Sleep Disorders

Find info on common problems like insomnia, restless legs, sleep apnea, and snoring. Also, not so common problems like excessive daytime sleepiness, narcolepsy, nonrestorative sleep, REM behavior disorder, sleepwalking, and tooth-grinding.

What Are Sleep Disorders?

First of all, sleep disorders are common. According to a National Science Foundation poll, up to 60% of Americans experience trouble sleeping at night or staying awake during the day. It may take you longer than half an hour to fall asleep, you may wake up several times during the night, or be unable to get back to sleep if you wake up too early in the morning. Even if you sleep 'soundly' through the night, you may still feel groggy and tired the next day, and find yourself nodding off at inconvenient times.

Who gets sleep disorders? Insomnia is particularly prevalent in teenagers, young adults, and the elderly, though it can be a problem at any age. Shift workers and sedentary office workers can suffer from lifestyles that do not promote good sleep habits. Anxiety, depression, and stress are responsible for many cases of sleeplessness. Some sleep disorders seem to run in families, though what that means in this case is not clear.

The price for all this bad sleep is high. Individuals who consistently get too little sleep are more likely to become depressed, lethargic, achy, irritable, or unfocused. If your uncomfortable nights are caused by sleep apnea, you may also run a greater risk of high blood pressure. And then we get up and drive to work. The National Highway Traffic Safety Administration estimates that over 100,000 car crashes every year are due to tired drivers at the wheel.

Our quality of sleep affects our minds in other ways. Poor sleep disrupts our ability to form long term memories and learn new things. Even an hour or two of sleeplessness per night is enough to disrupt our ability to improve at our daily tasks and solve problems. Our clarity of thought and ability to concentrate on the following day depends heavily on whether or not we feel rested and alert. Judgment and decision making ability suffers with insomnia and poor sleep. Combined with increased irritability, individuals with sleep disorders find themselves more prone to problems at work and troubled relationships at home.

Bodies also suffer for our insomnia; sleep is the body's prime time to heal itself. This is when your cells take out their garbage, do repair jobs, and most efficiently hunt down foreign invaders. Muscles cannot build themselves up, no matter how much time we spend at the gym, unless we give them time to heal the tears caused by our activities. Skin will not look healthy, even with the best care in our waking hours, if we don't get enough rest. Colds, flus, and other infections will often take longer to heal if we push ourselves, and generally less time to heal if we take it easy and get some sleep.

While eight hours of sleep is the general guideline, some people need as few as four hours or as many as ten. The key is knowing how much you personally need to feel awake and alert all day, and making sure you get it. If you generally have little trouble getting up, don't get tired during the day, and don't feel like nodding off if you sit quietly for a while, then you are getting enough restful sleep.

Everyone has the occasional sleepless night before a big event, or after a stressful one, or has had to cut their sleep short for the sake of an emergency or important job. This is nothing to worry about, and after getting a little extra sleep on a following night, things are usually back to normal. Speak to a doctor if your sleep hasn't returned to normal after a week to prevent your sleeplessness from becoming chronic.

It is definitely time to be concerned when you find yourself chronically tired during the day, or waking yourself or others during the night. If you find yourself dozing off during monotonous events, or often feel unreasonably irritable or off your game, you might not be giving yourself enough time to sleep, or your sleep may be disturbed. Conditions like sleep apnea or restless legs can make even a full night's sleep feel like a boxing match. If you get plenty of uninterrupted rest, but are still tired, something is preventing you from sleeping deeply. Nonrestorative sleep is common among fibromyalgia sufferers (see fibromyalgia fact sheet) or other individuals with chronic pain, who often wake feeling as though they'd been up half the night.

Why does sleep benefit us so much? Nobody can say for certain; but we know that without sufficient amounts of it, the human body just doesn't work very well. So let's look at the ways there are to get a bad night's rest, and hopefully, to improve that situation.

The Disorders

It helps to know what happens during normal sleep before examining disturbed sleep. There are four stages of sleep, starting with the light sleep of stage 1. While you do begin to relax, stage 1 sleep is not very helpful in terms of your body's recovery. In healthy individuals stage 1 sleep occupies very little of the night, and after a few minutes you should fall into stage 2 sleep. In stage 2 the relaxation becomes deeper, and brain waves slower but still occasionally erratic. Stages 2 and 3 are moderately useful in terms of physical repair. Through stages 3 and 4, your brain waves become very slow and your body is at its most relaxed. Stage 4 (delta) sleep is where your body does most of its repair work, healing your tissues and restoring your feeling of physical well-being. People deprived regularly of stage four sleep tend to have aches, pains, and a higher incidence of physical illness.

Within an hour or so of falling asleep, the nerve center controlling movement in your brain is 'switched off' to prevent you from acting out your dreams and you go into the mentally active state of REM (rapid eye movement) sleep. Our eyes can still move though, and anyone can see if a person is dreaming by seeing whether their eyes are flickering behind the eyelids. It's during REM sleep that our minds seem to make sense of their experiences, form memories, and generally restore themselves. Most dreams are forgotten immediately on waking up. Dream deprivation can lead to irritation, confusion, anxiety, and poor impulse control.

The typical person cycles in and out of these phases of sleep several times a night. Quality sleep is defined by how much stage 4, or delta, sleep you get. Short sleepers usually spend most of their nights in delta sleep, with only two or three REM cycles. Individuals who sleep longer tend to have less delta sleep which occurs early in the night and decreases as the night progresses. Most people spend about a quarter of the night dreaming, and have between four and six cycles of REM sleep.

Bedwetting (Enuresis): Ten to fifteen percent of children (slightly more boys than girls) still wet their bed at the age of five. This may be caused by a psychological disturbance, infection, kidney or urinary tract problem, pinworms, diabetes, epilepsy, sickle cell anemia, or sleep apnea.

Discipline and punishment are particularly ineffective treatments for this condition. As soon as they are old enough, the child should be encouraged to change their own bed and put the sheets in the wash in order to restore their self-confidence. Bladder control and stream-interruption exercises in the daytime can help with a physical cause. Avoiding liquids in the evening, going to the bathroom before bed, and always waking up fully to go to the bathroom may also help. Certain behavioral training programs may be useful, consult your pediatrician or other specialist in these matters.

In adults, this may be an indication of sensitivity to caffeine. Many incontinence problems in adults can be corrected by eliminating caffeine, which is found in coffee, green or black tea, chocolate, and the herb guarana. In men, it can be a symptom of an enlarged prostate gland. This can be alleviated by surgery, but also weight loss, eliminating smoking and caffeine, exercise, and a reduction of dietary fat and alcohol.

Painful, excessive, or bloody urine, or urine leakage during the day at any age should be brought to the attention of a doctor. These symptoms are indicative of a physical problem that should be treated.

Excessive Daytime Sleepiness: If you fall asleep at inappropriate times (particularly if you are trying to stay awake), feel drowsy all day, or have low energy, you may have a sleep problem. This can be caused by conditions which wake you up many times at night (sleep apnea or twitching limbs), neurological disorders, long-term sleep deprivation, hypoglycemia, medication side effects, medication withdrawal, chronic pain, or narcolepsy.

While depressed individuals may seek out sleep to feel better, someone experiencing daytime sleepiness may doze off even when they want or need very much to stay awake. This condition is almost always caused by some physical, not psychological, condition that merits attention.

If getting a couple hours of extra sleep every night for a week or so does not resolve this condition, you should seek evaluation by a doctor knowledgeable in the treatment of sleep disorders.

Hypersomnia: In some women, hormone fluctuations during the menstrual cycle can affect their sleep patterns. During some parts of their cycle they may be almost incapable of remaining awake all day long, and then have insomnia at other times. If excessive daytime sleepiness seems to be tied to your menstrual cycle, you should speak to an endocrinologist or your gynecologist.

