I'm originally from Canada, Vancouver, BC. That's where I grew up. But of course I live now in the San Francisco Bay area, as you mentioned.  And my  medical journey has kind of taken me all over the place. So I did my undergrad in Vancouver, medical school in Ireland.  Then I did my psychiatry training in Michigan, in Detroit, Michigan, sleep medicine fellowship in Boston, lived in Chicago for a few years, and then moved out to California. And through this whole journey, through this time,

03:14
going through medical school, going through residency. I was dealing with my own issues with anxiety, with burnout, like many of us do.  Whether you're in medicine or if you're a high achieving professional, many of us can relate to those patterns of, you know, being a perfectionist, being a high achiever, putting a lot of pressure on ourselves. So I was dealing with those things as well, in addition to sleep deprivation that we all experienced during medical training. So that kind of sparked my interest in looking deeper.

03:42
at health  and I got interested in yoga, meditation, just for my own benefit. And I started to see  how those practices were so impactful in my own life, yet I wasn't learning about these things in my residency. So I got curious about that. Well, you know, there was something to these practices that I'm doing. They're incredibly beneficial, but why am I not hearing about this in conventional training? So I started exploring integrative medicine, Ayurveda, nutrition,

04:11
functional medicine, all of these other modalities. And eventually I started to incorporate those into my  clinical work. And my interest in sleep came about for a couple of reasons. One was I was always that sleepy kid when I was in school. You know, I was the kid who couldn't get up for school on time. I was always tired by the end of the day. I wanted to take a nap and I felt like I couldn't get a handle on it. And then that just got amplified during residency and fellowship training because of the sleep deprivation.

04:40
And on top of that, in my psych residency, I was seeing all these patients with anxiety, depression, mental health issues,  and  inevitably they have sleep issues as well, right? So you're going to see sleep issues in the psychiatric clinic.  And I was learning a little bit about how to help them, a little bit about restless leg syndrome or about insomnia management, but that was about it.  And I wanted to go deeper in learning how to support those patients in a way that would actually heal them.

05:10
not just give them symptom relief, but give them  long-term  relief and improvement in their sleep quality, really optimize their sleep, because that's the foundation of everything which we're going to talk about today. So that led me to do a sleep fellowship. And then like I said, I was incorporating this integrative approach as well. And so that's kind of what I do now. That's how I came to this point where I now have a psychiatric practice where we support patients with a whole body approach to mental health  and sleep optimization where

05:38
incorporating the best of evidence-based medicine, cognitive behavioral therapy for insomnia, evidence-based sleep practices, and integrative practices as well. So that's kind of like how this journey came to be.  I love it. You know, personal stories and then that becomes your passion. Like, how do I solve this problem?  And now you're spreading it, you know, not just to the community, to people, but also teaching clinicians. So kudos to what you're doing.

06:06
So Dr. Bhopal, before we start, always have rapid fire questions. We'll have, you know, 607 for you.  And these are quick. That's why rapid fire, one-liner answers or one-word answers. And then we can get into the details of the deep dive. You ready? Okay. Let's do it. Okay. Number one, chores falls. Good sleep starts long before bedtime. And it's actually a daytime habit. True.

06:32
Number two, yes or no, is melatonin safe and effective for long-term sleep support? Okay, this one depends. There's not enough information on long-term use, but in some people it can be helpful long-term. So it depends.  Number three, one supplement you think is overrated for sleep? Magnesium. Really? Okay. Number four,  one supplement that actually has evidence behind it? Melatonin.

07:00
Ooh, lala. Okay. Number five, right or wrong? A consistent sleep schedule matters more than the total number of hours. Yes. So, regularity is one of the most important metrics, but that doesn't mean you shouldn't get enough sleep and just have a regular sleep schedule. So, short answer is yes. Duration also matters, Okay. Number six, yes or no? Feeling tired even after seven to eight hours of sleep is a red flag for deeper issues.

07:29
Yes. Okay. And the last one, number seven, one simple step or one simple sleep habit that every adult should start tonight after listening to this episode. Put your phone away at least one hour before you go to bed. you so much. Words of wisdom, simple, and some myth busting answers here. So I'm excited to learn more, Dr. Bhopal.

