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Taking Charge of Your Health & Wellbeing

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Well-educated, slender, and attractive, Julie seems to have it all. She has a PhD, an interesting career, and good friends. So everything's great, right?

Not exactly. Julie also has diabetes. And while she loves her job, she feels anxious about running a business. She often gets angry at herself, and snaps at others for small mistakes. Even scarier, despite careful monitoring of her blood sugar, she finds herself in a coma once or twice a month. What's going on?

It turns out that despite Julie generally healthy habits, her anxiety prevents her from paying attention to the cues her body gives her when her blood sugar is too low.

On her doctor's advice, Julie tries Mindfulness Based Stress-Reduction (MBSR) classes along with her regular diabetes care program. The MBSR practices help Sylvia slow down and actually pay attention to her body.

Julie begins to notice when her blood sugar is dropping, so she can eat to prevent herself from going into a diabetic coma. She also finds it easier to control her diabetes with insulin, probably because reducing her anxiety helps reduce her stress hormones. Her anger, a product of her stress, also fades away.

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What Is the Mind-Body Connection? | Taking Charge of Your Health & Wellbeing

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Well-educated, slender, and attractive, Julie seems to have it all. She has a PhD, an interesting career, and good friends. So everything's great, right? Not exactly. Julie also has diabetes. And while she loves her job, she feels anxious about running a business. She often gets angry at herself, and snaps at others for small mistakes.

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Overview

Harnessing the power of the mind-body connection

The mind-body connection means that you can learn to use your thoughts to positively influence some of your body's physical responses, thereby decreasing stress. If you recall a time when you were happy, grateful or calm, your body and mind tend to relax.

Research has shown that when you imagine an experience, you often have similar mental and physical responses to those you have when the event actually happens. For example, if you recall an upsetting or frightening experience, you may feel your heart beating faster, you may begin to sweat, and your hands may become cold and clammy.

Whether you have been diagnosed with an illness or need to prepare for a medical procedure such as surgery, it is very important to minimize the negative effects and maximize the healthy, healing aspects of your mind-body connection.

A variety of calming and empowering mind-body exercises have been proven to help people:

Decrease anxiety

Decrease pain

Enhance sleep

Decrease the use of medication for post-surgical pain

Decrease side effects of medical procedures

Reduce recovery time and shorten hospital stays

Strengthen the immune system and enhance the ability to heal

Increase sense of control and well-being

While the exercises described are not alternatives to medical or surgical treatments, they provide a powerful way for you to actively participate in your own health care, minimize pain and insomnia and promote recovery.

Calming/Relaxation Exercises

The goal of calming and relaxation exercises is to help change the way you perceive a situation and react to it - to help you feel more in control, more confident or secure, and to activate healing processes within the body. Become aware of any tension, anxiety, change in breathing, or symptoms that you recognize as being caused or worsened by stress. When you take about 15 minutes daily to practice these exercises to help "quiet" your mind and help your body become more relaxed, you can then call upon this ability with a shorter relaxation exercise at a stressful time.

Relaxation Breathing Practice

Be aware of your current breathing pattern and learn how to change your breathing rate from fast, shallow chest breathing to slow, abdominal breathing.

Focus on your breath while you place one hand on your chest, the other over your navel. Imagine there is a balloon in your abdomen. As you take a slow, deep breath, focus on inflating the balloon in your abdomen. You will notice that your abdomen will rise much more than your chest. As you exhale, just let your abdomen fall naturally.

The goal is to learn how to breathe at six breaths a minute, about three or four seconds inhaling and six or seven seconds exhaling. Once you have the slow, deep breathing accomplished, don't worry about counting and imagine breathing out any tension in the body or thoughts that get in the way of comfort and relaxation.

If it helps, you can imagine a spot located on your abdomen, just below your navel. Breathe into and through that spot, filling your abdomen with air, allowing it to expand. Imagine the air filling you inside from your abdomen, and then let it out, like deflating a balloon. With every long, slow breath out, you should feel more relaxed.

Try this exercise that incorporates a few different relaxation techniques:

Begin by interrupting your normal daily thoughts. Think about what is going on around you. Then switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly.

Mentally scan your body. Notice areas that feel tense or cramped, such as your neck or shoulders. Loosen up these areas. Let go of as much tension as you can.

Slowly rotate your head to the left in a smooth, circular motion, leaning your left ear to your left shoulder. Rotate your head to the right in a smooth, circular motion, leaning your right ear to your right shoulder. (Stop any movements that cause pain.)

Roll your shoulders forward and backward several times. Let all of your muscles completely relax.

Recall and focus on a pleasant memory.

Take another deep breath and exhale slowly. You should feel more relaxed.

Progressive Muscle Relaxation

Progressive muscle relaxation involves sequentially tensing and then relaxing specific muscle groups in the body, one at a time, and progressing throughout the entire body.

The key to this exercise is to tighten a specific muscle group for at least 5 seconds until you feel the tension, and then release the muscles for 10 seconds, noticing the difference in how the muscles feel before and after the exercise.

You can start by relaxing the muscles in your legs and feet, working up through each muscle group to your neck, shoulders, and scalp.

Mind Relaxation

Close your eyes. Breathe normally through your nose. As you exhale, silently say to yourself the word " one," or any other short word such as " peaceful," or a phrase such as " I feel quiet" or " I'm safe." Continue for 10 minutes. If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. Let your breathing become slow and steady.

Guided Imagery

Research shows that guided imagery and relaxation can decrease anxiety and pain and possibly shorten your hospital stay. Guided imagery is often presented on an audio program in which you are guided in using your imagination to induce peace, calm, strength and control. The calming music accompanying guided imagery can be helpful in quieting the mind.

The Cleveland Clinic Heart Center offers a free guided imagery programs for patients undergoing surgery and other procedures. Learn more

Heart Center patients may also bring their own relaxation or guided imagery tapes. Please ask your doctor or nurse for more information.

Healing Services Touch Therapies Program

The Touch Therapies Program includes light massage therapy, reiki and Healing Touch™ to assist your recovery from medical or surgical interventions. The Touch Therapies Program is offered through a partnership between the Healing Services Team and the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute.

Massage Therapy is used to support your medical condition and aid recovery from procedures. Massage can help reduce muscle tension, relieve stress and soothe pain. A light, 10-minute massage (with your physician's approval) can assist your experience of well-being as you are healing. Fee-based massage therapy is offered to family members and visitors to help decrease stress so they can effectively support you.

Healing Touch™ and reiki are relaxing, nurturing energy therapies where gentle touch assists in balancing your physical, mental, emotional and spiritual well-being to promote a deep sense of relaxation. These therapies work with your energy to support your natural ability to heal.

To receive any of these complimentary touch therapies, please call Healing Services at
ext. 59543 on your hospital phone or 216.445.9543. For more information about our program, please see the section in your binder, "Healing Services Touch Therapies Program."

Healing Services Team

The Healing Services Team provides a comprehensive approach to help you during your hospital recovery. Services include holistic nursing, spiritual care and complimentary touch therapies as described previously. If you would like someone from the Healing Services Team to visit you, please call ext. 59543 on your hospital phone or 216.445.9543. You can also ask your nurse to place an order.

Mind-Body Coach

A Mind-Body Coach is a trained professional who can teach you multiple ways to use your mind to reach a higher level of peace, calm and comfort before surgery. You'll also learn the "tools" to help you during recovery, including guided imagery. To schedule a one-on-one session with the Mind-Body Coach before or after surgery, please call Healing Services at ext. 59543 on your hospital phone or 216.445.9543. Please note this is a fee-based service. You can also ask your nurse to place an order.
Self Help Relaxation Techniques
These techniques will help you release muscle tension and relieve pain. Practice these techniques as often as necessary.

Fold and Hold: If a muscle in the shoulders or neck is tight, you can release it without rubbing it. Just bend toward the tight side and hold it for 90 seconds. The muscle should be soft after doing this. this causes any strain on the incision site, stop immediately. Please do not use this method on the legs.

Chucking/Jostling: If a muscle is tight, brush lightly over the muscle with your hand and it should release in 30 seconds. Do not rub over any muscles that are near or under an incision, tube or if a medical device is implanted in the area.

Spiritual Practices

Centering prayer and meditation are some of the oldest methods of relaxation involving a specific mental focus. These techniques induce a deep state of relaxation and well-being. Many people find spiritual practices helpful in achieving total mind-body relaxation.

At Cleveland Clinic, a chapel is open 24-hours a day, seven days a week, to people of all faiths. The chapel is located on the first floor of the Glickman Tower, next to the Q elevators. The Red Coat staff can provide directions. A Muslim prayer room is also available.

To schedule a clergy visit from Spiritual Care, please call ext. 42518 on your hospital telephone or 216.444.2518. Or call our 24-hour Prayer Line at ext. 57200 or 216.445.7200.

Music and Art Therapy

Under the supervision of a board-certified music therapist, music therapy combines music and therapeutic techniques and aids in the physiological, psychological and emotional well-being of the individual during treatment of an illness.

Art therapy utilizes art media and the creative process to help patients in their healing and recovery. Art therapy can help patients decrease anxiety, manage stress, and deal with emotional issues.

For more information about music or art therapy, contact the Cleveland Clinic Arts & Medicine Institute at ext. 55083 on your hospital telephone or 216.445.5083.

Relaxation and Massage Suites

The Relaxation and Massage Suites, located on the 5th and 8th floors of the Miller Family Pavilion, are open 24 hours a day, 7 days a week. Patients and family members are welcome to go to these rooms to take a quiet break from the daily hospital routine. If you are staying in a unit that's not on the 5th or 8th floors, please let your health care team know if you'd like to visit the suite. Please note that massages are available in these suites by appointment, during regularly scheduled times. To schedule a massage appointment, please call 216.986.HEAL (4325) and a scheduling specialist will assist you.

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The mind-body connection means that you can learn to use your thoughts to positively influence some of your body's physical responses, thereby decreasing stress. If you recall a time when you were happy, grateful or calm, your body and mind tend to relax.

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Mind/Body Connection: How Emotions Affect Health

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People who have good emotional health are aware of their thoughts, feelings, and behaviors. They cope well with stress and normal life problems.

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What is the Mind Body Connection & How to Harness It 

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A broken wrist is usually easy to diagnose and treat - and you likely know exactly what caused it. Some health conditions, though, are not so clear cut. Often, these health conditions involve a deep connection between the body and the mind.

Consider heart disease: there are many known lifestyle factors that contribute to it. These include smoking, poor diet and lack of exercise. But researchers are discovering that attitudes and emotions (the "mind") can also contribute to heart disease and other physical health challenges (the "body")

Stress causes a biological response known as fight or flight. You either confront a threat (flight) or you avoid it (flight). But that's a simple explanation. The stress response triggered in fight or flight is a complex mix of physical, mental and emotional reactions.

Have you ever had to give a big presentation? If so, you might remember how you felt. Your heart pounds, your breath quickens, your stomach gets butterflies and your palms get sweaty. This mind/body stress response isn't meant to make you feel sick. In this case, it's meant to help you perform well. This is called acute stress. It is in response to a challenge, and it goes away quickly. In the case of giving a big presentation, the response was probably over as soon as you finished presenting.

But sometimes, the stress response happens frequently. It can be triggered by more common day-to-day experiences. A spat at home. A slow commute. A work email. A bill in the mail. Over time, this type of stress, called chronic stress, can take a real toll on your emotional and physical health. Worried that you might be experiencing chronic stress? Here are some of the signs:

These are all signs that stress may be working overtime in your body.

With the hectic pace of life today, many people feel the negative effects of chronic stress. But it's worth noting that the mind/body link can also have many positive effects.

Building a positive mind-body connection

There are a number of things you can do to put the mind-body connection to work for you. By reducing stress, you can counteract some of its harmful effects on your body. With mind-body exercises like yoga or tai chi, you can help better control anxiety and pain. Some mindful activities can help boost your energy and your mood, and even help you find more happiness and compassion to improve the overall quality of your life.

Some mind-body practices include:

For these practices, you may need to seek help from an experienced guide, mentor, or professional. But you can do some mind/body exercises right in your own home, car or office, and you only have to spare a few moments.

For example, mindfulness meditation is something you can do when you have time and where you can find a few minutes to focus. You don't need a guide, a yoga mat or any other special equipment. You just need to close your eyes, pay attention to your breath, and focus on present thoughts. When your attention wanders, return to the present. Mindfulness can bring help you focus, tune out distractions and find a little calm in the moment - and over time, help your mind and body feel better.

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What is the Mind Body Connection & How to Harness It | Mental Health & Wellness | Kaiser Permanente

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A broken wrist is usually easy to diagnose and treat - and you likely know exactly what caused it. Some health conditions, though, are not so clear cut. Often, these health conditions involve a deep connection between the body and the mind. Consider heart disease: there are many known lifestyle factors that contribute to it.

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Doctors That DO: How to Improve Your Mind-Body Connection with Dr. Mike

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Mind/Body Connection: How Your Emotions Affect Your Health 

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Mind/Body Connection: How Your Emotions Affect Your Health (Accessible Preview)

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Finding a sense of peace and calm in our day-to-day lives can be difficult. Relaxation techniques can help to relax the mind and body and also manage some of the symptoms of anxiety and depression.

There are many types of relaxation, including breathing exercises, progressive muscle relaxation, visualisation, meditation, mindfulness, and gentle physical activities such as yoga and Tai Chi. And the good news is, many of these techniques can be practised almost anywhere and at little or no cost.

Learning to relax can take a bit of practise but the more you practise the more helpful the relaxation technique will be. Below are some downloadable MP3 files to help get you started. You can save these on your phone or computer to use at any time.

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Finding a sense of peace and calm in our day-to-day lives can be difficult. Relaxation techniques can help to relax the mind and body and also manage some of the symptoms of anxiety and depression. There are many types of relaxation, including breathing exercises, progressive muscle relaxation, visualisation, meditation, mindfulness, and gentle physical activities such as yoga and Tai Chi.

