30 Days to Better Sleep: Day 24 — Quiet Your Restless Legs

Resting at night depends on getting to sleep easily and staying asleep. Aside from insomnia, one of the sleep disorders that can make it difficult to fall asleep is restless legs syndrome (RLS). What is this condition and what are the major causes of RLS? Frequent bouts of restlessness in your legs may require treatment, so what are the options? Learning if you have RLS and finding an effective therapy will certainly help you to sleep better.

Restless legs syndrome, or RLS, is a commonly experienced but infrequently discussed condition. It may affect up to 20% of adults. It typically involves an uncomfortable or disagreeable feeling in the legs that occurs at night while sitting or lying, with an urge to move that is relieved by movement. The feeling may be described as a restlessness, an electrical sensation, like bugs are crawling under the skin, or even as a deep ache. It often affects the legs, but may affect the arms or any part of the body. Though it frequently occurs at night or in the evening, it may occur during the day, especially during prolonged sitting like on a flight or long car ride. As the name "restless legs syndrome" does not always characterize the symptoms completely, it has been more recently referred to as Willis-Ekbom disease, acknowledging the original doctors who described it.

No matter what you call it, RLS can really impact your ability to sleep. If you feel like bugs are crawling under your skin, and you have to constantly shift your legs so that you do not have the sensation, you can imagine that this might make it tough to relax and sleep. Many people who suffer from the condition have to get up and walk around to make the symptoms subside. This will delay sleep onset, and may contribute to feelings of insomnia. In order to understand how to relieve this, it is important to consider the major causes.

Restless legs syndrome may be primary or idiopathic. This means that it is not due to another known medical cause or that the underlying cause is simply unknown. For the vast majority of people, this is the best description of why RLS is occurring. There are, however, some recognized causes of RLS that can be reversed. The known causes of RLS include:

• Iron Deficiency

• End-stage Kidney Disease

• Diabetes

• Multiple Sclerosis

• Parkinson's Disease

• Pregnancy

• Rheumatic Disease

• Varicose Veins

Aside from these major causes, there are other conditions that seem to be associated with RLS. Obesity is by far the most common. Others include hypothyroidism, high blood pressure, and heart disease. Problems with the nervous system can contribute such as peripheral neuropathy, lumbosacral radiculopathy, or spinal stenosis. Diet can also contribute, including vitamin deficiencies, excessive caffeine intake, and low blood sugar (typically among diabetics on medications).

How do you know if you have RLS? The diagnosis is based only on symptoms. There is no testing required. Movement of the legs during sleep can be captured with a sleep study. These periodic limb movements of sleep (PLMS) are often associated with RLS. These are not, however, diagnostic of RLS. Restless legs syndrome is about the sensation, not the movement. Someone can have PLMS without having any symptoms of RLS, and thus would not be diagnosed with RLS. This is because PLMS may result from other conditions as well, including sleep apnea. If you do not have symptoms of RLS, even with PLMS on a sleep study, you do not need evaluation or treatment of RLS. It is sufficient for a sleep doctor to determine if you have RLS based solely on a proper history.

Once it is determined that you have RLS, it is often useful to check an iron level in the blood called ferritin. If this is low, oral iron supplementation may be recommended. If there is another contributing cause, this should be treated as appropriate. Residual symptoms can be treated with multiple effective medications.

If you have restless or uncomfortable feelings that disrupt your ability to fall asleep at night, you should see a sleep specialist. After a careful interview, you can discuss whether treatments for RLS may help quiet your restless legs and help you to sleep better.

30 Days to Better Sleep: Day 23 — Snoring and Sleepiness Equals Sleep Apnea

In reviewing the articles in this blog series, you may have become convinced that the only thing that affects sleep is not sleeping as part of insomnia. However, there are many other sleep disorders that can contribute to difficulty sleeping and waking refreshed. One of the major contributors to excessive sleepiness during the day is trouble breathing at night, best characterized by sleep apnea.

Sleep apnea occurs when the upper airway collapses during sleep. Tissues in the airway, from the nose past the soft palate to the base of the tongue, may obstruct the flow of air. When this occurs, this obstruction may be partial (hypopnea) or complete (apnea). It may be worsened by lying on one's back or during REM sleep when the body's muscles are actively paralyzed, including the muscles lining the airway. This soft, flexible tube is thus able to collapse and disrupt breathing. These events may occur as few as 5 times per hour or as many as hundred of times per night.

It may not matter much that the tissues at the back of the nose and mouth collapse during sleep. It wouldn't, that is, if our brain didn't recognize the problem. These disruptions to breathing trigger a panicked response from the brain. A burst of cortisol races through the body, while blood oxygen levels drop heart rate spikes, and sleep is briefly disrupted to restore breathing. This brief arousal is transient, lasting only seconds, but it shifts the brain from deeper stages of sleep to lighter ones, and often fully to wakefulness. Sleep becomes fragmented and the restorative properties diminish.

As a result, people with sleep apnea do not feel refreshed when they wake in the morning. Quite the contrary, they may even feel worse after sleeping. Whatever good is to come from sleep is lost. Upon awakening, there may be morning headaches and a strong desire to return to bed (sleep inertia). Later in the day, someone with sleep apnea is plagued by excessive daytime sleepiness; a "mental fog" with poor concentration, attention, and short-term memory; and mood issues including depression and irritability. There are serious health consequences to this fragmented sleep, including hypertension, diabetes, high cholesterol, memory loss, stroke, heart attack, and sudden death. This is a serious business, but it doesn't have to be.

How do you know if you have sleep apnea? People who snore at night have an airway that is narrow with the turbulent airflow causing a vibration that is heard as snoring. When this air stops flowing, apnea occurs. A careful observer may note pauses in breathing, lasting more than 10 seconds, followed by a sudden snort or gasp and return to snoring. When experienced, someone with apnea may wake up gasping or choking. (Incidentally, children should never snore and they often have undiagnosed or misdiagnosed sleep apnea with hyperactivity, attention problems, and growth restriction.) In adults, this condition can run in families due to upper airway anatomy and facial structure. It is worsened by weight gain, alcohol use, and smoking. In women, menopause may signal a time when sleep apnea worsens or first becomes evident. In anyone who is predisposed, aging and the associated loss of muscle tone can also exacerbate the condition.

Fortunately, there are effective treatment options for sleep apnea, including the preferred therapy called continuous positive airway pressure (CPAP). It works by maintaining the airway open with a constant flow of air. Though there can be initial hurdles, once these are overcome, CPAP can make a world of difference. There are no major side effects, and it can leave you sleeping and functioning a lot better.

If you snore at night and suffer from excessive daytime sleepiness (with a score higher than 10 on the Epworth sleepiness scale), you should seek evaluation for possible sleep apnea. If you have witnessed pauses in your breathing and are too sleepy, you almost certainly have sleep apnea. Treatment can be highly effective, so do yourself a favor and get checked out by a sleep doctor. Curing your sleep apnea is most certainly a major way to sleep better.

