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Women appear to be more vulnerable to sleep disturbances compared to men. As a result, women are more likely to take sleeping pills for insomnia — and it's important to be aware of the fact that sleep medications can act differently across genders.

A 2016 review published in Current Sleep Medicine Reports highlighted the fact that two medications commonly used to treat sleep disorders act differently in women compared to men.

The effect of zolpidem on women

Zolpidem is a sedative designed to treat insomnia. The drug comes in four formulations:

  1. Immediate-release tablet (Ambien)
  2. Controlled-release tablet (Ambien CR)
  3. Sublingual dissolvable tablet (Edular)
  4. Oral inhaler (Zolpimist)

It has been clinically proven that women eliminate zolpidem from their bodies more slowly than men. As a result, the  effects of zolpidem are stronger for women and the chance of an adverse side-effect is greater  — regardless of the formulation used.

This finding led to the U.S. FDA issuing a Safety Announcement in 2013 that urged health care professionals to half the recommended dose of all four formulations when prescribing them to women.

The effect of modafinil (Provigil) and armodafinil (Nuvigil) on women

Modafinil and armodafinil are used to promote wakefulness. These drugs are commonly prescribed to treat excessive daytime sleepiness associated with narcolepsy and sleep apnea.

Modafinil and armodafinil have also been found to work differently in women compared to men. Women who take these drugs have been found to have higher concentrations in their blood even when taking the same dose as men and they  may reduce the effectiveness of hormonal contraception. 

Both drugs now carry warnings about the potential interaction between these medications and hormonal birth control.

Using sleeping pills to treat insomnia

Sleeping pills can provide insomnia relief over the short-term. However, they are not a cure — because they do not treat the root cause of insomnia.

If you want to improve your sleep without sleeping pills, look into cognitive behavioral therapy for insomnia (CBTI). CBTI has been endorsed as the best insomnia treatment and it works by addressing the incorrect thoughts and behaviors that are the cause of most cases of insomnia.

Source: Current Sleep Medicine Reports

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There is a strong link between depression and insomnia. One study found that as many as 70% of individuals with depression had symptoms of insomnia and sleep disorders are one of the diagnostic criteria for depression.

Unfortunately, antidepressant drugs can come with a number of side-effects such as:

  • Nausea
  • Sedation
  • Dry mouth
  • Weight gain
  • Tachycardia
  • Constipation
  • Blurred vision
Is there a natural alternative to antidepressants?

Previous studies have found that antidepressants combined with acupuncture can be more effective than antidepressants alone. Other studies have found acupuncture to be effective when it comes to improving sleep quality, increasing sleep duration and reducing the amount of time taken to fall asleep when compared to receiving no treatment.

Research published in BioMed Research International set out to determine the effectiveness of acupuncture when it comes to treating depression-related insomnia.

Researchers carried out a systematic review and meta-analysis using data from 18 randomized controlled trials of acupuncture as a treatment tool for insomnia associated with depression. These trials included a total of 1,678 participants between the ages of 18 and 75 years old.

Acupuncture vs antidepressants

10 studies assessed the effectiveness of acupuncture compared to medication. Seven of them found acupuncture to be more effective at medication when it came to improving insomnia symptoms as measured by the Pittsburgh Sleep Quality Index. In the remaining three studies, there was no significant difference between the two groups.

As stated by the authors of this review, this indicates that  acupuncture treatment was more effective at improving insomnia symptoms than medication.  Acupuncture with antidepressants vs antidepressants alone

Four studies compared the effectiveness of acupuncture combined with medication and medication alone. Three showed acupuncture combined with medication to be  more effective at improving insomnia symptoms than medication alone.  The remaining study found no significant difference between the two groups.

The effect of acupuncture on depression symptoms

Six studies used the Hamilton Rating Scale for Depression (HRSD) to assess the effectiveness of acupuncture. Four of them found acupuncture to be more effective than medication, one found the control group to be more effective than the acupuncture group and the other found no difference between acupuncture and the control group.

Three studies looked at the effectiveness of acupuncture with medication versus medication alone, using the HRSD measure. All three found that  acupuncture combined with medicine was more effective at improving depression symptoms compared to medication alone.  So can acupuncture treat depression-related insomnia?

This review found that compared to medication,  acupuncture treatment was effective when it came to improving depression-related insomnia and the severity of depression symptoms.  However, when compared to acupuncture placebo groups, there was no significant difference.

As the authors of the review pointed out, the studies they investigated had a large range of treatment durations (from 18 days to three months), the diagnostic criteria were not all the same and there did appear to be some publication bias.

With that being said, this review did find that acupuncture can be an effective treatment for depression-related insomnia.  Acupuncture was found to be more effective at reducing insomnia symptoms  compared to conventional Western medicine  and significantly more effective at reducing symptoms of insomnia and depression when combined with medication compared to medication alone.  

