Episode 85: How to Sleep Better and Protect Your Mental Health as a Physician Mom — with Sushrusha Arjyal, MD

Meet the Expert: A Dual Board-Certified Psychiatrist and Sleep Specialist

From Psychiatry to Sleep Medicine: Why Dr. Arjyal Took the Path Less Traveled

The Intersection of Sleep and Mental Health: What Every Mom in Medicine Should Know

Tackling Sleep Struggles in Patients with Anxiety, Depression, and Beyond

Why Quality Sleep Is the Ultimate Prescription for Whole-Person Health

Cultural Expectations and Sleep Deprivation

Simple, Science-Backed Sleep Tips for the Busy Physician Mom

Red Flags: When It’s Time to See a Sleep Specialist

Staying Connected: How to Learn More from Dr. Arjyal

We’ve all heard it or said it ourselves: “I can run on five hours of sleep.”
But does that really work? Or does it cost you more than you admit?

Today, we’re talking about sleep and mental health for physician moms. They’re inseparable, yet so many women in medicine can’t seem to rest, even when they know better.

My guest, Dr. Sushrusha Arjyal, is one of the few doctors dual-certified in psychiatry and sleep medicine. She is the founder of Bliss Sleep & Psychiatry, she treats the whole person — mind, body, and rest.

Together, we’re unpacking how disrupted sleep worsens anxiety, depression, pain, memory, and even diabetes. You’ll walk away with evidence-based strategies to reset your nights starting tonight. Dr. Arjyal also shares the red flags too many moms in medicine overlook.

Take a breath and listen in.
You don’t have to earn your sleep.

Meet the Expert: A Dual Board-Certified Psychiatrist and Sleep Specialist, Sushrusha Arjyal MD

Dr. Cindy: Hi everyone. Welcome back to Inspired Mom MDs. Today I have a special guest. She is someone who brings two worlds together that deeply affect us all, and that is the mind and sleep. 

Dr. Arjyal is dual board certified in psychiatry and sleep medicine, one of fewer than 10 physicians in North Carolina with that rare combination.

She’s the CEO and founder of Bliss Sleep and Psychiatry, and a former assistant professor of both psychiatry and neurology at Duke University of School of Medicine. 

Originally from Katmandu, Nepal, Dr. Arjyal has built a career dedicated to treating the whole person, mind, body, and rest. She’s passionate about helping people, especially women, understand that mental health and sleep are inseparable.

Today we’ll explore the fascinating intersection of sleep and psychiatry and why so many high achieving women struggle to rest, and how physician moms can finally get the restorative sleep that they’ve been needing and missing. 

Welcome to the show, Dr. Arjyal. 

Dr. Arjyal: Thank you. Thank you so much for having me here. And I’m honored to talk about sleep, especially, you know, sleep in women’s mental and physical health, how it affects. Thank you. 

Dr. Cindy: Oh, you’re so welcome. You are an expert, and I’ve heard you speak before and I’m really excited that you’re here to share your wisdom. 

Dr. Arjyal: Oh, you’re kind. 

From Psychiatry to Sleep Medicine: Why Dr. Arjyal Took the Path Less Traveled

Dr. Cindy: I would just love to start briefly with your story. What first drew you to psychiatry and then later to specialize even further in sleep medicine. 

Dr. Arjyal: When I look back, I always find myself, even as a kid, I was very interested in people’s stories. I think I was a good listener. I’m going to do most of the talking, but, you know, I think, I was a good listener and I really liked understanding people’s journey, and their challenges, their success stories.

I think that that is something that led me to become a psychiatrist and I have learned so much, in the residency training and I continue to learn about human behavior. We can connect with each other when we are very vulnerable. We can connect with each other when we are successful or anything in between.

So that I find fascinating about psychiatry and I have really cherished my journey up to where, where I am today.

Dr. Cindy: I get that stories are so powerful. I love hearing about people’s stories. Now, are there stories of sleep deprivation? What drew you to sleep? 

Dr. Arjyal: You know, I hadn’t planned to be a sleep specialist. Very honestly, I had planned to be a psychiatrist and practice as a psychiatrist. 

In my fourth year of residency, we had the opportunity to do an elective, and I had a wonderful mentor, Dr. Mary O’Malley. She’s a psychiatrist and a sleep specialist and I listened to her talks, her lectures on sleep, and I started thinking, why don’t I do a sleep fellowship?

Because sleep disorders and psychiatric disorders are practically inseparable. You have to treat one if you really want the patient to feel better overall. So, I thought it was very fascinating. And, a little bit of sleep study reading, I find it fascinating as well.