Hypnagogic Hallucinations: Usually an early symptom of narcolepsy, but can occur in any severely sleep deprived individual (though this is rare). This occurs when a person nods off for a moment and goes directly into REM sleep, sometimes incorporating the situation around them into their dream. It can be startling, as you may experience a mix of waking and dream states, or hear and see things that aren't there. The individual may be easily woken, or may wake quickly on their own. This is not dangerous in itself unless you are falling asleep while performing a dangerous task like driving. It is not a symptom of a psychological disturbance, it's purely a 'mechanical' difficulty. If you find this happening to you, get evaluated for the possibility of a sleep disorder before it disrupts your life or causes an accident.

Insomnia: Whether you can't get to sleep, or wake early and can't return to sleep, insomnia can be frustrating. Often, our worry about lost sleep is more harmful than the lost sleep itself. While this can happen to anyone during a difficult life event, or right before an important day, it shouldn't happen very often. If sleeplessness lasts more than a few days, it's best to speak to a doctor.

Most cases of insomnia can be helped by a sleep hygiene regimen as described below, but sometimes medical attention can make it easier to resume a normal schedule. If insomnia has persisted for longer than a week, especially if it has lasted for months or years, it may be a sign of an underlying condition that needs to be treated. Emotional upset, diet, stress, prescription medications, and physical problems can all interfere with sleep. None of these issues should be taken lightly, as they are all important components of overall health.

Leg Cramps: Awakening to painful cramps in your feet or calves is no fun. This condition can be caused by muscles tensed from wearing high-heeled shoes, or from a deficiency of calcium, magnesium, or potassium. Stretching your calf muscles several times a day, or taking supplements of calcium, magnesium, and potassium may help.

Narcolepsy: This is a physical (possibly genetic) disorder marked in its early stages by excessive daytime sleepiness and poor sleep at night. The narcoleptic individual may experience overwhelming sleepiness during periods of inactivity, such that they cannot help falling asleep. This may occur during meetings, in slow traffic, or in any other situation where they are receiving little stimulus. Their condition may remain relatively mild, or become more severe. If it progresses the individual may experience cataplexy, a loss of muscle tone similar to what happens in REM sleep, during the day when they experience strong emotions. Temporary paralysis at the onset of sleep may also occur. Occasionally automatic behavior may occur, where a person has no conscious memory of normal actions performed over a period of minutes or hours.

In narcoleptics, REM sleep may occur within a couple minutes of sleep onset, instead of an hour or more after falling asleep. While falling asleep they may see or hear people and events that aren't there, as though their dream and waking states had become mixed up, called hypnagogic hallucinations. This is a symptom that is often important in sleep lab evaluation for diagnosing narcolepsy.

For narcoleptics, a couple of short (10-20 minutes) naps during the day may help tremendously. If possible, driving long distances should be avoided when the individual is not fully rested. Some medications, such as stimulants or antidepressants may help, but these often lose their effectiveness and may cause undesirable consequences with long-term or constant use.

Night Eating (Compulsive): This disorder is almost like sleepwalking, where an individual is not fully conscious of multiple trips to the kitchen during the night. Sometimes they only know because there are dishes in the sink, or food that has been put away in strange places. High carbohydrate foods are usually favorite snacks, but sometimes spoiled food or raw meat may be chosen. This condition often leads to weight gain and is very difficult to control by adjusting waking habits. It rarely improves with professional counseling or lifestyle changes. Night eating is one of the few sleep disorders that responds best to medication, though the proper treatment will vary among individuals. On occasion though, hypoglycemia is a contributing factor, and some relief can be had by consuming a high protein snack before bed to maintain blood sugar throughout the night. (Sugary or high carbohydrate snacks may make the condition worse as it will cause a spike and then a steep decline in blood sugar.)

Night Sweats: Frequent night sweats are often an indication of an infection disease like tuberculosis or a thyroid infection, though they may also occur during menopause. If sleeping in a cooler room, or with fewer covers doesn't correct the problem, see your doctor immediately.

Night Terrors: Night terrors differ from nightmares in that they occur during the deepest stage of sleep instead of during REM and typically cause extreme physical reactions. Delta sleep normally occurs early in the night, and often night terrors occur within an hour or so of falling asleep. The person may scream, open their eyes, experience a rapid heart beat, shaking, and sweating, yet will likely forget about it the next morning. Because it is so difficult to awaken from delta sleep, the individual almost never really awakens, even though they appear to be wide awake and panicking.

In children, this condition is usually not a symptom of any problem, though it may make overnight stays problematic. Ongoing therapy is not usually necessary for children, though, as they will typically grow out of this normally. In adults, however, this often indicates excessive anxiety or aggression. Adults who experience night terrors should seek out a counselor.

Nonrestorative Sleep: This condition, where an individual sleeps uninterrupted for a normal amount of time and still wakes up tired, seems to be caused by interference in deep sleep by alpha waves. Alpha waves are patterns of a relaxed waking state, which may be experienced without the individual consciously waking up. Any interference in deep sleep can produce the same symptoms as an outright lack of sleep. The elderly, and individuals with chronic pain are most likely to suffer from this problem. You should rule out a cause like sleep apnea or periodic limb movements to be sure that your treatment is appropriate, as individuals with these conditions may wake many times per night without realizing it. Physical fitness provides some protection from nonrestorative sleep, so consult your doctor about an appropriate exercise plan.

Nonrestorative sleep is very common in fibromyalgia (sometimes referred to as chronic fatigue syndrome or fibrositis) patients, whose aching muscles and joints seem to interfere with deep sleep, and whose poor sleep quality seems to worsen the aching of their muscles and joints. Sometimes, the exercise program prescribed as part of a treatment makes these individuals worse, and they should seek out a plan that takes their entire health picture into account.

Periodic Limb Movement: Periodic limb movement in sleep seems to be related to restless legs syndrome, and the two are often found together. The individual may not be conscious of their behavior, but they may find that their covers are very rumpled or show excessive wear near the feet. If you sleep with someone else, they will almost certainly notice. While this condition is not painful or dangerous, it can disrupt deep sleep. If you are tired during the day, you should seek treatment that will allow you to have more restful nights. The causes and treatments are often the same as restless legs syndrome, discussed below.

REM Behavior Disorder: Most often experienced by men over 60, and individuals with neurodegenerative disorders, this seems to be caused by interference with the normal mechanisms of REM sleep. Typically during REM sleep, our muscles are all paralyzed so that we cannot act out our dreams. In this disorder, the muscle paralysis is not complete and the individual may then perform actions from their dreams. This condition responds best to medications, like Klonopin, but precautions should be taken to prevent the individual from hurting themselves or others. Moving the mattress to the floor, keeping furniture well away from the bed, and providing thick carpeting will minimize the risk of injury.

Restless Legs: Sufferers of this syndrome often experience crawling, prickling, and tingling sensations in their legs during their waking hours which grow stronger when they are inactive or trying to sleep. Sometimes moving around is the only thing that will ease their discomfort. This condition can make relaxation and sleep very difficult, and result in chronic sleeplessness. Restless legs syndrome becomes more common with age, depriving many elderly people of needed rest.

As with periodic limb movement, prescription treatments are the most widely recommended therapy. Anemia (iron deficiency), metabolic problems, kidney trouble, poor circulation, lack of exercise, caffeine, or vitamin deficiency may play a role in their condition. Calcium, folic acid, iron, magnesium, potassium, vitamin E, and zinc are the most helpful nutrients. Try getting more exercise, and avoid caffeine for a while to see if this helps.

Sleep Apnea: Sometimes excessive daytime sleepiness may be caused by temporary stops in your breathing called apneas. The occasional apnea is nothing to be concerned about, but certain conditions can make apneas more frequent, and it can become a problem. For individuals who are reporting daytime sleepiness, their apnea may be very severe, with apneas occurring dozens of times per night. Many times, the individual is unaware of the mini-wakenings that occur as they gasp for breath. They often don't know until someone else listens to their breathing while asleep; some people go to a sleep disorders center to be monitored, but sometimes a partner or roommate will tell you about the stops in your breathing. If you have frequent apneas, they may begin within minutes of falling asleep, and become more frequent in deeper sleep as you become more relaxed.

