Attention-grabbing articles, backed by research.

The stay-at-home restrictions and social distancing necessitated by COVID-19 have had sudden ripple effects on mental health services for everyone who counts on these supports and treatments. 

College students have faced their own unique effects, as campuses have emptied requiring students to relocate to their respective homes. Although psychological treatment is included amongst essential services, social-distancing has created a widespread prohibition on in-person therapy. An added wrinkle for out-of-state students who’ve been mandated to leave college housing is that their therapist is most likely not licensed in the students’ home states (not to mention the situation faced by international students returning to their home countries).

Dealing with uncertainty is the core underlying theme of stress and anxiety. Hence, the quick switch to all online classes, its effects on graded assignments, and trying to figure out where and when to study without distraction in the home that now serves as a makeshift, all-in-one school and workplace all produce a state of flux. Not the least of these issues is questions about how to reconnect with or find a therapist for remote treatment – or if this is even possible.

A first proactive coping step is to identify the specific questions you are facing and take stock of your automatic thoughts about them – “What am I going to do about therapy?” Such rhetorical questions are usually veiled negative thoughts – “I’m not going to be able to have therapy sessions.” For a different approach, the next step is to consider actual information – what you know and what you do not know (yet) – and decide on a course of action. In the case of this sort of rhetorical question – “What am I going to do about [fill-in-the-blank]” – the task is constructing a literal answer to it and a realistic, attainable action plan. 

So, let’s focus on what we know about how to access therapy services during the COVID restrictions.

1) First and foremost, remember that psychological emergencies, such as suicidal thoughts, plans, and intentions warrant a trip to or at least contact with a hospital emergency department, urgent care center, or crisis response center, which are still open and accessible. Calling 911 for emergency response is also still the correct response to an imminent risk to one’s life due to suicidal thoughts and actions. Other resources include: 1-800-273-TALK (8255) / https://suicidepreventionlifeline.org (online chat available) / via Twitter @800273TALK

2) Don’t assume that your college counseling services are not available, as many institutions have transferred all of their services to telehealth. Reach out to your therapist and the college counseling center for information about how they are handling established (or new) clients, including out-of-state students.

3) Even before COVID-19, increasing numbers of therapists were using remote video platforms that allow for secure video-therapy sessions. With remote sessions now mandated, even therapists who might have been skeptical are utilizing such options. There has also been a loosening of privacy regulations to allow the use of some popular video platforms for remote sessions, such as Skype and Facetime, to meet the current need for accessibility to services during the emergency.

4) With the stay-at-home mandate, though, you will not have the same privacy of your therapist’s office, as household members are ever-present. The video-therapy platforms mentioned above are accessible by computer, tablet, and smartphone, which allow for portability. If you are open about your sessions with family, you can coordinate sufficient privacy for sessions; otherwise, it will require creativity, such as going outside for a walk, or driving your car and parking somewhere for a session on your phone, or other ideas for safeguarding your privacy that adhere to social distancing standards.

5) Many students live in different home states from where they attend college. Thus, a remote session would be with a now-out-of-state college therapist, which typically violates state licensing laws for the practice of psychology. However, many states have modified these licensing restrictions to address the need for continued, remote psychological services with established clients during the COVID-19 emergency. Although your therapist will be kept abreast of any new changes, you can check The Association of State and Provincial Psychology Boards for daily updates of states’ interjurisdictional remote practice status for COVID-19. See updates at:  https://www.asppb.net/page/covid19

6) Difficulties refilling psychiatric medication prescriptions is another issue that runs up against cross-state practice issues. As with therapy, reach out to your prescriber to collaboratively work out a solution. A complicating factor is that some classes of medications have specific restrictions in being prescribed through telehealth, most notably stimulants for ADHD. In some cases, out-of-state physicians have remotely consulted with students’ home-state primary care physicians to take over specific prescriptions until a return to treatment-as-usual.

7) Money is a common stressor that will span pre- and post-COVID life. Most insurance companies will reimburse for remote sessions during COVID-19 restrictions, even if they had not previously done so. Some are even waiving co-pays during this time and permitting coverage for a 90-day supply of medications. However, you cannot talk about insurance coverage without the time-worn but necessary caveat – contact your carrier as to how it is handling services and reimbursement during COVID.

