Insomnia in teens

I. INTRODUCTION
Teens are so full of potential, so full of life, so … sleepy. Research shows
that most teens do not get the sleep that they need on a daily basis.
Each person has their own need for sleep. This need may vary from
one person to another.
Teens are at an important stage of their growth and development.
Because of this, they need more sleep than adults.
The average teen needs about nine hours of sleep each night to feel
alert and well rested.
There are many factors that keep teens from getting enough sleep.
Causes for their lack of sleep include the following:
• rapidly changing bodies
• busy schedules
• active social lives
• a wrong view of sleep
Teen sleep problems can begin long before they turn 13. The sleep
habits and changing bodies of 10 to 12 - year - olds have a close link to
the teen years. The sleep patterns of teens are also firmly set in their
lives. It is not easy for them to change the way they sleep. Thus teen
sleep problems can continue well into their years as adults. For these
reasons, the information found here may apply to anyone from 10 to
25 years of age.

II. THE NEED FOR SLEEP
There are two main factors that affect how sleepy or how alert you are
at any given time in a day. The first is how long it has been since you
last slept. This is called the sleep - wake balance. If you stay awake for
too long, your sleep - wake balance will be off. This will make you
sleepy.
The second factor that affects your level of sleepiness is your internal
body clock. This clock controls the “ circadian rhythms ” in your body.

The word “ circadian ” means to occur in a 24 - hour cycle. These
rhythms make you feel sleepy or alert at regular times every day. Your
internal clock tells your body when it is time to sleep at night. It also
tells your body when it is time to be awake during the day. Everyone ’ s
body has this natural timing system. When you feel sleepy at night,
your circadian rhythms are telling you it is time to go to bed.
Most people feel a mild need for sleep in the afternoon. This need to
sleep grows much stronger at night. Because of this set rhythm in your
body, the urge to sleep will be triggered at these times of day. This
occurs no matter how much sleep you got the night before. But a lack
of quality sleep can also make you tired at the wrong times of day.
Teens can throw off their body clocks by often staying up late at night.
Their clocks will also be off if they are always changing their schedule
of when the sleep and wake - up. When their internal clocks are not set
right, teens can become very sleepy when they should be wide awake.
This can cause them to fall asleep at school, at work, or while they are
driving.


III. A SHIFT IN SLEEP
Puberty is a time when your body begins to go through many changes.
It is the stage of life when you become physically able to reproduce
sexually. There are many signs that show when this process is
underway. Girls see their breasts develop and have their first
menstrual period. Boys start to grow facial hair and hear their voices
begin to deepen. Girls have always begun to enter the stage of puberty
earlier than boys. Typically, this is between the ages of 10 and 11.
Boys usually enter puberty a couple years later. Today, some girls
begin to show signs of puberty as early as 7 or 8 years old.
One change in the body during puberty is closely related to how you
sleep. There is a shift in the timing of your circadian rhythms. Before
puberty, your body makes you sleepy around 8:00 or 9:00 p.m. When
puberty begins, this rhythm shifts a couple hours later. Now, your body
tells you to go to sleep around 10:00 or 11:00 p.m.
The natural shift in a teen ’ s circadian rhythms is called “ sleep phase
delay. ” The need to sleep is delayed for about two hours. At first, teens
may appear to be suffering from insomnia. They will have a hard time
falling asleep at the usual time. While they begin going to sleep later,
they still need an average of nine hours of sleep at night. Because
most teens have to wake up early for school, it is important for them
to go to bed on time. If they go to bed late, they will be unable to get
the sleep that they need. This change is a normal part of growing up.
With some extra care, teens will quickly adjust to the new sleep
schedule of their bodies.

If teens resist or ignore this change, they will make this time of
transition very hard on their bodies. They will only hurt themselves by
staying up too late at night doing homework or talking with friends.
Using a lot of caffeine or nicotine will also make it hard for a teen to
get quality rest. At the end of the school week, many teens are worn
out from all the sleep they missed. They think that sleeping in much
later on the weekend will help them catch up. This only throws their
body clocks off even more. It will be even harder for them to fall
asleep and wake up on time when the new school week begins.