This article is not medical advice. I am not a doctor. I am simply sharing peer-reviewed research. All questions regarding medication should be directed to a qualified healthcare professional. Do not make any changes to your medication without speaking to your doctor first.

Source: BioMed Research International

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Insomnia tends to be more prevalent in older adults. As a result, older individuals are more likely to seek help for their sleep issues, which unfortunately leads to higher rates of sleeping pill use.

A 2016 review published in Clinical Therapeutics set out to determine the safety and efficacy of sleep medicines prescribed to older adults. Its findings are outlined below.

I am not a doctor. I am simply sharing peer-reviewed research. All questions regarding medication should be directed to a qualified healthcare professional.
Benzodiazepines for sleep Estazolam

What effect does estazolam have on sleep?

Estazolam can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of estazolam?

Potential side effects and adverse effects include:

  • Daytime drowsiness
  • Dizziness
  • Lightheadedness
  • Dementia
  • Fall risk
  • Hip fractures
  • Mobility problems
Temazepam

What effect does temazepam have on sleep?

Temazepam can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of temazepam?

Potential side effects and adverse effects include:

  • Drowsiness
  • Dizziness
  • Dementia
  • Fall risk
  • Hip fractures
  • Mobility problems
Triazolam

What effect does triazolam have on sleep?

Triazolam can address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of triazolam?

Potential side effects and adverse effects include:

Flurazepam

What effect does flurazepam have on sleep?

Flurazepam can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of flurazepam?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Confusion
  • Dizziness
  • Impaired motor coordination
  • Fall risk
  • Motor vehicle accidents
Are benzodiazepines recommended for sleep problems in seniors?

The review pointed out that even if benzodiazepines are used for only a few days, they have the potential to cause physical dependence. Researchers concluded that benzodiazepine use should be avoided in the elderly, yet if they are used, the lowest dose for the shortest duration is preferred and follow-up visits should be scheduled every six months.

Nonbenzodiazepine receptor antagonists for sleep Eszopiclone

What effect does eszopiclone have on sleep?

Eszopiclone can address sleep onset latency, helping individuals fall asleep faster. It can also address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of eszopiclone?

Potential side effects and adverse effects include:

  • Headache
  • Unpleasant taste
  • Somnolence (sleepiness/drowsiness)
  • Dyspepsia (impaired digestions)
  • Dry mouth
  • Dizziness
Zolpidem

What effect does zolpidem have on sleep?

Zolpidem can address sleep onset latency, helping individuals fall asleep faster. It can also address sleep maintenance issues, helping individuals stay asleep and it can be used for nighttime awakenings.

What are the side effects of zolpidem?

Potential side effects and adverse effects include:

  • Headache
  • Dizziness
  • Drowsiness
  • Nausea
  • Vomiting
  • Anterograde amnesia
  • Hallucinations
  • Delirium
  • Unusual nighttime behaviors
Zaleplon

What effect does zaleplon have on sleep?

Zaleplon can address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of zaleplon?

Potential side effects and adverse effects include:

  • Headache
  • Nausea
  • Dizziness
  • Somnolence (sleepiness/drowsiness)
  • Rhinitis (stuffy nose)
  • Asthenia (physical weakness/loss of strength)
  • Abdominal pain
Are nonbenzodiazepine receptor antagonists recommended for sleep problems in seniors?

The review concluded that nonbenzodiazepine receptor antagonists have better safety profiles compared to benzodiazepines, but the recognized side effects should limit their use in the elderly.

Melatonin receptor agonists for sleep Ramelteon

What effect does ramelteon have on sleep?

Ramelteon can address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of ramelteon?

Potential side effects and adverse effects include:

  • Headache
  • Somnolence (sleepiness/drowsiness)
  • Nasopharyngitis (common cold)
Orexin antagonists for sleep Suvorexant

What effect does suvorexant have on sleep?

Suvorexant can help individuals fall asleep (sleep induction) and it can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of suvorexant?

Potential side effects and adverse effects include:

  • Somnolence (sleepiness/drowsiness)
  • Fatigue
  • Headache
  • Dry mouth
  • Residual daytime sedation
  • Sleep paralysis
  • Fall risk
Antidepressants for sleep Trazodone

What effect does trazodone have on sleep?

Trazodone can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of trazodone?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Headache
  • Nausea
  • Vomiting
  • Xerostomia (dryness in the mouth)
Mirtazapine

What effect does mirtazapine have on sleep?

Mirtazapine can address sleep onset latency, helping individuals fall asleep faster. It can also be used for nighttime awakenings.

What are the side effects of mirtazapine?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Anticholinergic effects
  • Weight gain
Doxepin

What effect does doxepin have on sleep?

Doxepin can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of doxepin?

Potential side effects and adverse effects include:

  • Headache
  • Somnolence (sleepiness/drowsiness)
  • Sedation
  • Mild anticholinergic effects
Are antidepressant medications recommended for sleep problems in seniors?

