What a Lifestyle Medicine Physician Wants You to Know About Nervous System Regulation
By Lienna Wilson, PsyD | Vagus Vitality
Carina Hopen, MD, MS, has spent her career looking past isolated symptoms and toward the daily patterns that shape how a person's nervous system actually functions. A functional and lifestyle medicine physician and former Naval flight surgeon with additional training in medical acupuncture, she founded Inspired Wellness, PLLC and the North Whidbey Center for Wellbeing on Whidbey Island, Washington. Her perspective is a useful corrective for anyone who has come to think of the vagus nerve as a switch to flip. For Dr. Hopen, regulation is not a technique. It is the accumulated result of how someone sleeps, eats, moves, connects, and rests, day after day.
The Vagus Nerve Is Not a Button to Push
"I don't think of the vagus nerve as a button that we need to keep trying to push," Dr. Hopen says. "It is part of a much larger system that is constantly taking in information about whether we are safe, supported, rested, nourished, or under threat."
She is not dismissive of the tools that have made the vagus nerve a wellness buzzword. "Things like humming, cold exposure, and breathing exercises can certainly be useful. I use some of them myself and with patients," she says. "But they are not going to overcome a life in which someone is chronically sleep-deprived, skipping meals, overworking, overexercising, isolated, or living under ongoing stress."
What she is really working toward with patients is flexibility, not calm. "We need to be able to become activated when life requires it, but we also need to be able to come back down afterward," she explains. "Regulation does not mean being calm all the time. It means being able to find your way back."
That is where lifestyle medicine comes in. "Sleep, food, movement, relationships, time outdoors, and regular moments of rest all send information to the nervous system," Dr. Hopen says. "I often say that healing happens in the home because what we do repeatedly matters much more than any one technique we try once in a while."
Sleep: The Pillar With the Biggest Ripple Effect
Asked which lifestyle pillar has the most noticeable effect on her patients, Dr. Hopen doesn't hesitate. "I would probably say sleep, although stress management and social connection are very close behind," she says.
"When people are not sleeping well, everything feels harder," she explains. "Their patience is shorter, cravings are stronger, pain may feel more intense, and relatively minor stressors can feel overwhelming. The nervous system simply has less reserve." Research on sleep and emotional regulation backs up that clinical observation: a night of insufficient sleep is reliably linked to heightened reactivity in brain regions involved in emotional processing and to a reduced ability to regulate the resulting response (van der Helm & Walker, 2012).
She points to social connection as an underrated lever as well. "We regulate through safe relationships," Dr. Hopen says. "Feeling seen, heard, and supported can affect the body in ways that another supplement or wellness device cannot." Nutrition rounds out the picture. "If someone is living on caffeine, going long periods without eating, undereating, or riding a blood sugar roller coaster all day, the body may experience that as another form of stress," she says. "Sometimes what feels like anxiety or dysregulation is partly a body asking for sleep, food, movement, or recovery."
Where to Start When Sleep Is Poor
When a patient's sleep has fallen apart, Dr. Hopen doesn't start with a nighttime routine. "I usually start with a consistent wake-up time and morning outdoor light," she says. "People tend to focus on forcing themselves to go to sleep, but wake time is often the easier place to begin. Morning light helps give the brain a clear signal that the day has started, which supports the timing of sleep later that night." That sequencing has research behind it: morning sunlight exposure has been associated with an earlier, more aligned sleep midpoint and better overall sleep quality, more so than exposure at other times of day (de Menezes-Júnior et al., 2025).
From there, she looks at "caffeine, alcohol, daytime movement, evening light exposure, and whether there is a predictable wind-down period. It does not need to be an elaborate nighttime routine," she adds. "It can be as simple as dimming the lights, putting the phone away, taking a warm shower, stretching for a few minutes, or slowing the breath."
