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Many people who have trouble sleeping tell us that a big part of the problem is their busy mind. The mind might be full of worry about work, relationships, past mistakes, or it might be jumping from one seemingly random topic to the next. Frustratingly, there's no off switch. Practising mindfulness does not switch the mind off, but it can help to calm the mind, switch it into a more accepting mode, and improve focus and wellbeing. A calm mind is a good friend of sleep. It's also a good friend of happier days.

Mindfulness based therapies have a strong developing evidence base for use in management of a range of difficulties such as depression, anxiety, stress, and insomnia. There is also evidence that mindfulness can improve overall wellbeing and quality of life. See our earlier blog post for more about how and why it might help poor sleepers.
If you'd like to learn more about Mindfulness, and how to implement practical strategies to get mindfulness into your life, come to an evening seminar by Annika Rose, wellbeing scientist.

Tuesday May 15th
7-9pm
Tickets are a bargain at just $10
https://www.trybooking.com/book/event?eid=372233
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Dr Jessica Tearne and Mr Paul Jeffery from Sleep Matters presented a seminar on teenage sleep to year 7 students and their parents at one of Perth’s high schools this week. It was a great opportunity to cover some interesting and important facts about sleep in adolescence.

Getting good quality and quantity sleep can be tricky in adolescence. At the very age the teenage body is demanding more sleep (an average of 9 hours), it is also the time where social and academic pressures significantly increase and compete for precious time. On top of this, teenagers typically experience a delayed sleep phase which is a biological shift in the body clock meaning that they don’t feel sleepy until later in the evening and want to sleep in later in the morning. It is not surprising then that up to 70% of students aren’t getting as much sleep as they need. It is important to be aware of what is getting in the way of sleep in order to to implement strategies for improved sleep.

The students Jessica spoke with echoed what the research tells us in that most of them are using devices (phones, iPads, laptops etc.) in bed every night. A report from the Australian Psychological Society (APS) states that close to 60 per cent of teens have trouble sleeping or relaxing after accessing social media sites and a similar number feel burnt out by constant connectivity. Jessica spoke about the two reasons why using these devices in bed might be a problem.
  • The first is simply that often what we are looking at is activating for our brains. It is hard for us to relax in to sleep if friends are messaging us or we’re feeling upset about someone’s Facebook status.
  • The second is the impact that blue light has on suppressing melatonin production which suppresses sleepiness. 
Ideally we should finish using devices at least 1 hour before bedtime. If this feels unrealistic, and you are using devices close to sleep, it is best to ensure that what you are looking at isn’t overly activating for your brain. Be aware of how looking at the device makes you feel - wound up or relaxed? Also, if you must use a device close to bedtime, use a blue light filter app/setting to limit exposure to blue light:
  • Apple devices – Night Shift setting
  • Android devices – Twilight app
 
If you are a teen (or you have a teen), the following might also be helpful in improving your sleep:
  • Set a schedule for the week. Having a set routine for sleep can help create strong sleep habits and can help to regulate the body clock. A good sleep routine includes a regular bedtime, that’s based on a realistic wake time. If you need to be up at 7 a.m. during the week, then a 10 p.m. lights out time will allow you roughly the 9 hours required per night. 
    • It’s okay to sleep in a bit on weekends, but if it’s longer than a couple of hours more than your weekday rising time, you might end up messing up your sleep cycle. An irregular rising time is a bit like putting the body into a constant state of jet lag. A quick nap (30 mins) early in the afternoon may be better than a long sleep in.
    • It may also help to schedule your study and leisure time to ensure that you have set aside enough time for sleep. Good sleep is helped by a balanced lifestyle.
  • Time outside. Exposure to sunlight, especially in the morning can help ensure that your body clock is working well for you, helping you feel less tired early in the day and more ready for bed at night. Try having breakfast outside to start your day. Bright light at night can interfere with sleep but bright light in the morning can assist it.
 
  • Exercise. Being active every day will help manage stress and ensure that you are tired enough to get to sleep at bedtime.
 