One of the goals of psychological treatment itself is to better manage the ups-and-downs of life. Current circumstances will put these skills to the test as you reconnect with your therapist, not to mention all the sudden changes thrown at you and other students. Facing the discomfort is what advances not just resilience but anti-fragility, the newfound strength and skills gained by muddling through and getting to the other side of difficult times. 

My therapy in college was interrupted by COVID-19 and I still need it – now what?

Across the country and indeed the globe, the coronavirus pandemic has upended people’s lives. Over 150 million Americans have been ordered to stay home, and the vast majority of them are not physically ill right now. This news still feels like a shock to the system, but as these radical changes shift from days to weeks and even months, the combination of widespread anxiety and social isolation will be a major strain on our mental health. Here’s what I’m doing (and what you can do) to maintain sanity during this insane time.

Coronavirus news is everywhere, and it is true that the facts are changing by the day. Naturally, I want to know about the latest number of cases, emerging science about the virus itself, and government plans to address the illness as well as the effects on the economy. However, being trapped at home makes the world feel small, and constantly reading about the coronavirus adds worry with little solace. A supervisor once told me that reading fiction is the best training for a psychiatrist. As we move from our own mind to another person’s point of view, we literally practice empathy. I have also come to realize that reading fiction transports me to another time and space (without exposing me to any viruses). This week, I finally read Tara Westover’s Educated. Reading about the Idaho mountains added a breath of fresh air to my small New York City apartment. 

Remember the mind and body are connected. Just because you can’t go to the gym doesn’t mean you can’t work out. I strongly prefer gyms or playing a sport, but these are not options right now. I’m focusing on what I can do from home: 5-minute yoga sequences in the morning to stay limber, and bodyweight workouts that do not require much space. The American Heart Association guidelines suggest we aim for at least 30 minutes of moderate activity 5 times per week or 75 minutes of intense physical activity per week. If you need people to help motivate you, many fitness studios and yoga classes are offering online streaming so that you can continue your group fitness class from the comfort and safety of your home. 

Do that project you’ve been putting off

Let’s face it: with the lack of commute to work and social events, most of us have more time on our hands than we’re used to. Especially for people who are feeling well and suffering from “cabin fever,” try to think of this time as an opportunity. We all have things we’ve been meaning to do when we get more time: clean out our closet, make a scrapbook, learn a language. Now is the time to work on these items. 2020 will be forever remembered as the year of coronavirus in history, but in your personal story it can also be the year you began something new. In my case, I’m working on improving my Gujarati skills to pass on the language of my parents to my newborn child.

Language and communication are the essence of what makes us different from every other animal species. While social distancing is the best public health strategy right now, social isolation runs counter to human nature. Perhaps that is why isolation is a risk factor for depression, anxiety, poor cognition, physical illness, and even premature death. I have family in 4 different states, and we’ve implemented a FamilyFaceTime on Saturdays at 12pm. It really is different (and better) to get dressed and look at one another in real-time. For many younger people reading this, a video-chat may feel intrusive in today’s text message-oriented culture, but remember, if they are a human on this planet, your friends and family are likely at home with more time on their hands too. While you’re at it, consider reaching out to people you care for but have lost touch with. Reconsider strained and estranged relationships in favor of burying the hatchet. Calamities like this one risk isolation and despair, but they are also an opportunity for mutual understanding and coming together.  

Extra time can make anyone stir crazy, but it is also an opportunity to consider what you want out of life. Introspection requires us to pause and think about who we are, what we believe in, and what we want out of life. Mindfulness and meditation using apps like Headspace and Calm can help with focusing our minds in the present moment. For people who find such exercises challenging, this reflection could take the form of journaling about where you are in your life and where you want to go. Finally, for people who have been considering it, now is an excellent time to start therapy - just be sure to find a provider using telehealth. 

College is a time of exploration, growth, and development. It has its own ups and downs. In that context, freshmen who were just getting their feet wet and seniors wrapping up their final semester (and everyone in between) have all been asked to halt everything, return home, and try to take their courses online. Naturally, much of the magic of college occurs in conversations, group meetings, clubs and extracurriculars, and class discussion. Feeling sad, disappointed, and even angry are all normal emotions to have during this time. If you are feeling particularly out of sorts, reach out to your college counseling center. They are likely still functioning (albeit online), and they can help you figure out the best way to get through this situation. 

Wherever you are, I hope these tips help you as we prepare for weeks and maybe even months of social distancing, lockdowns, and more time at home. Take care of yourself. Look after others. And above all, stay safe. 

