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Episode Transcript

Jenn: Hey everyone, welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

So, hey folks and welcome. I would like to introduce myself. I'm Jenn Kearney, and I am a digital communications manager for McLean Hospital. Wherever you're joining us from today, whatever time you're joining us today, I hope you're having a great day.

So, today's discussion is all about sleep and its relationship to our mental health. And as it turns out, there's actually a science to getting quality sleep and there's even more science behind how our health impacts our sleep and vice versa. And even though many of us are sleep deprived, myself included.

Those of us with mental health conditions are more likely to feel the impact of less sleep. In some research I was doing before the session, I discovered that about sleep problems tend to affect just about 80% of patients in psychiatric practices. So, the impact is there.

Over about the next hour-ish, maybe a little less, I will be talking with Dr. John Winkelman about the relationship between sleep disorders and our brains. We'll take some time to talk about the importance of sleep cycles for our mental health and functioning, chat about how we can treat sleep disorders and mental health conditions and talk about ways to improve our quality of life through getting a good night's sleep. So, I'm super excited to introduce John to all of you.

So, John Winkelman, MD, PhD, is a psychiatrist and the chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital. He's also currently a professor of psychiatry at Harvard Medical School and his research has primarily focused in two areas. Number one, epidemiology, physiology, cardiovascular consequences, and treatment of restless leg syndrome and two, the neurobiology and the treatment of insomnia.

So, John, hello, I'm super excited for you to be here today and thank you for joining. I did have a few questions that I wanted to get started with. So, let's dive in. First and foremost, can you provide some insight into the short and long-term importance of getting a quality night's sleep?

John: Sure, of course, Jenn. Obviously the, probably the essential or key question and it gets to maybe even a more fundamental question, which is what is the function of sleep? What does it do? And I have to say that after 30 years in the sleep field, I'm embarrassed to still say, I don't know. Sleep clearly has many functions.

We're not exactly sure how they work, how sleep interacts with these functions, but it serves metabolic purposes for the body. It clearly serves functions of memory consolidation, it is involved in learning and recent data suggests that during sleep, we are most able to clear toxins from the brain.

So, if we think about the reduction like Jenn had last night and seems to have on a regular basis of sleep, not getting enough sleep, they're going to be a variety of negative consequences in each of those areas.

In terms of those people with psychiatric illness, it generally is destabilizing, so that it makes it harder to manage mood, anxiety, and psychotic disorders and potentially substance use disorders as well. In the short term, people will find that if they don't sleep enough, they're going to be sleepy, they're going to probably be more irritable, have difficulty concentrating.

In the long term, there's probably an association, as I said, with metabolism, so harder to control blood sugar, harder to control weight, more difficulty with memory consolidation, learning new things. And there's a variety of evidence suggesting that chronic sleep problems increase the risk for mood disorders like, bless you, like depression.

And we'll probably have an opportunity to talk about this bidirectional relationship between sleep and psychiatric illness. Sleep problems can cause or increase the risk for psychiatric illness. And the reverse is true, psychiatric illness can increase the risk of sleep problems. So, it's kind of a chicken and egg phenomenon.

And so, I generally try to treat both, rather than choosing, oh, which one should I choose? Which one should I treat? The depression or the sleep, I generally would say treat both. So, at that I'm going to stop and let Jenn and others ask other questions.

Jenn: So, I didn't realize my camera's still on. So, I sneezed for people who were confused as to why John said, "bless you," but thank you. So, I'm curious about how common sleep disorders co-occur alongside mental health conditions? And which ones are most commonly occurring together, or does it tend to vary by person, age? What factors are there?

John: Yeah, well, the most common sleep disorder is insomnia. So, 10 to 15% of the general population will have chronic insomnia, meaning at least three times a week for at least three months. That's what chronic insomnia disorder is.

And as I said, the most common sleep problem, it is much more common in those people with psychiatric illness, then the general population and, in particular, anxiety and mood disorders, but psychotic disorders as well, some of the substance use disorders in addition.

The second most common sleep disorder is obstructive sleep apnea which is a disorder in which the upper airway collapses during sleep and our bodies have to choose whether to breathe or sleep. And so, you wake up very briefly, a few seconds, take a few breaths, go back to sleep.

And this is more common in people with psychiatric illness as well, when I ran the sleep disorders lab and clinic at McLean, which was from 1991 to 1996. When I was just a young man, I did a lot of consultations to people on the psychotic disorders unit, and recognized that there was a lot of sleep apnea in this population of individuals.

And some of that was probably related to the weight gain that is produced by some psychiatric medications, but it also may be influenced by those medicines themselves. So that's an important relationship that we should think about.

Next, I'm going to think about circadian rhythm disorders, in which there's really not a problem with sleep per se, but rather it's the timing of sleep. When does it happen? So, there are people who have a delayed sleep phase, they can't go to sleep till really late, then they can't wake up until late in the morning.

And then there are people with advanced sleep phase, they may fall asleep super early and then wake up kind of what some other people might call the middle of the night. And those sleep disorders, those circadian rhythm disorders also can be associated with various psychiatric illnesses.

Finally, I'll just mention restless leg syndrome, which is a disorder in which people's legs feel very uncomfortable, tingly, creepy-crawly at night and they have to move them to get them to feel comfortable. And that is also probably a risk for psychiatric illness, as well as having psychiatric illness cause it. And some of the medications, particularly the serotonergic reuptake inhibitors, SSRIs, can produce restless leg syndrome.

Jenn: So, we had someone write and I know that you were talking about circadian rhythms and just like when you can be asleep. Someone wrote in saying "I never seem to be able to sleep more than four hours at a time without waking up. Is this common? And do you have any suggestions for staying asleep for longer periods of time?"

John: Sure, so that's a classic insomnia complaint or description where people have problems maintaining sleep. Now, to some extent, this could be normal depending upon age, as people get older, it becomes more and more difficult to maintain sleep throughout the night.

The secret that I'll tell you is that and I know this from looking at thousands and thousands of sleep studies is that we all wake up many times, not only per night, but many times per hour, it's normal to have five to 10 three to five second awakenings per hour of sleep.

That's totally normal. Sleep is not a static state. It's not like turning off the lights and eight hours later you come and turn back on the light. There's a lot going on during sleep and that involves fluctuations from sleep to wake.

But it's clear that these awakenings are long enough for you to remember them. And it sounds like it's bothersome to you. And there are many ways that we can address insomnia. When I see patients with insomnia, I spend a full one hour just trying to understand what's going on.

So, for me to kind of come up and say, I can see through my computer screen here that the cause of your problem is X and that the treatment is Y. That would really be misleading.

But I can tell you that the most common causes of insomnia are mood and anxiety disorders or other psychiatric illness, medications, pain, things that cause shortness of breath, difficulties needing to pee overnight.

And then any neurological disorder is going to interfere with sleep as well, because the brain makes sleep. And so, what we generally try to do is treat underlying causes of insomnia, if they're present, if we can identify them.

If we can't identify any co-occurring psychiatric or medical reasons, then the two main approaches are either cognitive behavioral therapy for insomnia, CBT-I and this is different than CBT for mood or anxiety disorders, it's CBT for insomnia. And if that doesn't work, because CBT-I is first-line treatment, if that doesn't work, then we will use medications.

So that's kind of a general overview of how we treat insomnia. One, we try to identify underlying medical and psychiatric causes. And if those are present, we address them. If we can't find what we would call comorbid or concurrent problems, then we will turn to CBT-I. And if that doesn't work, then we would use medications.

Jenn: So, thanks to the internet, there's a ton of varying advice out there. And I would love some clarification on this. If we're having trouble falling asleep, should we stay in bed or should we get up and do something?

John: Yes, well, the psychologists would call this stimulus control, which is a fancy way of saying that over time, people with insomnia start to associate the bed and even their bedroom with anxiety about being awake. And so then if you didn't have that anxiety, then you'd wake up and you might be able to go right back to sleep in a minute or two.

But if you have that conditioned anxiety, if it's happened many, many, many, many times and you start associating the bed with, "Oh my God, I'm awake again," "How long am I going to be awake?" "I don't want to have another night like last night, that was terrible" or "I was up for an hour and I got a big day tomorrow. And I'm going to mess up in my interview with Jenn and it's going to be so embarrassing."

And all these thoughts start to develop in your head. And all that anxiety, whether it's physical anxiety, mental anxiety, starts to be associated with the bed and the bedroom. So, stimulus control means that you get away from that conditioned stimulus, the stimulus being the bed, because now the bed after years of insomnia or even weeks of insomnia, you start being anxious just being in bed awake.

And so, some people will say "you have to get out of bed, go to another room and read." I'm not so strict about that myself in my own practice with patients. I think what produces the anxiety for many people is not necessarily the bed or the bedroom, but it's the trying to fall asleep.

And the kind of quiet that's in your head when you're trying to fall asleep or hopefully it's quiet. In fact, what rushes into that quiet is all the nervy things that are going through your head. And so, I can say to people, you don't necessarily have to get out of bed, but I want you to try to stop falling, don't try to fall back asleep immediately. If your mind is going, you know, like a gerbil on a wheel.

Once your mind starts going like this, you have to say time out, let's take a break, stop trying to fall asleep so hard and let's get a little book out or do a Sudoku, something that I call R and D, relaxation and distraction. And this is the opposite of the anxiety gerbil kind of thing.

And whatever that might be for you. For some people, it might be a podcast, for some people, it could be the sound of waves, even for some people it could be television, because many people associate TV with falling asleep.

And so that is what helps them fall back asleep. So, we try to identify what it is that they associate with falling back asleep or falling asleep, maybe at the beginning of the night and then reintroduce that in the middle of the night.

And then over time, hopefully we break this association that people have developed of the bed and insomnia or the bed and anxiety about insomnia. I call this insomnia phobia, because that's really what happens over time is people develop insomnia phobia.

And it's not the pain that they had in their hip that kept them awake, you know, before that's now keeping them awake right now over time, what happens is this insomnia phobia develops and then that's what's keeping them awake. So, we want to break that association.

Jenn: So that actually segues really nicely into my next question, because it sounds like these are some components of CBT-I, maybe that's part of the treatment. But can you provide a little more insight into how CBT-I differs from traditional CBT?

John: Yes, of course, they have the same letters CBT, but in many respects they're quite different. And it's really important if you're going to do a CBT-I treatment with somebody that you make sure that they know that this is not regular CBT, that they've been trained in CBT-I, because the components are different.

It's a multi-component, I call it really an educational program or also could be considered therapy as well. The first component and this may be the most important one is restriction of time in bed.

So, most people with insomnia, as their insomnia develops, they spend more and more and more time in bed. So, to get eight hours of sleep, they used to spend eight hours and 15 minutes in bed, because it took them 15 minutes to fall asleep and then they'd sleep through the night.

Over time as they were having problems falling asleep or returning to sleep, they realized that they couldn't get the eight hours just in the eight hours and 15 minutes in bed. So, they start spending more, "I'm going to go to bed an hour earlier, because I know it's going to take me an hour to fall asleep.

And then I'm going to sleep an hour later in the morning, because I was up in the middle of the night for an hour." So now they're spending 10 hours in bed to try to get eight hours of sleep. And unless you're kind of a teenager or a very young adult, there's no way you can get 10 hours of sleep.

So now you've baked into the night two hours awake, because you can't get 10 hours of sleep. All their body can make is eight hours of sleep. So now that is established that they are going to be awake two hours in the middle of the night.

So, this time in bed restriction or sleep restriction therapy, returns bedtime and wake time so that they're eight hours apart. Now, what happens over the first couple of weeks is people get sleep deprived, take somebody with insomnia and now they're sleep deprived, because they've still taken time to fall asleep and they're still awake in the middle of the night.

But after the first couple of weeks, now they become increasingly tired during the day. And therefore, it's easier to fall asleep and easier to fall back asleep in the middle of the night. So, the 10 hours' time in bed now is only eight hours' time in bed. And now you find that they're getting most of that time now asleep. So, this is the core feature.

And for most people it's not eight hours, they say "I'm only getting six hours." So, I really limit people's time in bed, oftentimes to about six hours between the time they put their head on the pillow and close their eyes to the time the alarm goes off. And at the beginning, it's really hard. This is a no pain, no gain approach. And they wake-up cursing the name Winkelman.

When the alarm goes off, they say, "I just got back to sleep an hour ago, now the alarm is going off and Dr. Winkelman is making me get up" I say, yep, just hang in there, over the first few weeks you're going to find it's a lot easier to fall asleep, stay asleep, go back to sleep and then we'll gradually increase it. So that's sleep restriction.

Next component is the stimulus control that we talked about. If you're not falling back to sleep and the gerbil wheel is going in your head, take a time out, do the R and D, relaxation and distraction till sleep wants to come back, which it does, it's a strong drive, just you can't get in the way of it with your anxiety. So, you have to be thinking other things rather than the worries about sleeplessness.

The third component is relaxation therapies, whether it be a progressive muscle relaxation, the physical part of it or the mind relaxation, whether it be mindfulness or meditation, listening, you know, counting, breaths, that kind of stuff.

And the fourth component is sleep hygiene. And this is the stuff that we all, you know, kind of know, but don't necessarily follow, no caffeine after noon, no alcohol in the evening, exercise in the morning, but probably not exercise at night, quiet, dark room and very importantly, same bedtime. And even more importantly, same wake time, seven days a week.

Weekends are a social invention. There's no reason why our bodies should have a different timing two days a week, just because you don't have to go to work, than the other five days a week.

So, there are many people that would have what's called social jet lag. On weekends, they go to bed later and they sleep later by two or three hours. And this is really not a good plan for sleep and it really does mess up sleep.

So, bedtime and wake time should be really pretty much the same seven days a week. Most importantly is wake time, because that's when we get light and light is what sets our internal clock.

Jenn: So I know over the last year or so at this point we've had a lot of people having a really hard time sleeping, because of current events, but one group of people that's been having a hard time, even outside of the pandemic has been teens.

So, is there any correlation with screen time impacting teen and preteen quality of sleep? Or are there other factors at play around kids in that age range, developing sleep issues?

John: Yeah, it's clearly a time of a lot of change, a lot of stress, a lot of distress these teen years. And the last year has even been more so, because so many of their usual rhythms have been broken up. Now for some people, there's been a kind of a relaxation of it, because there's much less FOMO, people aren't missing out, there's nothing to miss out on.

So, for teens, they're less anxious about, what they're missing out on but for many people, they just feel stuck. And there's very high rates of severe psychological distress among teens. And this has been documented in a number of ways and the least stress are among people over the age of 55.

And I mentioned this to my son, who's in his early twenties. And I said, do you see, you know, look at this data, teens, very high levels of distress, people over the age of 55 with the lowest levels of anybody, any subgroup.

And he said, "of course," he said, you know, "it doesn't matter if there's really not much you can do, because you didn't have a life before this. And so, it doesn't matter if you can't do anything."

Whereas, you know, he was saying "I had a life." So, I think that there's a lot of stress, a lot of distress. In particular, I think screens can be a significant issue for a few reasons. One, I think this is most important. They're associated with psychological activation. What we're watching on screens is generally not very chill, it's more stimulating.

So, you know, it's a movie, and movies may not be so quiet, it's the news and the news is oftentimes not good or they're on Facebook or Instagram and they're looking what other people are doing and there's anxiety associated with that. So, there's that psychological distress about what the content is.

Then the other part of it is that the screen itself produces wavelengths of light that may be stimulating. In particular, it is thought that blue wavelengths are more activating whereas the red ones are not activating.

Many people's laptops at this point have, can't remember what it's called, night phase or something like that. Or if you're laptop or whatever device you're using doesn't, there's a nice website called f.lux, which changes the wavelength of light in the evening so that there's less blue light.

People can also get blue light blocking glasses, if they want, I think that that really may not be necessary, but it certainly produces a good look, if that's what you're into. Although you're usually in bed at the time, so probably no one's seeing you.

But if you can just block that from the screen, your phone or your iPad or whatever device you're using, f.lux is quite helpful. So, I think both the content of what's coming from the screen as well as potentially the light that's coming from the screen can be stimulating and interfere with sleep.

The key, as I said before, I think more important than light at night is making sure you get bright light at the same time every day. And I encourage young people to put their shades up.

So when the light comes up in the morning, you are getting light, you're going to be the early bird who's getting light in the morning, who's suprachiasmatic nucleus in the hypothalamus is getting this signal from the eye, even with your closed eyelids that it is light outside and it is now time to wake up.

And after you do wake up, then you get this light and it fixes, it sets our clock. This is morning. So that allows you 16 hours later to say, "okay, now it's time to sleep." But you have to have that time zero and that time zero is when you get light.

Jenn: So, I did want to ask, because I know that you said that screens are not great for before sleep. Do you know of any apps that would be helpful to helping people fall asleep?

John: You know, I don't, I probably should. Maybe I'm a little behind in apps. There's a lot of different apps that are available that provide all kinds of different sounds or stories that you can... Somebody just told me about one and I've already forgotten the name of it.

It depends what you're going to find most useful, whether it's sounds like the rain or waves, whether it's soft music, whether it's somebody reading you a story.

There are all of these apps, most them free that you can find on the internet or download from the Apple Store. And they should turn off after a certain amount of time, because you don't want them jabbering all night long while you're sleeping. You really just want it to go for 20 or 30 minutes and then automatically turn off.

Jenn: How accurate, 'cause I know so many people wear smartwatches to bed, I mean, I do, I keep my garment on all the time. How accurate are the sleep trackers that are in our watches versus any other devices that you might use in like a sleep lab?

John: Well, I'm not going to diss the sleep lab, because I read sleep studies for 30 years, they're beautiful, I love reading sleep studies. But they're inadequate in a number of respects in that you're not at home. And so, you're being asked to sleep in this foreign environment, which is difficult, but particularly for people with insomnia.

And further, it's only one night, whereas these devices are tracking sleep in your home environment, number one and number two, it's multiple, multiple nights. So, you get a much better picture of what's going on, it's like a video versus just a still shot.

That being said, most of these devices are making inferences, or conclusions about sleep from movement, really from nothing else. If you're moving, you're awake. If you're still for long enough, then it's sleep. And this is not always true, particularly for people with insomnia, because many people with insomnia have learned to just kind of lie there and be awake quietly.

And the equipment is going to think that, you know, your wrist device is going to think you're asleep. Similarly, for people who move a fair amount during their sleep, but are still sleeping, the wrist device is going to say that they're awake.

So, I think that they are probably better than nothing. Some of them are including more information than just movement, they may be incorporating heart rate. Some of them that you wear here, may be incorporating information either about eye movements or about EEG. And so, they're going to be much better. But we do need to be careful about conclusions that we make from them.

I'll just tell you very briefly about a study that was done in England in the last year or two, it was a really cool study and it tells you something about sleep. They took 30 people with insomnia and gave them all devices like yours Jenn, to wear at home.

And however, they programmed these devices, so that half the people with insomnia would have information in the morning that they slept poorly. And the other half of the people would get information that they slept really well.

And then they asked the people after a couple of weeks, actually they were asking them every day in the morning as well as throughout the day, not only how did you sleep, how do you feel you slept, but how irritable are you? What's your concentration level like? How much energy do you have?

And remarkably, even though there was no actual difference between the fake watch information and the real watch information, how they actually slept. The people who thought that they had slept poorly said that they were more irritable, had worse concentration, had low energy.

And the people who've been told that they slept well said, "I've felt much more energetic and much better mood." So, it's complicated, isn't it? So, there's the effects of sleep and then there's our conclusions. That then carry on and influence, how we feel during the day about how we slept.

And this is why for people with insomnia, it's really important as part of CBT-I to actually improve sleep, but also to counteract some of the inappropriate beliefs that people have about sleeplessness, because this is really what gets people, is these inappropriate beliefs. If I don't sleep seven hours straight, I won't be able to function.

And so, I'll say to people, how many times in your life have you, you know, in the last year, let's say, have you awakened two or three times during the night? And they said, "well, 90% of the time." And I said, how did you do at work the next day? Or with your loved ones? They said, "well, you know, I basically did fine."

And so, where do you then you get this idea, particularly these ideas take hold in the middle of night that you're going to be a total mess? And so, you need to kind of break these beliefs about sleep and how you feel during the day. And you know, at the very beginning Jenn asked me "well, what are the effects of sleeplessness?"

And I don't like to exaggerate them, because some of those effects are real, but the other part of the effects are our expectations of how we're going to feel after a bad night's sleep. And so, you really have to break those expectations that are unrealistic.

And sometimes they're catastrophic, people have all kinds of really exaggerated ideas about what's going to happen the next day if they don't sleep. And mostly those ideas are in our head in the middle of the night.

We don't think very clearly in the middle of the night, I mean, everybody's gone through this, the next day you think, "oh my God, why was I thinking those things in the middle of the night, they were way off base.

I was really super preoccupied and worried about X, Y, or Z. And now I realize it's not that such a thing." We're just not able to think clearly in the middle of the night. And it's important you realize that and this is one of the things that CBT helps with.

Jenn: So, do you have any recommendations for how to find a CBT-I specialist?

John: Even though I said this is first-line treatment for chronic insomnia, you'd think there'd be tons and tons and tons of CBT-I therapists and especially in the great mecca of medicine in Boston. But unfortunately, they're not, there's really just a handful. What I would recommend doing is there's a organization called Behavioral Sleep Medicine Society for Behavioral Sleep Medicine, something like that.

And they have a website and they have a list of people who provide cognitive behavioral therapy for insomnia, CBT-I. And I would go from that list of people who are established providers, because remember, there are people that do CBT-I for anxiety and mood, who think it's the same thing for insomnia and it's not. So, I would go to the Behavioral Sleep Medicine list.

There are also now, people should be aware digital CBT online providers. And these are programs that some of them are free, most of them are not free that you can sign up for, they're not personalized. They are basically algorithms, but it's kind of like reading a book that's somewhat interactive.

And you put in some of your information and it may then give you relatively generic feedback on maybe you want to, I see that you're spending this much time in bed. One, you try cutting down, changing your bedtime and wake time, but it's basically an algorithm, it's kind of a bot that's responding to you, not a person. But the evidence for digital CBT-I for people who engage with it and complete the programs is quite good for treating insomnia.

So it's a very reasonable place to start is try digital CBT-I, if for some reason it doesn't work and you feel like you need more individualized feedback, then you may want to go to an individualized, then go to the list of psychologists who provide CBT-I in a clinical setting. These days it's virtual, but usually it's face to face. But digital CBT-I has really, I think the wave of the future as the first line approach to chronic insomnia.

Jenn: So how do we know if we need to look for a sleep specialist?

John: I think anybody who has insomnia that is not responded to CBT-I should probably see a sleep specialist for a medical evaluation. Anybody who has excessive, daytime sleepiness, a difficulty staying awake during the day, even though you're getting adequate, let's say, seven to eight hours of sleep at night should see a sleep specialist in a medical setting, making sure there's no sleep apnea making sure that medications are not interfering with sleep or producing excessive sleepiness.

Anyone who has excessive movements during sleep. So, this could be restless leg syndrome, it could be a specific sleep disorder. It's called REM sleep behavior disorder, where people act out their dreams. So, you're dreaming, but you're not paralyzed. So, your moving around a lot, should seek out a sleep medicine evaluation.

Anybody with suspicion of sleep apnea, loud snoring, witnessed a bed partner who says that they hear you stop breathing or people who report shortness of breath awaking and short of breath during the night, there's strong suspicion of sleep apnea.

Particularly if you have hypertension or you have the physical features that are consistent with sleep apnea, which would mean overweight or obesity, a collar size in men that is, now I'm blanking on the inches. That is more than, you know what, I'm going to leave that aside, because I'm blanking on the exact number there, but we have a large neck or as I said, overweight. So again, sleep apnea risk.

I'd say those would be the main things. And then finally, anybody who has new-onset of sleep walking as an adult, should probably get sleep medicine evaluation. Many kids sleep walk, usually that resolves by the age of 10 or so, if it doesn't resolve and continues and is problematic, probably a good idea to get evaluation or if it just appears for the first time at the age of 30, 40, 50, 60, that probably suggests an evaluation too.

Jenn: Do you have any good sleep resources that providers can share with their clients? I know several folks have written saying that many of their clients who are struggling with sleep for a variety of reasons.

John: The American Academy of Sleep Medicine, AASM has a number of provider resources and patient resources, both online as well as hard copies that can be distributed. I would say that that's probably going to be the best resource is through the American Academy, AASM, American Academy of Sleep Medicine. I think that would be really the place to start.

There are sites, so Harvard has a healthy sleep site that those of us in the Division of Sleep Medicine at Harvard Medical School put together, Mayo Clinic has some offerings as well. If people subscribe to UpToDate, which is a resource usually for physicians, there's good physician related materials there, there's quite a bit that is available online.

Jenn: I know if you're a woman and you have the inevitable menopause period, there's a lot of women writing in saying that they encounter sleep issues during menopause. Can you explain if there's any correlation between irregular sleep and menopause and what you would recommend to aid poor sleeping during this transitionary period?

John: Sure, this is become quite common over the last 15 or 20 years as women less and less are going onto hormone replacement therapy. And so, the withdrawal of estrogen during the menopausal transition is certainly associated with an increased prevalence of insomnia.

And we don't really understand the mechanisms of this that, well, certainly one of the things that wakes women up during this period are hot flashes, which can be really quite disturbing and night sweats where people can really need to change all of their clothes, certainly their tops.

And then it's hard to go back to sleep. And so, for women who've been going through this and it clearly started in menopause, I think a big evaluation is probably not indicated.

However, CBT-I can be employed or medications can be employed that can assist with sleep maintenance, waking up less or falling back asleep more easily. There are some specific treatments that can address the hot flashes and night sweats.

So those medications could be attempted at least for some period of time until that's done. Some women unfortunately continue to have hot flashes and night sweats for years and years and years.