  • Limit caffeine. Ensure you don’t have any caffeinated beverages (coffee, red bull etc.) either at all, or at least after 2pm.
 
  • Manage anxiety. It is important to become aware of how you respond to stressful thoughts and feelings. Learning to respond effectively to these will bode well for you long into the future. Getting caught in worry and rumination can make it difficult to get to sleep. Relaxation and mindfulness practices can be helpful. Try the following apps:
    • Headspace
    • Smiling Mind
    • Grow: Mindfulness for Teens

Further Resources
​1. printable tipsheet for creating a healthy sleep routine.
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2. How to wake up earlier (and feel good about it).
Getting Help
If you are really struggling with your sleep, consider discussing with your parents, teachers, GP, or a psychologist with experience in sleep disorders who will be able to provide you with specific strategies.

Dr Jessica Tearne and Mr Paul Jeffery are Clinical Psychologists with training, enthusiasm and experience assisting children, adolescents and adults with Insomnia and other sleep difficulties. They also work with a broad range of concerns, including difficulties with anxiety, stress, trauma and low mood.
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Follow the steps below for 2 weeks and see if you become the early-bird you never thought you'd be.
We often help people who would like to get up earlier in the morning. This desire can be motivated by a number of things; fitting in exercise, making the morning routine before school/work less rushed, creating a more positive mindset to start the day, getting to work earlier or on time, or simply enjoying some quiet space in the day.


Even for people with a Night Owl Body Clock, it is usually possible to get up earlier and feel brighter in the morning, but it does take a little effort and commitment. 

1. Be clear on WHY you want to get up earlier and remind yourself of these motivations each day.
  • What advantages will an earlier rising time bring you?  - e.g. time for exercise, quiet time for meditation, reflection, journalling, or planning; reading the news, or creating a less frantic, more positive start to the day.  Getting up early shouldn’t feel like a punishment, but rather, an opportunity.

2. Work towards a CONSISTENT rising time.
  • Advance your rising time 15-30 minutes earlier every 1-2 days until your desired rising time has been reached. Then stick to this time like glue for 1-2 weeks, EVEN on WEEKENDS. This strategy may take some time, but the effects on your energy while you're making the adjustment will be minimal. Once you feel that you are waking easier in the mornings you can introduce a bit more flexibility (perhaps and extra 30-45 minutes in bed on the weekend).

3.Use an ALARM (at least initially).
  • Put the alarm across the room so you have to get out of bed to turn it off – then you are UP.
  • Minimise using the snooze button (any sleep you get in-between the snooze button is restless sleep, its better to have the alarm set for very close to the time you want to be up).
  • Choose an alarm sound that you like - many people find gentle music or nature sounds work well.

4. Have a detailed plan for the first 30 mins on waking. Consider what helps you to ‘wind-up’ into the day, something invigorating or that you look forward to. For example...,
  • Glass of water, stretch, clean teeth
  • Open curtains and make the bed
  • Straight into the shower on waking
  • Clothes laid out ready the night before for your morning exercise
  • A few push-ups/sit-ups to get the blood and oxygen flowing
  • Coffee machine/kettle on

5. Get some SUNLIGHT on waking, or other bright light (e.g. from light therapy glasses or a light box).
  • Bright light suppresses production of the sleep hormone melatonin and is very effective for training the body clock to wake earlier and helping us to feel brighter.
  • Get 30 minutes of bright light as soon as you can on waking. 

6. EVENING WIND DOWN. In the evening, dim the lights and limit close screen time (phone, computer, ipad). Bright light in the couple of hours before bed can suppress melatonin and make sleeping  more difficult. Make sure there is a buffer zone for relaxation between the business of the day and bedtime.

7. Remember that SLEEP INERTIA is normal and can last for 30-60 minutes.  Sleep inertia is when we feel groggy on waking, it’s a transitional state between sleep and wake. Food, drink, activity, and pleasant stimulation (eg uplifting music) may help. Flick your attention away from signs of tiredness – paying close attention to these will enhance feelings of fatigue and will make "I can't cope" thoughts more likely to appear. Instead, pay close attention to things such as what can you see, hear, smell, and taste.  