07:54
Before we get into, because I think some of those questions need more of an elaborate answers, if you can just give us an overview based on your expertise that why sleep is so important.  So how is it actually impacting our hormones, our metabolism, even like our long-term productivity and longevity? Yeah, absolutely. So the way that I think about sleep is that it's the conductor of your overall health, right? So if you think about your

08:23
your whole body, your physiology as an orchestra, the different instruments, right? They're working in tandem, but they all have their own jobs. Sleep is the conductor of all of that. So when you're not getting good quality sleep or you're not getting enough sleep, that orchestra just,  it kind of goes awry, right? It's not playing that beautiful melody. And so let me explain a little bit more of what actually happens. So sleep impacts are

08:49
brain. It affects the way that we think. It also affects memory consolidation. During sleep, actually consolidate information that we learn during the day. And that information is filed away into the right filing cabinets in the brain. But if you're not getting good quality sleep or not enough sleep, it's like the files are just strewn about all over the floor, right? They're not getting put in the right cabinet. So that's why you might find the next day that it's harder to focus and concentrate, but it's also harder to

09:16
whole information out and what was that person's name again or oh yeah I forgot to follow up on that email. These kinds of things can happen short term and so you can imagine on a long term basis if you're not getting good quality sleep that can have significant impacts on memory down the line. Another thing that happens in the brain during sleep is we start to wash out proteins that build up during the day. So things like amyloid protein and those proteins are implicated in the development of Alzheimer's.

09:44
So during stage three deep sleep, our brain actually washes out those proteins. So again, if we're not getting enough sleep, we can have a buildup of those proteins and that can lead to long-term cognitive decline. But if you just think about the short-term effects as well, like we all know that phrase, you woke up on the wrong side of the bed and we  all can relate to that feeling of not getting enough sleep, you're cranky the next day,  and you have those memory issues or focus issues like I was talking about, maybe you're more snappy at your partner.  And that's because not only

10:14
our cognitive functioning,  not only are those aspects impacted, but our emotional regulation is impacted too. So there's mental health impacts as well. And there's a bidirectional relationship with mental health issues and with sleep.  we know that anxiety and depression increase the risk of sleep issues, but vice versa. Having sleep issues increases the risk of developing anxiety and depression, and it also makes those conditions harder to treat. So the relationship goes both ways.

10:42
On top of that, sleep impacts metabolism. So again, you know, for sleep deprived, you're not getting good quality sleep. We have a shift in our hunger hormones and this, know this is your domain. So you have a lot of expertise in this area, which is we have an increase in ghrelin, which is the hormone that makes us feel hungry. I remember that by makes your stomach growl or it's a little hunger gremlin. So you have an increase in that and a decrease in leptin, which is the hormone that helps us feel.

11:11
satisfied. So people might eat more calories and actually studies do show this when people are sleep deprived. They eat at least 300 more calories per day. Your  shorter sleepers also have a higher risk of developing  other metabolic issues like type 2 diabetes and so on. On top of that, our immune system is affected. So sleep is kind of like your software update. That's what happens when you're sleeping. So your immune system is upregulated.

11:38
When people are sleep deprived, actually have a lower response to vaccinations. Vaccines aren't as effective. So the list goes on and on. I mean,  we could talk for days about all the impacts of sleep and how it affects our physiology. But ultimately,  sleep is a way to reduce inflammation. It's a way to improve your metabolic function. It's a  way to improve your cardiovascular health, your blood pressure.  And it's a way to improve your mental health, your cognitive functioning, and your overall sense of

12:07
help and wellbeing. Yes. You know, it's basically like in physicians when, you know, when the audience, if there are patients that you're seeing physicians, we have vital signs, right? The blood pressure, the heart rate, et cetera.  And for me, and I'm pretty sure for you, if you may relate,  sleep and bowel movements have become my other vital signs. Why has this become so important now, like sleep? What have we lost over the last few decades that, you know, now we have this specific specialty?