IV. COMPETING FOR SLEEP
Teens have to balance the weight of many demands on their time. The
biggest of these demands is school. Most schools start class very early
in the morning. After a long day at school, teens may also have to
study for hours at home. An early start and a lot of homework can
combine to make it hard for them to get to sleep on time.
Teens are faced with a lot of other things that compete for their time.
Once they are old enough, many of them begin to work after school.
Some simply want to have their own money to spend. Others have to
do this to help their families. Older siblings may also be needed at
home to look after younger brothers or sisters. After class is out,
schools offer many sports teams, clubs, and activities that teens can
join. These can take up as much time as a job.
Of course, many teens also like to spend hours of their time with
friends. With all of these options facing them, there simply isn ’ t
enough time for teens to do it all. They have to give something up. Far
too often, it is their sleep that gets left out.
Peer pressure can also cause teens to make poor decisions that will
affect their sleep. They may stay out too late,
drink, smoke, or use drugs. All of these things can disturb their sleep
patterns. It is also common for teens to simply have a wrong view of
sleep. They see it as something that keeps them from the things they
want to do. It is something to be conquered. It becomes a contest to
try to get by on as little sleep as possible. They rarely consider their
need for sleep and how it affects all that they do.
The burden of these demands combines with changes in their bodies to
make it hard for teens to get the sleep that they need. This causes
them to fight a daily battle against sleepiness. They struggle to wake
up and make it to school on time. The need for an alarm clock to wake
up is a sign that they are not getting enough sleep at night. They may
doze off during class, or sleep through family activities on the
weekend. Being sleepy also makes them grouchier and more irritable.
Feelings of depression can also be caused or enhanced by
sleeplessness. Teens are unable to think as clearly or perform their best in school, sports, or at work when they are tired. A lack of sleep
will also put them at a greater risk of being in an accident in the car or
on the job.
Many barriers prevent teens from getting the sleep that they need.
Their body clock begins to shift. They face new pressures at school,
home, work, and with friends. They are faced with decisions they
haven ’ t had to make before. All of this comes at a time when they also
have many other changes in their bodies, emotions, feelings, and
moods. They need to get plenty of sleep during these changes. This
will help them feel their best about themselves and about life. A lack of
quality sleep will only make this stage of life harder for them.

V. PROBLEMS WITH SLEEP
A lack of sleep is not the only cause of daytime sleepiness. Teens may
still feel sleepy during the day even if they do spend enough time in
bed at night. The following causes may explain this excessive daytime
sleepiness in teens:
Obstructive sleep apnea
Obstructive sleep apnea (OSA) occurs when the tissue in the back of
the throat collapses during sleep. This keeps air from getting in to the
lungs. This is very common, because the muscles inside the throat
relax as you sleep. Gravity then causes the tongue to fall back and
block the airway. It can happen a few times a night or several hundred
times per night. These pauses in breathing briefly wake you up and
disturb your sleep. This can cause you to be very tired the next day.
Young men who are overweight and snore loudly are at a higher risk of
having sleep apnea.
Narcolepsy
Narcolepsy is a sleep disorder that causes people to feel severely tired
during the day. They may fall asleep suddenly at any time or place.
These “ sleep attacks ” can occur while eating, walking or driving. This
disorder most often begins to affect people when they are between the
ages of 15 and 25.
Circadian rhythm sleep disorders
These disorders are common in teens. They can cause you to be sleepy
during the school day and most alert at night. Signs of these disorders
include the following problems:
• difficulty getting to sleep until the late evening or early morning
hours
• difficulty waking in the morning for school

• sleeping very late into the morning or afternoon on weekends

Emotional problems
Huge swings in emotions and moods are also common in teens. This
can result in major sleep issues. In extreme cases, depression can
develop. This can play a huge role in disrupting a teen ’ s sleep
patterns.

Medical conditions
Medical conditions such as epilepsy or asthma can cause teens to have
a hard time sleeping. Many medications will also affect how they
sleep.


VI. PARENTS AND TEEN SLEEP
Parents play a vital role in helping teens get the sleep that they need.
You should pay close attention to how your son or daughter sleeps,
acts, and feels. They will give you signs that show they are not getting
enough sleep. See if your teen shows any of the following signs:
• has trouble waking up most mornings
• acts irritable in the early afternoon
• falls asleep easily during the day
• has a sudden drop in grades
• sleeps for very long periods on the weekends
A lack of sleep can often be confused with attention -
deficit/hyperactivity disorder (ADHD). Some young people are thought
to have ADHD when in reality they are having a problem with their
sleep. Both of these problems share many of the same signs. The most
common signs of a sleep problem that are shared by ADHD include the
following:
• trouble concentrating
• mood swings
• hyperactivity
• nervousness
• aggressive behavior
You should often remind your teen to never drive when feeling tired.
Crashes related to drowsy driving take the lives of more than 1,550
people every year. These crashes are most often caused by young
people under the age of 25.
Their lifestyle choices make them more likely to be driving when they
are sleepy. Be prepared to offer other options if you expect that your
teen may be too tired to drive. A family member, a trusted friend, or
even a taxi can provide a much safer ride for a sleepy teen.
Parents also need to help teens make wise choices about their time.
Check up on your teen ’ s schoolwork load. Help your teen balance the
demands of school, work, clubs and sports, family, and friends. Decide
what is most important, and help him or her choose what may need to
be eliminated. Teens who work should try to limit their work hours on
school nights. They can put in longer hours on weekends to earn the
money they want or need.
Try to help your teen have a proper view of sleep. Sleep is not
something to fight off or try to avoid. Sleep greatly benefits teens who
make it a priority. They feel more alert and have more energy. They
think more clearly and make better decisions. They will be happier and
enjoy life more. There are simply too many benefits of good sleep for a
teen to miss out on them.