8. Make yourself ACCOUNTABLE .
  • Text your partner, friend or colleague to let them know what time you were up each morning. Or consider making a challenge with a friend and motivate each other each morning. Arrange to go for an exercise session or early breakfast with someone.
 
9. Remind yourself once again about why this is important to you, your life, or your loved ones……

For information on creating a sound sleep routine, see our printable tipsheet
Feel free to print out our tipsheet below....
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Good sleep can help us perform at our best, this is true for everyone, including elite athletes. Good sleep plays an important role in optimising performance and recovery outcomes across a range of sports.
 
Daniel Bonnar from Flinders University and Sleep Matters, has recently published the results of a research project, reviewing research on how interventions to improve sleep affect athletic performance and recovery.
 
The results are very interesting: The link is clear between sleep, performance and recovery, but interventions to maximise sleep in athletes require improvement
 
What we know about sleep and athletic performance
  • Total sleep deprivation (not sleeping at all on a given night) is linked to reduced performance.
  • A night or two of partial sleep deprivation (getting less sleep than usual) has minimal impact on strength and single bouts of aerobic exercise, but it does impair skill execution and submaximal, sustained exercise bouts.
  • In addition to physical impacts, poor sleep also impairs sport-related cognitive processes (eg. memory, decision making) and mood (with lower mood being linked to over-reaching and over-training).
  • Sleep aids physiological post-exercise recovery and has been suggested as the most important recovery mechanism.
 
   Whilst 7-9 hours sleep is suggested for healthy adults, 9-10hr is recommended for competitive athletes.
 
Difficulties with sleep faced by athletes
Sleep difficulty in athletes is surprisingly common:
  • During regular training periods due to late game or training times, caffeine use to assist post-exercise recovery, insomnia, or heavy training workload (overreaching).
  • During competitions, due to travel, unfamiliar sleeping environment, jet lag, and anxiety.
 
Sleep Interventions for athletes – what works?
1. Improving sleep routines (aka sleep hygiene)
  • Good sleep hygiene includes a regular wind-down period before bed, having a cool, dark, quiet sleep environment, turning off screens before bed time, and having a consistent sleep schedule. Research on the effectiveness of sleep hygiene alone is mixed, and larger, better designed studies are needed.
 
2. Post exercise recovery strategies
  • Studies have found that whole body cryotherapy (super cooling the whole body for 2-4 minutes) or red-light irradiation (to promote cell proliferation) is associated with improved sleep and performance.
 
3.Increasing sleep time and napping
  • Increasing sleep time (sleep extension) is the intervention with the strongest evidence-base for athletic performance. In one study, over a 6 week period, basket-ballers increased total sleep time from 6.6hr a night to 8.4hr a night and a significant improvement was found in sprint speed, shooting accuracy, and fatigue.
 
 
How to assist athlete’s sleep?
Recommendations arising from this important review paper emphasise that sleep interventions for athletes can be improved. Daniel and colleagues recommend that interventions should:
  • Be tailored.  For example with sleep hygiene recommendations it may be useful to develop individualised plans for each athlete depending on their pre-existing habits and sleep duration/quality.
  • Provide up to date, evidence-based education regarding sleep stages, sleep regulation, and 'normal sleep'.
  • Include not only athletes but also coaches and management staff.
  • Assess the athlete’s sleep and performance prior to and after the intervention. The use of sleep logs, questionnaires (the athlete sleep screening questionnaire), sport-specific outcome measures, and, where possible, objective measures of sleep such as actigraphy are encouraged.
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Sleep routines for children can change a great deal over the long summer holidays. Later nights, sleeping in, more variability and sleep-wake schedules, more screen time, less focus on a pre-bed wind down routine are some of the common changes.