Individuals with severe sleep apnea can be more accident prone and have delayed reaction times, or simply be less able to concentrate, a result of constant interruption of their deep sleep. High blood pressure, stroke, irregular heartbeat and other serious heart problems, or severe morning headaches can all be consequences of this potentially damaging condition. Apnea in heart patients especially needs to be treated, as it's very hard on the heart to deal with the constant change in air pressure and oxygen availability.

Apnea is commonly caused by overlarge tissues in your throat, or throat muscles which get too relaxed, which can both block the airway. Although sleep apnea can happen to anyone, at any age, it is more common in men and becomes increasingly prevalent in seniors of both genders. Sleep apnea in children can sometimes be linked to bedwetting, and occasionally a tonsillectomy will correct this.

If you have sleep apnea, do not treat your condition with sleeping pills of any type, drink alcohol near bedtime, or smoke, as these will all worsen the problem. Avoid narcotic pain medication that warns it may cause respiratory depression at bedtime. Excess weight can be a contributing factor, as can sleeping on your back. Elevating your head during sleep, sleeping on your side, losing extra weight, or using Breathe-Right strips may provide some relief. There are many dental devices that are used with varying success, CPAP (continuous positive air pressure) masks, and surgeries that may help.

Sleep Paralysis: Some individuals experience a few minutes of paralysis on falling asleep or waking up. They may be unable to move any part of their body besides their eyes, which strongly resembles the paralysis that sets in during REM sleep where the body is paralyzed but the eyes are free to look around. If this happens when you wake up, it is likely not a sign of anything else even though it may be disturbing. Sleep paralysis that occurs just before falling asleep may be a sign of narcolepsy, and you should be evaluated by a sleep disorders specialist. If this ever happens to you in the daytime (called cataplexy), particularly when you experience strong emotions, you almost certainly have narcolepsy and should seek treatment.

Sleep-Related Headaches: Morning headaches can be caused by a lack of oxygen flow to the brain in patients with sleep apnea. If these occur primarily on weekends, they can often be caused by caffeine withdrawal. If you are prone to migraine or cluster headaches these may be triggered in the mornings, also.

It appears that this condition may be related to blood flow in the brain, as it changes during the different stages of sleep. During non-REM sleep, especially deep sleep, blood flow is directed to the body and away from the brain, so that the blood vessels going to the brain contract. During REM sleep (which becomes more common later in the night) blood flow is directed to the brain and away from the body, causing those blood vessels to expand which may cause a headache.

Sleepwalking: Like night terrors, sleepwalking occurs during an interruption in the deepest stage of sleep, not during REM sleep. The sleepwalker may be aware enough to avoid bumping into things, but they may fall on the stairs, mistakenly pick things up, or wander outside. This is common in children and usually decreases with age. As long as certain precautions are taken (locking the doors and windows, putting away loose objects, etc.), little harm usually comes of it, and it does not necessarily indicate a deeper problem. If sleepwalking persists into adulthood, or appears in adulthood, it can indicate serious anxiety, stress, or undiagnosed epilepsy. Adults who sleepwalk should seek professional evaluation, and may be helped by relaxation training, biofeedback, hypnosis, or prescription medication.

Snoring: ...Needs no description, almost everyone has suffered trying to sleep in the proximity (sometimes from the other end of the house) of a heavy snorer. This can often be a sign of sleep apnea, and if it seems that breathing stops or the individual is often sleepy during the day, then medical attention is called for. If there is no apnea, the individual may have upper airway resistance syndrome, which can be caused by a deviation in the airway. (A deviated septum can usually be corrected by surgery.)

Surgery or CPAP (continuous positive air pressure) masks may alleviate the problem. Snoring can also be helped by avoiding alcohol close to bedtime, not smoking, sleeping on your side, or elevating the head. Sleeping pills are likely to worsen this condition. Avoid narcotic pain medication warning that it may cause respiratory depression when you are near bedtime.

Tooth Grinding (Bruxism): Nighttime tooth grinding is often a result of stress, and is not always improved by therapies that help with daytime tooth grinding. It can cause people to wake up at night, but even if it doesn't, it may result in headaches, aching jaws, or tooth damage. Orthodontal work may help if it's the result of a dental problem called malocclusion (improper meeting of the teeth). Often, the rubber mouth guards used by athletes will be suggested for use at night. These may prevent damage to the teeth, and can sometimes reduce the impulse to grind them.

Caution: If your sleep problem or daytime tiredness has persisted for years, speak to a doctor who is familiar with sleep disorders, or go to a sleep center for an evaluation. Sleep disorders can be a symptom of another problem that needs treatment, and some may put you at risk for chronic illness later in life. Daytime sleepiness can get you injured in an auto accident, degrade your ability to function at work, or decrease the overall quality of your life and relationships.

Society often attaches little importance to sleep, and a lot of stigma to being tired. Unfortunately, shrugging off sleep makes us less able to take care of our responsibilities, as it is a critical component of mental and physical health. Don't worry about what other people think, just get good results for yourself.

Sleep Disorder Triggers

Alcohol, Caffeine, and Nicotine: These substances are common causes of sleep problems. Try stopping your usual just for a week and see if it helps. If you can't avoid them completely, you can derive some benefit from avoiding them in the late afternoon and evening.

Anxiety: Fear and worry in response to stress are normal experiences, but on occasion these feelings can persist over time and interfere with a person's life. Certain medical conditions (breathing problems, head injury, heart condition, overactive thyroid) or medications (alcohol, cocaine, steroids, stimulants) may cause these feelings, or a person may have gotten into a cycle of negative emotions they are no longer able to get out of. Anxiety causes insomnia in many people who are trying to cope with this condition. Treating the anxiety often allows the sufferer to return to healthy sleep patterns. Seek counseling if you experience persistent fear or worry. Most individuals can be helped successfully within a few months of treatment. A combination of medication and therapy is typically effective.

Bad Habits: Oversleeping on the weekends, worrying excessively about your sleep, spending too much time in bed when awake, or negative attitudes about your sleep environment can all contribute to poor sleep quality. Read the sleep hygiene section on ways to develop good habits that will help you sleep well.

Depression: Depression is defined as persistent sadness, a loss of pleasure in life, and feelings of guilt or worthlessness. While everyone will likely experience brief situational depression caused by loss or grief in life, some individuals may experience these feelings on a regular basis with no apparent outside cause. Certain infections, diseases, prescription medications (notably high blood pressure medications), or withdrawal from a stimulant (like amphetamines or diet pills) can also cause depression. Depression can interfere with sleep either by making people lethargic so they sleep too much, or by causing them to be unable to sleep through the night. Often, treating this underlying cause will correct the sleep problem. Seek counseling if you experience persistent sadness or feel unable to enjoy life. Most individuals can be helped successfully within a few months of treatment. A combination of medication and therapy is typically effective.

Hypoglycemia: This condition, where blood sugar can drop unpredictably, is sometimes thought to be responsible for unconscious night eating. If you get shaky, confused, or lightheaded when hungry or soon after you eat, this may affect you. Though you likely crave high carbohydrate and sugary foods, you need to avoid them. Try getting more healthy protein (poultry, fish, nuts, soy) in your diet, and try a high protein snack in the evening before bed. Protein usually helps keep your blood sugar more stable and prevents cravings, but this may still not correct the issue. Night eating which happens without the conscious awareness of the individual is a difficult problem to treat without medication, and there are often other causes. Hypoglycemia may also cause, or add to, daytime sleepiness.