So, the transition becomes kind of a way of life for some people over a period of time. And the last thing is that men's risk of sleep apnea is much higher than women's until women go through menopause at which time the risk of sleep apnea goes way up in women postmenopausally.

So, women who start to have snoring, stopping breathing episodes should certainly be evaluated, if this is a nuance after menopause and certainly should be evaluated at any time, really.

Jenn: So, I know that we are starting to run out of time, I would be remiss if I did not ask about the effects of caffeine on sleep. And do you have any best practices beyond stop drinking coffee around noon?

John: That's really what it is. Caffeine is a great drug, but remember it is a drug, you know, it's probably the most commonly used drug in the United States and everybody loves it. And it's a wonderful assistance to feeling more awake, feeling more engaged, feeling more talkative. However, being awake, alert and talkative is not a good plan for when you're trying to go to sleep.

Some people are more sensitive to it than others. So, the exact time to cut off isn't clear, to be safe, I generally say noon. I'll hear people say to me, "oh, I can have a cup of coffee at 10 o'clock and go right to sleep." And God bless them, that's wonderful.

My guess would be that their sleep would be better if they didn't have the coffee then, but everybody makes their own decisions. But in general, I would say noon is the time to cut off.

Many people drink a lot of soda, many people who are taking medications that make their mouth dry need to drink something. So, they're having lots of diet sodas throughout the day, just make sure that it doesn't have caffeine in it. Caffeine really should stop at noon.

Jenn: So, I know that if you had a few bad night's sleep, folks might try to want to catch up or payback their sleep debt, which is one of the like new fun terms around it. Do you have any advice about the best ways to catch up or is that kind of an impossible task?

John: Well, you know, it fundamentally is impossible, because you lost that sleep and you were more tired, you were more irritable, you had more difficulty concentrating on those days that you just did. And so those days already happened. So, by getting sleep tonight, you can't be less irritable than you were two days ago. That already happened.

However, for people who need to be up at night and not get enough sleep, you're in a job setting where there's one or two days a week, let's say where you're going to be short-changed for sleep. I do think it's okay to sleep in after that, probably better, I shouldn't have said sleep in, probably better to go to sleep earlier and wake up at the same time, rather than going to sleep late and sleeping later.

Because remember that wake up time is really key, getting light first thing in the morning is key, setting our clock. So I would prefer if people were short-changed on sleep a couple of nights in a row, then on that third night, rather than sleeping in the next morning, you go to bed earlier to make up for that sleep and to catch up, because sleep deprivation is cumulative.

If you get one hour less sleep than you really need or want seven days in a row, it's almost like staying up a whole night at the end of that first week which is seven hours of cumulative sleep deprivation.

So, I would encourage people to try to make up, recognizing you can never really make up, because those days are past when you were sleep deprived. Going to bed earlier, i.e. falling asleep when you're sleepy, which is probably going to be earlier, but then trying to wake up around the same time.

Jenn: Got time for one more question, any last pieces of advice to get started on resetting our sleep schedule. How do I retrain my body to sleep better?

John: I think keeping sleep diaries is helpful. This way you can really monitor what's going on and you don't fill them out at night, for sure you fill them out in the morning. "Okay, what time did I think I tried to fall asleep?

Okay, it was about 10 o'clock and I think it took me about 15 minutes to fall asleep. I think I had two awakenings and I was up for a total of 10 minutes and I got up this morning at six."

How long did that take? Less than a minute. And you do that every morning. And then you start to see patterns of when you're sleeping poorly, when you're sleeping well, when you feel most rested and trying to keep bedtime and in particular wake time stable every night is a really good skill, a really good tool.

And for people who are having consistent problems with insomnia, I would encourage you to try to keep the amount of time that you are in bed, trying to sleep equal to the amount of sleep that you think you're getting.

If you think you're only getting 6 1/2 of sleep, I would probably try to make your bedtime and wake time 6 1/2 to seven hours apart, rather than nine hours apart. Keep it short and over a few weeks, you'll find that it's easier to fall asleep and stay asleep.

Jenn: I think that's a really great way to wrap up the session, 'cause I do know you've got to jump off, you have tons of other obligations. And John, I know that you said that you have decades of experience and clearly it shows you've given us so much valuable information.

I cannot thank you enough for taking the time to answer all our questions or as many questions as we could get through about sleep, our mental health and everything in between. So, thank you so much for joining and for everybody who joined us for the live session, thanks so much, this actually ends the session.

John: Thank you and hope everybody sleeps well.

Jenn: So, until next time, be nice to yourself, be nice to each other, wash your hands and don't drink caffeine past noon. Thank you so much, take care everybody.

Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don't forget, mental health is everyone's responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that's 877.870.4673.

- - -

The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

© 2021 McLean Hospital. All Rights Reserved.

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Podcast: Sleep's Relationship to Mental Health

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Jenn: Hey everyone, welcome to Mindful Things. The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show. So, hey folks and welcome. I would like to introduce myself.

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Hi there, My Name is Christopher Fitton and I am the face behind Sleep Cove. When treating people through Hypnotherpay for the last few years, and I realised how Sleep is such an important issue with many so people. So I've setup the Sleep Cove Podcast to help whoever needs some extra help with the free Podcast.

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Sleep Podcast, Youtube channel and website to help you sleep / Sleep Cove

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Hi there, My Name is Christopher Fitton and I am the face behind Sleep Cove. When treating people through Hypnotherpay for the last few years, and I realised how Sleep is such an important issue with many so people. So I've setup the Sleep Cove Podcast to help whoever needs some extra help with the free Podcast.

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‎Meet Moshi - a safe, fun, and entertaining app built just for kids. Moshi takes kids on extraordinary adventures in a magical world where they can play, explore, and relax - day or night. With over 85 hours of original audio stories, meditations, and music, as well as interactive mini games made u…

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‎◆ ◆ ◆ “New Apps we Love” - Apple ◆ ◆ ◆ ◆ ◆ ◆ “Struggling to Sleep? Try These Bedtime-Story Apps” - The Wall Street Journal ◆ ◆ ◆ ◆ ◆ ◆ “Protect And Boost Your Mental Health” - Forbes ◆ ◆ ◆ ◆ ◆ ◆ “Best sleep app” - Lifehack ◆ ◆ ◆ Trouble falling asleep? Try Slumber® for 5 minutes, and you’ll be…

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Adults generally need between seven and nine hours of sleep. About 1 in 3 people in the U.S. report difficulty sleeping at least one night per week. Insomnia is caused by difficulty falling or staying asleep, or waking up too early in the morning. Sleep deprivation is known to adversely affect mental health, so it's best to take efforts to improve or maintain good sleep. Here are some tips for getting better sleep.

Stick to a schedule. Aim to develop a regular sleep schedule and go to bed the same time every night.

Watch what you consume. Avoid consuming caffeine, alcohol or sugar before bedtime, or eating large meals.

Curb screen use. Shut down electronic, screened devices at least a half-hour before you plan to sleep, as the blue light they emit stimulates the brain.

Create a comfortable sleep environment. Is your bedroom cool and dark? Are your bed and pillow comfortable? Try to create an oasis that feels comfortable and cozy, so that getting into bed feels welcoming.

Employ relaxation techniques. Deep breathing, progressive muscle relaxation, body scan meditation, and mindfulness can help calm individuals and decrease anxiety about going to sleep.

Exercise. Studies show that exercise is associated with improved sleep quality. Talk with your health care provider about the kind of exercise that will work for you. Note on timing: Avoid exercise too close to bedtime.

Try therapy. Cognitive-behavioral therapy can help you control or eliminate negative thoughts and worries that keep you awake.

Find time to nap. A brief nap-up to 30 minutes-can help you feel alert again during the day. Even 15 minutes of daytime sleep is helpful. Avoid naps after 3 pm.

Don't fight sleeplessness. If you wake up and find you cannot fall back asleep, try getting up to reading a book or listen to music, instead of tossing and turning.

Be consistent. Aim to go to sleep and wake up the same time every day.

Talk to your doctor about medication and other remedies. If you suffer from insomnia, talk to your health care provider about medications and herbal remedies. Doctors don't generally recommend staying on medication for more than a few weeks for insomnia, but there are a few medications that have been approved for longer term use. The effectiveness of natural remedies, including melatonin and valerian root, have not been proven for most people, and neither treatment has been approved by the FDA. Also, avoid mixing drugs and alcohol with prescribed medications.

More on the Subject
Find out about sleep disorders
"Sleep Tips That Can Help with Depression" (NAMI National blog)

Sleep and Mental Health (Harvard)

COVID-19 and Sleep Disturbances (Standford Medicine)

Find more information on sleep and mental health from NAMI National.

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Better Sleep to Maintain Mental Health - NAMI California

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Adults generally need between seven and nine hours of sleep. About 1 in 3 people in the U.S. report difficulty sleeping at least one night per week. Insomnia is caused by difficulty falling or staying asleep, or waking up too early in the morning.

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Sleep for the brain is like gas for a car. When the tank is full we get where we need to be. But as time goes on, the gauge falls lower and lower until the gas is gone and the car stops. Without the fuel it needs, the car is useless.

Our brains operate in a similar way. The only difference is the brain's fuel is sleep. Without proper sleep, our minds begin to slow, unable to operate at their full potential. This happens until the mind becomes so deprived of the rest it needs, it breaks down. And without the commander-in-chief acting accordingly, the rest of the body pays the price.

In this guide, we are going to deep dive into the complex relationship between sleep and mental health, including how these two aspects of health are inversely related, the consequences of sleep deprivation on the mind, and the link between sleep disorders and mental health disorders.

You ready? We're really about to exercise your mind.

How Sleep Impacts Mental Health
Sleep is the mind's time to rest and recharge. When we get proper sleep, memories, emotions and new information are processed and filed away for our minds to retrieve later on. You know, so you can recall the name of the new coworker that started in your office last week. If you fail to get adequate sleep, well, let's just hope you don't run into that new coworker in the bathroom. Because sleep is the time our mind blocks for mental processing, it makes sense why we would be forgetful when we miss out on a good night's sleep. That's not all. Sleep is also the time emotional processing takes place. This is why if we miss out on precious rest, we are far more likely to silently curse the car who cuts us off in traffic, or worse.

While these may seem like comical examples of sleep deprivation's effects on the brain, unfortunately, the consequences are much more severe than forgotten names and road rage.

Consequences of Sleep Deprivation on Our Psychological State
The mechanisms of sleep disruption and mental health are complicated to understand. But what scientists do know is that sleep and mental health are intimately related. After all, it's during sleep that we process our emotions and memories.

Think about it like this: sleep for the mind is like the quiet hours at the office. When there is less to respond to, you get more work done. Same goes for the brain. When we are asleep, the brain can really get to work because it doesn't have to respond to all the external stimuli we encounter when we are awake. But if we rob the brain of this precious time, we pay the price.

Here are a few of the primary consequences sleep loss has on our psychological state.

Emotional Instability
Mood after a night of too little sleep.
Mood the night after too little sleep.

Have you ever noticed that when you miss out on sleep you tend to be more sensitive, easily irritated, or impulsive? There's a biological reason for that, and it has to do with two areas of the brain called the amygdala and prefrontal cortex.

The amygdala is in charge of our emotional responses. But to do its job correctly it needs us to sleep, because that's the time it's allocated to process emotion. When we miss out on sleep, the amygdala goes into overdrive, causing our immediate emotional reactions to intensify. In fact, one study using MRI brain scans showed that the amygdala was around 60% more emotionally reactive in participants who were sleep deprived compared to those who were well rested. Hence, why you are more prone to road rage after a night of poor sleep. It's not only negative emotions that intensify with lack of sleep; positive ones do too.

That's not all. The amygdala isn't the only area of the brain that gets hit with the consequences of sleep deprivation. Another area involved in emotional regulation, the prefrontal cortex, does as well. The prefrontal cortex does a lot of impressive things. One of which is being "the voice of reason" to our emotions (aka putting the brakes on our amygdala when it's being a diva). The prefrontal cortex helps control our impulses.

However, like the amygdala, the prefrontal cortex can't do its job properly when we don't sleep well. Much of this has to do with a disruption in communication between the amygdala and prefrontal cortex, who work closely with one another. This makes us more impulsive and less likely to think through our emotional reactions, which is a dangerous place to be.

The disruption of the amygdala in combination with the prefrontal cortex is what makes us more vulnerable to mood swings, erratic behavior, and increased emotional reactivity when we lose sleep. This is also why all parents dread when their teenager comes home from a sleepover.

Hormone Disruption
In addition to emotional instability, scientists know that lack of sleep causes a chemical imbalance in the brain. Some of the most valuable chemicals in the brain are our hormones.

Our body produces and regulates roughly 50 different hormones which act as chemical messengers for the brain, traveling through our blood and delivering messages from the brain to different areas of the body. Hormones influence appetite, weight, mood, immunity, growth, healing, and much more. In a word, hormones (amongst other things) allow us to function properly.

However, lack of sleep messes up the communication between the brain and it's messengers, causing our hormones to act incorrectly or deliver misinformation to the body. This is why sleep deprivation poses such a dangerous threat to mental health-there's a lot at risk if our hormones don't deliver the correct information across the body.

Hormone disruption caused by lack of sleep is mainly due to how sleep affects the endocrine system, particularly the hypothalamus which is attached to the pituitary gland. The endocrine system consists of several glands that secrete (aka produce) hormones. The mastermind behind the endocrine system is the hypothalamus.

The primary responsibility of the hypothalamus is to maintain balance in the body, including hormonal balance. It tells the glands of the endocrine system when to produce certain hormones and when to regulate others. Put another way, the hypothalamus tells the hormones what messages to communicate to the body and when. Much of this critical instruction from the hypothalamus is given during sleep.

At night, the hypothalamus instructs certain glands of the endocrine system to physically produce the following hormones and regulate others. But if we don't sleep, it can't deliver the proper information causing everything to fall out of balance. This puts our bodies in a state of chaos trying to find homeostasis again.

Although many hormone levels are influenced by sleep, cortisol (the hormone that impacts stress levels) has one of the biggest impacts on the state of our mental health.

Less Sleep, More Stress
Cortisol is a steroid hormone produced by the adrenal glands that plays a big role in our "fight or flight" response. It helps keep us alert. The production of cortisol is regulated by the pituitary gland (remember, the one the hypothalamus is connected too). It's very important for cortisol levels to be just right. If too much or too little cortisol is produced, there are consequences.

Unfortunately, when we don't get enough sleep, too much cortisol is produced. This puts our body in a constant state of stress, unable to relax. This is the reason individuals under a lot of stress struggle with insomnia-the increased amounts of cortisol keep them awake!

We know stress has a number of detrimental effects on the body, including impaired thinking, weight gain, and the inability to control emotions. The worst part is, sleep deprivation and stress contribute to a negative feedback loop that can be difficult to break and often results in mood disorders, anxiety disorders, and depressive disorders.

With heightened stress, comes heightened anxiety which can make you hypersensitive to all sorts of physical, mental, and emotional stimuli. For anyone diagnosed with mental health disorders or sleep disorders, additional stress can increase the severity.

Our mind is pretty complex, huh? Amazingly, this is only scratching the surface in terms of how sleep impacts our mental health. But what about how our mental state impacts sleep? That's a whole other fish to fry. I told you our sleep and mind have an intimate relationship.

How Mental Health Impacts Sleep
There's no denying sleep and mental health have a reciprocal relationship. Lack of sleep impacts mental health, and vice versa. One thing is for sure: when our mental health is on the rocks, our sleep is right there with it.

Research shows Americans with psychiatric conditions are far more prone to sleep issues and abnormal sleep habits. In fact, chronic sleep problems affect 50 to 80 percent of patients in a typical psychiatric practice, compared with 10 to 18 percent of adults in the general U.S. population. So what's the connection between mental illness and sleep disorders?

Mental Illness and Sleep Disorders

Traditionally, clinicians believed sleep disorders were a symptom of mental illness. Now, current research suggests sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. But it's not that simple. The link between sleep health and mental health is stronger and more complicated than ever.

It's important to note that the relationship between these two ailments varies in severity and complexity across different disorders. One mental illness may develop in part due to a specific sleep disorder, but it can also be a symptom of the same mental illness - creating a positive feedback loop. Some mental issues may show no causal relationships with sleep at all. And some sleep disorders have no relationship with mental disorders whatsoever.

The most common mental illnesses in the United States are anxiety and depressive disorders, affecting roughly 40 million American adults, of which 50 to 90 percent also have a sleep disorder. The most common sleep ailments for individuals with mental illness are insomnia (not being able to sleep) and hypersomnia (sleeping too much), with sleep apnea following close behind.

While the relationship is complex, here's what we know for a fact:

Sleep disorders are more common among the mentally ill
Lack of sleep can worsen mental illness and make it more difficult to cope with symptoms
It's very likely that treatment for sleep disorders will alleviate symptoms of mental health disorders
Those with mental health disorders often spend time in lighter, less restorative stages of sleep than deep, REM sleep, which is critical to health and healing
The relationship between lack of sleep and mental illness is particularly important to understand because it has the potential to become very dangerous when untreated. A University of Michigan study found a strong correlation between insomnia and suicide.

Common Mental Illnesses and Their Associated Sleep Disorders
Anxiety Disorder
Anxiety disorders are the most common mental illness across the United States, affecting 18 percent of the adult population. Anxiety disorders typically develop from a number of risk factors including genetics, brain chemistry, and life events. The good news is, anxiety disorders are highly treatable.

COMMON SLEEP PROBLEMS ASSOCIATED WITH ANXIETY DISORDERS
Insomnia
Hypersomnia
Nightmares
Night time panic attacks
Anxiety is a reaction to stress. While all of us experience and react to stress, the nervous system of those with an anxiety disorder fails to reset back to normal after fighting or fleeing the stressor. A heightened state of stress and anxiety keeps the nervous system alert, unable to relax enough for you to fall asleep. This is why insomnia is a common companion to anxiousness. Individuals with anxiety might also find themselves battling hypersomnia or oversleeping, as a response to the exhaustion from insomnia.

When anxiety is caused by trauma, such as PTSD, it's not uncommon for them to relive that trauma through a vivid, unsettling dream that jerks them out of sleep. For those with panic anxiety disorder, it's not uncommon for them to experience nocturnal panic attacks which take place during the lighter stages of sleep. The individual wakes up feeling extreme panic or fear, perhaps accompanied by sweats, pains in the chest, and increased heart rate.

Depression
Depression is a mood disorder that is far more severe than just feeling sad. We all experience low points, trying times, or stressors that bring our mood down-that is completely normal. It's when these negative moods persist and eventually manifest into harmful thinking or behavior that depression becomes a psychiatric disorder.

Roughly 16 million Americans suffer from depression, constituting 6.7% of the entire population. Depression is more prevalent in women and is the leading cause of disability in people ages 15-44. Fifty percent of depressed individuals also have an anxiety disorder as well.

COMMON SLEEP PROBLEMS ASSOCIATED WITH DEPRESSION
Insomnia
Hypersomnia
Sleep Apnea
Insomnia affects 75 percent of individuals with depression. Depressed individuals can struggle to fall asleep, stay asleep, and even wake up from sleep (hypersomnia). There has also been research that insinuates a relationship between sleep apnea and depression. In fact, individuals with sleep apnea are five times more likely to suffer from depression as well.

Attention Deficit/Hyperactivity Disorder (ADHD)
ADHD is one of the most common mental illnesses among children, affecting approximately eight to ten percent of school-aged children. It is a condition that consists of differences in brain development where attention, self-control, and hyperactivity are controlled.

COMMON SLEEP PROBLEMS ASSOCIATED WITH ADHD DISORDERS
Insomnia
Daytime Sleepiness
Sleep Apnea
Periodic Limb Movement Disorder (PLMD) and Restless Leg Syndrome
Both the symptoms of ADHD and the medication used to treat it result in fragmented sleep, as well as other sleep disorders. Seventy-five percent of individuals with ADHD suffer from insomnia, believed to be caused by a delayed circadian rhythm. In addition to trouble falling asleep, individuals with ADHD can have trouble staying asleep as well.

A Final Note on Mental Health
It's important to understand that mental illness is just that-an illness. Just like you get a fever or a sore throat, it's not something you have control over and it's not something to be ashamed of! Mental illnesses, like physical illnesses, can be treated. They just might be a little harder to recognize than a pounding headache. If you suffer from a mental illness of any kind, don't be afraid to seek help. Just as we nurture our bodies back to health, so we can nurture our minds back to health too.

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Sleep and Mental Health: Why Our Brains Need Sleep

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Sleep for the brain is like gas for a car. When the tank is full we get where we need to be. But as time goes on, the gauge falls lower and lower until the gas is gone and the car stops. Without the fuel it needs, the car is useless.

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Mood Matters: How Food, Movement & Sleep Can Have an Impact on You

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Connection Between Sleep and Mental Health

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Connection Between Sleep and Mental Health

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Public awareness of mental health struggles has made leaps and bounds in the last few years, but have you ever considered how your mental health can affect your sleep and vice versa?

Twenty-five percent of Americans suffer from insomnia each year- in fact, it's one of the most common sleep problems worldwide. Insomnia not only impacts your sleep, but it can also affect your mental health by increasing your risk of anxiety, depression, and mental distress.

When it comes to the sleep vs. mental health question, it's not as clear-cut as one disorder causing the other. But, the presence of one often does indicate the existence of the other.

March 13th through 19th marks Sleep Awareness Week in 2022, and this year we wanted to take a look at the connection between insomnia and your mental health. So if you've struggled with insomnia and stress, keep reading to learn how the two are connected- and what you can do to take care of your mental health.

What is Insomnia?

Insomnia is a sleep disorder that makes it difficult to fall asleep and get adequate restorative sleep through the night. Some common symptoms of insomnia include:

Difficulty falling asleep or staying asleep

Waking up at least once during the night

Waking up too early in the morning

Excessive daytime sleepiness- or not feeling rested even after a full night's sleep

Irritability

Acute Insomnia

There's more than one kind of insomnia. Short-lived, non-recurring bouts of insomnia are called acute insomnia, or transient insomnia. Acute insomnia usually has a specific underlying cause and can last anywhere from a few days to a couple of weeks. Some causes of acute insomnia may include:

Traumatic events- such as a death in the family or divorce

Stressful situations at work

Certain medications, including stimulants, beta-blockers, some antidepressants, and even some sleep medications

Environmental discomfort- such as a heatwave

Sensitivity to temperatures, noise, or light

Chronic Insomnia

Unlike acute insomnia, chronic insomnia recurs for an extended period of time. This type of insomnia can last for at least three months or in some cases longer, and often occurs at least three nights a week. Some causes for chronic insomnia may include:

An irregular sleep routine or poor sleep habits

Medical conditions- such as chronic pain, heart disease, and asthma

Poor eating habits

Substance abuse- abuse of tobacco, alcohol, or other drugs

Mental disorders- such as depression, anxiety, or bipolar disorder

So now that you know that mental health disorders can cause insomnia, let's take a closer look at the relationship between the two.

The Relationship Between Insomnia and Mental Health

Approximately half of all insomnia cases are linked to anxiety or stress. However, the link between mental health issues and insomnia is bidirectional. That means that untreated insomnia can potentially lead to mental health problems, and those anxiety problems can also increase a person's risk of insomnia or its severity. One might trigger or make the other worse, but neither one is technically the root of the other.

When many insomnia sufferers go to the doctor for their insomnia, they actually neglect to report the mental health-related symptoms that may be affecting their sleep disorder. This failure to report symptoms often leads to an incomplete assessment and ineffective treatment of the real problems.

Oftentimes, general practitioners or family doctors don't ask about underlying mental health conditions when discussing insomnia. It is important to be aware of the bidirectionality of these conditions and make your healthcare provider aware.

Many mental health disorders have been linked to insomnia. Some of them include:

Depression

Post-Traumatic Stress Disorder (PTSD)

Schizophrenia

Bipolar Disorder

Attention Deficit Hyperactivity Disorder (ADHD)

Generalized Anxiety Disorder (GAD)

Panic Disorders

Obsessive-Compulsive Disorder (OCD)

Can Insomnia Help Diagnose Mental Illness?

Yes, in a way. According to the National Alliance on Mental Illness , the way that insomnia affects you can be useful for helping with the diagnosis of any potential mental illnesses.

For example, insomnia related to depression is often characterized by waking up too early in the morning, and a lack of energy during the day. Post-traumatic stress disorder is often linked to sleep disturbances involving nightmares.

Having a mental disorder does not always mean that a person will have a sleep disorder- just like having a sleep disorder doesn't automatically mean a person has a mental disorder. However, someone who suffers from sleep disorders or mental health problems has an increased risk of having or developing both.

It's normal to feel anxious or sad sometimes- everyone has experienced these feelings at some point in their lives. However, if the feelings are persistent or severe, it's wise to consult your doctor or a mental health specialist.

How a Good Night's Sleep Benefits Your Brain

Good sleep quality plays a significant role in maintaining your mental and emotional well-being. Here are five ways that sleep helps our brains stay healthy.

1. Sleep Helps Boost Your Mental Health

As we said earlier, treating a sleep disorder may alleviate or reduce the severity of mental health disorders. Similarly, treating mental health issues may reduce the likelihood of developing a sleep disorder, or reduce the severity of an existing sleep disorder.

2. Sleep Helps with Memory and Learning

Not getting enough sleep makes concentrating or remembering information more difficult. However, this isn't the only way that sleep keeps our memories sharp. Sleep also helps consolidate your experiences and the things you learned during the day, and turns them into long-term memories.

According to a study from the Journal of Neuroscience , the brain may also prioritize saving what information may be most useful to you in the future. This might be why, for example, you were able to memorize the lyrics to We Don't Talk About Bruno , but not what time you were meeting your friend for lunch.

