GRUMPY, SNAPPY AND EXHAUSTED by day?
Suffering from sleepless nights? Can’t get to sleep? Disturbed wakeful sleep? Wake up far too early – and still feel tired. You are not alone!
While about 40 million Americans suffer from and inability to get a good night’s sleep at some time in their lives, it is perfectly normal to have the occasional restless night. Some people panic, and lie awake fretting – but for others, the quiet time for themselves, in a warm cosy bed, can be a delight.
But if the lack of sleep is affecting your life – then it requires further attention. And the first thing to do is figure out, why you aren't getting the sleep you should be
Just as there are many causes for lack of sleep, so there are many ways to deal with it. The difficulty lies in finding what works for you.
We have listed a series of questions – the answers you give will direct you to successful ways to sort out your sleeping and get the night’s sleep you need.
Feeling cluttered, disorganized or uncomfortable in your bedroom can really hinder your sleep.
Although you are asleep and you may not think you notice your bedroom, it does make a difference to your quality of sleep
Setting up your bedroom as a place you want to go at night is important. It may sound like a lot of money for no particular gain, but feeling positive about where you sleep is very important.
Having a bedroom that promotes sleep means:
Having your brain working overdrive from too much stimulation or energy before bed is an easy way to fall into sleeplessness
Your brain gets ready for sleep throughout the whole day, but night time is very important. The conditions inside and outside of our heads needs to be conducive to sleep , otherwise it wont happen
Stimulants and over excitement should be avoided at least 2 hours before bed time.
These things do affect the length and quality of your sleep so it is important to pay attention to them
To treat the sleeplessness associated with stress means making lifestyle changes – you have to believe you are worth taking a little time over. If you are able to do this, your sleep will improve and your daytime efficiency will also improve.
It is also important that when we go to sleep we don't have things racing around in our mind. Although there are some things biologically that can help prevent ‘overthinking' at night, it is important to do what you can during the day
For example, if you are worried about a particular issue, try to deal with it that day if possible, rather than next day when you are thinking about it all night
The stress hormone, cortisol, is produced by your adrenal gland, close to your kidneys.
The adrenals respond to signals from the brain which involves neurotransmitters. These are chemicals produced by the brain to enable the nerve endings to interact with other nerve endings and so carry an action along the nerves to other organs on the body. When these are in disarray, so other hormones, like cortisol, are also affected.
When you are in danger the level of cortisol rises, and when the danger goes away the levels should fall. Unfortunately, in our busy, busy lives, the stress may continue, and the cortisol levels never really fall.
Sleep problems and depression have an intertwining relationship. Lack of sleep may make depression worse, and depression may make sleeping difficult. Yet research into sleep patterns are finding that sleep deprivation may be a treatment option for people with depression. This should be medically supervised to reduce the risk of making matters worse.
A random survey of 24,686 individuals in Japan were surveyed in the year 2000. They found that people who slept between 6-8 hours per night were less likely to be depressed. 
Other studies have looked at sleep deprivation as a way to help depressed patients. One study resulted in a 57.9% improvement in depression following total sleep deprivation – but partial sleep deprivation is better tolerated – and may be as effective. Oddly enough, done correctly, having less sleep can improve depression! 
Another study showed that people with endogenous depression (as opposed to neurotic depression) responded favourably to one night’s sleep deprivation. 
Research is on going. The actual quality of sleep is being measured – the cycles or REM (rapid eye movement) and Non Rem sleep are different in people with depression. It seems that the first period of non REM sleep shows the greatest specific deviation and in time, no doubt treatments to help depressed patients get better sleep will come of this research. 
However, if you are depressed you need to see your doctor and discuss sleeping issues with him. A change in medication may be advised.
If you are taking prescribed medication and you can’t sleep discuss it with your doctor. It is more likely to be the underlying illness that is keeping you awake.
If you take vitamins or over the counter remedies, also see your doctor. Some of them may be helpful, but others- even popular ones like St John’s Wort, can have very serious side effects and it also reacts with many other medications you may be taking. But in the right circumstances St John’s Wort can help you get to sleep especially if you are depressed.  
People suffering for restless syndrome (RLS) have an almost irresistible urge to move their legs – less often arms or torso. This may be accompanied by an unpleasant feeling in the legs. It can be difficult to fall asleep and may people are woken up by repetitive jerky movements.
Between 4% and 15% of adults may be affected in the west, and RLS is associated with many immune conditions. These include Parkinson’s, Crohn’s Disease, multiple sclerosis, diabetes, Alzheimer’s and depression.  
But there are some simple things you can do to alleviate the symptoms of RLS
Mild exercise in the evening or late afternoon may help – but not too close to bedtime. Some people find a hot shower beneficial – or a relaxing bath. Also getting up for a short while and doing something you really feel involved in if you just can’t get to sleep.