The review concluded that sedating low-dose antidepressants may be a good option for insomnia when the individual is also suffering from depression.

Researchers identified trazodone as the safest option due to the lack of anticholinergic activity. The review suggested that mirtazapine may be beneficial for insomnia in those suffering from frailty syndrome since the drug also stimulates the appetite.

Miscellaneous medications for sleep Gabapentin

What effect does gabapentin have on sleep?

Gabapentin can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of gabapentin?

Potential side effects and adverse effects include:

  • Drowsiness
  • Somnolence (sleepiness/drowsiness)
Pramipexole

What effect does pramipexole have on sleep?

Pramipexole can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of pramipexole?

Potential side effects and adverse effects include:

  • Insomnia
  • Hallucinations
Tiagabine

What effect does tiagabine have on sleep?

Tiagabine can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of tiagabine?

Potential side effects and adverse effects include:

  • Drowsiness
Are these medications recommended for sleep problems in seniors?

The review pointed out that although pramipexole and tiagabine have been used for insomnia, they have considerable adverse effects and have not been extensively studied in the older population.

Researchers pointed out that gabapentin may be useful in those suffering from restless legs syndrome or chronic neuropathic pain and insomnia.

Over-the-counter medications for sleep Diphenhydramine

What effect does diphenhydramine have on sleep?

Diphenhydramine may be used to address sleep onset latency, helping individuals fall asleep faster. It may also be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of diphenhydramine?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Anticholinergic effects
Valerian

What effect does valerian have on sleep?

Valerian may be used to address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of valerian?

Potential side effects and adverse effects include:

  • Drowsiness
  • Headache
  • Depression
Melatonin

What effect does melatonin have on sleep?

Melatonin may be used to address sleep onset latency when taken within an hour of sleep, helping individuals fall asleep faster.

What are the side effects of melatonin?

Potential side effects and adverse effects include:

  • Residual daytime sedation
Are over-the-counter medications recommended for sleep problems in seniors?

The review concluded that diphenhydramine isn't suitable for the elderly due to its anticholinergic effects. Furthermore, researchers pointed out that tolerance can develop after one to two weeks of uninterrupted use.

Melatonin may be an option due to the low side effect risk, yet data remains inconsistent. Researchers pointed out that both valerian and melatonin are unregulated (in the United States).

Conclusion (and a few words about cognitive behavioral therapy)

The authors of this review confirmed that  cognitive behavioral therapy for insomnia should always be the initial therapy for insomnia. 

For pharmaceutical options, researchers singled out ramelteon as a potentially desirable option for older patients who have tried sleep hygiene without success due to low adverse effects combined with its effectiveness at reducing sleep onset time and increasing total sleep time.

Suvexorant was also mentioned due to its effectiveness at reducing sleep onset and increasing total sleep time, but researchers pointed out that although adverse effects are also mild, residual daytime sedation has been reported and there is currently limited clinical experience with the drug.

The fact of the matter is this:  sleeping pills do not cure insomnia.  They may offer relief in the short term, but if you want to address your sleep issues permanently, cognitive behavioral therapy for insomnia is usually the best option.

Source: Clinical Therapeutics

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When it comes to the best treatment option for insomnia, there is a ton of conflicting information out there.

I see plenty of bad advice handed out to people suffering from insomnia and I see many so-called insomnia cures that have little (or no) evidence on their safety or effectiveness get recommended on a regular basis.

Let's change all that, starting today.

The American Academy of Sleep Medicine conducts comprehensive reviews of scientific literature on a periodic basis to help determine which insomnia treatments actually work.

Want to know how to cure insomnia? Continue reading! Listed below are the insomnia treatments that have been comprehensively reviewed and graded by experts appointed by the American Academy of Sleep Medicine.

Legend
Standard recommendation; a generally accepted strategy with a high level of clinical certainty.
Guideline; a strategy with a moderate degree of clinical certainty.
Uncertain clinical use; inconclusive or conflicting evidence or expert opinion.
 Cognitive behavioral therapy (CBT)

CBT combines cognitive and behavioral techniques to improve sleep. CBT addresses incorrect thoughts, beliefs, and behaviors towards sleep. These are often  the root cause of many cases of insomnia .

Cognitive behavioral therapy for insomnia usually includes a combination of sleep education, stimulus control therapy, sleep restriction, relaxation training, and sleep hygiene education.

  You can learn more about CBT in my free two week insomnia sleep training course.
 Relaxation training

Relaxation techniques help reduce the mental arousal that can make sleep difficult. This mental arousal is sometimes described as a racing mind.