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Healing Depression the Mind-Body Way: Creating Happiness with Meditation, Yoga, and Ayurveda

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Healing Depression the Mind-Body Way: Creating Happiness with Meditation, Yoga, and Ayurveda [Liebler, Nancy] on Amazon.com. *FREE* shipping on qualifying offers. Healing Depression the Mind-Body Way: Creating Happiness with Meditation, Yoga, and Ayurveda

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"An accessible, concise, systematic, and comprehensive primer on wellness and healing." (Dr. Gabor Maté, MD, author of Do you regularly experience chronic pain, anxiety, fatigue, gut issues, or other symptoms of chronic stress? The Mind-Body Cure will teach you how to manage your stress hormones and eliminate chronic stress in seven simple steps. When the Body Says No: The Cost of Hidden Stress)
In The Mind-Body Cure, Bal Pawa, MD, shares her own story of chronic pain following a tragic car accident. Only when she recognized how stress hormones were disrupting every system in her body, from digestion to immunity to sleep, was she able to reclaim her health. Having healed herself - and many patients since - Dr. Pawa now shares the secrets to long-lasting health and wellness in The Mind-Body Cure.

Most people today are familiar with chronic stress - whether it's family or work pressures, the anxiety we experience each day never seems to end. It may even feel like we're always in fight-or-flight mode. As Dr. Pawa explains, the continuous and excessive release of stress hormones in our bodies are behind 75 percent of visits to a doctor's office. What if we could manage our stress and its harmful side effects with easy and affordable tools? The Mind-Body Cure teaches you to do just that.
PLEASE NOTE: When you purchase this title, the accompanying PDF will be available in your Audible Library along with the audio.
Dr. Pawa's original REFRAME Toolkit offers seven simple ways to reduce chronic stress, including making specific changes to your diet, sleep, exercise habits, and more tools including meditation and mindfulness techniques. Interweaving evidence-based science with practical advice to calm your mind, The Mind-Body Cure helps you move from primitive fight-or-flight mode to send healing hormones into your body instead.

"What a wonderful combination of medical smarts with heartfelt practical wisdom! Comprehensive, full of examples, and always so useful, The Mind-Body Cure is an excellent book." (Rick Hanson, PhD, New York Times best-selling author of Budda's Brain, NeuroDharma, Just One Thing)

"Dr. Pawa moves mind-body medicine from the margins to the mainstream. Written with compassion, dedication, and rigorous science, this book is the definitive guide to holistic health - both for those who know the mind's power to help heal the body and for those who have yet to discover it." (Shimi Kang, MD, psychiatrist, and best-selling author of The Dolphin Parent and The Tech Solution)

"Dr. Bal Pawa is a compassionate physician who successfully integrates recommendations for the mind and body. She helps us realize that our thoughts can be our reality, especially when it comes to our health. And she explains how hormones affect our sleep, immune system, and emotions and how we can support them for optimal health." (Lorna R. Vanderhaeghe, author of A Smart Woman's Guide to Hormones)

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The Mind-Body Cure: Heal Your Pain, Anxiety, and Fatigue by Controlling Chronic Stress

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Amazon.com: The Mind-Body Cure: Heal Your Pain, Anxiety, and Fatigue by Controlling Chronic Stress (Audible Audio Edition): Dr. Bal Pawa, Carri Toivanen, Greystone Books: Books

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The mind and the body are not two separate entities-although they are often treated that way. Physical health and emotional health are intimately intertwined in what's known as the mind-body connection.

Our chemistry and biology impact our mood and emotions, as well as thoughts and beliefs. With all of these factors combined, they play a major role in influencing our stress and physical health. If you've ever felt your stomach tighten up when you were anxious, you've experienced the mind-body connection.

The Biochemistry of the Mind-Body Connection

While we still don't understand everything about the mind-body connection, scientists are discovering some of the ways in which communication occurs. Dr. Jennifer Weinberg, MD, MPH, MBE, a preventive and lifestyle medicine physician, describes the brain as "the hardware" that allows us to experience the thoughts, beliefs, attitudes, and emotions that we collectively call the "mind."

Communication happens via chemical and physical messengers, such as hormones and neurotransmitters. In fact, researchers have identified the actual neural networks that connect the cerebral cortex to the adrenal medulla, which actives the body's response in stressful situations. These findings illuminate how mental states, such as stress and depression, can influence organ function.

"According to the mind-body or biopsychosocial paradigm, which supersedes the older biomedical model, there is no real division between mind and body because of networks of communication that exist between the brain and neurological, endocrine and immune systems." -Oakley Ray, Professor Emeritus of Psychology, Psychiatry and Pharmacology at Vanderbilt University

Stress and Physical Health: An Evidence-Based Link

Studies have also determined that stressful emotions decrease immunity by altering blood cell function. In one study, researchers found that stress diminishes white blood cell response to infected cells and cancer cells. In addition, when individuals are stressed, they heal more slowly and vaccinations are less effective. Moreover, research has found that talk therapy, such as Cognitive Behavioral Therapy, can strengthen cell function and therefore enhance the body's ability to fight disease.

One breakthrough study looked at the impact of the mind-body connection on a group of breast cancer survivors. One section of study participants lowered their stress by either practicing mindfulness meditation or attending a support group. A control group did neither.

As a result, researchers found that the groups that meditated or went to a support group had longer telomeres-protein complexes at the end of chromosomes-than the control group. Shortened telomeres are associated with disease, while longer ones protect against disease.

"We already know that psychosocial interventions like mindfulness meditation will help you feel better mentally, but now for the first time we have evidence that they can also influence key aspects of your biology." -Linda E. Carlson, PhD, principal investigator and director of research, Psychosocial Resources Department, Tom Baker Cancer Centre, Alberta, Canada

Cognitive Behavior Therapy and the Mind-Body Connection

As another example of the mind-body connection, neuroimaging research has shown that talk therapy-specifically Cognitive Behavioral Therapy -can significantly alter the way the brain works.

CBT focuses on teaching individuals how to identify and change thought patterns. The goal is to consciously activate positive thoughts and behaviors until these responses become more automatic. And researchers have discovered that in the process, people's brains and nervous systems actually change.

A 2009 review looked at 13 studies that used neuroimaging to investigate how CBT affects brain circuits and function. Researchers concluded that CBT treatment modifies the neural circuits involved in regulating fear and other negative emotions. For example, in a study on CBT for PTSD, participants who had CBT treatment showed increased brain activity in areas related to social cognition-encompassing emotions such as forgiveness and empathy. A similar study on social phobia found that CBT decreased activity in brain areas related to fear and threat. Studies on Obsessive-Compulsive Disorder and panic disorder, among others, also found alterations in various parts of the brain following CBT treatment.

In other words, people's thoughts and behaviors have the ability to change their neurobiology-our stress and physical health are intertwined. That's the power and mystery of the mind-body connection at work.

How Yoga and Meditation Positively Impact the Brain and Body

Research on yoga and meditation has further explored the connection between mind, body, and spirit. Studies show that the mindful movement and breathing done in yoga activates the relaxation response (rest-and-digest system), via the vagus nerve. Consequently, yoga moves the nervous system out of the "fight, flight, or freeze" response associated with stress, and into the "rest and digest" response-increasing emotional well-being.

Furthermore, yoga increases levels of GABA, a neurotransmitter in the brain that helps relax the mind. In a 12-week study, participants either walked or did yoga for an hour three times a week. The yoga group showed greater increases in GABA levels, along with greater improvement in mood and reduced the physical effects of anxiety.

Another study compared a Cognitive Behavioral Therapy (CBT) intervention to a CBT intervention with a yoga component. After two months, both groups reported reductions in the physical effects of anxiety and panic-related body sensations. However, the changes were more significant for those who did both CBT and yoga which gives weight to the connection between mind, body, and spirit.

"By focusing on and controlling our breath, we can change how we think and feel. We can use the breath as a means of changing our emotional state and managing stress." -Tommy Rosen, yoga teacher and addiction recovery expert

The Mind-Body Connection in Guided Imagery

While the impact of the breath on the mind is an example of one type of mind-body connection, the use of guided imagery is an example of how what's happening in the mind impacts the body. When we imagine a situation, the primal parts of the brain react as if it was really happening. Therefore, positive visualizations have a beneficial impact on the entire nervous system, automatically relaxing all of the body's systems.

Because calming the body's stress response supports the immune system, visualization may even help fight disease, according to some research.

"Visualization is effective as it bypasses our logical (or illogical) mind by tapping into a global sense of ourselves and our emotions. It allows us to remember emotions, or to promote an emotional state connected to certain contexts." -Dr. Michel Mennesson, MD, Psychiatrist at Newport Academy

In conclusion, the mind-body connection is real, and it has a powerful impact on our well-being at every level. Experts are discovering how it can be used in treating both mental and physical disorders. And we can learn to harness the power of the mind-body connection in our own lives to optimize our happiness and health.

Nutrition and the Mind-Body Connection

What goes into our body also impacts our mind and mental health. What we eat has the power to prevent or help reverse mental health challenges. Research, including the groundbreaking SMILES Trial, demonstrated the impact of food on our mood. Moreover, specific nutrients have been linked to measurable positive outcomes in mental and emotional well-being.

In addition, the mind-body connection manifests in the communication between the brain and the gut. About 95 percent of serotonin, one of the primary hormones involved in mood and emotion regulation, is produced in the gastrointestinal tract. Sometimes called "the second brain" or "belly brain," this enteric (intestinal-related) nervous system consists of some 100 million neurons sheaths of neurons embedded in the walls of the gut. Moreover, information travels mostly from the gut to the brain, rather than vice versa.

As a result, researchers have found that people with healthy, diverse gut microbes are less likely to suffer from anxiety and depression. Furthermore, studies in both animals and people demonstrate that replacing bad bacteria in the gut with good bacteria can significantly alter mood and emotional regulation.

Sources:
J Neuropsychiatry Clin Neurosci. 2009 Spring;21(2):114-25. EMBO Rep. 2006 Apr; 7(4): 358-361. Soc Work Health Care. 2008;46(4):17-37. Cancer. 2015 Feb 1;121(3):476-84. Ann Gastroenterol. 2015 Apr-Jun; 28(2): 203-209.

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The mind and the body are not two separate entities-although they are often treated that way. Physical health and emotional health are intimately intertwined in what's known as the mind-body connection. Our chemistry and biology impact our mood and emotions, as well as thoughts and beliefs.

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Exercise is a powerful tool for increasing emotional and physical wellbeing and is an effective evidence-based treatment for many mental health conditions. Unfortunately, many people fail to meet the recommended target of 150 minutes of moderate physical activity per week [1] and rates of exercise in people suffering from mental health problems are even lower than average [2]: this means that motivating your patients to engage in exercise is a valuable therapeutic skill. In this article we will review the evidence linking exercise and mental health and discuss practical strategies that you can use to motivate your clients to get active.

What is exercise and physical activity?

Physical activity is defined as any movement produced by the skeletal muscles and exercise is defined as a structured form of physical activity that has the intention of improving a health-related outcome [3]. Exercise can be categorized according to the nature of the activity, or the health-related outcome it is intended to improve. For example, resistance exercise increases muscular strength or endurance by applying resistance to bodily motions, whereas aerobic exercise involves our aerobic respiratory system by working at a low intensity over a sustained period of time (e.g. long-distance running).

What does exercise do for the mind and body?

Exercise has been associated with positive effects upon multiple markers of physical and mental wellbeing:

Exercise increases our energy levels. Increased physical activity is associated with reduced feelings of low energy or fatigue [4]. A 2013 meta-analysis found that acute exercise participation enhances feelings of energy [5] and multiple randomized controlled trials have indicated that increasing physical activity leads to an increase in self-perceived energy compared to non-active controls [6,7].

Exercise leads to better sleep. Many forms of exercise have been demonstrated to be beneficial for improving sleep quality [8,9,10]. Exercise has even been suggested as an alternative or complimentary form of therapy for clients with sleeping problems [9]. Research seems to suggest that doing exercise 4 to 8 hours before bedtime is likely optimal for improving sleep quality, although some exercise at any time of day seems to be beneficial [8].

Exercise is associated with greater self-esteem. People who take part in regular physical activity tend to have a higher level of physical self-worth, improved body image, and a higher level of self-esteem [11]. Physical activity was also found to be directly and indirectly associated with self-esteem and advocated as an adjunct treatment for adults with lower self-esteem [12].

Exercise lowers your risk of death. Physical inactivity is estimated to cause 9% of all premature deaths [13]. In the USA, research has suggested that men and women over 50 who change their physical activity status from inactive to active increase their life expectancy by between 1.3 - 3.7 and 1.5 - 3.5 years respectively [14].

Exercise lowers your risk of ill-health. Regular physical activity is strongly associated with a decreased risk of many physical health conditions such as diabetes, stroke, and cancer [15,13]. Oftentimes, these health-related benefits occur in the absence of weight changes and therefore clients who make little progress in achieving their weight-loss goals should be reminded of the profound impact that exercise can have on their health regardless [16].

Exercise is associated with improved brain function. Exercise is shown to have a positive association with cognitive performance [17,18]. Exercise has also been found to improve concentration, reduce levels of irritability [3], and may slow the deterioration in balance and mobility in patients with Alzheimer's disease [19].

"Physical activity is one of the most fundamental factors necessary for maintaining health and warding-off risk factors" [20]

How can exercise help with mental health conditions?

Exercise has been investigated as both a standalone intervention and as part of comprehensive treatment packages for a variety of mental health conditions. When high-quality studies are reviewed the evidence for introducing exercise as an intervention for people struggling with mental health problems is mostly very encouraging. We will review the evidence for the effects of exercise upon a variety of conditions including depression, anxiety, psychosis, addiction, and ADHD.

Exercise and Depression

Depression is a disorder primarily characterized by a low mood and a lack of interest in activities that were previously pleasurable. Depression is the leading cause of disability worldwide, with around 300 million people affected globally [21]. Major depressive disorder (MDD) is associated with an increased likelihood of school dropout, chronic physical diseases, and extended periods off work [22]. Despite the availability of effective treatments for depression, only a minority receive professional help [22].

Given the impact depression can have upon people's lives and the extensive costs associated with the disorder, it is encouraging that research consistently finds exercise to be an effective treatment for depression, with a magnitude of effect similar to other established forms of treatment such as CBT and medication[3,23,24]. An additional benefit of exercise is that it is not associated with the side effects and discontinuation problems associated with antidepressant medication, nor is it as costly as psychotherapy.