12:36
because we have so many disorders and the numerous, the diverse implications that it is having if it's abnormal, the sleep. Yeah, I think that's such a great question. And well, on one hand, there's just been greater awareness of sleep. Like when I did my sleep fellowship back in 2012, it was not really commonplace at that time. And even some of my attendings asked me, why are you going to sleep medicine? Like, what even is that?

13:02
I didn't even know that it was a specialty that you could go into when I started my residency. Now there's much more awareness about sleep issues. People are talking about it on social media. A lot of people are wearing sleep trackers like Oura Rain, Fitbit, and things like this. So there's just a lot more awareness, which is a wonderful thing. But as you said, there are so many sleep issues in this modern day and age to the point where the CDC has declared that insufficient sleep is a public health crisis.

13:29
because one in three adults in the US are not getting the recommended amount of sleep. Why is that? Well, it could be because of our modern world, just the amount of technology that we have available to us, the amount of stimulation we have, 24-7  work schedules  as well. So, you know, there's so many different reasons. We're also seeing higher rates of obesity. So that can lead to other sleep disorders like sleep apnea.

13:56
We're seeing that there are nutritional deficiencies and insufficiencies maybe related to depletion of micronutrients in the soil. So we're seeing more people with magnesium insufficiency and we'll talk about magnesium because I said that was one of the most overrated supplements and I'll explain what I mean by that.  Iron deficiencies can lead to restless leg syndrome, restless sleep. So there's all of these different factors at play  is absolutely  one of the vital signs that I look at with my patients, whether they're coming to me for sleep issues.

14:25
or if they're coming to me for psychiatric support. One of those things where, you know, if I ask a patient, how do you sleep or how much sleep are you getting? Based on their answer, I can almost immediately tell, okay, what's, you know, what's going on with them? Okay, you're struggling at work, you're struggling in your relationships, you're probably experiencing anxiety and depression that's not getting better. You're probably experiencing headaches or migraines that aren't getting better. You're, oh, you're struggling with weight gain or difficulty losing weight, things like this. And then we can oftentimes trace that back to

14:54
some kind of sleep issue that's at play, not always, but many times we can. And I love that you mentioned bowel movements as well, because sleep is important for gut health. When you are not getting adequate sleep, it causes gut dysbiosis, changes in the microbiome, and that can go hand in hand with issues with bowel movements. So sleep is absolutely one of those fundamental factors, those fundamental vital signs that all of us deal with, right? Everybody has to sleep.

15:24
And if you're a physician or a clinician working with patients and clients, they all have to sleep too. So it's one of these things all need to have some understanding of. Yes, very, very beautifully said. It actually ties in with the way you were describing about the orchestra of how everything has to be in harmony for the melody. So that one piece sleep is going to be so crucial. You also mentioned about the sleep devices. So there are sleep apps, the Aura Ring.

15:51
Do you use this in your clinical practice or if patients are asking you that, ah know, I would love to use this device? Do you  usually use the data to interpret or help your patients?  Yeah, I do. Depending on the patient. So I actually have an aura ring myself.  Mine died, so I'm not wearing it at the moment. But I do find it to be a useful tool with the caveat that for patients who are struggling with chronic insomnia, I usually recommend they don't use their tracking device.

16:20
because it can start to create a little bit more fixation on sleep, a little bit more anxiety about it. So in those cases, I usually recommend putting the device away, let's tune back into your body. But for other patients, the device can be incredibly helpful. And I was actually just chatting with a colleague of mine. He had posted something on LinkedIn. He's also a sleep doctor. posted on LinkedIn about the impact of alcohol on sleep. And we were having a discussion about that and how trackers can be really useful in that regard because

16:48
Oftentimes when we speak to our patients about the impact of alcohol and sleep, nobody wants to hear that.  They don't want to hear that that evening glass of wine is having a negative impact  on their sleep quality when they feel like, well, no, it helps me relax. It helps me fall asleep. But if you look at the data on your tracker, you're going to see that your heart rate variability  goes down, that your sleep quality decreases. So these tools can be useful for behavioral change and for motivation.