A good night's sleep may also decrease the size of synapses in your brain. Synapses are areas where information gets passed between brain cells. Reducing the size of synapses can help strengthen important connections in your brain while also making space for new memories and information. Basically, it's your brain's way of "trimming away" the unimportant connections so that new information is easier to remember.

3. Sleep Helps Remove Toxins from Your Brain

Your body's glymphatic system is very important to your brain health. This system helps deliver nutrients to your brain, and uses cerebral spinal fluid to remove brain waste. Some of this brain waste- beta-amyloid and tau proteins- can be especially dangerous. That's because the build-up of these toxins has been linked to Alzheimer's Disease.

The glymphatic system is at peak efficiency during slow-wave sleep, one of your deep sleep phases. As you grow older, slow-wave sleep becomes harder to maintain. Many researchers believe that this may contribute to the onset of Alzheimer's Disease as well.

Related: How Poor Sleep Can Put You At Risk for Alzheimer's Disease

4. Sleep Helps You Make Better Decisions

"Let me sleep on it."

We've all heard this before. Basically, the idea is that you should get a good night's sleep before making an important decision. That's good advice- especially because people who are sleep-deprived tend to make riskier or more impulsive decisions.

Another study from the Journal of Neuroscience instructed participants to purchase food and non-food items from a computer-generated auction. Interestingly, sleep-deprived participants were more likely to choose unhealthy snacks and pay more than those snacks were worth than those who got adequate sleep did. Remember this when you go out for breakfast or coffee after a night of poor sleep!

5. Sleep Helps You Regulate and Process Your Emotions

We all know how cranky we can be after a night of poor sleep. Some people may even be prone to mood swings after a night of insufficient sleep. That's because when you don't get enough sleep, your amygdala goes into hyperdrive and impairs your ability to regulate your emotions! The amygdala is the part of your brain that helps process your emotions. It's especially well-known for its connection to fear, anxiety, and its ability to alert us of danger.

Experts believe that getting enough REM sleep specifically is vital to regulating your emotions. In fact, one theory is that a lack of REM sleep may be the reason there's a high correlation between mental health issues and insomnia.

One study from the journal also found that good quality sleep may also you process disturbing or traumatic events. The study observed 65 healthy women who were exposed to an experimental laboratory trauma. They were then divided into two groups- one that slept afterward, and one that stayed awake. The study found that the participants who slept within 24 hours of witnessing trauma had fewer distressing emotional thoughts compared to those who didn't sleep.

10 Tips for Reducing Nighttime Anxiety

Anxiety and insomnia often go hand in hand, but don't worry. If you're having trouble sleeping, making a few small changes to your nighttime routine may help relieve anxiety and decrease your chances of developing chronic insomnia.

Here are Sleep Centers of Middle Tennessee's tips to help you get better sleep:

Practice good sleep hygiene. This means creating good sleep habits and following a consistent bedtime routine, even on the weekends.

Avoid caffeine at least 6 hours before your regular bedtime. This includes caffeinated beverages like soda, coffee, and tea. Be careful of other foods that may contain caffeine or other stimulants as well, like chocolate or other candy.

Create a relaxing bedroom environment. If you're bothered by a bright street light outside your window or the sound of frogs croaking in a nearby pond, you don't have to put up them for a good night's sleep. To block out intrusive light, we recommend using blackout curtains, or an eye mask like those from Manta Sleep . For masking unwanted noise, we recommend using a white noise generator or a sound machine.

Keep your bedroom at a comfortable temperature. Remember, the ideal temperature for sleep is between 60 and 67 degrees Fahrenheit. This can vary from person to person, so you can experiment to see what works best for you.

Only use your bed for sleep and sex. Some people work or even eat in bed, but this can make getting proper sleep more difficult. This is because it can you associate your bed with everything but a good night's sleep- so make sure your bed is only used for sleep and sex.

Avoid screens before bed. The generated by your phone, computer, and TV interferes with your ability to sleep by reducing how much melatonin your brain produces before bed. If your brain doesn't produce enough, then you may be up later than you want to be.

Get plenty of morning sunshine. It helps your body regulate its circadian rhythm and signals your brain to stop producing melatonin to help you wake up. Ideally, get sunlight on your face and eyes for about 10-20 minutes first thing in the morning. A quick walk in the morning will do wonders for your day and quickly reduce melatonin production.

Exercise regularly, but not too close to bedtime. Exercising too close to bedtime can actually make it harder for you to fall asleep.

Consuming tobacco or alcohol in excess can disrupt sleep. Stop drinking a few hours before bedtime, and if possible- for myriad health reasons- quit smoking altogether.

Practice relaxation techniques. Techniques like meditation, journaling , a warm bath, or positive visualization are all great ways of getting into a relaxed headspace.

Related: Top 5 Tips To Help You Fall Asleep and Stay Asleep

Need Help With Your Sleep?

Sleep's benefits for your brain and mental well-being are undeniable. That said, getting a good night's sleep should never be a challenge.

If you struggle with insomnia and want to improve your sleep and mental health, we can help. The highly trained staff at the Sleep Centers of Middle Tennessee has successfully treated all 90 recognized sleep disorders, including insomnia. We're prepared to help you get a better night's sleep. Contact the Sleep Centers of Middle Tennessee today and we'll help you get back on the path to a healthy, restful night's sleep.

References

"Sleep Disorders." NAMI - National Alliance on Mental Health , www.nami.org/about-mental-illness/common-with-mental-illness/sleep-disorders.

Wilhelm, Ines, et al. "Sleep Selectively Enhances Memory Expected to Be of Future Relevance." The Journal of Neuroscience: the Official Journal of the Society for Neuroscience , Society for Neuroscience, 2 Feb. 2011, www.ncbi.nlm.nih.gov/pubmed/21289163.

Rihm, Julia S, et al. "Sleep Deprivation Selectively Upregulates an Amygdala-Hypothalamic Circuit Involved in Food Reward." Journal of Neuroscience , Society for Neuroscience, 30 Jan. 2019, www.jneurosci.org/content/39/5/888.

Kleim, Birgit, et al. "Effects of Sleep after Experimental Trauma on Intrusive Emotional Memories." Academic.oup.com , Sleep, 1 Dec. 2016, www.academic.oup.com/sleep/article/39/12/2125/2706348.

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The Surprising Connection Between Sleep And Mental Health

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Public awareness of mental health struggles has made leaps and bounds in the last few years, but have you ever considered how your mental health can affect your sleep and vice versa? Twenty-five percent of Americans suffer from insomnia each year- in fact, it's one of the most common sleep problems worldwide.

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How Sleep Deprivation Impacts Mental Health

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How Sleep Deprivation Impacts Mental Health

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Columbia University Department of Psychiatry

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Americans were having trouble sleeping before COVID-19. Unfortunately, it only got worse when the pandemic isolated us from friends and family, closed our schools and offices, and sent shock waves through the economy.

According to a study of 22,330 adults from 13 countries published in Sleep Medicine in November 2021, one in three participants, had clinical insomnia symptoms and nearly 20 percent met the criteria for insomnia disorder-rates more than double what they were before the pandemic. Furthermore, sleep disturbances were linked to higher levels of psychological distress. Anxiety and depression rates were also considerably higher than pre-pandemic levels in the same survey.

"Just like our electronics need to be charged, sleep may recharge or reset the brain to optimize functioning," says Elizabeth Blake Zakarin, an assistant professor of psychology (in Psychiatry) and a clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders.
Columbia Psychiatry News spoke with Zakarin about the psychological impact of sleep deprivation, challenges brought on by the pandemic, the influence of food on our sleep patterns, and effective treatments for sleep difficulties.
Why is sleep so important to our mental health?

Many of us know that we feel better after "a good night's sleep" and more grumpy or foggy if sleep deprived. And there is now robust evidence similarly supporting that sleep is critical to not only our physical health but also our mental health. Poor or insufficient sleep has been found to increase negative emotional responses to stressors and to decrease positive emotions.

While more research is needed to understand the mechanisms underlying the connection between sleep and mental health, we know that sleep is important to a number of brain and body functions engaged in processing daily events and regulating emotions and behaviors. Sleep helps maintain cognitive skills, such as attention, learning, and memory, such that poor sleep can make it much more difficult to cope with even relatively minor stressors and can even impact our ability to perceive the world accurately.

What are the psychological effects of sleep deprivation? Is there a link between insufficient sleep, mental health disorders (also suicidal ideation)?

Absolutely. Not getting enough sleep or poor-quality sleep can increase risk for mental health disorders. While insomnia can be a symptom of psychiatric disorders, like anxiety and depression, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health problems, including depression, anxiety, and even suicidal ideation.

Sleep deprivation studies show that otherwise healthy people can experience increased anxiety and distress levels following poor sleep. Those with mental health disorders are even more likely to experience chronic sleep problems and, in turn, these sleep problems are likely to exacerbate psychiatric symptoms and even increase risk for suicide. The good news is that there are ways to improve sleep quality and quantity, so identifying and addressing sleep problems is critical to alleviating the severity of psychiatric disorders.

Sleep Awareness Week March 13-19

In 1998, the National Sleep Foundation launched Sleep Awareness Week as a way to promote better sleep and increase overall health and well-being. The annual campaign begins at the start of Daylight Savings Time, when Americans lose an hour of sleep.

Do individuals vary on the amount of sleep they need? Are there really larks and owls?

The amount of sleep individual's need in part depends on their age. In general, children and teens need more sleep than adults. While there are certainly individual differences in the amount of sleep each adult needs, the American Academy of Sleep Medicine (AASM) recommends that adults sleep at least 7 hours on a regular basis to promote optimal health and functioning, with most adults needing somewhere between 7-9 hours. Teens typically need 8-10 hours and older adults (65 years and older) between 7-8 hours. Although the amount of sleep we get is important, good quality sleep is also essential.

In addition to the amount of sleep, there are individual differences in "chronotype" the natural inclination of your body to feel more alert at certain periods of the day and more tired at others. The two most well-known chronotypes are often referred to as "night owls" and early birds (or "morning larks"), though many people likely fall somewhere in between. Genetics, age, and other factors impact whether you are more likely an owl or a lark. As you can imagine, getting enough sleep with a typical work schedule may be easier to do for a lark than for a night owl.

The COVID-19 pandemic created a host of new challenges to sound sleep. What is "Coronasomnia" and how does it differ from insomnia?

Insomnia disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is characterized by difficulty falling asleep, staying asleep, or waking too early, resulting in daytime impairments. While insomnia symptoms and insufficient sleep were already a widespread problem pre-pandemic, people are reporting more sleep problems than ever before. The increase in insomnia and related sleep problems related to stress caused by the COVID-19 pandemic have been labeled " Coronasomnia."

We know that stress can interfere with sleep and understandably the global pandemic has significantly increased daily stress and uncertainty. Spending more time at home and changes to daily routine can also impact sleep patterns by limiting light-based cues for wakefulness that help keep your circadian rhythm on schedule. And more time in bed and less activity or exercise can also interfere with sleep by reducing sleep drive. In a survey by AASM, over half (56%) of Americans (and 70% among those 35-44 years old) say they have experienced sleep disturbances during the pandemic. Common sleep disturbances include problems falling or staying asleep, sleeping less, and experiencing worse quality sleep.

Are there foods that promote sleep, and foods we should avoid? And can sleeping more help you lose weight?

Reduced sleep has been linked with increased eating and higher risk for weight gain and obesity. Conversely, studies show that getting more sleep can lead to consuming fewer calories and improve weight loss.

While some foods, such as milk products, fish and fruit (for example, kiwis and tart cherries) have shown some sleep-promoting effects, research is too limited to draw definitive conclusions or recommendations about specific foods to help sleep. Growing research suggests that the quality of diet or having sufficient nutrients can impact the quantity and quality of sleep. Low fiber, high saturated fat, high sugar diets have been associated with poorer quality sleep. Another large study found that deficits in nutrients, like as calcium, magnesium, and vitamins A, C, D, E, and K, were associated with sleep problems. As such, it's likely most important to focus on eating a balanced and consistent diet and creating healthy food-related sleep habits, such as limiting caffeine intake in the afternoon/evening and trying not to eat large meals too late.

For some, skipping sleep is a sign of strength and productivity. But health professionals have called for a cultural shift in the way we think about sleep. Is that shift happening?

Unfortunately, we know that pre-pandemic and especially over the course of the last two years, a large percentage of the population continues to experience insufficient sleep. Longer work hours, constant access to social commentary and entertainment, and increased stressors all contribute to people getting less sleep. The good news is that there is increasing awareness of the importance of sleep for daily functioning and health. In order to see a shift in sleep behaviors, ongoing work is needed to promote science-based policies that help improve sleep health, such as encouraging employers to help promote healthy sleep and introducing later school starting times. And we need to increase access to care for individuals with sleep difficulties.

What treatments are most effective for sleep difficulties?

For some sleep difficulties, adopting healthy sleep habits may help to improve sleep. However, those with more chronic insomnia should seek professional help, including cognitive behavioral therapy for insomnia (CBT-I), which is recognized as a first line treatment for insomnia. CBTI involves educating people about sleep and aims to change their sleep-related behaviors and thought processes by teaching strategies such as stimulus control, sleep restriction, relaxation techniques and cognitive therapy.

If sleep problems persist or you continue to experience daytime sleepiness even after getting enough sleep, then it might be time to see a sleep specialist who can help determine whether you need cognitive behavioral therapy, medication, or another treatment.
In this video Dr. Zakarin discusses the relationship between sleep, mental health, and suicide in adolescents and steps we can all take to improve the quality of our sleep, which include some of the following:

Tips for creating healthy sleep habits and improving sleep

Try to keep a consistent sleep schedule, waking up around the same time even on weekends.

Set a bedtime that is early enough for you to get at least 7 hours of sleep. However, don't go to bed unless you are sleepy.

Establish a relaxing bedtime routine that helps to transition from your day.

If you're having trouble falling asleep, don't lie in bed awake. If you can't get to sleep, get out of bed, and do something relaxing until you feel tired.

Create a healthy sleep environment- avoid bright lights and loud sounds, keep the room at a comfortable cool temperature, and try to limit electronics in your bedroom.

Exercise regularly (but not within the few hours before going to bed).

Avoid caffeine and nicotine late in the day and limit alcoholic drinks before bed.

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How Sleep Deprivation Impacts Mental Health

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While insomnia can be a symptom of psychiatric disorders, sleep problems can also contribute to the onset and worsening of problems such as depression, anxiety, and even suicidal ideation.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi there. Thanks so much for joining the session, and I hope wherever you are, you're doing well. I'd like to introduce myself. I'm Jenn Kearney, and I am a digital communications manager at McLean Hospital.

And before I introduce Eriana and get the session started, I want to ask you, how'd you sleep last night? How'd you sleep the night before? If you thought to yourself and said, "Pretty good, I feel pretty well-rested," you're in a really small percentage, and that's awesome.

If you feel like you could have used about another week or so of uninterrupted slumber, welcome to the club. So during this session, Eriana and I are going to talk all about sleep hygiene, what it is, how it can impact your mental health and how we can improve our sleep hygiene.

We'll be answering your questions on the subject all the way from blue light emissions to setting up better sleeping conditions.

So Eriana Buteau is a doctor of occupational therapy and is an occupational therapist at Pathways Academy at McLean Hospital. Pathways Academy is a year-round therapeutic day school developed to meet the social, sensory, psychological and educational needs of children and adolescents with autism spectrum disorders.

She's also a professor of pediatrics and mental health at Mass General Hospital's Institute of Health Professions.

So Eriana thank you so much for joining me today, and let's get started. I would love to know, first and foremost, what exactly is sleep hygiene, and what factors into having good sleep hygiene?

Eriana: Thank you, Jenn, and I'm so happy to be here. This is a topic that is so relevant for everyone. The term sleep hygiene, I would love if it could be looked at just like hygiene for the body as well.

It refers to the series of these habits that we create for ourselves to fall asleep and stay asleep. And so these could be habits that are not helpful and habits that are. And our bodies, our hygiene that we use to take care of our bodies, we have habits, routines. We use soap and showers and shampoo daily.

We brush our teeth twice a day with toothpaste. We wash our hands now, especially with antibacterial soap, and for our specific protocols. So we have these hygiene habits already in other areas of our life.

Sleep hygiene really refers to the hygienes that we create, good and bad, that keep us asleep, quality and consistency of a good sleep.

Jenn: So how do you actually know if your sleep hygiene is good or not? What criteria are there for assessing if your sleep quality is good, beyond how much coffee you actually need the next morning?

Eriana: That's a great question. How can you tell? In some ways it can feel obvious, like if you're waking up a lot throughout the night. In some ways it can be a little more discreet. So sleep hygiene consists of a sensory component, right?

Our environment, our environmental factors, how we're purposefully setting up our sleep space, how we're using our sleep hygiene items and our routines based on our preferences.

So signs that you might be, your sleep is affected in this area, in this sensory component and this environmental component might be, are you waking up too hot or too cold? Or are you waking up to noise? Are you waking up to light that's affecting your sleep?

Our sensory systems also affect our insides. So are you waking up to headaches? Are you waking up to a sore or injury? These types of sensory components can be a factor into why you're not sleeping well.

But then also a huge portion of sleep hygiene is your relaxation skills, your stress reduction skills and your routine maintenance skills. So those two major components could both play a huge role in if you're able to stay asleep, if you're able to fall asleep.

In terms of how you might present throughout the day, if you're not sleeping well, that lack of consistency in quality might leave you with less resources.

And so managing emotions, making decisions, thinking clearly, these are all effected, even just feeling out of it or feeling clumsy, dropping things might be a sign that you're too tired. Another big one that people don't often think of is snoring could be a huge sign that you're not sleeping well.

And there is a lot of studies that link snoring and sleep apnea to anxiety, to depression, these kind of bigger emotions that are linked to our ability to breathe at night and our ability to have a sound night's sleep without waking up feeling panicked, you know, several times to many times throughout the night.

So you could have presentations and signs that are from that sensory environment component. You could also have sleep deprivation signs that are from that relaxation, stress reduction, routine maintenance area.

Jenn: So one thing that we, I think we all struggle with is using technology right before we go to bed. We're living in a time where, you know, people are actually like in love with our phones. It's really hard to even disconnect, so to speak.

How bad is tech usage before bedtime affecting our sleep, and when should I start putting my phone down or shutting my laptop off, if I don't want to start impacting my quality of sleep?

Eriana: That is such a relevant question, especially right now when our technology is really what's connecting us to the world around us.

And so to put it down means something different than it used to, especially I think even so specifically around the holidays approaching and this kind of feeling of winter coming, and we want to be connected.

And that's really one of the tools that's at our fingertips, literally to have us connected with the outside world. And that's our current social world that we live in. But when we take a few steps back and we look at more of the innate, instinctual, what causes us to feel sleepy, what causes us to fall asleep? Our circadian rhythms.

We have these chemicals that are very innate inside of us that are triggered by our sensory world. Is it getting dark? Is my brain letting me know that I should be getting tired? It's time to recharge.

An article I read a little while ago, but I thought it was so interesting is that city lights are starting to affect migratory birds that fly at night. And so their internal navigation is being thrown off by these pockets of lights that are cities at night. And it just goes to show how much innate chemicals are going on in our bodies.

And a circadian rhythm, for just as a side note is that, for those who don't know, is a natural internal process that regulates our sleep-wake cycle, and it repeats on the rotation of the Earth.

So it's every 24 hours. It's very, you know, it's grounded in something we can't even control necessarily. So this artificial light keeps our brain chemicals going, and the sensory inputs keep our circadian rhythm from getting on the right time for what we need, for what our life needs.

And so it's hard to shut off our brain when those artificial lights are still triggering our neurons and keeping our brain awake. There's even studies that straight up say, evening use of light-emitting technology negatively affects sleep, circadian timing, and next morning alertness.

And so the National Sleep Foundation recommends that 30 minutes is the kind of like at least 30 minutes, put down your technology, do something in the bedroom that is not tech based, or in your house that's not tech based for at least 30 minutes before you're expecting to lay down and go to bed.

Jenn: Alright. So if I'm waking up during the night, and I can't go back to sleep for hours, how do I stay asleep? How do I even achieve that deep sleep that's going to keep me from waking up?

Eriana: This can be the most frustrating part for people experiencing sleep deprivation is I keep waking up or I can't fall asleep, and I'm just sitting there thinking about how I can't fall asleep. A lot suggests that getting up is helpful.

So try for 20 minutes. If you're in that zone where you're just zombieing out and can't fall asleep, every 20 minutes or so, get up, do a lap around the house, take a look out the window. You know, it's kind of nice sometimes to see the world at three in the morning, but then try again.

I hate when people get stuck on this idea that sleep looks like you're a mummy in a bed and everything's quiet and dark, and it doesn't have to be, there's no golden standard. It doesn't have to be this one way for every person.

For example, I kind of love sleeping on the floor. I find that very comfortable. So sometimes if I can't fall asleep, I'll give myself that 20 minutes and then I'll go try a different place. I'll go try, I call it a floor palette, somewhere cozy in my house, or think outside the box for yourself. You don't have to fit into this cookie cutter of what everyone thinks sleep should look like.

Jenn: That makes me think so much of when, like you can't sleep and you get up and you sleep on the couch instead and having it be kind of like that surface palate cleanser to see if you could actually like, if something else is going to work for you in the interim.

Do you have any suggestions about helping sleep issues that are due to menopause?

Eriana: So not specifically because my specialty is with pediatrics. But I do know that there's a huge sensory component involved in that and then a huge medical side as well that your doctors are working with you on, certain medications and melatonins and things that can help with sleep.

But again, I feel like the sensory component, if you're overheating, get up and have a Popsicle and sit for 10 minutes and read on the couch and then try again or really look into the basics of your bedding.

Is your down comforter too hot in the middle of the night? Is your mattress too firm or too soft? Those are the things we have a lot of control over that you might not be necessarily thinking about. Are you hydrated? These kinds of things, kind of like a checklist before bed.

Jenn: So I know that you had mentioned melatonin, and there are so many supplements for melatonin that are now on the market. Are they useful to use? Is there a certain threshold of like how much you should take or shouldn't take, or can you become too dependent on melatonin?

Eriana: I'm not quite sure of that answer in terms of the use of supplements over time. I do know that melatonin is a really popular go-to for over-the-counter supplements to help with sleep.

That is the chemical that's released during your circadian rhythm, but that would be a question more for your healthcare provider, just to make sure it fits your specific needs.

Jenn: So if you work night shifts like three times a week, I know we have a lot of healthcare providers on here, which first and foremost, thank you so much for your service, but if you're working varying shifts, how do you have good sleep hygiene, if your internal clock can get thrown off?

Eriana: That is such a good question and such a tricky way to start getting patterns introduced into your neurology and into your calendar. So I would suggest if that part is a little bit out of your control, then really being purposeful about your sleep space and your sleep environment.

It might be in an on-call room. It might be, you know, you might have to kind of get sleep where you can. And so therefore, a lot of those external factors are out of your control. But some things that might be in your control is maybe a sleep kit or a little bag of things that help you wherever you go.

For example, I have, you know, something that's from my grandmother, a tea that's a little sentimental to me, some pictures, some imagery, so things that are kind of your things you can take with you, an eye mask. Something I always suggest a lot is playlists.

So something that you can control that maybe starts creating a routine in your neurology is a 30-minute sleep playlist. And so no matter where you are, you can have that 30 minutes, and it can help you gauge where you are in your sleep routine, and it will start to help your brain remember, this is my cue to start getting tired.

Again, we're creating habits. So it doesn't start automatically. And we might even have bad habits that we have to work on at the same time. So it is, we want our brain just to start recognizing these patterns that we're introducing it to.

Jenn: So my partner told me that I snore, and I wasn't aware that I snored before this happened. What should I do? Is this a problem? Should I get a sleep test? Or how do I gauge if there is an issue?

Eriana: Such a great question. My partner snores like a wild animal. And so I've bought, I've been through the process with them of getting a sleep study, looking into it with his doctor, getting a CPAP machine, working on the medication routine. So it's not just all on you.

There's a team of people out there that are there to help you, if this seems like you're trying everything, and it's still not working. Snoring is such a big sign of, you might not realize that you're losing sleep.

And if someone that can hear you is telling you you're snoring, I would suggest telling that to your doctor. If you experience anxiety or something in that realm, it might be interesting to you to see if there's a connection if you also are a snorer.

It might be a connection you didn't make before. And then I think that's still valuable information to tell your doctor. You would have to tell your primary care, of course, first. And then that goes into the referral for a sleep study and further investigation. But my partner has a CPAP and it has changed his sleep. And it's amazing. So I wouldn't be afraid of that route, if you think that that might be helpful for you.

Jenn: I mean, it's probably also changed your sleep too-

Eriana: Yes.

Jenn: If he's not waking you up.

Eriana: Maybe that's really what I mean.

Jenn: So how do we understand our own personal REM cycles? I feel like that's something that if we're constantly waking up or getting extra sleep, you can still wake up groggy, even if you got like miraculously 10 hours of sleep the night before.

Eriana: Right, yes. The science of sleep, this REM cycle. I've heard that we're on a 90-minute cycle. And so an average person, and a sleep study can tell you this as well. An average person will go through an hour and a half of a full cycle with REM being in the middle.

And so they say even, you should set your alarm clock based on that hour and a half theory. So never wake yourself up breaking one of those hour and a half chunks.

So say if you go to bed at nine at night, average out an hour and a half chunk until maybe you have to wake up a little bit earlier than you would expect, but it's better than breaking into one of your REM cycles.

Jenn: So when thinking about breaking into a REM cycle, if you're getting not enough or too much sleep that it's throwing off your functioning, do you have any recommendations for like helping you or a partner find a balance beyond that 90-minute timer?

Eriana: Can you clarify that a tiny bit?