What is the evidence for encouraging people with depression to exercise?

In 2016 Felipe Schuch and colleagues published a high-quality meta-analysis in the Journal of Psychiatric Research [25]. A meta-analysis is a 'study of studies' and theirs included data from 1487 adults with depression who had taken part in 25 randomized controlled trials. Half of the participants had been randomized to receive 'non-active control treatment' (such as a waiting list, usual, care, or placebo pills). The other half of the participants received an exercise intervention which they defined as "planned, structured, repetitive and purposeful physical activity". Further, the authors adjusted their results to pay more attention to the high-quality studies. They found "large antidepressant effects of exercise on depression when compared to non-active control conditions". They observed larger effects in outpatients compared to inpatients and when exercise was supervised by qualified exercise professionals, and cautiously observed that moderate or vigorous exercise was more effective than light to moderate exercise. They conclude that "our results provide robust evidence that exercise can be considered an evidence-based treatment for the management of depression."

Earlier meta-analyses are consistent with Schuch and colleagues' findings. A 2012 meta-analysis published by the Cochrane foundation showed a moderate effect of exercise on symptoms of depression compared to a waitlist or placebo condition [23] with the effect size for the exercise intervention found to be of similar magnitude to the effect size for cognitive-behavioral therapy (CBT). They concluded "it is reasonable to recommend exercise to people with depressive symptoms and to those who fulfil diagnostic criteria for depression".

What type of exercise is most effective for treating depressive symptoms?

Several RCTs have indicated a dose-dependent relationship between exercise and depressive symptoms, suggesting that a moderate to high intensity is most effective. Aerobic, non-aerobic, and resistance training were all found to be helpful [26,27]. This position is tentatively supported by the Schuch (2016) meta-analysis, although other meta-analyses found that a lower intensity aerobic exercise program 3-5 times per week was optimal for mood improvements [28] and even low intensity exercises such as walking have been shown to have a large and significant effect on depressive symptoms [29]. The take-home messages are that some exercise is much better than none when it comes to depression, more seems to be better, and all types of exercise seem to be effective.

Exercise and Anxiety

Around 1 in 3 Americans will develop an anxiety disorder at some point in their lifetime [30]. Common anxiety-related mental health problems include generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). There is interesting evidence that exercise can be an effective treatment for anxiety disorders with acute as well as long-term effects. Even in non-clinical populations, physical activity has been shown to reduce symptoms of anxiety [31]. Evidence from epidemiological studies indicates that those who take part in regular physical activity have a reduced likelihood of developing an anxiety disorder [32,33].

Acute effects of exercise upon anxiety

A single bout of aerobic exercise can have a powerful anxiolytic effect [34,35]. In a 2015 study by LeBouthillier and Amundson [34], forty-one participants were randomized to complete 30 minutes of aerobic exercise or 30 minutes of stretching. They found that participants who completed aerobic exercise, but not those who did stretching, experienced significant reductions in anxiety sensitivity, intolerance of uncertainty, and increases in distress tolerance. Higher levels of trait anxiety sensitivity are associated with the development and maintenance of anxiety disorders, particularly those with a body-focus and so exercise appears to be a promising intervention with immediate effects.

The effects of exercise as a stand-alone treatment for anxiety

A 2017 meta-analysis by Brendon Stubbs and colleagues published in Psychiatry Research [36] examined the effects of exercise upon anxiety in people with anxiety or stress-related disorders (including panic disorder, PTSD, GAD, and social anxiety). They included data from six high-quality trials totalling 262 adults. Compared to a non-active control condition (e.g. usual care, wait-list, or placebo pills) exercise was associated with a medium effect size. The authors conclude that "exercise should be considered an evidence-based option for anxiety symptoms among people with anxiety / stress related disorders."

The effects of adding exercise to other treatments for anxiety

The evidence appears to indicate that exercise can be considered a standalone, evidence-based treatment for anxiety [37,38,36]. But what about combining exercise with other medical and psychological treatments? A number of interesting studies have examined exercise as an additive intervention to conventional treatments. One RCT examined how a 12-week exercise program added to usual care would compare to usual care alone for reducing PTSD symptoms in a group of 81 participants, where usual care consisted of psychotherapy, pharmaceutical interventions, and group therapy [39]. Clinically significant improvements were seen in PTSD symptoms (as well as depressive symptoms and physical characteristics) in the exercise intervention group compared to usual care alone. For patients with panic disorder with or without agoraphobia, 8 weeks of aerobic exercise had an additive anxiolytic effect to CBT alone [40]. Across a variety of anxiety disorders (GAD, social anxiety disorder, and panic disorder), similar results have also been observed when walking is added as an intervention to group CBT [41]. Summarizing a systematic review of exercise for anxiety, Javakody and colleagues conclude that " exercise seems to be effective as an adjunctive treatment for anxiety disorders"[42].

What types of exercise are most effective for treating anxiety symptoms?

The anxiolytic effects of exercise have been examined in a number of trials. Interesting questions are "which exercise is most helpful for reducing anxiety?" and "do different anxiety disorders respond to different forms of exercise?". Evidence addressing these questions is fairly limited. There is growing support for the idea that individuals with panic disorder benefit from aerobic exercise such as running, particularly as an adjunct to psychological therapy [43]. A 2011 study examined the effectiveness of aerobic and resistance exercise for the treatment of GAD and found that both groups had similar reductions in trait anxiety after a 6-week intervention [3]. When looking at the exercise intensity, several RCTs have indicated a benefit of moderate/hard intensity over low intensity exercise on anxiety symptoms [40,44]. A fair summary of the current research is that exercise appears to be helpful for anxiety disorders, but more data is needed to determine which exercise type and intensity is most helpful for each individual condition.

Exercise and psychosis

People diagnosed with psychosis and schizophrenia experience symptoms including hallucinations and delusions. Standard psychiatric treatment for schizophrenia is antipsychotic medication, which is somewhat effective at managing the positive symptoms such as hallucinations and delusions, although it is less effective at treating the negative symptoms such as anhedonia, emotional flattening, and behavioral withdrawal [45,46,3,47]. Antipsychotic medications are also associated with side effects including weight gain, lipid abnormalities, and metabolic syndrome. For these reasons among others, adherence to medication is often poor [47,3].

A growing body of research supports the use of exercise interventions to augment standard treatment and improve negative symptoms in patients with schizophrenia (e.g. [46,48,49,3]). In 2015 Elisa Vera-Garcia and colleagues published a systematic review in Psychiatry Research [50] which considered the effectiveness of physical therapy interventions within the multi-disciplinary management of schizophrenia. Their review included 13 randomized controlled trials representing 549 participants. Specifically, they looked at studies which included aerobic exercises, strength exercises, relaxation training, body awareness exercises, or a combination of all of these. Their results clearly demonstrate that aerobic, strength exercises and yoga reduce psychiatric symptoms while improving health-related quality of life. They conclude that "There is currently sufficient scientific evidence to conclude that aerobic exercise reduces negative symptomatology and improves cardiorespiratory fitness." [3]

Exercise and addiction

There is substantial evidence to suggest that acute exercise participation can reduce cravings, improve withdrawal symptoms, and attenuate triggers in heavy cigarette smokers [51,52,53]. Exercise may also help individuals resist urges to use other substances such as alcohol, high-energy foods, and psychoactive drugs [54,55]. Although evidence supporting the effect of exercise for those with problematic alcohol use appears to be more mixed, with Hallgren and colleagues [56] reaching the conclusion that "exercise appears not to reduce alcohol consumption but has significant improvements in other health outcomes including depression and physical fitness".

Attention Deficit/Hyperactivity Disorder and Exercise

Individuals with attention deficit hyperactivity disorder (ADHD) display symptoms of inattention, hyperactivity, and impulsivity and are often treated with a combination of medication and psychosocial interventions. It is one of the most frequently diagnosed neurodevelopmental disorders in school-aged children, with a worldwide prevalence rate of 5.29% [57]. Medication is largely effective at improving behavioral symptoms, executive functioning, and productivity [58] although it is associated with side effects such as sleep difficulties and mood changes [59].

In 2016 Ruta Vysniauske and colleagues published a meta-analysis in the Journal of Attention Disorders [60] exploring the effects of physical exercise on children who met criteria for ADHD. Ten studies with a total of 300 participants were included in the analyses, with the average age of participants being 9.3 years old. Compared to no-exercise conditions they found a significant and medium-sized effect of physical exercise upon functional outcomes in ADHD. Similarly, a 2015 systematic review and meta-analysis published in Child Care Health and Development concluded that "The main cumulative evidence indicates that short‐term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD" [61].

Mechanisms by Which Exercise May Influence Mental Health

So we know that exercise can be an effective way of improving mental health, but why is it effective? A useful way of understanding why is to systematically consider the biopsychosocial factors.

Biological mechanisms by which exercise improves mental health

There are several biological pathways by which exercise may improve mental health. These include:

Brain Derived Neurotrophic Factor (BDNF). BDNF is a protein that is thought to play a role in neurogenesis, neuroprotection, synaptic transmission [3], and is an important component in the extinction of fear [62]. Exercise has been shown to increase resting BDNF levels with aerobic exercise leading to greater increases than resistance exercise [63].

Increased stress tolerance. Exercise is thought to decrease activity of the sympathetic nervous system and activity in the hypothalamic-pituitary-adrenal (HPA) axis [64]. The effect of this is that individuals are less reactive to stress and are therefore thought to be more resilient to daily stressors.

Inflammation. There are a number of theories which posit that depression in some individuals is underpinned by inflammation which results in 'sickness behaviors' [65,66]. Aerobic exercise can be used to reduce inflammation in both the periphery and the brain [67] and "Exercise is a promising intervention for the prevention and treatment of various diseases characterized by chronic inflammation" [3].

Endorphins / endocannabinoids. Traditionally the mood changes resulting from aerobic exercise such as running have been attributed to the increase in endorphins [68]. However, more recent research suggests that endocannabinoids (eCBs) could largely explain the anxiolytic and analgesic effects of aerobic exercise [69]. eCBs bind to the same cannabinoid receptors as the psychoactive component in cannabis or marijuana, therefore making the term 'runners high' somewhat appropriate [70].

Psychological mechanisms by which exercise improves mental health

There are several psychological pathways by which exercise may improve mental health. These include:

Exercise promotes a sense of mastery and achievement. Depression is a state of inertia and people who are depressed tend to have lower than usual levels of activity and achievement. Physical activity is a behavioral 'antidote': patients increase their activity levels with the resulting opportunity to increase self-mastery and sense of achievement.

Exercise assists the expenditure of anxious energy. Anxiety is characterized by avoidance and an overactive 'fight or flight' response. When the sympathetic nervous system is activated during a state of anxiety, the body gears up to expend energy by fighting or running away. Exercise is a safe and socially acceptable way of expending this energy in order for the parasympathetic nervous system to activate and bring the body back to a relaxed state.

Exercise promotes development of improved self-esteem. Exercise can lead to an improved body image, body satisfaction or acceptance through a perceived increase in physical competence and ability in different aspects of fitness. All of which can positively influence self-esteem or self-estimation and promote a sense of autonomy and control [71,11].

Social mechanisms by which exercise improves mental health

There are several social pathways by which exercise may improve mental health. These include:

opportunities to mix with other people through engagement in social activities such as exercise classes or running clubs;

improved sense of belonging and significance through relationships with exercise leaders or others in the exercise group [11].

increased social skills, social interest, and social communication resulting from group exercise [72].

What are the benefits of using exercise as a treatment for mental health conditions?

Exercise comes with a number of benefits when compared with other interventions for mental health difficulties:

Exercise can be low-cost. Exercise does not come with the considerable costs associated with psychological or medical treatments. "The evidence reveals that especially brief exercise training counselling is an efficient, effective, and cost-effective means to increase physical activity... and to bring considerable clinical benefits to various patient groups." [73]

Exercise leads to physical health benefits. Exercise comes with a host of other beneficial effects and can often mitigate some of the adverse side effects of medication. These benefits include a lower risk of death and many non-communicable diseases such as cancer, stroke, and coronary heart disease.

Exercise can be done independently by clients. Exercise interventions do not require expert medical assistance and can be performed alone, with friends, or a qualified exercise professional. Some patients may feel empowered when they understand that they have the capacity to improve their mental health difficulties with physical exercise.

Exercise is non-stigmatizing. Some people may feel embarrassed about receiving therapy or medication for mental health problems but "exercise does not carry the same stigma as psychotherapy or medications; indeed most people are proud to say they exercise" [62]

Exercise has social benefits. Physical activity can be a social activity. Group exercise therapy and classes can provide clients with a means of ongoing group interaction and represents a form of exposure therapy for those with social anxiety disorder.

Innovative ways of integrating physical exercise into psychological treatment plans

A number of studies have integrated exercise into psychological treatment programmes. Some innovative uses of exercise as an additive intervention are worth reviewing.

Exercise in the treatment of PTSD

A 2018 study by Van Woudenberg and colleagues, published in the European Journal of Psychotraumatology [74] integrated physical exercise sessions into a treatment program for PTSD. Notable features include:

Three hundred and forty-seven individuals with PTSD were invited to attend and intensive 8-day treatment program over 2 weeks (4 days per-week).

Psychological treatment consisted of prolonged exposure (PE) in the morning and EMDR therapy in the afternoon. Daily physical exercise sessions were also offered alongside an evening psycho-education program. The physical activity on offer included walking, badminton, archery, and for physically impaired patients, table tennis. Patients were instructed to choose their own exercise intensity level.

At the end of the study 82.9% of patients reported clinically significant improvements in their PTSD symptoms and over half (54.9%) no longer met criteria for PTSD.

The authors concluded that their results show "that an intensive treatment format combining PE, EMDR, physical activity, and psycho-education is a potentially effective and safe treatment alternative for patients suffering from severe PTSD, complex trauma histories, and multiple comorbidities".

Exercise in the treatment of PTSD

A 2016 study by Rosenbaum and colleagues published in Acta Psychiatrica Scandinavica [39] augmented usual care for PTSD with exercise:

The researchers allocated forty-two patients to usual care alone and thirty-nine patients to usual care with an exercise intervention.

