Circadian Rhythms, Sleep Hygiene, and Well-Being: An Insightful Q&A With Thrive Wellness Reno Primary Care Physician, Internal Medicine Lorrie Oksenholt, D.O.

Thrive • May 26, 2022

When working optimally, the body’s circadian rhythms cause individuals to feel sleepy around bedtime and refreshed upon waking. When disturbed by external or internal factors, circadian rhythms don’t function correctly, which can contribute to inadequate sleep. Mental, emotional, and physical health challenges can then arise. Below, dive into the topic of circadian rhythms in an insightful Q&A with Thrive Wellness Reno Primary Care Physician, Internal Medicine Lorrie Oksenholt, D.O.

What are circadian rhythms?

All living beings have internal clocks called circadian rhythms that regulate sleep and wakefulness. Just as pets tend to wake up earlier than their owners and many flowers curl their petals toward their buds in the evenings, humans instinctively follow natural sleep and wake patterns triggered by circadian rhythms. Circadian rhythms work at a cellular level in accordance with changing light throughout the day.

How do circadian rhythms function?

Changes in light signal the body to produce certain hormones that are helpful for sleeping and waking. The eyes and brain work together to initiate this hormone production. The suprachiasmatic nucleus located in the brain’s hypothalamus responds to light and dark indicators from the eye’s retinal nerve. These fluctuations in light and dark trigger the body to produce cortisol in the mornings and melatonin in the evenings. Cortisol helps increase energy, heart rate, and body temperature which benefit waking. Melatonin serves as the body’s sleep-inducing hormone and promotes relaxation, although its exact mechanisms are not fully understood.

How do circadian rhythms change over a lifetime?

Circadian rhythms change during infancy, adolescence, and elderly years. 

  • Infancy: When babies are born, they don’t have consistent sleep and wake patterns. Instead, they sleep up to 18 hours a day at various intervals. When they reach around four to six months old, babies begin to develop circadian rhythms that allow them to sleep more throughout the night.  
  • Adolescence: Many adolescents develop “sleep phase delay” which occurs when their bodies produce melatonin later in the evening than typical. This physical phenomenon might help explain why many teenagers tend to stay up late and have difficulty waking up. 
  • Elderly years: During the aging process, circadian rhythms become less reliable. In general, elderly people tend to experience both sleepiness earlier in the evening and wakefulness earlier in the morning. Additionally, hormonal changes associated with aging, such as menopause in women, can frustrate sleep. 

How can circadian rhythms become disrupted?

​​In a perfect world, circadian rhythms would allow individuals to rise in the morning with energy to perform daily tasks and then wind down as the evening darkens so that falling asleep occurs easily at bedtime. Without disruption, this process would repeat daily. However this is, of course, not always the case. Instead, circadian rhythms can become interrupted by external circumstances. Some interferences to circadian rhythms include:

  • Changes in daylight: Daylight savings time, traveling through time zones, and seasonal weather oscillations can affect the body’s responses to light and dark. These disturbances can cause irritability, daytime sleepiness, and difficulty concentrating. 
  • Alternative schedules: Any work, school, or other obligatory schedules that fall outside the hours of 7 a.m. and 6 p.m. can impact circadian rhythms. This is especially the case for those who work shifts in the early mornings or late nights. Because these schedules don’t align with the body’s biological fluctuations, they can cause trouble sleeping and impede individuals’ ability to perform tasks effectively.
  • Artificial light: Urban light pollution, light from screens and electronics, and light from inside individuals’ homes can impact sleep quality by confusing the body’s responses to natural daylight and darkening cadences. Those who experience insomnia may be highly sensitive to artificial light. These individuals as well as anyone with sleep struggles may consider removing electronic devices from their bedrooms, dimming their lights inside the home in accordance with the darkening sky, and refraining from screen time during the evening.
  • Stress : As part of the body’s instinctual fight-or-flight response, it shuts down the circadian rhythm sleep signal when stressed. While this mechanism is helpful if survival is threatened, stress from daily life can cause unnecessary sleep issues and resulting sleeplessness.

How can discordance in circadian rhythms impact well-being?

After losing only a single night’s sleep, it’s common for individuals to be less effective at carrying out physical activities, completing cognitive tasks, and regulating their emotions. When circadian rhythms are upset and sleep quality consequently suffers for extended periods of time, the effects of inadequate rest on physical, mental, and emotional health are magnified. A prolonged inability to achieve good sleep can lead to heart and immune system problems, trouble concentrating, and increased irritability, as well as symptoms of depression and anxiety .  