VII. HELP FOR BETTER SLEEP
It can be hard to determine the cause of a teen ’ s sleep problems. Talk
with a family doctor if these problems with sleep continue for more
than a couple weeks. A doctor or a counselor can help teens find ways
to deal with any stress that may be causing them to have a hard time
sleeping.
They may need to see a sleep specialist if poor sleep continues to
affect their daily lives. A sleep specialist has the expertise to find the
source of sleep problems in teens. He also knows what is needed to
help teens begin to get the sleep that they need.
Most teens will sleep much better if they simply develop the habits of
good sleep hygiene. Sleep hygiene consists of basic tips that help you
develop a pattern of healthy sleep. See the Resources section of this
site to find out how anyone can start down the path to better sleep.
Because teens are in a stage of life that is very unique, the tips listed
below are even more important for them:
1. Parents should create a calm atmosphere in the home at bedtime.
2. Teens should have a regular, relaxing routine just before bedtime.
They often have busy, hectic schedules. They need a chance to unwind
at night.
3. To help them relax, teens should avoid activities that will excite
their senses late in the evening. They should find another time for
computer games, action movies, intense reading or heavy studying.
4. They should not have anything with caffeine (including soda and
chocolate) after 4:00 p.m.
5. They should also avoid smoking and drinking. Along with hurting
their health, nicotine and alcohol will disturb their sleep.
6. A regular exercise routine and a healthy diet will help them sleep
better at night.
7. Keep the lights dim in the evening. Open the curtains or blinds to let
in bright light in the morning. This helps keep their body clocks set at
the right time.
8. If they must take a nap, they should keep it to under an hour.
9. It can be hard for teens to get enough sleep during the week. They
may need to wake up later on weekends. But they should not wake up
more than two hours later than the time when they normally rise on a
weekday. Sleeping in longer than that will severely disrupt a teen ’ s
body clock. This will make it even harder to wake up on time when
Monday morning arrives.

The need for sleep

Although we are not yet sure of all the benefits sleep brings, several points are clear.

 

1) REM sleep is essential for emotional health. Dreaming has the function of ridding the emotional centres of the brain of unfulfilled emotional arousal from the previous day, thus leaving us more able to cope well with the next day's emotionally arousing incidents.

 

When we don't get enough REM sleep, we can often feel a bit 'hyperactive'. REM is suppressed by alcohol - you may have noticed the effect of being a bit 'wound up' the day after a heavy night's drinking. This is due, in part at least, to the fact that you have not dreamed enough. You can imagine what happens if we constantly under-dream. Click here for more information on dreaming. Anti-depressants also suppress REM sleep.

 

2) Slow wave sleep is essential for rejuvenation of physical processes. The exact ways in which this happens are as yet unclear, but we do know that the immune system benefits from a good night's sleep. A reduction in sleep of 2 hours per night has been shown to reduce the number of natural killer cells (disease fighters) by as much as 20%.

 

3) Extreme sleep deprivation can cause highly unpleasant and bizarre effects such as loss of balance, memory and even hallucinations. So we can see that a good night's sleep is not a luxury; it is an absolute necessity.

Why are sleep problems so common?

Sleep can be disrupted easily for many of us as it requires

progressive relaxation in order to take place. Therefore anything that

raises our adrenaline levels, or causes us to worry, can interfere with

the natural process of sleep. Some people seem to be able to 'switch off'

the day's worries and can sleep in any environment. For others, sleep

seems to be much more delicate.

 

Sleeping pills - a real 'Insomnia Cure'?

 

When you haven't slept for days, the thought of 'sweet oblivion' is

extremely attractive, and who can blame those of us who choose a fail-safe

option like a sleeping pill? In the long run however, they can lead to

more problems. Sleeping pills impair quality of sleep and often have other

side-effects such as anxiety and disorientation.

 

So what can be done about insomnia in the long-term?

 

When a person has chronic insomnia it is almost as if they have 'forgotten'

how to sleep properly, or that they have become

 

conditioned to responding to the sleep situation (i.e. bedtime) with anxiety

or irritation instead of relaxation. What often needs to happen in these

circumstances is a 're-training' of the mind and body in achieving the

state necessary for sleep to occur.

 

The difficulty with sleep is that the harder you try to sleep, the less

likely it is to happen. This means we need to approach it in a different

way. Rather than going directly for the goal, we need to 'set the scene'

so that natural sleep processes can take place by themselves.

How Much Sleep Is Enough?

Animal studies suggest that sleep is as vital as food for survival. Rats, for example, normally live 2–3 years, but they live only

5 weeks if they are deprived of REM sleep and only 2–3 weeks if they are deprived of all sleep stages—a timeframe similar to death due to starvation. But how much sleep do humans need? To help answer that question, scientists look at how much people sleep when unrestricted, the average amount of sleep among various age groups, and the amount of sleep that studies reveal is necessary to function at your best.