Relaxation training includes:

  • Guided imagery
  • Abdominal breathing
  • Progressive muscle relaxation

Progressive muscle relaxation involves tensing and relaxing muscles throughout the body in a methodical fashion. There are many ways to do this. Here's one method:

  1. Lie in bed with the lights off
  2. While breathing in, tense the muscles in your toes for about five seconds
  3. Quickly release the tension and breathe out
  4. Relax for about 30 seconds. Feel the looseness in your relaxed muscles and notice how different they feel compared to when they were tensed
  5. Repeat one more time or move up the body to another muscle group (such as your calves) and repeat the process
  6. Continue until you reach the top of your body
 Stimulus control therapy

This technique helps to associate the bed with sleep (not wakefulness) and converts negative associations into positive ones.

Stimulus control involves:

  • Avoiding daytime naps
  • Only going to bed when sleepy
  • Keeping a regular sleep/wake schedule
  • Getting out of bed if you can't fall asleep
  • Using the bed for sleep and sexual activity only
  You can learn more about stimulus control in my free sleep training course for insomnia.
 Multicomponent therapy

This uses various components of CBT, but not all of them. For example, multicomponent therapy may include stimulus control, relaxation training, and sleep hygiene education — but not sleep restriction.

 Sleep restriction

Although commonly referred to as sleep restriction, I prefer to use the term restricting time allotted for sleep in order to avoid the  common misperception that sleep restriction reduces sleep duration.  It doesn't!

This technique involves reducing the amount of time spent in bed to more closely match the amount of sleep you're getting. It is designed to increase sleep pressure, increase sleep duration, and help you associate the bed with sleep — not wakefulness.

To try this technique, you'll need to keep a sleep diary for at least a week. Every day, write down the time you went to bed the previous night, the time you got out of bed in the morning and how many hours of sleep you got.

The aim here is to make sure you  do not spend more than an hour over your nightly sleep duration in bed .

Here's an example:

Day: Monday Tuesday
Bed time: 11pm 10.30pm
Out of bed time: 6am 7.30am
Hours of sleep: 5 hours 5 hours
Total time in bed: 7 hours 9 hours
 For the sake of brevity, I've only used two days in the example above. You should keep a sleep diary for at least a week if you want to try this technique.

In the example above, we can see that - on average - this individual is allotting eight hours for sleep each night ( (7+9) / 2 ). Yet, they are only averaging about five hours for sleep each night ( (5+5) / 2 ).

 Adding one hour to their average nightly sleep duration  would mean allotting about six hours for sleep each night. This would be a more appropriate amount of time to allot for sleep.

This individual should now write down when they want to get out of bed each morning, deduct six hours from that time, and they have their new regular bedtime.

  The amount of time you allot for sleep should not be less than five-and-a-half hours.

This amount of time allotted for sleep can be increased by half an hour each week as long as sleep efficiency remains above 85%. Sleep efficiency is measured by dividing sleep duration by time allotted for sleep, and multiplying by 100.

For example, if I spend seven hours in bed and get six hours of sleep, my sleep efficiency is 85.7%.

 Paradoxical intention

The insomnia remedy that many haven't heard of, paradoxical intention therapy involves confronting the fear of insomnia by trying to remain awake, but relaxed.

This addresses the 'performance anxiety' suffered by many insomniacs who struggle to fall asleep.

 Biofeedback

Biofeedback uses visual or audio feedback to help reduce arousal.

 Sleep hygiene as a single therapy

It's important to note that sleep hygiene only comes without a recommendation  when used as a single treatment strategy .

Sleep hygiene is a form of behavioral intervention that teaches individuals about lifestyle practices that impact sleep. It should be combined with other techniques such as sleep restriction, cognitive therapy, and stimulus control.

Sleep hygiene techniques include:

  • Eating a healthy diet
  • Getting regular exercise
  • Keeping a regular sleep schedule
  • Exposure to natural light in the day
  • Avoiding caffeine and other stimulants
  • Keeping the bedroom cool, dark, and quiet
  • Avoiding exposure to artificial light at night
  My free sleep training course goes into more detail about sleep hygiene.
 Imagery training as a single therapy

As with sleep hygiene, this technique only comes without a recommendation when used as a single treatment strategy.

Imagery training involves visualizing pleasant or neutral images with the aim of blocking out unwanted thoughts before sleep. The theory behind this is it can help promote relaxation and calm a racing mind before bed.

Cognitive therapy as a single therapy

Cognitive therapy is not the same as cognitive behavioral therapy. Cognitive therapy only aims to address incorrect thoughts, beliefs, and attitudes towards sleep. Unlike cognitive behavioral therapy, it does not specifically target the behaviors that influence sleep.

Cognitive therapy,  when used within cognitive behavioral therapy, is effective and comes with a recommendation . Cognitive therapy as a single therapy does not.