How can individuals maintain their circadian rhythms?

Practicing good sleep hygiene and sleep-promoting self-care strategies can help one avoid many sleep disruptions while reinforcing their natural circadian rhythm. Some ways to incorporate these into your routine include:

  • Going to bed and waking up at the same time every day. Adhering to a regular schedule for going to sleep and waking up can help regulate circadian rhythms.
  • Exposing yourself to sunlight. Sunlight can help promote wakefulness by reinforcing the body’s light signals to stimulate cortisol production. When the sun begins to set, the body is able to easily contrast the previous sun exposure with the darkening evening, so that it readily begins producing melatonin.
  • Making time for daily movement: Thirty minutes of physical activity daily can help release pent-up energy that may contribute to restlessness. Physical activity does not have to be rigorous exercise to be beneficial. Mindful movement can promote a healthy circadian rhythm among many other perks.
  • Practicing mindfulness : Meditation, gentle yoga, and breathing practices can help reduce stress and tension that may be impeding your ability to sleep well.
  • Avoiding certain substances leading up to bedtime. Limiting caffeine and alcohol intake in the afternoon and evening can promote restful sleep. 
  • Considering the time that you take any medications. Discuss with your medical provider whether any medications you’re taking might impede your sleep and would be better to take in the morning rather than at night.
  • Seeking primary care support. Speaking with your medical provider about struggles with your circadian rhythm can help determine whether there are any underlying medical conditions, such as sleep apnea or thyroid problems
  • Seeking mental health support: Attending therapy can provide insight on whether any mental health conditions may be contributing to upset in your circadian rhythm. Mental health providers can implement evidence-based therapeutic interventions, such as cognitive behavioral therapy (CBT), which can be beneficial for reducing sleep-interfering thoughts and behaviors before bedtime. 

THRIVE HERE

By obtaining clinical support, individuals can reset their sleep and wake cycles, improve their sleep quality, and boost their daytime effectiveness. Thrive Wellness’ interprofessional team provides integrated care for physical, mental, and emotional health concerns. Our specialists can help you uncover the roots of sleep-related challenges and improve your health holistically so you can embrace your full potential every day. Reach out to learn more about our outpatient services as offerings vary by location. 

About the Contributor

Thrive Wellness Reno Primary Care Physician, Internal Medicine Lorrie Oksenholt, D.O.

After earning a bachelor’s degree in foods and nutrition at Walla Walla College in Washington state, Dr. Lorrie Oksenholt attended medical school at the University of Missouri-Kansas City where she obtained her medical degree as a doctor of osteopathic medicine. She completed her internal medicine residency through the University of Nevada, Reno where she also served as a clinical professor of medicine in both inpatient and outpatient settings. Additionally, Dr. Oksenholt worked as the chief of staff and acting medical director at Nevada Mental Health.

Dr. Oksenholt has been practicing internal medicine for over thirty years and has significant experience treating general health concerns as well as issues specific to women’s health and men’s health, respectively. Throughout her career, she has worked closely with clinical specialists to treat mental and behavioral health issues, including eating disorders. She is passionate about a whole-person approach to health care that addresses the mind, body, and heart for overall well-being. As an internal medicine physician at Thrive Wellness Reno, Dr. Oksenholt finds fulfillment in working alongside caring clinicians to foster holistic health for patients. She strongly believes in the power of preventative medicine and is committed to collaborating with those in her care to achieve optimal health.

Outside of her practice, Dr. Oksenholt enjoys taking advantage of the abundance of outdoor activities that Northern Nevada has to offer. She and her husband enjoy spending time together as well as with their children and grandchildren as often as possible. Dr. Oksenholt has many hobbies including glasswork, jewelry making, and quilting.

