Melatonin use in children

This article discusses melatonin use in children.

What we do know: Supplemental melatonin can help children with sleep dysfunction (those who lie awake for hours at bedtime) fall asleep. However, melatonin only helps with sleep initiation (falling asleep) not staying asleep. So if you are dealing with wake ups during the night... melatonin is not the solution. Normal awakenings shift and change due to all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically!

What Is Melatonin?
Melatonin is a naturally-occurring hormone that our brains produce to help regulate sleep and wake cycles. People call it the "sleep hormone" because unlike the parts of body that drive wakefulness, melatonin drives sleepiness. Normally, melatonin levels begin to rise in the late evening (around 8 p.m. for kids, around 10 p.m. for teens), remain high for most of the night, and then drop in the early morning a couple hours before we wake up. Light inhibits melatonin and affects how much melatonin your body produces. Hence why being outside in the light during the day with a newborn (especially the ones who want to party all night) or when switching time zones makes a lot of sense! Light from screens (Kindles, iPads, tablets, computers, TVs) inhibits melatonin from being released. Getting outside during the day helps teach your brain day vs. night -- an important strategy for anyone struggling with sleep.

The Melatonin Supplement
The melatonin supplement you find at your local drug store is synthetically produced in factories. Because it's a supplement and not a medicine it's not regulated by the FDA like medicines. Therefore inconsistency in dosing is possible (no one can say that one brand's 1-mg tablet is the same dose as another's). Potency varies by brand and even between different batches from the same manufacturer. Always avoid "natural" melatonin (derived from cow or pig brains) and purchase only the man-made synthetic supplement that is far more readily available.

Melatonin Dosing Recommendations
"There are no clear-cut dosage guidelines because neither melatonin nor any other medication or supplement is approved by the FDA for the purpose of treating insomnia in children," said sleep expert Dr. Maida Chen of Seattle Children's Hospital.

Typically you always want to use the lowest dose: 0.5mg or 1mg -- then consider increasing by 0.5mg every few days if your child isn't falling asleep within an hour of bedtime. While increasing dose, make sure you're also working on consistent bedtimes, policing screens in the bedroom, and working to get good exercise OUTSIDE during the day. Many children will respond to a dose 0.5mg or 1mg an hour or two prior to bedtime. Some children and teens with significant challenges falling asleep are often given doses as high as 3mg to 6mg with severe insomnia at bedtime but in my experience many children get the hypnotic effect at smaller doses. Talk with your child's physician about how to determine a dose if or when melatonin is being used and if it's not working, GET OFF OF IT. Not all children respond to the hypnotic effect of supplemental melatonin.

Timing: You want to give melatonin prior to bedtime to help with increasing sleepiness. Most physicians recommend giving about 1-2 hours prior to ideal bedtime when helping little children fall asleep. However, it does depend why and how you plan to use melatonin. Here's a GREAT on how melatonin works and when to administer from Dr. Craig Canapari -- a pediatric sleep expert at Yale.

Children With ADHD and/or Autism Spectrum Disorders (ASD)
Children with ADHD and/or autism spectrum disorder are known to have challenges falling asleep. Studies with melatonin have been done in these populations of children. Dr. Chen explains:
"More trials of melatonin for sleep difficulties have been done in children with ADHD or ASD than studies for typically developing children. Evidence from these trials suggests that melatonin is safe and does shorten the length of time it takes to fall asleep. However, the effects are not generally overwhelming and not every child who takes melatonin shows sleep improvement. The studies mostly evaluate short-term use only." Most worries about long-term use and safety are speculative (based on studies in animals or adults) but without clarity from research it's always best to get kids off melatonin when you can.

Sleep matters. Good sleep is essential. But it's rare for a child to need meds.

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Health effects of sleep apnea

This article discusses the effects of sleep apnea beyond snoring.