Jenn: Yeah, so an individual wrote in, just saying that they've experienced that they can either get not enough or too much sleep and that it's not good for their functioning.

How can they achieve that balance without, you know, considering that like the understanding the 90 minutes might not actually work for them.

Eriana: Especially if you're waking up and like it's almost even another thing to think about. So one thing that immediately came to my mind is I would suggest, and I would suggest this with anyone interested in starting here is to make a two-week sleep journal to keep track of your night's sleep over the course of two weeks.

And notice any patterns and notice if you notice Tuesdays or a certain hour of the night you're waking up, or there might be patterns you're not recognizing.

So to give yourself a little more information about your own sleep patterns, keep a two-week journal just to start keeping track of patterns. I think this is great information for your doctor as well.

They might ask for that if you go to them. So it might be good to have it already. Does that answer the question?

Jenn: Yeah. If we're having trouble falling asleep, because we're spending hours worrying about everything, which in this day and age makes sense, any advice for ways to cut off that worry before we're trying to fall asleep?

Eriana: Absolutely. So anxiety and our senses are so linked, and sleep and our senses are so linked. And so it really depends on, you know, what calms you and what doesn't.

And everyone says with sleep hygiene, read, but I don't know about you, but I'm not much of a reader, and it doesn't really turn my thoughts off necessarily.

Things that maybe might fill those thoughts, audio books, even if it's, I know someone that listens to the first Harry Potter every single night before they go to bed, and they fall asleep at the exact same time every single time.

But if you think about it, it's creating a neurological pattern that your brain recognizes. And so the anxiety, you know, we can't necessarily control our emotions. We can't control the feelings we're feeling, but we can control the actions we do and the routines and the patterns we create for ourselves.

So there's a thousand apps out there that are so helpful in terms of meditation, mindfulness, relaxation. You can go towards the more old fashioned route. I hate to say, but like crossword puzzles, Sudoku, coloring.

Try and think of a multisensory approach that are things that are calming for your anxiety, sensory oils, candles, just try and be purposeful about that routine. Those are things that could help your anxiety at any point in the day. And so purposely putting them into your night routine and making even a checklist.

Sometimes we feel anxiety of that lack of control. Create control for yourself. Create a checklist that has exactly what you want to do and when you want to do it, and feel good checking those boxes off and completing it.

A multisensory approach can also be helpful with this too. So not just thinking about one smell and that's it, or one weighted blanket and that's it. Think about doing stretches while drinking hot tea and listening to a calming song and then journaling.

Think about more than one sensory input you can put into your checklist, into your routine, into those things that you do have control over.

Jenn: So when thinking about senses, how important is it for your bedroom to be dark? I know that there's a little bit of a jury that's out on it, but what are your thoughts?

Eriana: I personally will wake up with the sunrise. So in the summer when the sun comes up at 5:45, I'm up. In the winter, so I'm someone where light in terms of my sensory profile, light very much affects me.

I am a big fan of light-blocking shades, as long as you open them during the day when you're supposed to be awake and letting your brain have that light when it's supposed to be alert. And I'm a big fan of face masks, and they come like jelly, weighted, fuzzy, anything you can think of.

So I would hate for someone to compare themself to a category that wouldn't be beneficial for them.

You know, if you're someone where you're super sensitive to light and that super affects your sleep, then it is important that you have a dark room, and it is important that you can control the darkness, especially on those days where you work night shifts or where you're actually trying to get some sleep during the day.

No, I would think light has a huge component into the sensory part of sleep.

Jenn: Yeah, I mean, from my personal experience, I have a sleep mask. I use the light-blocking curtains, and I also have one of the alarm clocks that mimics sunrise.

So there's birds and it eventually grows lighter. So for me, I know for like my good to get better sleep, I need to have that like multisensory approach. So I totally appreciate that question.

When it comes to blocking light, have you heard anything about people that wear blue light blocking glasses overnight to help them sleep? Would it be something to consider? And do you have any thoughts on using blue light glasses during the day?

Eriana: The only research I've read is using blue light glasses when you're in front of a lot of screens and a lot of technology. And there seems to be a lot of benefit to using that in terms of that circadian rhythm and that ability to calm your brain back down.

But in terms of overnight, I have not read a lot about that. I'd be very interested. I will look it up after this. I'm very interested to see that research.

Jenn: I think I'd just be concerned about squishing them, because I move a lot when I sleep. So I feel like I'd just break an investment, because I roll over onto them. I don't think I would love that, but I use them during the day.

I know these have a blue light filter on them too. And I find that it helps so much with eye strain. I think it's been, you know, from personal experience, it's been super helpful. Alright, do you have suggestions for kids or adults that have ADHD to help them fall and stay asleep?

Eriana: Yes, I work with a lot of kids who experience ADHD, and that can be one of the hardest things they experience is even throughout the day, let alone trying to go to sleep is focusing on turning your mind off, being present, being in the moment, calming your body down.

What I have found successful working with that population is more of those CBT style relaxation methods, stress reduction methods. They say typically physical exercise might, too much might wake you up before you need to go to sleep.

It's important throughout the day so that your body feels tired, but typically they say not to do it right before bed. But I have found with sleep hygiene and my teenagers especially who experience ADHD that some type of kind of vigorous stretching or like a quicker paced yoga, something that's not necessarily like running or cardio, but something that gets a little bit of energy out.

And again, a multisensory approach, maybe doing some stretching while... Multisensory approaches are great for kids who experience ADHD, because you would think, like I was about to say doing stretching while reading something or a while participating in other, you know, stretching while brushing your teeth might be overwhelming for someone who doesn't have, who can concentrate on that one thing at a time.

But a multisensory approach might be really refreshing for someone experiencing ADHD. And it might help them kind of categorize where they are, what they're doing and getting ready for bed, but I'm also able to get a little bit of energy out.

Jenn: Do you have any insight for folks that go to bed comfortable, but in the middle of the night are waking up because they're too hot? Are there any solutions to this?

Eriana: So that happens to me all the time. And I find that when I go, just on a personal level, when I go to bed, you're so cozy. And then in the middle of the night, you're like stripping things off. So I find that really look into the material of your bedding, even the what's underneath you.

So I don't know if you have a pillow topper, or if you're using a flannel bottom sheet, that can get very hot. A feather down comforter, that can, especially if you have pets and things that are running a hundred degrees inside your bed and other people maybe. So it might feel comfortable going to bed.

But if you're waking up hot often, I would suggest using a heavier, thinner blanket, maybe a quilt that's got a little bit of a weight to it, but it's also breathable. A lot of materials that aren't breathable are so warm and cozy, but then if you spend five hours wrapped up in it, it can get really hot.

So that would be my first suggestion is look into your bedding, look into the breathability of the materials and then go from there.

Jenn: Alright. Is it possible to get a headache from oversleeping, or is it because you've just been sleeping for so long that you're dehydrated?

Eriana: That was my first thought is a headache after eight or more hours of not drinking water makes sense. That's a long time to go without drinking water.

If you're someone who needs that much sleep, I would suggest having water by your bed, making sure you're drinking a lot of water throughout the day, maybe not right before you go to sleep, but making sure that you're extra hydrated if you can sleep that long. That's both impressive and you need to stay hydrated.

Jenn: So if someone has experienced a lot of trauma and loss during this time, and it seems more daunting at night, when you lie down you don't have those distractions, how can they sleep better, knowing that these thoughts are just reemerging at night?

Eriana: That is a heavy situation. And I know a lot of people are experiencing this intense level of stress right now, let alone if you've gone through something even more personal. So at that point, I think that if you feel like you can't really get a control over your sleep and it's affecting your day, I really suggest you reaching out to your healthcare provider.

I don't know if you have a behavioral health or a mental health professional you work with. But then I would say the next step is making sure that you have a team with you working through all of that, 'cause you don't need to do it alone.

And there's a lot of professionals out there that, you know, trial and error or whether they have an exact help, I would really want more people on your team. So make sure that you're reaching out.

Jenn: So this next question, I feel like can impact so many people. After a few nights of having a hard time falling asleep, it's possible to get more anxious and stressed about going to bed thinking that you're not going to be able to get another good night's sleep. Do you have any suggestions for breaking this anxiety, stress, exhaustion cycle?

Eriana: Yes, that's the whole beast of anxiety, isn't it? Is sometimes we get anxious because we know it might happen, and it's so uncomfortable and miserable that it caused that cyclical effect, yes.

So a lot of studies suggest that a good amount of, I always hate to like say the basic stuff, like a good amount of exercise helps, but again, like if you're feeling in a funk, you might not want to exercise. You kind of get into a rut.

And so I would say if you're not already exercising every day, try and find some type of exercise that you can do. We're about to go into the winter time. The daylight is decreasing as we speak. And this is a new kind of era of challenges for us as humans.

And so there is a bit of personal responsibility, and with new challenge comes new solutions. And we need to find maybe some more hobbies, some more routines, some more things at home we can be doing that we weren't necessarily doing before.

Jenn: So if you're dealing with constantly being unable to fall asleep, and you've already tried walking around the house, trying new surfaces, trying a book, these techniques still aren't resulting in getting sleep, what would you recommend the next step be in trying to fall asleep better and stay asleep longer?

Eriana: If you feel like you have exhausted kind of your own personal resources in exploring why you can't sleep, I really do strongly suggest you contact your health provider, talk to your therapist.

I think that is the next tier. If it really feels out of your own control, there's a team of professionals that are there to step in and start helping you figure it out.

Jenn: So if a person can fall asleep in the afternoon really quickly if they lay down to rest, but at night it's taking them hours to fall asleep, do you have any insight as to why that might be happening?

Eriana: So a lot of factors that I don't know about that specific situation, but research does say that if you take big naps during the day, it might affect your ability to fall asleep and stay asleep at night.

So you might need that nap during the day, but I'd be curious to how long you're napping and if you could put more parameters on it so that you're intentionally more tired later in the day.

Jenn: If you have the flexibility and the ability to wake up naturally, should you avoid using an alarm, or is it a good idea to just keep that as part of that routine that you understand and are used to?

Eriana: That's a really good question. I think if you wake up naturally, that's beautiful, and you should not interrupt your body's natural ability to wake itself up and feel alert. Alarms can often be very disruptive and cause a little bit of panic in the morning, or I'll give you...

We associate the, even when you hear it in commercials, we associate that alarm sound as something so awful. If your body wakes up naturally, I would not interrupt that. I think that's a gift.

Jenn: And I know so many people are using smartphones too for their alarms and the alarms on those can be so abrasive sounding that it's just like, you almost get your day started on the wrong foot by using something that's so jarring and like makes you want to jump out of bed and shut it off.

Eriana: Absolutely.

Jenn: So an individual asked about using a website's sleep calculator that advises when they should wake up, when they should be going to sleep or when they should be going to sleep, if their goal is to wake up at a certain time.

Do you have any thoughts around using supports like this in order to achieve better sleep quality?

Eriana: I'm always a fan of using as many resources as you can get your hands on. I would not take it too seriously though, because it really depends on how you feel. So they're putting you into a statistically average calculation, and that might not fit you perfectly.

So you might feel great and it says you shouldn't, and that doesn't make any sense. So really go off of your own personal experience. But I think it's good to keep track of stuff like that.

And there's a lot of apps that can help you have more of a structure and more of a control to it. And there's nothing wrong with that ever.

Jenn: After a really hectic workday, this individual often listens to classical music tuned to a very low sound level throughout the night. But they're asking if this practice has the potential to be harmful.

Eriana: I'm not aware of any harm that would cause, unless someone else doesn't like it, but I don't know who wouldn't. That sounds lovely.

Jenn: So my impression of this would be that if they're associating this music with a stressful work day, that it could have the, it would have a connotation later on that might actually like reignite stressful thoughts.

Eriana: Yeah, that makes sense. Well, and then if you start, we're always growing and we're always changing. So if you find a sensory tool, you find a strategy for sleep that's working for you, you do still have to be flexible, that might change.

Your current experiences might, and your past experiences might alter that. So just keeping vigilant of your sensory reactions, and if something starts to be unpleasant, that is your job to take it out of your routine, does not belong there.

Jenn: So if you've got a constant running to-do list in your head that just is keeping you up at night, is it good to get up and actually write it out or keep track of it somewhere else? Or should you just let it go and flip your pillow over and try sleeping again?

Eriana: So I might speak for at least some people when you try to ignore it and flip over and not think about it, that does not work. I'm a lister, I'm a checklister. I love lists.

I make five a day, even if it's repetitive, because I have found that that is a tool that helps my anxiety. I'd rather make five to 10 checklists a day than toss around thinking about it at night.

So if that strategy helps you get it out of your brain and you're able to find a calm body afterwards, then that's a good strategy for you, absolutely.

Jenn: So there have been a lot of ads and products that are coming up for ways to sleep better. And one of them is actually a cooling blanket that you sleep on.

Is there any evidence around better sleep and having a lower body temperature or feeling cooler at night?

Eriana: So I have not read any direct research that supports that, but from a personal standpoint, I think that makes a lot of sense, because I think at night we're laying still under a lot of covers. We're in the 98 degree range of temperature.

It makes sense that we get hot at night. And so I have not read any direct research that supports those products, but I'd be interested to hear from people who have tried them and see if it's helped at all.

Jenn: If I'm getting a lot of headaches and migraines and I'm not sleeping for days, do you have any suggestions as to how I can go about fixing this?

Eriana: So what I hear in that question is that you're not sleeping for days, and that's a big deal and that can affect a lot of things.

I would suggest, again, talking to your healthcare provider about that, if some of these other kind of sensory environmental type of suggestions have not been working. Sleeping for days would make a huge impact on you, headache and a lot of other things too.

Jenn: What do you do if you don't have time for a pre-sleep routine? And I know that there are plenty of parents, there are people who are working weird hours.

You just don't have that time for yourself. Would sensory suggestions like playing Sudoku work, even if you only have 10 minutes?

Eriana: Quick answer, yes. Five minutes, two minutes, 10 minutes. As long as it's intentional, as long as it's with the purpose of creating a sleep routine, anything's better than nothing. I would also challenge you to look at your routines as a whole throughout the day.

Is there anything that you're doing at night that you could do in the morning or in the afternoon, or rearranging something throughout your day that so you have a little bit more time at night, or incorporating some of those things into your night routine. Maybe you're done with your technology a half hour before bed, and in that half hour, that's when you make your lunches for the next day.

That's when you listen to music and do your stretches or take care of some of the routines that you might take care of throughout the day instead of at night.

Jenn: So if you're having trouble falling asleep, is there any proof that mindfulness and mindful breathing are helpful?

Eriana: Mindfulness, mindful breathing, meditation, body scanning, visual imagery, these are all really powerful strategies and have had a lot of research-based evidence in helping with sleep, with helping with anxiety.

If you haven't tried them yet, I suggest exploring, and I can always get in touch with you with some intro resources. I find it very helpful in being able to manage being present, which is a huge part of anxiety at night is not delving into the past, not worrying about the future, being able to just be here now.

And those types of exercises can help you with your night routine, can help you get the most out of that routine that you set for yourself.

Jenn: And speaking from personal experience, I know for mindfulness, just envisioning, closing your eyes and envisioning that you're putting, you're powering down each of your body parts.

So each of your feet, each of your shins, each of your thighs and working all the way up to your head, by the time you get to about your shoulders, you should probably be asleep, but I've noticed even anywhere like one to five minutes of actively powering down has been really helpful.

And there's another method that's called 4-6-7 breathing where you breathe in for four counts, you hold for six and you exhale for seven, because it's scientifically proven to lower your heart rate to be more optimal for sleeping.

If you have asthma or any cardiovascular conditions, please talk to your doctor, I'm not an MD. So please do not jump into that without talking to your doctor. But back to the questions, how would you manage your own sleep if you are sharing a bed with somebody else who probably has different sleep than you do?

Eriana: I'm sure that's something we have experienced a lot at one point or another. So there's all different types of varying sleep routines. What time you go to bed, if you're a snorer, what time you wake up, and so I think that just has to be an open conversation, and the agitation and frustration can build up very quickly when it comes to not having similar or copacetic sleep patterns.

And so, as long as I think that's an open conversation and you establish some rules, like my partner knows that he can't come into the bedroom and turn the TV on.

And if you can be able to make these, you know, clear expectations for it's okay if you don't go to bed at the same time, it's okay if you wake up earlier, but respect each other's need for sleep.

As long as there's that type of agreement, I think you should be able to make it work. Otherwise, you know, that's a bigger conversation, I think.

Jenn: What suggestions do you have for balancing good sleep habits and being able to fall asleep again in the middle of the night, if you're getting up to use the bathroom, which you are definitely hydrating well, if that is the case?

Eriana: Absolutely. And medications can absolutely affect that as well. So to a certain extent, it might not be in your control. If you're taking a medication at night that makes you need to use the restroom more often-

Jenn: Of course.

Eriana: But I would, so I would suggest, if you do need to use the restroom and that is an expected part of your night routine, obviously make sure the path is clear, make sure that you maybe even have like a little nightlight in your bathroom, you know that you're going to have to get up and use it.

In terms of if it's not a medication thing, just try to be more vigilant of being hydrated throughout the day and give your chance, give your body a chance to use the restroom before you go to bed.

Jenn: Going to ask you the $64,000 question, what is the ideal amount of sleep?

Eriana: Again, it depends. So always, I hate the answer, it depends. But they say six and a half to eight. It all depends on age, but again, like I've gotten less than that and felt fine.

So it's more of a long-term thing. You can go a day with less than that. You can spend a day of sleeping in, but overall, are you able to have consistent, quality sleep?

Jenn: Yeah, I feel like there is a rule of thumb I read about that depending on how many hours you're awake, you should be aiming to be asleep for half of that the following evening. Is that like a decent rule of thumb to go by?

Eriana: I haven't directly heard that one, but it does bring up a lot of questions about circadian rhythms and differences in genealogy even, that's very interesting.

Jenn: I would also hope that people would not be awake for 36 hours straight and then have to sleep 18, though if you are like a surgeon or something, and you do necessitate being awake that long, I totally understand.

So let's talk about people taking over-the-counter medications when they don't sleep well. Some folks rely on Benadryl. There are other drowsiness inducing medications.

Is it safe? Is this good for short-term use? What are the side effects for long-term use? Any insight?

Eriana: So I would think using a antihistamine as a sleep aid wouldn't necessarily be the main use of that medication or that over-the-counter drug. It does help with drowsiness or like a NyQuil, if you have a cold will help fall asleep.

But if you're using that just as a sleep aid, as an over the counter, I would think that maybe that's the time to start talking to your doctor about actual sleep aid medications, a sleep study.

And then there's a lot of, like we said before, a lot of talk about melatonin and some more herbal supplements that might help, some Sleepytime tea if you're looking more of the over-the-counter route.

But if you're starting to use a medication over the counter consistently for sleep that's not necessarily prescribed to you, I think then that's a time to have a conversation with your doctor, because there might be something that's even less invasive than a Benadryl that might help you.

Jenn: So if my parents are having the same sleep disturbances that I have is that because sleep issues are hereditary? Is this something that runs in families?

Eriana: That's a really good question. I would love to see more research on hereditary sleep disorders.

I know sleep apnea and things of that type of sleep disorders, when you get into the diagnoses of sleep disorders, that can be genetic, but in terms of, it's hard to tell what like you and your parents experience, but it could also just be nature versus nurture type deal.

So you might have the same sensory profile that your parents might experience as well.

Jenn: So I know previously in the hour, you had talked about the short-term physical effects of lack of sleep. You might be a little bit clumsier. Your memory might not be as great the next day. You might be more irritable.

What are the long-term effects of constant sleep deprivation? And is there any way for us, I guess this is a two-part question, is there any way for us to pay off our sleep debt, so to speak? Can we catch up on it later and negate these effects?

Eriana: I've been asked that question a lot. Can we catch up on sleep? And I think that's a really good question, but it doesn't take long to see the effects of sleep deprivation, in terms of long-term sleep deprivation.

I would think that would mean just a few days. So that's when we start talking about things like insomnia and apnea, snoring, or you know, where your breathing gets disrupted throughout your sleep, and one of the signs of sleep apnea is snoring can cause insomnia.

You're waking up so many times from not breathing well that you're creating an apnea based insomnia, and insomnia is when you're not sleeping well. I don't think it takes very long to see those long-term effects, and they can be very detrimental.

You know, you might not be able to operate a machine or a car. You might not be able to cook a dinner. You might lose where you are. You might feel very euphoric. You might be very forgetful.

So it doesn't take long to see the sleep deprivation and long-term side effects, and they can be very serious. And it can really affect your day. I would think it would be extremely obvious if you were experiencing that for yourself.

Jenn: Is it true that lack of sleep is actually the equivalent or worse than drunk driving?

Eriana: I would agree. The severity is just as severe. If you fall asleep at the wheel and hit someone, or if you're under the influence and hit someone, that outcome is still just as awful.

And yes, absolutely. I wouldn't say it's more or less. I would say it's just as severe as being under the influence.

Jenn: And I know you've talked a ton about the importance of having a bedtime routine. What about a wake-up routine?

Is this just as important, and how do we establish one, especially when there's so many things happening, it can be kind of impossible or seem impossible to craft getting up in the same way every day?

Eriana: Absolutely. Especially if you live in a circus of a house, which a lot of us do. So my biggest suggestion was, again, go back to that what you do control, go back to that checklist, go back to evaluating your environment.

And what is the most productive use of your time? Relaxation strategies. Morning routines are just as important, not necessarily for the grade of your sleep but for the consistency of your day and the consistency of the patterns we want our brain to recognize.

And so the more patterns we can give our brain to recognize, the more consistency, the more onboard it's going to be with this, alright, it's time to do this. Alright, it's time to do this.

And so if you do the same thing every morning, or try to, at least a few things the same thing, your brain will start to pick up on that.

Jenn: We had a couple of folks asking for a little bit more clarity around whether or not you could make up lost sleep. So is that truly possible to do so? And like, how do we bank things into our sleep debt, if so?

Eriana: So I do think that you can make up REM sleep, but I've also heard a lot of contrary research saying that it's useless. Again, that's when I go with, there's no golden standard for you. And if you're tired, you need sleep. If you're not tired, then you don't.

And so you don't need to necessarily gauge your own sleep patterns and your own ability to have consistent quality sleep on research studies necessarily. They're a great rule of thumb, a great place to start in exploring your own sleep patterns, but you might be different.

Jenn: So this actually concludes our session. Eriana, I just want to say thank you so much for all of the information that you've shared with us today. I personally think I'm going to be sleeping a lot better from all of the advice you've given, and I hope that you do too.

This actually concludes the webinar in our Mental Health Education series. Thank you so much for joining us, and I hope you have a great day. Take care.

Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don't forget, mental health is everyone's responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that's 877.870.4673.

- - -

The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

© 2021 McLean Hospital. All Rights Reserved.

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Podcast: Simple Ways To Improve Sleep Hygiene

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Jenn: Welcome to Mindful Things. The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show. Hi there. Thanks so much for joining the session, and I hope wherever you are, you're doing well.

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SLEEP HYGIENE - ITS IMPORTANCE  & METHODS TO PRACTICE GOOD SLEEP HYGIENE

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Matt Walker: How sleep affects your emotions

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It's not just your imagination -- you're more irritable when you're low on zzzzs. Sleep scientist Matt Walker explains how our nightly slumber affects the emotional centers in our brains, and why we can think of sleep as first aid for our feelings.

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Sleep plays a critical role in your health and well-being. Unfortunately, sleep disorders are common and sleep deprivation can have both short- and long-term consequences. Sleep hygiene is something you can learn to help you sleep better.

What is sleep hygiene?

Sleep hygiene is a set of habits that promote quality sleep. This includes:

creating a bedroom environment that is comfortable with limited disruptions

maintaining a regular sleep schedule

practicing techniques for relaxation prior to bed

avoiding things that will disrupt the quality of your sleep

How many hours of sleep should you get per night? Does it vary by age?

The Centers for Disease Control and Prevention recommends that an average adult should strive for seven to eight hours of sleep per night. Of course, every individual is different. Age does play a factor in how much sleep you need. As you get older, you require less sleep.

What are good sleep hygiene techniques, and good things to do before bed?

One of the most important things you can do to sleep better is to maintain a consistent routine before bed. This will help your brain process that you are preparing for sleep.

Begin winding down about 30 minutes prior by doing things that will relax your body. Some options include stretching, light music, breathing exercises, and meditation. There are several apps available that offer guided meditation and breathing exercises specifically for sleep.

Certain teas that do not contain caffeine, such as chamomile, can promote sleep.

If you need a small snack before bedtime, cherries, bananas, and walnuts provide a natural source of melatonin, a hormone that promotes sleep.

What are bad sleep hygiene practices and things to avoid doing before bed?

While there are good habits you can adopt to help you sleep better, there are also some things you should avoid before going to bed:

Things that stimulate your brain such as phones, tablets, laptops and watching television should be avoided for at least 30 minutes prior to bed.

Caffeine should be avoided in the afternoon and evenings.

Avoid alcohol before bed. While alcohol may help you fall asleep, your quality of sleep will not be as good.

Tips to fall back to sleep if you wake in the middle of the night

If you wake up in the middle of the night and are unable to fall back asleep after 20 minutes, leave bed and try to do something calming. Try reading, stretching, or meditating before returning to bed and trying to fall asleep again.

Do you recommend sleep aids, such as melatonin or over-the-counter medications? Are there side effects?

Over-the-counter sleep aids like melatonin can be useful when used short term. The most common side effects include headaches, dizziness, and nausea. Melatonin can interact with various medications and is not recommended for long-term use.

This holds true for many over-the-counter sleep aids. Many of these medications contain antihistamines, which could actually make you feel groggy the next day, and like melatonin, are not for long-term use.