17:16
and tracking those changes over time. The other  way that I do find them helpful is to kind of see how much sleep are you actually getting. These trackers are usually pretty good at sleep duration. They're not so good at sleep staging though. So for anyone who's using a tracker, don't get too fixated on how much REM sleep or deep sleep you're getting because these  trackers are really not good at measuring that. So I don't even look at that data.  I'm looking more at trends over time. I do like to look at the heart rate variability.

17:47
and the sleep duration and sleep regularity. Sleep staging, I usually don't look at. That's interesting to know, yes, because  there are several of my patients who are fixated, cannot live without the RR ring, and now I get to learn more about.  And they're usually focused on the REM sleep or, you know, what's the stage I am in most of the time. Thank you. Yes, and you can look at the trends so you can see, okay, my REM sleep has increased.

18:13
you know, over time because I've implemented a more consistent sleep routine and I've cut out alcohol or, whatever it is, but that absolute percentage is really not that meaningful. How insightful. Okay. So this, now we know the importance of sleep  and  one is, you know, also seeing a  clinician if there is a sleep disturbance and you have these apps or devices that can also track with the help of expert.

18:38
Coming back to the rapid fire questions, because we had a couple of them relevant to supplements, and this is your expertise. So what works, what doesn't? Like there is so much out there,  and it's very easy to market them, you know, get your best sleep. But how does a consumer or your patient, how can they get some insights today that this is definitely not for me, and maybe I could consider this, but also seek medical expertise? So what do we have in terms of evidence? Yes. Okay, great.

19:08
So the first thing I tell people is that supplements are just that. They are a supplement. They are an adjunct to sleep promoting behaviors, to healthy lifestyle, to  sleep treatment, right? They are not the  sole thing that are going to help you get better sleep. Supplements just don't work that way. The second thing for people to know,  and this is something we teach inside of our sleep coaching program as well,  is that if you are going to be using a supplement,  one, remember that

19:37
just because something is natural doesn't mean that it's safe. So it can have interactions with other supplements, with other medications. So you wanna check with your doctor or your healthcare practitioner to make sure it's appropriate for you. The second thing is that supplements are regulated differently by the FDA compared to medications. So what that means is that companies can bring these supplements to market without getting FDA approval. So they can make all kinds of claims about what their supplement does. And it doesn't...

20:06
necessarily have to match what it says on the label, right? So you want to be using, if you are using a supplement, make sure it's third party tested. And what that means is that it's been tested to ensure that what it says on the label is actually what's in the supplement itself. This is a particular relevance to melatonin, which I'll speak about in a moment because there were some studies that came out in the past few years. One was in the Journal of Clinical Sleep Medicine in 2017. The other was in the Journal of the American Medical Association in 2023.

20:35
looking at over-the-counter melatonin supplements and they found that some of them didn't have melatonin in them, even though they were marketed as a melatonin supplement. Some of them had hundreds of times percent more melatonin in it than what the supplement claimed. So again, we need to just be really careful with quality. Okay, so what actually works for sleep? So again, there's nothing that quote unquote works in terms of like you're going to take it and it's going to make you fall asleep, but there are supplements that can be helpful as a support.

21:04
The one with the most data is melatonin. Melatonin is produced naturally. Our brain and gut produce melatonin. Melatonin is a sleep-wake regulator. So it's not a sleep aid. It's more of a signal. It tells your brain that it's time to sleep, but it's not as sedative, right? It's not gonna work like Ambien or something like this. But melatonin can be really useful. It's actually not indicated for chronic insomnia. And this is where I  see a lot of people

21:33
getting stuck because they're struggling with insomnia, they're trying melatonin, and they say, that didn't work for me. Well, it's actually not meant to be used for chronic insomnia. And this is important for physicians and clinicians to know as well that there are ways to use melatonin strategically. And that's something we teach inside of my sleep education program for clinicians. But when you use it strategically, it can be quite effective. And what it is useful for is circadian rhythm disorders. So we can use it for that.