Lack of Exercise: A sedentary lifestyle is an enemy of good sleep. The more activity people get, the sounder they generally rest. Physical fitness can also protect people from the effects of disturbed sleep, making it less likely that a bad night will wipe you out. Getting an extra 2-3 aerobic exercise sessions every week will typically improve insomnia, sleep apnea, and nonrestorative sleep. You can meet this minimum by taking a 20 minute walk every couple of days.

Obesity: This is a known risk factor for sleep apnea. If you are heavily overweight you should avoid alcohol and sleeping pills as the sedation will make the airway blockage much worse. Even minimal exercise will be of some benefit in improving the quality of your sleep.

Prescription Medication: Some high blood pressure medication, certain antidepressants, and stimulants of any type (diet pills, decongestants, etc.) may cause insomnia. Speak with your doctor about this possibility if you are taking any of these medications. There may be another treatment that you can use, or steps you can take (reducing dosage, taking it earlier in the day, etc.) to reduce interference in your sleep.

Shift Work: Rotating shifts or night work causes sleep disorders in many people who would otherwise have no difficulty with their sleep. The human body takes about two weeks to adjust to a change in sleep schedule, though if such a schedule is maintained consistently it can work very well. In practice, though, shift workers often switch schedules every week or so and frequently change their schedule on their days off. Also, as people get older, the body loses it's ability to adjust quickly and problems may become more obvious. Shift workers have an increased tendency towards 'daytime' sleepiness, sleep related tension, lack of alertness, and greater incidence of vehicle accidents and injury.

If shift work is unavoidable, it can be helped by rotating shifts forward around the clock (first morning, then evening, then night) instead of randomly or backwards, and maintaining the same shift schedule for a period of at least three weeks. Sleep schedules should be maintained, if possible, even on days off to minimize sleep disturbance.

If at all possible, individuals should be asleep between 2 and 6 a.m. in the morning, as this is a time when our bodies naturally tend to shut down. Many of the world's most serious industrial accidents (and numerous minor ones as well) have occurred in these dangerous early morning hours when people are most likely to feel the effects of poor sleep.

Stress: This is the number one cause of insomnia, and can contribute to the severity of other sleep disturbances. Typically stress is associated with a temporary situation or life event, and any sleeplessness associated with it goes away soon as well. If stress-induced insomnia persists for longer than a week, see your doctor about it. Sometimes a pattern of poor sleep can become chronic if not dealt with early on. If you have a great deal of persistent stress in your life, you might consider seeing a counselor, as it can be a great relief just to have someone listen to you without judging.

Standard Sleep Disorder Treatments

Sleeping Pills and Antidepressants

While there are medications designed specifically to help you sleep, some medications prescribed to treat anxiety or depression will also help you to sleep. This is particularly true for individuals whose anxiety or depression is causing their sleep disorder, but they are sometimes successful in low doses for people who are not at all anxious or depressed. These medications can also be less likely to result in dependence, and may remain effective for a longer time.

Sleeping pills are typically prescribed for no more than a week or two, just to break a pattern of insomnia and give your body a chance to resume normal sleep. The occasional pill may be useful without creating habituation; take them no more than once or twice a week on an ongoing basis. Take the smallest effective dose, breaking pills in half if necessary, to be sure you don't take too much.

If you snore, or have sleep apnea, you should never take sleeping pills. These medications could make your condition more severe, by further relaxing the muscles of the throat and leading to worsened airway obstruction.

Virtually all individuals who take sleeping pills encounter rebound insomnia when they stop taking them, and may take the medication longer than needed in order to avoid this. This can be minimized by taking the lowest possible effective dose of a sleep medication. Many sleeping pills also have negative effects on performance and coordination the next day, as they may remain in your system and continue to exert a sedative effect. The best result you can get with a sleeping pill is to feel as alert as you would after a normal night's sleep, but they will not improve your performance.

Some of these medications run the risk of dependence, and their use should be monitored and probably not continue for too long. With all of them there is the common possibility that you will become tolerant of them, and find that they stop working for you. None of these medications should be mixed with alcohol use, or any herb or drug that also makes you drowsy. Unless specifically recommended by your doctor to treat unresponsive depression or anxiety, these medications should not be mixed with each other. Stimulants of any kind, including caffeine and nicotine, are known to disrupt sleep and decrease the effectiveness of prescription treatments for sleep disorders.

Always inform your doctor, anesthesiologist, or dentist if you are going in for surgery or dental work if you take any of the following medications, especially if you are not seeing your regular doctor. Many of these prescription treatments can interact with the drugs given in surgery, or with the antibiotics sometimes prescribed to prevent infection afterwards. There is need for particular caution with antidepressants which remain in the body for a long time. Be sure to discuss this issue well in advance of your surgical procedure.

If you choose to seek a prescription treatment for your sleep disorder, be aware that tranquilizers, hypnotics (most sleep medications), and most antidepressants are typically short-term therapy. Few of them retain their effectiveness over constant use, and many can cause habituation or dependence. If your sleep problem persists for months or years, especially with treatment and a sleep hygiene regimen, you are advised to seek advice from a sleep disorder specialist or to get evaluated in a sleep lab. The best results over time for most people come from finding lifestyle adjustments that help them sleep better naturally.