Usual care consisted of psychotherapy, pharmaceutical interventions and group therapy and treatment length was around 3 weeks for an in-patient group and several months for the larger out-patient group. The exercise intervention consisted of a weekly supervised exercise session, two unsupervised home-based sessions, and individualized daily step count targets using a pedometer for 12 weeks

Compared to the usual care group the exercise group demonstrated an additional moderate and significant reduction in PTSD symptoms. Large and significant reductions in waist circumference and depressive symptoms were also observed in the exercise group compared to the non-active controls.

The researchers concluded that "the findings of the current controlled trial provide support for the use of structured exercise as an augmentation strategy for the treatment of people with PTSD."

Exercise in the treatment of binge eating disorders

In 2004 Fossati and colleagues published a study comparing a traditional cognitive behavioral approach for treating binge eating disorders with the addition of a nutritional and physical activity program [75].

Sixty-one women who met criteria for binge eating disorder were split into three groups: 13 in a traditional CBT group, 23 in a nutritional-CBT group, and 25 women in a nutritional-CBT with physical activity group.

The CBT consisted of 12 weekly 90-minutes sessions which included the use of daily food records, the creation of eating schedules, and cognitive restructuring. The nutritional-CBT group received nutritional education designed to reduce the amount of fat consumed alongside the CBT treatment. Those in the physical activity group were also given physical activity recommendations such as taking the stairs instead of the elevator and advised to plan 30 minutes of structured activity three times per week, every week.

They found that the addition of physical activity and nutritional education to CBT led to the greatest reductions in eating disorder scores, and that participants in these groups lost significantly more weight than the other two approaches. The largest reductions in measures of anxiety and depression were also observed in the physical activity group.

Practical ways that therapists can integrate exercise into their psychological treatments

Exercise is a helpful and evidence-based intervention for anxiety, depression, and as an augmentation therapy for a range of other disorders. There are lots of helpful ways that psychological therapists can recommend and integrate exercise into their client's treatment programs.

Increase client's motivation to exercise

Exercise takes effort and some of the gains are not immediate. It is helpful to build your client's motivation to begin exercising, and to persist despite the short-term discomfort that can result. Some ways to increase your client's motivation to exercise include:

Provide information. Provide clear information about the physical and mental health benefits of exercise, particularly written information. There is evidence from multiple research studies that "exercise prescription or motivational messages in printed form or by computer are more effective than face-to-face counselling alone" [76]

Think about goals and values. Discuss your patient's short, medium, and long-term goals and values. A useful acronym to remember when goal-setting is SMART: are the goals specific, measurable, achievable, realistic, and time bound? Is being physically and mentally healthy consistent with their values? Helping your patients to remind themselves of their values is a proven approach to help them 'stay on course'.

Monitoring progress. Exercise is Medicine (EIM), a global health initiative urges health-care providers to assess their patients' level of physical activity at every clinical visit. "The more often a provider discusses physical activity with their patient, the more likely that person is to both recall such advice and to engage in regular physical activity. [77]. Record whether tasks are being attempted, whether goals are being met, and monitor current physical activity levels. A useful framework for assessing your clients current physical activity levels is the Physical Activity Vital Sign (PAVS).

Correct misperceptions. Take the time to understand how your patient thinks about the relationship between exercise and energy and correct any misperceptions. Some patients think about exercise according to a 'resource depletion' model, a bit like liquid in a cup: they think that exercise will deplete their resources, leaving them less to do other things. Although intuitively appealing this metaphor is wrong, it is more helpful to think of exercise as being like an elastic band in a child's toy: exercise 'winds up' the elastic band storing more energy in it. This approach is supported by the research - exercising regularly leads people to have more energy [5]

Use technology. Some clients may find that integrating technologies such as pedometers, smart watches, and smart phone applications is helpful for them. Wearable technologies represent affordable and accessible ways to constantly remind clients about the importance of regular exercise and applications can help increase levels of physical activity through healthy competition and effective monitoring (e.g. Strava and MyFitnessPal).

Don't underestimate your motivational role. Engaging in psychological therapy is often a time when clients are motivated to change and receptive to new ideas. Having a therapist be interested in their experience of exercise and being willing to check-in, monitor, and explore difficulties can be extremely motivating. Also consider your position as a role model, "If we are going to talk the talk, then we must consistently walk the walk. When our patients observe us adhering to longevity enhancing health behaviors they are much more likely to do the same." [77]

Identify barriers to exercise and help your clients to overcome them

Clinicians are used to working with their patient's 'barriers to change' in therapy. When trying to help clients to engage in beneficial exercise it can be helpful to conceptualize 'barriers to engaging in exercise' as being similar to 'barriers to completing homework tasks'. Interventions to help your patients overcome their barriers to exercise include:

Make the implicit explicit. Make sure to discuss your client's potential barriers to change, or potential barriers to integrating exercise into their lives. Forearmed is forewarned!

Take a collaborative approach. Making life changes can be difficult, and change can be met with resistance. It is helpful to 'sit alongside' clients and to collaboratively problem-solve ways of making exercise fit into their lives.

Think about obstacles. Try to consider practical obstacles (location, equipment), financial obstacles (money for the gym), and psychological obstacles (too anxious to leave the house, worried about being 'the fat person' in the gym, worried about people looking at me).

Set reasonable 'no-fail' expectations. Some clients have rigid or black-and-white views about success and failure. The research appears to indicate that any exercise is better than none, and so any moves towards integrating exercise should be encouraged and rewarded. "Individuals should be informed that 30 minutes of moderate-intensity physical activity on most days of the week is a target and not a threshold required for achieving health benefits" [77]

Barriers to exercise Ways to overcome the barrier

Lack of knowledge

Understand client's position on physical health and how important it is to them
Provide psychoeducation about physical and mental health benefits of exercise

Fatigue

Educate about physical vs. mental fatigue
Reinforce the idea that physical exercise will give you more energy

Negative past experiences

Choose different activities
Take part in fun and motivating classes which focus on enjoyment rather than outcome

"Ultimately the key to motivating patients to exercise is to help them understand why exercise will benefit them. If they understand why exercise will benefit them, then most patients will find the means to do it." [77]

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[48] Gorczynski, P., & Faulkner, G. (2010). Exercise therapy for schizophrenia. Cochrane Database of Systematic Reviews, (5).

[49] Firth, J., Cotter, J., Elliott, R., French, P., & Yung, A. R. (2015). A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychological Medicine, 45(7), 1343-1361.

[50] Vera-Garcia, E., Mayoral-Cleries, F., Vancampfort, D., Stubbs, B., & Cuesta-Vargas, A. I. (2015). A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: an update. Psychiatry Research, 229(3), 828-839.

[51] Roberts, V., Maddison, R., Simpson, C., Bullen, C., & Prapavessis, H. (2012). The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis. Psychopharmacology, 222(1), 1-15.

[52] Haasova, M., Warren, F. C., Ussher, M., Janse Van Rensburg, K., Faulkner, G., Cropley, M., ... & Taylor, A. H. (2013). The acute effects of physical activity on cigarette cravings: systematic review and meta‐analysis with individual participant data. Addiction, 108(1), 26-37.

[53] Taylor, A., & Katomeri, M. (2007). Walking reduces cue-elicited cigarette cravings and withdrawal symptoms, and delays ad libitum smoking. Nicotine & Tobacco Research, 9(11), 1183-1190.

[54] Wang, D., Wang, Y., Wang, Y., Li, R., & Zhou, C. (2014). Impact of physical exercise on substance use disorders: a meta-analysis. PloS one, 9(10), e110728.

[55] Ledochowski, L., Ruedl, G., Taylor, A. H., & Kopp, M. (2015). Acute effects of brisk walking on sugary snack cravings in overweight people, affect and responses to a manipulated stress situation and to a sugary snack cue: A crossover study. PloS one, 10(3), e0119278.

[56] Hallgren, M., Vancampfort, D., Giesen, E. S., Lundin, A., & Stubbs, B. (2017). Exercise as treatment for alcohol use disorders: systematic review and meta-analysis. British Journal of Sports Medicine, 51(14), 1058-1064.

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[73] Vuori, I. M., Lavie, C. J., & Blair, S. N. (2013, December). Physical activity promotion in the health care system. In Mayo Clinic Proceedings (Vol. 88, No. 12, pp. 1446-1461). Elsevier.

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APA reference for this article

Jeavons, M. (2019). The therapist's guide to exercise and mental health. Psychology Tools. Retrieved on [date], from https://www.psychologytools.com/articles/the-therapists-guide-to-exercise-and-mental-health/

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The Therapist's Guide To Exercise And Mental Health - Psychology Tools

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Exercise is a powerful tool for increasing emotional and physical wellbeing and is an effective evidence-based treatment for many mental health conditions. Unfortunately, many people fail to meet the recommended target of 150 minutes of moderate physical activity per week [1] and rates of exercise in people suffering from mental health problems are even lower than average [2]: this means that motivating your patients to engage in exercise is a valuable therapeutic skill.

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Physical activity can improve your mental wellbeing. Being physically active means moving your body and working your muscles: for example, by walking, running, dancing, swimming, doing yoga or gardening.
*Last updated 8 April 2021
Physical activity is not only good for your body, it's also great for your mind

Being active releases chemicals in your brain that make you feel good - boosting your self-esteem and helping you concentrate as well as sleep well and feel better. Not bad for something many of us can do for free!

Being active doesn't have to mean taking out an expensive gym membership or running marathons. Finding an activity you enjoy can give you a goal to aim for and a sense of purpose. It can also be a great way to meet people, have a break from daily life and gain confidence. Other benefits include:

less tension, stress and mental fatigue

a natural energy boost

a sense of achievement

more focus and motivation

feeling less angry or frustrated

a healthy appetite

having fun.

It's even better if you're able to get active outdoors. Research shows that being in nature can make us feel happier, feel our lives are more worthwhile, and reduce our levels of depression and anxiety. Nature doesn't have to mean forests or national parks either: walking to a local common, visiting a friend's garden or simply noticing trees and flowers planted by the roadside can boost your mental wellbeing.

For some of us it can be hard to be active, perhaps because we have a mental or physical disability or health condition. Our tips below on things to consider before starting exercise may help . The NHS has a webpage about getting active if you have a disability or health condition, with tips on building activity into your day and finding accessible activities and classes.

How active do I need to be?

Any amount of physical activity is better than none. Finding an activity you like and are able to do regularly is more important than pushing yourself to do something you don't enjoy. You could try brisk walking, mowing the lawn, dancing, swimming, following an exercise video or online class, trying a new sport or anything that gets your body moving.

Government guidelines suggest adults aim to do 150 minutes of moderate activity a week or 75 minutes of vigorous activity a week. The NHS website has different examples of activities you could try. This might sound like a lot but don't be put off if you don't feel you can manage this now. If you don't do much physical activity, start small and build up slowly.

Think about your current fitness levels, how much time you have to exercise, and what feels realistic to you. Anything you do to get active and reduce the amount of time you spend sitting or lying down is good.

If you have a mental health condition, there may be factors that affect the amount or type of physical activity you can do. Here are some things you may need to consider.

I take regular medication.

Certain medications can affect the exercise you can do. For example, taking betablockers will mean your heart works harder when exercising, so you may need to adjust the type or amount of exercise you do. If you take lithium, losing fluid from your body through sweating can increase the concentration of lithium in your blood to a harmful level. Talk to your doctor before you start exercising or if you change your medication.

My medication and/or mental health condition makes me feel tired and lethargic.

Work with your body and your mood. For example, if you know your medication makes you feel tired in the mornings, plan to get active later in the day. If you feel unmotivated all day, try just going for a walk. Even a short walk can clear your mind and boost your energy level. If there are times when you just don't have the motivation or energy to exercise, be kind to yourself. It's ok to slow down, do less or take a break. Do what you can, when you can.

I have / am recovering from an eating disorder.

While exercise can be a positive part of recovery, some people with an eating disorder find they are over-exercising. Talk to your GP before starting to get active.

I have anxiety or experience panic attacks.

The way you feel when you get active - breathless, hot, sweaty, a fast heart rate - can feel similar to the symptoms of anxiety or panic attacks. This can be distressing and may then cause a panic attack or increased anxiety.

If this happens to you, try a lower impact activity such as yoga or pilates. When this feels ok, build up the intensity slowly and notice the difference between the effects of physical activity and a panic attack. Exercising with someone else may help you feel reassured that help is available if you feel anxious.

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Physical activity can improve your mental wellbeing. Being physically active means moving your body and working your muscles: for example, by walking, running, dancing, swimming, doing yoga or gardening. *Last updated 8 April 2021 Being active releases chemicals in your brain that make you feel good - boosting your self-esteem and helping you concentrate as well as sleep well and feel better.

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Depression and anxiety: Exercise eases symptoms

Depression and anxiety symptoms often improve with exercise. Here are some realistic tips to help you get started and stay motivated.
By Mayo Clinic Staff
When you have depression or anxiety, exercise often seems like the last thing you want to do. But once you get motivated, exercise can make a big difference.

Exercise helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis. Research on depression, anxiety and exercise shows that the psychological and physical benefits of exercise can also help improve mood and reduce anxiety.

The links between depression, anxiety and exercise aren't entirely clear - but working out and other forms of physical activity can definitely ease symptoms of depression or anxiety and make you feel better. Exercise may also help keep depression and anxiety from coming back once you're feeling better.

How does exercise help depression and anxiety?

Regular exercise may help ease depression and anxiety by:

Releasing feel-good endorphins, natural cannabis-like brain chemicals (endogenous cannabinoids) and other natural brain chemicals that can enhance your sense of well-being

Taking your mind off worries so you can get away from the cycle of negative thoughts that feed depression and anxiety

Regular exercise has many psychological and emotional benefits, too. It can help you:

Gain confidence. Meeting exercise goals or challenges, even small ones, can boost your self-confidence. Getting in shape can also make you feel better about your appearance.

Get more social interaction. Exercise and physical activity may give you the chance to meet or socialize with others. Just exchanging a friendly smile or greeting as you walk around your neighborhood can help your mood.

Cope in a healthy way. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol, dwelling on how you feel, or hoping depression or anxiety will go away on its own can lead to worsening symptoms.