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By Brianna Villalpando, LMSW, LCSW March 19, 2025
Teen eating disorders are serious. As a parent or caregiver, one of the most difficult situations you can face is noticing that your teen may be struggling with a basic human need like eating. Adolescence is already a rough period for many teens filled with fluctuating emotions, changing bodies, and social pressures. However, sometimes coping with these challenges can manifest in unhealthy ways, like developing complicated relationships with food, body image, control, or exercise. Many teens face body image issues as their bodies mature, excessive pressure to meet unrealistic expectations fueled by social media and peers, and emotional instability and anxiety during their adolescent years, all of which can combine to create the perfect storm for an eating disorder. These challenges can often make your teen more vulnerable to unhealthy coping mechanisms , such as restricting food intake, excessive exercise, or engaging in disordered eating behaviors . If you’ve started noticing signs that something may not be right, it’s essential to take action to help your teen get the support they need. Recognizing the Signs of an Eating Disorder Eating disorders can vary in appearance, but there are some common signs and symptoms to watch for. If you notice any of the following behaviors or changes in your teen, it may indicate a problem that requires further attention: Preoccupation with body image : Teens with eating disorders often show increased focus on their weight or appearance, frequently expressing dissatisfaction with their body. Excessive discussions about dieting : If your teen frequently talks about dieting, food restriction, “getting skinny,” or often makes weight-related comments, this could be a red flag. Obsession with calorie counts : Teens who are obsessed with tracking every calorie, comparing the caloric content of foods, or controlling their calorie-intake may be struggling with an eating disorder. 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It's important to emphasize empathy and understanding, conveying that your primary concern is your teen's health and well-being. Initiating this conversation compassionately can create an environment of trust and openness to explore the problem. Selecting a calm, comfortable, and private setting is vital so your teen feels safe discussing a sensitive topic that may cause them to feel anxiety or shame. Effective communication hinges on using open-ended questions and active listening. Encourage your teen to share their thoughts and feelings without fear of judgment. By actively listening, you validate their experience, making them feel heard and understood. Before diving into the conversation, educating yourself about eating disorders can provide a solid foundation for discussing the issue knowledgeably. Some quick preparation with research allows you to dispel myths and provide accurate information when you talk to your teen. Why It's Crucial to Seek Medical Help When you notice warning signs, it’s important not to wait to get help. Eating disorders can be life-threatening, both physically and emotionally. They take a serious toll on a teen’s health, affecting their metabolism, hormonal function, and overall well-being. Beyond the physical impact, eating disorders can often involve deeply ingrained psychological and emotional challenges, such as low self-esteem, anxiety, depression, and trauma. After an initial conversation, the first step is to schedule an appointment with a medical provider. Your teen’s primary care doctor or a pediatrician can help evaluate their physical health and provide guidance for next steps. Be prepared to discuss the specific behaviors or signs you’ve observed, as this will help your provider better understand the situation. The doctor may conduct a physical examination, lab tests, and discuss your teen's emotional and psychological state. Building a Support Team Once you’ve taken the first step to ensure your teen’s immediate medical needs are addressed, it’s time to build a multidisciplinary treatment team . This may include: Therapists : A licensed, specially trained therapist who specializes in eating disorders or adolescent mental health can help your teen address the emotional and psychological root causes of their disorder. Medical doctors : Your teen’s doctor can monitor their physical health during the recovery process, ensuring they are safe while navigating the challenges of nourishing their body. Nutritionists or dietitians : A professional who specializes in eating disorders can create a nutrition plan tailored to your teen’s specific needs and help them rebuild a healthy relationship with food. Psychiatrists : In some cases, medication may be prescribed to address underlying mental health issues contributing to their behavior. Act Quickly and Seek Professional Guidance It’s crucial to act as soon as you recognize signs of an eating disorder in your teen. The longer eating disorders go untreated, the harder they can be to overcome. Recovery from an eating disorder is a complex journey, involving both physical and mental obstacles to tackle. It can be incredibly difficult for both the teen and the family to manage this process at home without professional support. A well coordinated team of medical providers, therapists, and eating disorder specialists is essential in guiding your teen through their recovery. This team can help monitor your teen’s progress, provide emotional support, and ensure that your teen is getting the care they need for both short and long-term recovery. Supporting Your Teen on Their Recovery Journey Eating disorders are serious, but with the right care and support, recovery is possible. If you suspect that your teen may have an eating disorder, don’t hesitate to reach out for help. Seek medical advice first, and build a support team of professionals who can work together to provide comprehensive care. Eating disorders are complex, and it’s not something you or your teen should have to face alone. Taking swift action and offering compassionate support will help your teen regain control of their health and their life so that they can thrive through their adolescence and beyond. At Thrive, we offer specialized treatment for anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID). Our adolescent intensive outpatient and partial hospitalization programs have not only changed lives, but saved them. If you believe your teen is struggling, don't hesitate to reach out for help, we are ready to conduct a complimentary intake assessment today. To learn more about eating disorders, download our free guide "Recovery is Real" filled with practical insights and strategies to help a loved one navigate the journey toward recovery.