Acetaminophen (Tylenol) - The occasional Tylenol just at bedtime can sometimes help improve sleep during the second half of the night, having a four hour delay in its effect. This is most effective for individuals who wake early. Used nightly, you will become habituated to it and, like any other treatment, it will stop working. Do not mix acetaminophen, or any drugs containing acetaminophen, with over the counter pain relievers. Ask your doctor about possible interactions with oral contraceptives, blood-thinners, or high cholesterol treatment. Do not drink excessive amounts of alcohol with acetaminophen, as it can increase your risk of liver damage and stomach bleeding. Do not mix with NSAIDs (non-steroidal anti-inflammatories) of any other type.
Aspirin - The occasional aspirin just at bedtime can sometimes help improve sleep during the second half of the night, having a four hour delay in its effect. This is most effective for individuals who wake early. Used nightly, you will become habituated to it and, like any other treatment, it will stop working. Also, aspirin can reduce your body's natural production of melatonin, the hormone that regulates and promotes sleep. Aspirin (or any salicylate, such as salicylamide, or salicylic acid) can cause kidney or liver damage when taken in high doses, and over long periods of time, in combination with acetaminophen. When taken in the recommended doses for a short time, it has not been seen to produce this effect, but caution is still advised. Do not mix aspirin with other pain relievers. If you are taking aspirin as a preventive heart disease regimen, you should still not take it with other pain medications; speak to your doctor about alternate or non-interacting treatment.
Barbiturates - These medications may help you relax and sleep better if anxiety or muscular tension is disturbing your sleep. Be aware that these medications run a high risk of both habituation and dependence. The risk of both side effects and habituation increase with dosage and frequency of use. These medications are rarely prescribed any more. Can cause rebound sleep difficulties or insomnia. Barbiturates may make oral contraceptives less effective, and should not be mixed with alcohol, most antidepressants, narcotic pain medication, or other medications that may make you drowsy.
Benzodiazepines - This class of antidepressants, anti-panic agents, tranquilizers, and muscle relaxants such as Ativan (lorazepam), Valium (diazepam), Halcion (triazolam), Restoril (temazepam), Librium (chlordiazepoxide), Xanax (alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam), Dalmane (flurazepam), Doral (quazepam), and Klonopin (clonazepam), are generally very safe and have a long history of use. They are best for people who need both help sleeping and additional sedation during the day, as they tend to stay in the body for a relatively long time. Klonopin is sometimes effectively used to treat restless legs syndrome or periodic limb movements. The long acting versions, Dalmane and Doral, can reduce rebound insomnia, as they remain in your system for a couple days after you stop taking them. If you need to be alert in the mornings, several of these drugs may not be advisable for you. Halcion is the only one approved as a short acting medication. You can build up a tolerance of these medications, such that you need a higher dose to give the same original effect if they are used continuously, and there is some risk of dependence in certain individuals. They should not be used in combination with alcohol, antidepressants (unless specifically suggested by your doctor for drug resistant depression), or any drug or herb that makes you drowsy.
Ergotamines - Permax (pergolide) and Parlodel (bromocriptine) are anti-Parkinson's medications used to treat restless legs and periodic limb movements. They should not be taken with ergotamine based treatments such as DHE 45 injections, Cafergot, Ergostat, Sansert, the senility drug Hydergine, or Migranal nasal spray, or any other ergot alkaloid for any reason. Do not take these medications within 24 hours of any triptan medication, and avoid taking them with cold or decongestant remedies that contain ephedrine compounds or phenylpropanolamine. Do not take them with any form of nicotine (cigarette smoke, patches, or gum), or with the migraine preventive treatment Inderal (propranolol). They may interact with oral contraceptives, low blood pressure medications, and tranquilizers. Not all antibiotics are safe to mix with ergotamine treatment. Tell your doctor, dentist, or nurse that you take an ergotamine, especially if you are being prescribed a post-surgical regime of antibiotics to prevent infection and are not dealing with your regular doctor.
Narcotic pain medication - These include Codeine, Demerol (meperidine), Buprenex (buprenorphine), Darvon (propoxyphene), Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine, OxyContin (oxycodone), Percocet (oxycodone, acetaminophen), Stadol (butorphanol), Talwin compound (pentazocine), Vicodin (hydrocodone, acetaminophen), and Vicoprofen (hydrocodone, ibuprofen). These medications are used to treat, or augment treatment, for restless legs and periodic limb movement. There are many brand names for most of these, so look for the generic ingredients on the label. These medications should not be mixed with barbiturates, some antidepressants, or each other. Do not take these with cough medications containing alcohol or a narcotic (codeine or hydrocodone), or Tylenol with codeine. Do not mix them with over the counter pain medication unless your doctor specifically tells you it is safe to do so.
Short-acting Sleeping Pills - Ambien (zolpidem) and Sonata (zaleplon) are new medications which are removed from the body very quickly. Ambien can be cleared from the body within 6-8 hours, and Sonata in 4-6 hours. They have a low risk of rebound, side effects, and habituation, though these can occur in certain sensitive individuals or if large doses are taken. These sleeping pills should be taken at their lowest effective dose if you will be taking them more than 7-10 days, and should be stopped gradually after long usage to minimize rebound sleeplessness. They should not be used in combination with alcohol, or any drug or herb that makes you drowsy.
Sinemet (carbidopa and levodopa) - This anti-Parkinson's medication is used to treat restless legs and periodic limb movement. Sinemet and Sinemet CR (controlled release) should not be mixed with tranquilizers, tricyclic antidepressants, tranquilizers, other antispasmodics, or antacids.
Tricyclic Antidepressants such as Elavil (amitriptyline) or Sinequan (doxepin) may sometimes be prescribed in low doses to help you sleep. Tofranil (imipramine) may be used to treat bedwetting in children. Typically these doses are far lower than the effective doses for treating depression, and do not imply any psychological condition. If your insomnia or early awakenings are caused by depression, however, these treatments may help both conditions. Sun sensitivity is a known side effect of tricyclic antidepressants, always wear protective clothing and sunblock when you go out. These medications may worsen restless legs syndrome or periodic limb movement. They should not be taken in combination with other prescription treatments for insomnia, antidepressants (unless specifically suggested by your doctor for drug resistant depression), alcohol, or any medication or herb that may make you drowsy.

Other Medications

Some medication you might take for other conditions may not mix well with prescription treatment for sleep disorders. The medications prescribed for sleep disorders like insomnia are classed as central nervous system depressants, which includes any other drug that may make you drowsy. Drugs or medications that make you drowsy should not be combined together. You may run the risk of oversedation, rebound sleeplessness or headache, severe daytime drowsiness, respiratory (breathing) depression, and in some cases, coma or death.

Certain prescription treatments or over the counter preparations may also contribute to sleep problems. Try removing all potential over the counter stimulants for at least a month to see if this helps. Speak to your doctor about any prescription that disturbs your sleep. Medication for asthma, congestion, depression, high blood pressure, or steroids, may all cause sleep problems. They can cause insomnia, frequent sleep interruptions, or cause you to wake early. Your doctor may know how to offset the effects of your medication, or may suggest a different treatment that doesn't keep you awake.

Be sure to read the list of drug interactions on your package inserts, and ask your doctor or pharmacist to check the safety of combining multiple medications you may need. If you are seeing multiple doctors, it is very important that you inform each of them of other prescriptions you may be taking so they can account for interactions and side effects. Check to see if you need a dosage schedule created to ensure that you take multiple medications as safely as possible. As always, over the counter medications or supplements are not beyond suspicion:

Alcohol - Do not combine alcohol use with prescription sleep aids, antidepressants, or any medication which could make you drowsy. This could result in oversedation, overdose, coma, or possibly death. Individuals with sleep disorders are generally urged by their doctors to avoid alcohol. If you are not taking prescription sleep aids, you should still have no more than one drink in the evening (but not too near bedtime) if you experience trouble sleeping or daytime fatigue. While an occasional drink is not likely to damage your sleep, and may even make you drowsy, alcohol use can disrupt the deep stages of sleep. Do not use in the evenings if you snore or have sleep apnea.
Bronchodilators - Drugs containing aminophyliline, ephedrine, or norepinephrine are stimulants that can cause insomnia. These are often contained in asthma medications.
Caffeine - This stimulant is often used to mask the effects of poor or insufficient sleep and can further interfere with your sleep patterns. Withdrawal from caffeine is often responsible for weekend or Sunday morning headaches that may be experienced on mornings when you do not have your 'usual' cup of coffee. Caffeine is also found in green and black tea (but not in purely herbal teas), chocolate, cola drinks, over the counter stimulants like NoDoz or Vivarin, and the stimulant herb guarana. While avoiding caffeine is a necessity in several sleep disorders, you can also benefit from avoiding it in the late afternoon and evening. Take it out of your diet for a week to see if your sleep improves.
Chemotherapy - If you are being treated with chemotherapeutic medications, some of these may disrupt your sleep along with other of your body's natural functions. Speak to your doctor about counteracting any resulting insomnia.
Cold Medications and Decongestants - Unless you are taking a nighttime version of these medications, certain ingredients may act as stimulants and disrupt sleep. Talk to a pharmacist about getting a treatment that won't keep you awake.
Diet Pills - Many varieties of diet pill such as Phentermine/Adipex (fastin) or Meridia (sibutramine) will act as a stimulant and can keep you awake.
Herbal Diet Preparations or Stimulants - These may contain several stimulant herbs like ephedra, ginseng, or gotu kola, as well as natural sources of caffeine such as guarana.
High Blood Pressure Medication - Some medication for high blood pressure, like beta-blockers or calcium channel blockers, can cause insomnia as a side effect. Speak to your doctor about minimizing the effect or switching to a blood pressure medication that does not have this effect on you. While drugs within the same class will be similar to each other, you may not react the same to all of them.
Sedatives - Medications like Amytal (amobarbital), Fioricet (butalbital, acetaminophen, and caffeine), Fiorinal, Nembutal (phenobarbitol), Seconal (secobarbitol), or other barbiturates can interfere with your sleep-wake cycle or cause rebound insomnia. These should not be mixed with prescription or over the counter sleep aids. They should not be mixed with antidepressants unless your doctor specifically recommends this for some other condition.
Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline) may cause insomnia as a side effect, though this is not common and can usually be remedied by taking your medication in the morning or daytime. Speak to your doctor about minimizing any potential for insomnia resulting from your SSRI treatment.
Sleeping Pills - Can cause rebound insomnia. Use the minimum amount possible, and no more than once a week on an ongoing basis. Do not use if you snore or have sleep apnea.
Steroids - Steroid based medications, including those used to treat asthma, may cause insomnia. Topical creams should have a negligible effect.
Street Drugs - Do not mix street drugs of any kind with prescription treatments for any condition as this could result in dangerous interactions or a potentially fatal overdose. Also, many of these drugs can interfere with sleep on their own. They may act directly as stimulants, or can have an effect like alcohol where they initially make you drowsy but interfere with deep sleep.
Thyroid - The thyroid supplements used to treat underactive thyroid conditions can cause insomnia.
Tobacco - While smoking may leave you feeling relaxed, nicotine is a stimulant that can disrupt your sleep cycles and make it hard to feel fully rested after sleeping. If you snore or have sleep apnea this drug will worsen your condition. Individuals with sleep disorders are usually advised that smoking may be a strong factor in their inability to sleep well, and that they will get better results from treatment if they stop.
Tranquilizers - Can cause rebound insomnia. Use the minimum amount possible, and speak with your doctor about a plan for keeping the frequency of your usage low if you are taking them for another condition. Do not use if you snore or have sleep apnea.