According to the American Sleep Apnea Association, about 22 million Americans have sleep apnea and about 80 percent of those cases are undiagnosed. Sleep apnea is an involuntary sleep disorder in which breathing repeatedly stops and starts.

Sleep apnea can occur when tissue in the back of the throat blocks the airway. If the airway is blocked, the amount of oxygen delivered to the body’s organs is reduced. When blood-oxygen levels drop low enough, the body wakes itself up. Sometimes it happens so fast that it goes unnoticed to the sleeper. People with sleep apnea can stop breathing hundreds of times during the night and often for a minute or longer.

Sleep apnea can have serious and life-shortening consequences if it is not treated. These include high blood pressure, heart disease, stroke, memory problems, diabetes and depression.

Symptoms of sleep apnea:

• loud snoring
• fatigue
• insomnia
• persistent daytime sleepiness
• awakening out of breath during the night
• frequently waking in the morning with a dry mouth or a headache

The most widely used treatment for sleep apnea is a Continuous Positive Airway Pressure (CPAP) machine. The CPAP has a mask that goes over the nose, or sometimes nose and mouth, during sleep and supplies pressurized air that flows into the person’s throat. The increased air pressure keeps the airway open. Sometimes people still struggle with sleep apnea even after they use a CPAP. In those cases, surgery may be needed.

Sleep apnea is sometimes caused by the back of the tongue or tonsils blocking the airway. In these cases, an uvulopalatopharyngoplasty (UVPPP) is required. UVPPP involves shortening the soft palate and removing the tonsils, and it has been the most common sleep apnea surgical procedure performed in the past 25 years. In addition, robotic-assisted resection of the base of tongue is a minimally invasive approach to remove obstructive tongue tissue blocking the airway. After this surgery, sleep apnea is often corrected. At Long Beach Memorial, the da Vinci Si Robotic Surgical System is used to remove redundant tongue tissue and is performed in conjunction with the UVPPP to help our patients get a good night’s rest.

In order to properly diagnose sleep apnea, a physician must conduct a sleep study in a sleep lab, usually overnight. A sleep study monitors activity during sleep such as measuring brain waves, heart rate and rhythm, breathing patterns and oxygen levels.

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Six ways electronics disrupt neurophysiology and cause mood disturbance...

A really excellent piece sent to me by Ari Rotenberg. Late at night.....

Dr. Josh Rotenberg

Victoria L. Dunckley M.D.

Screentime Is Making Kids Moody, Crazy and Lazy

Computers at night upset physiology and cause sleep disorders...Dr Rotenberg myspecialist.clinic

Children or teens who are “revved up” and prone to rages or—alternatively—who are depressed and apathetic have become disturbingly commonplace. Chronically irritable children are often in a state of abnormally high arousal, and may seem “wired and tired.” That is, they’re agitated but exhausted. Because chronically high arousal levels impact memory and the ability to relate, these kids are also likely to struggle academically and socially.

At some point, a child with these symptoms may be given a mental-health diagnosis such as major depression, bipolar disorder, or ADHD, and offered corresponding treatments, including therapy and medication. But often these treatments don’t work very well, and the downward spiral continues.

Here’s a look at six physiological mechanisms that explain electronics’ tendency to produce mood disturbance....  Read more. 

Cognitive behavioral therapy showed to help with insomnia, even with other health conditions

A study shows that talk therapy, specifically cognitive behavioral therapy, helps people with insomnia, even if they have other health conditions.

Talk therapy may help treat insomnia in people with physical or mental health problems, a new study suggests.

With cognitive behavioral therapy, people talk with a therapist to identify the negative thoughts and feelings that cause them problems, and to learn ways to solve their problems, according to the U.S. National Institute of Mental Health.

Past studies have found cognitive behavioral therapy for insomnia can improve sleep. But, many of those studies didn't include people with psychiatric and medical conditions.