22:01
There is evidence for its use in patients over the age of 55 because our melatonin secretion decreases with age. So after about the age of 50 or 55, your brain produces less melatonin. So extended release melatonin, two milligrams is actually indicated as a prescription in many countries, like the UK and Australia. It can be useful in menopause. There's some research for that as well. So there is good evidence for melatonin, but it has to be used correctly. Magnesium, I'll just say a couple of lines about that because

22:30
That's one that I see a lot of physicians talking about it. I see a lot of my patients taking it. It's all over social media. I get lots of ads for it on Instagram. Magnesium is a supplement that I use a lot with my patients. In fact, I have most of my patients on some form of magnesium because it is such a critical nutrient. It's involved in hundreds of different enzymatic reactions. It's not a sleep aid though.  I've even seen physicians say like, oh, I don't want to take magnesium because it's going to make me sleepy in the morning.

23:00
Maybe for some people it does have that effect, but the data on magnesium for sleep is actually pretty limited. There are some small studies showing mixed findings in older adults, but overall we don't have a lot of good research saying that magnesium is supportive for sleep. But like I said, it's such a critical nutrient that it works in the background as a support physiologically, but not specifically as a sedative. So I think that's why I said it's the most overrated supplement for sleep, because it's actually not really

23:30
that robust when it comes to sleep issues. I've had a lot of patients like the mood stabilizers and I had one of the psychiatrists also interview. What about ashwagandha for sleep? Yeah, so there actually is evidence for ashwagandha for sleep and the studies have looked at about 600 milligrams for eight weeks  and it can be helpful for patients who have  anxiety, for people who have high stress, that sort of nervous system hyperarousal. And so I do use it.

23:59
in those patient populations. Again, we want to use a good quality supplement. The supplement should be made from the root extract. 5 % with anal lides is what's shown to be effective. And it does take about two months before people start to notice an improvement. Because I'll have patients tell me, well, I took it for a week and it didn't do anything. Well, it's not enough time for it to work because it's an adaptogen. So it helps your body adapt to the effects of stress. And it also should not be taken indefinitely.

24:28
I usually recommend taking it for about 12 weeks and then you take a break and we reassess. Again, quality is incredibly important. So you want to make sure it's a third party tested supplement.  And Ashwagandha can have other impacts on blood pressure, on thyroid. So again, it's not something to be taken just kind of on your own, especially if you have medical issues or are on other medications. It's a medication that's been used in Ayurveda for thousands of years. So we need to treat it as such. Thank you.

24:57
Oh, I got to learn more about magnesium today. Okay. So there was one more. think I've had a few patients seek your care and the sleep coaching  and I've seen the prescription, not prescription, but suggestion of L-T-N-E. What's the role there? Yeah, it's one of my go-to supplements for people who need more support with anxiety. It can also help with ADHD like symptoms  and it's calming. So it's not as sedative. It's not a sleep aid.

25:27
But the way that it can support sleep is by calming the nervous system.  And that allows us to access  sleep, because then we're not in this kind of hypervigilant state, right? So a few cases where it can be helpful is for those people who are struggling with winding down, they're dealing with a lot of anxiety, there is actually research showing that it can be effective for children with ADHD and sleep issues as well. Generally, we start with around 200 milligrams.

25:55
The research shows that taking it for about two to four weeks  as a daily dose can be helpful. Sometimes I'll titrate above that depending on the patient. But again, we want to make sure it's  safe given your, you know, whatever else you might be dealing with medically or medication wise, good quality supplement is recommended. And it's not the only thing, right? It's just a small part of the treatment plan. And that's the big mistake that I see both clinicians and patients making is like, okay, take this thing and

26:24
Let's see if it works and what does it mean if something even works? You we have to understand like what are the appropriate expectations to have around this supplement, but you can't just use it on its own. It has to be done as part of a whole treatment plan. So that's what we do in our urchin program. The bulk of what we do is working on nervous system regulation and then we'll use tools like L-theanine for additional support.