I wanted to incorporate that, in a kind of abstract world of psychiatry, something more objective, so to speak. So, I think it was a very good balance that way. Sleep fellowship is one year, so I did one year of sleep fellowship. I mean, people could, there are programs which offer two years of sleep fellowship if they want to do research about the fellowship. I did was for one year.

So, I learned a lot and that’s what I try to do now, incorporate both in my practice. 

Dr. Cindy: Got it. So, it’s a balance of the more abstract psychiatry world and the very concrete sleep world with the studies and the data that you can get from people. Yeah, I see that. 

Dr. Arjyal: Yeah. And when I have the sleep study and I sit down and read to my patients, like this is the slow wave sleep, this are, this is the deep sleep. You do have sleep apnea; you don’t have sleep apnea. 

And even with patients with insomnia, it is very therapeutic for them to take a look at that. And for me, and in a very selfish way, then I’m not like, you know, trying to find three or four more people to treat. It’s easier for me to treat both, you know, so I have the results faster there.

I mean, the fields that I don’t have expertise in, of course, I will refer the patients out. 

Dr. Cindy: Yeah. So, it’s under one roof. 

Dr. Arjyal: Yes. 

The Intersection of Sleep and Mental Health: What Every Mom in Medicine Should Know

Dr. Cindy: For physicians, especially those with kids, or maybe especially those with younger kids, sleep deprivation almost feels baked into the culture. 

I remember balancing being on every fourth night call with having little kids and everything that comes with having kids. And I did not have much time for restorative sleep. And I know this is true for many physicians. 

From your perspective, what are some of the mental health consequences of chronic poor sleep? 

Dr. Arjyal: Yeah, there are many. For that we would have to understand what not sleeping does to our brain, right?

Dr. Cindy: Okay.  

Dr. Arjyal: So, when we don’t sleep, or when our sleep is disrupted for various reasons, it could be anxiety, it could be sleep apnea, it could be restless legs. It could be just chronic pain or life circumstances, right? Any kind of acute stress. Our hormones, for example, the cortisol, go up.

Strangely oxytocin goes up but can cause mood disturbance. Our good hormones like serotonin, they will go down. Then you’re less happy. Dopamine goes down. 

So, if we have to put it technically, any kind of sleep disruption is going to exacerbate any mood symptoms. 

It can be depression, when people have postpartum blues versus depression, right? People are more likely to be diagnosed with postpartum depression if they continue to have disrupted sleep. People with post-traumatic stress disorder are more likely to have exacerbation in their symptoms or can be treatment resistant if they continue to have poor sleep.

Same with people with bipolar disorder. They are likely to have more phases of mania, and that is one of the main symptoms that we target in people with bipolar disorder, is mania. If someone has mania, we’d say, okay, all bets are off, have them sleep, you know? We’ll take care of the side effects tomorrow.

You have to get your patient to sleep, not just let them sleep. Same is true for people with schizophrenia. So, to answer your question, we as physicians are not immune. From any of the stressors or from mental health, the diagnosis, that is a very important point, right?

If we don’t sleep well, and we have been diagnosed with chronic insomnia, which is disrupted sleep for three months or more. We are very likely to experience exacerbation of all these symptoms. And if we have not been diagnosed with mental health problems, we are more likely to be diagnosed versus people who are getting solid sleep for seven, eight hours sleep. Those would be the mental health consequences. 

Dr. Cindy: Wow. So, it exacerbates underlying issues that may or may not be diagnosed already? 

Dr. Arjyal: That is correct, yes. 

Dr. Cindy: And it’s true for physicians too, not just other people.

Dr. Arjyal: Yes. We belong to the world. 

Dr. Cindy: Oh yeah. We’re all human. All humans. That’s interesting. 

Tackling Sleep Struggles in Patients with Anxiety, Depression, and Beyond

Dr. Cindy: Patients who struggle with, let’s say anxiety or depression or you mentioned several other conditions who also have sleep issues, how do you begin to untangle which came first or does it matter?

Dr. Arjyal: You know, that’s a very interesting question. I used to wonder about this as well initially when I started, but now what I do is, first of all acute care. 

When I say in my talks that I treat patients as individuals, I do treat them as individuals. Meaning, if a person would come to me and say, “Hey, I haven’t slept properly in two months, and I’m gonna lose my job if I continue to do this.” Then for me that is a priority. 

You know, for me, getting her to sleep or him to sleep is a priority. But if the person has depression and has sleep disruption in the context of depression, then I might want to say, okay, let’s do it parallelly. I will treat your sleep as well, but let’s take a look at your mood symptoms too.