Is a structured exercise program the only option?

Some research shows that physical activity such as regular walking - not just formal exercise programs - may help improve mood. Physical activity and exercise are not the same thing, but both are beneficial to your health.

Physical activity is any activity that works your muscles and requires energy and can include work or household or leisure activities.

Exercise is a planned, structured and repetitive body movement done to improve or maintain physical fitness.

The word "exercise" may make you think of running laps around the gym. But exercise includes a wide range of activities that boost your activity level to help you feel better.

Certainly running, lifting weights, playing basketball and other fitness activities that get your heart pumping can help. But so can physical activity such as gardening, washing your car, walking around the block or engaging in other less intense activities. Any physical activity that gets you off the couch and moving can help improve your mood.

You don't have to do all your exercise or other physical activity at once. Broaden how you think of exercise and find ways to add small amounts of physical activity throughout your day. For example, take the stairs instead of the elevator. Park a little farther away from work to fit in a short walk. Or, if you live close to your job, consider biking to work.

How much is enough?

Doing 30 minutes or more of exercise a day for three to five days a week may significantly improve depression or anxiety symptoms. But smaller amounts of physical activity - as little as 10 to 15 minutes at a time - may make a difference. It may take less time exercising to improve your mood when you do more-vigorous activities, such as running or bicycling.

The mental health benefits of exercise and physical activity may last only if you stick with it over the long term - another good reason to focus on finding activities that you enjoy.

How do I get started - and stay motivated?

Starting and sticking with an exercise routine or regular physical activity can be a challenge. These steps can help:

Identify what you enjoy doing. Figure out what type of physical activities you're most likely to do, and think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening, start your day with a jog, or go for a bike ride or play basketball with your children after school? Do what you enjoy to help you stick with it.

Get your mental health professional's support. Talk to your doctor or mental health professional for guidance and support. Discuss an exercise program or physical activity routine and how it fits into your overall treatment plan.

Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think realistically about what you may be able to do and begin gradually. Tailor your plan to your own needs and abilities rather than setting unrealistic guidelines that you're unlikely to meet.

Don't think of exercise or physical activity as a chore. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise or physical activity schedule the same way you look at your therapy sessions or medication - as one of the tools to help you get better.

Analyze your barriers. Figure out what's stopping you from being physically active or exercising. If you feel self-conscious, for instance, you may want to exercise at home. If you stick to goals better with a partner, find a friend to work out with or who enjoys the same physical activities that you do. If you don't have money to spend on exercise gear, do something that's cost-free, such as regular walking. If you think about what's stopping you from being physically active or exercising, you can probably find an alternative solution.

Prepare for setbacks and obstacles. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you can't maintain an exercise routine and might as well quit. Just try again the next day. Stick with it.

Do I need to see my doctor?

Check with your doctor before starting a new exercise program to make sure it's safe for you. Talk to your doctor to find out which activities, how much exercise and what intensity level is OK for you. Your doctor will consider any medications you take and your health conditions. He or she may also have helpful advice about getting started and staying motivated.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.

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Show references

1. Cooney GM, et al. Exercise for depression. JAMA. 2014;311:2432.

2. Peterson DM. The benefits and risks of exercise. https://www.uptodate.com/contents/search. Accessed Sept. 15, 2017.

3. Greer TL, et al. Improvements in psychosocial functioning and health-related quality of life following exercise augmentation in patients with treatment response but nonremitted major depressive disorder: Results from the TREAD study. Depression and Anxiety. 2016;33:870.

4. Schuch FB, et al. Exercise as treatment for depression: A meta-analysis adjusting for publication bias. Journal of Psychiatric Research. 2016;77:42.

5. Understand physical activity, exercise and your heart. Society for Cardiovascular Angiography and Interventions. http://www.secondscount.org/healthy-living/physical-activity-exercise#.WbGhPWeWzRF. Accessed Sept. 7, 2017.

6. Physical activity and health. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm. Accessed Sept. 7, 2017.

7. Exercise for mental health: 8 keys to get and stay moving. National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-Blog/May-2016/Exercise-for-Mental-Health-8-Keys-to-Get-and-Stay. Accessed Sept. 7, 2017.

8. Exercise for stress and anxiety. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety. Accessed Sept. 7, 2017.

9. Zschucke E, et al. Exercise and physical activity in mental disorders: Clinical and experimental evidence. Journal of Preventive Medicine and Public Health. 2013;46:512.

10. Anderson E, et al. Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry. 2013;4:1.

11. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 19, 2017.

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Depression and anxiety: Exercise eases symptoms

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Research on depression and anxiety shows that exercise and other physical activity can help improve mood, reduce anxiety and improve other health problems.

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Tell us more What do you want to tell us about? Note: Please don't include personal details like your name or email address. If you do, data protection law means we'll have to delete your comments. Unfortunately we can't reply to this. If you want a response from us, see our Contact us page.

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Details

This week I talk to Dr Brendon Stubbs, Head of Physiotherapy at the South London and Maudsley NHS Foundation Trust and Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, Kings College London.

Brendon's research focuses on physical activity, mental health and the mind-body interface.

Brendon and his team have published over 400 academic papers, and in 2016 he was identified in the journal 'Nature' (one of the biggest journals) - as one of the most productive scientists over all disciplines in the world.

In this episode, we talked about inflammation, we talked about diets, we talked about movement and how increasing physical activity rather than just focusing on specific exercise regimes, can all have benefits to our overall wellbeing and in particular our mood.

These are all topics that I talk about in my new book Eat to Beat Illness - in the section on 'Mood' where I talk about nutritional science but also lifestyle features, that can improve and preserve our brains, our cognition as well as our psychological wellbeing.

And you can find all of this information and more at www.thedoctorskitchen.com and don't forget to subscribe to the newsletter for weekly science based recipes and listen to the end of the pod for a summary of our discussion.

Summary
'People with mental health conditions, such as schizophrenia, or major depression or bi-polar disorder are dying on up to average, 15-20 years earlier than people in the general population who don't have those conditions'.
Dr Brendon Stubbs

What an incredible episode and guest we had on the show today. Dr Brendon Stubbs is such a fountain of knowledge in this field and I'm so excited that he's pioneering the research looking at exercise based interventions for mental health illness.

We talked about Brendon's book Exercise Based Intervention for Mental Illness and I highly recommend that health practitioners in particular go and get this book.

One thing to re-iterate from our conversation with Brendon, and something that he agrees with. It would be naive and reductionist to think that we can reverse all our symptoms of depression or other mental health issues with just one intervention alone, be that diet or movement or pharmaceutical. And in many cases, patients require more than a collection of foods or an exercise regime to treat something as complicated as mental health issues. So it's not simply a case of a Neurochemical imbalance that needs boosting - and its really really important to keep sight of that fact.
Making sure that you get the right help and interventions from your doctor and other health professionals is key and Psychotherapy as well as exercise, as well as diet, as well as pharmaceutical interventions on occasion, can all have an important role to play.
Guest: Dr Brendon Stubbs

Dr Brendon Stubbs is Head of Physiotherapy at the South London and Maudsley NHS Foundation trust and a clinical lecturer at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London.

Brendon's research focuses on physical activity and mental health and the mind-body interface. Brendon has published over 400 academic papers and in 2016 was identified in the journal "Nature" as one of the most productive scientists across all disciplines in the world (top 0.001% of all published authors).

Brendon's research has been featured in the New York Times, TIME magazine, CNN, Men's Health, BBC news, BBC Radio, ITV news and Sky News (among others). Brendon is lead author of the recently published European Psychiatric Association guidelines and position statement on the use of exercise for mental illness and senior author on a forthcoming Lancet commission to improve the physical health of people with mental disorders.

Brendon was recently (2018) awarded the Schizophrenia International Research Society (SIRS) senior investigator award for his research investigating physical activity and schizophrenia. Brendon has worked in mental health services for over 15 years and continues to greatly cherish and learn from patients in his weekly physiotherapy clinic in a secure forensic hospital.

The book that Brendon has published - Exercise Based Interventions for Mental Illness focuses on physical activity as a treatment for mental health conditions and is a great resource.

Finally, by clicking on this link you will be able to view all of Dr Brendon's research papers for reference

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#25: Exercise for Mental Health with Dr Brendon Stubbs | The Doctor's Kitchen

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This week I talk to Dr Brendon Stubbs, Head of Physiotherapy at the South London and Maudsley NHS Foundation Trust and Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, Kings College London. Brendon's research focuses on physical activity, mental health and the mind-body interface.

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Inspiring strategies from a wellness expert for keeping fit, relieving stress, and strengthening emotional well-being. We all know that exercise is good for physical health, but recently, a wealth of data has proven that exercise also contributes to overall mental well-being. Routine exercise alleviates stress and anxiety, moderates depression, relieves chronic pain, and improves self-esteem.

In this inspiring book, Christina Hibbert, a clinical psychologist and expert on women's mental health, grief, and self-esteem, explains the connections between exercise and mental well-being and offers readers step-by-step strategies for sticking to fitness goals, overcoming motivation challenges and roadblocks to working out, and maintaining a physically and emotionally healthy exercise regimen. This book will help readers to get moving, stay moving, and maintain the inspiration they need to reap the mental health benefits of regular exercise. The 8 keys include improving self-esteem with exercise, exercising as a family, getting motivated, changing how you think about exercise, and the FITT principle for establishing an effective exercise routine.

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8 Keys to Mental Health Through Exercise

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8 Keys to Mental Health Through Exercise [Hibbert, Christina, Rothschild, Babette] on Amazon.com. *FREE* shipping on qualifying offers. 8 Keys to Mental Health Through Exercise

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One out of every two Americans will suffer from some mental disorder during their lifetimes, with depression being the most common problem. How do most of us cope? Usually, we turn to overeating, drinking, and smoking. In short, we treat our unhealthy mental reactions to the American lifestyle with even unhealthier physical habits.Clinical psychologist Keith Johnsgard ― an inveterate runner who is in his 70's! ― proposes a better solution in this uplifting book. Why not turn to exercise ― one of the healthiest aspects of American lifestyle ― as a means of improving not just our physical well-being but our state of mind as well? Though usually associated with losing weight and physical fitness, exercise does in fact offer many mental health benefits. Johnsgard inspires us to put on a pair of sneakers and start moving. He draws from a lifetime of clinical experience, research on the psyche of the athlete, and personal experience as an athlete to make a convincing case that exercise can greatly enhance our mental outlook. Further, physical activity decreases the symptoms of depression as well as psychotherapy and drugs, and with only positive side effects! Exercise not only reduces depression and anxiety, but also boosts your energy level and self-esteem.If depression and anxiety have overshadowed your life, or you just want to improve your mental outlook while enhancing your physical fitness, this book is a superb motivator to help you help yourself through the healthiest, least expensive, and simplest method available.

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Conquering Depression and Anxiety Through Exercise

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Conquering Depression and Anxiety Through Exercise [Keith Johnsgard] on Amazon.com. *FREE* shipping on qualifying offers. Conquering Depression and Anxiety Through Exercise

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Are you running out of ways to keep your child active? Do you fear that screen time is dominating the day? You're not alone, this is a common challenge for many families today! Inspire your kids to get up and move through a fun and motivating tale! Check out some of our favorite books that will encourage your little one to move many times, many ways, and many places throughout the day.

1. Get Up and Go!
This story inspires kids to love and appreciate their body, no matter the size or shape! Encouraging text will motivate children to care for their body through regular movement.

2. Move!
Less a story, and more of a game, this book directs readers to move in a variety of ways. Also, forget the traditional page flipping- the unique format of this board book will have you using it as a boat's oar, dinosaur jaws, etc.

3. Run and Hike, Play and Bike: What is Physical Activity?
Physical activity is much more than exercise! Through goofy text and bright illustrations kids will uncover many ways to move and learn that activity can, and should, be fun!

4. Lazy Ninja: A Children's Book about Setting Goals and Finding Motivation
This ninja has become lazy! Instead of playing with friends and family, all he wants to do is watch TV or play on a tablet. Thankfully, a friend helps ninja to discover all the fun he is missing out on and the importance of setting movement goals.

5. ABC Yoga
Get active with your ABCs! Kids will discover basic yoga poses while learning the alphabet. Prepare to crawl like a crocodile, stretch like a fox, and hop like a grasshopper!

6. Shake a Leg!
Designed for the younger readers, Grover and Elmo guide kids through fun movements. This board book is sure to get your toddler wiggling and giggling.

7. Oh, The Things You Can Do That are Good for You: All About Staying Healthy
Created in collaboration with the Partnership for a Healthier America, the Cat in the Hat educates kids, through adventure and fun rhymes, on the importance of healthy habits. Stick around after the story to find activities and healthy recipes, perfect for kids of all ages.

8. The Busy Body Book: A Kid's Guide to Fitness
Discover how your muscles, lungs, heart, brain, etc. all work together to help you move. Kids will learn more about how their body works while uncovering fun ways to stay active.

9. Move Your Body!
Follow along as Natalie's team prepares for field day. Ms. Starr teaches the team about the importance of stretching and keeping our bodies moving! Your child will discover new stretching exercises and recharge with Natalie's team.

10. My Amazing Body
Through fun illustrations and kid-friendly language, this book educates kids on the importance of health and physical activity. Children will also explore how they can care for their body!

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Top 10 Children's Books to Inspire Physical Activity

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Are you running out of ways to keep your child active? Do you fear that screen time is dominating the day? You're not alone, this is a common challenge for many families today! Inspire your kids to get up and move through a fun and motivating tale!

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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.

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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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Different age groups need different amounts of sleep. In each group, the guidelines present a recommended range 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 of nightly sleep duration for healthy individuals. In some cases, sleeping an hour more or less than the general range may be acceptable based on a person's circumstances.

Sleep recommendations for vary widely UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. newborns are not available because sleep needs in this age group View Source and can range from as few as 11 hours to as many as 19 hours per 24-hour period.

These guidelines serve as a rule-of-thumb for how much sleep adults need National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. babies, children, and View Source while acknowledging that the ideal amount of sleep can vary from person to person. Some people need more or less sleep each night than those reflected in the ranges.