While many kids and teens adjust easily to the school sleep routine, others may benefit from some structured adjustments to create a great routine around sleep. 

The week before school starts is a perfect time to bring some routine and normality back in preparation for the school year starting. Here's some suggestions:

1. Gradually shift the sleep routine. If your child needs to get up earlier and go to bed earlier during the school term, start by having them up out of bed earlier by 15-30 minutes each day this week. Parents are often tempted to get their kids into bed earlier as a first step. However, we find that advancing the morning rising time can be the best way to go initially, rather than enforcing an early bed time. Think of rising time as an anchor for the body clock; if you gradually advance the rising time, you will be able to time the bedtime earlier within a couple of days and the child will more easily be able to fall asleep. It is often the case that an enforced earlier bedtime straight away will be met with resistance and can make falling asleep difficult as the body clock is not used to sleeping at this early time straight away. 

2. Morning sunlight is a great way to advance the body clock (ie to make falling asleep and getting up happen at earlier times). In combination with tip 1, if you and the kids can have breakfast outside in sunlight or go for some morning exercise, this can really assist the process. Sunlight turns off melatonin production in the brain and helps us to wake up. The opposite applies in the evening- limit close screen time (tablets, phones) to less than an hour if possible.

3. Consistency. Once the correct bed time and rising time has been reached, keep it consistent even on the weekend. This will encourage the new timings to stick and to become more natural. 

4. Wind Down to create a buffer between the day and the night. Help your child to establish a wind down routine that encourages relaxation and sends a cue to the body and brain that sleep time is approaching. Reading to your child, or them engaging in silent reading is a great wind down. Colouring-in or quiet play may also be relaxing for your child.  Gentle music, or an audio book are other options. 

5. Create a helpful sleep space. Make sure your child's bedroom is cool, quiet, and dark. Ideally, no screens in the bedroom. 

6. Get the day right. Recipe for good sleep = active, happy, balanced days with good food and time outside.

If you've implemented the above but have a child that is still not sleeping well, or if implementing the above has been challenging, give Sleep Matters a call. Also see our other blogs on child and teen sleep.

Thanks for reading!
​The Sleep Matters team.
Printable copies of the above sleep tips here.
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We know that sleep is essential for health and wellbeing. Sleep supports the immune system, assists physical growth and repair, strengthens memory, and improves mood and wellbeing. Lack of sleep can contribute to feeling irritable, stressed and overwhelmed which are common experiences in our busy modern Christmases. 
 
It’s common for sleep to deteriorate during the festive period due to increased busyness and stress associated preparing food, buying presents, end of year work functions, completing work tasks before going on leave, kids being on holidays (while you’re still working), travel, entertaining guests, & increased financial pressure. Phew, it’s an exhausting list. 
 
Add in a large measure of alcohol and an increase in indulgent treats – and you have a time of year that isn’t the kindest on our bodies.
 
One recent survey suggested that stress related to Christmas is one of the biggest causes of lack of sleep at this time of year – and this is especially the case for women, with a third of women losing sleep because of festive stress.
 
So how can we respond to festive sleep-stressors in a helpful way? Read on......

Also see our tip-sheet for setting up a healthy sleep routine
Christmas Stress

When stressed, we produce cortisol and adrenaline, hormones that provide energy and help us function through stress. These hormones keep us alert so if they are around in great quantities, are not conducive to a good night’s sleep.

Especially when busy during the day, we’re prone to take our busyness to bed with us. We can feel fatigued before bed, but when the head hits the pillow, worrying thoughts, deadlines, and to-do lists pop up, and then cortisol and adrenaline floods in.

Daytime (not nighttime) is the time for thinking, planning, & worrying.
It's possible to train the mind to do it's thinking/planning, & worrying during the day and get it out of the bedroom. Try using a notebook or your phone during the day so that you can write down reminders and worries as they come up. Create 15 minutes a day to quietly sit, reflect, plan and problem solve. Or talk about what is on your mind with a friend or family member.  Revisit your notebook/phone list at this time.
 