Ravi N. Shah (@RaviShahMD) is assistant professor of psychiatry at Columbia University Irving Medical Center and Co-Founder of Mantra Health. 

Tips from a Psychiatrist on Coping at Home During Coronavirus

by Kristel Carrington, Medical Director at Mantra Health

Treating depression involves a holistic approach that addresses its biological, environmental and psychological causes. Medications, when needed, are just one tool I recommend in the treatment of my depressed patients. However I also prescribe non-medication interventions that focus on building positive experiences and reducing symptoms of depression. These natural antidepressants can help to reduce risks of depression, improve current symptoms of depression, and help to prevent recurring episodes of depression. They are readily available and I enjoy helping clients think of ways to incorporate them into their lives. The supplements and lifestyle goals mentioned below have strong evidence for improving symptoms of depression.  

There are dietary supplements that have been shown to improve mood due to their ability to boost the building blocks of hormones that can be depleted in those suffering with depression. [1] Three of these supplements with the most evidence are:

5-HTP (5-hydroxytryptophan) is an important ingredient for making serotonin, a major hormone associated with depression symptoms. 

SAMe (S-adenosyl-L-methionine) is a naturally occurring compound in the body which is involved in the creation of other brain hormones hypothesized to play a role in depression.

Omega-3 Fatty acids have evidence for improving both depression and cognition in adults. Low levels of omega-3 are seen in people with clinical depression. Other than supplements, omega-3 is found in healthy fish, like salmon, and also some nuts and seeds.  

Though research on how diet directly affects depression symptoms is lacking, the food that are shown to promote better health have some things in common: less sugar, lean meats, LOTS of fruits and vegetables. [2] There is an emerging field of research regarding the gut microbiome (the bacteria that populate your gastrointestinal tract) that may offer some clarity as to how diet affects our mental health. [3] 

See our blog piece on food for more information: https://mantrahealth.com/post/developing-your-food-mantra

2. Improve your sleep hygiene: Sleep disruption is a common symptom of depression and can take the form of sleeping more or getting little to no sleep. Sleep hygiene refers to a set of behaviors that promote better sleep. Better sleep means better mood, more energy, more motivation. [4]

See blog piece on sleep habits: https://mantrahealth.com/post/by-kristel-carrington-medical-director-at-mantra-health

3. Establish a routine: There is a specific form of cognitive therapy called behavioral activation. Behavioral activation is a coping strategy designed to increase your contact with positively rewarding activities. In behavioral activation, you small and specific goals and work toward them. The key word is small. Focusing on one or two things that you want to work on. Behavioral activation helps to build a sense of mastery and accomplishment. 

4. Connect with nature: Nature can have a powerful influence on depression. Research suggest that interacting with nature can improve cognition and mood. [5] Many of us live in concrete jungles, which can make it difficult to even think about nature, so try to think about where you can reconnect with it. Remember what it’s like to see the vibrant colors, shapes, and contrasts that natural world offers. 

5. Connect with people: Depression makes the sufferer want to isolate, due to diminished energy to engage in social activities and due to feelings of guilt at the prospect of negatively affecting the moods of friends or family. We are social creatures and connecting with others in positive ways can improve mood and coping.

6. Mindfulness: Mindfulness is a practice that cultivates one’s awareness of the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. It is used as a therapeutic technique that helps my clients connect their inner and outer worlds, thereby enhancing awareness of their daily lives in a different, more deliberate way. Research shows that activities like yoga, deep breathing, meditation, and journaling, help to promote a mindful mental state. [6]

7. Exercise: No surprise here. Exercise is associated with a greater reduction in depression symptoms, improved cognitive function, and better sleep. Research shows that exercise can be as effective as medication for treating depression. [7] Although there are no clear guidelines regarding advice on exercise for patients with depression, evidence shows that both aerobic and anaerobic exercise has positive effects. Shoot for 120-150 minutes a week of moderate exercise.

8. Challenge negative thinking: Depression can hijack your thinking into becoming more pessimistic and negative. You may find yourself focusing only on things that went wrong instead of the things that are going right. When working with my patients, I teach them about positive affirmations and have them make a list for themselves. They are often skeptical but once doing the exercise, they are reminded of things they are proud of and feel an improved sense of self-worth. They also recognize how much they’ve lost appreciation for those good things.  