When healthy adults are given unlimited opportunity to sleep, they sleep on average between 8 and 8.5 hours a night. But sleep needs vary from person to person. Some people appear to need only about 7 hours to avoid problem sleepiness whereas others need 9 or more hours of sleep. Sleep needs also change throughout the lifecycle. Newborns sleep between 16 and 18 hours a day, and children in preschool sleep between 10 and 12 hours a day. School-aged children and adolescents need at least 9 hours of sleep a night.

The hormonal influences of puberty tend to shift adolescents’ biological clocks. As a result, teenagers are more likely to go to bed later than younger children and adults, and they tend to want to sleep later in the morning. This sleep–wake rhythm is contrary to the early-morning start times of many high schools and helps explain why most teenagers get an average of only 7–7.5 hours of sleep a night.

As people get older, the pattern of sleep also changes—especially the amount of time spent in the deep sleep stages. Children spend more time than adults in these sleep stages. This explains why children can sleep through loud noises and why they might not wake up when they are moved from the car to their beds. During adolescence, a big drop occurs in the amount of time spent in deep sleep, which is replaced by lighter, stage 2 sleep. Between young adulthood and midlife, the percentage of deep sleep falls again— from less than 20 percent to less than 5 percent, one study suggests— and is replaced with lighter sleep (stages 1 and 2). From midlife through late life, people’s sleep has more interruptions by wakefulness during the night. This disruption causes older persons to lose more and more of stages 1 and 2 non-REM sleep as well as REM sleep.

Many older people complain of difficulty falling asleep, early morn¬ing awakenings, frequent and long awakenings during the night, daytime sleepiness, and a lack of refreshing sleep. Many sleep problems, however, are not a natural aspect of sleep in the elderly. Because older people are more likely to have many illnesses that can disrupt sleep, their sleep complaints often may be due, in part, to illnesses or the medications used to treat them. In fact, one study found that the prevalence of sleep problems is very low in healthy older adults. Other causes of some of older adults’ sleep complaints are sleep apnea, restless legs syndrome, and other sleep disorders that become more common with age. Also, older people are more likely to have their sleep disrupted by the need to urinate during the night.

 

Some evidence shows that the biological clock shifts in older people, so they are more apt to go to sleep earlier at night and wake up earlier in the morning. No evidence indicates that older people can get by with less sleep than younger people.

 

Poor sleep in older people is linked to excessive daytime sleepiness, attention and mem¬ory problems, depressed mood, and overuse of sleeping pills.

 

Despite variations in sleep quantity and quality, both related to age and between individuals, studies suggest that the optimal amount of sleep needed to perform adequately, avoid a sleep debt, and not have problem sleepiness during the day is about 7–8 hours for adults and 9 or more hours for school-aged children and adolescents. Similar amounts seem to be necessary to avoid further increasing the risk of developing obesity, diabetes, or cardiovascular disorders.

 

Quality of sleep is as important as quantity. People whose sleep is frequently interrupted or cut short may not get enough of both non-REM sleep and REM sleep. Both types of sleep appear to be crucial for learning and memory—and perhaps for all the other restorative benefits of healthy sleep, including the growth and repair of cells.

Many people try to make up for lost sleep during the week by sleeping more on the weekends. But if you have lost too much sleep, sleeping in on the weekend does not completely erase your sleep debt. Certainly, sleeping more at the end of the week does not make up for the hampered performance you most likely had at the beginning of or during that week. Just 1 night of inadequate sleep can adversely affect your functioning and mood during at least the next day.

 

Daytime naps are another strategy some people use to make up for lost sleep during the night. Some evidence shows that short naps (up to an hour) can make up, at least partially, for the sleep missed on the previous night and improve alertness, mood, and work performance. But naps don’t substitute for a good night’s sleep. One study found that a daytime nap after a lack of sleep at night did not fully restore levels of blood sugar to the pattern seen with adequate nighttime sleep. If a nap lasts longer than 1 hour, you may have a hard time waking up fully. In addition, late afternoon naps can make falling asleep at night more difficult.

Do You Think You Have a Sleep Disorder?

At various points in our lives, all of us suffer from a lack of sleep thatcan be remedied by making sure we have the opportunity to getenough sleep. But, if you are spending enough time in bed and stillwake up tired or feel very sleepy during the day, you may have a sleepdisorder.

One of the best ways you can tell if you are getting enough goodquality sleep, and whether you have signs of a sleep disorder, is bykeeping a sleep diary, to record the quality and quantity of your sleep; your use of medications,alcohol, and caffeinated beverages; your exercise patterns; andhow sleepy you feel during the day. After a week or so, look overthis information to see how many hours of sleep or nighttime awakeningsthe night before are linked to your being tired the next day.

This information will give you a sense of how much uninterruptedsleep you need to avoid daytime sleepiness. You can also use thediary to see some of the patterns or practices that may keep youfrom getting a good night’s sleep.

 

You may have a sleep disorder and should see your doctor if yoursleep diary reveals any of the following:* You consistently take more than 30 minutes each night to fallasleep.

* You consistently awaken more than a few times or for long periods of time each night.

* You take frequent naps.

* You often feel sleepy during the day—especially if you fall asleep at inappropriate times during the day.