What are signs of poor sleep hygiene and not getting enough sleep?

The most common signs of not getting enough sleep appear during your waking hours. They include:

excessive daytime sleepiness

lack of energy

reduced concentration

delayed thinking

mood changes, including irritability and anxiety

If you’re having trouble sleeping, when should you see a doctor?

You should see a doctor if your inability to sleep is affecting your ability to function for your daily activities. If you are suffering from insomnia, a good thing to do before seeing your doctor is to keep a sleep diary for about 10 days. In this, include the following details:

when you go to bed

when you fall asleep

when and how often you wake up

how often and when did you nap and for how long

your exercise

your alcohol and caffeine intake

This will help your doctor identify if sleep can be improved by making changes to sleep hygiene or if it requires further investigation. Your primary care provider can also refer you to other specialists if necessary.

Stay up to date with the latest in mental and emotional wellness on the Being section of our Lifespan Living health and wellness blog.

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Sleep Hygiene and How to Sleep Better | Lifespan

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Sleep is key to your health and well-being and sleep hygiene is a set of habits that promote quality sleep.

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Here we are sharing tips for sleep hygiene for kids, and the role that occupational therapy has on sleep. Did you know that sleep is an occupation? It's a part of our daily activities that impact function. And, sleep has been established as critical for optimal health, wellbeing, occupational performance and participation (American Occupational Therapy Association, 2012). When it comes to sleep hygiene, occupational therapy can be a big help in offering tips for better sleep, suggestions for more efficient or effective sleep, and how to manage areas that impact sleep.

sleep hygiene for kids

It seems as though every parenting book has something to say about sleep; Whether you are a parent of young children or a therapist serving kids (and their families), you'll probably come across sleep questions such as:

How to get your infant on a sleep schedule?

How many hours a day a child should sleep based on their age?

How some behavior problems may be related to the amount or quality of sleep?

As kids get older, they may change their sleeping habits, or never grow out of old ones. They may be too needy or dependent on you come nighttime, or maybe your five-year-old still co-sleeps and you're wondering how in the world can you get them to sleep in their own bed. Sleep hygiene is necessary at each stage of childhood.

What is sleep hygiene for kids?

Sleep hygiene refers to quality sleep and making the actions, habits, and necessary actions to set up a child for success in their sleep. Sleep hygiene involves nightly routines, modifications to the environment (quiet sleep space, dark room, etc.), and daily decisions (limiting caffeine in the hours before bedtime, being active during the day, etc.) that will optimize sleep.

According to the CDC, there are specific amounts of time that children of different ages need to sleep. And, the amount of sleep needed at each age changes as you grow. Here is a simple breakdown of sleep needed at each age:

The Importance of Sleep Hygiene

Occupational therapists can help with sleep hygiene. OTs help to improve sleep in children (or adults) because sleep has been determined to be an occupation, or a task that occupies your time. Not only that, but sleep impacts your ability to complete functional tasks, and perform activities. When poor sleep occurs, mood, cognitive processes, emotional regulation, can suffer. In kids, sleep hygiene is needed to learn, play, and complete tasks.

OTs work with individuals on task completion, participation in activity, and engagement in daily tasks. In each of these aspects of function, sleep is pivotal. Sleep is needed for overall health and wellbeing.

Just some of the implications of consistently poor sleep hygiene include:

Poor focus

Trouble concentrating

Problems paying attention

Health problems: obesity, type 2 diabetes, poor mental health, and injuries

Attention and behavior problems

Poor academic performance in school

Excess weight

Decreased physical activity

Increased food intake

Poor mental health, including depression, depressive symptoms

Unhealthy risk behaviors including alcohol, tobacco, and drug use

Risk-taking behaviors, bullying,school violence-related behaviors, and physical fighting

Higher risk of unintentional injury

In this article we will break down sleep hygiene for children, and how you can improve sleep so that kids can perform functional tasks.

healthy sleep habits for babies

For starters, we want to reassure you that no one has the exact right answer that will work for everyone. What works for you and your family may not work for your neighbor. We hope to provide you with education, resources, and maybe even some new things to try, as you and your family find what works best for you.

One thing to remember is to start healthy sleep habits early.

Sleeping habits, like most things, are easier to maintain if you start off on the right foot early in life. For example, if you know that you want your child to sleep independently for whatever reason, do not have them sleep in your bed from the start. Simply put: do not start a habit if you do not want it to continue.

This is easier said than done, as with most things in parenting life, but remain resilient. For those of you with babies, start their sleeping journey off right with a routine that you can stick to for years to come.

Usually 4 months old is a good time to start developing a routine, and by 6 months, most babies can sleep through the night. For older children, it is never too late to start these healthy sleep habits! Better now than never.

Healthy Sleep Habits for Toddlers

Sleep in the toddler years builds on the earlier baby stage. Habits that were established in the first year can become routine. This is when you may see the toddler that needs to sleep in the parent's bed every night. You may have a pre-bedtime routine that is long and tedious. You might see separation anxiety at bedtime rear it's head. Maybe you have the toddler that wanders from their bed and room each night.

Sleep hygiene for toddlers involves different environmental set-up compared to babies. For toddlers, optimal environment can involve a toddler bed that is low to the ground for safe entry and exit, bed bars for safety, comfortable sheets, or stuffed animals that comfort the toddler. Children may begin to prefer a nightlight at this age, or a dim light that shines onto the ceiling.

Other strategies to promote sleep hygiene in toddlers can include:

Bedtime routine with bath, story, song, prayers, etc.

Cozy pajamas with feet to prevent diaper removal during the night or socks being lost

Settling down an hour or more before bedtime

Physical activity during the day time hours

Reading the same story each night as part of a routine

Consistent routine and sleep space

Quiet the home after bedtime

Remove screens, tablets, phones, etc. from the bedroom

Limit screen time prior to bedtime

Safe sleep space (toddler bed, bed rails)

Comfortable sleep space with sheets, blankets)

Stuffed animal or special blanket to comfort the child

Healthy Sleep Habits for Preschoolers

During the preschool years, children may be more exposed to tablets, cell phones, and learning apps. They may have more use of these screens as a learning tool. But when limits are not put into place, we can see overuse at this young age. For preschoolers, we might see screen use right before bedtime so that it impacts sleep quality.

In the preschool years, there is much learning. Children are gaining physical, cognitive, emotional, social, and communication skills daily it seems! Sleep is very much needed as a rest for the brain and body. But, some children may fight the sleep time and it is possible to impact hygiene of sleep.

Let's break down healthy sleep hygiene habits in preschool aged children:

Bedtime routine

Consistent bedtime

Dark room or dimmed lights

Nightlight

Bedtime stories

Bath before bed

Songs and/or prayers before bed

Limit caffeine during the day

Consistent nap times or quiet time during the day

Consider a wake up clock so that kids can see the time to get out of bed in the morning (and not wake up too early)

Quiet, cool, and calm sleeping space

Calm bedtime routine (try to incorporate these bedtime stretches)

Healthy Sleep Habits for Older Children

When it comes to older kids, including grade school aged kids (6-12 years), middle school aged children (12-14), and high school aged kids (14-18 years), healthy sleep habits change. Even within these age ranges, there are different sleep requirements, but many of the contributing factors of sleep hygiene are similar. Also, many of the tips for healthy sleep hygiene are alike in these age ranges. I'm including these tips and contributing factors together, for these reasons.

In older children, factors that impact sleep hygiene may include:

Later bedtimes

Earlier rise times related to earlier school star

Increase in schoolwork (later bedtimes as a result)

Later afterschool and evening activities

Working in the evening

More child-led decisions and fewer parent-set bedtimes

Use of late-night technology in the bedroom

Puberty

Caffeine intake in the afternoon or evening

Many of these reasons for poor sleep qualitity can not be changed, such as the need to work or complete school work in the later evening hours, or puberty that impacts sleep and circadian rhythems. However, in the older children, there are some ways to impact healthy sleep:

Limit screen use before bed

Remove screens from the bedroom

Limit caffeine use in the evening hours

Encourage physical activity

Relaxation strategies

Low lights and relaxing music in the bedroom

Limit snacks before bedtime

Sound machines

Create a sleep log to monitor sleep and outcomes

Try light reducing shades or curtains for a darker sleep environment

Avoid sleeping in during the weekends; stick to a routine on the weekends

This literature review covers aspects of sleep hygiene in older students.

Like previously mentioned, there are many different aspects of sleep habits in this stage, and no two children and family dynamics may be the same.

Successful Bedtime Routines

Following a bedtime routine, no matter the age, will convince the brain that it is almost time to sleep, and it will start producing melatonin. This sleep hormone will cue the yawns, stretches and sleepy eyes that parents dream of.

Allow for some habit-breaking if it is a special day (late-night sleepover, anyone?), your child is sick, or the routine is just not going to work that day. Otherwise, maintain your chosen routine and your child is likely to sleep soundly throughout their lives.

Using a bedtime routine signals relaxation to the body and the brain. For some children, a visual schedule is needed for sleep routines. It can become automatic for other children.

Example of a sleep routine

1. Baths before bed- Start at a specific time

2. Reading books in bed- Consider a selection of the same books or types of books

3. Singing a song together- Use the same songs

4. Saying your prayers- Follow a consistent or similar prayer

5. Always sleep in the same spot

6. Lights out, parent leaves the room (door open or closed, nightlight or not, etc.)

General Tips for Good Sleep Hygiene

The ideas and tips below are general strategies that can impact sleep hygiene across different ages and stages.

If your child needs you in order to fall asleep, you are their sleeping aide. This is not always sustainable, and if your child wakes in the middle of the night without you by their side, you may be in for a rude awakening in the way of nighttime wake-ups or a difficult to change routine.

1. Go for a tired/awake stage- Leave the room before they are asleep, and offer them a different sleeping aide that they can snuggle all night long. They may be over-tired if they are screaming and crying for hours, have the delirious "sillies" late at night, or cannot settle their bodies, minds, or voices after 30 minutes.

2. Shift the bedtime routine up a bit if you sense that they are getting tired earlier than usual. If this doesn't work, think about their activities from that day. Did they eat too much sugar? Not enough physical activity? How was their rest time? Find the right balance of daily activities that leads them to be ready to sleep around bedtime. Bedtime stalling is another reason why kids may not be getting enough sleep. If your child tends to ask for one more story (again), another drink of water, to go "check" on one of their toys, or needs more than one potty break at bedtime, they are a bedtime staller.

3. Stick to your bedtime routine! Be kind, but be firm: it is time to sleep. Make return visits to their room as short as possible, and know when to stop going back. What if your child just doesn't like sleep? Every night is a struggle and nothing seems to be working. You may be frustrated and dread bedtime, too.

4. Check your attitude towards sleep, your child's perspective, and what both of your emotions are like at bedtime. The caregiver's mood is most important - you must believe that they will sleep in their bed (or whatever desired place), happily and peacefully. You should also try and use your mood to signal that sleeping is wanted and really, quite lovely. If you believe it, and your emotions follow, your child is likely to follow along. Although it can be frustrating, never use anger or threaten your child into going to bed - this may work short-term, but it is not going to benefit their sleep in the long run.

5. Create a "bedtime" and stick to it even on weekends. (Ex: In bed by 8:30pm)

6. Remove stimulating toys, video games, TV, music, lights, etc. an hour before bedtime. Tip: Install light dimmers so that you can lower the lights in the house at this time.

7. Think about sleeping space. If your child sleeps better on the floor, let them!

8. Keep sleeping areas consistent (i.e. always the floor in front of their bed), and eventually your child will want to climb into their bed.

9. Find the "cozy" in your child's life. Maybe they have a special blanket or lovey. Perhaps they feel most restful underneath only a sheet, while your other child needs a weighted blanket to find rest.

10. Light and Noise Sound machines and nightlights can be a nice signal for bedtime and provide comfort, but they are not always necessary. Hold off on purchasing them until you see a need.

SLEEP RESOURCES

It should go without saying that these "easy fixes" may not work overnight. They may not feel all that easy, either. Be patient, be kind, and be strong. You can do this!

Don't hesitate to reach out to your physician to discuss your child's sleeping habits, especially if you or your child are getting significantly less sleep than you should. They will guide you in the right direction.

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Here we are sharing tips for sleep hygiene for kids, and the role that occupational therapy has on sleep. Did you know that sleep is an occupation? It's a part of our daily activities that impact function. And, sleep has been established as critical for optimal health, wellbeing, occupational performance and participation (American Occupational Therapy Association, 2012).

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Obtaining healthy sleep is important for both physical and mental health, improving productivity and overall quality of life. Everyone, from children to older adults, can benefit from better sleep, and sleep hygiene can play a key part in achieving that goal.

Research has demonstrated that forming good habits is a central part of health National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . Crafting sustainable and beneficial routines makes healthy behaviors feel almost automatic, creating an ongoing process of positive reinforcement. On the flip side, bad habits can become engrained even as they cause negative consequences.

Thankfully, humans have an impressive ability NIH News in Health The NIH, a part of the U.S. Department of Health and Human Services, is the nation's medical research agency - making important discoveries that improve health and save lives. View Source to make our habits serve our long-term interests. Building an environment and set of routines that promote our goals can really pay off.

Sleep hygiene encompasses both environment and habits, and it can pave the way for higher-quality sleep and better overall health.

Improving sleep hygiene has little cost and virtually no risk, making it an important part of a public health strategy National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source to counteract the serious problems of insufficient sleep and insomnia in America.

What Are Signs of Poor Sleep Hygiene?

Having a hard time falling asleep, experiencing frequent sleep disturbances, and suffering daytime sleepiness are the most telling signs of poor sleep hygiene. An overall lack of consistency in sleep quantity or quality can also be a symptom of poor sleep hygiene.

Good sleep hygiene is all about putting yourself in the best position to sleep well each and every night.

Optimizing your sleep schedule, pre-bed routine, and daily routines is part of harnessing habits to make quality sleep feel more automatic. At the same time, creating a pleasant bedroom environment can be an invitation to relax and doze off.

A handful of tips can help in each of these areas, they aren't rigid requirements. You can adapt them to fit your circumstances and create your own sleep hygiene checklist to help get the best sleep possible.

Set Your Sleep Schedule

Having a set schedule normalizes sleep as an essential part of your day and gets your brain and body accustomed to getting the full amount of sleep that you need.

Have a Fixed Wake-Up Time: Regardless of whether it's a weekday or weekend, try to wake up at the same time since a fluctuating schedule keeps you from getting into a rhythm of consistent sleep.

Prioritize Sleep: It might be tempting to skip sleep in order to work, study, socialize, or exercise, but it's vital to treat sleep as a priority. Calculate a target bedtime based on your fixed wake-up time and do your best to be ready for bed around that time each night.

Make Gradual Adjustments: If you want to shift your sleep times, don't try to do it all in one fell swoop because that can throw your schedule out of whack. Instead, make small, step-by-step adjustments of up to an hour or two so that you can get adjusted and settle into a new schedule.

Don't Overdo It With Naps: Naps can be a handy way to regain energy during the day, but they can throw off sleep at night. To avoid this, try to keep naps relatively short and limited to the early afternoon.

Follow a Nightly Routine

How you prepare for bed can determine how easily you'll be able to fall asleep. A pre-sleep playbook including some of these tips can put you at ease and make it easier to fall asleep when you want to.

Keep Your Routine Consistent: Following the same steps each night, including things like putting on your pajamas and brushing your teeth, can reinforce in your mind that it's bedtime.

Budget 30 Minutes For Winding Down: Take advantage of whatever puts you in a state of calm such as soft music, light stretching, reading, and/or relaxation exercises.

Dim Your Lights: Try to keep away from bright lights because they can hinder the production of melatonin, a hormone that the body creates to facilitate sleep.

Unplug From Electronics: Build in a 30-60 minute pre-bed buffer time that is device-free. Cell phones, tablets, and laptops cause mental stimulation that is hard to shut off and also generate blue light that may decrease melatonin production.

Test Methods of Relaxation: Instead of making falling asleep your goal, it's often easier to focus on relaxation. Meditation, mindfulness, paced breathing, and other relaxation techniques can put you in the right mindset for bed.

Don't Toss and Turn: It helps to have a healthy mental connection between being in bed and actually being asleep. For that reason, if after 20 minutes you haven't gotten to sleep, get up and stretch, read, or do something else calming in low light before trying to fall asleep again.

Cultivate Healthy Daily Habits

It's not just bedtime habits that play a part in getting good sleep. Incorporating positive routines during the day can support your circadian rhythm and limit sleep disruptions.

Get Daylight Exposure: Light, especially sunlight, is one of the key drivers of circadian rhythms that can encourage quality sleep.

Be Physically Active: Regular exercise can make it easier to sleep at night and also delivers a host of other health benefits.

numerous sleeping problems National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Don't Smoke: Nicotine stimulates the body in ways that disrupt sleep, which helps explain why smoking is correlated with View Source .

Reduce Alcohol Consumption: Alcohol may make it easier to fall asleep, but the effect wears off, disrupting sleep later in the night. As a result, it's best to moderate alcohol consumption and avoid it later in the evening.

Cut Down on Caffeine in the Afternoon and Evening: Because it's a stimulant, caffeine can keep you wired even when you want to rest, so try to avoid it later in the day. Also be aware if you're consuming lots of caffeine to try to make up for lack of sleep.

Don't Dine Late: Eating dinner late, especially if it's a big, heavy, or spicy meal, can mean you're still digesting when it's time for bed. In general, any food or snacks before bed should be on the lighter side.

Restrict In-Bed Activity: To build a link in your mind between sleep and being in bed, it's best to only use your bed for sleep with sex being the one exception.

Optimize Your Bedroom

A central component of sleep hygiene beyond just habits is your sleep environment. To fall asleep more easily, you want your bedroom to emanate tranquility.

While what makes a bedroom inviting can vary from one person to the next, these tips may help make it calm and free of disruptions:

Have a Comfortable Mattress and Pillow: Your sleeping surface is critical to comfort and pain-free sleep, so choose the best mattress and best pillow for your needs wisely.

Use Excellent Bedding: The sheets and blankets are the first thing you touch when you get into bed, so it's beneficial to make sure they match your needs and preferences.

Set a Cool Yet Comfortable Temperature: Fine-tune your bedroom temperature to suit your preferences, but err on the cooler side (around 65 degrees fahrenheit).

Block Out Light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.

Drown Out Noise: Ear plugs can stop noise from keeping you awake, and if you don't find them comfortable, you can try a white noise machine or even a fan to drown out bothersome sounds.

lavender National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. Try Calming Scents: Light smells, such as View Source , may induce a calmer state of mind and help cultivate a positive space for sleep.

The basic concept of sleep hygiene - that your environment and habits can be optimized for better sleep - applies to just about everyone, but what ideal sleep hygiene looks like can vary based on the person.

For that reason, it's worth testing out different adjustments to find out what helps your sleep the most. You don't have to change everything at once; small steps can move you toward better sleep hygiene.

It's also important to know that improving sleep hygiene won't always resolve sleeping problems. People who have serious insomnia or sleep disorders like obstructive sleep apnea may benefit from better sleep hygiene, but other treatments are usually necessary as well.

In other words, even though it may be beneficial, sleep hygiene alone isn't a panacea. If you have long-lasting or severe sleeping problems or daytime sleepiness, it's best to talk with a doctor who can recommend the most appropriate course of treatment.

Learn more about our Editorial Team

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Mastering Sleep Hygiene: Your Path to Quality Sleep | Sleep Foundation

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Looking for ways to sleep better? Improving sleep hygiene can make your habits, routines, & environment more conducive to consistent and restorative sleep.

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Sleeping Better - Guided exercises and activities 

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Getting enough sleep, and the right type of sleep, is vital for our overall health and wellbeing. While you sleep, your body works to support healthy brain function and maintain your physical health. And for children and young people, sleep is how their bodies and minds grow and develop.

When you do not get enough sleep, you feel tired, you find it hard to concentrate and remember things and you may be grumpy. Lack of sleep can also impair your judgement and impact your physical coordination. So not getting enough sleep affects the way you feel, think, work, learn and get along with other people.

If you are having problems getting to sleep or staying asleep, or if you often feel tired during the day, you may need to work out what's happening. But the good news is most sleeping problems are easily fixed.

Sleep and moods

Think about how one bad night's sleep, or not enough sleep, makes you feel the next day. For many of us, we're grumpy and irritable, we find it difficult to concentrate, and we have no energy. We can overreact when things don't go our way, and we may find we're less excited if something good happens. So it is easy to see how ongoing sleeplessness can be a worry.

Long term sleep deficiency can increase the risk of chronic health problems such as heart disease and diabetes. It can also significantly affect your mood.

Sleeplessness and mood disorders are closely linked. And it can work both ways - sleep loss can affect your mood, and your mood can affect how much and how well you sleep.

Studies show people who are sleep deprived report increases in negative moods (anger, frustration, irritability, sadness) and decreases in positive moods. And sleeplessness is often a symptom of mood disorders, such as depression and anxiety. It can also raise the risk of, and even contribute to, developing some mood disorders.

Your mood can also affect how well you sleep. Anxiety and stress increase agitation and keep your body aroused, awake and alert. You might find you can't turn your brain off, your heart beats faster and your breathing is quick and shallow.

So getting enough sleep and the right kind of sleep is important.

How much sleep do you need?

How much sleep you need depends on your age, physical activity levels, and general health.

Children and teenagers need 9-10 hours of sleep a night. Younger children tend to go to sleep earlier and wake earlier. As children grow into teenagers, they seem to get tired later and sleep in later.

Adults need around 8 hours sleep each night. We tend to need less sleep, as we get older.

These are some general guidelines. If you (or your children) are tired during the day, you may need more sleep.

Some tips on getting a good night's sleep

If you've been having trouble getting enough good sleep, the good news is there are many . Try these tips:

Get a routine and stick to it. Try going to bed around the same time every night and getting up at the same time each morning.

Avoid drinking coffee and alcohol too close to bedtime. And finish eating at least two hours before your head hits the pillow.

Keep TVs and iPads out of your bedroom.

Make your bedroom a haven. Make sure your bed is comfortable. Turn the lights down as you get into bed. Read using a bedside light.

Try some simple meditation, like closing your eyes for 5-10 minutes and focusing on taking deep, slow breaths.

Enjoy a warm bath.

Don't lie awake watching the clock. If you are tossing and turning, try getting up and reading a book for half an hour or so before trying to go to sleep again.

And if you still can't sleep?

So what can you do if you can't sleep when you want to, or if you can't stay asleep?

The first step is to . They will help you work out whether a is affecting your sleep, such as:

insomnia

jet lag and shift working

sleepwalking, nightmares and night terrors

restless legs

snoring

sleep apnoea.

Your GP can talk to you about some non-medical treatments for sleep disorders, such as relaxation training. has useful techniques for children and adults. Other strategies include stimulus control and cognitive behaviour therapy (CBT).

Your GP may also prescribe you medication or sleeping tablets, which can help you fall asleep. But medication will not be enough in the long run. It can help you fall asleep, but it won't help you with an underlying problem like stress or anxiety. It also becomes less effective over time (as your body gets used to it). And it can be addictive.

Remember...

We all need enough sleep, and the right type of sleep, to be happy and healthy.

In the long run, not getting enough sleep can affect our moods as well as our physical wellbeing.

There are lots of things you can try to improve your sleep quality and quantity.

But if you try these things and you still can't sleep, talk to your GP.

Where to get help

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Mood and sleep | betterhealth.vic.gov.au

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Getting enough sleep, and the right type of sleep, is vital for our overall health and wellbeing. While you sleep, your body works to support healthy brain function and maintain your physical health. And for children and young people, sleep is how their bodies and minds grow and develop.

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by Arianna Huffington

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The Sleep Revolution: Transforming Your Life, One Night at a Time

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The Sleep Revolution: Transforming Your Life, One Night at a Time [Huffington, Arianna] on Amazon.com. *FREE* shipping on qualifying offers. The Sleep Revolution: Transforming Your Life, One Night at a Time

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The Little Book of Sleep: The Art of Natural Sleep

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The Little Book of Sleep: The Art of Natural Sleep

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by Dr. Nerina Ramlakhan

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The Little Book of Sleep: The Art of Natural Sleep

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The Little Book of Sleep: The Art of Natural Sleep [Ramlakhan, Dr. Nerina] on Amazon.com. *FREE* shipping on qualifying offers. The Little Book of Sleep: The Art of Natural Sleep

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Why We Sleep: The New Science of Sleep and Dreams

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by Matthew Walker, Ph. D.

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Why We Sleep [Matthew Walker] on Amazon.com. *FREE* shipping on qualifying offers. Why We Sleep

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The Doctor's Guide to Sleep Solutions for Stress and Anxiety

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The Doctor's Guide to Sleep Solutions for Stress and Anxiety

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by Robert S. Rosenberg

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The Doctor's Guide to Sleep Solutions for Stress and Anxiety: Combat Stress and Sleep Better Every Night

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The Doctor's Guide to Sleep Solutions for Stress and Anxiety: Combat Stress and Sleep Better Every Night [Rosenberg, Robert S.] on Amazon.com. *FREE* shipping on qualifying offers. The Doctor's Guide to Sleep Solutions for Stress and Anxiety: Combat Stress and Sleep Better Every Night

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Your behaviors during the day, and especially before bedtime, can have a major impact on your sleep. Learn about healthy sleep habits.

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Centers for Disease Control and Prevention

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Good sleep habits (sometimes referred to as "sleep hygiene") can help you get a good night's sleep.

Some habits that can improve your sleep health:

Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends

Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature

Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom

Avoid large meals, caffeine, and alcohol before bedtime

Get some exercise. Being physically active during the day can help you fall asleep more easily at night.

For more
http://www.sleepeducation.org/essentials-in-sleep/healthy-sleep-habits

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Good sleep habits (sometimes referred to as "sleep hygiene") can help you get a good night's sleep.