For the new study, researchers from Rush University Medical Center in Chicago looked at 37 previous studies. The research included nearly 2,200 people and looked at cognitive behavioral therapy for insomnia in people who had depression, alcoholism and post-traumatic stress disorder and/or with medical conditions such as cancer, chronic pain and fibromyalgia.

The new analysis showed that cognitive behavioral therapy for insomnia reduced insomnia symptoms and sleep disturbances. Twice as many people who received the therapy no longer had insomnia, compared to people who didn't have the therapy, the researchers said.

Cognitive behavioral therapy was also associated with positive effects on co-existing psychiatric and medical conditions, but it showed the strongest benefit with psychiatric disorders.

This may be due to a stronger link between psychiatric disorders and insomnia, the researchers said.

The findings provide support for using talk therapy as a treatment for insomnia in people who have other psychiatric conditions, study author Jason Ong, a behavioral sleep medicine specialist at Rush University Medical Center, and colleagues concluded in a university news release.

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Sleep disorders are more common in racial/ethic minorities

According to a recent study, sleep disturbances occur more frequently in middle-aged and older adults who are racial or ethnic minorities.

A new study suggests that sleep disturbances and undiagnosed sleep apnea are common among middle-aged and older adults in the U.S., and these sleep problems occur more frequently among racial/ethnic minorities.

Results show that 34 percent of participants had moderate or severe sleep-disordered breathing measured by polysomnography, and 31 percent had short sleep duration with less than 6 hours per night measured by actigraphy. Validated questionnaires also showed that 23 percent reported having insomnia, and 14 percent reported excessive daytime sleepiness. Only 9 percent of participants reported being told by a doctor that they had sleep apnea.

After adjustment for sex, age, and study site, blacks were most likely to have short sleep duration of less than six hours, and they were more likely than whites to have sleep apnea syndrome, poor sleep quality, and daytime sleepiness. Hispanics and Chinese were more likely than whites to have sleep-disordered breathing and short sleep duration, but Chinese were least likely to report having insomnia.

"Our findings underscore the very high prevalence of undiagnosed sleep disturbances in middle-aged and older adults, and identify racial/ethnic disparities that include differences in short sleep duration, sleep apnea and daytime sleepiness," said lead author Dr. Xiaoli Chen, research fellow in the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston.

Study results are published in the June issue of the journalSleep.

The study population was recruited from six U.S. communities and comprised 2,230 racially/ethnically diverse men and women who were between the ages of 54 and 93 years. Data gathered by polysomnography, actigraphy and validated questionnaires were obtained between 2010 and 2013.

According to Dr. Chen and her colleagues, this is the first study that has comprehensively evaluated objective measures of sleep apnea, short sleep, and poor sleep, as well as subjective measures of habitual snoring, insomnia, and daytime sleepiness in a multi-ethnic U.S. population that includes Chinese Americans. Results suggest that sleep disturbances may contribute to health disparities among U.S. adults.

"As sleep apnea has been implicated as a risk factor for cardiovascular disease, stroke, diabetes, and mortality, our findings highlight the need to consider undiagnosed sleep apnea in middle-aged and older adults, with potential value in developing strategies to screen and improve recognition in groups such as in Chinese and Hispanic populations," said senior author Dr. Susan Redline, professor of medicine at Harvard Medical School and Division of Sleep Medicine at Brigham and Women's Hospital and Beth Israel Deaconess Medical Center in Boston. The study was supported by grants from the National Institutes of Health (NIH) and an award from the National Center for Advancing Translational Sciences (NCATS).

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Study: Link between insomnia and stroke

A recent study indicates that those suffering from insomnia have a greater risk of stroke than those who do not have insomnia.

Insomniacs face a much higher risk of stroke than restful sleepers, according to a recent study.

The study, published in the peer-reviewed scientific journal Stroke, an American Heart Association (AHA) publication, sought to link cardiovascular health with sleep-related health.

Past research has shown that not getting enough sleep can lead to a significant number of health problems, including elevated stress levels, symptoms of Alzheimer's disease, and even widespread pain conditions such as fibromyalgia.

