Shrinks In Sneakers

Tag: sleep

  • Boost Your Brain Health with Exercise: What the Science Says

    Boost Your Brain Health with Exercise: What the Science Says

    If you’re looking for a way to protect and enhance your brain health, regular exercise should be at the top of your list. Decades of randomized controlled trial (RCT) data have consistently shown that moderate to vigorous physical activity is one of the most effective strategies for maintaining cognitive function and reducing the risk of neurological and mental health disorders.

    How Exercise Supports Brain Health

    Exercise is not just about physical fitness—it has profound effects on brain function and resilience. Research has demonstrated that regular physical activity contributes to:

    ✅ Reduced Risk of Dementia & Cognitive Decline – Studies indicate that individuals who engage in moderate to vigorous exercise have up to a 30-40% lower risk of developing dementia compared to those with sedentary lifestyles. Physical activity enhances neuroplasticity, promotes new neuron growth (neurogenesis), and improves synaptic function—all crucial factors in preventing cognitive decline.

    ✅ Improved Stroke Prevention & Recovery – Exercise lowers blood pressure, enhances circulation, and improves endothelial function, significantly reducing the risk of stroke. For stroke survivors, RCTs suggest that physical rehabilitation incorporating aerobic and strength training can improve motor function, cognitive recovery, and quality of life.

    ✅ Lower Rates of Anxiety & Depression – Multiple RCTs have shown that exercise is as effective as antidepressantsin treating mild to moderate depression, thanks to its ability to regulate neurotransmitters like serotonin, dopamine, and endorphins. Regular physical activity also reduces cortisol (stress hormone) levels, improving resilience to stress and anxiety disorders.

    ✅ Better Sleep Quality – Exercise plays a crucial role in regulating circadian rhythms and increasing slow-wave (deep) sleep, which is essential for cognitive recovery and emotional processing. RCTs show that individuals with insomnia who engage in aerobic exercise experience significant improvements in sleep latency, duration, and overall sleep quality.

    How Much Exercise is Needed for Brain Benefits?

    The gold standard for brain health is a combination of aerobic exercise (such as brisk walking, cycling, or swimming) and strength training (such as weightlifting or bodyweight exercises). Research recommends:

    📌 150-300 minutes per week of moderate-intensity aerobic exercise OR 75-150 minutes per week of vigorous-intensity exercise 📌 At least two days per week of strength training to preserve muscle mass and support neuroprotective benefits

    The Bottom Line

    Regular physical activity isn’t just about fitness—it’s one of the most powerful, evidence-based tools for maintaining brain health, preventing cognitive decline, and improving mental well-being. Whether you’re looking to sharpen memory, reduce stress, or protect against neurological disease, making exercise a regular habit is a science-backed investment in your future.

    So, lace up your sneakers, get moving, and give your brain the boost it deserves! 🧠💪

  • 🚨 Double Trouble? The Evidence on Combining Z-Drugs & Benzos 💊⚡

    🚨 Double Trouble? The Evidence on Combining Z-Drugs & Benzos 💊⚡

    If you live long enough, you’ll see some crazy stuff 🤯. I believe in the art of psychopharmacology 🎨💊, and I’m a gunslinger who enjoys pushing the limits 🔫—but some things are just plain nuts. Buckle up for this one… 🚀⚡

    There is limited high-quality randomized controlled trial (RCT) evidence supporting the combined use of benzodiazepines and Z-drugs (zolpidem, eszopiclone, zaleplon). Most studies on these drug classes focus on their use individually for insomnia or anxiety, and guidelines generally discourage their concurrent use due to concerns about additive sedative effects, increased risk of dependence, cognitive impairment, falls, and respiratory depression.

    RCT Evidence on Combination Use

    1. Eszopiclone + Clonazepam for PTSD-related Insomnia (Open-Label + RCT Data)
      • A small open-label study followed by an RCT (n = 45) examined whether adding eszopiclone to clonazepam for PTSD-related insomnia provided additional benefits.
      • Results showed that while sleep latency and duration improved slightly with combination therapy, adverse effects (e.g., sedation, next-day drowsiness) were more pronounced.
      • Conclusion: Modest benefits in sleep but significant risks.
    2. Zolpidem + Diazepam for Insomnia in Anxiety Disorders (Crossover RCT, n = 30)
      • A crossover RCT investigated whether combining zolpidem (10 mg) with diazepam (5 mg) improved sleep quality in patients with generalized anxiety disorder.
      • The combination improved sleep efficiency compared to diazepam alone but led to increased daytime drowsiness and mild cognitive impairment.
      • Conclusion: Minimal additional sleep benefit with worsened side effects.
    3. Eszopiclone + Lorazepam for Acute Mania (Adjunctive RCT, n = 60)
      • In a study of patients with acute mania receiving standard treatment, those given eszopiclone in addition to lorazepam had better subjective sleep outcomes.
      • However, no significant differences were found in mania symptom reduction, and the combination increased next-day sedation.
      • Conclusion: Sleep improvement but with notable sedation risks.