So, the acuity, and first of all, making sure the patient is safe because not sleeping and chronic insomnia, added to other factors, can actually cause patients to have suicidal thoughts. 

Keeping them safe and taking care of the acute issues first and taking care of the bigger picture.

To answer your question, most of the time now I start things in parallel. I do a very thorough sleep evaluation, and I do a very thorough psychiatric evaluation because a lot of sleep disorders overlap with the symptoms with psychiatric disorders. 

I’ll give you very common example, if someone has obstructive sleep apnea, they can present with low energy, sleep disruption, low interest, right? They can be irritable, lethargic, and all of these are also the symptoms of depression. So, they are diagnosed with depression and sometimes can be treated for depression for years without having a sleep study.

And I asked my patients, okay, this is all good, but did you ever get a sleep study? And they would go, you know, I don’t snore. And then I asked them, you know, bed partner, do they snore? Yes. So how do you know you do not snore? Well, I really don’t know, but I think I don’t snore, so nobody wanted a sleep study for me.

So, there is a huge overlap. And in those cases, what I might do is get a sleep study, get them diagnosed, and treat the sleep apnea and slowly see if they actually need the antidepressant. You know, so I try to do it parallelly. 

Dr. Cindy: So, working in parallel but definitely addressing the acute issues.

I have a question. Just going back, I’m curious, so you mentioned a few minutes ago about patients who have mania, you want to get them to sleep, help them sleep. How do you help a person with mania sleep?

Dr. Arjyal: Yeah, you know, the rule for insomnia is don’t give them medications first. Cognitive behavioral therapy of insomnia is the gold standard of treatment for outpatient treatment for chronic insomnia. What I’m getting at is when people have mania, this rule does not apply when people are suicidal because of chronic sleep deprivation, then safety first, right?

In those cases, we use sedating, anti-psychotics, to help them sleep and then slowly taper them off as the patient continues to feel better. Or even benzodiazepines are not first line and should not be used on a regular basis. But, in acute cases, a patient [who] has severe anxiety, and I’m talking about an inpatient acute setting for a few days, that might not be a bad idea as well.

But if we are just giving SSRIs, it’ll be hard for them to just sleep right away. But they can be tried as well, some sedating antidepressants can be tried as well. 

Dr. Cindy: Okay. Yeah. And again, those are probably the exceptions to the general patient population that you see.

Dr. Arjyal: Correct. Especially when I’m talking about this, I’m talking about inpatient facility patients with mania who we are trying to contain. If they sleep for two, three days, there is such a drastic improvement in mood symptoms. 

Dr. Cindy: Wow. Okay. 

Why Quality Sleep Is the Ultimate Prescription for Whole-Person Health

Dr. Cindy: I’m shifting gears a little bit. Many folks in the world say that they can survive on four or five hours of sleep a night, and they swear up and down that I’ve been doing this for years.

I’m fine. What do you as a specialist in psychiatry, and in sleep medicine say to this, I’m curious. 

Dr. Arjyal: You know, that’s not sustainable. And the reason why I see this is we talked about the mental health consequences of insomnia and sleep disruption due to other sleep disorders.

Let’s talk about the physical consequences. What happens when we don’t sleep? 

Insomnia is not just one symptom. It is connected to a lot of other functions of our body. Let’s begin with our sugar level. If we don’t sleep our sugar level goes up, because of cortisol and several other factors.

So, in people with diabetes, this worsens if you don’t sleep, your diabetes worsens. Then same with memory. When we sleep, what happens is we have something called slow wave sleep. Different stages of sleep and then something called REM sleep. Dream sleep. 

So, what these two stages do is slow wave sleep, takes the new memory and takes them from the hippocampus to neocortex. Meaning it’s like storing the memory. Very nicely. And what dream sleep, which is REM sleep, what it does is it clears out the unnecessary memories or unnecessary substances from the brain so that it can clear the brain, make space for new memories. 

What happens when these two function very well, meaning we get deep sleep and dream sleep consistently is we can learn new things.

You know, we can remember more. We feel better. We have more energy during the day, so when people consistently sleep less than seven hours, they have higher risk of having memory disorders like Alzheimer’s, Parkinson’s. Yhe risk of dementia is high. 

And then we have other factors like chronic pain. Sleep is very much related to pain. If people sleep better, there is internal endorphin that gets released, the cannabinoids that get released that help in pain relief, so to speak. If we don’t sleep, we tend to perceive the pain more so people who don’t sleep well have the exacerbation of chronic pain.