At Sleep Matters, we find this 'thinking time' a helpful strategy for our clients. ‘Bottling up’ stress tends to lead to poor sleep.  If you are able to process worries during waking hours they are less likely to pop up whilst in bed at night. What’s more, if they do pop up at night, it can be easier to let go of them if you know you will come back to them during your thinking time the following day.

Stimulus control
If overthinking and stress does get the better of you overnight and you feel there’s no way you’ll be able to get back to sleep, we advise to get out of bed. This is an insomnia treatment technique called Stimulus Control. Get up out of bed and ask ‘what will help me wind down?’  It might be listening to a relaxation app, practicing some slow breathing, adding items to your list to organise the next day, reading a book, or doing a crossword. Once you notice that sleepiness has returned or that you are feeling calmer, return to bed.
Alcohol
Many of us enjoy a tipple or two at Christmas time, but alcohol can negatively impact our sleep. It changes the structure of sleep, so even if you get enough sleep hours, you won’t feel as refreshed when you wake up the next day. Further, getting up to the loo, or feeling dehydrated can be causes of sleep disruption. See our earlier blog post on the impact of alcohol on sleep.
 
  • ‘Knit one, pearl one’ when it comes to Christmas alcohol consumption. This means, have a glass of water in between every drink. And drink plenty of water before retiring to bed.
  • Avoid drinking on an empty stomach, Even an energy bar, nuts & fruit to help fill your stomach is better than no food at all.
  • Set a time for your last alcoholic drink. Ideally with a space between this drink and when you retire to bed. Tis will allow for a little more processing of alcohol before sleep.
Travel
The festive season is a time for travel for many.

Jet lag can be an issue for those traveling across time-zones. While there is no way to completely avoid jet lag, there are ways to overcome it faster, for example by moving your sleep schedule towards the new time zone before you travel.  I love to tell people about Jetlag Rooster – a great resource complete with calculators which can help people plan for traveling across time zones.  Taking short acting melatonin for a few days can also be very effective. 

Sleep is of course essential for people travelling long distances by car. If you feel sleepy whilst driving,  it’s crucial to stop and have a rest or short nap, or swap the driving with another passenger.
Naps

If you’ve travelled, are stressed, or have had a few late nights you may benefit from a short daytime nap to keep you going.

However, the guidelines around napping may surprise you. Keep naps short and early. We recommend naps to be less than 30 minutes and 7+ hours before the night-time sleep period. Most people find surprisingly good benefit from even a short nap like this. Check our our earlier blog post for more on naps. 
Finally, do your best to avoid over worrying about sleep

Remember that disturbed sleep for a night or two, or even a week won’t cause long-term harm – your body is resilient in the face of short term sleep loss.
 
Make sensible decisions about sleep but don’t 'over-worry' about it. Worry about sleep tends to make sleep much worse.

Click through for our tip-sheet on setting up a healthy sleep routine.
 
 
Melissa and the Sleep Matters team would like to wish you  a safe, happy, fun, and restful Christmas season!
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This year, researchers won a Nobel prize for their work on understanding the role of the body clock, aka circadian rhythm.  We have a master clock deep in the brain (the suprachiasmatic nuecleus to be exact) which controls the timing several bodily features such as body temperature, hunger, and sleepiness. Melatonin is an important hormone controlled by our body clock and it has a strong influence on when we feel sleepy and when we feel awake. Exposure to light is a strong factor that influences melatonin production and hence the timing of the body clock. 

Knowing whether you are a night owl or an early bird can help you to plan for when to sleep, and when you are likely to function at your best. Click through for more on this here


Night Owls - late to bed, late to rise 
Night owls find it easy to stay up late (often well beyond midnight) and often like to sleep in late the next day (beyond 10am).This is because melatonin is timed to increase later in the evening in these people, and the brain continues to produce melatonin later in to the morning, making rising early very difficult. These are not morning people and will describe feeling groggy on waking. They will lie awake in bed tossing and turning if they go to bed too early for their body clock. Teenagers often fit this pattern, so don't be too hard on them when they struggle out of bed in the morning. See an earlier blog post and management tips for this here.