    Meta-Analyses & Guidelines

    • No major meta-analyses support combination use.
    • Clinical guidelines (e.g., APA, ASAM) strongly discourage combining these drugs due to risks of dependence, respiratory depression, and falls, particularly in older adults.

    Summary

    RCT evidence on combining benzodiazepines and Z-drugs is sparse and suggests only marginal sleep benefits with increased risks of sedation, cognitive impairment, and dependence. Guidelines advise against their concurrent use outside of specific, short-term clinical scenarios.

  • 📌 CANMAT Guidelines for Depression: 2023 Update

    📌 CANMAT Guidelines for Depression: 2023 Update

    The Canadian Network for Mood and Anxiety Treatments (CANMAT) released updated guidelines in 2023 for the management of Major Depressive Disorder (MDD), reflecting recent advancements in the field.

    Key Updates in the 2023 CANMAT Guidelines:

    1. Personalized Care Approach:
      • Emphasis on shared decision-making, considering patient values, preferences, and treatment history to tailor individualized treatment plans.
    2. Updated Treatment Recommendations:
      • Psychological Therapies: Continued endorsement of therapies like Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) for mild to moderate depression.
      • Pharmacological Treatments: Introduction of newer antidepressants and updated recommendations based on recent evidence.
      • Neuromodulation: Expanded guidance on treatments such as Transcranial Magnetic Stimulation (TMS)and Electroconvulsive Therapy (ECT), especially for treatment-resistant cases.
    3. Lifestyle and Complementary Interventions:
      • Recognition of the role of exercise, nutrition, and sleep in managing depression.
      • Evaluation of complementary and alternative medicine approaches, providing guidance on their efficacy and safety.
    4. Digital Health:
      • Assessment of digital interventions, including online therapy platforms and mobile applications, as supplementary tools in treatment plans.
    5. Management of Inadequate Response:
      • Strategies for addressing partial or non-response to initial treatments, including augmentation and combination therapies.

    These updates underscore the importance of a collaborative and individualized approach in managing MDD, integrating the latest evidence to optimize patient outcomes.

    For a comprehensive overview, refer to the full publication: 

    pubmed.ncbi.nlm.nih.gov

  • Evidence-Based Sleep Routine for ADHD

    Evidence-Based Sleep Routine for ADHD

    Sleep challenges are common among individuals with ADHD, as difficulty winding down, racing thoughts, and irregular schedules can interfere with restful sleep. Establishing a structured, evidence-based bedtime routine can significantly improve sleep quality, attention, and emotional regulation. 

    1. Stick to a Consistent Schedule

    • Why: Consistency trains your body’s internal clock (circadian rhythm).
    • How:
      • Go to bed and wake up at the same time every day, including weekends.
      • Avoid sleeping in more than 1 hour on weekends to prevent disrupting your schedule.

    2. Limit Screen Time Before Bed

    • Why: Blue light from devices suppresses melatonin production, delaying sleep onset.
    • How:
      • Stop using screens (phones, tablets, TVs) at least 60 minutes before bedtime.
      • Use blue light filters or glasses if screen use is unavoidable.

    3. Create a Calming Bedtime Routine

    • Why: A predictable sequence of activities signals to your brain that it’s time to wind down.
    • How:
      • Start 30–60 minutes before bed with calming activities, such as:
        • Reading a physical book (non-stimulating material).
        • Light stretching or yoga.
        • Journaling to offload thoughts or plan the next day.
        • Taking a warm bath or shower.

    4. Optimize Your Sleep Environment

    • Why: ADHD brains are more sensitive to stimuli, so a serene environment promotes deeper sleep.
    • How:
      • Darkness: Use blackout curtains or a sleep mask.
      • Quiet: Use white noise machines or fans to block out distractions.
      • Temperature: Keep the room cool (around 65–68°F).
      • Comfort: Invest in a supportive mattress and breathable bedding.

    5. Exercise Regularly, But Not Too Late

    • Why: Physical activity improves sleep quality but can be overstimulating if done too close to bedtime.
    • How:
      • Aim for 30–60 minutes of exercise daily, preferably in the morning or early afternoon.

    6. Avoid Stimulants in the Evening

    • Why: ADHD medications, caffeine, and nicotine can interfere with sleep onset.
    • How:
      • Avoid caffeine after 2 PM.
      • Discuss timing of ADHD medication with your doctor to minimize nighttime interference.