By Brianna Villalpando March 12, 2025
It can be difficult to know when it's time to reach out for help. We often try to manage stress, anxiety, sadness, or relationship issues on our own, thinking it’s just a phase or something we can work through to “get over.” But sometimes, these feelings or behaviors persist and can start affecting our overall mental and emotional well-being. The truth is, seeking therapy shouldn't be a last resort. Therapy is a valuable tool for anyone looking to better understand themselves, improve their emotional health, and work through life’s challenges. If you’ve been wondering whether it’s time to seek therapy, there are a few key factors to consider when performing a self-evaluation. Here are five signs that it might be time to reach out for additional support: 1. Is My Mood Affecting My Life or Relationships? One of the most telling signs that you may need support is noticing that your mood is negatively impacting your daily life or interpersonal relationships. Have you noticed an increase in conflict with friends, family, or colleagues? Are you feeling stuck in patterns of negativity that seem hard to shake? If your mood is affecting how you function at work, school, or in your personal life, it may be time to talk to a therapist. Pay attention to your behaviors; are you withdrawing from activities you usually enjoy? Are you reacting more intensely to situations than usual? If your emotional state is beginning to impact your relationships, interactions, or your ability to move through everyday life, a therapist can help you explore underlying causes and develop tools to improve your social wellness. 2. Am I Isolating Myself to Avoid Conflict? There’s a big difference between being introverted and isolating yourself as a way to avoid conflict. If you find yourself consistently pulling away from social situations, not because you need time to recharge, but because you’re avoiding uncomfortable conversations or emotional confrontations, this could be a sign of a deeper issue. It’s natural to want to avoid tension or discomfort, but consistent isolation can worsen feelings of loneliness and make it even harder to work through conflicts. Therapy can help you learn healthy coping mechanisms, problem-solving and communication skills, so you can feel more comfortable facing conflict in a productive way rather than shutting down or avoiding it at the cost of self-isolation. 3. Are My Emotions Out of Control? Do you ever feel like your emotions are so overwhelming that you can't regain control? If you're finding it difficult to calm yourself down, quiet your thoughts, or manage your feelings, this might be a sign that therapy could be helpful. Emotions like anger, disgust, fear, anxiety, or sadness are natural, but if they start taking over your thoughts and actions, it can be exhausting and difficult to complete daily tasks. A therapist can help you understand why your emotions are so intense and teach you strategies to regulate them and regain a sense of balance. 4. Have I Experienced Trauma That’s Affecting My Daily Life? Trauma comes in many forms, it could be from a single incident or from ongoing experiences that have affected your sense of safety, connection, or well-being. Sometimes, trauma is tied to experiences in childhood, but it can also be linked to recent events, like accidents, loss, or abuse. If you've experienced trauma and are struggling to perform basic daily tasks or meet your needs, therapy can be incredibly beneficial. Unresolved trauma can lead to feelings of anxiety, depression, or being stuck in past experiences. A trauma-informed therapist can help you process these experiences, understand their impact on your life, and work toward healing and recovery. 5. Am I Hurting Myself or Others? If your mood or behaviors are causing you to hurt yourself or others, it’s crucial to seek help immediately. Whether it’s through emotional or physical self-harm , or unintentionally inflicting harm on the people around you, this is a serious sign to find support from mental health professionals. A therapist can provide a safe, nonjudgmental space to talk about what you’re going through and help you work toward healthier ways of coping. If you’re in immediate danger or experiencing thoughts of self harm, it’s essential to reach out for help as soon as possible. There’s no shame in seeking support when you're struggling with harmful thoughts or actions. Why is Professional Mental Health Support Necessary? Although there may be barriers to seeking therapy, reaching out for professional mental health support is worth it to address the emotional and psychological issues that you shouldn’t have to deal with alone. Therapists have the knowledge and tools needed to guide you through your struggles, offering insights and solutions that aren’t available outside of the therapeutic setting. Their expertise promises not only a deeper understanding of your challenges, but the application of practical methods and skills to resolve them in your everyday life. Additionally, trained mental health professionals offer personalized strategies and coping mechanisms tailored to your unique situation and needs. These strategies are informed by evidence-based practices and a therapist’s experience working with and healing emotional and mental struggles. Personalized therapy helps clients receive the most relevant and effective guidance for their personal challenges. Embracing the Journey Toward Mental Wellness Recognizing that you might need support is the first step toward