 

Your Sleeping Posture

Your sleeping posture can also have a very significant effect on how deep you sleep.

If you sleep on your back or on your side, you should be fine. However, if you sleep

on your front, or need to lie on your front to fall asleep; this could have some serious

repercussions on your sleep and your back!

Sleeping on your front puts unnecessary pressure on some of your vital organs, like

your stomach, liver, and intestines. You'll also put a lot of strain on your neck and

your back, which makes your sleep very un-restful, and often is a major cause of

back problems. Whenever you're sleeping in a position that puts unnecessary

pressure on your body, it makes it harder for you to sleep deeply.

How Sleep Apnea Manifests Insomnia

The clinical definition of a sleeping disorder is a disruptive pattern of sleep that may include difficulty in falling or staying

asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.

There are four basic categories that each sleeping disorder can be put into: insomnia, hypersomnia, sleep disruptive

disorders, and basic trouble with adhering to a normal sleep pattern. Some symptoms of having a sleeping disorder are:

difficulty in falling asleep, daytime drowsiness, loud snoring, fatigue, depression, anxiety and lower leg movements during

sleep.

Sleep apnea is a common disorder in which a person's breathing stops during sleep for 10 seconds or more, sometimes

more than 300 times a night.

There are two main types of sleep apnea. The first is Obstructive Sleep Apnea which may represent the stoppage of

breathing due to a mechanical blockage of the airway. The second is Central Sleep Apnea which appears to be related to a

malfunction of the brain's normal signal to breathe.

Some of the symptoms of sleep apnea may include restless sleep, loud and heavy snoring which is often interrupted by

silence and then gasps, falling asleep while driving or when the person is at work or at home while watching TV, morning

headaches, loss of energy, trouble concentrating, and mood or behavioral changes.

Snoring is usually associated with apnea. Snoring is defined as noisy breathing one occurs during sleep when the flow of air

through the airways is blocked or when the airways vibrate during breathing.

Several factors tend to make people snore: nasal congestion, being overweight, smoking, drinking alcohol before bedtime,

and sleeping on your back. Sleeping pills, painkillers and other drugs that cause drowsiness can also make snoring more

likely.

Because a person is not able to sleep well or not get good nights sleep, some doctors are now conducting research to see

how Apnea manifests insomnia since both interferes with the daytime functioning o f a person. Some causes which still

have to be confirmed are the certain medicines available in the market to treat such disorder; medical conditions, excess

stress, or poor sleep habits can all affect the quality of your sleep.

To check if a person has a sleeping disorder, a diagnosis is made by a physician specially trained in sleep medicine. After a

physical examination of the upper airway and an interview with lots of questions, if it the tests have determined that the

patient has a sleeping disorder, one will have to undergo a polysomnogram (sleep test). Most sleep centers and labs

monitor 16 different sleep parameters including EEG, EKG, eye movement, chin movement, air flow, chest effort, abdomen

effort, SaO2, snoring and leg movement. Each parameter serves to help the physician make a correct diagnosis.

Test are conducted in a sleep room much like a motel room. A technician will paste electrodes at certain points on your

head, face, body and legs. Those electrodes will be hooked to monitoring equipment that will record the entire night study.

Most patients do not experience anxiety or difficulty in going to sleep. The patients in most case are extremely sleepy and

will be asleep in just a few minutes.

Once a correct diagnosis has been made, the doctor may recommend a variety of treatments available for those that suffer

from sleep apnea, including medications, behavioral therapy, and, in extreme cases, surgery.

Although over-the-counter sleep aids may be helpful it is not advisable to use these products on a regular basis. These

sleep aids don't eliminate the problem but only provide temporary relief and may become less effective after a few days of

use.

Doctors however often recommend a prescription device called a continuous positive airway pressure (CPAP) device for

patients with sleep apnea. During sleep, the patient wears a mask that fits over the nose. The mask is attached to an air

compressor adjusted to blow enough air through the nose to keep the airway open. If a CPAP device doesn't help, then

surgery on the upper airway may be the last resort.

By developing good sleeping habits, one may be able to break the pattern of sleeplessness without needing other therapies.

Good habits include going to bed and waking up at a regular time, eliminating naps, and avoiding stimulation from exercise

or caffeine shortly before bedtime. Relaxation techniques and changes in diet can also help some people.

 

Reduce Worry/Anxiety

Perhaps you're someone whose mind is always busy. Do you think about the events of your day as you wind down for the evening? Do you worry about

your family, your job, your finances, and what tomorrow will bring?

Sometimes it's difficult to empty your mind of all these details long

enough to fall asleep. This can lead to tossing and turning as your mind fights

sleep.

There are several ways that you can reduce the worry about situations

and events in your life long enough to allow you to rest and fall asleep. The

key is finding a process that works for you. The goal is to clear your mind and consciously realize that tomorrow is the time to tackle problems and tonight is the time to sleep.

One technique you can try is the practice of writing down all your worries and concerns before you retire for the night. Keep a notebook available for just this purpose.