Now, researchers from Taiwan's Chia Nan University of Pharmacy and Science, and the Department of Medical Research at Chi-Mei Medical Center, have tied insomnia - a condition of chronic sleep deprivation - to an elevated risk of stroke.

To determine this, the researchers analyzed the medical records of more than 21,000 insomniacs in Taiwan, China. The medical data on these patients was observed for a four-year period, allowing the researchers to conclusively differentiate the intensity of each insomniacs' condition.

The participants were identified as having either chronic or persistent insomnia - disturbed sleep lasting for more than a month; relapse insomnia - return of insomnia symptoms after being free of the condition for more than 6 months; or remission insomnia - becoming non-insomniatic at any point during the study.

These groups were then compared to the medical histories of over 60,000 people who did not have insomnia.

Looking at hospital records, the researchers were able to determine that the patients with insomnia had a 54 percent increased risk of stroke than the non-insomniacs. Even more alarming, insomniacs who were diagnosed with the sleeping disorder when they were young-adults between 18 and 35 years old were a whopping eight times more likely to be hospitalized for stroke, compared to non-insomniacs.

Predictably, the risk of stroke was also found to be greatest in those who suffered from chronic or persistent insomnia or had diabetes.

According to the researchers, although they did not determine a cause-and-effect relationship with this study, past research has suggested that the stress disturbed sleep can have on your heart can cause inflammation, increased blood pressure, and even impaired glucose levels.

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The link between insomnia and chronic pain

This study looks into a potential link between insomnia and chronic pain.

People who have problems sleeping may also be more sensitive to pain, thus potentially worsening the effects of chronic pain conditions, new research from Norway shows.

In the study, researchers measured pain sensitivity in more than 10,000 adults who were participants in the Tromsø Study, an ongoing public health study in Norway that began in 1974.

The results of the study showed that people who had insomnia were more sensitive to pain than people who didn't have sleep problems. In particular, people who were experiencing chronic pain and who also had insomnia showed a greater increased sensitivity to pain. Pain sensitivity was also linked to the amount of time it took to get to sleep.

The findings show that "the need to improve sleep among chronic pain patients, and vice versa, is evident," the study authors, led by Børge Sivertsen of the Norwegian Institute of Public Health in Bergen, Norway, wrote in their article.

In the study, the researchers first asked questions of the participants about their experience with insomnia, how long it took them to fall asleep and other sleep issues. For example, participants rated their experiences with insomnia during the previous year on a four-point scale, ranging from "never" to "more than once a week." Out of all of the participants, 10.5 percent had what the researchers considered an insomnia disorder.

The participants then completed the cold-pressor test — a standard method used to mimic chronic pain in which people are asked to place their hands in cold water for a set period of time. People who remove their hands early show a decreased tolerance to pain. In this study, the participants were asked to keep their hands in water at 3 degrees Celsius (37 degrees Fahrenheit) for 106 seconds.

The results showed that 42 percent of patients who had insomnia took their hands out of the water before the 106 seconds were up, whereas only 31 percent of all of the participants did so. This increased sensitivity to pain was greater in those with more severe or more frequent insomnia. For example, people who had insomnia once a week were 52 percent more likely to take their hands out of the water early, compared to those without insomnia. Moreover, patients who had insomnia monthly were 24 percent more likely to take their hands out of the water early.

The total amount of time that people spent sleeping showed no effect on their pain tolerance, according to the study.

The link between sleep problems and chronic pain appeared especially pronounced, according to the study. The patients with both severe insomnia and chronic pain were more than twice as likely to take their hands out of the water earlyas participants who had neither condition. This effect was "synergistic," meaning the two conditions combined had a greater effect than one would expect from just summing their individual effects, the study authors reported.