Sleep Disorders And Diet

A good diet isn't about being hungry all the time, it's about making sure that your body's nutrition requirements are met and that you don't over consume things your system has a hard time dealing with. Hunger pangs can sometimes be your body's way of saying that even though you may have eaten, it's still missing something. Just one of the many reasons that trying to starve yourself into submission often backfires disastrously.

An easy plan for a healthier way of eating is to remember some simple substitutions, and try including them in your normal diet a little at a time. As with anything else, try these suggestions for a little while and see if they work for you.

Steak or pork? Have lean poultry or fish instead.
For white bread, white rice, and sugary cereal, substitute whole grains and brown rice. (In grains like wheat and rice, the hulls contain most of the nutrition and fiber. When these are taken out in processing you're left with mostly starch.)
If you're craving french fries, try getting a side of steamed vegetables instead. Vegetables are very good for satisfying nutrition and fiber requirements, the fresher, the better.
For fruit juice, substitute a piece of whole fruit. Most fruit juices contain few nutrients, too much sugar, and are little more valuable than soda.
Fat in the diet is a tricky topic for most people. We need some fat in our food, it's essential to good health and to our sleep, but there are different kinds. The sort of fat found in olive oil, cold water fish, flax seeds, eggs (unless you have high cholesterol), and nuts are healthy and essential in moderate quantities. Including these foods in your diet can make meals more satisfying and reduce hunger between meals. The sort of fat found in fried foods, red meat, candies, ice cream and cakes, heavy sauces, and most chips can be harmful in the quantities that are often contained in our food. It takes a lot of energy to digest these foods and this can disrupt deep sleep.
Instead of caffeinated drinks or soda, have an extra glass of water. If you crave some flavor, add some lemon, try mineral water, or herbal tea. Nothing substitutes for extra water, but if you have a hard time making the transition, substitute one glass of water per day for your usual coffee or soda until you are drinking six to eight glasses every day. Additional water helps every body system function better, and most people find that replacing coffee and soda improves their sleep.

When it comes to planning your meals, try to remember that digestion can interrupt deep sleep. Heavy meals at night can make you sleepy, but they can also keep you from getting the quality of sleep you need later at night. Try making breakfast and lunch your heaviest meals, and keep dinner light, with a healthy snack in the evening like fruit and nuts. Be sure that your dinner contains a serving of vegetable protein (soy, nuts, whole grains) or lean meat, as protein satisfies your body longer. Include a serving of vegetables and a healthy fat (included already if you have olive oil, nuts, or fish). If you awaken at night, or have a tendency to eat at night, have a balanced but high protein snack right before bedtime. The classic, a small glass of warm milk, really can work to help some people sleep.

Any foods that cause you indigestion or heartburn, commonly fatty, spicy or garlicky foods, sometimes beans or peppers, can disrupt sleep. Avoid these foods, especially late in the day. MSG (monosodium glutamate) intolerance is common, and can both disrupt digestion and cause insomnia. Avoid this if you notice that Chinese food is linked to your insomnia.

Food allergies may also disrupt sleep, but they aren't usually obvious like allergies to pollen or other airborne irritants. While many of the symptoms caused by food intolerance can be caused by other things as well, it's often worth investigating. If the solution to a health problem like insomnia is as simple and cheap as cutting something out of your diet, it can be worth investigating. Consult a nutritionist to be sure that you have a good plan for investigating this possibility, and be sure to rule out other causes of difficulty.

In babies, milk is the most common allergen (cow's milk, not mother's milk). If your baby has trouble sleeping, you may want to take milk away from their diet and see if it improves. If you are breastfeeding, try taking milk out of your diet as well; the proteins that cause the allergy can pass through breastmilk to your child.

In children, allergies may be a culprit not only in sleep problems, but behavior difficulties as well. If your child has digestive trouble and problems sleeping (whether combined with a behavior problem or alone), examine the possibility of allergies.

Adults are often more tolerant of allergens and less likely to manifest strong symptoms or behavior problems, but allergies can cause insomnia along with digestive complaints in adults as well. Vague aches, a feeling of general discomfort, recurrent nausea and headaches, and daytime sleepiness can all be connected to food allergies.

The most common food allergens are: chocolate, corn, egg whites, milk, MSG, nuts, seafood, soy, red or yellow dye, wheat, and yeast. Any foods derived from these foods, or in the same food family, may sometimes produce similar reactions. If you do find that you are intolerant of a food, learn to read labels and identify ingredients derived from your allergen.

Alternative Sleep Disorder Treatments

Herbs: If you try herbal preparations, be aware that some of them can interact with prescription treatments. In fact, many prescription treatments are developed from plant components. Rotate any herbal treatments that you use, as they may become less effective or cause pollen allergies if used constantly. Speak to a trained herbalist to be sure that you take them safely and effectively.

Popular herbalist Susun Weed advises people to avoid taking herbs in capsules, and take herbs in teas for maximum effectiveness and safety. (This is also the best way to ensure that you are taking only the herb you want to take.) She explains that plants develop many compounds that make animals want to avoid eating them, and that these can be unhealthy if they are dropped into the middle of our digestive systems from a capsule. Our body's defenses against these compounds start in our mouths, where an early warning system tells the body what it needs to break down. A pill, she suggests, can bypass this arrangement and leave your body unprepared to digest the herb.

In any case, you should research any herbal treatment you want to try, as they are more likely than vitamin or mineral supplements to interact with other medications. As a rule, you should not take them with sleeping pills of any type. Your doctor or pharmacist may not be familiar with these interactions, but that does not mean there is no danger.

Chamomile - A cup of chamomile tea half an hour or so before bed is a traditional relaxation remedy with a growing number of modern fans. This herb is safe enough for children. Chamomile may cause ragweed allergy if used daily over long periods of time, be cautious of this herb if you presently have a ragweed allergy. Do not use with alcohol or sedatives.
Passionflower - This herb has a mild sedative effect, and has also been traditionally used to relieve pain. It is most helpful to relieve early morning awakenings. Passionflower should not be used during pregnancy, or in combination with antidepressants or benzodiazepines.
Valerian - This popular herb acts as a mild sedative, and is an effective and gentle treatment for insomnia. Do not use with alcohol, sleeping pills, or antidepressants.
Vervain (verbena, lemon balm) - Mild relaxant that's helpful for insomnia. Do not use during pregnancy, may stimulate uterine contractions.

Supplements: Certain supplements are recommended as part of a natural preventive therapy. Please remember that while supplements are typically very safe, not all of them should be combined with prescription therapies or with certain medical conditions. Certain supplements can cause adverse effects if taken in large quantities. Some supplements should be taken together, and some should be taken alone. No food supplement should be taken as though it were candy. Look for hypoallergenic products that are labeled as being free of common allergens.

These statements have not all been approved by the FDA, as per their guidelines on food supplements.

