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Thursday, August 21, 2014
Controlling my sleep
I`m 23 years old and I have been off work for about a month now. I can`t fall asleep at nightime at all. I will toss and turn and end up just coming out of the bedroom to watch televison. I don`t go to sleep until 5 or 6 in the morning. That`s really bad. I don`t drink soda or coffee at all. I will sleep until 4pm in the daytime. I trid to force myself to sleep at 10 to 11 pm but i end up waking up at 2am and couldn`t sleep after that. This just started right after i was unemployed. I went to my interview sleepy, and was suprise they even hired me. Now that I`m started my new job, I don`t want my sleep to interfere with my work. Can you tell me what I should do? I haven`t tried any sleeping pills, but I`m considering it. If you can give me any kind of advice that will be great! Help!
Thank you for using NetWellness. I will attempt to provide some guidance to you with regards to your current problem. However, with the limited information from your question, I cannot make a diagnosis and you may well need a full evaluation by a sleep physician in your area in order to make sure you receive an appropriate evaluation and therapy, if needed.
Based on the information you provided, it seems that there are 2 probable explanations for your sleep problems, namely a delayed sleep phase and/or a disrupted sleep cycle and poor sleep hygiene (poor sleep practices). It’s likely that anxiety from being unemployed is playing a role as well. I’ll discuss the possibility of a delayed sleep phase first and then mention some tips that can help you improve your sleep.
Our internal body clocks play a major role in determining when we feel sleepy and when we feel awake. For most individuals, their internal body clocks ensure that they are sleepy at night and awake during the daytime – this is compatible with times of normal work and school schedules. However, for some individuals, the circadian rhythm or internal clock is advanced (falling asleep early in the evening and awakening early – “morning larks”) or delayed (staying up very late and sleep sleeping in late – “night owls”). You appear to fit in the latter category with a delayed sleep phase. This becomes a problem when you have to get up in early in the morning for work, which can lead to difficulty with obtaining enough sleep on a nightly basis.
Difficulty arising early in the morning is not uncommon in your age group as a delayed sleep phase is typical in the young, while an advanced sleep phase is typical in the elderly. Delayed sleep phase syndrome (a delayed sleep phase that interferes with daily activities) can usually be treated with behavioral modification and measures to help change the circadian rhythms, also known as biorhythms, to a more normal schedule. The body’s circadian rhythms usually cycle over a 24 to 25 hour time period. These rhythms are reset daily to match a 24 hour day by factors such as exposure to daylight and social cues, for example when we eat our meals. The internal clock can be advanced (moved forward so you are sleepy earlier in the evening) or delayed (moved backwards so you are more awake late into the night) by changing the timing of light exposure and other social cues. However, the internal clock can only be adjusted by 1-2 hours in either direction per day with these maneuvers. When individuals try to alter their rhythms by more than this, they tend to feel poorly with fatigue, sleepiness and nausea (as seen with Jet Lag, for example). Furthermore, it often takes several days to fully adjust our circadian rhythms to a new schedule.
The most powerful tools available to shift the sleep pattern forward (or to “advance” sleep) are light exposure and melatonin. Light exposure has the strongest effect on the circadian cycle and timing of light exposure is crucial for individuals with circadian rhythm disorders. For delayed sleep phase syndrome, early day light while avoiding bright light late in the day can advance the sleep schedule. However, for this to be effective, enough bright light for a long enough time period is usually required (this is often accomplished with the use of a “light box” that can deliver 2000 to 2500 lux for at least 2 hours, though the optimal dose and length of exposure are not clearly known). Strictly adhering to a treatment regimen is vital to ensure success for this therapy and this should be done under the supervision of a Sleep Specialist as mistiming the light exposure can actually further delay your sleep schedule.
Melatonin, which is naturally produced by the brain in response to darkness, helps to promote sleep. For those with delayed sleep phase syndrome, use of this drug during the daytime may help to advance the sleep phase. However, caution must be advised as this drug is sold as an over the counter supplement and is not FDA regulated. Therefore, there is no guarantee with regards to the purity of the product and this may place an individual at risk for unpredictable side effects. Other tools that can help to shift the sleep phase include timing of meals (avoiding late meals), pre-bedtime rituals (avoiding stimulating activities) and avoiding medications or substances (for example caffeine and nicotine) with stimulating side effects near bedtime. Daytime stimulant therapy is not typically recommended for delayed sleep phase syndrome as the above measures, when adhered to, are often quite effective.
Another technique that can work for some individuals with delayed sleep phase syndrome is to “sleep through the clock.” This requires a person to have no other daytime commitments and to adhere to a strict sleep schedule. The idea here is to delay the sleep schedule by 2 hours a day (gradually moving bedtime back through the day) until the individual reaches their desired bedtime, whereupon they maintain a regular sleep schedule at that time thereafter. This approach can be difficult and requires close supervision in addition to a very flexible and motivated patient.
In addition to trying to adjust your sleep cycle, you should try these maneuvers or tips to optimize your sleep:
- Avoid afternoon naps - if you decide to nap limit it to one session per day with a maximum of 60 minutes
- No TV, reading or using the computer/smart phone in the bedroom
- Ensure that the bedroom has good climate control - (warm in the winter & cool in the summer; one generally sleeps better in a slightly cool environment)
- Ensure that your bedroom is noise free
- No pets in the bedroom and ensure you have comfortable bedding
- No afternoon caffeine (e.g. tea, coffee, sodas, chocolate), evening or nighttime nicotine or evening alcohol
- Evening exercise 3-4 hrs before going to bed and an evening shower/bath 3-4 hrs before going to bed
- Ensure that you are not hungry before going to sleep
- Have a set sleep and rise time
- Attempt relaxation techniques before going to sleep - the hour before going to bed should be for unwinding - try yoga or meditation
- If you can't fall asleep in 15-20 minutes, get up out of bed and go to another room and relax - no active work or watching TV during those times - you want to avoid stimulating your brain; then go back to bed after a short while - repeat the cycle until you fall asleep
- Limit your time in bed. For most individuals, they should not stay in bed more than 8-9 hours per night.
As you can see, while there are some simple maneuvers you can attempt at home, if these fail, then it. I recommend you attempt these first, but if your problems persist, then you should seek the help of a Sleep Specialist. The evaluation and management can be quite complicated and physician oversight by a specialist with expertise in this area may be needed.
Thank you for using NetWellness.
Steven Kadiev, MBBCh
College of Medicine
The Ohio State University