The extreme form of being a night owl is called Delayed Sleep Phase and occurs when the person's body clock is timed too late to fit with their daily obligations - they might often be waking too late for school, university, work, or getting kids off to school.

Early Birds - early to bed, early to rise
Early birds are just the opposite. They fall asleep very easily in the evening (often before 10pm) and wake up easily in the morning (before 6am, but sometimes as early as 3 or 4am). It is common for the human body clock to advance earlier through the lifespan, with more over 60's fitting the advanced sleep phase pattern than their younger counterparts.

The extreme for of being an early bird is called Advanced Sleep Phase and occurs when the person's body clock is timed too early to fit with their daily obligations. These people often don't feel they are getting enough sleep due to their early wakings. Further it can be difficult for them to work or socialise in the vening due to feeling sleepy. ​
Are Circadian Rhythm Disorders harmful?
In themselves, circadian rhythm disorders are not necessarily dangerous or unhealthy. Some sufferers are able to achieve the correct amount of sleep if their family and work routines allow them to go to bed and get up at times that fit their body clocks. If however, the circadian rhythm regularly prevents the person from achieving a healthy amount of sleep, unwanted consequences can occur.

Is it possible to shift the body clock?
Yes, for most people it is possible. If you need to wake earlier or stay up later, the body can usually be trained. Recovering from jet-lag is a good example of shifting the body clock - training it to match a new time zone.

Bright light therapy and careful timing of bed times, rising times, and daily activities such as meals and exercise can be effective in altering the timing of the body clock and treating circadian rhythm disruptions. Please feel free to call Sleep Matters to discuss. 
 Are you a night owl or an early bird?
Follow this link for a quiz that will tell you if you're a night owl or early bird.  
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This year, the first Nobel Prize in the area of sleep science was won. The prize was based on important research that improves understanding of how the body clock (circadian rhythm) influences our body & mind - including why we feel so awful when we are jet lagged.

At Sleep Matters, the body clock is one of the three factors we assist people with to get their sleep on track. Read our earlier blog for more on this. 

Regular rising time and morning sunlight looks after the body clock and can make a really positive difference to sleep and energy levels.

Read more about the research here.

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Having trouble with your sleep?
 
The University of Western Australia, in collaboration with The Australia Alzheimer’s Research Foundation, is offering a scientifically-supported sleep training program to adults aged 60 and over.  This program is part of a research project looking at the relationship between sleep and thinking skills.  It provides training in coping skills to improve sleep quality and quantity over 7 individual and group meetings between November and February.  In addition, you will be provided with a comprehensive evaluation of thinking skills, and of your sleep in the sleep lab at UWA.  There is a minimal cost to participants (less than $20 per session) for the training session to defray expenses. However, for the testing of thinking skills sessions we provide $15.00 to cover your travel costs.  If interested please contact us at 6457 0264 to see if you are eligible.
 
This study is approved by the University of Western Australia Human Research Ethics Committee (Ref: RA/4/1/7799)
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Dr Melissa Ree from Sleep Matters is part of a team from the University of Western Australia who have implemented a sleep clinic within the north metro mental health service. We're delighted to announce that this service has recently been awarded a high commendation from the Australian Council of Healthcare Standards (ACHS).

So many people with mental health problems also suffer with poor sleep which often remains untreated. We know that poor sleep has a negative impact on wellbeing and mental health symptoms (depression, anxiety, psychosis). The clinic provides access to a brief (3 session) sleep therapy intervention for sleep problems occurring in the context of mental illness (insomnia, nightmares, hypersomnia). Cognitive Behavioural principles were the basis of the therapy intervention.

Results showed that the program improved sleep, depression, anxiety, psychotic symptoms and well-being.

See also the recently published clinical guidebook developed by the team. 

​Please contact us if you are interested in this evidence-based program for your health facility. 
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