9. LAUGH: Laughter really IS medicine. Laughter is a positive sensation, and seems to be a useful and healthy way to overcome stress. [8] I encourage my clients to seek laughter from their favorite sources. I still end up laughing until my stomach hurts when I watch old episodes of Martin. 

10. Seek Inspiration: What are you passionate about? Depression makes it hard to get excited about life. Whether you find it in art, nature, people, animals, volunteering, or activism, it is important to seek and cultivate things you are passionate about. When inspired we feel a deeper appreciation for life. 

Feeling relief from depression is not the only goal. You have to discover (or reconnect with) things that give you a sense of peace. Maintaining this balance helps foster your resilience when faced with challenges. 

Varteresian et al. Natural Products and Supplements for Geriatric Depression and Cognitive Disorders: An Evaluation of the Research. Current Psychiatry Reports. 2015

Firth, Wolfgang et al.The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosomatic Medicine. 2019

Dash et al. The gut microbiome and diet in psychiatry. Current Opinion in Psychiatry. Jan 2015

Carney et al. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial. Sleep. 2017

Can Nature Walks With Psychological Tasks Improve Mood, Self-Reported Restoration, and Sustained Attention? Results From Two Experimental Field Studies

McCarney et al. Effectiveness of mindfulness-based therapies in reducing symptoms of depression: A meta-analysis. European Journal of Psychotherapy and Counseling. 

Exercise for Depression. JAMA Clinical Evidence Synopsis.2014

Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review

You already know that a healthy diet has been shown to improve physical health, reducing the risk of heart disease, diabetes, and other common chronic conditions. Now, scientific research is increasingly showing the importance of a balanced diet for a balanced mind. It turns out you really are what you eat: diet can affect your emotions, focus, and mood. 

The Mediterranean diet has been shown to promote a healthy heart as well as a healthy mind. While there is no single definition of the Mediterranean diet, it tends to have the following characteristics, per the Mayo Clinic:

Daily consumption of vegetables, fruits, whole grains and healthy fats

Weekly intake of fish, poultry, beans and eggs

High-quality scientific research is emerging demonstrating the Mediterranean diet's benefits on mental health. This makes sense. Your brain uses a lot of energy and needs the right fuel, including nutrients, vitamins and the right fats. BDNF, an important molecule that influences the growth of brain cells, has been shown to increase in response to better nutrition.

The HELFIMED trial was a randomized control trial that compared patients eating a Mediterranean diet and taking fish oil compared to people who were not. The study demonstrated that people eating the Mediterranean diet had significant improvement in their depression scores. Another study, the SMILES study, also showed that patients on a Mediterranean diet were more likely to achieve remission in their depressive symptoms. Not only that, these patients also saved money on phone by eating the healthier Mediterranean diet. Psychiatrist Drew Ramsey, author of Eat Complete: The 21 Nutrients That Fuel Brainpower, Boost Weight Loss, and Transform Your Health and The Happiness Diet is an expert on nutrition and mental health. He identifies several important nutrients for brain health, including: Omega-3 Fatty acids, zinc, vitamin B12, magnesium, folate, fiber and probiotics, vitamin E, vitamin K, vitamin A, carotenoids, phytonutrients, monounsaturated fats, vitamin D, selenium, iron, thiamine, choline, calcium, potassium, iodine, and vitamin C.

“If it came from a plant, eat it; If it was made in a plant, don’t.” - Michael Pollan

The amount of nutritional information out there can be overwhelming. Here are some practical tips to help get you started on your very own happiness diet. Start with implementing one habit at a time and once you’ve mastered it, try the next one.

1. End your weekend with a “Smart Prep”

Schedule time at the end of your weekend to prepare meals for the week. You don’t have to prep for every meal, or even every day. Having a couple of healthy meals ready for the upcoming week will make it easier to eat well during a busy week. Keep things simple by chopping vegetables that you can easily store, or pre-cooking your favorite protein and grains (brown rice or quinoa) to store in the fridge.

Trips to the vending machine have costs on your wallet, but the costs to your health are even greater. Pack easy-to-eat vegetables (carrots, celery), fruits (apples, oranges) and nuts that you can eat during the day. Other healthy alternatives include trail mix and hummus. Having some healthy snacks throughout the course of the day will also help you avoid overeating when it’s time for lunch and dinner. 

It’s easy to feel overwhelmed by the number of recipes out there and numerous ingredients. Try to keep it simple with just 3 ingredient  meals. For example, you can combine one protein, one vegetable and one grain. Or you can combine 2 vegetables and grain. You get the idea. 