If you have medicines for restless leg syndrome– make sure you take them just BEFORE the usual time of onset of symptoms. Also, it is worth going over your drug schedule with you doctor as some medications can make matters worse.
Alcohol, caffeine and nicotine all have an adverse affect on RLS. Cheese and tomatoes contain high quantities of tyramine, which can also make matters worse. Even antihistamines – a common remedy for sleeplessness, may do so.
This common disorder happens when your breathing passage is partly or completely blocked while you are asleep. It can happen over 30 times an hour and last from a few seconds to minutes. Typically, there is a loud snort as normal breathing resumes.
Because you are asleep, you may not realize you have it – it’s the long- suffering partner who realizes. However, because of the poor quality of sleep you are likely to feel tired in the day time. Sometimes this happens to children with very large tonsils.
A less common form of sleep apnea – central sleep apnea can happen when your brain doesn’t send the right signals to you breathing muscles. It is commoner in some medical conditions and when taking certain medicines.
Once diagnosed there are various treatments to be tried – and risks if untreated.
Our body has been finely tuned over the course of thousands of years to a schedule. The ‘day wake, night sleep' schedule is as much apart of us as any other.
The schedule also means that there is peak times for things during particular times. One of those is exercise. Exercising during the day helps use our energy and prepare us for sleep
Sleeping during the day can have the opposite affect of what our schedule wants.
If you are caught out of your regular wake/sleep schedule then it can take some time to get it right. But exercising regularly during the day and avoiding naps if possible is the best way to get your proper sleep schedule back
First – check it out with your doctor or physiotherapist. You may need medication, either to relieve the pain at bed time or simply to alter the time at which you are advised to take your medication.
Be aware that many analgesics require you to take food at the same time to avoid stomach ulcers and acid reflux. Or you may need a different mattress or pillow, or propping up to avoid reflux.
If you suffer from long standing pain, and have low Vitamin D levels, then Vitamin D will help you sleep better – but get your levels checked before taking supplements as too much can have adverse effects.  However, the actual dosage needed still needs to be clarified. 
GABA (Gamma-amino-butyric-Acid) is one of the brain neurotransmitters. Its effect is to calm the brain, making one feel relaxed and at peace. It would be so nice to just take GABA pills, but there is a problem. GABA cannot be absorbed from your bloodstream into the brain. It cannot cross the blood brain barrier.
To overcome this, doctors have prescribed benzodiazepines, which activate GABA receptors in the brain. Sadly, because of their addictive qualities, not only do they not work after a period of time, but it is difficult to stop taking them.
For more information on GABA and sleep – see our 3 part series here
Your own doctor has to be your first port of call. But he can only help you if you tell him exactly how your illness if affecting your sleep. Sounds obvious – but many people feel shy about “wasting” the busy doctors time with sleep problems. A simple example – but not uncommon – is the patient taking pills to reduce swelling. The pills make them urinate more often, but some patients take the pills in the evening – and then need to get up during the night.
Even more common is the worry that may go with illness. This can keep you awake, and discussing your fears with your doctor, or a referral to some kind of counselling may be very beneficial.
Pain, headaches and stomach problems need and deserve individual advice from your doctor – so write down exactly how you are not sleeping and then discuss it with your own doctor.
Doctors are a little reluctant to prescribe sleeping pills as the old standbys – benzodiazepines were addictive. However, antihistamines have been shown to relax you and may be a temporary solution. You can buy these over the counter, and are popular and safe in correct dosage, and may cause daytime drowsiness which is a driving hazard.  
We have a natural rhythm inside us which keeps very roughly to 24 hours – and daylight and night darkness make this feeling stronger. When we disrupt the natural order of things, then we may find it hard to sleep.
The lighting is also important, it has been shown that the bright “daylight” bulbs may upset our won inborn circadian rhythms, and especially blue light may make it harder to get to sleep
Night workers may benefit from cutting out blue light – but so far the use of goggles to do this has not been convincing – although there are people who find them helpful.
It is not uncommon to wake during the night. Maybe our ancestors need to check on things during the night. But frequent night time wakening can be exhausting.
Some people find a relaxation technique may help. But if you wake up at least 3 times a week, it’s been going on for longer than 30 days and it takes you longer than 30 minutes to get back to sleep, you may wish to consult your doctor in case there are other preventable causes.
There are many ways to help yourself get to sleep, but above all, don’t panic. You can try the methods here, you can probably think up some just for you, and when necessary, don’t be afraid to “bother” your doctor.
The Relationship Between Depression and Sleep Disturbances: A Japanese Nationwide General Population Survey.
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