That synergy between chronic pain and sleep disorders suggests health care providers should consider jointly treating the two conditions in some patients, the authors stated. Both cognitive-behavioral therapy and medications are used to treat the two conditions separately, the authors noted, so further studies should look at using these methods to treat the conditions together.

Future research should look into not only clinical implications, but also the role of neurotransmitters in the co-occurrence of sleep disorders and pain, the authors said.

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Childhood sleep disorders could hurt a child's heath

When you think of sleep disorders in children, the first types likely to spring to mind are night terrors, nightmares and sleepwalking. These fall into a class of sleep disorders known as parasomnias.

It is estimated that up to 6.5% of children - particularly those aged 4-12 years - experience night terrors, defined as episodes of intense fear, screaming and flailing during sleep. Approximately 3% of preschool and school-aged children experience nightmares, while up to 15% of children aged 4-12 years sleepwalk.

Perhaps less associated with children and adolescents is insomnia and obstructive sleep apnea. In fact, insomnia, the inability to fall asleep or frequent awakening, is estimated to affect around 25% of children and teenagers. Obstructive sleep apnea - when an individual stops breathing for long periods during sleep - affects around 2-4% of children.

What are the causes and symptoms of childhood sleep disorders?

There are a number of factors that can cause childhood and adolescent sleep disorders.

Just like adults, children and teenagers can experience stress, which can interfere with sleep. Consumption of energy drinks - which contain caffeine - is also known to disrupt sleep, as is use of certain medications, such as antidepressants and corticosteroids.

Children and adolescents are also more likely to develop sleep disorders if they have a family history of such conditions, and poor sleep habits, or poor "sleep hygiene" - such as going to bed at irregular times or attempting to sleep in an inadequate environment - can negatively affect sleep quality.

Increasingly, researchers are pointing to the use of technology as a driver for sleep disorders. Last month,Medical News Today reported on a study published in BMJ Open that found children are 50% more likely to have problems getting to sleep if they spend 4 hours a day or more using media devices.

"In adolescents, with the increase in popularity of technology, many teens are staying up very late communicating with friends on smartphones and tablets. The stimulation and light exposure from these devices are associated with late bedtimes and insomnia," Dr. Neil Kline, a sleep physician and internist at the American Sleep Association, told MNT.

Although often harmless, snoring can be a major indicator for a sleep disorder in children and adolescents. It can be a sign of sleep apnea or disturbed sleep quality.

Other symptoms of sleep disorders to look out for include difficulty getting to sleep, daytime fatigue, poor memory, lack of concentration, reduced attention span, irritability and mood swings, hyperactivity and depression.

"If there is any concern for a sleep problem, such as a child taking longer than 20-30 minutes to fall asleep, not sleeping through the night after about age 1 year, or snoring, it is important to discuss this with the child's pediatrician, health care provider or a sleep doctor," Dr. Shalini Paruthi, a spokesperson for the American Academy of Sleep Medicine (AASM), told us.

Children and teenagers are not getting enough sleep

According to recently updated recommendations from the National Sleep Foundation (NSF), the number of hours sleep children and adolescents need is as follows:

Over the past 20 years, the number of hours teenagers sleep each night has fallen.

• Newborns (0-3 months): 14-17 hours a day
• Infants (4-11 months): 12-15 hours
• Toddlers (1-2 years): 11-14 hours
• Preschoolers (3-5 years): 10-13 hours
• School-age (6-13 years): 9-11 hours
• Teenagers (14-17 years): 8-10 hours.

However, it seems many children and teenagers are failing to meet sleep recommendations.

A 2014 poll from the NSF, which asked parents to estimate how much sleep their child gets on a school night, found that children aged 6-10 are only getting around 8.9 hours sleep a night, while 13-14-year-olds are only getting around 7.7 hours sleep each night.

More recently, MNT reported on a study published in the journal Pediatrics revealing that the number of hours teenagers sleep each night has declined over the past 20 years.