When you are extremely busy at work, school, or home, it’s easy to forget to drink water. But not drinking enough water is a huge mistake. Your brain needs ample water to carry out its functions effectively (like the rest of our body, our brain is mainly water). Dehydration can impair your ability to focus and zap your energy levels. Finally, drinking water can help stave off hunger and unnecessary snacking. Try carrying a water bottle with you when you are at work. If you find that you don’t have time to refill your water bottle during the day, get a BIG (32oz+) water bottle to ensure you stay well-hydrated all day. During the winter, switch the water for hot tea to keep you warm. 

Nutrient-rich vegetables are an easy way to add nutrition to a dish. For example, if you’re eating mac and cheese, try adding some Kale to it in order to add some nutrients to what would otherwise be a fairly nutrient-deficient meal. In fact, psychiatrist Drew Ramsey wrote an entire book on Kale and ways to incorporate it into your diet. But it doesn’t have to be kale, try adding spinach to smoothies, cauliflower to your tacos, etc. 

Bonus Tip -  Embrace the crock pot (or Instant Pot®)

Once you find food and recipes that you love, try cooking in larger quantities. Use a slow cooker (or a fancy all-in-one pressure cooker, like an Instant Pot), to cook large quantities of delicious, healthy food without having to be in the kitchen for hours at a time. There are numerous cookbooks that can help you find simple recipes - it’s easy (and fun) to experiment. 

People who are employed full-time spend most of their waking hours at work. With hyper-competitive work environments, increasing student debt, and a drive towards perfectionism, it’s no wonder that workers frequently experience anxiety at work. Good news: First, you’re not alone: in fact, about a third of people will have symptoms severe enough to meet criteria for an anxiety disorder at some point in their lives. That means even more people experience anxiety (feelings of nervousness, worry, unease) during the work day. Second, remember that anxiety is a normal part of emotional life. That said, when anxiety is holding you back or causing significant distress, it’s helpful to have some coping skills handy to help you weather the storm of emotions that come with a tough day. Here, two Columbia University psychiatrists offer 7 practical tips you can use to manage anxiety at work. 

Around one-third of adults in the United States do not get enough sleep). You’ve probably heard that sleep is important for memory and cognition, which is why people remind kids to get a good night’s rest before a test. You may have also heard that sleepy drivers are as bad as drunk drivers, which demonstrates the importance of sleep in motor performance and judgment. However, many people forget that restorative sleep is critical for optimal emotional performance and resilience. That’s where we get the phrase: “someone woke up on the wrong side of the bed.” Most people need 7-8 hours of sleep per night. Thrive Global’s sleep page has more information and more tips to improve your sleep. With our patients, our three favorite recommendations are: 

Create a bedtime routine to decompress prior to bedtime. 

Use sleep masks, earplugs, and/or white noise machines to minimize disruptions to sleep. 

Turn off your phone and all sound and light notifications or use software to eliminate blue light from your screens at certain hours. 

These simple tips will help you your mind to truly rest and repair from the day. 

Caffeine is the world’s most commonly consumed mind-altering drug. Like many, we drink coffee daily and enjoy the boost that it gives during the work day (especially in the mornings!). But, like any other substance, dosing matters. Many people fall into a problematic cycle of using caffeine to boost energy even late into the day. Too much caffeine can lead to spikes in your anxiety and worry at work. Having caffeine later in the day can negatively impact the quality of your sleep, hurting your productivity the next day and leading to more anxiety. Try to limit your daily coffee (or caffeinated tea consumption) to at most 2 (Starbucks tall-sized) cups per day, and switch to decaf if you need a pick-me-up after 3pm. 

Do you ever find yourself staring down an important task, not knowing where to start and feeling stuck? The accumulation of tasks is a common cause of workplace anxiety. If you then get paralyzed, other tasks begin to pile up and you find yourself falling behind, causing even more anxiety. If this happens to you, try switching up your order of operations and do the easiest (even mindless) tasks on your list first. This “productive procrastination” will give you a needed sense of accomplishment and build up momentum you can carry over to your bigger tasks. Feeling productive even at a few small tasks will give you peace of mind and boost your mood, helping to alleviate anxiety. 