Deciding how much sleep you need means considering your overall health, daily activities, and typical sleep patterns. Some questions that you help assess your individual sleep needs include:

Are you productive, healthy, and happy on seven hours of sleep? Or have you noticed that you require more hours of sleep to get into high gear?

Do you have coexisting health issues that might require more rest?

Do you have a high level of daily energy expenditure? Do you frequently play sports or work in a labor-intensive job?

Do your daily activities require alertness to do them safely? Do you drive every day and/or operate heavy machinery? Do you ever feel sleepy when doing these activities?

Are you experiencing or do you have a history of a sleep disorder?

Do you depend on caffeine to get you through the day?

When you have an open schedule, do you tend to sleep in more?

You can use your answers to these questions to hone in on your optimal amount of sleep.

The American Academy of Sleep Medicine organized a panel of sleep experts to create these recommendations. The panel members reviewed hundreds of high-quality research studies about sleep duration and key health outcomes like cardiovascular disease, depression, pain, and diabetes.

After studying the evidence, the panel used several rounds of voting and discussion to narrow down the ranges for the amount of sleep needed at different ages. The final recommendations have been endorsed by other medical organizations, such as the Sleep Research Society, the American Academy of Pediatrics, and more.

Once you have a nightly sleep goal based on the hours of sleep that you need, it is time to start planning for how to make that a reality.

Start by making sleep a priority in your schedule. This means budgeting for the hours you need so that work or social activities do not trade off with sleep. While cutting sleep short may be tempting in the moment, it does not pay off in the long run because sleep is essential for you to perform at your best, both mentally and physically.

Getting more sleep is a key part of the equation, but remember that it is not just about sleep quantity. Quality sleep matters too, and it is possible to get the hours that you need but not feel refreshed because your sleep is fragmented or non-restorative. Fortunately, improving your bedroom setting and sleep-related habits, is an established way to get better rest. Examples of improvements include:

If you are a parent or caregiver, many of the same tips apply to help children and teens get the recommended amount of sleep. Teens in particular face a number of unique sleep challenges to getting the sleep they need.

If you or a family member are experiencing symptoms such as significant sleepiness during the day, insomnia, leg cramps, snoring, or another symptom that is preventing you from sleeping well, you should consult your primary care doctor or find a sleep professional to determine the underlying cause.

You can try using our sleep diary to track your sleep habits. This can provide insight about your sleep patterns and needs. It can also be helpful to bring with you to the doctor if you have ongoing sleep problems.

Learn more about our Editorial Team

References

1. Paruthi, S., Brooks, L. J., D'Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., Maski, K., Nichols, C., Quan, S. F., Rosen, C. L., Troester, M. M., & Wise, M. S. (2016). Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: Methodology and discussion. Journal of Clinical Sleep Medicine, 12(11), 1549-1561.
https://pubmed.ncbi.nlm.nih.gov/27707447/

2. Kirsch, D. (2022, September 12). Stages and architecture of normal sleep. In S. M. Harding (Ed.). UpToDate., Retrieved March 1, 2023, from
https://www.uptodate.com/contents/stages-and-architecture-of-normal-sleep

3. Consensus Conference Panel, Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., Tasali, E., Non-Participating Observers, Twery, M., Croft, J. B., Maher, E., ... Heald, J. L. (2015). Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of Clinical Sleep Medicine, 11(6), 591-592.
https://pubmed.ncbi.nlm.nih.gov/25979105/

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How Much Sleep Do You Need? | Sleep Foundation

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Sleep is essential, but how much sleep do we really need? Learn about how many hours of sleep kids and adults need and ready useful tips for how to get them.

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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.

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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.

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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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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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‎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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Sleep Time App - Track Your Sleeping Patterns

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You've just started Sleep Time and you're getting ready for a good night's sleep. Sleep Time detects slight movements as you adjust to a more comfortable position in between sleep cycles. Your body stops movement during your deepest phase of sleep.

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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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A good night's sleep is just as important as regular exercise and a healthy diet.

If you want to optimize your health or lose weight, getting a good night's sleep is one of the most important things you can do.

Here are 17 evidence-based tips to sleep better at night.

David Prado/Stocksy United

Natural sunlight or bright light during the day helps keep your circadian rhythm healthy. This improves daytime energy, as well as nighttime sleep quality and duration (, , ).

In people with insomnia, daytime bright light exposure improved sleep quality and duration. It also reduced the time it took to fall asleep by 83% ().

A similar study in older adults found that 2 hours of bright light exposure during the day increased the amount of sleep by 2 hours and sleep efficiency by 80% ().

While most research involves people with severe sleep issues, daily light exposure will most likely help you even if you experience average sleep.

Try getting daily sunlight exposure or - if this is not practical - invest in an artificial bright light device or bulbs.

SUMMARY
Daily sunlight or artificial bright light can improve sleep quality and duration, especially if you have severe sleep issues or insomnia.

Blue light - which electronic devices like smartphones and computers emit in large amounts - is the worst in this regard.

There are several popular methods you can use to reduce nighttime blue light exposure. These include:

Download an app such as f.lux to block blue light on your laptop or computer.

Install an app that blocks blue light on your smartphone. These are available for both iPhones and Android models.

Stop watching TV and turn off any bright lights 2 hours before heading to bed.

SUMMARY
Blue light tricks your body into thinking it's daytime. There are several ways you can reduce blue light exposure in the evening.

However, when consumed late in the day, caffeine stimulates your nervous system and may stop your body from naturally relaxing at night.

In one study, consuming caffeine up to 6 hours before bed significantly worsened sleep quality ().

If you do crave a cup of coffee in the late afternoon or evening, stick with decaffeinated coffee.

SUMMARY
Caffeine can significantly worsen sleep quality, especially if you drink large amounts in the late afternoon or evening.

While short power naps are beneficial, long or irregular napping during the day can negatively affect your sleep.

In fact, in one study, participants ended up being sleepier during the day after taking daytime naps ().

Another study noted that while napping for 30 minutes or less can enhance daytime brain function, longer naps can harm health and sleep quality ().

However, some studies demonstrate that those who are used to taking regular daytime naps don't experience poor sleep quality or disrupted sleep at night.

SUMMARY
Long daytime naps may impair sleep quality. If you have trouble sleeping at night, stop napping or shorten your naps.

Your body's circadian rhythm functions on a set loop, aligning itself with sunrise and sunset.

Being consistent with your sleep and waking times can aid long-term sleep quality ().

One study noted that participants who had irregular sleeping patterns and went to bed late on the weekends reported poor sleep ().

If you struggle with sleep, try to get in the habit of waking up and going to bed at similar times. After several weeks, you may not even need an alarm.

SUMMARY
Try to get into a regular sleep/wake cycle - especially on the weekends. If possible, try to wake up naturally at a similar time every day.

Melatonin is a key sleep hormone that tells your brain when it's time to relax and head to bed ().

Melatonin supplements are an extremely popular sleep aid.

In one study, taking 2 mg of melatonin before bed improved sleep quality and energy the next day and helped people fall asleep faster.

Additionally, no withdrawal effects were reported in either of the above studies.

Melatonin is also useful when traveling and adjusting to a new time zone, as it helps your body's circadian rhythm return to normal ().

In some countries, you need a prescription for melatonin. In others, melatonin is widely available in stores or online. Take around 1-5 mg 30-60 minutes before bed.

Start with a low dose to assess your tolerance and then increase it slowly as needed. Since melatonin may alter brain chemistry, it's advised that you check with a healthcare provider before use.

You should also speak with them if you're thinking about using melatonin as a sleep aid for your child, as long-term use of this supplement in children has not been well studied.

Shop for melatonin supplements online.

SUMMARY
A melatonin supplement is an easy way to improve sleep quality and fall asleep faster. Take 1-5 mg around 30-60 minutes before heading to bed.

Several supplements can induce relaxation and help you sleep, including:

Ginkgo biloba: A natural herb with many benefits, it may aid sleep, relaxation, and stress reduction, but the evidence is limited. Take 250 mg 30-60 minutes before bed ().

Glycine: A few studies show that taking 3 grams of the amino acid glycine can improve sleep quality (, , ).

Valerian root: Several studies suggest that valerian can help you fall asleep and improve sleep quality. Take 500 mg before bed (, , ).

Magnesium: Responsible for over 600 reactions within your body, magnesium can improve relaxation and enhance sleep quality (, , ).

L-theanine: An amino acid, L-theanine can improve relaxation and sleep. Take 100-200 mg before bed (, ).

Make sure to only try these supplements one at a time. While they're not a magic bullet for sleep issues, they can be useful when combined with other natural sleeping strategies.

SUMMARY
Several supplements, including lavender and magnesium, can help with relaxation and sleep quality when combined with other strategies.

Having a couple of drinks at night can negatively affect your sleep and hormones.

It also alters nighttime melatonin production, which plays a key role in your body's circadian rhythm (, , , ).

Another study found that alcohol consumption at night decreased the natural nighttime elevations in human growth hormone (HGH), which plays a role in your circadian rhythm and has many other key functions ().

SUMMARY
Avoid alcohol before bed, as it can reduce nighttime melatonin production and lead to disrupted sleep patterns.

Many people believe that the bedroom environment and its setup are key factors in getting a good night's sleep.

These factors include temperature, noise, external lights, and furniture arrangement ().

In one study on the bedroom environment of women, around 50% of participants noticed improved sleep quality when noise and light diminished ().

To optimize your bedroom environment, try to minimize external noise, light, and artificial lights from devices like alarm clocks. Make sure your bedroom is a quiet, relaxing, clean, and enjoyable place.

SUMMARY
Optimize your bedroom environment by eliminating external light and noise to get better sleep.

Body and bedroom temperature can also profoundly affect sleep quality.

As you may have experienced during the summer or in hot locations, it can be very hard to get a good night's sleep when it's too warm.

One study found that bedroom temperature affected sleep quality more than external noise ().

Around 70°F (20°C) seems to be a comfortable temperature for most people, although it depends on your preferences and habits.

SUMMARY
Test different temperatures to find out which is most comfortable for you. Around 70°F (20°C) is best for most people.

That said, the quality and type of your late-night snack may play a role as well.

In one study, a high carb meal eaten 4 hours before bed helped people fall asleep faster ().

Interestingly, one study discovered that a low carb diet also improved sleep, indicating that carbs aren't always necessary, especially if you're used to a low carb diet ().

SUMMARY
Consuming a large meal before bed can lead to poor sleep and hormone disruption. However, certain meals and snacks a few hours before bed may help.

Many people have a pre-sleep routine that helps them relax.

In one study, a relaxing massage improved sleep quality in people who were ill ().

Strategies include listening to relaxing music, reading a book, taking a hot bath, meditating, deep breathing, and visualization.

Try out different methods and find what works best for you.

SUMMARY
Relaxation techniques before bed, including hot baths and meditation, may help you fall asleep.

A relaxing bath or shower is another popular way to sleep better.

In one study, taking a hot bath 90 minutes before bed improved sleep quality and helped people get more deep sleep ().

SUMMARY
A warm bath, shower, or foot bath before bed can help you relax and improve your sleep quality.

An underlying health condition may be the cause of your sleep problems.

This condition may be more common than you think. One review claimed that 24% of men and 9% of women have sleep apnea ().

If you've always struggled with sleep, it may be wise to consult your healthcare provider.

SUMMARY
There are many common conditions that can cause poor sleep, including sleep apnea. See a healthcare provider if poor sleep is a consistent problem in your life.

Some people wonder why they always sleep better in a hotel.

One study looked at the benefits of a new mattress for 28 days, revealing that it reduced back pain by 57%, shoulder pain by 60%, and back stiffness by 59%. It also improved sleep quality by 60% ().

It's recommended that you upgrade your bedding at least every 5-8 years.

If you haven't replaced your mattress or bedding for several years, this can be a very quick - although possibly expensive - fix ().
Want suggestions? Browse our market, filled with editor-trusted and expert-verified pillow and mattress recommendations.
SUMMARY
Your bed, mattress, and pillow can greatly affect sleep quality and joint or back pain. Try to buy a high quality bedding - including a mattress - every 5-8 years.

Exercise is one of the best science-backed ways to improve your sleep and health.

One study in older adults determined that exercise nearly halved the amount of time it took to fall asleep and provided 41 more minutes of sleep at night ().

In people with severe insomnia, exercise offered more benefits than most drugs. Exercise reduced time to fall asleep by 55%, total night wakefulness by 30%, and anxiety by 15% while increasing total sleep time by 18% ().

Although daily exercise is key for a good night's sleep, performing it too late in the day may cause sleep problems.

This is due to the stimulatory effect of exercise, which increases alertness and hormones like epinephrine and adrenaline.

SUMMARY
Regular exercise during daylight hours is one of the best ways to ensure a good night's sleep.

Drinking large amounts of liquids before bed can lead to similar symptoms, though some people are more sensitive than others.

Although hydration is vital for your health, it's wise to reduce your fluid intake in the late evening.

Try to not drink any fluids 1-2 hours before going to bed.

You should also use the bathroom right before going to bed, as this may decrease your chances of waking in the night.

SUMMARY
Reduce fluid intake in the late evening and try to use the bathroom right before bed.

Sleep plays a key role in your health.

One large review linked insufficient sleep to an increased risk of obesity by 89% in children and 55% in adults ().

If you're interested in optimal health and well-being, it's recommended that you make sleep a top priority and incorporate some of the tips above.

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A good night's sleep is just as important as regular exercise and a healthy diet. If you want to optimize your health or lose weight, getting a good night's sleep is one of the most important things you can do. Here are 17 evidence-based tips to sleep better at night.

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Sleep Problems - How does sleep relate to mental health and how can I improve my 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

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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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Why We Sleep: Unlocking the Power of Sleep and Dreams

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The quality of the food you eat can impact your overall physical and mental health. Eating nutritious foods can go a long way toward achieving a healthy lifestyle, so make every bite count.

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Digesting the connection between food and mood 

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F or most of her life, the woman would not let herself eat cake. She feared that if she started, she would never be able to stop. The presence of cake at every birthday party she attended tormented her. She grew so preoccupied with thoughts of cake that she had food fantasies about eating it.