The study, which involved more than 270,000 adolescents, found that 72% of 15-year-olds were getting at least 7 hours or sleep each night in 1991, but this fell to only 63% in 2012.

"Declines in self-reported adolescent sleep across the last 20 years are concerning and suggest that there is potentially a significant public health concern that warrants health education and literacy approaches," said lead study author Dr. Katherine W. Keyes, of Columbia University's Mailman School of Public Health.

But why is lack of sleep among children and adolescents a public health concern?

Sleep deprivation linked to obesity, diabetes and heart problems

Sleep deprivation can cause a number of health problems for children and adolescents, both in childhood and adulthood.

In 2011, a study published in The BMJ claimed that children who do not get enough sleep are at significantly higher risk of becoming overweight, compared with children who get sufficient sleep.

Another study published in The Journal of Pediatrics in December 2014 reported a similar finding, associating severe lack of sleep and sleep-disordered breathing in early childhood with increased risk of obesity.

The researchers found that children with the shortest sleep time at the ages of 5 and 6 years were at 60-100% increased risk of obesity by the age of 15, compared with children with sufficient sleep times.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented," commented lead study author Prof. Karen Bonuck, from the Albert Einstein College of Medicine of Yeshiva University in New York, NY.

In March last year, another study published in the same journal found that overweight adolescents who do not get enough sleep may be at increased risk of diabetes, heart disease and stroke.

Past studies have also associated sleep apnea in children with delayed growth and heart failure.

Lack of sleep 'makes it nearly impossible for children to reach their full potential'

It is widely accepted that sleep is important for learning and memory. In June 2014, MNT reported on a study that suggested as such. It found that sleep after learning boosts growth of connections between brain cells, helping them to communicate with each other.

A more recent study found that sleep is particularly important for infants' learning skills. Published in theProceedings of the National Academy of Sciences, the researchers revealed that infants aged 6-12 months who had at least one 30 minute nap within 4 hours of learning a new skill were much more likely to demonstrate the skills they learned once they awoke.

With findings such as these, it is no wonder that lack of sleep and poor sleep quality has been associated with poor learning and educational attainment among children and adolescents.

A 2013 study conducted by researchers from Boston College in the UK found that sleep deprivation was a major contributor to poor grades in numerous countries. While taking literacy tests, 76% of American 9-10-years-olds were identified as sleep-deprived, and these students were found to have poorer results.

"I think we underestimate the impact of sleep. Our data show that across countries internationally, on average, children who have more sleep achieve higher in maths, science and reading. That is exactly what our data show," study co-author Chad Minnich told BBC News.

Dr. Paruthi believes sufficient sleep is crucial for a child's overall health and development. She told MNT:

"Sleep disorders in children and teens can hinder them in school, in social situations, in development and nearly every other aspect of their lives, with the negative impact potentially extending into adulthood. Without healthy sleep, it will be nearly impossible for children to reach their full potential."

Parents should not assume children will 'grow out' of sleep disorders

It is possible that as a child or teenager gets older, symptoms of their sleep disorder may ease. This is most likely for parasomnias, such as sleepwalking and night terrors.

But in some cases, sleep disorders can persist well into adulthood. "For example, children who have sleep apnea are more likely to develop sleep apnea as adults," noted Dr. Kline.

As such, sleep physicians say parents should not ignore signs of sleep disorders in children with the assumption they will "grow out" of them.

"Parents should never assume that their child will grow out of a sleep disorder," Dr. Paruthi told us. "Parents should talk to their child's doctor about how their child sleeps and discuss any potential sleep problems. It is important for a doctor to monitor sleep problems during childhood, identify any underlying causes and prescribe appropriate treatment when necessary."

Depending on what form of sleep disorder a child has, there are a number of treatments available. Doctors may recommend a melatonin supplement, for example. Melatonin is a natural hormone made by the body that helps regulate sleep.

Cognitive behavioral therapy may also be useful, in which psychological approaches - rather than medication - are used to improve a child's sleep time and quality.