List in point form those things that you are worrying about. Make note of which of these items you can deal with tomorrow. Have a decisive plan of action for what you are going to accomplish tomorrow.

This will make you feel positive that tomorrow you will take care of certain items on your "worry list".

Make a separate list in your notebook that contains only those things in your life over which you have no control. Firmly tell yourself that these items are beyond your power.

Once you have completed your two lists it is time to close the notebook and repeat to yourself that you will not think of these worries until tomorrow.

If, during the night, you find yourself thinking about any of the items in either list make a mental note to catch yourself and sternly remind yourself that the covers of the notebook are closed and cannot be opened.

Another technique for keeping daily anxiety and worry out of your thoughts while you try to fall asleep is to keep a daily diary.

Make sure to include all your worries and fears in your diary along with the events of the day. The goal here is to actualize your feelings in writing so

that you can be free of them in the evening.

The act of physically writing is the key here to acknowledging that you are worried while at the same time giving yourself permission to rest and deal

with these feeling tomorrow.

You can reduce the effects that worry and stress can create for your

body by using some of the other methods for achieving relaxation described in this book.

You may want to consider a combination of soothing music and yoga to

clear your mind. Or perhaps reading quietly will keep your mind from

wandering back to the stressful thoughts you had during the day.

Once again, the goal here is to relax and prepare you for a night of restful sleep.

 

The Interrelationship of Depression and Insomnia

Insomnia is a sleeping disorder characterized by any of the following: a) light, interrupted sleep that one is still tired upon

waking up, b) not being able to sleep, even if fatigued, c) lack of sleeping hours.

Insomnia can be classified into three types based on the length of time it affects an individual.

Transient insomnia lasts only a few days and is usually due to changes in living or working conditions, which may be minor

or traumatic.

Short-term insomnia, or acute transient insomnia, lasts for less than three weeks and has similar causes as transient

insomnia.

Chronic insomnia, on the other hand, is more complex. This condition is characterized by one of the following: a) light,

interrupted sleep that one is still tired upon waking up, b) not being able to sleep, even if fatigued, c) lack of sleeping

hours.

Based on the causes, chronic insomnia may be considered as primary or secondary:

* Primary chronic insomnia - when the insomnia is not caused by any physical or mental imbalance.

* Secondary chronic insomnia - may be caused by physical and mental conditions, such as depression, or emotional and

psychiatric disorders.

Since insomnia is just a symptom of an underlying disease or an imbalance, evaluating the cause of insomnia is very

important before prescribing any medication.

Depression is the most common cause of chronic insomnia, especially in the elderly.

A study shows that depressed elderly patients, if they suffer from insomnia, have a tendency to be depressed for over a

year.

Another study shows that even without a history of depression, if an elderly patient suffers from insomnia, they have a high

risk of being depressed. This is usually observed in women.

It has been proven that insomnia can affect ones' lifestyle negatively. Once this happens, the person starts to worry.

Worrying, then causes depression.

Depression is an emotional condition characterized by sadness or misery. Although many have experienced this at one

time, clinical depression is a mood disorder characterized by feelings of sadness, anger or frustration affect daily life for an

extended period of time.

Another interesting relationship between depression and disrupted sleep is that some medications used for depression can

cause insomnia. This is because these medications are used to make the patient more energetic, that at times, these make

the patient anxious.

The new anti-depressants that have stimulant effects include Prozac, Paxil, Zoloft and other serotonin-reuptake inhibitors.

Serotonin-reuptake inhibitors are substances that prevent the reabsortion of substances in the kidney. During the

biological elimination process of substances taking place in the kidney, some substances are reabsorbed in the kidneys,

thus, prolonging the effect of such substances.

With the presence of serotonin-reuptake inhibitors, serotonin is not reabsorbed and is continued to be eliminated from the

body.

Serotonin is an important monoamine neurotransmitter that plays a large role in depression, anxiety and bipolar disorders.

Some serotonin is converted by the pineal gland, the pea-sized gland at the center of the brain, into melatonin. Melatonin

is a hormone that helps regulate the sleeping and waking cycles.

In addition to the prescribed medications to treat insomnia, a patient may also practice the following procedures to combat

insomnia.

* Control exposure to caffeine, alcohol and nicotine.

These three substances are known to disrupt one's normal sleeping patterns.

* Maintain regular sleeping time and waking time.

This would help in maintaining the circadian rhythm thus minimizing the effects of fatigue caused y insomnia.

* Regular exercise is good for the body but this shouldn't be done late in the afternoon or early in the evening.

This is because exercise tends to start-up the body. If the body has gained more energy by the end of the day, this can

prevent one from being able to sleep at night.

* Go to be only when about to sleep. Reading or watching TV in bed is discouraged or to be avoided.

When the mind is conditioned that the bed is for sleeping, once one goes to bed, he or she can readily get some sleep.

* Eat meals regularly.

Meal intake affects biological activities due to increased blood blow to the stomach.