There are a lot of other, problems overall. People who sleep better would have a better quality of life. For whatever reasons, if someone says, I don’t sleep more than five hours, they might have some other consequence [that] might not have been diagnosed or treated. With one exception though, there is less than 3%, very, very less, percentage of there are people who can survive on less than six hours of sleep.

They are called short sleepers, but they’re a very small percentage. They have some gene mutation that can cause them to sleep less and still feel better the next day. But in regular cases it doesn’t happen. We do need seven hours or more. 

Dr. Cindy: It sounds like sleep is a prescription for all these things.

It’s a prescription for diabetes, for chronic pain, for helping to prevent, later onset dementia. It sounds like a panacea almost. It is just something that would help a little bit of everything. 

Dr. Arjyal: It is, you know, I was recently giving a lecture to medical students. And we talked about sleep and I told them, sleep is, a very healthy way of forgetting that you have had a bad day. If you can get sleep right. Some people don’t. 

But if you had a really bad day, if you sleep, next day, you’ll just, the problem won’t go away, but it won’t seem as big as it was the previous day. 

Dr. Cindy: Absolutely. That’s what my mother used to tell me. Just go to bed. It’ll be better in the morning.

Dr. Arjyal: It is true. 

Dr. Cindy: She was right. 

Dr. Arjyal: Yeah, she was right. 

Dr. Cindy: Oh gosh. So, are there some small evidence-based changes that you could recommend that would make a big difference even for the women with unpredictable call schedules and kids? What are some suggestions you would make to help get more sleep?

Dr. Arjyal: You know, the biggest evidence-based advice that I can give is if you are not sleepy, please do not stay in bed because psychologically we are training our mind to say that it’s okay not to sleep. What you might want to do instead is to go to bed when you are very sleepy and have a fixed wake up time.

And this is keeping in mind, and with all due respect to the shift workers, it’s not in our control, especially when we look at the physicians and others too, other healthcare professionals. Other professionals. It’s hard, it’s hard. But even within those circumstances, if you could do that, that would be healthy.

Reducing caffeine, at least several hours before bedtime would be good. Meaning limiting the caffeine only to the morning, reducing any kind of alcohol intake, definitely not smoking. All those things are evidence-based and they’re very helpful. 

Dr. Cindy: And sometimes you don’t realize, for take caffeine for example, it can affect different people differently. So even though you haven’t had coffee for eight hours, I mean, what’s your take on when you should stop drinking caffeine? Does it just depend on the person? 

Dr. Arjyal: Let’s say if you are sleeping at around at like 9:00-10:00 PM right? I would stop at noon. 

Dr. Cindy: Okay.

Dr. Arjyal: Yeah. But depending on what your, bedtime is.  

Cultural Expectations and Sleep Deprivation

Dr. Cindy: You served on committees that address race, equity, and access to care. How do cultural expectations, especially around productivity and self-sacrifice, play into the way women experience sleep deprivation?

Dr. Arjyal: You know, it’s a very neat question. And an excellent question. Very deep. So, when I look at how we are conditioned and how we perceive ourselves it plays into sleep with everything else. 

We are conditioned to feel guilty about everything.

We have to, it’s almost like we are in charge of everything and anything that goes wrong is our fault, which is, you know, it’s not true. But we are made to feel this way. And it goes across I don’t know exactly what kind of percentage in which culture, but I have lived in different countries and it’s more or less the same really.

But where it differs is if there is good education, there is an awareness. And if someone divides childcare responsibility with the partner or household responsibility with the partner. If the partner is aware enough to help in those small steps personally and professionally, then it becomes easier because you have to carve out the sleep time from the 24 hours.

All of us have those 24 hours. If someone takes that off your plate, then you can do something else so that you can sleep. Culturally, if you look at it worldwide, unpaid labor, which is the household work, childcare mostly falls on the females.

You know what percentage it differs again with the society, how evolved it is, how educated people are, and how they implement the education in their practical life. Because that is also very important. 

And how they are aware that, it takes a village to raise a child. And to find that village, the responsibility of creating that village is not on mothers only. I would say it takes a village to create the village too. It’s not only the mom who’s going to find the support for the child, it has to be everybody contributing to some extent, at least.

Biologically, I understand moms are the ones who are giving birth, and mothers are the ones who are like, playing a huge role in lactation, taking care, at least initially. But after that, if you leave that, then anybody can do the childcare part. 

I think it was very interesting to me when I looked at the studies and also when I have patients with different diverse backgrounds, cultural backgrounds, educational backgrounds. But as humans, like I mentioned initially, we have an ability to connect with each other when we are vulnerable, when we have shared problems. And the solution is also not very different. 