4. Use noise cancelling headphones to block out distractions

These days, most people work in settings with open floor layouts. While this design enhances connectivity, it also brings with it distractions galore. Frequent interruptions, especially when working towards meeting a deadline, can impair productivity and raise anxiety levels. Noise cancelling headphones are an easy way to block distractions that most workers can use (I’m using a pair as I write this). Simply having the headphones on will signal to others that you’re busy and make them think twice before interrupting your flow. Try soothing music without words, like jazz or classical so that the lyrics don’t interfere with your focus. Or if you prefer, simply enjoy the silence provided by the noise cancellation.

If you’re feeling panicky or overwhelmed with anxiety, it may be time for a break to regain perspective. First, try taking a short walk or drinking a glass of water. If those don’t work, try an audio guide. There are 3 different types of audio guides we like: guided imagery, mindfulness, and progressive muscle relaxation. The premise is to have a soothing human voice refocus your attention and help you calm down. They have all been proven to reduce stress and anxiety.  There are numerous apps for this (check out a few we recommend here), and most of them have free exercises you can try. You can also find links just by searching Google or Youtube. By reducing the stress hormones associated with the fight or flight response, relaxation may even help boost your brain’s memory.

Anxiety may be a sign that you’re not working on the right things. Review your goals, both personal and professional. Then, compare your goals with your to-do list. A large disconnect may be a sign that you aren’t moving in the right direction. Your to-do list shouldn’t be limited to discrete work-oriented tasks to be checked off and just get you through the day. As you are making your list, ask yourself if your to-do items are leading you towards accomplishing your broader personal and professional goals. If they are not helping you lead the type of life you want to lead, it may be time to start course correcting. For example, if you have a personal goal of being physically fit or running a marathon, and exercise is not anywhere on your calendar or to-do list, try to add in 1 workout per week to start making your week look like the life you want. 

Finally, talking to someone about whatever is on your mind can help relieve symptoms of anxiety. You don’t have to speak to a therapist to get the benefit of human connection and communication. Whether you are speaking with a close friend, partner, or coworker, talking to another human being allows us to process our own thoughts and feelings while getting support from others. Other people can provide a fresh perspective on our anxiety and help “check the facts” to bring worries that have gotten out of hand back down to size. At the risk of sounding old fashioned, try to make these conversations in person. If that’s not possible, go for a video call or phone call. Texting is a great communication tool, but it won’t give you the same emotional connection to another person that hearing their voice will. 

Anxiety is a common part of work and life, and we hope these tips will help you manage your worry in a healthy way. However, if your worries are excessive and persistent or accompanied with debilitating physical symptoms (heart racing, sweats, stomach upset), they may leave you feeling physically and emotionally exhausted. If you feel anxiety symptoms are significantly impeding your ability to function at work or at home, you may have an anxiety disorder. Don’t feel you need to suffer in silence: reach out to a mental health professional to discuss your symptoms and the potential role of therapy and/or medications to help you with your anxiety. The good news is: treatment for anxiety disorders in general is highly effective, and the tools you learn will last a lifetime. 

7 Practical Strategies for Managing Anxiety at Work

I did not consider myself someone with sleep issues. I never struggled with insomnia, and I enjoyed sleep more than most people. I could fall and stay asleep very easily, in both public and private settings. I was that person in lectures, conferences, and focus groups who was asleep before the hour was up. My classmates teased me for my particular talent of maintaining an alert sitting posture even while sleeping. I tried to cope with fatigue by fidgeting, biting the insides of my cheeks, and drinking more coffee, but often I just gave in and passed out. This was my MO from high school through medical school. I was used to it and never gave it serious thought. With no consistent routine, I often stayed up late and told myself that I functioned well on ~4-6 hours of sleep per night. Then something changed: I met my partner during residency, and he was committed to consistently getting eight hours of sleep. I quickly adopted his habit but only reflected on it when I started noticing how this change was improving my life.  

I was no longer sleepy after sitting for more than 30 minutes. I no longer craved a nap (or coffee recharge) at 3pm. No more falling asleep in lecture, my attention and focus improved, and that constant tug of fatigue was gone. I drank less coffee, felt less irritable, and I literally felt lighter. What was the difference? I was reaping the benefits of sleeping eight hours every night. Not only was it a revelation, but it is now my broken-record anecdote used when trying to encourage clients to examine and/or change their sleep habits.

Neglecting sleep is common in adolescence and often continues into adulthood. In time, sleep becomes a victim of bodily self-neglect. With busy schedules and impending deadlines many adults tend to forego sleep because they hope it will give them back something they desperately need and feel deprived of - time. If you care about improving your overall health, start by examining your relationship with sleep.