30 Days to Better Sleep: Day 22 — Address Underlying Mood Disorders Including Anxiety and Depression

Sleep walks hand in hand with mood. Anyone who has tried to go to bed upset knows that time is spent tossing and turning instead of sleeping. It is good advice to not go to bed angry, but what about other negative feelings? Mood problems such as anxiety and depression can severely affect sleep. Consider how addressing these psychiatric conditions may help you to sleep better.

In order to sleep, we have to ensure that certain conditions are meant. It is a rich tapestry with the integration of distinctive elements. Some of these are physical; we have to have been awake long enough to feel sleepy, for instance. Some of these are behavioral; we have to go to a place where we will be comfortable to sleep, typically our bedroom. Other conditions imperative to sleep depend on our thoughts or moods, sometimes referred to as the cognitive element of sleep. Interplay exists between all of these factors, and mood is particularly powerful.

If we are in a state of stress, we are unlikely to fall asleep easily. This is protective. If we have witnessed something that we find emotionally distressing, the resulting anxiety provokes us to stay awake to ensure our personal safety. Once the anxiety fades without further being incited, our state of arousal remits and we can rest. Psychiatric problems that lead to persistent disturbances in our moods, such as anxiety or depressive disorders, can also lead to chronic difficulties sleeping. In fact, these disorders can change the very structure of sleep.

People with depression often suffer from early-morning awakenings. Rather than waking with an alarm clock, people with depression may wake several hours before intending to. Depressed people also have a quicker onset of rapid eye movement (REM) sleep during the night.

In contrast, anxiety problems such as generalized anxiety disorder are commonly associated with insomnia that may impact the entire night. It takes longer to fall asleep. There is more wakefulness after sleep onset, with nighttime awakenings followed by prolonged periods awake. The total amount of sleep is reduced. In addition, people with anxiety may also experience early-morning awakenings, similar to what occurs in depression.

There appears to be a clear relationship between mood and sleep problems. Not only do mood problems often result in sleep disorders like insomnia, but people with insomnia are more likely to develop anxiety or depression. The combination increases the risk of suicide. People with sleep apnea often have depression as well.

These facts should lead us to a comprehensive conclusion: in order to sleep better at night, it may be necessary to address any coexistent mood disorders. When symptoms of anxiety or depression are present, these must be improved in order to fix the difficulty sleeping. By tackling each factor that contributes, it will be possible to improve your sleep so that you can face your day fully rested and feeling your best.

30 Days to Better Sleep: Day 21 — Restrict Your Time in Bed, Consolidate Your Sleep

Our beds can be a place of almost heavenly repose, where we retire at the end of a full day and restore our bodies and minds with sleep. This may not always be the case, however. When the bed becomes a place of turmoil and struggle, the night filled with wakeful anguish, it is not what it could be. If you struggle with insomnia, limiting the amount of time spent in bed may actually help you to sleep better.

Insomnia is characterized by difficulty falling or staying asleep. People with it will often spends hours lying awake in bed at night. Although some light sleep may occur, the desire for sound sleep is diminished by this extended time in bed. It is not uncommon for insomniacs to go to bed early or sleep in as they attempt to maximize the amount of sleep that they get. Unfortunately, this works against the natural systems that contribute to the ability to sleep.

There are two processes that work in combination to promote sleep. The first is the natural timing of sleep called the circadian rhythm. If you try to sleep at the wrong time, as may occur after jet lag, your struggle will increase. The other contribution is homeostatic sleep drive. This is the desire for sleep that builds the longer a person stays awake. This occurs due to the build up of a chemical within the brain called adenosine. By spending more time in bed, especially in light sleep, the sleep drive is diminished.

In order to consolidate your sleep, you should track your sleep patterns with a sleep log. Over 1 to 2 weeks of time, track your typical bedtime, wake time, and the number of hours spent sleeping. Then, to the best you can estimate, calculate your total sleep time. Let's take an example. If you crawl into bed at 10 PM, spend 1 hour falling asleep, spend 2 hours awake in the night, and get up at 6 AM, you would estimate that you got 5 hours of sleep. It is recommended that the nightly total sleep time be averaged over at least 1 week. This way you may have good nights and bad nights without skewing your average too significantly.

Once you have calculated the average amount of sleep that you are getting, you should arrange your bedtime and wake time to reflect these needs. Most people with insomnia will calculate that they are getting between 5 and 7 hours of sleep. There are certainly some who will estimate even less (or none). You should pick your average, but not less than 5 hours. Then consider what your preferred wake time is. If you want to get up at 6 AM and you estimate you are getting 5 hours of sleep based on your numbers, then you do some simple arithmetic. Subtract 5 hours from 6 AM and you have your new bedtime: 1 AM. The suggestion that this be taken as the new bedtime inevitably meets with stern resistance.

Why would sleep experts encourage you to spend even less time in bed when you are struggling to get enough sleep? If your sleep is fragmented, punctuated by awakenings and prolonged periods spent awake, how can you expect to sleep enough to function with less time in bed? Fortunately, you are not the first person to suffer from insomnia and experience and research demonstrates that sleep restriction is a highly effective treatment. In seeking out expertise in this matter, you have reached a point where your insomnia has negatively affected your life. It is time to take the action needed to set things right.

Restricting the time you spend in bed will consolidate the amount of sleep that you get. By staying up late, you will build up a stronger sleep drive. Therefore, when you crawl into bed, you will be even sleepier. So sleepy, in fact, that you will fall asleep more quickly. In addition, this desire for sleep will keep you asleep during the time that you are in bed. You will then wake up at your desired wake time. You must keep your commitment to the wake time. Set an alarm clock, two if you must, or have someone else wake you. If you have a rough night or two, ride it out: it will get better.

When you start to get reconnected with the feeling of sleepiness (and not fatigue), you may start to add additional time to your total sleep time by going to bed earlier. Do this slowly. You didn't develop insomnia overnight, so don't expect it to be fixed in a few nights. It is probably best to add back 15 minutes every 3 days. Do this until you reach your desired total sleep time. If you calculate your sleep needs, you may stop adding time at 7 or maybe 8 hours. Therefore, if you start at 5 hours, you will have moved your bedtime back sufficiently in about 3 weeks. The best part is that this effective treatment has none of the side effects common to sleeping pills!

If you suffer from insomnia, you can effectively set things right by restricting the time you spend awake in bed. You can consolidate your sleep with a tailored sleep or "time in bed" prescription based on your recent sleep needs. By slowly adding time in bed, you will find that you fall and stay asleep much easier. If you need additional guidance in this process, you can find a cognitive behavioral therapist for insomnia who can ease you through the changes. No matter how you go about it, you will be grateful that you took the initiative to sleep better.

30 Days to Better Sleep: Day 20 — Don’t Take Naps

What's the harm in taking a nap? If you have difficulty sleeping at night, you may do well to cut out napping during the day. How do you know if your nap is harming your ability to sleep?