These pointers may be helpful in managing conditions associated with insomnia. Still, some situations require sleeppromoting

medications prescribed by a medical specialist.

 

Reduce Nighttime/Evening Stimulation

The more relaxed you are before you begin your nighttime routine the more successful you will be. An hour before going to bed it’s a good idea to reduce any type of external stimulation that could be causing your mind and body to remain overly alert.

Avoid watching television since watching television keeps your senses active.

If you find yourself unable or reluctant to give up that last hour of television try to choose programming that is more relaxing rather than violent and action filled.

Never watch television in your bedroom. Your mind and body need to separate the event of sleeping from the action of watching television.

Do not exercise two to three hours before bed. This was discussed and stressed in a previous chapter and bears mentioning again. Exercise will

increase your blood flow and heart rate, thus awakening your mind and body.

This is the opposite of what you are trying to accomplish. Reserve exercise for the earlier part of the day to ensure that you get the most out of your physical routine.

Try to avoid going to bed immediately after you have been out for the evening. Your mind will be stimulated from outside events and you may find it difficult to relax sufficiently enough to complete your nighttime routine.

As you work through the remedies in this book to reach your goal of healthy sleeping you may find it necessary to adjust your evening hours so that you are returning home with plenty of time to complete the bedtime routine you have designed for yourself.

Light reading may be included in your nighttime routine, especially if you find that reading makes you drowsy. Avoid reading anything too stimulating, such as work-related material or text books.

This will be a personal preference and over time you will discover what catapults your mind into a state of relaxation and what increases your thinking activity.

Make note that you don't want to fall asleep in bed with the light on. This will likely cause you to waken at some point during the night, effectively sabotaging your efforts to establish your sleep routine.

The goal of this chapter is to find an equal balance in your life between relaxation and stimulation.

The easier and faster that you can relax in the evening the more

successful you will be when it comes to falling asleep naturally.

 

Diet

What you eat during the day and evening can affect your sleeping patterns. If your diet consists of a high amount of processed foods you may want to try eating more wholesome products.

You may want to eliminate, reduce, or substitute the amount of sugars, fats, and preservatives from your daily intake of food. This may benefit your ability to fall asleep at night as well as improve your general health.

Eat a well balanced diet by following the recommended daily food

allowance.

Make sure you are meeting the daily requirements for fresh fruits and

vegetables. Eat complex carbohydrates and choose protein that is low in fat.

You can also choose healthy meat substitutes, such at tofu and

vegetarian burgers.

Become aware of any food allergies that you have and try to avoid them. If your body is allergic to certain foods it may affect the way you think and

feel.

This could be a contributing factor to your sleep problem. Some

common food allergies that are known to contribute to insomnia are corn, dairy

products, wheat, and chocolate.

Try to schedule your last evening meal at least four hours before bed.

Eat a healthy, well balanced meal. Try not to overeat as this may cause you to

become tired after your meal.

You want to avoid feeling tired or napping in the early evening hours as this will greatly hinder your ability to fall asleep at bedtime. As well, try to

eat enough so that you are not hungry later and find yourself reaching for foods

that are high in fat or sugars.

If you find that you are hungry before bed you may find that a small

snack an hour or two before bedtime will help. Avoid foods that are high in

protein, fats, and sugars.

You should also avoid foods that are too heavy or spicy. Try a bit of

cereal and milk or one serving of low-fat yogurt. The key idea is to provide

your body with a bit of nourishment to avoid hunger pangs and not overindulge in an evening snack.

The goal is to reduce your hunger and allow your body to rest and relax.

Make sure that you drink enough water during the day. Studies show

that your daily recommended water intake should be around 8 glasses, or 2

liters.

If your body is well hydrated it won't signal you to wake up during the

night. Try to avoid drinking water or other liquids one hour before bed if the

need to urinate wakes you up during the night.

The healthier you eat the more balanced you will feel both physically

and emotionally.

The target here is to get you to sleep regularly and deeply without

waking during the night.

Insomnia and sleep disorders

Insomnia and sleep disorders

Avoid Stimulants

Along with external stimulants there are several internal stimulants that

you should try to avoid. The following foods and beverages contain caffeine,

sugars, and chemicals that may affect the way you relax, think, and feel. This

does not mean
span>body reacts to sugar much as it does to caffeine. It stimulates your body and mind for a short period of time (chemical reaction needed here). Try to avoid chocolate in any form at least two to three hours before bed.

Soda Drinks contain huge amounts of sugar and colas have the added impact of caffeine. The carbonation of pop drinks can cause, bloating and stomach gas which can create discomfort. Try to eliminate soda

beverages from your evening diet.

• Alcoholic beverages should be avoided before bed. Alcohol may make you drowsy and cause you to fall asleep easily. However, you may find yourself waking during the night feeling dehydrated and have difficulty falling asleep again. Although an evening glass of wine may relax you, it is not something you want to become dependent upon as a sleep aid. This could lead to a reliance on alcohol to signal your body that it is time for sleep, thus leading to addiction.