Sleeping pills

The following are consensus-based recommendations and reflect the shared judgement of an expert insomnia panel assembled by the American Academy of Sleep Medicine:

  • Short-term hypnotics should be supplemented with behavioral and cognitive therapies
  • Those taking sleeping pills long-term should receive an adequate trial of cognitive behavioral therapy
  • Over-the-counter antihistamines/analgesics and herbal/nutritional substances such as valerian and melatonin are not recommended for chronic insomnia due to lack of data on their safety and effectiveness

If you are struggling with sleep, speak to your doctor. Don't blindly follow the advice of others without doing your due diligence first!

Sources:

Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. Journal of Clinical Sleep Medicine, 4(5), 487–504.

Morgenthaler T., Kramer M., Alessi C., Friedman L., Boehlecke B., Brown T., Coleman J., Kapur V., Lee-Chiong T., Owens J., Pancer J., Swick T. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep, 29(11), 1415-9.

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A lot of insomnia sufferers I talk to have one thing in common —  no matter how hard they try to fall asleep and stay asleep, they just can't do it. 

And that's the problem.

Sleep is a natural process. As soon as we try to force sleep, we immediately make it more difficult to sleep.

This has been confirmed in studies, too.

One of them, published in the Journal of Sleep Research, involved 33 good sleepers with an average age of 24. Participants visited a sleep lab twice, and started off in one of two groups.

The neutral instruction group were told:

You should just lie down as if you decided to have some rest during the day. Whether or not you fall asleep doesn't matter. Just relax.

The motivation instruction group were told:

It's very important for you to make yourself fall asleep as quickly as possible. Use all the methods you know. If you can fall asleep really quickly, you will get an additional monetary reward.

The rewards were staggered as follows:

  • 300 rubles for falling asleep within 5 minutes
  • 200 rubles for falling asleep within 10 minutes
  • 100 rubles for falling asleep within 15 minutes

Those in the neutral instruction group for their first visit were placed in the motivation instruction group for their second visit. Those in the motivation instruction group for their first visit were placed in the neutral instruction group for their second visit.

The study found that  when participants were in the motivation instruction group , they experienced:

  • Less time asleep
  • More fragmented sleep
  • Higher levels of arousal
  • More awakenings after sleep onset

In other words, as soon as participants actively tried to fall asleep, their sleep quality got worse.

Why?

When we actively try to sleep, we don't allow the body to relax. We keep it alert, constantly checking to see if we are asleep.

Furthermore, as we becoming increasingly anxious about not falling asleep, the body's stress response kicks in and acts as an additional hindrance to sleep. Environmental distractions can also become more pronounced; we may end up focusing intently on that barking dog or dripping faucet, making sleep virtually impossible.

Interestingly, this study found that instruction type did not affect how long it took participants to actually fall asleep. This may be down to the fact that when participants were asked about strategies they used to try to fall asleep, they reported:

  • Prayer
  • Relaxation
  • Visualization
  • Attempts to stop thinking

Perhaps the fact that these techniques tend to involve relaxation rather than attempts to force sleep explains the unusual result for this sleep measure.

How to fall asleep and stay asleep

The best thing you can do to improve your sleep is  stop worrying about sleep . Don't try to force sleep. Don't try to set yourself goals when it comes to how long it takes to fall asleep or how much sleep you should be getting.

Instead, try techniques such as paradoxical intention therapy, address dysfunctional sleep thoughts, and consider trying relaxation and meditation techniques.

Finally, recall that the advice given to those who got the best sleep was:

You should just lie down as if you decided to have some rest during the day. Whether or not you fall asleep doesn't matter. Just relax.

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Teenagers should be getting between seven to 11 hours of sleep, with eight to 10 hours being the current recommendation from the National Sleep Foundation.

However, it has been suggested that as many as 69% of high school students get seven hours of sleep or less. Furthermore, close to half have reported serious difficulty when it comes to staying awake at school.

Childhood sleep deprivation is a big problem in the United States and can lead to a number of health and lifestyle problems including:

A study published in the Journal of Youth and Adolescence found that  just one extra hour of weekday sleep  can reduce the odds of:

Researchers investigated self-reported weekday sleep duration and its association with feelings of hopelessness, suicidality, and substance abuse in almost 28,000 eighth, 10th, and 12th grade students in Fairfax County, Virginia.

Sleep duration was measured by a survey question that asked:

On an average school night, how many hours of sleep do you get?

Response categories were: four or less hours, five hours, six hours, seven hours, eight hours, nine hours, and ten or more hours.

Hopelessness/suicidality was measured by the following three survey questions:

During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?

During the past 12 months, did you ever seriously consider attempting suicide?

During the past 12 months, did you ever actually attempt suicide?

Substance abuse was measured by a question that asked how many occassions over the past 30 days the child had used a specific substance. The list of substances included cigarettes, alcohol, hallucinogens, cocaine, and prescription drugs without a doctor's order.

The findings

For every hour of lost sleep,  student hopelessness, suicidal thoughts, suicide attempts, and substance use increased significantly .