There are plenty of people who can get by taking a nap during the day with no ill effects on that night's sleep. Unfortunately, there are others who will struggle falling asleep as a result. The ability to sleep is dependent on two factors: homeostatic sleep drive and circadian rhythm. Sleep drive builds throughout the day: the longer you stay awake, the stronger the desire to sleep. It is similar to hunger and the desire to eat: the longer you go without eating, the hungrier you become. If sleep overnight is a feast, naps during the day are snacks. By eating a snack, you will be less hungry for the feast. By taking a nap, there is a weaker desire and ability to fall asleep and stay asleep overnight.

Many people with insomnia will be unable to sleep during the day, including during naps. These individuals are "tired but wired," with complaints of fatigue, exhaustion, and diminished energy, but a notable inability to sleep during the day if given the opportunity. An insomniac will lie down to rest and spend the time awake. If sleep is obtained, even briefly, it can be very disruptive to sleep at night. There are others who will find it easy to fall asleep during the day, with little impact on the ability to sleep at night.

If you are getting an inadequate total number of hours of sleep at night, failing to meet your sleep needs, the difference may be partially made up with naps. As an example, if you need 7 hours of sleep and only get 6 hours, an hour long nap during the day may effectively make up the difference. When sleep is of poor quality due to sleep apnea, naps may also be a common occurrence. In addition, naps can be an important coping mechanism in conditions such as narcolepsy. Naps can also be very helpful to prevent or provide relief from drowsy driving.

There are societies in the world where naps are integrated into the daily schedule. This "siesta" time takes advantage of the natural lull in wakefulness that occurs in the early to mid-afternoon, just after lunch. Is it better to avoid naps altogether?

If you are struggling to sleep at night, especially if you have difficulty falling asleep, you should cut out naps during the day. This will increase your drive to sleep and make it easier to fall and stay asleep. If you have an underlying sleep disorder, or suspect you might, naps may occur commonly and may suggest a need for evaluation. Naps can be a wonderful, refreshing opportunity to take a break in the day, incorporated into lifestyles and societies around the world. However, for those who fight with insomnia and have difficulty sleeping at night, it may be time to discover a simple way to sleep better: don't take naps.

30 Days to Better Sleep: Day 19 — Instead of Trying to Sleep, Change the Focus to Rest

Have you ever really tried to fall asleep? The more effort that is attempted, the harder it is to doze off. Why is it hard to fall asleep when it becomes the focus of our attention? Consider what to do when you have difficulty falling asleep and why it can be helpful to change the focus to rest.

Insomnia is commonly characterized by difficulty falling or staying asleep. Whether this occurs at the start of the night, or after an overnight awakening, difficulty falling asleep may be worsened by an active mind. It can be helpful to change the focus: rather than striving and struggling to sleep, the focus should shift to obtaining rest.

We have a very peculiar ideal of sleep, and one that can be difficult to meet. Our expectation is that we will crawl into bed, fall asleep immediately, sleep soundly without awakening during the night, and immediately jump out of the bed in the morning feeling refreshed. Unfortunately, sleep is typically much more different than this, especially in the setting of insomnia.

It is normal to wake up in the night. If a loud noise didn't awaken us, we may find ourselves placed in harm's way. Though unconscious, we remain reactive to stimuli in our sleep environment. A mother quickly wakes to her crying infant, for example. In addition, we naturally wake during sleep, especially during transitions between sleep stages. As we get older, our ability to sleep uninterrupted during the night decreases. More time is spent in lighter stages of sleep and sleep may seem less refreshing.

Studies have shown that when someone is awakened from the lightest stage of sleep, called stage 1, 50% of people will say they were awake and 50% will say they were asleep. All of them are, in fact, asleep. This means that there can be a misperception about when sleep is occurring. Some people with insomnia will greatly underestimate the quantity of sleep obtained due to this misperception. If someone with insomnia has a sleep study, they may report that they didn't sleep a wink, but the objective data from the test may suggest otherwise. Therefore, light sleep in the night may occur and be perceived as wakefulness, and anxiety about not sleeping may not be fully justified.

The more our attention dwells on whether or not we are asleep, the less likely it is that we will be able to fall asleep. These thoughts are alerting. The constant checking of what state of consciousness we are in actually wakes us up. It leads to arousal and vigilance, two characteristics that undermine our ability to drift off to sleep. If we focus on sleeping, and put forth effort to do so, we will inevitably fail.

What if you set a different goal for the time spent in bed? Ideally, you would spend the night in the deepest, most refreshing stages of sleep. However, it is normal to spend time in lighter stages and even awake. This time is still restful to both the body and mind. It is also possible that time you believe to be spent awake is actually a light stage of sleep. The focus can then shift to obtaining rest, rather than striving to obtain sleep. You will never be able to force sleep to come, so give up the fight and let yourself rest. Quiet wakefulness can be a normal part of the night, and it does not need to be a source of aggravation. Learning to let go can be accomplished with a treatment called paradoxical intention.

If you find yourself struggling at night, trying with all your might to sleep, you should change your focus. By allowing your attention to shift elsewhere, you may find that you have a more enjoyable night and wake feeling more refreshed. Part of getting better sleep may be accepting rest as an acceptable alternative.

30 Days to Better Sleep: Day 18 — For a Racing Mind, Make a List

It can be hard to get to sleep when you have a lot of things on your mind. For people with insomnia, characterized by difficulty falling or staying asleep, this is a frequent occurrence. Difficulty sleeping may provoke anxiety, and one technique to ease a racing mind is to make a list.

Why does anxiety disrupt sleep? The time before falling asleep should be relaxing. If it becomes a source of anxiety or stress, it can be far more challenging to fall asleep. Anxiety, stress, worry, or tension will provoke alertness. In a state of anxiety, your mind is triggered to keep you safe. Part of this is maintaining vigilance to your environment and preventing inattentiveness or sleep. This has an evolutionary advantage: if you get drowsy with a lion on the prowl, you will soon become its dinner. Unfortunately, this works against us in modern life.

Many people with insomnia will complain that they try to fall asleep and cannot. It becomes a chore to relax and drift off to sleep. After crawling in bed, the mind of an insomniac may rev up. Scattered thoughts may come to mind, like a movie made up of rapidly changing but distinct images. The litany of worries and preoccupations that fill the day present themselves to be addressed. Anticipation for the next day's events may also become provocative. There may be associated feelings with these thoughts that themselves are disruptive and alerting.

Let's take an example. You are leaving on a European vacation early in the morning. You know that you need to get up at 4:30 AM to catch your flight, and you rushed readying things up to the point of crawling into bed. Now that you are settled under your covers, you are starting to review your preparations. "Did I pack the camera? I need to water the plants in the morning. The passport is in my bag. Do I have enough cash? I stopped the mail. Have I left enough time in the morning to make it to the airport? What is the weather going to be like? Where is my black coat? ... Why can't I get to sleep?" This may be an infrequent example, but the same can occur on a daily basis with different concerns coming to mind.