• Smoking can signal your body to wake during the night as your body's need for nicotine increases toward the morning hours. If at all possible try to reduce the amount you smoke before bed. Your goal is not only to fall asleep naturally, but also to remain asleep for the entire night.

Insomnia and sleep disorders
Insomnia and sleep disorders

Breathing and Relaxation Techniques

There are many breathing and relaxation techniques that you can learn

to use to promote relaxation and relieve stress. The deeper and slower that

you breathe the more relaxed and sedated you will become.

Sleeping with the window open will help the air to circulate in your

bedroom and fill your lungs with fresh air. Relaxation techniques will help your

body to wind down and prepare for the sleep cycle.

Try this breathing technique when you first get into bed:

Take a deep breath.

Breathe in through your nose and visualize the air moving down to

your stomach.

As you breathe in again silently count to four.

Purse your lips as you exhale slowly.

This time count silently to eight.

Repeat this process six to ten times.

The results of this breathing technique are immediate. You will feel

your shoulders and arms relaxing. Your chest will feel less constricted and you

will feel less stress and tension.

Practice this breathing technique on a daily basis so that it becomes a

natural routine for you and helps to induce natural sleep.

As well as using breathing techniques to encourage natural sleep you

can try several relaxation exercises. The goal is to relax your mind and let

your body unwind and surrender to sleep.

Try the following relaxation exercise before you get into bed:

Lay on your back on the floor with your feet slightly apart, your hands by your sides, and your palms turned upward.

Close your eyes and concentrate on every part of your body.

Begin at the top of your head and work your way down to your toes.

Start by feeling your forehead tense, then your eyes, face, and jaw.

Tense and release each muscle group, such as your shoulders and neck.

Give attention to each area of your body from the top of your head, down through the trunk of your body, down along your legs, and ending at the tip of your toes.

Stay in this relaxed condition for a few minutes. Concentrate on your breathing and let all worry and stress dissipate from your mind and body. Make sure that your breathing comes from deep in your stomach and flows slowly and evenly.

Stretch slowly before standing.

The above exercise will tell your body and mind that it is okay to settle

down, leaving behind thoughts of worry, fear, and stress.

There are many more techniques and exercises available to promote

deep breathing and relaxation. You will have to find what method works best

for you.

Your goal is to recognize that deep breathing and concentrated

relaxation are tools available for you to achieve natural sleep.

 

Room Conditions

After establishing a consistent bedtime routine it is important to create a comfortable and relaxed atmosphere in your bedroom. The more cozy and harmonic your bedroom is the more relaxed you will feel.

Your goal is to promote a calming and restive atmosphere. This can be achieved by creating a bedroom environment that is not only appealing to you but also functions without interruptions or annoying irritations.

Ensure that the room temperature is set according your preference. Ideally your room should be on the cooler side; however you should experiment with your own comfort level.

You don't want to wake during the night either too hot or too cold and then find yourself wide awake once again. Sleep experts say that the ideal room temperature is 65 to 70 degrees F.

If at all possible try to sleep with the window open, however slightly. This will allow for proper room ventilation. Adequate air current is necessary for you to breathe in circulating air. This will aid your body in breathing deeply and correctly.

You may be sensitive to noises around you and outside of the bedroom.

If this is the case and you find that noise is disturbing or interrupting your sleep you may want to consider purchasing ear plugs.

Ear plugs may take a little getting used to, however there are plugs on the market that are specifically designed to be comfortable and unobtrusive to your sleep. Take time to try what works best for you.

If you find ear plugs to be too uncomfortable you may want to use a

"white noise" machine, such as a fan. "White noise" from the fan is used to

over-ride or mask other sounds that may be disturbing to your sleep, such as

traffic and voices.

Ideally your bedroom should be as dark as possible so that you

experience the daytime/nighttime cycle. Light may disrupt your normal

circadian rhythm and signal your body that it is time to wake up.

If you find it difficult to fall asleep in a room that is infused with too

much light, try purchasing an eye mask. There are eye masks on the market that will be comfortable to wear as well as effectively block out any interfering

light.

If you find an eye mask to be too uncomfortable try hanging thick

curtains or install blinds.

If you find yourself listening to the sound of a ticking clock you may

want to remove the clock from your bedroom and replace it with a digital

clock.

If you find yourself constantly looking at the time to see how many hours

you have left to sleep you may want to turn the digital clock to the wall.

Knowing that time is passing will only increase your anxiety and stress about

not sleeping.

Make sure that your room has no stimulation to lure you from sleep.

This includes the television, computer, stereo equipment. You want to ensure that your bedroom is only used for sleeping and sex.

If you have a CD player in the bedroom make sure that you only use if

for playing relaxing music or sleep inducing CDs.

If you find that your room is too dry you may want to purchase a

humidifier, especially in the winter months.

Wear comfortable, loose clothing. The more constrained or

uncomfortable you are the more likely you are to wake up during the night.

The goal of this chapter is to encourage to you find the ideal sleep

conditions for you personal preferences. You may have to experiment and try a

variety of techniques to find what works best for you.