5-HTP - This supplement improves your body's ability to manufacture serotonin, which regulates sleep and digestive cycles. This supplement is the chemical step in the body between the amino acid tryptophan (which is no longer sold on its own) and serotonin. Some people find that they become drowsy an hour or so after taking it, so it may be best to try it in the evening and see how it affects you. This supplement can positively affect the mood, and is considered a natural remedy for a mild case of the blues. Do not take 5-HTP with milk, or other protein rich foods, as this may decrease it's effectiveness. Do not take this supplement if you are taking a medication which affects your serotonin levels, particularly SSRIs like Prozac, Paxil, or Zoloft.
Beta-carotene - 10,000 IU daily, as a general rule. Take higher doses only under the direction of a physician. Take this instead of Vitamin A to be sure that you don't get too much. Your body turns beta carotene into vitamin A as needed.
B vitamins - Take a balanced B complex vitamin to avoid getting too much of any of them. B vitamin deficiency can be a cause of insomnia, though large doses of B vitamins can act as stimulants, so avoid them in the evening. Sufficient quantities of B vitamins are necessary for the proper metabolism of many nutrients, like iron. These nutrients can be found most commonly in eggs, meat, liver, fish, and various whole grains. Individuals especially prone to deficiency include smokers, heavy drinkers, vegetarians, pregnant women, women taking oral contraceptives, and anyone experiencing significant amounts of stress.
Calcium and Magnesium - Be sure to take these minerals together, with roughly twice as much calcium as magnesium. These minerals are natural relaxants, and are rapidly depleted during times of stress. Few people get enough in their diets for optimum health. Calcium should not be taken with meals, or with iron rich foods. Large amounts of protein, fat, sugar, and phosphorus (contained in most soda) can interfere with calcium absorption. A dose of 500 mg of calcium with 250 mg of magnesium at bedtime seems optimum.
Coenzyme Q10 - Helps improve poor circulation, which can be a cause of restless legs syndrome.
Folic Acid - 400 mcg daily. While this is one of the B vitamins, and may be included with a B-complex supplement, it is an especially important nutrient for women and some insomniacs. Deficiencies can also result in restless legs syndrome.
Iron - Iron deficiency may result in restless legs syndrome or poor sleep quality, though supplemental iron should be taken only under the supervision of a medical professional. Do not take iron in supplements, unless your doctor has advised you otherwise. Iron can be found in abundance in dark, leafy greens, eggs, fish, meat, molasses, whole grains, beets, bran, dates, pumpkins, raisins, and soy. Vitamin C consumption (supplemental or natural) improves iron absorption, while vitamin E and calcium can interfere with it and should not be taken with iron rich foods. Overconsumption of iron can be particularly damaging to men and young children. (Box cereals containing iron generally do not contain it in a form digestible by humans, so it is not likely to help if you are deficient in this nutrient. This is a deliberate action taken by food processors to protect children from overconsumption of iron.)
Melatonin - This is a natural hormone which regulates the sleep cycle. Melatonin production decreases with age, and the supplemental form seems to help many adults sleep better. This should be taken anywhere from 2 hours to half an hour before bedtime, and a good starting dose is 0.5mg, up to a maximum of 10mg. If you feel groggy in the morning, you've exceeded your ideal amount. Taking melatonin constantly can stop your body's own production of this hormone, so use it as infrequently as possible. Bananas, barley, corn, ginger, oats, rice, and tomatoes are all natural sources of melatonin. Pregnant and nursing women, individuals with immune disorders or cancers, and healthy children should not take supplemental melatonin as safety studies have not been conducted.
Potassium - Deficiency linked to restless legs syndrome, helps improve circulation and aids in calcium absorption. Try eating more high potassium foods such as apricots, avocados, bananas, brown rice, figs, garlic, mangoes, mushrooms, nuts, oranges, radishes, spinach, sweet potatoes, tomatoes, wheat bran, yams, or yogurt.
Vitamin D3 - 1000 IU daily, but no more. Helps metabolize calcium. You can also get vitamin D from sunlight, try making sure that you get a few minutes of exposure either before 11am or after 3pm, every day.
Zinc - 15-25 mg daily, no more than 75mg. Promotes immune health and tissue recovery in delta sleep. May decrease incidence of restless legs syndrome.

Sleep Hygiene

These simple tips can usually help relieve most cases of short term insomnia, some cases of chronic insomnia, and can help to prevent recurrences. Some individuals with chronic insomnia who need medical intervention find that after treatment helps them resume normal sleep patterns, these practices help them maintain their good sleep in the long-term.

Bed: Beds should only be used for sleep and intimacy, especially if you have difficulty sleeping. Reading, watching television, catching up on work, etc., can lead to bad sleep habits. You may come to associate getting into bed with less restful activities, and even feelings of frustration. If you can't sleep, try getting up and going into another room to engage in a calming activity, then come back to bed when you feel tired.

Bedroom: Your bedroom should be dark and quiet at night. The temperature and amount of covers should be comfortable for you. Some people find that a bedroom decorated in soothing or neutral colors helps them to get in a relaxed frame of mind before lying down.

Clocks: While you want to be able to reach and hear your alarm clock, you shouldn't watch it while you're trying to go to sleep. It can keep you from falling asleep. Try turning it to the wall if you need to break a clock-watching habit.

Exercise: The usual recommendation for exercise is 2-4 sessions of aerobic exercise per week, for 20-30 minutes. Some doctors suggest daily exercise, though it often takes a while to work up to that, and many people don't have the time.

We all know that most of us fall short of the ideal and then become so discouraged that we give it up entirely. That's a shame, because the point of encouraging physical activity is that you just get more. Insomnia, sleep apnea, and many conditions not related to sleeping, all respond positively to getting more physical activity. Extra exercise even improves your mood by elevating your endorphin (feel-good chemical) levels, and it's the rare person who wouldn't benefit from an extra pick-me-up.

So, more than what? More than you're getting right now. While optimal benefits can be had from getting 20-30 minutes of aerobic exercise 3-4 times a week, some benefits can be had by going for an extra walk around the block a couple times every week. It may take a long time before you work up to an optimum amount of exercise, but you gain in small steps the whole way. Just remember to exercise no later in the day than 3 hours before bedtime, as you may find that you are unable to wind down.

For people with chronic pain, chronic illness, or fibromyalgia, exercising for the recommended amount of time may sound like torture, and it may make you feel worse. When you don't feel well, just try a little stretching. If you're feeling a little better, go for a walk, or try some calisthenics in your room. But don't tire yourself or do things that you know will make you feel worse, and try to quit while you're ahead. If you can go a little farther than usual, great. But always stop before you feel tired. A steady schedule of moderate exercise is more effective than heroic efforts that leave you unable to exert yourself for a week. If you're patient, you can often slowly recover many benefits of the fitness you had before you became unwell.

Naps: Some doctors suggest napping during the day as a way to get a second wind, and our bodies do seem to wind down just a bit in the afternoon. Other doctors say that sleeping during the day can prevent you from being tired enough to fall asleep easily at night, or from sleeping deeply. While napping can't replace a good night's rest, it works great for some people. Everyone is different, so if you feel tired during the day, you might want to experiment and find out for yourself. Try it a couple times and see if it helps you get through the day occasionally, but also note if you then have more trouble falling asleep at bedtime. Remember that if you sleep too long in a day, your sleep may be shallower and less restorative.

Relaxation: For many people, relaxation is difficult and unfamiliar. Learning to relax often requires instruction and a significant amount of practice, even though it sounds like it should be easy. Really, it can be the hardest. Meditation, yoga, Tai Chih, breathing exercises, qi gong, biofeedback, hypnosis, and neurolinguistic programming can all help individuals learn to relax. Find a class in your area, get a good relaxation tape, or speak to a counselor who is familiar with teaching one or more of these techniques. Learning how to release stress and tension at will is a powerful method for improving sleep and increasing your focus during the day.