What is the best way to diffuse a racing mind? Although a simple solution, it actually can be very helpful to make a list. It is best to set aside some time in the afternoon or early evening, several hours from bedtime, to sit and write down the issues in your life that might lead to stress. These may include incomplete home or work tasks, family stress, health concerns, financial problems, and a variety of other stressors. Enumerate these concerns. By writing them down, you no longer have to devote mental energy to keeping track of them. As part of this, you may even write down action points, any ideas you have to reduce or eliminate the source of stress.

Why is making a list helpful? This process orders your thoughts. It helps you to recognize, organize, and articulate what is leading you to feel stressed. By supplementing this with an action plan, you will decrease your stress because you have identified ways to make this better. You no longer have to worry about remembering these things. If you can set aside time each day to review the list, you will have scheduled a time to address these concerns. Then, if the thoughts come to mind as you are trying to fall asleep, you simply tell yourself, "I have written this down on my list and I will address it tomorrow when I have my time to review it." You then disengage from the anxiety, not dwelling on the thought, and let it go.

When partnered with a relaxing period before bedtime, this list can be a powerful way to diffuse anxiety and turn off a racing mind. For those who struggle with insomnia, it may be just the thing to finally get to sleep.

30 Days to Better Sleep: Day 17 — Manage Your Stress with Relaxation Techniques

Stress can have a major impact on your ability to fall and stay asleep. Feelings of anxiety, worry, and tension can lead to insomnia. Sometimes the cause is obvious: a lost job or loved one, a big project at work, an examination, a divorce, a trauma, and so on. In other circumstances, the underlying trigger may be less evident. When stress undermines your ability to sleep, you may benefit from relaxation techniques. What is the best way to handle stress? Learn how to manage and relieve your stress with some specific recommendations to unwind.

In an anxious state, it can become impossible to sleep at night. There is an innate "fight or flight" response programmed into your nervous system. Therefore, when you are under conditions of perceived threat, you won't accidentally nod off and put yourself in harm's way. Although this protective mechanism has served humanity well when we lived in the wild, it can be disruptive in the modern world. The stressors of life may put us in a heightened state of arousal, leading to persistent difficulties sleeping at night.

People with insomnia seem to have a higher degree of arousal, which makes it easier to stay awake during the day but harder to sleep at night. When it is time to unwind and transition to sleep, insomniacs may find their minds racing and sleep difficult to obtain. It is important to preserve a buffer zone before going to sleep and wait until sleepiness comes before retiring to bed. As part of this transition period, there are a number of relaxation techniques that can prove to be helpful.

It should be acknowledged that the exact same activity may be relaxing to one person and stress-inducing to another. For example, reading is a pastime that many people find soothing before bed. However, someone who struggles with dyslexia may find reading to be very stressful. Therefore, it is best to individualize the relaxation techniques that you utilize. It can be helpful to brainstorm a list of activities that you find relaxing. To get you started, consider these possibilities:

• Take a warm bath or shower

• Listen to relaxing music

• Read a book or magazine

• Spend time praying or meditating

• Stretch from a lying position

• Breathe slowly in and out

• Write in a journal

• Practice yoga

• Knit, sew, or work on a craft project

• Relax your muscles

• Clean or organize your home

• Take a long walk

If tension and worry is taking a toll on your sleep, it can help to dial back the anxiety by engaging in targeted relaxation techniques. Reflect on what you personally find to be a source of relaxation. Even the act of generating a list of relaxing activities can put your mind at ease as you focus on things that make you calm and happy. By incorporating these pastimes into the hour before bed, you will more readily transition to sleep and sleep better through the night. For those with persistent anxiety, it can also be helpful to speak with a professional therapist to obtain stress relief recommendations.

30 Days to Better Sleep: Day 16 — Don’t Lie Awake in Bed at Night

This is it. In 30 days of lessons to improve your sleep, this is the one you print out and hang above your desk. This is the one you e-mail to your family and share among your social networks. This is the lesson that, once mastered, will guarantee you sleep better for the rest of your life. It is simple, common sense, and the heart of it all: Don't lie awake in bed at night.

Insomnia is difficulty falling or staying asleep or an adequate amount of sleep that is not refreshing, in the absence of another sleep disorder. It is characterized by feeling "tired but wired," a sense of fatigue or exhaustion with an inability to sleep, especially during daytime naps. It may run in families. It may be provoked by periods of stress, but it may simmer beneath the surface for years, waiting to raise its ugly head. Once begun, changes may occur that perpetuate the effects. No matter how it manifests, it nearly always includes lying awake in bed at night.

What happens when an insomniac lies awake at night in bed? This is time that is not spent sleeping, which is a source of endless aggravation. Inevitably, sleep becomes a focus of attention and a source of tension. Questions flood a racing mind: "Why can't I sleep? What is wrong with me? Why can't I turn off my mind?" Anxiety inevitably builds as concerns turn to the effects on the next day. When sleep is pursued, it becomes a struggle. Sleep is evasive, fleeting in pursuit. You cannot strive to sleep. You have to give up the struggle.

If you cannot fall asleep within 15 to 20 minutes, you should leave your bed. Move to another place where you can recline and engage in relaxing activities while waiting for sleepiness to come. These activities should not be stimulating or rewarding. Avoid computers and television, and instead choose to read a boring book or an old magazine. You may choose to stretch or breathe slowly, allowing any tension to dissipate. Only when you feel drowsy or sleepy - your eyelids getting heavy, lingering in closure - only then do you return to bed. You must only go to your bed when you feel sleepy and periods of wakefulness must be truncated.

What happens if we stay in bed while awake? We learn to associate our beds with wakefulness and perhaps even tension or anxiety. Those with insomnia must break a negative association with the bed: "That is the awful place where I struggle to sleep." Pavlov was famous for his dogs. He would ring a bell while feeding them, the food initially prompting salivation. In time, a bell alone, without food, would lead to salivation. This is a conditioned response. Similarly, those with insomnia may develop a negative association with the bed. This must be extinguished and in its place it is necessary to re-establish the relationship of bed with sleep.

Many people with insomnia will try to get as much sleep as they can manage. If difficulty falling or staying asleep starts to erode away the total amount of sleep a person gets, it is natural to extend the opportunity to sleep. Why not go to bed early or sleep in to catch up? If you spend hours awake in the night, it makes sense to try to balance this out by spending more time in bed. Unfortunately, this is the opposite of what should be done. Going to bed early will lead to more time spent awake before falling asleep as you will diminish your desire for sleep and disrupt your circadian rhythm. By staying in bed longer into the morning, you will spend some of this time sleeping, which will make it harder to fall asleep the next night for the same reasons. Sleep consolidation works by harnessing your ability to sleep, and lying awake in bed at night undermines it.

For those with insomnia, the cure you seek is entirely within your grasp: Don't lie awake in bed at night. There can be hurdles to mastering this simple advice, however. It is sometimes necessary to incorporate additional lessons to facilitate the change, including the management of thoughts, behaviors, attitudes, and emotions linked to sleep. It can be especially helpful to have a guide in this journey, such as a sleep doctor or a trained cognitive behavioral therapist who specializes in insomnia. You have the ability to reclaim your sleep; we can help.

