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Counting sheep

When you have trouble falling or staying asleep, or do not feel rested when you wake up, this can be due to insomnia.

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As a medical student, I was no stranger to lack of sleep. I’ve lost many hours of sleep staying up late to study and then from being on call overnight at the hospital every three to four days.

Then came the sleepless nights after having children. Now that they’re older, I was looking forward to getting more sleep. But I sometimes find myself still awake past midnight and I have difficulty falling asleep.

When you have trouble falling or staying asleep, or do not feel rested when you wake up, this can be due to insomnia. Insomnia is not just a problem with the number of hours of sleep, but also the quality of sleep.

Everyone needs a different amount of sleep. On average, an adult needs seven to nine hours of sleep. Children need a few hours more, depending on their age (nine to 10 hours for teenagers and 10 to 12 hours for small children.) The body needs sleep to rejuvenate and to fight off infections. Long-term lack of sleep also increases the risk of obesity, diabetes and heart disease.

Some symptoms of insomnia include:
Trouble falling or staying asleep;
Feeling tired during the day even after a full night of sleep;
Being forgetful or having trouble thinking clearly;
Having less energy or interest in doing things;
Being irritable, anxious or cranky;
Making mistakes more often; and
Stressing over not being able to sleep.

If these symptoms are bad enough, they can affect relationships, studies and work. If you have insomnia and it is troubling you, talk to your doctor. Special tests, such as a sleep study, are not usually needed. It may be as simple as keeping track of your activities and food intake then making some lifestyle changes to help you sleep better.

Having good “sleep hygiene” can help. Here are some things that you can do for better sleep:

Sleep only long enough to feel rested and then get out of bed.

Avoid taking long naps during the day.

Go to bed and get up at the same time every day.

Do not try to force yourself to sleep. If you can’t sleep, get out of bed and try again later.

Avoid caffeine (coffee, tea, sodas, chocolate) in the afternoon and evening.

Avoid alcohol at bedtime. It can make you sleepy at first but it disrupts sleep later.

Avoid smoking. In addition to smoking being a major health risk, nicotine can interfere with sleep.

Avoid large, high-fat meals late in the day.

Don’t drink too many fluids before bedtime. This can cause you to wake up repeatedly to use the bathroom.

Make your bedroom conducive to sleep. Keep it dark, cool, quiet, and free of reminders of work or other things that can cause stress.

Do not exercise right before bed.

Avoid looking at electronic devices that give off light before bed, such as cellular phones, laptops or reading devices (e-books).

What about counting sheep?

It’s possible that something repetitive such as counting sheep or counting backwards from 100 may be relaxing, but this has not really been shown to help, probably because it entails doing maths! Visualizing a tranquil setting in nature for example may have a more calming effect.

You can also try relaxation therapy, where you focus on relaxing the muscles in your body one at a time, starting from the top of your head down to your toes.

Can medication help me sleep?

Your doctor can prescribe sleep medications, but these should only be tried after trying the techniques for better sleep hygiene. Sleep medicines should also not be used every night for long periods of time or you can become dependent on them for sleep.

Melatonin supplements might be helpful, taken 1-3 hours before the desired sleeping time. Melatonin is a hormone that is part of the natural sleep-wake cycle, with blood levels highest at night.

Melatonin is generally safe for short-term use and unlike other sleep medications you most likely will not become dependent on it. Side effects though can include headache, dizziness and daytime drowsiness.

Check with your doctor first before starting melatonin as it can interact with various medications, including blood thinners, anti-seizure drugs, contraceptives, diabetes medications and medications that suppress the immune system (immunosuppressants).

Can you make up for lost sleep?

More sleep isn’t always better. For adults, sleeping more than 9-10 hours a night may actually result in poor quality of sleep. You can increase your sleeping time by 30 minutes to an hour to make up for some lost hours, but you can’t oversleep to completely make up for a lack of sleep.

In some cases, insomnia can be caused by a medical condition — sleep apnea, restless legs syndrome or chronic pain or depression. Treatment of these underlying conditions may be necessary for insomnia to get better. Treating insomnia may also help depression symptoms improve faster.

We all have trouble sleeping from time to time. But if you frequently have insomnia, see your doctor to find out what can be done to improve your sleep.

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