The woman's unhealthy relationship with food eventually led her to Michele Smith, a licensed professional counselor who operates a private practice called The Runaway Fork in Westfield, New Jersey. With Smith's guidance, the woman decided to conquer her fear by eating a sheet cake while she was alone.

The client took her first bite, but it wasn't the experience she had fantasized about. It tasted artificial and waxy. She thought perhaps it was only the frosting that she didn't like, so she took another bite, this time focusing more on the cake itself. It only confirmed the horrible taste from her first impression. The woman ended up throwing out the entire cake.

The client's craving for cake had caused her years of suffering, yet when she finally ate it mindfully, she discovered that she didn't even like it, says Smith, who is also a licensed mental health counselor in New York.

"There's all this unnecessary suffering around food, weight and body," Smith continues. At the same time, "there seems to be a lack of services available for everyday people who do not have eating disorders [but] who want to discuss and heal their relationship with food, body and weight."

For this reason, Smith, a certified mind-body eating coach and a member of the American Counseling Association, created her private practice to help people who struggle in their relationship with food. She doesn't have a precise phrase to explain this special niche she has carved out with her counseling practice, but she says it differs from nutritional counseling, which focuses on helping clients figure out what to eat. Instead, Smith attends to who clients are as "eaters." This includes connecting their relationship with food to other life domains and psychosocial factors - such as anxiety, depression and trauma - that professional clinical counselors work with every day.

Researchers are not completely sure how food fits into the overall mental health equation, but recent studies suggest a strong connection. In general, food can promote wellness in three ways: 1) by providing the brain with nutrients it needs to grow and generate new connections, 2) by tamping down inflammation and 3) by promoting gut health.

In 2017, the world's first study of dietary intervention for clinical depression, called the SMILES trial, found that a modified Mediterranean-style diet (which encourages whole grains, fruits, vegetables, legumes, low-fat/unsweetened dairy, raw unsalted nuts, lean red meat, chicken, fish, eggs and olive oil, while discouraging sweets, refined cereals, fried foods, fast foods and processed meat) resulted in a significant reduction in depression symptoms when compared with the typical modern diet loaded with fast food, processed foods and refined carbohydrates.

A randomized controlled trial published last year in PLOS ONE supports the findings of the SMILES trial. Researchers found that adults who followed a Mediterranean-style pattern of eating for three weeks reported lower levels of anxiety and stress and a significant decrease in their depression symptoms.

These and other findings suggest that counselors should no longer think of mental health in isolation but rather as part of a complex system that includes what people eat.

A missing piece of the mental health puzzle

Lisa Schmidt, a licensed associate counselor, certified whole foods dietitian nutritionist, and instructor in the School of Social Work at Arizona State University, points out that people seldom think about what they eat. "The act of eating is considered a nuisance. It's something people don't have time for until they're just so hungry, they have to eat something, and when you get to that point, you often make very poor nutritional choices," she says.

For instance, people may grab fast food and eat it in the car on the way to their next meeting or to pick up their kids. Then, when they have trouble sleeping later that evening, they assume it is related to their feelings of anxiety, thus overlooking any possible connection to food, Schmidt adds.

"Most people don't know that the kind of foods we choose [to eat] can help us regulate our nervous system and perhaps is the missing link in mental health care," Schmidt notes.

Schmidt, an ACA member in private practice in Scottsdale, Arizona, says that mood-related disorders often have a food component to them because nutrition-poor diets affect mood. The standard American diet, often aptly referred to by its acronym SAD, frequently leads to people being hungry and tired and having dysregulated moods, she continues. People often alternate between periods of escalation, during which they fuel themselves with caffeine, processed sugar and refined carbs, and periods of starvation. This unhealthy pattern leads to dysregulated moods, Schmidt explains.

In addition, stress (which is common in fast-paced, disrupted lifestyles) dysregulates people's nervous system responses. When people are stressed and in fight-or-flight mode, their bodies secrete glucose into the bloodstream, fueling them to run away from real or imagined danger. Then the pancreas secretes insulin as it tries to regulate blood sugar levels, Schmidt explains. These swings in blood sugar levels affect mood and can lead people to become "hangry" - hungry and angry, she adds.

Two researchers at the University of North Carolina at Chapel Hill recently set out to study the underlying mechanism behind the complicated "hangry" reaction, and their results challenge the theory that hanger is the result only of low blood sugar. They found that hunger-induced feelings can lead to tantrums and anger when people are in stressful situations and are unaware of their bodily state. In other words, hunger pangs might turn into other negative emotions in certain contexts.

This suggests that people should slow down and pay attention to both their physical and their emotional cues. Smith advises her clients to carefully set the scene before eating, telling them that eating should be stress free, relaxing and pleasant. To achieve this, they might consider using a candle or playing calming music. They shouldn't be using their phones, watching television or walking around, she says. And although some families use dinner as a time to reprimand their children, there shouldn't be any arguing while eating, Smith adds.

Because the quickest way to relax the body and mind is through breathing, Smith instructs clients to take as many deep breaths as they need to calm down before they begin eating. She also recommends that clients put their forks down between bites or use their nondominant hand to help them slow down and fully experience their food.

Mindful eating also involves approaching the meal with all of the senses, Smith says. She often illustrates this type of eating in session by having clients - especially those prone to eating quickly or eating distractedly as they work or stare at a screen - engage their senses while eating a Girl Scout Thin Mint cookie. During this activity, Smith asks clients to forget about their ingrained diet rules, negative self-talk, or whatever else might be in their heads and focus on their bodily experience of eating.

First, she has clients look at the cookie so the brain will register that food is present. Next, she has them touch the cookie and notice its texture. Then Smith asks them to smell the Thin Mint because scent affects our pleasure or displeasure with food. Once clients put the cookie in their mouths, they slowly roll it on all parts of their tongues without biting into it. When they finally bite the cookie, they listen to the sound it makes and notice how it tastes and when the taste starts to diminish. At the end of the exercise, Smith asks clients to rate their experience as pleasant, unpleasant or neutral.

This simple exercise is an eye-opening experiment for most of Smith's clients, who often admit they would normally just throw the cookie in their mouths and not think twice about it. When people learn to slow down and eat mindfully, they become better at noticing when they are full or if they are no longer tasting their food. Smith says one of her clients discovered through the exercise that she actually didn't like Thin Mint cookies, even though she had eaten them all of her life.

It's one thing to tell clients what mindful eating is; it's another thing for them to experience and feel it for themselves, Smith says. "Mindful eating as a practice can be helpful at reawakening [our] appreciation for food," notes Schmidt, author of Sustainable Living & Mindful Eating. "As we wake up to how we feel and what we experience, we have the possibility of change."
The emotional toll of restrictive eating
"Every diet is some form of food restriction," Smith asserts. "When you eliminate certain foods or when you deem certain foods bad or forbidden, you're actually going to create the overeating through that sense of deprivation." For example, the night before someone starts a no-carb diet, he or she might binge on bread as a "farewell" (often referred to as "Last Supper" eating). People on diets never reach habituation, so when they are exposed to restricted foods, they may overeat them, which only reinforces the idea that they can't be trusted around a particular food, Smith adds.

Licensed clinical professional counselor Heather Shannon wrote a book chapter on nutritional stress management strategies for volume one of the book Stress in the Modern World: Understanding Science and Society. She says the all-or-nothing, judgmental thinking that is common with most diets often creeps over into character judgment: "I'm bad because I ate that carb" or "I feel horrible that I cheated on my diet by eating that cupcake," for example.

Shannon, who offers coaching and teletherapy as a psychotherapist at Lotus Center in Chicago, had one client who was fit and healthy but fixated on losing three pounds. One morning, the client woke up feeling great, but the second she stepped on her scale and saw she had gained one pound, her mood changed. She went from feeling wonderful to feeling horrible in two seconds.

Fixating on an outcome, such as the number on the scale or the number of times a person has gone to the gym that week, is a big part of anxiety, Shannon says, and it opens up the possibility of good and bad labeling (e.g., "I'm bad because I went to the gym only once this week"). Instead, she helps clients focus more on their habits and which habits make them feel good, healthy and connected to their bodies. "If you're treating your body really well, then whatever the results are is how your body is supposed to be," she says.

Smith, a certified intuitive eating counselor, helps clients let go of the dieting mentality and reawaken their intuitive eater. In the intuitive eating model, there are no "good" and "bad" foods. Smith describes it as "a non-diet, flexible style of eating where you follow your internal sensations of hunger and satiety to gauge what, when and how much you eat."

Smith points out that not every client will automatically be ready to put all foods back on the table. Under those circumstances, counselors can instead help raise awareness around dieting and how it may be interfering in clients' lives. For instance, counselors might ask: How has your diet affected or changed your relationships with others? How much time and money have you spent on diets? How has it affected your social life and mental health? What in your life has changed because of dieting?

Schmidt also tries to help clients adjust their mindset around food. "Nourishment is not determined by one episode," she says. "It's an eating pattern over time." For this reason, she advises clients to follow the 80-20 rule, in which 80% of the time people make choices that are whole foods (mostly plant-based), and then they don't need to worry about the 20% of the time that they have a treat or indulge.

"We eat for reasons that are other than just to feed our bodies," Schmidt says. "We eat as part of celebrations, and food is pleasurable. So, adopting a very restrictive, Spartan way of eating" - particularly one that demonizes any particular food group - "... can become disordered eating and cause problems for some people. ... And research shows eating this way will fail 95% of the time."

Instead of adopting the latest diet fad, people should find a way to eat that they can follow for the rest of their lives and that simultaneously supports their health and mood, Schmidt says.

Using foods to cope with moods

If clients understand biological hunger and still reach for food without feeling hungry, then they are often engaging in emotional eating, Smith says. This may mean that a client eats because of unresolved trauma or grief. Maybe the client has perfectionist tendencies and uses food to manage his or her anxiety. Or perhaps food is the way a client copes with being in a marriage or job that makes them unhappy.

Smith works with clients to figure out what they are feeling - such as anxious or lonely, for example - when they experience emotional hunger. "This is where the mental health piece comes in," she says. "You're talking about eating, but the root cause of the eating is really psychological issues. ... They're people pleasing. They need boundaries. They need to be assertive. They need to say no to people and they can't, so they use food to cope."

Shannon, author of the ACA blog posts " Nutrition for Mental Health" and " How Does What You Eat Affect How You Feel? " finds the internal family systems approach effective for uncovering underlying issues associated with emotional eating, especially if clients have a playful side. She first helps clients identify the part of themselves that is overeating by asking what this eating part of them feels like in their bodies. One client might feel it in their stomach, whereas another client might sense it as a coach whispering in their ear.

Shannon also instructs clients to personify the part of them that is overeating by naming it (for example, the Snacking Part, Cake, or even a human name such as Maria). Then, both she and the client can easily address and reference this personified part.

Shannon might ask the part, "What is going on when you overeat?"

And the part almost always provides an answer. For example, "Well, I feel like I work too hard, and I need this because it's my pressure release valve" or "I feel like I can't count on people, so I'm counting on food."

Smith and Shannon both caution against having clients keep a food journal that tracks food intake or weight. They say that activity takes clients out of themselves rather than tuning inward. In addition, they warn, it can promote obsessiveness. But they agree that clients can benefit from journaling about their emotions and feelings associated with food. For example, a client could write down what he or she feels right after overeating as a way of identifying what emotions are associated with the behavior.

Schmidt has clients keep a food and mood journal, but not to track food intake or to promote weight loss. Instead, the goal is to help clients build an awareness of when they're eating and how they feel before and after eating. This ultimately gives them a better understanding of how food affects their mood and how mood can affect their eating habits.

She provides an extreme but not unusual example: While journaling, a client noticed that they did not eat anything until 2 p.m. They felt terrible but only had 10 minutes to eat, so they ingested a protein bar and soda. Immediately afterward, they felt good, but an hour later, the client was starving, mad and stressed again.

"Most people ... spend less than two minutes a day thinking about what they're going to eat. They just react," Schmidt says. "So, building awareness of all our habits, including our fueling habits, is really important."

In addition, if people are not fueling their bodies in a healthful way, it will create difficulties for them, Schmidt says. Chronic pain, substance abuse, anxiety and depression are all issues for which food is a huge component, she asserts. Schmidt had a client who would eat seven to nine bowls of Froot Loops for breakfast while in recovery from drug use. People recovering from substance use may often transfer their addiction to food, especially highly processed, sugary types of foods, she says.

Smith encourages her clients to approach their relationship to food with a compassionate curiosity. Clients can view nutritional changes as an experiment to figure out how their bodies react or what works best for them, she explains. Also, if clients haven't fully mastered their new coping skills and continue to engage in emotional eating, then Smith advises them to be compassionate with themselves and say, "I'm reaching for food, and I know I'm not hungry. I look forward to the day when I can cope with my emotions without using food."

Smith has noticed that many counselors shy away from discussing any issue related to food with clients, reasoning that it falls outside their scope of practice and because becoming a certified eating disorder specialist or nutritionist requires specialized training. But she encourages counselors to rethink this mindset. "It's not out of [counselors'] scope of practice to talk about people's relationship with food. It's such a critical part of everybody's day. So, to not look at it is missing a big part," Smith says.

"You don't have to talk about the grams of protein per se, which is out of our scope ... to really help somebody," she continues. "Because [clients are] dying to talk about it, and they need that space. And it's connected to so many other life domains [e.g., trauma, grief, anxiety, depression, stress] which counselors are more than equipped to talk about."

As a certified health coach, Shannon says she would never prescribe foods for clients or tell them what they should or shouldn't eat, but that doesn't prevent her from talking about food in session. In fact, on her intake form, she screens for potential issues with food by including general questions such as: What do you generally eat for breakfast, lunch and dinner? Do you snack or skip meals? Do you overeat or under eat? Then, in her first session with clients, she discusses this information and asks follow-up questions to gain a better understanding of clients' relationship with food and the way this could be affecting their mental health.

"Even if you're not a nutrition expert, we all know some basic stuff. We all know whole foods are better than processed foods. We all know excess sugar is not helpful," Shannon says. For this reason, she recommends that counselors screen for basic nutritional information to see if food might be a piece of the client's mental health puzzle.