30 Days to Better Sleep: Day 15 — Avoid Heartburn at Night

There are few things as miserable as waking with the discomfort of heartburn. As you make progress in sleeping better, one of the key milestones is avoiding heartburn at night.

Heartburn goes by many names: reflux, gastro-esophageal reflux disease, GERD, water brash, acid indigestion, or pyrosis. It all amounts to the same thing, however. The esophagus is a muscular tube that extends from the mouth to the stomach. At the connection between the esophagus and the stomach is a muscular ring called the lower esophageal sphincter (LES). This cincture is meant to close and keep the contents of the stomach from regurgitating back into the esophagus or mouth. When the lower esophageal sphincter becomes weak, or the acidity of the stomach excessive, heartburn occurs.

People who suffer heartburn can list the inciting culprits: coffee, tomato products, citrus, chocolate, fatty foods, peppermint, and alcohol. A glass of orange juice, a spicy dinner, a few pints of beer; these are the stuff of a night of indigestion. Many of these foods actually cause the lower esophageal sphincter to relax and become leaky. How can this be avoided? The most obvious solution is to not eat or drink these particular foods. It may also be especially important to avoid late meals. These may not be the only necessary remedies, however.

Believe it or not, there are actually sleep disorders that can contribute to heartburn and reflux. The most common contributor is obstructive sleep apnea. It may seem bizarre that a breathing problem can contribute to a condition that affects the stomach and esophagus, but these pipes are closely related.

The esophagus lies directly behind the windpipe or trachea. Sleep apnea is characterized by a collapse of the airway during sleep. This occurs in the muscular portion that is able to collapse, most often at the back of the throat. The effort to breathe will persist through this obstruction, with the brain prompting the diaphragm and respiratory muscles to continue working. When the lungs expand against a closed airway, a negative pressure is created. This negative pressure within the thorax can suck the contents of the stomach into the esophagus, resulting in reflux.

Therefore, it is imperative to treat sleep apnea. If you experience heartburn at night, this is a necessary consideration. In the context of loud snoring, pauses in breathing during sleep, and excessive daytime sleepiness, it is virtually diagnostic of sleep apnea. Interestingly, untreated heartburn may lead to a side effect with the mainstay therapy for sleep apnea called continuous positive airway pressure (CPAP) treatment. Some people have aerophagia, or air swallowing, that leads to belching, flatulence, or bloating. Aerophagia seems to occur due to weakness in the lower esophageal sphincter, allowing air to get into the stomach during treatment. This may improve with the use of medications to treat GERD (such as proton pump inhibitors), over-the-counter gas relief such as simethicone or Gas-X, or by raising the head of the bed by 30 degrees.

If you find heartburn disrupting your sleep at night, you may start by making some simple dietary changes and avoid large meals too close to bedtime. In the setting of other symptoms suggestive of sleep apnea, you should speak with your doctor. It is possible to sleep well at night, and this certainly should include avoiding unnecessary heartburn.

30 Days to Better Sleep: Day 14 — Decrease the Frequency of Trips to the Bathroom to Pee

There is nothing worse than having to wake up in the middle of the night to go to the bathroom. Once you get to sleep, the last thing you need is a full bladder waking you up. For some people, these awakenings may even evolve into difficulty falling back asleep, a symptom of insomnia. How can you decrease the number of trips to the bathroom to urinate in the night? Fortunately, there are a few changes that you can make that will help you to stay asleep and, if you do awaken, fall back asleep more easily.

First, it is uncommon for younger people to get up in the night to pee. Children may have enuresis, or bedwetting, but this is typically outgrown. There are also a number of effective behavioral treatments and even medications that can help. If your child is waking during the night to pee, it could be a sign of another medical condition or even a sleep disorder such as sleep apnea.

Later in life, our ability to concentrate urine overnight declines. As a result, bladders fill more quickly and compel trips to the bathroom. In particular, men who are middle aged or older may develop urinary frequency as part of benign prostate enlargement. When urination occurs during the night it is called nocturia. Nocturia may also be part of medical problems such as diabetes, chronic kidney disease, or heart failure. It may also frequently occur as a side effect of taking diuretic blood pressure medications - sometimes called "water pills" - including furosemine or Lasix.

Aside from the role of aging, these medical conditions, and the side effects of medications, there are some causes of nighttime urination that can be controlled. Drinking an excessive amount of water before going to bed will increase the likelihood of nighttime awakenings to pee. This is especially true if these liquids are consumed in the 4 to 6 hours before bedtime. Caffeine, which works as a stimulant, is also a mild diuretic that can increase urination. By reducing fluid intake before bed, you may decrease the trips to the bathroom in the night.

Finally, it is important to treat sleep apnea as this can also lead to nocturia. There are two major reasons for this. Sleep apnea leads to the fragmentation of sleep. Deeper stages of sleep are disrupted by the breathing disruption and the affected person spends more time in light sleep. In these lighter stages, there is more awareness of how full the bladder is. In addition, research suggests that sleep apnea itself triggers the release of hormones that increase urination at night.

If you do wake during the night to pee, you should try to minimize the amount of light that you expose yourself to during the night. By using a small nightlight, you may make it easier to fall back asleep. You should also limit your activities; make a quick trip to the bathroom and return promptly to bed. Don't wander around the house, get a snack or drink, or get distracted by other tasks.

If you find yourself getting up during the night to pee, there are certain changes that you can make to decrease the frequency and degree of waking. If you have sleep apnea or a medical condition, speaking with your doctor may provide some relief. By decreasing the frequency of trips to the bathroom to pee, you can sleep better.

30 Days to Better Sleep: Day 13 — Get Exercise at the Right Time

Exercise is alerting and revs up both the body and mind. If it is poorly timed, this may make it more difficult to fall asleep, leading to insomnia. Why does exercise disrupt sleep? When is the best time to exercise?

Exercise is an important part of a healthy lifestyle. You can keep yourself strong and in shape. It can improve your mood. It is a great way to maintain a healthy weight and avoid unwanted medical problems. Staying fit may also help you to sleep more soundly at night. The timing of this exercise may be important, however.

There are physical changes that occur during exercise. Your heart rate and breathing rate will increase. Your body temperature will rise. Hormones such as adrenaline will course through you. Your brain will become more alert. Some of these changes may have a negative effect on your sleep.

People with insomnia endure difficulty falling or staying asleep. They tend to be light sleepers. Some research suggests that their body temperature is slightly at higher at night. By partaking in an alerting activity that raises the body temperature, exercise may make it harder to fall asleep. Not everyone will be adversely affected by exercise at night, but for those who are susceptible, it may be necessary to choose a different time to exercise.

According to guidelines to improve sleep, it is recommended that exercise be avoided in the 4 hours preceding sleep. For most people, this may eliminate exercise in the evening hours. If you can fall and stay asleep easily, there may not be a reason to change the time that you exercise. However, if you struggle to sleep at night, it may be recommended to exercise in the morning. If you can go for a walk or run outside in the morning upon awakening, this will be a great way to start your day and it will be less likely to disrupt your sleep at night.