For students who got nine hours of sleep:

  • 19.2% felt hopeless
  • 8.1% considered suicide
  • 1.8% attempted suicide
  • 14.1% used tobacco, alcohol or marijuana in the previous 30 days
  • 7.3% used illicit/prescription drugs in the previous 30 days

For students who only managed four hours of sleep:

  • 51.6% felt hopeless
  • 31.5% considered suicide
  • 13.3% attempted suicide
  • 39.5% used tobacco, alcohol or marijuana in the previous 30 days
  • 22.9% used illicit/prescription drugs in the previous 30 days

After further analysis of the data, researchers found that for each hour of sleep loss, the odds of:

  • Feeling sad and hopeless increased by 38%
  • Seriously considering suicide increased by 42%
  • Attempting suicide increased by 58%
  • Using tobacco, alcohol or marijuana increased by 23%
  • Using illicit/prescription drugs increased by 37%

Interestingly, researchers also found that  girls averaged less sleep than boys , with the difference becoming more pronounced in the transition from middle school to high school, and that  Asian, black and hispanic students averaged less sleep than white students .

What can be done?

It's clear that childhood sleep deprivation is a serious problem. Early school start times may be a contributing factor - it's worth noting that students in Fairfax County begin school at 7.20am.

It's important for us to monitor and regulate the sleep habits of our children. This includes setting a regular (and appropriate) bedtime and restricting evening activities that harm sleep.

The fact of the matter is, however, that adolescent body clocks can make it difficult for teens to fall asleep before midnight.

Campaigning for later school start times may be the single best thing we can do for the sleep (and well-being) of our children.

Source: Journal of Youth and Adolescence

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We already know that sleep deprivation harms memory and learning. Now it would appear that the consolidation of memories during sleep is influenced by  how much we care about those memories .

In research presented at the British Science Festival, events that are considered to be important are given preferential treatment by the brain when it consolidates memories during sleep.

The study involved 80 English-speaking university students who were shown 28 Welsh-language words before being kept awake or being allowed to sleep for at least six hours.

12 hours after being presented with the Welsh words, participants were tested on how many words they remembered.

Unsurprisingly, those who were allowed to sleep after being shown the words were able to remember them better than those who were kept awake.

What was particularly interesting though, was that for those allowed to sleep after being shown the words,  memory recall was best in those who placed a personal value on the Welsh language .

In conclusion then, if you have some important things to remember it pays to:

  1. Care about those things
  2. Get enough sleep

Source: British Science Festival

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If you read the news and believe all the sensationalist headlines, you're probably under the impression that mankind is going through a stage of chronic sleep deprivation. That may not be the case, though.

Although some studies have suggested that average sleep duration has declined over the last few decades, others have cast doubt on such findings.

As a result of this, researchers set out to conduct a review of literature published from 1960 to 2013 to see if sleep duration really has been in decline.

Their review involved 168 studies with 257 data points representing over 6,000 individuals between 18 and 88 years of age.

After analyzing the data, researchers concluded that there was  no significant association between sleep duration and the study year .

In other words, over the last half-century,  objectively-recorded sleep durations remained relatively stable . This remained the case even when comparing sleep durations across age groups and genders.

Furthermore, sleep duration still remained stable regardless of whether data was collected from actigraph units or from sleep studies, or whether study participants were assessed during fixed sleep schedules or their usual sleep schedules.

So what does this mean for the general assumption that we're experiencing a modern epidemic of insufficient sleep?

Well, it's worth highlighting the limitations of the literature used in this review.

Specifically:

1. The ethnic and racial composition of participants in most studies were probably not representative of the general population.

In particular, it's thought that shorter sleep durations are more common in black individuals compared to white individuals. Furthermore, it has been suggested that the prevalence of shorter sleep durations is increasing more among blacks compared to whites.

2. Most of the studies excluded women or did not separate data between genders.

3. Other factors that have been associated with sleep duration such as employment and socio-economic status, career, and education were also not reflected in many of the study samples.

4. Most studies were conducted in sleep labs. Sleep studies many not be able to adequately record a decline in sleep duration that may be occuring at home, but not in a lab environment.

Furthermore, sleep studies generally limit sleep periods to eight hours. Therefore, if participants used to get more than eight hours of sleep, but this fell to less than eight hours over time, these studies would not have been able to record the decline.

Finally, sleep studies tend to record sleep over a set period of time - not a 24 hour period. Therefore, naps (which should be included in sleep duration figures) go unrecorded.

5. Older studies did not screen for other sleep disorders such as sleep apnea. Therefore, earlier studies may have resulted in lower estimates of sleep duration compared to newer studies.

What was particularly interesting about this review was the finding that if the optimal objective sleep duration for adults is between six and six-and-a-half hours,  more participants are at risk due to too much sleep rather than not enough sleep .

So why do we think sleep durations have been in decline?