Rather than telling clients what to eat, Shannon takes a behavioral approach and asks, "What are you eating, and how is that working for you? What do you think might work better?" Sometimes, she will also provide clients with helpful resources and advise them to talk to their doctor or a nutritionist about other options they could pursue.

Schmidt finds that discussing alcohol use with clients can serve as a great segue into talking about their diet in general. In her experience, alcohol often comes up with clients who have mood disorders, and because alcohol is a nervous system depressant, it is not advised for these clients. While discussing their alcohol use, Schmidt will ask other questions about their diet, such as if they eat breakfast consistently or if they eat lots of processed, high-sugar foods. From there, she might suggest that clients try to limit the amount of food with added sugars that they eat and experiment with eating fresh fruit as a snack or dessert most days of the week. Schmidt will also use the Healthy Eating Plate (created by Harvard Health Publications and nutrition experts at the Harvard School of Public Health) as a way to help clients visualize how to build meals that support balanced moods.

Schmidt recommends that counselors interested in the food-mood connection experiment with their own eating habits to see how this affects their mood. "It is particularly difficult for a counselor who has a poor diet to talk about the food-mood connection with a client," she says. Similar to how counselors practice meditation themselves before teaching it to clients, Schmidt believes counselors should first reorganize their own way of eating to include mostly foods derived from plants, to limit caffeine, and to limit or eliminate alcohol.

After counselors have experimented on their own with the food-mood connection, Schmidt says, then they can ask clients to do a chain analysis. For example, if a client is having panic attacks, the counselor might ask, "What do you remember doing just before the panic attack? Did you have anything to eat or drink? If so, what did you eat or drink?" Maybe the client will say that he or she remembers drinking coffee or alcohol before the panic attack happened. The counselor could follow up and ask whether the client noticed any change in how he or she felt after drinking three cups of coffee or drinking alcohol to excess before having a panic attack. This technique will help clients connect their dietary choices, which are ultimately under their control, to the way their mood is affected, Schmidt says.

Smith acknowledges that counselors' scope of practice does limit just how far they can go in addressing food issues with clients. For instance, counselors cannot provide nutritional advice to clients. "That creates this barrier that is hard to get around," she says. "So, then, you do have to reach out to other professionals like nutritionists and dietitians and really work as a team." She says counselors can either work with a nutritionist to determine what nutritional treatments and approaches are best for the client, or work with clients to ensure they are advocating for their own dietary preferences (such as using plans that focus on well-being instead of weight loss) with the nutritionist or speaking up when they feel a certain nutritional approach is harming or not helping them.

But at what point should counselors refer to a nutritionist? Counselors have referred clients to Schmidt, in her role as a nutritionist, because they suspected their clients had an eating disorder or were binging on foods. Schmidt thinks it is a good idea to also refer to an eating specialist if clients talk about food or their bodies frequently in counseling, are extremely overweight or underweight and the condition is disruptive for them, or have suddenly lost a significant amount of weight.

When finding referral sources, Schmidt recommends that counselors look for professionals trained in the Health at Every Size approach, which promotes size acceptance and serves as an alternative to the weight-centered approach.

Smith agrees that "the focus always has to be on wellness, not weight loss." She advises counselors against referring clients to dietitians, nutritionists or doctors who track calories, encourage weigh-ins, or engage in fat shaming. Instead, she suggests looking for health professionals who teach intuitive eating and operate from a weight-neutral model .
Adding in the nutritional piece
People routinely look for mental shortcuts or a magic bullet to solve their problems, and this tendency extends to food consumption. From research, we know that people will tend to eat 30% more of a food that they deem "healthy," Schmidt notes. Researchers even have a name for this tendency to overestimate the overall healthfulness of an item based on a single claim such as being low calorie or low in fat: the health halo effect. This halo effect appears to encourage people to eat more than they otherwise would because they feel less guilty about consuming the food.

Clients often come to see Smith because they are confused and don't know what to do. They have dieted for years with little or no success, and they are confounded by all the conflicting nutritional advice. For Smith, it comes down to a core question: "How does this [food] feel in your body?"

"You're making peace with food," she says. "This is your journey of one, and only you can know whether pizza feels good or depleting and when and under what circumstances." Counseling can help clients tune in to their own unique nutritional needs and preferences and connect this piece to how their mood is affected, Smith says.

Schmidt advises counselors to focus on the big picture and not get caught up in one particular approach to eating. Instead, it is about helping clients make their own connections between what they are eating and how it affects their moods.

Also, because everyone is unique, the nutritional advice that has benefited a counselor personally may not help the counselor's clients. However, the majority of clients (and all people) need to eat more fruits and vegetables, so if counselors encourage them to do that, it could have a huge impact on clients' health and mood, Schmidt asserts.

"Having a personal connection to food and its life-giving properties is one of the most amazing gifts we can give ourselves, as well as elevating the status of food and eating for our clients," Schmidt says. "Helping clients understand that the process of food and feeding is a central part of their recovery is a message that's independent of what they should be eating."

"Nutrition is always a piece of the puzzle," Shannon adds. "So, by understanding the nutrition ...
even a little bit, you're going to be potentially twice as effective working with your clients."

****

Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

****
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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Digesting the connection between food and mood - Counseling Today

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F or most of her life, the woman would not let herself eat cake. She feared that if she started, she would never be able to stop. The presence of cake at every birthday party she attended tormented her. She grew so preoccupied with thoughts of cake that she had food fantasies about eating it.

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Food and mood - what's the link?

Eating a diet that is well-rounded and nutrient-rich can help to improve mood, increase energy levels and help you think clearer. There are several elements at play here, from the number of carbohydrates you eat to the way deficiencies in vitamins and minerals affect mental health. Let's start by looking at the importance of carbohydrates.
Carbohydrates and eating regularly
In order for your brain to be able to concentrate and focus, it needs energy (20% of all energy needed by the body is used by the brain). This energy comes from blood glucose, and the glucose in our blood comes from the carbohydrates we eat.

When we don't have enough energy for the brain, we can feel weak, tired and unable to think clearly. Ensuring you eat regular meals containing some carbohydrates will help with this. Alongside starchy foods like pasta and rice, sources of carbohydrates include:

When your blood glucose rises and falls rapidly, it can have an impact on mood, making you feel irritable, low and even triggering symptoms of anxiety. Keeping your blood glucose levels steady throughout the day is key. Try foods that release energy slowly like oats, cereals, nuts and seeds, and aim to eat smaller portions spaced out throughout the day.
Proteins and fats
Alongside the energy it gets from carbohydrates, your brain needs amino acids to help regulate thoughts and feelings. As protein contains amino acids, it's important to get enough of this in your diet. Protein is found in lean meat, fish, eggs, nuts and seeds, cheese, soya products and legumes.

Some people may be under the impression that all fat is bad for us, but this isn't the case. Fatty acids, like omega-3 and omega-6, are essential for our brains to function well. Healthy fats can be found in nuts, seeds, oily fish, poultry, avocados, dairy products and eggs.

Our focus on low-fat diets may have also inadvertently affected our mental well-being. The brain is around 60% fat and omega 3 fatty acids are important for neurons to communicate effectively.

- Read more on how diet affects mental wellness.

Vitamins and minerals
When we don't get enough of certain vitamins and minerals, both our physical and mental health can suffer. The best way to ensure you're getting enough of the vitamins and minerals you need is to eat a varied and balanced diet, rich in fruit and vegetables. For some, a supplement may be needed, but be sure to check this with your doctor or a nutrition professional.

Here are some examples from the British Dietetic Association of how different vitamin/mineral deficiencies can affect your mood.

Iron: A lack of iron can lead you to feel weak, tired and lethargic. Foods rich in iron include red meat, poultry, fish, beans and pulses and fortified cereals.

B vitamins: Not getting enough B1, B3 and B12 can make you feel low, tired and irritable. Animal protein foods such as meat, fish, eggs and dairy, and fortified cereals are rich in B vitamins.

Folate: When you don't get enough folate you can be at a higher risk of feeling depressed. Folate can be found in green vegetables, citrus fruits, liver, beans and fortified foods like marmite.

Selenium: A selenium deficiency may increase the chance of feeling depressed and other negative mood states. Good sources of selenium include Brazil nuts, seeds, wholemeal bread, meat and fish.

A helpful way to make sure your diet is nutrient-rich is to ensure you're getting at least five portions of fruit and vegetables every day.

Dehydration anxiety

Hydration and nutrition go hand in hand, but the vast amount of information available can often overwhelm us and cause feelings of anxiety. For some, these feelings can be severe. Dehydration anxiety is a fear that you aren't drinking adequate amounts of water. You may fear going anywhere without your water bottle. This fear can lead to high consumption of water - more than your body requires - which can lead to illness. The fear stems from not giving your body sufficient hydration to perform at its best. This chronic form of anxiety is closely linked to obsessive-compulsive disorder and orthorexia.
Signs of dehydration anxiety include:

monitoring your daily intake to the litre

feeling a sense of dread when you don't have your water bottle

worrying about where to get water from, e.g. when shopping or travelling

experiencing panic attacks when water isn't immediately available

"When I went to buy a new water bottle, I had to check every one to find the largest available. I'm aware that I can feel thirst, but now I'm not sure if it's psychological or real. If I go to London, I'm constantly thinking, 'Can I get water?', and 'Is there a toilet?'. It's a vicious circle."

- Read Alice's story, detailing her experience with dehydration anxiety and how it led to her drinking in excess of five litres a day.

Nutritional therapy and hydration

The recommended six to eight-glasses-a-day advice (approx two litres) can be used as a general guideline for your water intake, alongside consideration of your individual dietary needs. The specific amount of hydration needed varies from person to person, so it's important to tune into your whole lifestyle when considering how much water is sufficient hydration for you.

Nutritional therapist Karen Alexander says that it's not only the water you drink, but your diet, gender, age, exercise and lifestyle are also contributing factors to your water needs.

Hypnotherapy can help you get your life back. In a nutshell, after a few sessions, you will be in control and enjoying a ...

- Hypnotherapist Fiona Vitel discusses hypnotherapy for internet addiction.

"Other than listening to your thirst, another way to judge your water needs is via urine colour. Ideally, you want pale yellow urine - be aware that if you are taking Riboflavin (vitamin B2) this can make urine bright yellow. Many vegetables contain high water content and can be counted towards your daily intake including most fruit, cucumber, celery, lettuce, courgette, tomato, potato, cabbage and even foods like salmon and eggs if not over-cooked. If your intake of vegetables and fruit is low you will need to drink more to ensure you are getting enough."

If you are concerned you're drinking too much water, or too little, it can be helpful to speak to a nutritional therapist who can work through your hydration needs.
Where to get help
If hydration anxiety is becoming a constant state in your life, counsellor Sophie Robinson-Matthews details some helpful tips to overcome these anxious feelings in Happiful's 'What is dehydration anxiety? '

Gut health and mental health

The link between our gut health and our mental health is becoming clearer. Often dubbed the 'second brain', our digestive system produces over 90% of all serotonin (the 'happy' hormone) in our body. Our gut can also affect immunity and resilience to stress, which can both have an effect on our mood. Having a healthy digestive system, in general, ensures we're able to absorb vitamins, minerals and nutrients our brains need to thrive.

Often, when we're feeling stressed or anxious, we'll feel it in our gut. Digestion may speed up or slow down, depending on how we're feeling. To keep your gut happy, ensure you eat plenty of fibre and get lots of fluid and regular exercise.

Fermented foods can give the good bacteria in our gut a boost, so try to incorporate these into your diet where possible. Other gut-friendly foods include fruits, vegetables, whole grains and beans and pulses.

In this TED talk, nutritionist, microbiologist and neuroscientist Ruairi Robertson discusses the link between our gut and our brain.

Medication and your diet

It's worth noting that if you're taking a certain medication for your mental health, there may be some foods you need to avoid. Be sure to speak to your doctor about any medications you're taking and ask about any dietary changes you may need to make.

How a nutritionist can help

Mental health and wellness require a holistic approach. Eating a balanced diet that contains the nutrients your brain and gut needs can complement other therapies and approaches you're using to manage mental health.

To ensure you're getting the right foods for your particular circumstances, it can help to seek professional support from a nutritionist. They will be able to talk to you about your needs, take into account your individual requirements and tailor a diet plan to suit you.

On the face of it, our diets may seem to be sufficient but our digestion, absorption, health history and inherited health traits can affect the amount of nutrients our body needs. One or more of these factors can tip the balance towards poor mental health. A personalised approach to diet and lifestyle can also help you regain physical and mental well-being.

- Nutritionist Sarah Hanratty.

A note on caffeine - Caffeine is often a go-to when you need a burst of energy, but its stimulating properties can disturb your sleep and even trigger anxiety and depression symptoms. If you drink a lot of coffee, tea, cola or other energy drinks, you may want to try swapping them out for non-caffeinated drinks like herbal teas or enjoy decaf versions.

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Did you know that blueberries can help you cope with the after-effects of trauma? That salami can cause depression, or that boosting Vitamin D intake can help treat anxiety?
When it comes to diet, most people's concerns involve weight loss, fitness, cardiac health, and longevity. But what we eat affects more than our bodies; it also affects our brains. And recent studies have shown that diet can have a profound impact on mental health conditions ranging from ADHD to depression, anxiety, sleep disorders, OCD, dementia and beyond.
Dr. Uma Naidoo is a board-certified psychiatrist, nutrition specialist, and professionally trained chef. In The Food-Mood Connection, she draws on cutting-edge research to explain the many ways in which food contributes to our mental health, and shows how a sound diet can help treat and prevent a wide range of psychological and cognitive health issues.
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Update to MyPlate

Remember the Food Guide Pyramid? It was great for its time, but much has changed since 1992. USDA invites you to update to MyPlate. It's the modern way to eat better every day. It's easy to use, customizable, based on science, and an overall great way to enjoy healthier eating.

Launched in 2011, MyPlate's symbol is a simple visual reminder to choose a variety of foods throughout the day and throughout the week. It represents what and how much to eat from each of the food groups over the course of the day, whether you eat on a plate, from a bowl, or another way.

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What is MyPlate? USDA MyPlate is the five food groups! The benefits of healthy eating add up over time, bite by bite. Small changes matter. Start Simple with MyPlate. A healthy eating routine is important at every stage of life and can have positive effects that add up over time.