I kind of tend to say depression is not different in the United States, compared to depression in Nepal. The symptoms, clinical science symptoms, treatment, it’s not very different. Yes, social support, cultural support or, depending on financial independence, all of them play a role in how the mood symptoms can evolve or can be treated or access to care. Yes, they are, but clinical signs and symptoms are the same.

I don’t if that answers your question. 

Simple, Science-Backed Sleep Tips for the Busy Physician Mom

Dr. Cindy: Yeah. I realized that was such a broad question and you answered it beautifully. Because how can you take every culture into consideration with one answer? And I think you tied it back to being human and that the underlying symptoms are there and that the underlying guilt is there too.

Thank you for answering that.

If you could tell every tired, doctor mom, listening right now, if you could tell her one thing about sleep that could change her life starting tonight, what would that be? 

Dr. Arjyal: First of all, sleep is absolutely important. We cannot survive on five hours of sleep. It affects all aspects of our life, including our physical health, mental health, and childcare.

Also it is important to validate ourselves for the small things that we do. Because if we start validating ourselves, then it’ll come from external sources as well, but it has to come from us first. Right. 

And what I would say is you are not alone. I’m a physician, I’m a mom. I do understand the struggles. I mean, it’s huge. And trying to balance and trying to just not let any, any of it fall and shatter, it’s a huge burden.

What we can do is instead of setting up a huge goal, is set up small goals. And once those goals are achieved, then pat yourself [on the back] and say, “Yeah, you know, I did a good job today.”

For example, I talk about if someone is very keen on cleaning the whole house, not setting a goal of like, “okay, I’ll clean the house” versus, “okay, I’m gonna clean this table today.” That’s my goal, so if we set up small goals, we are less likely to disappoint ourselves.

That would be my advice for tonight. 

Dr. Cindy: For tonight. So tonight, yes. You can take one small step.  

Red Flags: When It’s Time to See a Sleep Specialist

Dr. Cindy: I have a burning question I forgot to ask. How do people know when this is just burnout or when they should reach out for help? When should people pick up the phone or reach out and talk to someone just like you for help?

How do they know if this is a bigger issue. Like for example, your sleep apnea patient didn’t even know that they snored. So how do you know yourself when to get help or when to just pay more attention to habits. Like, okay, let’s cut back on caffeine. Let’s get to bed at the same time each night, et cetera.

Dr. Arjyal: For this, what I would say is, please don’t try to do everything yourself. 

Generally, when your body starts showing symptoms of lethargy, sleepiness, when people around you start telling you, “Hey, I think you are a little too irritable. And this is not you.”

Please keep a low threshold for seeing a doctor. 

We have make it parallel. Mental illness and physical illness should be thought about in a similar manner when we are thinking about physicians. If we have something physical, we don’t wait for months and try to fix it.

Similarly with mental illness too, it doesn’t hurt to go to the doctor. It doesn’t hurt to say, “Hey, you know, I don’t think I snore, but I’m so, so, so tired and I’ve done everything.” But you know, why don’t we get a sleep study? 

I would say please keep a low threshold if you have physical symptoms, if you have mood symptoms, if you are just not able to function properly, then it’s time to seek help.

And I wouldn’t wait months, because those are the months, then you would be suffering. 

Dr. Cindy: Right. Oh, that really puts it in perspective for me. If my arm hurt, I wouldn’t just, chalk it up to, oh, I must be doing something wrong. I would go, I would go see somebody. Yes.

And mental health and physical health are one and the same. They should not be separate. 

Dr. Arjyal: No. No, they shouldn’t be. 

Staying Connected: How to Learn More from Dr. Arjyal

Dr. Cindy: So how can listeners find you? 

Dr. Arjyal: I have a clinic in Cary, North Carolina, but I do video appointments. I’m licensed in North Carolina, Virginia, and Florida. Okay, so my, they can email me at contact@blisssp.com, or they can call me at my office number, (919) 342-3627, and I will return your call within 24 hours. 

Dr. Cindy: Okay, wonderful. I will put your contact information in the show notes so they can reach out to you. 

Dr. Arjyal: Thank you. 

Dr. Cindy: Anyone can just check out your website, check out things you’ve written, check out more information. 

Dr. Arjyal: Sure. Thank you. 

Dr. Cindy: I thank you so much for being here today. I really, I really appreciate your perspective and your wisdom and your willingness to be on the show today. Thank you. 

Dr. Arjyal: Well, thank you so much. It was a pleasure. 

Links for Dr. Arjyal:

Email: contact@blisssp.com

Office phone: (919) 342-3627

Website: Sleep Disorder & Psychiatry Expert | BLISSSP