Tips to improve a child's sleep

But while there are a number of therapies that can help treat symptoms of sleep disorders, there are many things the NSF say parents can do to improve the likelihood of their child getting a good night's sleep:

The NSF say parents should ensure their child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep.

• Make sleep a primary health priority in your family
• Talk to your child about the importance of sleep for their health and well-being
• Set regular bedtimes for yourself and your children and stick to them
• Be aware of how your child is using media devices in the bedroom and set boundaries for use before bedtime
• Ensure you and your child are educated on how light from media devices may impair sleep
• Rather than watching TV, playing video games or browsing the Internet before bedtime, encourage your child to read a book or listen to music
• Ensure your child is sleeping in an adequate environment; if it is too noisy, too cold or too hot, this can disrupt sleep
• Talk to your child's teacher to find out about their alertness during the school day, and ask them to inform you if they fall asleep in lessons.

To find out more about how to improve your child's sleep, visit the NSF website. Our Knowledge Center articles provide more general information on specific sleep disorders, including obstructive sleep apneaand insomnia.

Tips to beat insomnia

This article gives 10 tips to help you beat insomnia.

Insomnia is the inability to get enough sleep needed to wake up feeling refreshed and well-rested.  Millions of people are suffering from this sleeping disorder.   You can cure insomnia without the additional cost of medication with just little changes in your lifestyle.

1. What you drink and eat before bedtime are also factors that can induce insomnia.  Cut down on alcohol, and do not eat heavy meals before bedtime.  Stick to light snacks and chamomile tea.Cut the caffeine – caffeine is a stimulant.  Cut down on other drinks and foods that have caffeine also, like sodas, teas, and tiramisus.  Coffee should be drank in the morning or at least eight hours before sleep.
2. Keep a quite, dark, and cool bedroom – an uncomfortable sleeping area will not induce sleep. Noise, light, and heat interfere with sleep.
3. The bed is for sleeping and sex – train your brain and body that the bed is for sleeping and sex. Doing office work and reading in bed is a no-no.  The goal is to associate the bed with relaxation and sleep.  Avoid watching TV while lying down in bed, watching TV stimulates your brain to think.  It may make your eyes tired, but the brain is busy converting images to thoughts.  Better yet, transfer the TV to the living room.
4. Avoid naps – try hard not to get that super nap in the afternoon. Naps disrupts sleep at night.  If you really can’t avoid it, limit it to 30 minutes before 3 pm.
5. Quit Smoking – nicotine, like caffeine, is a stimulant. The more you smoke, the more awake you’ll be.  Aside from the hazards of smoking, quitting will do wonders on your sleeping habits.
6. Change the way you think about insomnia – self-defeating thoughts help fuel insomnia. Think positive.  Instead of thoughts like “It’s the same every night,  another night of misery’, think this way instead “This does not every nught, some nights I get enough rest.”  Don’t worry too much, quit this mental habit.
7. Do away with stressful situations before bedtime – avoid heated discussions, heavy mental activities, even strenious activities before bedtime. Try some relaxing activities instead, listening to soft music with keeping the lights low will help in relaxing the brain.
8. Ban Blue Light in the bedroom – Short waves from blue light interferes with sleep. Use devices that have blue light an hour before going to sleep.  This includes TV, cellphones, and digital clocks.
9. Fat or Flat – not the body types, this refers to pillows. The discomfort you give your necks affects the quality of sleep, aside from having a sore neck upon waking up.  Pillows should be just the right size.  Side sleepers should have their nose align with the center of the body while sleeping.  Stomach sleeping should be avoided as this cranes the neck.
10. Control your body clock – go to sleep and wake up around the same time daily, irregardless if its a holiday or a weekend the next day. Our bodies have biological clocks and it is light regulated.  Try getting a ray of sunshine the minute you wake up, for 5 to 30 minutes.

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