26:43
Say if an individual is walking to the store, melatonin is all over, right? And you talked about the 2-milligram extended release for individuals above 55 if they were dealing with insomnia and not chronic insomnia. What about these other doses that are available over the counter? You know, I have so many friends who use it for their jet lag changes, and that's been very helpful. So what do we have in terms of evidence for using the lower doses for anyone walking into a grocery store or a pharmacy?

27:13
Yep, great question. So the way that I think about it is dividing into  a physiologic dose and a pharmacologic dose. So generally what we're using is a physiological dose, meaning a dose of about 0.3 to 0.5 milligrams. And that is typically what we're going to use for circadian regulation, whether it's from jet lag, shift work, delayed sleep phase, advanced sleep phase, these kinds of conditions. So  mostly when I'm using melatonin with my patients,

27:42
I'm using it for circadian shifting or circadian regulation in a dose of about 0.3 to 0.5 milligrams. Personally, I'm a little bit on the night owl side. So if I need to shift my rhythm, I use 0.3 milligrams.  And that's what most of the data supports.  For general sleep support, the data kind of shows that 0.3 to 3 milligrams is what is most effective. Once we start going beyond that, beyond like 3, 5, 10 milligrams, you might see at CVS or Target,

28:11
Those are more like pharmacologic doses. Those aren't  as needed for most people. They might make you feel more sedated. That's why we call it a pharmacologic dose. There is an indication for those higher doses for REM behavior disorder. There's also emerging research, and this is kind of beyond sleep indications, but there's emerging research on melatonin's antioxidant effects, anti-inflammatory effects. So it's being used for long COVID, for IVS, for  sepsis, for cancer.

28:41
And those are higher doses. Those are like 20 milligrams, 50 milligrams, even hundreds of milligrams. So I'm not talking about that. There is use for those. But for sleep, generally the data supports 0.3 to three milligrams. And you want to make sure it's a good quality supplement. How fascinating. So when I did my endocrinology fellowship, I don't think so we had melatonin supplements or maybe just very few, but not all over.

29:07
Melatonin was only discussed in physiology, like where it's produced in the brain and what it does. We didn't have any  information, which as fellows, we needed to learn about the physiological doses versus the pharmacological doses versus the evidence of,  like you mentioned about a prescription dose for  elderly. So in  more than 10 years, it's been a while, so 18 years, we've learned, you're telling me about the data. So I'm guessing all this data is the last 18 years or a decade.

29:37
Yeah, in the last 10 to 15, so like when I was in my sleep fellowship, we were using melatonin supplements, but only for circadian indications in that 0.3 milligram dose. Even just in the last like two to three years, there's been this explosion of research on its other indications that I mentioned, like the anti-inflammatory effects and things like this. So I think like in the next five to 10 years, we're gonna be seeing like even more emerging evidence on melatonin and even more use cases for it.

30:07
and a clearer answer to that question on whether or not it's safe for long-term use, which is one of the rapid fire questions. Because right now we just don't have enough research showing what happens when it's taken long-term. So yeah, it's one of the most widely misunderstood supplements  out there when it comes to  sleep issues. You you'll hear from your patients, like I hear all the time from patients and from colleagues, melatonin doesn't work or it didn't work for me. And there's usually three reasons for that.

30:35
One is that it's the poor quality supplement.  Number two, it's the wrong indication. Or number three, it's the wrong timing. Melatonin is a chronobiotic. It tells your body what time it is. So if you're taking it at the wrong time, it's either going to be ineffective or it's going to have the opposite effect that you want. And that's based on something called the phase response curve. So I have a whole training on that on my YouTube channel if anyone wants to learn more about the phase response curve and the right timing for melatonin. But...

31:03
It's not as simple as just going to CVS, getting a melatonin supplement and taking it bedtime. There's more nuance to it. How fascinating. Thank you. This was basically a mid-busting the rapid fire plus every small insight and detail that you've provided today. So before we end the conversation today, Dr. Bhopal, if you can share because, one of your expertise is integrative holistic care. And you talked about, you know, merging or integrating lots of other strategies.