If you are seeking ways to sleep better at night and you have difficulties with insomnia, you might change the timing of your exercise regimen. By moving your exercise to the morning, you will avoid potential negative effects on your sleep at night and also be able to incorporate light exposure in the morning, another way to sleep better.

30 Days to Better Sleep: Day 12 — Stop Smoking and Start Sleeping

You know you should stop smoking. Perhaps it has even been a recent New Year's resolution. There are plenty of reasons to quit smoking, but could improving your sleep be one of them? How does smoking cigarettes affect sleep?

In the consideration of sleep, any products that contain nicotine can be lumped together: cigarettes, cigars, pipes, hookah, and so forth. Nicotine is the key ingredient. Nicotine is what, potentially, can disrupt your sleep. Just like caffeine, nicotine acts as a stimulant. Stimulants make it easy to stay awake and, conversely, hard to fall asleep. Unlike caffeine, the withdrawal effects of nicotine can also be problematic.

Studies have demonstrated the adverse effects of nicotine on sleep. People who smoke change the structure of their sleep. Sleep normally follow regular patterns. When comparing the sleep of smoker and non-smokers, clear differences become apparent. It takes longer for smokers to fall asleep. This is an increased sleep latency. In addition, those who smoke have decreased deep or slow-wave sleep. In its place, there is increased light sleep or wakefulness. In fact, smokers sleep less in general.

These disruptions may lead to increased difficulty staying or falling asleep, symptoms of insomnia. This problem is compounded by the withdrawal effects of nicotine. For heavy smokers, those with a greater degree of dependence on nicotine, sleep may become disturbed when withdrawal sets in. Awakenings in the night to have a cigarette can have a significant toll. Whether you smoke close to bedtime, or have a cigarette in the night, the nicotine may stimulate you to stay awake.

Smoking can also lead to inflammation in the airway, including the nose and throat, that might predispose to snoring. Studies have shown that smokers are at twice the risk of snoring. This may disrupt the sleep of both the smoker and others nearby.

What is the best way to quit smoking? The first step is to pick a time to quit smoking. Why not today? Alternatively, you may select a date that is significant for you: a birthday, an anniversary, a favored holiday. Honestly assess your own willingness to quit, your level of commitment to the enterprise. You should try to arrange support, even making a pact to quit with other smokers in your life. It may be helpful to use nicotine replacement therapy, including gum, patches, or even electronic cigarettes. You can obtain additional support, including medications to ease the transition, from your doctor.

You know that you should quit smoking, and if you are motivated to do so, you may also benefit your sleep. Do your health a favor: stop smoking and start sleeping.

30 Days to Better Sleep: Day 11 — Cut Out the Caffeine

Caffeine can be one of the great joys of life. No matter your preferred indulgence - coffee, espresso, cappuccino, tea, hot chocolate, soda pop, or energy drinks - it can give your energy and spirit a boost. But, unfortunately, it may also disrupt your sleep. For people who have difficulty falling or staying asleep, symptoms of insomnia, it may be time to cut out the caffeine. How does caffeine affect sleep?

Caffeine is a natural stimulant. It improves alertness and decreases sleepiness. How does this occur? Caffeine interferes with a chemical in the brain, or neurotransmitter, called adenosine. The longer a person stays awake, the more adenosine accumulates within the brain. In a sense, adenosine is a marker of sleepiness: the higher the levels, the sleepier a person feels. By blocking the effects of adenosine, caffeine decreases sleepiness. This may seem most desirable, especially if you are struggling to stay awake. However, it may also lead to difficulty sleeping at night in susceptible people.

Not everyone is affected in the same way by caffeine. Some people are highly sensitive to its effects. A small sip of coffee in the afternoon may lead some to a restless night of sleep. Others may enjoy a caffeinated beverage just before bedtime with nary an effect. Why is there variability in this phenomenon? It likely relates to different levels of an alerting signal in the brain. Some people have a higher level of arousal that results in wakefulness - both in the day and night. If a person has a higher level of alertness, it will be more difficult to fall asleep. Add a stimulant such as caffeine into the mix and this alertness will increase even further, making insomnia more likely.

This varying sensitivity to caffeine may also lead to different negative effects. Some people may be subject to adverse effects when using caffeine, including: jitteriness, fast heart rate (tachycardia), frequent urination, and anxiety. When it is taken away, withdrawal may even ensue. Not everyone will experience these difficulties, just as not all will find that caffeine disrupts sleep.

If you sleep well at night with your current use of caffeine, there may be little reason to set it aside. However, if you have difficulty falling or staying asleep, it should draw your attention. In some cases, it should be avoided after noon to avoid the disruptive effects. In others, it should be cut out completely. How do you know how much it affects your sleep? The safest bet would be to eliminate it completely. In the setting of persistent insomnia, this is highly recommended.

In order to sleep better, there are certain changes that are completely within your control. Whether you consume caffeine, no matter it's form, is something that you can change. Moreover, if you cannot sleep well at night, it is probably something that you should.

30 Days to Better Sleep: Day 10 — Avoid Alcohol Near Bedtime

With few sleeping pill options historically, difficulty falling asleep has been helped with home remedies, including a shot of alcohol. These "nightcaps" seem to make it easier to fall asleep, but with a better understanding of the effects, they are now discouraged. It seems to be a contradiction: alcohol makes you feel sleepy, but it worsens your sleep. Why should you avoid alcohol near bedtime?

Alcohol comes in myriad forms: beer, wine, and spirits or hard liquors such as rum, vodka, whiskey, tequila, brandy, and so forth. No matter its form, it all works the same. Alcohol acts as a depressant of the central nervous system, specifically the brain. It can affect behavior, concentration, and attention. At higher blood alcohol levels, increasing sleepiness and even depressed levels of consciousness can occur. Someone who is highly intoxicated may "pass out," becoming unresponsive to the environment and appearing to be asleep.

In light of these experiences, it would seem to be logical to use alcohol to increase sleepiness and aid the transition to sleep. For people who suffer from insomnia, often characterized by difficulty falling or staying asleep, it is a readily available fix. However, it is unfortunately one to avoid. Why is this so?

The effects of alcohol are short-lived. Though it may make you feel sleepy, it is rapidly cleared out of the body by the liver. As the blood alcohol levels drop, its depressant effects on the brain quickly abate. Your brain acutely rebounds from its depressed state, and this will lead to awakenings or arousals from sleep. Therefore, your sleep becomes more fragmented as the alcohol wears off. This can lead to worsened insomnia during the night.

Moreover, alcohol can have specific effects on the muscles of the airway. It is a muscle relaxant and when the muscles lining the nose, mouth, and throat relax, the airway collapses. This can lead to signs and symptoms of obstructive sleep apnea. As the airway collapses, the brain recognizes this and wakes the affected person to restore breathing, furthering the fragmentation of sleep.