feeling better and getting the most out of life. Therapy isn’t just for when things are at their worst; it’s a proactive way to improve your emotional health, work through challenges, and build skills for resilience. If you relate to any of these situations, it might be time to reach out and explore therapy as an option. It’s okay to need help, and you don’t have to navigate this journey alone. If you’re unsure whether therapy is right for you, consider talking to a mental health professional to discuss your concerns and explore specialized support options available to you. You deserve to feel your best, and therapy can be a stepping stone to help you reach your goals. Are you in need of support? At Thrive Wellness, we offer personalized therapy and treatment to support you in whatever you're going through, don't be afraid to reach out for help . We also offer a FREE comprehensive guide to wellness in our “How to Thrive” guide . This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being. Start your journey towards a balanced and fulfilling life today with these simple yet transformative steps.
By Sage Tippie February 14, 2025
This Eating Disorders Awareness Month, we’re focusing on fighting the misinformation and stereotypes surrounding eating disorders that so often create barriers to diagnosis and treatment. Myths about eating disorders can perpetuate harmful stereotypes and keep people from receiving effective and timely treatment when they need it. It’s no secret that the field of eating disorders is riddled with misinformation, leading to confusion, stigma, and shame for those struggling. In this blog post, we'll explore the common myths about eating disorders and fight them with concrete facts in the hopes of building a more informed and educated community when it comes to these serious mental health conditions. Eating Disorder Myths Versus Facts Myth: Only those who are medically underweight have an eating disorder. Fact: Someone can have an eating disorder at any weight. In fact, less than 6% of those diagnosed with an eating disorder are medically underweight. There is even a specific diagnosis for those who are not underweight showing the symptoms of anorexia called atypical anorexia. People of all sizes are at risk for serious complications from an eating disorder, not just those that are underweight. Myth: Only women have eating disorders Fact: Although often associated with teen girls, eating disorders can affect those of any gender and age. While stereotypes and stigma surrounding eating disorders may tell us that men are not commonly affected by them, research has found that nearly 25% of those who present for eating disorder treatment are male. Keeping an open mind around who can be affected by eating disorders allows for more accurate and timely diagnosis and treatment for those who need it. Myth: Eating disorders are just about food. Facts: While eating disorders always involve an unhealthy relationship with food or body image, they also are rooted in biological, psychological and sociocultural aspects. Eating disorders cannot be treated just by changing eating behaviors, but by addressing the mental aspect of the illness as well. This is why integrated treatment involving a team of social workers, primary care specialists, therapists, and in some cases occupational therapists or psychiatrists is so crucial: a holistic approach is needed to treat all aspects of an eating disorder. Myth: Eating disorders aren’t that serious. Fact: Eating disorders are extremely serious and life-threatening mental disorders that require dedicated treatment. In fact, anorexia nervosa has the second highest mortality rate of any psychiatric disorder. By taking eating disorders and their diagnosis and treatment seriously, we can save lives. Myth: Eating disorders are a choice. Fact: Just like any other illness, eating disorders are not a choice or a phase, nor is recovery from an eating disorder just a simple decision to start eating more or less. Recovery is not dependent on willpower, but on ongoing professional treatment and long-term support. The recovery process can be lengthy and challenging, requiring patience and a supportive environment and team on your side. It is a gradual, step-by-step journey, rather than an instantaneous decision made on one person’s part. Myth: Eating disorders always involve negative body image. Fact: Avoidant/restrictive food intake disorder (ARFID) does not have to do with body image. Those with ARFID may avoid many foods because of texture, taste, color, or smell, or feared outcomes of eating like choking or vomiting. Like any other eating disorder, ARFID is serious and requires specialized treatment like exposure-response prevention therapy. Myth: Eating disorders only affect White people. Fact: Although Black, Latina/o/x/e, Indigenous/Native, and Asian people are historically underrepresented in studies of eating disorders, large-scale studies have found that rates of eating disorders are the same or higher in all racial and ethnic groups as compared to white individuals (NEDA). Removing racial stereotypes around eating disorders can help to remove barriers that BIPOC individuals commonly face when seeking treatment. Dispelling the Myths: A Path Towards Understanding By addressing and dispelling these myths, we can create a safe space that promotes understanding and empathy. Eating disorders are not choices or phases, but debilitating mental health issues that can affect anyone. Recognizing the seriousness of these disorders is so important in reducing stigma and ensuring that those who are struggling receive the care and support they require. This month and every month, we encourage you to fight misinformation and stick up for those experiencing eating disorders, because knowledge and education can be one of the greatest assets to recovery for those who need it. If you or someone you know is in need of eating disorder support, don’t be afraid to reach out , our team of healthcare professionals are here for you. To learn more about eating disorders and the journey to recovery, download our free eating disorders guide .
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