Rituals: Develop some healthy pre-sleep habits that help relax you in the evening before bed. Find an activity that helps you wind down, and tells your body that it's time to rest, and leaves you feeling pleasantly calm. Avoid any physically strenuous or exciting activities, as they may simply get you keyed up. Examine your current evening activities to see if even minor changes in your current activities might leave you more relaxed when you head off to bed.

Routines: Sometimes keeping a regular schedule is the best prevention for chronic insomnia. Getting up at the same time each morning, even weekends, can help maintain a regular sleep rhythm. You can then work with your bedtime to see when you need to go to sleep in order to feel rested the next day. If you find yourself wanting to sleep in on your days off, it may be a sign that you aren't sleeping enough during the week. A consistent schedule can be especially important for teenagers who have sleep difficulties, as their body clocks shift during adolescence and are easily thrown out of balance.

Sleep Disorders and Children

There are several sleep disorders which affect children most often, like bedwetting, night terrors, or sleepwalking, which they typically grow out of. While bedwetting may be caused by an underlying condition (occasionally sleep apnea), it usually responds well to either behavioral therapy or medication. Unlike adult onset night terrors or sleepwalking, children with these conditions often have no obvious physical or emotional problem, and are as likely as other children to be well adjusted during their waking hours.

However, childhood onset of sleep disorders such as insomnia, sleep apnea, or narcolepsy, are likely to continue into the adult years and may prove difficult to treat. If your child is often groggy, falls asleep in class, or seems 'lazy' at a young age, a chronic sleep disorder may be at the root of the problem. It's best to diagnose these disorders quickly, as they may seriously interfere with later schooling or work performance, disrupting a person's ability to succeed in life.

Teenagers often have trouble sleeping at night and getting up in the morning, but if this condition has not been present since childhood, it will usually correct itself with age or a structured sleep hygiene regimen. It is important that adolescents get up at the same time every morning, even on weekends, as this is usually the best way to ensure that they will fall asleep early enough at night. Poor sleep in these years strongly affects their ability to form memories and learn new tasks, and may have a negative impact on academic performance. During adolescence, a person's body clock seems to be easily disturbed and during this time of physical growth, a teenager may need more sleep than they think they do.

If your child or teen experiences difficulty staying awake all day, has a hard time falling asleep at night, or wakes up tired after a full night's rest, consider having them evaluated for a sleep disorder.

Sleep Disorders and Pregnancy

Prescription sleep aids or antidepressants, and some herbs, should not not be taken during pregnancy, and most of these are not compatible with breastfeeding. Tranquilizers and narcotics may cause birth defects, or might result in withdrawal symptoms in the infant. Very few drugs have been approved as safe during pregnancy, and doctors wisely hesitate to experiment with this.

If you have a sleep disorder, or other condition for which you are taking medication, consult your doctor about alternative treatments if you are planning to become pregnant.

Consider relaxation training, biofeedback, hypnosis, or acupuncture to relieve insomnia caused by stress. Consider a gentle stretching and exercise program to maintain circulation to the legs, as pregnancy sometimes induces restless legs syndrome. Vitamin therapy is particularly safe, and deficiencies are more common during pregnancy, although you should not take high doses of fat soluble vitamins like vitamins A or D. Speak to your obstetrician and/or a nutritionist to be sure that your diet contains adequate nutrients and is well balanced.

Helpful nutrients:

Beta-carotene - 10,000 IU, but no more. Take this instead of Vitamin A to be sure that you don't get too much. This is important, as excessive vitamin A can harm a growing fetus. Your body turns beta carotene into vitamin A as needed.
B vitamins - Take a balanced B complex vitamin to avoid getting too much of any of them. B vitamin deficiency can be a cause of insomnia, and pregnant women need much more of these vitamins.
Calcium and Magnesium - Be sure to take these minerals together, with roughly twice as much calcium as magnesium. These minerals are natural relaxants, can decrease the incidence of restless legs, and prevent your body from being depleted of these minerals during the fetus' bone formation.
Coenzyme Q10 - Helps improve poor circulation, which can be a cause of restless legs syndrome.
Folic Acid - 400 mcg daily. While this is one of the B vitamins, and may be included with a B-complex supplement, it is especially important for fetal development and deserves special mention. Deficiencies can also result in restless legs syndrome.
Iron - 30 mg daily with vitamin C to promote absorption. You may easily become deficient in this mineral and and iron deficiency may result in restless legs syndrome.
Potassium - Deficiency linked to restless legs syndrome, helps improve circulation. Try eating more high potassium foods such as apricots, avocados, bananas, brown rice, figs, garlic, mangoes, mushrooms, nuts, oranges, radishes, spinach, sweet potatoes, tomatoes, wheat bran, yams, or yogurt.
Vitamin D3 - 1000 IU daily, but no more. Helps metabolize calcium. You can also get Vitamin D from sunlight, try making sure that you get a few minutes of exposure either before 11am or after 3pm, every day.
Zinc - 15-25 mg daily, no more than 75mg. Promotes immune health and may decrease incidence of restless legs syndrome.

Sleep Disorders and Seniors

While it is a myth that seniors no longer need to sleep as often, it is true that their sleep quality or ability to get to sleep may diminish significantly with age. Delta sleep, the deepest and most physically restorative stage of sleep, may all but disappear. This can be caused by, and worsen, chronic pain conditions and metabolic disorders. Also many prescription treatments for conditions more common in the elderly, such as high blood pressure, may cause sleeplessness. Conditions such as insomnia, sleep apnea, periodic limb movements or restless legs become more likely and may rob them of sufficient deep sleep to feel restored in the morning.

Elderly patients also tend to process drugs through their system more slowly, which can increase the likelihood of medication interfering with sleep or of sleeping pills causing daytime sedation. If you use sleeping pills or tranquilizers, the possibility of daytime motor difficulties, mental impairments, and memory problems is increased, as well as the risk of falls. If you need to take sleeping pills, take the smallest possible dose, and ask your doctor for medications that are passed out of the bloodstream as quickly as possible. Be sure, also, to see if changing other medications or dosing schedules can alleviate your sleep problem without having to take a prescription treatment.

Try not to sleep more than you did before retirement, and maintain a regular sleep schedule. Naps should be foregone when possible, although they may be unavoidable when chronic pain disturbs your regular sleep. Try to avoid watching television or reading in bed, as you may come to associate your bed with activities that you want to stay alert for.

Retired people need to make sure that they get enough activity and stimulation during the day, or they will almost certainly have trouble sleeping at night. Exercise can fill this need, as well as maintain the stamina and muscle tone that help facilitate good rest. Activity will also stimulate the metabolism, which can potentially prevent unwanted buildups of medication.

If chronic pain or joint conditions interfere with physical activity, consider finding a nearby facility where pool exercises are offered. Without as much weight on the affected bones and joints, exercise may become easy again. Gentle exercise such as Tai Chih and regular stretching can also help maintain flexibility without causing too much stress, and may help with muscle aches.

Links and References:

American Sleep Apnea Association

Breathe Right strips for reducing upper airway resistance.

National Sleep Foundation

We Move More information on restless legs syndrome, and other movement disorders.

Books - These can be purchased at most online book sellers or acquired through your local bookstore.

"No More Sleepless Nights" by Peter Hauri, Ph.D, and Shirley Linde, Ph.D, has been an invaluable reference. If you wish to learn more about self-care options and standard medical treatments for these disorders, this book touches on everything.

"Prescription for Nutritional Healing" by Phyllis A. Balch, CNC, and James F. Balch, MD is a good source for planning sound use of food supplements and herbal treatments. It covers self care for many conditions besides sleep disorders, and is very comprehensive.

This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. The dosages mentioned are general manufacturers guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. Dosage recommendations for children and seniors may vary significantly from standard dosages, and pregnant women should always speak to their OB/GYN before taking any medication. We have made every effort to ensure that the information presented is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.