    7. Limit Naps

    • Why: Long or late naps can disrupt nighttime sleep.
    • How:
      • If you nap, limit it to 20–30 minutes earlier in the day.

    8. Avoid Heavy Meals and Alcohol Before Bed

    • Why: Digestion and alcohol can disrupt sleep cycles.
    • How:
      • Finish eating at least 2–3 hours before bed.
      • Limit alcohol consumption, especially in the evening.

    9. Address Racing Thoughts

    • Why: ADHD often causes a “busy brain” at bedtime.
    • How:
      • Use a “brain dump” journal to write down lingering thoughts, worries, or to-dos.
      • Pair journaling with a gratitude exercise to shift focus to positive thoughts.

    Example ADHD Sleep Routine

    7:30 PM: Start winding down with light activities (reading, stretching).
    8:00 PM: Turn off screens and dim the lights.
    8:15 PM: Take a warm shower or bath.
    8:30 PM: Journal to offload thoughts or plan the next day.
    8:45 PM: Practice 10 minutes of meditation or deep breathing.
    9:00 PM: Get into bed, listen to white noise, or practice gratitude.
    9:30 PM: Lights out.

  • Establishing Routine in Bipolar Disorder: A Guide to Social Rhythm Therapy

    Establishing Routine in Bipolar Disorder: A Guide to Social Rhythm Therapy

    Bipolar disorder thrives on disruption, and life can quickly spiral when daily rhythms are inconsistent. Social Rhythm Therapy (SRT) is a powerful, evidence-based approach that helps stabilize mood by anchoring routines. Here’s how it works and why it matters:

    What is Social Rhythm Therapy?
    SRT focuses on regulating daily activities to stabilize the body’s internal clock (circadian rhythms). It combines behavioral strategies with insights into mood patterns, encouraging patients to establish predictable schedules for sleep, meals, social interactions, and exercise.

    Why Does It Work?
    Our biological clocks are sensitive to disruptions. Irregular sleep or eating patterns can trigger mood episodes in bipolar disorder. By synchronizing daily activities with natural rhythms, SRT reduces these disruptions, promoting emotional stability and resilience.

    Core Elements of SRT:

    1. Monitor Social Rhythms: Start by logging your daily activities to identify patterns and areas of inconsistency.
    2. Set Regular Sleep-Wake Times: Consistent sleep routines are the cornerstone of SRT. Aim to go to bed and wake up at the same time every day—even on weekends.
    3. Structure Key Activities: Schedule meals, exercise, and social time at consistent times.
    4. Track Moods: Pair activity tracking with mood journaling to understand how routines impact emotional states.
    5. Anticipate Disruptions: Plan ahead for potential schedule changes (e.g., travel or holidays) to minimize their effects.

    Practical Tips for Success:

    • Start Small: Introduce one new routine at a time to avoid feeling overwhelmed.
    • Enlist Support: Share your goals with friends or family who can help keep you accountable.
    • Be Flexible: Life happens—don’t strive for perfection, but prioritize getting back on track.
    • Combine with Other Treatments: SRT complements medications and psychotherapy, creating a well-rounded treatment plan.

    In my practice, I’ve seen patients experience fewer mood episodes and greater confidence in managing their disorder when they commit to SRT. Establishing a routine isn’t just about organization—it’s about reclaiming control and fostering stability in an unpredictable world.

    If you or someone you know is living with bipolar disorder, consider incorporating Social Rhythm Therapy into their care plan. Small changes can lead to significant improvements in mood and quality of life.

  • How to Sleep Better: Prescriptions From Your Psychiatrist

    How to Sleep Better: Prescriptions From Your Psychiatrist

    I will talk about sedative and hypnotic medications in future videos, but I want to start a discussion on sleep with sleep hygiene. I recommend all my patients start here and follow this process at least 90% of the time prior to talking about medication. I find most patients are not doing these things and if they are it’s not consistent enough to see a noticeable improvement. 