When should you stop drinking alcohol to reduce its effects on sleep? It is recommended that alcohol not be consumed in the 4-6 hours preceding sleep. This may seem rather strict as it basically eliminates the consumption of alcohol in the evening, when most people drink. As an alternative rule of thumb, you should allow 1 hour of time to pass before going to bed for every alcoholic beverage you consume, starting from your last drink. If you have one drink at 9 PM, you can go to bed at 10 PM. For people with sleep apnea, especially if it is untreated, it may be advisable to avoid alcohol entirely as it may worsen the degree of sleep apnea.

So, contrary to custom, you should avoid alcohol before going to bed. Though it may cause transient sleepiness, it ultimately fragments your sleep and could contribute to sleep-disordered breathing such as sleep apnea. If you are serious about sleeping better, avoiding alcohol before bedtime is one small change you can make that might make a big difference.

30 Days to Better Sleep: Day 9 — Create a Relaxing Buffer Zone with Sleep Rituals

Okay, so you don't need a bed made out of pillows to get to sleep. Nevertheless, you can sleep better by creating a relaxing buffer zone prior to trying to sleep. As part of this, you can incorporate sleep rituals that will put your mind to ease and help you fall asleep.

One of the first tasks is to draw a line in the sand. Let's face it, your day will never end. You will always have more work to do, another chore to complete, just one more thing to take care of. Even if you are not working, you might not be ready to go to bed. If your evening is your "me time", there are endless TV programs or movies to watch, sports to play, books to read, and hobbies to indulge. If you let these pastimes creep into your devoted sleep time, there will be no end to the sacrifice. Once you have elected to make sleep a priority, you must start by concluding your day and transitioning towards sleep.

Many people find it helpful to create an artificial closure to the day. This is accomplished by selecting a time that you pronounce to be the end of your day. If you want to go to bed at 10 PM, you might select 8 PM as the time that works best for you. You want to allow yourself several hours to relax. As part of this, you must put aside your work. Those e-mail responses can wait until tomorrow. It's the time to turn off your phone. You have permission to ignore those unfinished tasks. You are only human, and your day has come to its close.

How should you fill the several hours before going to sleep? Try to indulge in an activity that you find relaxing. This activity should not be stimulating; nothing that gets your heart racing or your blood boiling. Pick something that, in the buffet of life, is oatmeal. Many people enjoy reading, taking a bath, stretching, or listening to music. You should probably avoid exposure to light, especially from screens such as your tablet or laptop computers. If possible, it is best to have some time completely free of electronics. This is time that will help you unwind and transition towards sleep.

Once you have identified activities that you find relaxing, make this a habit. Just as children benefit from a nightly bedtime routine, your body will appreciate a consistent transition to sleep. These "sleep rituals" will mentally, emotionally, and physically prepare you for the transition to sleep. Ultimately, it will make it easier for you to crawl into bed and fall asleep quickly. This can be especially helpful if you have insomnia.

Another useful tip is to make this buffer zone free from anxiety and stress. As part of this, it can be helpful to schedule a "worry time" earlier in the day. By focusing your energy on relaxation and rest in the hours before bedtime, you will sleep better and wake feeling refreshed.

30 Days to Better Sleep: Day 8 — Go to Bed Only When Sleepy

After carefully considering the difference between sleepiness and fatigue, you can now make an important choice: go to bed only when sleepy. Among people who suffer from difficulty falling asleep, a common occurrence as part of insomnia, this can be a life-changing decision. It also may defy common practice.

In early life, there is no decision made about when to go to sleep. A sleepy child is soon asleep. When the desire for sleep comes, no matter the timing, it is quickly indulged. As we get older, sleep becomes complicated by our behaviors. We may choose to stay awake, even fight sleepiness, to pursue pastimes. Alternatively, if we have trouble sleeping and feel like we need more sleep, we may go to bed early. We may stop listening to our body's natural cues.

Sleepiness or drowsiness is a cue to get ready to sleep. We should naturally prepare ourselves by settling down into bed. We make ourselves comfortable and, if everything goes to plan, we are soon asleep. In contrast, other descriptions of how we feel - fatigue, tiredness, and exhaustion - may not reflect a desire for sleep if they do not promptly proceed into sleep. Therefore, if we crawl into bed feeling fatigued, this may not result in sleep. Instead, we may be setting ourselves up for insomnia.

People with insomnia often complain of feeling fatigued or tired, but if given the opportunity to sleep, they will struggle mightily. Insomniacs cannot routinely take naps, for instance. If they lie down to rest in the afternoon, they will lie there awake. Insomnia is often described as feeling "tired but wired". Sleep is desperately wanted, but opportunities to sleep are corrupted by wakefulness.

Let's imagine a common scenario that occurs with insomnia and how someone might end up going to bed when he or she doesn't feel sleepy. Insomnia may be provoked by a stressful situation, but it is perpetuated by the resulting changes that are made around sleep. Insomnia is defined as difficulty falling asleep, difficulty staying asleep, or sleep that is not refreshing (in the absence of another sleep disorder). Sleep may become fragmented due to anxiety, with normal awakenings stretching into prolonged wakefulness during the night. By spending several hours awake in the night, it may seem natural to extend the time in bed. Rather than going to bed at 11 PM and getting up at 7 AM, a person with insomnia may go to bed at 10 PM or even 9 PM. In an effort to get more sleep, the time spent in bed is lengthened. However, something inadvertent has happened: this person may now be going to bed when they are less sleepy.

There are two major contributors to the ability to sleep: homeostatic sleep drive and circadian rhythm. The sleep drive is the desire for sleep that builds throughout the day; the longer a person stays awake, the sleepier they become. The circadian timing relates to when we should naturally be awake and asleep, and for humans sleep should occur overnight. (Nocturnal creatures like rats, on the other hand, should be sleeping in the day and awake at night.) By going to bed 1 or 2 hours early, there is less drive to sleep and the timing may be off. As a result, this insomniac may go to bed feeling less sleepy.

As a result, there is a diminished ability to sleep. It would not be unexpected for this person to now have a problem lying awake at the start of the night. By going to bed before sleepiness or drowsiness has developed, the ability to sleep is likewise lost. Similarly, lying awake for prolonged periods in the morning can be detrimental. Even short periods of sleep will diminish the sleep drive and could affect the circadian rhythm.

Therefore, train yourself to go to bed when you are feeling sleepy, not because the clock says it is time to sleep or because you are fatigued. You will find that you fall asleep more easily and sleep better through the night. To help yourself feel more sleepy, you can also work on creating a relaxing buffer zone before bed, a project to commence next.

30 Days to Better Sleep: Day 7 — Learn the Difference Between Sleepiness and Fatigue

It may seem like semantics, arguing over the meanings of similar words, but it really does matter: What is the difference between sleepiness and fatigue? Not only may discriminating between these distinctive feelings identify different causes, but it may also help to treat insomnia.

Some people lose touch with what it feels like to be sleepy. Sleepiness or drowsiness is the extreme desire to fall asleep. Imagine that you are sitting after lunch in your most comfortable chair. You are cozy and relaxed. Your eyelids become heavy, each time they close they stay that way a moment longer. You are ready to doze off. You are sleepy.