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Sleep Podcasts that Will Help You Doze Off

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Sleep Podcasts that Will Help You Doze Off

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Do you find yourself staring up at the ceiling at night?

If you do, you're not alone. Trying to fall asleep can be a real struggle. Whether you have a lot on your mind or just can't get comfortable in bed, sometimes we need a little extra help to drift off to sleep. Perhaps what's missing from your nighttime routine is listening to a sleep podcast.

Sleep-focused podcasts offer a variety of sleep inducers, like music, stories, and meditation. While we can't guarantee sleep on podcasts like our mattresses, we think these podcasts are worth a listen to help make sleeping a little easier.

So, we rounded up 15 of the best sleep podcasts designed for sleep. Get ready to put on your pajamas, turn on one of these babies, and hang on tight for your ride to Slumberville.

Best Podcasts for Sleep

Not sure which kind of podcast to start? Here are some of our favorite podcasts where you can experiment with sleep-inducing sounds and genres.

Sleep with Me
No sleep podcast list is complete without Sleep With Me. Known as the Sandman of sleep podcasts, this highly praised show is perfect for any insomniac. In each episode, the narrator takes a random topic and fills it with extra tangents, rambling sentences, and a soothing monotone voice, making the show as incomprehensible and sleep-inducing as possible.

Listen here.

Deep Energy Podcast
If listening to people doesn't sound like your cup of tea, maybe a podcast with ambient sounds will do the trick. Think rainstorms, streams, sunsets, drums, and ocean waves, all set to an ethereal, new-age backdrop. Not only do these sounds help with meditation, but this type of ambient noise has been shown to help you fall asleep faster.

Listen here.

In Our Time
Remember those days when you fell asleep during a college lecture? In Our Time is a bit like that. While not designed as a sleep podcast, this well-researched show dives deep into various academics topics to help calm and soothe listeners. One week might have you learning about the Salem Witch Trials, and another week bird migration patterns.

Listen here.

Casper Sleep Channel
Shameless plug: we recently launched a new podcast for sleep! Wind down to a collection of sounds, meditations, and bedtime stories narrated by "June the Moon". Our weekly show will feature big names in the podcasting world like Meredith Goldstein (Boston Globe's Love Letters), Nathan Thornburg (The Trip), and Kathryn Nicolai (Nothing Much Happens: Bedtime Stories for Grown-Ups).

Listen here.

Bedtime Stories Podcasts

Ever wonder why children love bedtime stories? Experts suggest that kids like the familiarity of the experience and not having to concentrate hard during storytime. This helps to ease them into falling asleep. There is no reason that adults can't benefit from them too.

Sleepy
This podcast takes us back to our roots, as one is ever too old for a classic bedtime story. Otis Gray reads stories in the public domain, such as Sherlock Holmes, Peter Pan, and the Wonderful Wizard of Oz, with a warm and inviting voice. The show is perfect for those who like the sound of calming, deeper voices.

Listen here.

On a Dark, Cold Night
Usually, it's the stuff of nightmares that keep us up at night. However, narrator Kristen Zaza tells original scary stories with a slow, raspy voice to put listeners to sleep. Her material capitalizes on the eerie and often sad realm of horror as a way to calm the mind.

Listen here.

Nothing Much Happens: Bedtime Stories For Adults
With no central plot, this podcast walks you through calming experiences with great detail and description. An episode can take you the experience of taking an unexpected nap or that happy moment of baking fresh bread. Nicolai tells each story twice - the second telling with slower speech and longer pauses, the kind of narration that you can fall asleep to.

Listen here.

Stories from the Borders of Sleep
In this podcast, Seymour Jacklin tells original fantasy stories and poems, making this the perfect show to tune in with children. The imaginative stories combined with Jacklin's calm narration and carefully selected background music whisk you off into the realm of sleep.

Listen here.

Meditation Podcasts to Help You Sleep

You're all tucked into bed but you can't fall asleep. The culprit? Most likely, your stress and anxious thoughts. Studies suggest that mindful meditation and breathing can help fight insomnia. Here are some podcasts to help you reach that sleep-ready state of mind.

Tracks to Relax: Guided Sleep Meditations
Having a hard time relaxing? Guided Sleep Meditations provides soothing exercises, directions, and visualizations designed to deeply calm your mind before bedtime. Be prepared to journey through forests, beachsides, and caverns as you make your way into your comfort zone.

Listen here.

The Daily Meditation Podcast
While not specifically designed to make you doze off in bed, The Daily Meditation Podcast offers guided meditations for everyday themes like self-love and negative thoughts. This can help you relieve the feelings of stress that get between you and that worry-free sleep. Hearing all this from a calming voice like host Mary Meckley's doesn't hurt either.

Listen here.

Meditation Minis
Like The Daily Meditation Podcast, Chel Hamilton's show offers brief 10-minute episodes aimed at helping busy minds shut out the noise. Hamilton, a hypnotherapist, uses a combination of imagery and positive self-talk to help you wrangle anxious thoughts, increase confidence, and put you at the edge of sleep.

Listen here.

On Being
The On Being podcast provides a different approach by inspiring you to reflect on your spirituality and existence. Hosted by Krista Tippett, each weekly episode features a well-crafted interview with scientists, thinkers, and artists to help you embrace mindfulness and meditation.

Listen here.

Relaxing Podcasts

What you do before bed is just as important as what you do on it. These podcasts are some of our favorites to help you unwind before you close your eyes. Pair them with a relaxing bedtime routine for maximum effect.

Sleep Whispers
Inside voices only. For those of you with minds that run a hundred miles each night, this show is designed to slow down your thoughts and reset your mind. Sleep Whispers tells everything from various histories to recipes in hushed whispers, which has been shown to help adults sleep.

Listen here.

The ASMR Podcast
If you're hoping to relax before bed, you may benefit from a dose of ASMR. ASMR stands for Autonomous Sensory Meridian Response - a calming, pleasurable, and sometimes tingling sensation that can run down your spine when you're responding to stimuli. Not everyone can experience ASMR, but if you're trying to drift off to sleep, this podcast may just be your remedy.

Listen here.

Classical Music Discoveries
Not into the ASMR craze? Try good ol' classic music instead. The benefits of classical music are widely covered, from health and wellness to creativity to -you guessed it-sleep. The Classical Music Discoveries podcast releases new episodes daily.

Listen here.

What is the Best Sound to Fall Asleep To?

We tend to think that we need peace and quiet to fall asleep. However, studies show that sounds can actually aid in getting some shuteye. Even when we're in deep slumber, our brains are still able to perceive and process sounds. The sounds we pick up can be either relaxing or alarming, which varies for each individual.

Sleep podcasts often utilize different techniques for those who crave sleep. Try out some of these sleep-inducing sounds to see which ones are most relaxing for you.

Pink Noise
Pink noise is a type of signal like white noise that mixes high and low frequencies. Small studies have found that pink noise can decrease the time it takes to sleep by 38 percent.

Examples of pink noise include rainfall, beach waves, and rustling leaves. Researchers suggest that water sounds, even when loud, rise and fall smoothly in intensity, so our brains see them as non-threatening. This is why many people swear by rain apps like Rainy Mood and Rain Rain Sleep Sounds to help them fall asleep.

Music
We're not talking about that catchy song on the radio. Instead, listen to music that has a steady rhythm, soft melodies, and lower pitches. Studies have shown that classical music can be a remedy for those who feel restless at night. A podcast like Classical Music Discoveries can be the perfect place to start listening to the classics.

Human Voices
Sometimes, another human voice can just as relaxing as ambient sound. Scientists theorize that soft voices and sounds can trigger that ASMR sensation, helping us to relax and doze off. It's estimated that as many as 40 percent of people can experience mild ASMR. Many apps like pzziz can help lull you into sleep with soothing voices.

With their easy and digestible format, podcasts are becoming increasingly popular. Sleep podcasts take it a step further by incorporating some sounds we need to help us catch some Zzs. The next time you are laying in bed with your eyes wide open, give these podcasts a try.

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15 Sleep Podcasts That Will Help You Doze Off Easier | Casper Blog

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Do you find yourself staring up at the ceiling at night? If you do, you're not alone. Trying to fall asleep can be a real struggle. Whether you have a lot on your mind or just can't get comfortable in bed, sometimes we need a little extra help to drift off to sleep.

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1. Sleep With Me

San Francisco Bay Area host Drew Ackerman (aka Scooter) records his twice-weekly podcast, Sleep With Me, from within a "Harry Potter closet under the stairs" at his house, he says. And the whole idea behind his "bedtime stories for grownups," which are usually an hour to 90 minutes long, is that you're on the phone with a friend (one "you don't really have to listen to," he says) who's telling you a story to help you fall asleep. Ackerman suggests using a smart speaker with a sleep timer to listen to his show, which might include him paging through old HBO guides and detailing other similarly dull things designed to make you lose interest - and wakefulness. "There's a lot on peoples' minds right now," he adds. "You deserve a good night's sleep."

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San Francisco Bay Area host Drew Ackerman (aka Scooter) records his twice-weekly podcast, Sleep With Me , from within a "Harry Potter closet under the stairs" at his house, he says.

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Pillow's sleep statistics are designed to be easy to understand and rich with information. Quick glanceable summaries inform you about important sleep metrics.

Want to delve deeper? Each metric offers weekly, monthly and yearly views with rich information. Compare your sleep quality and other sleep metrics with your Steps, Weight, Caffeine consumption and many more.

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Best sleep tracker app for the Apple Watch, iPhone and iPad. Monitor sleep, record snoring, improve your sleep.

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Sleep Cycle Smart Alarm Clock, Sleep Tracker with Sleep Cycle Analysis and Soundscapes for Better Sleep

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Typical Night of Sleep

Sleep Time analyzes your movement throughout the night, graphs your sleep cycles, and learns to wake you up at the perfect moment of your lightest sleep phase.

Jetlag

Although this jetlagged user went to bed at 10pm, we can see it was difficult for her to maintain regular sleep cycles throughout the night. She spent a good portion of night awake or in light sleep.

Disrupted Sleep

This user drank a caffeinated beverage before bedtime and took about one hour to fall asleep. Throughout the night, he had abnormal sleep cycles and even woke up once in the middle of the night. Sleep Time helps you analyze how your habits affect your sleep.

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Typical Night of Sleep Sleep Time analyzes your movement throughout the night, graphs your sleep cycles, and learns to wake you up at the perfect moment of your lightest sleep phase. Jetlag Although this jetlagged user went to bed at 10pm, we can see it was difficult for her to maintain regular sleep cycles throughout the night.

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## A fun and simple way to develop healthy sleep habits
##【New Features and Updates】Apart from building alone, you can now build with family and friends by reaching the same sleep goals together! Make it fun to build healthy sleep habits, invite your friends and family to join the SleepTown circle now!

Developed by SeekrTech, the creator of Forest app which has more than 25 million users around the globe. Study hard in the morning, put down your phone and sleep well at night!

SleepTown is an incredible app that helps you attain a healthy, regular sleep schedule. Construct amazing buildings just by achieving your bedtime and wake-up goals every day. Put down your smartphone before going to bed and build your own town while you sleep.

Do you often stay up late scrolling on your phones? Hit the snooze button until you're late? If you have trouble putting your phone down at bedtime, or if you suffer from insomnia and want to attain a healthy, regular sleep schedule, SleepTown is the solution for you!

How it works: 3 steps to a healthy sleep schedule
1) Set your own challenging bedtime and wake-up goal.
2) Open the SleepTown app before your bedtime goal and start constructing a building.
3) Wake up before your wake-up goal, shake your phone to clear your mind, and see which building you got. Every morning the building is a surprise that will motivate you to wake up!
Repeat these steps every day to maintain a regular sleep cycle and create a lovely "SleepTown"!

SleepTown Can Help You:
* Beat your phone addiction and get more sleep
* Maintain regular sleep hours between 4-10 hours a day
* Construct amazing buildings by achieving your bedtime and wake-up goals
* Wake up to a reward every day - your new building!
* If you don't go to bed at your bedtime goal, you cannot construct a building
* If you use your phone during your sleeping time, your building under construction will be destroyed
* View your "SleepTown" and all your sleep statistics in the town page
* Night shift mode helps reduce blue light
* You can also join a circle with family and friends and set the same sleep goals. Build healthy sleep habits together and contribute energy to construct the wonders of the world!

Construct Your Own Town:
* Over 70 types of unique buildings available
* Spend your earned coins to unlock new buildings
* Earn revenue after each successful construction
* Earn extra revenue from consecutive successful days
* Design your own town with land, buildings, and decorations
* Apply special themes on holidays to decorate your SleepTown
* Elaborately designed wonders of the world make your town spectacular!

Customize Your Sleeping Schedule:
* Set up to two days off in a week: failing on your "day-off" won't end your streak, so relax and take a break!
* Reset bedtime & wake-up time goals anytime
* Set up a bedtime reminder and alarm clock
* Adjust the volume and sound of your alarm
* Adjust "shake your phone" challenge to wake you up easily in the morning

Other features:
* Earn rewards for your first successful building and for inviting a friend
* Unlock achievements and earn extra rewards
* Create an account to back up your data (all your sleeping stats and lovely buildings!)
* Sync your sleep data to Apple's HealthKit

Go to sleep on time, and start building your own "SleepTown" tonight!

Notice:
SleepTown is an app available for both iPhone and iPad. Once purchased it can be restored on other iOS devices. To download a non-iOS version of SleepTown, a separate purchase is required. However, by logging into the same registered account, the account data can be synchronized across different platforms and devices.

Like us on Facebook: https://www.facebook.com/SleepTownApp
Follow us on Twitter: https://twitter.com/sleeptownapp
Follow us on Instagram:https://www.instagram.com/sleeptownapp/

Find out more on https://sleeptown.seekrtech.com!

Privacy Policy:https://sleeptown.seekrtech.com/privacy/

Sound Design:Shi Kuang Lee

Version 3.2.17

* Some bug fixes.

Probably my favorite app?

I genuinely don't even know if I had this regular of a sleep schedule when I was a kid. I have ADHD and would regularly spend until four in the morning researching whatever that week's new interest was on my phone instead of sleeping. The novelty of getting new buildings, the frustration of a house collapsing, and the desire to keep consistent so I have the funds to configure new areas of my town are all strong enough to keep me from blowing it off, which is a pretty huge feat. Also, when I did hit a patch of not using it for awhile, I discovered the Circles function, and having friends build projects with me gave me the added element of public accountability. The only fundamental way this app could be better would be if you were somehow able to download it onto other devices and your desktop so that you can't hop from your phone to somewhere else, but also, like, an app can't actually be a full adult for you, so 🤷🏼‍♀️. (That said, developers, if you could give the option to edit the sleep goals for Circles groups every couple of weeks in case of slight schedule changes in the group, I would love you forever.) Anyway, it's an incredible app, and my mental and physical health are measurably better for it.

Surprisingly addictive (the good kind)

Alright so it's not a game, nor will it require time away from anything. I was first brought onto SleepTown by way of Forest which has changed the way I use my iPhone for the better! SleepTown has not only surpassed my expectations but believe or not I am going to bed on time and not spending time on my iPhone (how simple that may sound I know there are millions of us who can't due to the phone addiction) then waking up to a surprisingly building that provides me with a weird satisfaction that I slept and obtained a building for my town. Look, this is probably not for anyone who could give a rip about spending countless hours on their phones while in bed or could care less about sleep (if this is you... life catches up), but if you are in the class of "I care about the quality of sleep and want to break away from giving my attention to a device that is a time sucking, data hog, irrelevant piece of metal and plastic"... then I would suggest SleepTown.

A bit too strict

It's a nice app but it's so strict, if you miss by a couple minutes, even if you still get to bed in roughly the same time, the building will be destroyed.
Another thing I don't like is that once you missed my sleeping time that's it, you failed the night and there's nothing else you can do. But really, even if I missed my sleeping time by hours, it still helps to just click "build" and put down the phone when I do decide to sleep. I want to use this app for helping me get away from my phone, and i still want to use this feature even if I did miss my sleeping time. But right now "missing you sleeping time" is just the end of the story.
I don't even want to open this app after not being able to build a single house for three days. There're tracking apps more forgiving rewarding and helpful than this one.
---------
What I think might help is to add a period in which you want to go to bed, then a deadline by which you have to get off your phone. Say you want to sleep at 10pm, it may help to give you a period between 9:30 to 10:30 in which you can hit sleep and start building the house, but still allow you to have some flexibility, say I can still reply to a text at 10:05. But then by 10:30 is the hard deadline after which the house will be destroyed if you look at your phone again.

Hello,

Thank you for your suggestion, we will take this into consideration. :)

The developer, SEEKRTECH CO., LTD., has not provided details about its privacy practices and handling of data to Apple. For more information, see the developer's privacy policy.

No Details Provided

The developer will be required to provide privacy details when they submit their next app update.

Information

Seller

SEEKRTECH CO., LTD.

Compatibility

iPhone

Requires iOS 10.0 or later.

iPad

Requires iPadOS 10.0 or later.

iPod touch

Requires iOS 10.0 or later.

Languages

English, French, German, Japanese, Korean, Russian, Simplified Chinese, Spanish, Traditional Chinese

Family Sharing

With Family Sharing set up, up to six family members can use this app.

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‎## A fun and simple way to develop healthy sleep habits ##【New Features and Updates】Apart from building alone, you can now build with family and friends by reaching the same sleep goals together! Make it fun to build healthy sleep habits, invite your friends and family to join the SleepTown circle n...

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** Best of 2018 Award Winner ** - Apple

** 2017 App of the Year ** - Apple

** Happiest App in the World ** - Center for Humane Technology

Calm is the #1 app for Sleep, Meditation and Relaxation. Sleep better, relieve stress, lower anxiety and refocus your attention. Explore an extensive library of guided meditations, Sleep Stories, breathwork, exclusive music and stretching exercises.

Invest in your mental health and choose a guided meditation session that fits within your busy schedule. Add Calm to your daily routine and join the millions experiencing the life-changing benefits of practicing mindfulness. Beginners, intermediate and advanced users can all find their home in Calm.

Let relaxing music and calming sounds help you meditate, focus and sleep better. Sleep Stories are bedtime stories that are guaranteed to lull you into a deep and restful slumber. Pick from 100+ exclusive Sleep Stories, featuring well-known talent such as Matthew McConaughey, Stephen Fry, Rosé, Jerome Flynn and P!nk.

Calm is recommended by top psychologists, therapists and mental health experts. Take a deep breath and find your Calm.

CALM FEATURES

MEDITATION & MINDFULNESS
* Meditate with seasoned experts, regardless of your experience level
* Introduce mindfulness into your daily routine and learn to calm your mind
* Mindfulness topics include Deep Sleep, Calming Anxiety, Managing Stress, Focus and Concentration, Breaking Habits, Happiness, Self-Esteem and so much more

SLEEP STORIES
* Sleep soundly listening to bedtime stories for adults and children alike
* Wonder - Join Matthew McConaughey on a dreamy story about the mysteries of the universe
* Blue Gold - Journey through the sleepy village of Provence with master storyteller Stephen Fry
* The Nordland Night Train - Travel up the scenic coast of Norway aboard a remote railway
* Happy Little Zzzs - Drift off to the soothing brush strokes of beloved painter Bob Ross

RELAXATION & STRESS RELIEF
* Learn to relax and lower stress with daily meditation and breathing exercises
* Focus on a goal with Dailies - Reduce anxiety with daily 10-minute original programs like the Daily Calm with Tamara Levitt, the Daily Trip with Jeff Warren, or the Daily Jay with Jay Shetty
* Shift your thinking and find your calm through inspiring stories with Wisdom
* Daily Move: Mindful stretching and movement to relax your body during the day

ALSO FEATURING
* Daily Streaks & Mindful Minutes: Track and celebrate your progress
* 7 and 21 day mindfulness programs for both beginner and advanced users
* Music: Exclusive music engineered to help you focus, relax or sleep
* Soundscapes to sleep: Ocean waves, Heavy Rain, Camp Fire, Babbling Brook and more

Calm saves your meditation and sleep sessions to your Apple Health app.

Subscription pricing and terms:
Calm offers an auto-renewing monthly subscription at $14.99/month and an auto-renewing yearly subscription at $69.99/year to provide you with unlimited access to the Calm Collection while you maintain an active subscription. Calm also offers a Lifetime subscription for $399.99 which is paid for by a one-off upfront payment with unlimited access to the Calm Collection forever.

Payment will be charged to the credit card connected to your iTunes Account when you confirm the initial subscription purchase. Subscriptions automatically renew unless auto-renew is turned off at least 24-hours before the end of the current subscription period. Your account will be charged for renewal within 24-hours prior to the end of the current period, and the cost of the renewal will be identified. You may manage your subscription and auto-renewal may be turned off by going to your Account Settings after the purchase. Any unused portion of a free trial period, if offered, will be forfeited when you purchase a subscription, where applicable.

Read more about our terms and conditions here:
Terms of service: https://www.calm.com/terms
Privacy policy: https://www.calm.com/privacy

Calm is the #1 app for sleep and meditation. Discover a happier, healthier you through our meditations, Sleep Stories, music, and more.

Calm is for anyone, whether you're brand new to meditation or a seasoned expert. It's also for anyone who needs a mental break, a soothing sound, or a peaceful night's rest. Our guided meditations are available in lengths of 3 to 25 minutes, so you can choose the perfect length to fit your schedule.

We offer a new 10-minute Daily Calm every day, Sleep Stories narrated by well-known voices like Matthew McConaughey, a music library with exclusive tracks from top artists like Keith Urban and Disney, short videos with mindful movement and gentle stretching for every body type, Masterclasses taught by world-renowned experts in the field of mindfulness, soundscapes and nature sounds to use during meditation or to help you sleep, breathing exercises to help you relax, and more.

With over 100 million users worldwide, we're having a positive effect on more and more people each day. Take a moment to prioritize yourself today, and enjoy the app.

Editors' Choice

Take a deep breath. That phrase greets you whenever you open Calm. It's both a call to action and a defining feature of the app's approach to meditation: You're going to get through this, and all you need to start is a moment. In the increasingly crowded field of apps for meditation and mindfulness, Calm stands out for its ease of use and attention to (soothing) detail.

Has become better with years

Calm has always been a good app. As they grew, so did frustrating tech issues but they seem to have solved those and have added to their programs. It's as if they have beautifully sculpted the app with time. I really appreciate the choices given when I open Calm. Sometimes I need a moving meditation. Sometimes I need the wisdom Sometimes a little humor and sometimes only Tamara's calming voice will do. I really appreciate the meditating sounds of soft rain or a washing machine or waves ebbing & flowing. But my very tough Working K9 will only calm when going through his annual vet visit with blood tests and shots and such to Baby Shhh and it works every time. So I guess if Calms me and my dog, I have to give it five stars. I love the breathing part. I use it almost daily. Not a fan of the music but the sleep stories are the best and I love that I can use the search bar and find one of my favorites I may be in the mood for such as a dream over Paris or the history of the Library at Oxford or the train stories. Also the narrators offer excellent choices and their are certain ones whom I just need to hear at hard times because their soft melodic gift of storytelling puts me right out. I really appreciate the variety. I have had the Calm app I believe since not long after it launched and as others have come and gone and Calm has had its own growing pains, it's the one with which I remain. So, thanks Calm, from my Tough Dog and I both.

So sorry for the trouble you've experienced! Please try leaving the app open on the loading screen, as this should allow the app to fully load. Upon subsequent app launches, the app should then load normally without any delay on the "take a deep breath" screen. If you are experiencing issues on an older version of the iOS app, please update to the latest version, then follow the steps above if you experience any loading issues.

𝔸 𝕗𝕖𝕒𝕥𝕦𝕣𝕖 𝕥𝕠 𝕓𝕖 𝕒𝕕𝕕𝕖𝕕

Felix has a stunning, soothing, and low pitched voice. He should be added because a lot of people love his voice. And it could amplify the app's popularity among stays. It's a good idea. But it's not necessary. If your app is a voice-over, then you should use the same pitch as the voice, or even a lower one. The same goes for the text. A Felix has a stunning, soothing, and low pitched voice. He should be added because a lot of people love his voice. And it could amplify the app's popularity. Felix gets a load of support. If Felix's voice can help a 10 year old with autism calm down, it can help your users too. So it's good to have him. You can even add a Felix to your text messages if it helps your customers. This is an excellent idea and one that I've seen in a few places. I like this idea, because Felix has a stunning, soothing, and low pitched voice. He should be added because a lot of people love his voice. And it could amplify the app's popularity. Felix gets a load of support. If Felix's voice can help a 10 year old with autism calm down, it can help your users too. We have a ton of users that love Felix. His voice is amazing. That's why we'll be adding him to the list. Maybe you want to add Felix because he has this video series that is intended for people who can't sleep.

Data Used to Track You

The following data may be used to track you across apps and websites owned by other companies:

Data Linked to You

The following data may be collected and linked to your identity:

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‎** Best of 2018 Award Winner ** - Apple ** 2017 App of the Year ** - Apple ** Happiest App in the World ** - Center for Humane Technology Calm is the #1 app for Sleep, Meditation and Relaxation. Sleep better, relieve stress, lower anxiety and refocus your attention.

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No sign up required, just instant access to four free hypnotherapy and meditation recordings and a choice of over 140 in-app purchase options covering insomnia, stress, anxiety, mindfulness, sleep, weight-loss, confidence, self-esteem, the solfeggio frequencies, binaural beats, spiritual healing, phobias, addictions and much more.

Glenn records each meditation, hypnosis and mindfulness track through a Neumann U87 microphone and uses the very best analogue to digital converters. He also spends a lot of time and care honing each production. This is why these tracks sound so professional and easy on the ear. We also have countless testimonials relaying life-changing transformations from people using the recordings.