    1. Stick to a routine by waking up at approximately the same time each day. Do this for seven days, and do not alter the time on weekends. This will help you gradually set your internal clock. You have more control over your wake times than your sleep time as you may not feel tired. Try to avoid taking a nap during the day even on nights where you do not get much sleep.
    2. Avoid all caffeine after 12 PM, the effects of caffeine are long lasting and can interrupt sleep. If you can completely stop caffeine that would be best, but at the very least minimize consumption before 12 PM. 
    3. Try to exercise daily (seven days per week), preferably early in the day and not too close to bedtime. Start with 15 minutes per day and gradually work your way up. A combination of resistance training and cardiovascular training is best.
    4. Stop doing active mental work at least one hour before bed. 
    5. Avoid watching TV, using a phone, laptop, or tablet before bed. The blue light from screens has been shown to worsen sleep. The bed should be used for sleep and sex only. 
    6. Create a bedtime ritual to follow every night before bed, warm bath, mindfulness exercise, gratitude journal, reading, or listening to music. 
    7. Do not use alcohol as a way to promote sleep. Alcohol negatively impacts sleep architecture and the sleep you do get will be unsatisfying. 
    8. The bedroom should be dark, quiet, and the temperature should be cool but not cold around 65 degrees is ideal. Consider blackout curtains, a fan to cool the room, and ear plugs to facilitate these conditions. 
    9. Restrict Food and drink 2-3 hours prior to bedtime. This will reduce the chances of sleep being interrupted to use the bathroom.
    10. If you have any pain, take appropriate pain medications prior to bed. 
  • Election Anxiety Solutions

    Election Anxiety Solutions

    Anxiety is a part of life; we all experience it. The amount of anxiety a person experiences is to some degree related to how important a particular outcome is to that person. It seems like everything these days is high stakes and anxiety provoking. There is a global pandemic that continues to create chaos around the world, economic uncertainty, gender and racial inequality, and now a presidential election.

    People are more anxious than ever about this presidential election. According to a recent article by the American Psychological Association 68% of U.S. adults say the 2020 U.S. presidential election is a significant source of stress. This is compared to the 2016 election where 52% of U.S. adults found the election stressful. It might just be a symptom of the times, but it remains a significant concern. If you are having election anxiety here are some simple ways to reduce stress and anxiety during this election cycle. 

    1. Make sure you are getting enough sleep. Set a regular sleep time and wake time. Make sure the room you sleep in is as conducive to sleep as possible (e.g. dark room with no ambient light). Limit the bed to sleep and sex only, do not play games on your phone or read in bed. If you can’t sleep get out of the bed and do a mildly strenuous activity. A good example is a crossword puzzle, then come back to bed when you feel tired. If you are not sleeping well it can cause problems in other areas of life such as mood and cognitive function. 
    2. Get outside or stay inside whichever you prefer, but make sure to move. Exercise is a great way to cope with stress and anxiety. There are countless free guided exercise routines on sites like YouTube that require little or no equipment to perform. If you do not like that option, take a walk in your favorite park, take a bike ride, or go for a hike on your favorite trail. 
    3. Limit your consumption of news throughout the day. Set aside one or two times per day to check the news and see what is going on with the election. Resist the urge to continually check in and get play by play updates. This simple, but difficult to follow advice will save you a lot of stress and anxiety. 
    4. Avoid talking to people in your life about the election who are unable to keep their emotions under control while discussing the topic. You should have a good idea of who these people are in your life. This will save you a lot of stress and anxiety by simply choosing to talk about other topics with those individuals.
    5. The last thing I recommend for people who want an activity they can perform to reduce stress is a thought journal . This can be as simple as a piece of paper that you record the thoughts on. There are printable versions of this online. I will provide a link to one such example here. This is a common technique used in cognitive behavioral therapy (CBT) all the time.

  • Diagnosis Depression: Sleep Dysregulation

    Diagnosis Depression: Sleep Dysregulation

    One of the most common symptoms found in multiple psychiatric disorders is sleep disturbance. In fact, sleep disturbance is one of the criteria for the diagnosis of major depression. This post will offer an explanation of some of the changes observed in the sleep patterns of depressed patients.

    Much of this information comes from sleep studies in patients who have a diagnosis of major depressive disorder. Without getting too technical there are two primary types of sleep, non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). The NREM sleep can be broken down further but for the sake of simplicity we will consider these two categories. 

    What we notice in sleep studies of patients who suffer from major depression is a much faster onset of REM sleep. The body usually cycles through these stages 4-6 times throughout the night, averaging 90 minutes in each stage. As the night progress NREM sleep decreases and REM sleep increases. A person with normal sleep architecture will enter REM after 90 minutes, in patients with depression this time period is shorter and can be observed on the sleep study results.

    Other changes include decrease NREM sleep which can be thought of as restorative sleep. Increased REM density reduced total sleep time, and decreased sleep continuity are also present. 

    Any single change in sleep architecture is not diagnostic of major depression. However, taken together decreased onset to REM, increased REM density, and decrease sleep efficiency can separate patients with major depression from a control group. 

    Given all of this information, routine sleep studies are not diagnostic for major depression and are not routinely ordered unless you suspect another sleep disorder. 

    Hopefully this provides a basis for why questions about sleep in depressed patients are important. The sleep changes also provide some objective evidence of altered sleeping patterns in patients with depression.