For some patients, she also uses Alpha-Stim, a cranial electrotherapy stimulation device, as part of that evening transition. "For certain patients, Alpha-Stim may be another part of that evening transition, particularly when anxiety, physical tension, or difficulty shutting down is interfering with sleep," she says. "But I still don't want it to become another task they believe they must perform perfectly." She is careful to describe what the device is and is not. "Alpha-Stim is not directly stimulating the vagus nerve in the same way as a vagus nerve stimulation device," she explains. "It provides a very low-level electrical current through ear clips and works more broadly with the nervous system. I see it as a supportive tool or a bridge, not the entire answer. We still need to ask why the person's system is struggling and address sleep, nutrition, movement, hormones, pain, trauma, relationships, and the other factors affecting their health." A recent meta-analysis of randomized trials found that cranial electrotherapy stimulation produced meaningful improvements in anxiety, depression, and insomnia symptoms compared to control conditions, with the Alpha-Stim device specifically shown to be more effective than sham treatment for anxiety symptoms (Chung et al., 2023).
And she is quick to note the limits of any nervous system tool. "I also don't want people to turn sleep itself into a performance test. That creates even more pressure," Dr. Hopen says. "Of course, we also need to ask why the person is not sleeping. Breathing exercises and relaxation devices are not going to correct untreated sleep apnea, restless legs, pain, hot flashes, medication effects, or alcohol-related sleep disruption. Sometimes the best nervous system intervention is getting the right medical evaluation."
Mindfulness Without the Performance Pressure
Dr. Hopen tailors how she explains mindfulness to who is in front of her. "Some patients love knowing the physiology, while too much technical language makes other people more anxious," she says. Her working definition stays simple: "I usually explain mindfulness as noticing what is happening without immediately deciding that it is bad, dangerous, or something we have to fix. That small pause gives us more room to respond instead of reacting automatically."
She is candid that mindfulness is not always a peaceful experience. "When some people become still, they become more aware of anxiety, grief, physical discomfort, or traumatic memories," she says. "I never want mindfulness to feel forced. Sometimes the most mindful thing a person can do is open their eyes, move their body, or stop the practice." As she puts it, "Mindfulness is not about forcing yourself to calm down. It is about learning how to stay present with yourself without adding more urgency."
When You Cannot Sit Still
For patients who bristle at the idea of meditation, Dr. Hopen's answer is direct. "I tell them they do not have to sit still. Meditation is one form of mindfulness, but it is not the only one," she says. "Walking can be a mindfulness practice. So can gardening, stretching, painting, knitting, cooking, drinking tea, singing, humming, or simply noticing the feeling of your feet against the ground." Sometimes, she notes, "movement needs to happen before stillness. They may need to walk, shake out their arms, stretch, or push against a wall before their body is ready for a quieter practice."
She also relies on simple sensory anchors. "Look around and notice what you see. Listen for the farthest sound you can hear. Feel the chair or ground supporting you," she says. "These practices help bring attention back into the present without requiring someone to sit silently with their eyes closed." For a patient who becomes more frustrated when asked to meditate, she sometimes turns again to Alpha-Stim in the clinic. "It allows the person to receive a calming input without needing to concentrate, control their thoughts, or feel as though they have to 'do meditation correctly,'" she says. "They can simply sit comfortably, listen to music, or rest during the session. Sometimes a person needs to experience what 'settled' feels like before they can learn how to find their way back there." Her guiding principle: "The best practice is the one someone will actually do and does not dread."
Where Acupuncture Fits
Dr. Hopen, who has additional training in medical acupuncture, sees real overlap with vagus nerve function, but she is careful not to overstate it. "Acupuncture provides sensory input through the peripheral nerves, and that input may influence brain regions and reflex pathways involved in autonomic regulation," she says. "There is emerging research suggesting that certain types of acupuncture and electroacupuncture may affect parasympathetic activity, inflammation, and communication between the brain and internal organs." A recent meta-analysis of randomized trials found that acupuncture produced modest improvements in heart rate variability, a marker of autonomic and vagal function, though the authors noted the evidence remains limited by small sample sizes and inconsistent methods across studies (Ma et al., 2025).