Relax & Sleep Well Free by Glenn Harrold was placed 1st in Healthline's list of the Best Insomnia Apps in 2020! "Healthline's editors carefully selected each winner based on quality and usability."

Relax & Sleep Well also includes a playlist feature, a manage storage feature to help control the size of the app, a breathe feature, and an easy to navigate interface with detailed descriptions for each title. All support and help issues are replied to within 24 hours.

Relax & Sleep Well has helped well over 4 million people to meditate and sleep well every night!

# Number 1 Grossing Lifestyle App in New Zealand
# Number 1 Grossing Lifestyle App in Ireland
# Number 1 Grossing Lifestyle App in South Africa
# Number 1 Grossing Lifestyle App in Denmark
# Number 1 Grossing Lifestyle App in Israel
# Number 1 Grossing Lifestyle App in Peru
# Number 1 Grossing Lifestyle App in Norway
# Number 1 Grossing Lifestyle App in Jordan
### And many more.................

Download Now to find out why this app has been number 1 in over 50 countries!

The free tracks include Relax & Sleep Well, which is a full 29-minute hypnotherapy session that will take you on a relaxing journey into the deepest levels of self-hypnosis. The subtle soundscapes supporting Glenn's calming voice will help you connect with a profound feeling of relaxation and mindfulness. It will also help you to alleviate stress and anxiety, overcome insomnia and encourage healthy sleep patterns.

The next free track is a 30-minute lite version of the stunning 639 Hz Solfeggio Sonic Meditation, which is based upon the ancient Solfeggio musical scale. When you experience this powerful healing meditation it will give you an idea of what the full range of Solfeggio Meditation titles sound like. Overcome insomnia stress and sleep well with this dreamy, relaxing meditation recording.

There are also free versions of 'Mindfulness for Releasing Anxiety', 'Morning Meditation' and 'Meditation 4 Inner Wisdom'.

This app also includes two free eBooks: The Solfeggio Scale eBook and Glenn's guide to Self-Hypnosis eBook, which is an in depth guide showing you how to use self-hypnosis to help you in many areas of your life.

A typical Glenn Harrold hypnosis recording features dreamy background sound effects recorded in specific keys and frequencies to help guide you into a deep state of mental and physical relaxation.

All of Glenn's Hypnosis and Meditation Recordings Feature:

* The very latest hypnotherapy, mindfulness and healing meditation techniques combined with state-of-the-art recording technology.

* Glenn's highly acclaimed hypnotic vocal techniques guiding you into a deeply relaxed state.

* Background sound effects recorded in specific musical keys and frequencies to compliment the hypnotic suggestions and deepen the relaxation effect.

* Stereo-echoed affirmations, which pan from ear-to-ear across the stereo range - a deeply relaxing and unique effect.

Glenn is one of the world's most successful hypnotherapists. His recordings have sold over 10 million and he is a published author of 8 self-help health books. Glenn has 20 years of hypnotherapy experience and has worked with many celebrity clients.

- New Sessions
We have recently added 2 new free titles: 'Morning Meditation FREE' and 'Meditation 4 Inner Wisdom FREE'
We have added 10 new paid titles: 3 new co-authored titles by Glenn Harrold & BBC Radio 2's Janey Lee Grace - 'Quit the Alcohol Habit', 'Joyful Pregnancy' and 'Conceive Easily'. We have also added 'Morning Meditation For A Productive Day', '8D Abundance Affirmations Part 1 & 2', 'Clear Your Mind of Negative Thoughts', 'Awaken & Ascend', 'Let Go of Fear', 'Create Inner Peace' and 'Develop Inner Calm'.

- Family Sharing
you can now share in app purchases with those in your family sharing group

- New Course
We have added a new 10 day Course 'Learn to Mindfully Manage Stress & Anxiety'.

- New Share Feature
Share links to individual in-app tracks with friends.

- Download All
The 'Download All' feature has been updated to allow you to select which sessions you would like to download.

Won't recognize me AND PRIOR PURCHASES

December 2017- I did want to say that the recordings for sleep and relaxation are very good. Don't bother with weight loss..

Every hypnotist I've checked out assumes all fat people are fat because they eat too much all the time and must be guzzling sweets and sugary sodas like crazy. Nothing could be further from the truth for me. The truth is, after 51 years of alternating strict calorie reduction and normal consumption the body (especially women's bodies) learns to be very efficient at storing and holding onto calories. Maybe the programs need to account for that and maybe they need to help overcome magical thinking that not eating enough will make the fat person lose weight. Maybe there could be a program to help people believe it is safe to eat more, but in smaller amounts at more frequent intervals. But no one does those programs well, and Glenn's is no worse than anyone else's. So if the problem is that you just eat too much all the time, his program might help. Otherwise, abandon hope of finding anything effective unless you pay $1500 for a custom program.

December 2016 Sells in bad faith! I bought several sessions last year and apparently they get ditched from memory if you don't use them. I was able to restore purchases before if I'd already bought them. Now it says "In app purchases not allowed, so apparently I have to do repurchase them. NOT GOOD!

Fixed my severe insomnia

For months I was only sleeping 2-3 hours every 2 days or so, no medication or white noise or any other methods were working for me. So I tried this app. The free version allowed me to sleep for 5 hours straight through, which was usually what I would get over a whole week. I paid for and downloaded the paid full version shortly after finding that the free version worked, last week I used the full version for the first time, I slept for 7 hours and 56 minutes that first night! It really works! I also purchased the deep sleep, pain control, heal your body, and complete relaxation sessions, which I put into a playlist and let run through when I go to sleep, and in the 1 week I have had those extra sessions I have already noticed a difference in my overall heath and mood in the mornings. And as someone who suffers from a chronic pain condition and severe migraines, is has been a life saver for me to have these sessions to turn to when I'm not feeling well. I have also used pain control and heal your body both during the days when a migraine is starting up, and it's actually cut down on the severity and length of my migraines now.

Download this now! You won't regret it!

I absolutely LOVE this app! I have been greatly helped by this incredible man and his amazing app. His hypnosis sessions will completely relax you and will make u feel so much better. When I first used this I was a bit weary. I didn't think it would work at all. But to my surprise it did! I remember laying in bed and starting the session. After a few minutes I felt as if the entire world had vanished away and I was just floating in air. In a way I could still hear his voice. But almost in a surreal dream like state. I remember waking up the next day. And my headphones were neatly wrapped and sitting on my nightstand. But had no recollection of doing so. But even then I felt so relaxed. So at peace. It was amazing! The only request would be to have a session to help in anger management. There are a lot of ways to relax. Or build relationships. Enhance your self confidence. But I just wish there was one for getting rid of anger and turning it into something good. Or a way to change it and get over it quickly.

The developer, Diviniti Publishing Ltd, indicated that the app's privacy practices may include handling of data as described below. For more information, see the developer's privacy policy.

Data Not Collected

The developer does not collect any data from this app.

Privacy practices may vary, for example, based on the features you use or your age. Learn More

Information

Seller

Diviniti Publishing Ltd

Compatibility

iPhone

Requires iOS 12.2 or later.

iPad

Requires iPadOS 12.2 or later.

iPod touch

Requires iOS 12.2 or later.

In-App Purchases

1. Deep Sleep Every Night $2.99

2. Relax & Sleep Well (Awake)

3. Solfeggio Relax Meditation
more

Family Sharing

With Family Sharing set up, up to six family members can use this app.

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‎No sign up required, just instant access to four free hypnotherapy and meditation recordings and a choice of over 140 in-app purchase options covering insomnia, stress, anxiety, mindfulness, sleep, weight-loss, confidence, self-esteem, the solfeggio frequencies, binaural beats, spiritual healing, ph...

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Relationship Between Sleep, Mental Health, and Suicide 

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Relationship Between Sleep, Mental Health, and Suicide 

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Dr. Blake Zakarin Discusses the Relationship Between Sleep, Mental Health, and Suicide

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Make this 6X App of the Day winner the app of your night!

"The most positively reviewed app in the history of the Apple Store" - Business Insider

"It's Like a GPS directing you how to fall asleep" - The Guardian

Having trouble unwinding & falling asleep? We get you, and we've got you. Sleep to your own beat with Relax Melodies.

Tune-out stress, anxiety & fall asleep easily. Mix endless sounds & music, countless meditations, and shelves of stories with our smart technology.

Recommended by leading doctors and neuropsychologists, Relax Melodies helps you fall asleep more easily. Now, that sounds good.

HOW ARE WE UNIQUE?

Because YOU are. No two people decompress the same way. That's why Relax Melodies gives you the freedom to create your very own relaxation and bedtime experience by mixing:

- Endless sounds & music. Lull yourself into easy sleep by mixing soothing sounds & music, designed by our in-house sonic gurus.

- Guided meditations. Discover your simple, go-to sleep meditation (even if you're a novice). Let tons of guided practices like visualization, hypnosis, Yoga Nidra, and more help you calm & quiet your mind.

- Shelves of stories. Lose yourself in one, or many, blissful bedtime stories. Warmly narrated and enhanced by a rich, custom soundtrack and specially written to ease your mind into sweet sleep.

- Calm breathing exercises. Inhale peace and exhale the day with simple, guided breathing techniques that are paired with beautiful nature sounds to lull you to sleep.

- Proven SleepMoves. Let your mind & body connect (so you can disconnect) with a series of gentle guided exercises and relaxation techniques developed with top sleep experts.

Over 200+ Sounds & Music:

* Nature sounds
* ASMR sounds
* White noise
* Water sounds
* Meditation music
* Isochronic Brainwaves
* Binaural Beat
* Healing music
* 3D sounds

Over 160+ Meditations & SleepMoves:

* Restful sleep
* Stress and Anxiety relief
* Tinnitus relief
* Yoga nidra
* Gratitude
* Better sleep
* Deep sleep
* Napping
* Dreams
* Kids
* Couple exercises
* Travel
* Cooldown
* Morning

Bedtime Stories :

* Fairytale
* Mystery
* Sci-fi
* Fantasy
* Kids
*Journey
* Non-Fiction

Also featuring:

Bedtime reminder: Set one every night to get more restful sleep
Timer: Stop the application after a set amount of time
Favorites: A section to add your favorite mixes

And more!

Relax Melodies optionally integrates with the Health app to save your meditation sessions.

...

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Ipnos gives you the best in the world of wellness apps.
Need help with the app? E-mail support@ipnos.com

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Version 11.14

Hello Sleepers! Have you ever listened to something great, only to be unable to find it again? Look no further! In this update, easily find all your recently played content on your homepage. We've also added Solfeggio brainwaves, specially made to help quiet your mind. Add one to your favourite mix and tell us what you think! Enjoy!

(Love app) update glitch

I downloaded multiple sleep apps, I'm really picky about what I can fall asleep too. This was the only app that gave you great soothing options for free. I couldn't fall asleep after losing my fur baby and this app not only helped me fall asleep but kept me asleep and drowned out all the noise from the early risers in the house. My sleep and peace at night depends on this app. This is a total must have and I highly recommend it. The reason for the 1 star rating is because after the recent update, there is a constant tapping in the background for any music option and for the last 6 months I've been using this app, I've never heard this. I reached out to support and was told to reset my phone and download the app again. I did all this and even used a different device but the sound is still happening. It comes about every 10 seconds and sounds like someone is tapping a table. It is enough to keep anyone awake and drive you nuts. Please please look into this and make a new update. My sleep depends on this app and my specific mix. I will update the rating to 5 stars as soon as this is resolved.

UPDATE: this issue has not been resolving changes rating to 5 stars because the support for this app is amazing. I've been able to contact multiple people and they are all so kind. I hope the tapping is fixed in the next update but I'm using the dream sound right now which is working great. Thank you to the awesome team of this app!

Hello there, thanks for your support over the years! I'm glad our app helps you sleep better. Sorry for the issues you've been experiencing. The last thing we want is to cause any stress. It's important to us that you have the most relaxing experience with our app and it's not expected behaviour. Thank you for everything you've done! Does this issue continue after clearing the RAM memory in your iOS device? Please contact us at support@ipnos.com so we can continue to look for the solution. We'll make sure you are able to listen to all your content. We are here to help! Thank you. 🙂 Maroussia from Ipnos

Happy and Peaceful Escapes to Beautiful Worlds

This app has been the greatest gift to help me SLEEP! I can create happy sounds of the nighttime environment experienced when I was a child, taking me far away from the pressures and responsibilities of the days responsibilities to joyful happiness and peace. My breathing slows down, my body succumbs to a relaxed state and often a slight restful happy smile comes to my lips as my mind travels through space and time, enjoying imaginations created by gentle sounds, time and space. 3 years ago someone ran a red light and changed my physical world forever. I will never know the absence of sound or still quiet again because of the constant buzzing sound of tinnitus created in my head by the crash impact to my head. My form of tinnitus is the ability to hear the normal sounds of the brain functioning, which normally we can't hear. Relaxed Melodies has given so much to strengthen my life, rest better and feel positive. My brain may never experience quiet again, but the creators of Relaxed Melodies has given me something far better and more valuable to my life than experiencing 'quiet'. They've given me the ability to experience beautiful dreams and imaginations in waking and sleep states of mind. I will be forever grateful to their work and share it with as many people as possible.

Very Satisfied and is a very good app

This app is amazing and it has really helped me to fall asleep. All of the different possibilities with all the different selections of sounds, is very welcoming to the viewer and it inspires them to create their own works of art. In my opinion, my favorite section is the stories section of the app. Sure there aren't many stories open without paying for premium, but there is one story that has made up for it-The underwater city. On one of my later reviews of the app I asked the developers to create a second part to "the underwater city" and I was delighted to get a reply from the developers telling me that their team was now working on a second part for "The underwater city" This app is really nice, and they have actual people looking at the reviews and trying to make the app better. And that is actually one of the small reasons why I'm giving this app a five star review. Also, if you make more and more parts for "the underwater city" please make it so they are not premium only, so then everybody can enjoy the amazing adventure that they are taken on whenever they listen.

Edit: Even after all good things I've said about the app, there is one problem that I've encountered lately. Sometimes when I'm listening suddenly, it will erase what I had playing and then add in a bunch of random sounds. I don't know if it's because I've dropped my iPod like once or twice, or if it's because of the app, but could you please try to find a solution.

Hi there, thank you so much for your new review. I sincerely appreciate all your valuable feedback! We work hard to make sure our app reflects what users want, and I'm also looking forward to part 2 of The Underwater City. It's also one of my favourite stories! So glad you also enjoy it. Do sounds stop, but the app remains open? I'm really sorry to learn about this, we would not want to cause you any trouble. I would love to find a solution for you as soon as possible. May you please send us an e-mail at support@ipnos.com, or please tap on the in-app Help button? It will be our pleasure to sort this out for you as soon as possible. Thank you so much once again for all your support! Have a relaxing day 🙂 Maroussia from Ipnos

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Information

Seller

Ipnos Software Inc.

Compatibility

iPhone

Requires iOS 10.0 or later.

iPad

Requires iPadOS 10.0 or later.

iPod touch

Requires iOS 10.0 or later.

Mac

Requires macOS 11.0 or later and a Mac with Apple M1 chip.

Apple TV

Requires tvOS 9.0 or later.

Languages

English, French, German, Italian, Japanese, Korean, Portuguese, Russian, Simplified Chinese, Spanish

In-App Purchases

1. Relax Melodies Premium $59.99

2. Lifetime Access - All Features $19.99

3. Subscription $39.99
more

Family Sharing

With Family Sharing set up, up to six family members can use this app.

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‎Make this 6X App of the Day winner the app of your night! "The most positively reviewed app in the history of the Apple Store" - Business Insider "It's Like a GPS directing you how to fall asleep" - The Guardian Having trouble unwinding & falling asleep?

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by William C. Demet, M.D., Ph. D., Christopher Vaughan

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The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health, Happiness, and a Good Night’s Sleep

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The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health, Happiness, and a Good Night’s Sleep [Dement, William C.] on Amazon.com. *FREE* shipping on qualifying offers. The Promise of Sleep: A Pioneer in Sleep Medicine Explores the Vital Connection Between Health…

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Center for College Sleep: Sleep and Mental Health

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4 Reasons Why Sleep Is Important for Mental Health

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Sleep Deprivation and it's Link to Depression and Anxiety

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Sleep Deprivation and it's Link to Depression and Anxiety

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Is Sleep Deprivation Linked to Depression/Anxiety?

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Improving sleep hygiene to get a better night's sleep

Sleeping well directly affects your mental and physical health. Fall short and it can take a serious toll on your daytime energy, productivity, emotional balance, and even your weight. Yet many of us regularly toss and turn at night, struggling to get the sleep we need.

Getting a good night's sleep may seem like an impossible goal when you're wide awake at 3 a.m., but you have much more control over the quality of your sleep than you probably realize. Just as the way you feel during your waking hours often hinges on how well you sleep at night, so the cure for sleep difficulties can often be found in your daily routine.

Unhealthy daytime habits and lifestyle choices can leave you tossing and turning at night and adversely affect your mood, brain and heart health, immune system, creativity, vitality, and weight. Whether you struggle to fall asleep when you get into bed or wake up in the night and find it difficult to go back to sleep, the solution often lies in establishing healthy sleep habits, known as "sleep hygiene". By improving your sleep hygiene, you can fall asleep faster, stay asleep for longer, boost your overall health, and improve how you think and feel during the day.

How fast should I fall asleep?

Everyone is different, but most healthy adults should be able to fall asleep at night within 10 to 20 minutes. If it takes you longer than 30 minutes, it may be a sign that you have an underlying condition, such as insomnia.

However, it's also possible to fall asleep too quickly. If you regularly fall asleep as soon as your head touches the pillow, it may be a sign that you're suffering from sleep deprivation. In other words, you're not getting enough quality sleep at night.

This could be due to a sleep disorder, such as sleep apnea, where your breathing is frequently interrupted while you sleep, disrupting your rest at night and leaving you feeling tired during the day. Sleep apnea is often accompanied by loud snoring, choking, or gasping while you sleep. It can cause serious health problems so it's important to speak to your doctor right away.

Whether you're falling asleep too fast or if it's taking you an age to finally drop off, by experimenting with the following tips, you can improve your sleep hygiene and enjoy better, more refreshing sleep at night.

Tip 1: Keep in sync with your body's natural sleep-wake cycle

Getting in sync with your body's natural sleep-wake cycle, or circadian rhythm, is one of the most important strategies for sleeping better. If you keep a regular sleep-wake schedule, you'll feel much more refreshed and energized than if you sleep the same number of hours at different times, even if you only alter your sleep schedule by an hour or two.

Try to go to sleep and get up at the same time every day. This helps set your body's internal clock and optimize the quality of your sleep. Choose a bed time when you normally feel tired, so that you don't toss and turn. If you're getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock, you may need an earlier bedtime.

Avoid sleeping in-even on weekends. The more your weekend/weekday sleep schedules differ, the worse the jetlag-like symptoms you'll experience. If you need to make up for a late night, opt for a daytime nap rather than sleeping in. This allows you to pay off your sleep debt without disturbing your natural sleep-wake rhythm.

Be smart about napping. While napping is a good way to make up for lost sleep, if you have trouble falling asleep or staying asleep at night, napping can make things worse. Limit naps to 15 to 20 minutes in the early afternoon.

Start the day with a healthy breakfast. Among lots of other health benefits, eating a balanced breakfast can help sync up your biological clock by letting your body know that it's time to wake up and get going. Skipping breakfast on the other hand, can delay your blood sugar rhythms, lower your energy, and increase your stress, factors that may disrupt sleep.

Fight after-dinner drowsiness. If you get sleepy way before your bedtime, get off the couch and do something mildly stimulating, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may wake up later in the night and have trouble getting back to sleep.

Speak to a Licensed Therapist

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Tip 2: Control your exposure to light

Melatonin is a naturally occurring hormone controlled by light exposure that helps regulate your sleep-wake cycle. Your brain secretes more melatonin when it's dark-making you sleepy-and less when it's light-making you more alert. However, many aspects of modern life can alter your body's production of melatonin, shift your circadian rhythm, and make it harder to sleep.

Here's how to influence your exposure to light:

During the day

Expose yourself to bright sunlight in the morning. The closer to the time you get up, the better. Have your coffee outside, for example, or eat breakfast by a sunny window. The light on your face will help you wake up

Spend more time outside during daylight. Take your work breaks outside in sunlight, exercise outside, or walk your dog during the day instead of at night.

Let as much natural light into your home or workspace as possible. Keep curtains and blinds open during the day, and try to move your desk closer to the window.

If necessary, use a light therapy box. This simulates sunshine and can be especially useful during short winter days.

At night

Avoid bright screens within 1-2 hours of your bedtime. The blue light emitted by your phone, tablet, computer, or TV is especially disruptive. You can minimize the impact by using devices with smaller screens, turning the brightness down, or using light-altering software such as f.lux.

Say no to late-night television. Not only does the light from a TV suppress melatonin, but many programs are stimulating rather than relaxing. Try listening to music or audio books instead.

Don't read with backlit devices. Tablets that are backlit are more disruptive than e-readers that don't have their own light source.

When it's time to sleep, make sure the room is dark. Use heavy curtains or shades to block light from windows, or try a sleep mask. Also consider covering up electronics that emit light.

Keep the lights down if you get up during the night. If you need some light to move around safely, try installing a dim nightlight in the hall or bathroom or using a small flashlight. This will make it easier for you to fall back to sleep.

Tip 3: Exercise during the day

People who exercise regularly fall asleep faster at night, sleep better, and feel less sleepy during the day. Regular exercise also improves the symptoms of insomnia and sleep apnea and increases the amount of time you spend in the deep, restorative stages of sleep.
[Read: The Mental Health Benefits of Exercise]

The more vigorously you exercise, the more powerful the sleep benefits. But even light exercise-such as walking for just 10 minutes a day-improves sleep quality.

It can take several months of regular activity before you experience the full sleep-promoting effects. So be patient and focus on building an exercise habit that sticks.

For better sleep, time your exercise right

Exercise speeds up your metabolism, elevates body temperature, and stimulates hormones such as cortisol. This isn't a problem if you're exercising in the morning or afternoon, but too close to bed and it can interfere with sleep.

Try to finish moderate to vigorous workouts at least three hours before bedtime. If you're still experiencing sleep difficulties, move your workouts even earlier. Relaxing, low-impact exercises such as yoga or gentle stretching in the evening can help promote sleep.

Tip 4: Be smart about what you eat and drink

Your daytime eating habits play a role in how well you sleep, especially in the hours before bedtime.

Focus on a heart-healthy diet. It's your overall eating patterns rather than specific foods that can make the biggest difference to your quality of sleep, as well as your overall health. Eating a Mediterranean-type diet rich in vegetables, fruit, and healthy fats-and limited amounts of red meat-may help you to fall asleep faster and stay asleep for longer.

Cut back on sugary foods and refined carbs. Eating lots of sugar and refined carbs such as white bread, white rice, and pasta during the day can trigger wakefulness at night and pull you out of the deep, restorative stages of sleep.

Limit caffeine and nicotine. You might be surprised to know that caffeine can cause sleep problems up to ten to 12 hours after drinking it! Similarly, smoking is another stimulant that can disrupt your sleep, especially if you smoke close to bedtime.

Avoid big meals at night. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods within two hours of bed. Spicy or acidic foods can cause stomach trouble and heartburn.

Avoid alcohol before bed. While a nightcap may help you relax, it interferes with your sleep cycle once you're out.

Avoid drinking too many liquids in the evening. Drinking lots of fluids may result in frequent bathroom trips throughout the night.

Nighttime snacks may help you to sleep

For some people, a light snack before bed can help promote sleep. For others, eating before bed leads to indigestion and makes sleeping more difficult. If you need a bedtime snack, try:

Half a turkey sandwich.

A small bowl of whole-grain, low-sugar cereal.

Milk or yogurt.

A banana.

Tip 5: Improve your sleep environment

A peaceful bedtime routine sends a powerful signal to your brain that it's time to wind down and let go of the day's stresses. Sometimes even small changes to your environment can make a big difference to how fast you fall asleep and the quality of your sleep.

Keep your room dark, cool, and quiet

Keep noise down. If you can't avoid or eliminate noise from neighbors, traffic, or other people in your household, try masking it with a fan or sound machine. Earplugs may also help.

Keep your room cool. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.

Make sure your bed is comfortable. Your bed covers should leave you enough room to stretch and turn comfortably without becoming tangled. If you often wake up with a sore back or an aching neck, you may need to experiment with different levels of mattress firmness, foam toppers, and pillows that provide more or less support. Using an adjustable base could help to improve your sleep position.

Reserve your bed for sleeping and sex. By not working, watching TV, or using your phone, tablet, or computer in bed, your brain will associate the bedroom with just sleep and sex, which makes it easier to wind down at night.

Tip 6: Wind down and clear your head to fall asleep

Do you often find yourself unable to get to sleep or regularly waking up night after night? Residual stress, worry, and anger from your day can make it very difficult to sleep well. Taking steps to manage your overall stress levels and learning how to curb the worry habit can make it easier to unwind at night. You can also try developing a relaxing bedtime ritual to help you prepare your mind for sleep, such as practicing a relaxation technique, taking a warm bath, or dimming the lights and listening to soft music or an audiobook.

Problems clearing your head at night can also stem from your daytime habits. The more overstimulated your brain becomes during the day, the harder it can be to slow down and unwind at night. Maybe, like many of us, you're constantly interrupting tasks during the day to check your phone, email, or social media. Then when it comes to getting to sleep at night, your brain is so accustomed to seeking fresh stimulation, it becomes difficult to unwind.
[Read: Smartphone Addiction]
Help yourself by setting aside specific times during the day for checking your phone and social media and, as much as possible, try to focus on one task at a time. You'll be better able to calm your mind at bedtime.