As a psychiatrist, I spend a lot of time discussing sleep in the context of depression and anxiety. Most people agree that their sleep could be “better” and they could do more to optimize it, but sleep habits are some of the hardest to motivate people to address. I practice cognitive behavioral therapy (CBT), an evidence-based treatment that helps a person recognize and examine beliefs and attitudes they have about their lives, and how those beliefs drive their behavior. I have observed common themes in what clients express about their relationship with sleep. Here are a few typical examples: 

“I just can’t get to bed earlier. Period.”

“I can function just fine on less sleep”

“I need my phone/iPad/TV to fall asleep.”

“I’m avoiding having to face the next day” 

Do any of these resonate with you? Once identifying these beliefs, you can examine and challenge them, a process that is important in helping someone form new and healthier habits. Be honest with yourself about these ideas influence your behavior and what the actual consequences are. Consider the examples above. Feeling deprived by going to bed early is understandable. Still, unless you have a small child or have a job that expects you to be available 24/7, what is preventing you from physically getting to bed earlier? The later you go to bed, the less sleep you give yourself to function optimally the following day, which likely results in feeling too fatigued to carry out the goals you’ve set for the day. And contrary to popular opinion, you cannot make up for a week’s worth of poor sleep over the weekend. One or two days of increased sleep does not make up for the cumulative cognitive and physiological effects of chronic sleep deprivation, a term known as sleep debt. We all engage in these habits to some degree, but once you accept that the beliefs underlying your sleep habits are not helpful, you can start to make changes. I educate my clients on the concept of sleep hygiene, which refers to a set of behaviors that one can adapt in order to form better sleep habits and/or improve sleep quality. The list below cover the most important and commonly helpful tips to improve your sleep, and ultimately, help you bring your best self to everyday life. 

Consistency: This is crucial. Try to have a consistent bedtime and wake time. Maintain that consistency, even on the weekend. This is key to conditioning your body back to its natural sleep rhythms.

Exercise: People sleep significantly better and feel more alert during the day if they get at least 150 minutes of exercise a week.[iii] Try not to exercise (within 3 hours of bedtime, as that can interfere with falling asleep.

Turn off the screens: If electronics are part of your current sleep routine, be aware that light emitted from our screens suppresses production of an important sleep-promoting hormone in our brains.[iv] If background noise helps you fall asleep, there are meditation and white noise apps you can download and play while keeping your screen off.

Stock up on sleep promoting items: Environmental factors like ambient noise, poor mattress quality, abundant light through windows all decrease sleep quality. Invest in earplugs, sleep masks, black out curtains, and/or a good mattress.

Reduce/avoid caffeine and alcohol: Though people often use alcohol as a sleep aid, it actually worsens sleep quality. Avoid caffeine later in the day (after 1pm)

Keep naps short: Long naps during the day can disturb sleep quality at night. Think of it like a snack. A large snack before dinner time will reduce your appetite and how much you eat. Between 20 to 30 minutes is an ideal nap duration and less likely to disrupt sleep rhythms at night.

See your doctor: If your sleep issues are ongoing despite behavior changes, or if you are considering a medication, I strongly recommend checking in with your doctor to rule out medical causes of your sleep issues, discuss medications, or getting a sleep study.

Change your attitude about sleep: Studies show that people who placed high importance on adequate bedtimes report better sleep quality, mood, and perception of their health.[v]

Have some self-compassion: Self-criticism does not work. If you fall short of your goals intermittently, remind yourself that you are really making efforts towards change and that it is okay to be patient with yourself. 

There is a plethora of research correlating sleep disturbance with mood, anxiety, cognitive, and physical conditions. Despite my medical knowledge, I was oblivious about my poor sleep habits for a long time, and that recognition made me question what other habits I needed to examine. Embrace this self-inquiry and ask yourself where you can start making small changes. Those small changes will have lasting positive benefits. 

9 sleep hacks used by a Mantra psychiatrist

Parked Thoughts

Attention-grabbing articles, backed by research.

My therapy in college was interrupted by COVID-19 and I still need it – now what?

Tips from a Psychiatrist on Coping at Home During Coronavirus

Our top 10 natural antidepressants

Developing your food Mantra

7 Practical Strategies for Managing Anxiety at Work

9 sleep hacks used by a Mantra psychiatrist