"That does not mean that every acupuncture point directly stimulates the vagus nerve," she cautions. "The effects may differ depending on the point, the depth, the type of stimulation, and the individual person." She also thinks the ritual of the treatment itself plays a role. "With patients, I usually describe acupuncture as another way of giving the nervous system new information," she says. "The entire experience may matter too: lying in a quiet room, slowing down, breathing more deeply, and feeling cared for. I don't think we can always separate the needle from the context in which the treatment occurs."
The One Habit Worth Starting Today
Asked for the single habit she would recommend above all others, Dr. Hopen doesn't point to a supplement or a device. "I would start with a ten-minute outdoor walk, ideally in the morning," she says. "It sounds simple, but it combines several helpful things at once: natural light, rhythmic movement, visual orientation, a change in environment, and a break from screens. It can support circadian rhythm, sleep, mood, blood sugar, and cardiovascular health without requiring someone to learn a complicated technique."
"If ten minutes feels like too much, start with two," she adds. "What matters is repetition. The nervous system learns through repeated experience, not through perfection. My favorite nervous system practice is the one that fits into a person's real life."
A Final Thought
"I would love for readers to know that nervous system dysregulation is not a personal failure," Dr. Hopen says. "A body that remains vigilant may be responding to chronic stress, trauma, illness, hormonal changes, caregiving, loneliness, financial strain, inadequate recovery, or an environment that genuinely does not feel safe."
"We should not use nervous system regulation as another way to tell people that they should be able to breathe their way through everything," she says. "These practices and tools can be very helpful, but sometimes healing also requires medical care, therapy, boundaries, community support, or meaningful changes in a person's circumstances."
About Dr. Carina Hopen, MD, MS
Dr. Hopen is a functional and lifestyle medicine physician and former Naval flight surgeon with additional training in medical acupuncture. She is the founder of Inspired Wellness, PLLC, and the North Whidbey Center for Wellbeing on Whidbey Island, Washington. Known for looking beyond isolated symptoms, Dr. Hopen blends evidence-informed medicine with nutrition, movement, sleep, mindfulness, acupuncture, and nervous system support to help patients understand the deeper patterns influencing their health and translate that understanding into realistic, sustainable changes. Her guiding philosophy is simple: healing happens in the home. Learn more about her practice at inspiredwellnesspllc.org
Note: This article is intended for educational purposes only and does not constitute medical advice. It is not a substitute for professional diagnosis or treatment. Please consult a qualified healthcare provider before starting any new practice, supplement, or device, especially if you have an underlying health condition.
References
Chung, F.-C., Sun, C.-K., Chen, Y., Cheng, Y.-S., Chung, W., Tzang, R.-F., Chiu, H.-J., Wang, M.-Y., Cheng, Y.-C., & Hung, K.-C. (2023). Efficacy of electrical cranial stimulation for treatment of psychiatric symptoms in patients with anxiety: A systematic review and meta-analysis. Frontiers in Psychiatry, 14, 1157473. https://doi.org/10.3389/fpsyt.2023.1157473
de Menezes-Júnior, L. A. A., Sabião, T. da S., Carraro, J. C. C., Machado-Coelho, G. L. L., & Meireles, A. L. (2025). The role of sunlight in sleep regulation: Analysis of morning, evening and late exposure. BMC Public Health, 25, 3362. https://doi.org/10.1186/s12889-025-24618-8
Ma, Y., Zhang, P., Du, T., Wang, Z., Wang, T., Fu, A., Wang, Z., Ma, T., & Zhang, W. (2025). Clinical efficacy and safety of acupuncture in modulating autonomic nervous function: A meta-analysis of randomized controlled trials. Frontiers in Neuroscience, 19, 1694110. https://doi.org/10.3389/fnins.2025.1694110
van der Helm, E., & Walker, M. P. (2012). Sleep and affective brain regulation. Social and Personality Psychology Compass, 6(11), 773-791. https://doi.org/10.1111/j.1751-9004.2012.00464.x