A deep breathing exercise to help you fall asleep

Breathing from your belly rather than your chest can activate the relaxation response and lower your heart rate, blood pressure, and stress levels to help you drift off to sleep.

1. Lay down in bed and close your eyes.

2. Put one hand on your chest and the other on your stomach.

3. Breathe in through your nose. The hand on your stomach should rise. The hand on your chest should move very little.

4. Exhale through your mouth, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move very little.

5. Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count slowly as you exhale.

To follow along with a guided deep breathing exercise, click here.

A body scan exercise to help you fall asleep

By focusing your attention on different parts of your body, you can identify where you're holding any stress or tension, and release it.

1. Lie on your back, legs uncrossed, arms relaxed at your sides, eyes closed. Focus on your breathing for about two minutes until you start to feel relaxed.

2. Move your focus to the sole of your right foot. Tune in to any sensations you feel in that part of your body and imagine each breath flowing from the sole of your foot. Then move your focus to your right ankle and repeat. Move to your calf, knee, thigh, hip, and then repeat the sequence for your left leg. From there, move up your torso, through your lower back and abdomen, your upper back and chest, and your shoulders. Pay close attention to any area of the body that feels tense.

3. Turn your focus to the toes of your right foot. Notice any tension while continuing to also focus on your breathing. Imagine each deep breath flowing to your toes. Remain focused on this area for at least three to five seconds.

4. After completing the body scan, relax, noting how your body feels. You should feel so relaxed you can easily fall asleep.

For a bedtime sleep meditation that uses deep breathing, mindfulness, and body scan techniques to help you wind down and clear your head, click here.

Tip 7: Use the military method to fall asleep fast

The military sleep method has been popularized on social media in recent years, with many people claiming it can help you fall asleep within two minutes. First appearing in Bud Winter's 1981 book Relax and Win: Championship Performance, the military method combines several proven relaxation techniques, like the deep breathing and body scan exercises detailed above.

1. Once comfortable in bed, close your eyes, and breathe deeply. Take several long, slow breaths and relax all the muscles in your face. Start with your forehead and then move down to your cheeks and jaw.

2. Working down from your face, relax your neck muscles, drop your shoulders, and relax your arms. Continue breathing deeply and let go of any tension in your shoulders, arms, and hands, all the way down to the tips of your fingers.

3. Relax your chest, abdomen, and hips, feeling all your muscles relax as you breathe.

4. Focus on your legs, and relax them one at a time. Strat with the thigh and move down to your calf, your foot, and your toes. Relax the muscles and imagine yourself sinking into the mattress.

5. Clear your mind. To do this, you can either repeat a mantra over and over, such as "relax" or "don't think." Or you can picture yourself in a relaxing space, such as lying in a hammock or in a canoe on a still lake.

If this last step proves difficult, try using our Sleep Meditation Using Guided Imagery.

Tip 8: Learn how to get back to sleep if you wake up

It's normal to wake briefly during the night but if you're having trouble falling back asleep, these tips may help:

Stay out of your head. Hard as it may be, try not to stress over your inability to fall asleep again, because that stress only encourages your body to stay awake. To stay out of your head, focus on the feelings in your body or practice breathing exercises. Take a breath in, then breathe out slowly while saying or thinking the word, "Ahhh." Take another breath and repeat.

Make relaxation your goal, not sleep. If you find it hard to fall back asleep, try a relaxation technique such as visualization, progressive muscle relaxation, or meditation, which can be done without even getting out of bed. Even though it's not a replacement for sleep, relaxation can still help rejuvenate your body.
[Listen: Sleep Meditation Using Guided Imagery]
Do a quiet, non-stimulating activity. If you've been awake for more than 15 minutes, get out of bed and do a quiet, non-stimulating activity, such as reading a book. Keep the lights dim and avoid screens so as not to cue your body that it's time to wake up.

Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when it will be easier to resolve. Similarly, if a great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you'll be much more productive after a good night's rest.

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How to Fall Asleep Fast and Sleep Better

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Learn the secret to good sleep. These tips will help you sleep better at night and be more energetic and productive during your waking hours.

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5 sleep tips that can help with depression

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5 Sleep Tips that Can Help with Depression

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The relationship between sleep and mental illness, specifically depression, is complicated. But everyone experiencing depression should work to improve and regulate their sleep because there are only benefits to be had.

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The effects of lack of sleep include increased stress, anger, and worsened symptoms of mental health conditions. Learn how lack of sleep affects mental health.

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for freebies and kindness

We invited leading sleep neurologist, Dr Kirstie Anderson, to explain why sleep is important and the role it plays in our mental wellbeing.
Some questions we ask:

What can we do to improve the quality of sleep?

What's the best way of re-setting your body clock?

What can we do to help our brain unwind before bed?

How important is a bed-time routine?

Click to Tweet: Sleep, glorious sleep. Come and listen to the new episode of Everybody Blurts, with Dr Kirstie Anderson http://ctt.ec/uzFb4+
Want to learn more about Dr Anderson? Here you go:
Dr Kirstie Anderson BMedSci, MBBS, MRCP, DPhil (Oxon)

Dr Anderson delivers the Cognitive Behavioural Therapy (CBT) for insomnia programme at sleepstation and runs a large research programme within Newcastle University. She is one of the UK's foremost sleep specialists. As one of the few consultant neurologists to specialise in sleep, she works within one of the country's largest sleep clinics where people with every type of sleep disturbance are seen and successfully treated including those with severe insomnia. She has published papers on a range of sleep disorders and delivers lectures on every aspect of sleep.

Website: https://sleepstation.org.uk
We do hope you enjoyed this episode of the Everybody Blurts podcast. Don't forget to subscribe to us on iTunes, Stitcher Radio or SoundCloud and join in the conversation on Twitter and Facebook.

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for freebies and kindness We invited leading sleep neurologist, Dr Kirstie Anderson, to explain why sleep is important and the role it plays in our mental wellbeing. Some questions we ask: What can we do to improve the quality of sleep? What's the best way of re-setting your body clock?

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Sleep problems - How does sleep relate to mental health and how can I improve my sleep

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Brain activity fluctuates during sleep, increasing and decreasing during different sleep stages that make up the sleep cycle. Each stage plays a role in brain health, allowing activity in different parts of the brain to ramp up or down and enabling better thinking, learning, and memory. Research has also uncovered that brain activity during sleep has profound effects on emotional and mental health.

Sufficient sleep, especially rapid eye movement (REM) sleep, facilitates the brain's processing of emotional information. During sleep, the brain works to evaluate and remember thoughts and memories, and it appears that a lack of sleep is especially harmful to the consolidation of positive emotional content. This can influence mood and emotional reactivity and is tied to mental health disorders and their severity, .

As a result, the traditional view, which held that sleep problems were a symptom of mental health disorders, is increasingly being called into question. Instead, it is becoming clear that there is a bidirectional relationship between sleep and mental health in which sleeping problems may be both a cause and consequence of mental health problems. Further research is needed to identify the diverse connections between sleep and mental health as well as how their multifaceted relationship that can be influenced by numerous factors in any specific person's case.

Obstructive sleep apnea (OSA) is another aspect of sleep that has been linked to mental health. OSA is a disorder that involves pauses in breathing during sleep and a reduction in the body's oxygen levels, creating fragmented and disturbed sleep. OSA and may detract from their physical health and heighten their risk of serious mental distress.

Sleep and Specific Mental Health Problems

The way that sleep and mental health are intertwined becomes even more apparent by reviewing what is known about how sleep is tied to a number of specific mental health conditions and neurodevelopmental disorders.

Depression

It is estimated that over have depression, a type of mood disorder marked by feelings of sadness or hopelessness. Around , and many people with depression also suffer from excessive daytime sleepiness and hypersomnia, which is sleeping too much.

Historically, sleeping problems were seen as a consequence of depression, but growing evidence suggests that poor sleep may induce or exacerbate depression. The difficulty in identifying clear cause and effect reflects what is believed to be a bidirectional relationship in which sleep problems and depressive symptoms are mutually reinforcing.

While this can create a negative feedback loop - poor sleep worsens depression that then further interrupts sleep - it also opens a potential avenue for new types of treatment for depression. For example, for at least some people, a focus on improving sleep may have a corollary benefit of .

Seasonal Affective Disorder

Seasonal affective disorder is a subtype of depression that most often affects people during times of the year with reduced daylight hours. For example, people in northern climates may experience seasonal affective disorder during the fall and winter.

This condition is closely tied to the disruption of a person's internal biological clock, or circadian rhythm, that helps control multiple bodily processes, including sleep. Not surprisingly, then, people with seasonal affective disorder tend to sleep too much or too little or experience changes to their sleep cycles.

Anxiety Disorders

Every year, anxiety disorders in America affect an estimated and . These disorders create excess fear or worry that can affect everyday life and create risks for health problems including heart disease and diabetes. Types of anxiety disorders include general anxiety disorder, social anxiety disorder, panic disorder, specific phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Anxiety disorders have a strong association with sleeping problems. Worry and fear contribute to a state of hyperarousal in which the mind is racing, and hyperarousal is considered to be a central contributor to insomnia. Sleep problems may become an added source of worry, creating anticipatory anxiety at bedtime that makes it harder to fall asleep.

Research has found an especially strong connection between PTSD and sleep. People with PTSD frequently replay negative events in their mind, suffer from nightmares, and experience a state of being on alert, all of which can interfere with sleep. PTSD affects many veterans, and at least .

Sleeping problems aren't just a result of anxiety. Research indicates that poor sleep can , and chronic insomnia may be a predisposing trait among people who go on to develop anxiety disorders.

Bipolar Disorder

Bipolar disorder involves episodes of extreme moods that can be both high (mania) and low (depression). A person's feelings and symptoms are quite different depending on the type of episode; however, both manic and depressive periods can cause major impairment in everyday life.

In people with bipolar disorder, sleep patterns change considerably depending on their emotional state. During manic periods, they usually feel less need to sleep, but during depressed periods, they may sleep excessively. Sleep disruptions often continue when a person is between episodes].

Research has found that many people with bipolar disorder experience changes in their sleep patterns before the onset of an episode. There is also evidence that sleeping problems and that, because of the bidirectional relationship between bipolar disorder and sleep, treatment for insomnia can reduce the impact of bipolar disorder.

Schizophrenia

Schizophrenia is a mental health disorder characterized by a difficulty in differentiating between what is and is not real. People with schizophrenia are . Sleeping problems may be exacerbated by medications that are used to treat schizophrenia. Poor sleep and symptoms of schizophrenia may be mutually reinforcing, so there are potential benefits to stabilizing and normalizing sleep patterns.

ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that involves reduced attention span and increased impulsiveness. ADHD is , but it may last into adulthood and is sometimes only formally diagnosed when someone is already an adult.

Sleeping problems are common in people with ADHD. They may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. Rates of other sleeping problems, such as obstructive sleep apnea and restless leg syndrome (RLS) also appear to be . Sleep difficulties associated with ADHD have been studied primarily in children but have been found to affect adults as well.

There is evidence of a bidirectional relationship between sleep and ADHD. In addition to being a consequence of ADHD, sleep problems may aggravate symptoms like reduced attention span or behavior problems.

Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a term that encompasses several neurodevelopmental conditions affecting communication and social interaction. These conditions are usually diagnosed early in childhood and may persist in adulthood.

Children and adolescents with ASD have a higher prevalence of sleep problems including insomnia and sleep-disordered breathing. These issues tend to be more persistent than sleeping problems in children without ASD, and they can . Addressing insomnia and other sleep disturbances is an important component of care as it may decrease excessive daytime sleepiness as well as other health and behavior problems in people with ASD.

Interaction of Mental Health Conditions

Many mental health conditions don't arise in isolation; instead, co-occurring conditions may influence one another as well as a person's sleep.

For example, it is not uncommon for people to experience both depression and anxiety, and people with both conditions have been than people with just depression or anxiety. These conditions also influence other important aspects of well-being, such as perception of pain, a process that may also influence the risk of sleeping problems.

Ways To Improve Both Sleep and Mental Health

Mental health conditions can disrupt sleep, and lack of sleep can affect mental health. This multifaceted relationship makes for complex connections between sleep and psychiatric disorders, but it also means that treatment for both issues can go hand-in-hand. Steps to improve sleep may even form part of a preventive mental health strategy.

Every individual's situation is different, so the optimal treatment for mental health and sleep problems depends on the person. Because these conditions can have a major impact on quality of life, it's important to receive proper care, which entails working with a trained health professional.

A medical doctor or psychiatrist can review the potential benefits and risks of different types of treatments, including prescription medications. They can provide tailored care, including in situations with multiple co-occurring physical or mental health issues. For example, diagnosing and treating an underlying condition like obstructive sleep apnea may offer benefits for mental health.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) describes a type of counseling known as talk therapy. It works by examining patterns of thinking and working to reformulate negative thoughts in new ways.

Different types of CBT have been developed for specific problems such as depression, anxiety, and bipolar disorder. In addition, CBT for insomnia (CBT-I) has a proven track record in reducing sleeping problems. A large clinical trial also showed that , improving emotional well-being and decreasing psychotic episodes.

Whether and how types of CBT can be combined or sequenced to address both sleep and mental health problems is subject to ongoing research, but for many patients, help from a trained counselor to reframe their thinking can meaningfully improve both their sleep and mental state.

Improve Sleep Habits

A common cause of sleeping problems is poor sleep hygiene. Stepping up sleep hygiene by cultivating habits and a bedroom setting that are conducive to sleep can go a long way in reducing sleep disruptions.

Examples of steps that can be taken for healthier sleep habits include:

Having a set bedtime and maintaining a steady sleep schedule

Finding ways to wind-down, such as with relaxation techniques, as part of a standard routine before bedtime

Avoiding alcohol, tobacco, and caffeine in the evening

Dimming lights and putting away electronic devices for an hour or more before bed

Getting regular exercise and natural light exposure during the daytime

Maximizing comfort and support from your mattress, pillows, and bedding

Blocking out excess light and sound that could disrupt sleep

Finding the best routines and bedroom arrangement may take some trial and error to determine what's best for you, but that process can pay dividends in helping you fall asleep quickly and stay asleep through the night.

Learn more about our Editorial Team

References

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Mental Health and Sleep | Sleep Foundation

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Sleep and mental health are deeply intertwined. Learn about the complex relationship between sleep and mental health problems and how to improve both.

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Abstract

During your lifetime, you will spend almost 250,000 h asleep. Why do we need so much sleep? Sleep is not just rest from the day, but also necessary for your body and brain to be healthy, particularly as you grow up. For example, a good night's sleep enables you to pay attention and learn the next day. When and how long you sleep will change as you get older. So, how do you know how much sleep you should get, or when you should go to bed at night? Here, we will share answers to these questions and more. We have studied the science of sleep and we now understand a little more about what your brain does throughout the night: keeping you healthy, alert, and ready for school and fun the next day. If you read this right before bed, you will be sure to get enough ZZZ's tonight.

Of all the things you do, which do you do the most? It is not eating or drinking, it is sleeping! We spend a third of our lives sleeping. Scientists have worked for decades to understand why we sleep. While your body lies still in your bed, your brain is processing the day's information to get you ready for tomorrow. Here, we will explain the what, when, why, and how of sleeping and how it changes as you grow up.

When Do You Sleep?

If we asked, "When do you sleep?" you might say, "at night!", or "when I am tired!" Turns out, both are right. Humans prefer to sleep at night, which makes us diurnal, as opposed to nocturnal animals that sleep during the day. This preference is hard-wired. Deep in your brain sits the suprachiasmatic nucleus (SCN). The SCN is your biological clock. It tells time for every part of your body. We call this the (circadian is Greek for "about a day," because the rhythm of sleeping and waking repeats once every 24-h). Like any clock, the SCN can be reset, based on when we see sunlight. When we travel, our bodies adjust to the new pattern of light. This is why people who travel from North America to Australia can adjust to a new pattern of sleep within a couple of days.

Saying, "I sleep when I am tired," is also true. Have you ever taken a nap in the middle of the day? Another system in the brain keeps track of how much time you have been awake and how much you slept the night before. We call this the . Homeostat sounds like another word: "thermostat," which is a good way to think about this. Just like a thermostat turns the air conditioning on when it is too hot and turns it off when it is too cool, the sleep homeostat listens to how long you have been awake. Your need to sleep grows throughout the day, and when it reaches a certain point, you fall asleep. Once you have rested, the sleep homeostat turns off and lets you wake up, and the process repeats every day. The sleep homeostat, however, does not know if it is daytime or nighttime outside, only whether you have been awake or asleep. If you force yourself to stay awake all night, the need for sleep will continue to grow throughout the night until you finally go to sleep. If you skip a night's sleep, you might be very tired and it will take longer to pay back that sleep need (just like it would take longer for the A/C to cool a super-hot room). The circadian rhythm and the sleep homeostat ultimately work together, which is why you may feel alert in the middle of the day, even if you did not get much sleep the night before, or why you suddenly feel tired at night, even if you woke up late that day.

How Does Your Sleep Change As You Get Older?

Think about your own sleep. You probably sleep differently now compared to when you were a baby or a young child. The SCN and the sleep homeostat change as we grow up ( Figure 1). When you hit puberty, your SCN acts as if it shifted time-zones. Your body wants to wake up later and go to bed later. Eventually, somewhere in your twenties, the SCN starts reversing again ( Figure 1A).

Figure 1 - Why do you sleep when you do?

In each graph, the sleep of younger children (6-13 years) is plotted in blue and that of older children (14-17 years) is plotted in orange. Dark bars indicate nighttime; light bars daytime. (A) Circadian Rhythms: the biological clock, organized by the SCN, keeps us awake during the day and asleep at night. It is affected by light, cycles every 24 h, and shifts during adolescence. (B) Sleep Homeostat: the thermostat for sleep and wakefulness. It tracks how long we have been awake. The need for sleep increases throughout the day as we remain awake and decreases during the night as we sleep. If we skip sleep, the homeostat tracks that we are awake, until we are able to sleep again. As we get older, this process is slower, allowing us to stay up longer before we need to sleep.

As for the sleep homeostat, during puberty, your need for sleep builds a bit more slowly than it did when you were young. Put another way, if we remember the thermostat example, you have slowed down how quickly the room heats up, so that the A/C waits longer before turning on ( Figure 1B). As both the SCN and the homeostat change during puberty, it becomes easier to stay up late.

How Much Sleep Do You Need?

The National Sleep Foundation recommends that school-aged kids (6-13 years) sleep between 9 and 11 h a night. Teens are recommended to get 8-10 h a night and adults about 7-9 h []. If you are a student, particularly in the United States, you may find it difficult to get this amount of sleep on school nights. As you go through puberty, your body wants to go to bed later and sleep later. But school (particularly in the U.S.) often starts too early! This makes it hard for teenagers to get enough sleep on school nights []. By the weekend, you probably have missed so much sleep that you feel particularly sleepy, and you may dramatically oversleep as your sleep homeostat works hard to recover the sleep you need. If you oversleep all weekend, however, this can make waking up on Monday morning a miserable experience.

Why Do You Need Sleep?

Sleep is critical for both your body and your mind. In your body, your metabolism (how you digest and use food), your immune system (how quickly you get over being sick), and your physical fitness (how exercise impacts your body) all benefit from a good night's sleep. We will focus on one organ in your body: your brain. All the functions of your mind depend on your brain's different regions. For example, your brain controls your ability to pay attention (such as staying focused in class), to learn and remember (when taking a test, for example), and to process emotions (like not getting too grumpy if things do not go your way). We will focus on attention and emotion, and how they are aided by sleep ( Figure 2).

Figure 2 - Regions in the brain affected by sleep.

A side view of the brain, as if looking in from the ear. Two regions are impacted by a good night's sleep and support brain health: The prefrontal cortex (blue) is critical for paying attention in school; and the amygdala (pink) is a key center for regulating emotion and mood.

Attention

Have you tried paying attention in class after a bad night's sleep? It is hard. The last part of the brain to fully develop, the , sits at the very front of the brain. This special region is critical for paying attention, planning, and switching between tasks. If you do not sleep the night before, or only sleep a little bit, the PFC cannot function efficiently the next day [], making it extra hard to concentrate without getting distracted. If you do not get enough sleep, studying in the evening becomes hard as well. Students often ask if it is better to go to bed or stay up late to study. We hope by this point you can guess the right answer. Data shows that sleep is important for grades! An extra hour of sleep was associated with 3-5 point improvement on standardized test scores [].

Emotion

After a night without good sleep, we often feel more irritable. Sleep is involved in keeping you happy and keeping your emotions in check. Sleep directly refreshes the emotional centers of our brain, like the [ 3]. This means that not only is your mood more stable after a good night's sleep, but you are also better able to respond to emotional things in your life. When looking at your friends' faces, you can tell if they are mad, sad, or happy. But when sleep deprived, we lose the ability to tell the difference between these emotions. A good night's sleep helps us process these complicated signals so that we are better able to detect, process, and react to emotions.

Sleep and Mental Health in Children

We all have some bad nights of sleep that can affect us the next day. The good news is that restoring healthy sleep habits will often fix these issues right away. However, some children may experience prolonged sleep difficulties that can impact their mental health in the long run. Because of all the ways sleep impacts the brain, sleep problems and mental health issues [like attention-deficit/hyperactivity disorder (ADHD), autism, anxiety, or depression] often go hand-in-hand. Children and adolescents struggling with mental health can also experience trouble falling and/or staying asleep, or difficulty waking up. We are still working to understand the connection between sleeping and mental health, to determine whether helping children sleep better can help children with mental health issues [].

How Can You Have Healthy Sleep?

We hope you are convinced that sleep is important. But, what can you do to sleep better?

Good sleep begins with good sleep habits ( Figure 3). First, go to bed around the same time each night, to keep the SCN and sleep homeostat properly functioning. Second, build a bedtime routine to make going to bed easier, like reading a book or dimming the lights. Third, try to limit the amount of digital screen time right before bed. This is for two reasons: (1) the light from your devices might trick your SCN into thinking it is still daytime, and (2) the excitement from games, TV shows, and the internet can keep you from settling down to sleep. Fourth, keep your bedroom simple, cool, dark, and free of distractions like TVs and devices (try not to take your phone to bed). Fifth, when possible, try not to do your homework in bed; keep your bed for sleeping. Finally, try to limit caffeine (soda, energy drinks, coffee/tea) during the day and avoid these drinks after 4 p.m. Caffeine essentially tricks your sleep homeostat, making you feel less sleepy, but without decreasing sleep need, which is not helpful when school starts at the usual time the next day.

Figure 3 - Tips for good sleeping habits.

Good sleep begins with good sleep habits. Working on each of these tips will help you get the best sleep you can each night, and to feel rested and ready for school the next day.

Speaking of school-it is important that teachers and principals understand that sleep is critical for learning and health. Scientists are working with schools and governments to make school start later for teenagers. If you feel your school starts too early for you to get a good night's sleep, tell your teachers or write a letter to your mayor, governor, or congressperson. Tell them why it is important for schools to help protect everyone's sleep health.

Sleep: What Is It All For?

Sleep is one of the strongest predictors of health, yet why we sleep is a mystery to us. We hope that we have shed light on that mystery and that you, your teachers, and you parents may better understand and apply the power of sleep to support learning success, emotional health, and brain health. We hope you sleep well tonight.

Glossary

Suprachiasmatic Nucleus (SCN): ↑ A small region deep in the brain that forms the "biological clock" and generates the circadian rhythms.

Circadian Rhythms: ↑ One of the two ways we know when to sleep. The naturally occurring pattern of sleeping and waking that repeats every 24 h in response to light.

Sleep Homeostat: ↑ One of the two ways we know when to sleep. Sleep need increases as we stay awake and decreases as we sleep.

Prefrontal Cortex: ↑ The front portion of the brain, critical for paying attention and planning.

Amygdala: ↑ A small region deep in the middle of the brain responsible for processing emotions.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors thank Dr. Mary Carskadon and Chloë Bergmark for their helpful guidance. The authors would also like to thank those who assisted in the translation of the articles in this Collection to make them more accessible to kids outside English-speaking countries, and for the Jacobs Foundation for providing the funds necessary to translate the articles. For this article, they would especially like to thank Nikki Lee for the Dutch translation. MK-V was supported by the Royal Netherlands Academy of Arts and Sciences (KNAW Ter Meulen Grant) and a Fulbright Award. JS was supported by NIMH (K01MH109854), the Rhode Island Foundation and the Jacobs Foundation.

References

[1] ↑ Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., et al. 2015. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health 1:40-3. doi: 10.1016/j.sleh.2014.12.010

[2] ↑ Crowley, S. J., Wolfson, A. R., Tarokh, L., and Carskadon, M. A. 2018. An update on adolescent sleep: new evidence informing the perfect storm model. J. Adolesc. 67:55-65. doi: 10.1016/j.adolescence.2018.06.001

[3] ↑ Krause, A. J., Simon, E. B., Mander, B. A., Greer, S. M., Saletin, J. M., Goldstein-Piekarski, A. N., et al. 2017. The sleep-deprived human brain. Nat. Rev. Neurosci. 18:404-18. doi: 10.1038/nrn.2017.55

[4] ↑ Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A., and Bogels, S. M. 2010. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med. Rev. 14:179-89. doi: 10.1016/j.smrv.2009.10.004

[5] ↑ Gregory, A. M., and Sadeh, A. 2016. Annual research review: sleep problems in childhood psychiatric disorders-a review of the latest science. J. Child Psychol. Psychiatry 57:296-317. doi: 10.1111/jcpp.12469

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A Good Night's Sleep: Necessary for Young Minds

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During your lifetime, you will spend almost 250,000 h asleep. Why do we need so much sleep? Sleep is not just rest from the day, but also necessary for your body and brain to be healthy, particularly as you grow up. For example, a good night's sleep enables you to pay attention and learn the next day.