Here are a few theories:

1. Increased public awareness about sleep

More of us are aware of the importance of sleep. Consequently, we have seen a rise in the number of sleep disorder diagnoses, and an explosion in the availability (and use) of sleeping pills. This may have influenced our perception.

An increase in knowledge about sleep has also led to individuals paying more attention to their sleep. Being aware of the amount of time spent asleep versus the amount of time spent in bed could also create the perception that we're now getting less sleep than we used to.

2. Sleep is still associated with leisure

Although sleep education has increased, we still tend to associate sleep with leisure and relaxation. As life becomes increasingly stressful and we feel more intense time pressures, we may feel we have less time for sleep even if we're still getting precisely the same amount of sleep as we always have.

3. Depression rates are on the rise

Poor or inadequate sleep is associated with depression. Therefore, as depression rates increase, there are more complaints of insufficient sleep.

4. Cultural influence

As we continue to hear that we're a sleep deprived society, we begin to believe it. Our perception of sleep is influenced by reports from the media and sleep scientists.

Conclusion

The fact of the matter is this:

The evidence tells us that sleep durations are not in decline.

Furthermore, you're probably getting more sleep than you think you are.

Source: Sleep Medicine Reviews

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The Dysfunctional Beliefs and Attitudes about Sleep Scale is a 16-item survey designed to evaluate sleep related thoughts.

Studies have found that those who score highly on the scale (ie those with the strongest dysfunctional beliefs and attitudes) are more likely to have issues with insomnia, particularly when it comes to falling asleep.

Take a look at the 16 statements below. If you can relate to them, it's important to take steps to correct these thoughts since they're making it more difficult for you to get a good night's sleep.

Dysfunctional beliefs and attitudes about sleep

I need 8 hours of sleep.

Note: You don't. See: How much sleep do I need?

Chronic insomnia may have serious consequences on my physical health.

Note: The significance of any link between insomnia and negative effects on physical health is often decreased (or disappears entirely) after controlling for baseline health and factors that are known to affect mortality (such as stress, smoking, alcohol use, and lack of exercise).

It's also important to note that:

a) Sleep loss in a laboratory environment is often far more severe than sleep loss in a home environment, which can skew the results and findings of studies that make the news.

b) Surveys that ask people to record how much sleep they get each night are notoriously unreliable since we often get more sleep than we think.

I believe that insomnia is the result of a chemical imbalance.

Note: One study from 2008 found that those suffering from chronic insomnia for more than six months had lower GABA levels compared to the control group. However, the study only involved sixteen individuals and GABA levels for the entire brain were extrapolated based on measurements from a small number of areas. Furthermore, the study didn't note whether participants were awake or asleep when GABA levels were measured.

Finally, the study was funded in part by Sunovion Pharmaceuticals and four of the authors have connections to one or more of GlaxoSmithKline, UCB Pharma, Novartis, and Pfizer.

The fact is, research does not currently corroborate the idea that insomnia is the result of a chemical imbalance.

Insomnia is ruining my ability to enjoy life and prevents me from doing the things I want.

Note: Negative thoughts like this can be self-fulfilling. It's important to avoid such thoughts, or at the very least, put them in context.

Think of the last time you stayed out late with friends; you got less sleep, but it's unlikely you ended up in a bad mood the following day. That's because you knew the circumstances were under your control.

When your sleep loss is a result of insomnia, it's important that you do not focus on negative thoughts about that sleep loss. The fact of the matter is, your daytime functioning after a night of sleep loss is affected not only by that lack of sleep, but also by your attitude towards it.

When I don't get enough sleep, I need to catch up the following night.

When I sleep badly on one night, it will disturb my sleep schedule for the entire week.

Note: Many insomniacs try to 'catch up' on lost sleep by spending more time in bed. Unfortunately, spending more time in bed isn't the same as getting more sleep. In fact,  spending more time in bed can actually make sleep more difficult. 

Spending too much time in bed reduces sleep efficiency and can lead to your mind associating the bed with wakefulness, not sleep. You should stick to a regular (and appropriate) sleep schedule every day, regardless of how well (or poorly) you slept the previous night.

Without enough sleep, I can hardly function the next day.

I know that a poor night of sleep will interfere with my daily activities the following day.

When I feel irritable, depressed or anxious it's because I did not sleep well the night before.

When I feel tired, lack energy, or don't function well during the day, it's generally because I didn't sleep well the night before.

I avoid or cancel obligations after a poor night's sleep.

I struggle to manage the negative consequences of bad sleep.

Note: Sleep deprivation can definitely affect next-day performance when it comes to tasks such as memory recall, problem solving, and reaction times. However, the consequences are not as dire as you may suspect. Furthermore, sleep deprivation affects individuals in different ways.

The main consequences of insomnia tend to be related to mood; we're more likely to feel irritable, frustrated, and less motivated when we don't get enough sleep. In other words, usually  the worst effect of insomnia is being in a bad mood the following day. 