Contrast this sleepiness with a different collection of words: fatigue, tiredness, exhaustion, and low energy. These sentiments are felt deep in the bones and muscles, a heaviness to the limbs, as if you just ran a marathon. You can't summon the energy to accomplish what you need to. You are physically and mentally dragging through the day. This may occur in the setting of other illness, such as anemia, hypothyroidism, or even cancer. It may even be labeled as chronic fatigue syndrome.

No matter how extreme the fatigue, it does not result in sleep. People who feel fatigued may lie down to rest or take a nap. They do not, however, fall asleep. People with extreme sleepiness or drowsiness will be able to sleep if given the opportunity. Why does this matter?

Sleepiness often occurs in sleep deprivation among those who get inadequate total sleep time. It may also be a symptom of sleep disorders such as sleep apnea or narcolepsy. In contrast, fatigue is a common complaint among those with insomnia.

Not only does distinguishing between sleepiness and fatigue lead to a different set of possible causes, but recognizing sleepiness can also contribute to improving insomnia. How might this work? This concept will be discussed more in the next article, but it is critically important for people to only go to bed when they feel sleepy. If fatigue is used as a prompt to go to bed, this may result in lying awake for prolonged periods of time at the start of the night, trying to fall asleep. This is a major contributor to insomnia.

Consider carefully whether you are having more difficulty with sleepiness or fatigue. It may point to a distinct underlying cause and correcting it will depend on a different set of treatments. As you work to sleep better, use this exercise to reflect on your own needs.

30 Days to Better Sleep: Day 6 — Pay Off Your Sleep Debt

In these economic times, we are perhaps overly familiar with financial matters, including debts. As we put our collective financial house in order, it similarly may be appropriate to focus on improving our sleep by paying off our sleep debt. What is a sleep debt and what can be done about it?

The concept of sleep debt is meant to highlight that there are consequences to failing to meet your individual sleep needs and that, to a limited extent, you can correct this sleep deficit. As previously discussed, everyone has a specific sleep requirement in order to feel rested. Although it may average close to 8 hours, there is some variability, with some people requiring more or less. When you fail to get enough sleep to meet your requirement, you will begin to accumulate a sleep debt.

The most important consequences of inadequate total sleep time relate to sleep deprivation. There are specific symptoms that occur, from sleepiness to poor concentration to mood changes. There may be physical effects, including weight gain and decreased pain tolerance. Some people will experience hallucinations in extreme sleep deprivation. It may even increase your risk of death.

Many people will attempt to recuperate lost sleep by varying their sleep schedules. If you have to get up early to go to work on weekdays, you may not get an adequate amount of sleep. By the weekend, when you have more control of when you wake up, you may sleep in to catch up on the lost sleep. In a sense, you are running up a sleep debt during the week (which manifests as sleep deprivation) and then paying it off by sleeping more on the weekend.

How might this work? One important occurrence during sleep is the clearance of a neurotransmitter in the brain called adenosine. This chemical contributes to sleepiness and is responsible for the homeostatic sleep drive, in which the longer we stay awake, the more likely we are to fall asleep. When we do not have enough pillow time, we cannot fully clear out the accumulated adenosine. We are left with the residual mental effects described above. By extending the total sleep time on the weekends, we can finish clearing it out.

There are limits to this ability, it seems. If we had a period of sleep deprivation in the remote past, we are unable to make up for it by catching up on sleep now. It is unclear what long-lasting consequences result from sleep deprivation, but the health effects of sleep disorders suggest that these may not be insignificant.

If you find yourself running up a sleep debt, it is rather simple to correct the situation. Once you have determined your sleep needs, you should ensure that you allow an adequate amount of time in bed to meet it. Initially, you may need to sleep in several days in a row to make up for the recent sleep that you have lost. By thereafter maintaining an adequate sleep period, you will avoid the undesirable consequences of chronic sleep deprivation.

As you make broader changes to sleep better, it will be key to build a solid foundation and start by paying off your sleep debt.

30 Days to Better Sleep: Day 5 — Sleep at the Right Time for You

It is amazing how many people struggle to sleep due to the simple fact that they are trying to sleep at the wrong time. In order to better understand when you should be sleeping, it might be best to start by considering the two major reasons we sleep at all.

There is admittedly much that we don't know about sleep. Our current understanding nevertheless identifies two processes that contribute to our ability to sleep: homeostatic sleep drive and circadian rhythm. The first concept is rather simple: the desire for sleep builds the longer that we stay awake. No one will argue with this; it's easy to test. The science behind it relates to the gradual accumulation of a chemical within the brain, or neurotransmitter, called adenosine. It makes us feel sleepy. And, incidentally, blocking it is what makes caffeine effective as an alerting stimulant.

The other major player in the timing of sleep is our circadian rhythm. This is the pattern of internal processes that are synchronized to the natural day-night cycles. This directs key functions of our body and associated behaviors, including: body temperature, blood pressure, hormone levels, hunger, and sleep. It strongly dictates when we feel tired and when we are most awake.

As a brief aside, each and every cell of our body has "clock genes" that direct the activity of the cell. Even our fat cells follow a circadian rhythm! This helps the body to coordinate its activities. There is a part of the brain that is responsive to light called the suprachiasmatic nucleus (SCN). The SCN is the central pacemaker of the body, coordinating all the peripheral clocks with carefully timed hormonal changes. Therefore, sunlight (especially morning light) seen through the eyes and relayed to the SCN has a powerful effect on our circadian patterns, especially when we sleep.

With the circadian patterns of sleep, there is also clear variability between people in the timing of the longest sleep period. This sleep phase may be delayed in people who identify as night owls or advanced in morning larks. Night owls often feel most productive into the late evening and may not go to bed until 2 AM or later. This delayed sleep phase syndrome is especially common among teenagers. Conversely, elderly people are more likely to have an advanced sleep phase and go to bed and rise earlier. This has important implications on the appropriate timing of attempted sleep.

If you are a night owl and your body's natural tendency is to go to sleep at 2 AM, what do you think will happen if you try to go to bed at 11 PM? It should be no surprise that you would complain incessantly of difficulty falling asleep (insomnia). It might take 2 or 3 hours before you fall asleep; coincidentally, right about the time that your body is ready for you to be sleeping. Imagine what would happen if you forced someone with a "normal" sleep phase to go to bed early. Instead of hitting the hay at 10 PM, this person is forced to go to bed at 7 PM. No one would be surprised if they complained of trouble falling asleep. When we attempt to sleep is key to our ability to sleep.

Many people are aware of their natural tendency, whether they prefer to go to bed early or stay up late. It may be clear throughout life, but it can also change subtly. For those who find themselves needing to sleep at more standard times, there are ways to harness the power of the SCN to fall asleep easier and wake feeling refreshed, no matter what time it is. If you have trouble falling asleep, take an honest look at your sleep patterns and consider whether you are trying to sleep at the right time for you.