31:31
So what are these real life strategies?  And one of your rapid fire was, you know, technology, like one habit for everyone  was to stay away from screen or technology. So can you guide us through at least like five simple steps or bedtime routine or our daytime habits that can help improve sleep? Absolutely. Okay. So the first thing is going back to your first rapid fire question, which is when does good sleep start? So good sleep starts during the day.

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What we do first thing in the morning and throughout the day sets the scene for how well we sleep at night. So number one is to have a consistent wake time within about an hour of the same time every day. The second thing is to get bright light first thing in the morning, ideally with natural sunshine. But if you don't have access to that, if it's dark outside when you start work or this kind of thing, you can use a light therapy device. The third thing that I recommend  is to actually have your meals on a regular schedule throughout the day. It's one of those really subtle things, but

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I recommend this to all of my patients struggling with sleep issues and they notice that their sleep starts to stabilize pretty quickly when you have that regular routine. In terms of technology, I really like this technique called the bookend strategy, which means no screens or technology for the first hour after you wake up and then for an hour before you go to bed. So put away your phones, your iPads, this kind of thing with a caveat that it's okay to watch TV in the evening, especially if you find it relaxing, helps to get your mind off things.

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that's okay, but you want to stay away from social media, stay away from the scrolling, from checking your email, catching off on work. That's too stimulating, but more passive activities like watching TV in low light can be helpful for some people. And then the last thing is to have some kind of a wind down routine. It doesn't need to be a rigid bedtime routine. And in fact, something that I work with with my insomnia coaching  clients is we want to shift away from rigidity. So I have patients, especially those with insomnia,

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who will have these very strict bedtime routines. First, I need to do these 10 things. I had one patient who was an engineer. in the Bay Area, so we see a lot of engineers. He had like a 30-step bedtime routine, and that kind of thing actually creates more anxiety. So we need to allow some flexibility, but having some wind down, whatever that looks like for you. So it could be having a shower, having a warm bath, doing some stretching, reading a book, maybe doing some journaling, listening to yoga nidra.

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Maybe it's watching your favorite show,  this kind of thing, but something that you look forward to in the evening. And sleep takes time to catch up. So, you know, if you do these habits for one or two days, if you're struggling, not necessarily going to work right away. But if you do this consistently, it's like exercise. You do it consistently over time, you'll start to see improvements. Yeah.  Simple, solid and powerful.

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Thank you. See, we talked about supplements. We talked about  all the effects that poor sleep can have.  And you're just leaving us with very simple steps, which I really loved. And they're not nuance. They're actually very simple. So anyone listening, watching, these are magic words, and they actually work.  So thank you so much, Dr. Bhopal. Before we end, please let us know your website. You talked about your coaching program.

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and the YouTube channel if you can leave us with that information, but we'll also have it in our notes for the episode. Excellent. Well, thank you so much. And I just want to say one last thing before we wrap up, which is, so let's say you're doing all of these things, you're following all the steps, what I just shared, and you're still struggling, then don't hesitate to get an evaluation because sleep issues are highly treatable. And there's over 40 different sleep disorders.

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So, you there could be sleep apnea, restless leg syndrome, hormonal sleep changes, circadian rhythm issues. So if you're doing all the things I described and you're still struggling, go and get evaluated for that because there's help available. And as far as where people can find me, so you can find me on YouTube at Intra Balance. It's I-N-T-R-A Balance. I've got lots of information about sleep there. If you want to work with us for sleep coaching, you can go to our website at Pacific Integrative Psychiatry. So it's pacificintegrativesyke.com.

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or you can connect with me on LinkedIn. Okay, there you go. So if you need medical expertise, not sure where to start, either talk to your physician or you have all these resources that Dr. Bhopal shared with us. Thank you so much. It was such a delight to learn a lot about sleep today. Thank you.  Thanks for hanging out with me on Hormones and Hope.  If you've loved this episode, do me a favor,  hit subscribe, share it with someone you care about,  and drop a review if you're feeling generous.

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Want more tools to support your hormones and health?  Head over to unifiedandocrinecare.com.  We've got free guides, resources,  and more waiting for you.  Until next time,  stay curious, stay kind to your body, and keep your hormones happy.