Medication is probably the only solution to sleeplessness.

To be alert and function well the following day, it's better to take a sleeping pill than have a poor night's sleep.

Note: Sleeping pills do not cure insomnia. In fact, it has been suggested that much of the benefit of sleeping pills may come from the placebo effect.

Since sleeping pills do not address the root cause of insomnia, they are unable to cure insomnia. Furthermore, because of the amnesic effects of certain types of sleeping pills, you may think you're sleeping better with them simply because you can't remember being awake.

Many people who find their sleep improves with sleeping pills will experience rebound insomnia as soon as they stop taking the medication.

I can never predict whether I'll have a good or bad night of sleep.

I'm worried that I may lose control over my ability to sleep.

Note: You should not attempt to predict the quality of your sleep. Sleep cannot be forced. Sleep is not the result of a conscious effort. It is a natural process that only comes when you relax and don't think about it.

You cannot control sleep, and  it is impossible to have an inability to sleep. 

How to address dysfunctional beliefs and attitudes about sleep

One of the most effective treatments for insomnia is cognitive behavioral therapy. It works because it specifically addresses the incorrect thoughts and behaviors many insomniacs have towards sleep.

You can learn more about CBT for insomnia by enrolling on my free sleep training course. It uses CBT techniques to help improve sleep without the need for sleeping pills.

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Most cases of insomnia are caused by incorrect thoughts and behaviors towards sleep. Known as psychophysiologic insomnia, sufferers often focus far too much attention on their sleep (or lack of it). This makes sleep more difficult, creating a negative cycle of worry and sleep deprivation.

Healthy sleepers tend to take a passive approach towards sleep. It's time for bed, so they get into bed. They switch off the lights, relax, and sleep comes.

Insomnia sufferers will often try to force sleep. They'll go to bed earlier than they should (in an attempt to get more sleep), they'll keep checking the clock and worry that they aren't asleep yet. They'll think about how tired they'll be in the morning.

 The fact of the matter is that sleep is a largely automatic process that needs little intervention.  The more we try to intervene, the more we risk harming our sleep.

Take breathing as an example; we don't normally think about our breathing. Yet, during a panic attack we can easily place too much attention on our breathing. We may worry that we're not getting enough oxygen, leading to hyperventilation. The symptoms of hyperventilation then make us worry even more, making the cycle even worse.

 If you want to improve your sleep, you need to stop thinking about your sleep.  This is why cognitive behavioral therapy for insomnia is so effective; it addresses incorrect thoughts and behaviors towards sleep and teaches individuals to abandon attempts to control their sleep.
The cause of psychophysiologic insomnia

To get all academic, C.A. Espie et al. suggest that the attention-intention-effort pathway is a critically important process when it comes to sleep disruption. Broken down, this pathway involves excessive:

Attention: Paying too much attention to sleep. Worrying and questioning sleep (and the consequences of sleep deprivation) in the pre-sleep period (also known as negative sleep thoughts).

Intention: Developing an explicit intention to sleep. Ironically, this actually makes sleep more difficult. Healthy sleepers do not have an explicit intention to sleep; instead, they just get into bed, turn off the lights and get comfortable.

Effort: Making too much of an effort to fall asleep and stay asleep. This leads to higher levels of arousal, making sleep more difficult. You may be putting too much effort into sleep if you find yourself tossing and turning at night, unwilling to get out of bed and 'give in' or 'admit defeat', or if you try exercising yourself to the point of exhaustion in an attempt to sleep.

What is paradoxical intention therapy?

Since good sleepers don't use any 'strategies' to fall asleep, one suggested treatment is paradoxical intention therapy.

Paradoxical intention therapy attempts to replace 'trying to fall asleep' with 'trying to stay awake'. The aim of the technique is to get you to take a more passive role towards sleep by deliberately preventing your attempts to fall asleep.

How to use paradoxical intention therapy to improve your sleep

In their book, 'Insomnia: A Clinical Guide to Assessment and Treatment', Morin and Espie summarize the instructions for paradoxical intention therapy as:

  1. When you are in bed lie in a comfortable position and put the lights out.
  2. In the darkened room, keep your eyes open, and try to keep them open 'just for a little while longer'. That's your catch phrase.
  3. As time goes by, congratulate yourself on staying awake but relaxed.
  4. Remind yourself not to try to sleep but to let sleep overtake you, as you gently try to resist it.
  5. Keep this mind-set going as long as you can, and if you get worried at staying awake remind yourself that is the general idea, so you are succeeding.
  6. Don't actively prevent sleep by trying to rouse yourself. Be like the good sleeper; let sleep come to you.

The key take-away is this: stop trying to sleep.  Sleep is involuntary .

Paradoxical intention therapy can help break the cycle of persistent insomnia (and no sleeping pills are required).

Source: Sleep Medicine Reviews

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