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Insomniacs Are Helped by Online Therapy, Study Finds

The same digital screens that have helped nurture a generation of insomniacs can also help restore regular sleep,
researchers reported on Wednesday. In a new study, more than half of chronic insomniacs who used an automated
online therapy program reported improvement within weeks and were sleeping normally a year later.
The new report, published in the journal JAMA Psychiatry, is the most comprehensive to date suggesting that many
garden-variety insomniacs could benefit from the gold standard treatment cognitive behavior therapy without
ever having to talk to a therapist. At least one in 10 adults has diagnosable insomnia, which is defined as broken,
irregular, inadequate slumber at least three nights a week for three months running or longer.
Ive been an insomniac all my life, Ive tried about everything, said Dale Love Callon, 70, known as Dacie, a math
tutor living in Rancho Palos Verdes, Calif., who recently used the software. I dont have it 100 percent conquered,
but Im sleeping much better now.
Previous studies have found that online sleep therapy can be effective, but most have been smaller, or focused on a
particular sleep-related problem, like depression. The new trial tested the digital therapy in a broad, diverse group of
longtime insomniacs whose main complaint was lack of sleep. Most had used medication or supplements over the
years, and some still did.
These results suggest that there are a group of patients who can benefit without the need of a high-intensity
intervention, like face-to-face therapy, said Jack Edinger, a professor in the department of medicine at National
Jewish Health in Denver, who was not a part of the study. We dont know yet exactly who they are the people who
volunteer for a study like this in first place are self-motivated but theyre out there.
In the study, led by researchers at the University of Virginia, doctors recruited 303 people ages 21 to 65 over the
internet. Half were randomly assigned to receive education and advice on insomnia a digital placebo, of sorts,
though an active one, in that such advice often helps people sleep better. The other half got a six-week focused online
therapy product, called SHUTi.
Some of the researchers, as well as the university, have a stake in this product, which costs $135 for 16 weeks of
access. None of those connected to the company analyzed the data or had access to it, or participated in the data
analysis, said Lee Ritterband, the lead author and a developer of the online therapy.
SHUTi is not the only digital insomnia therapy product on the market. Sleepio, which costs $300 for a years access,
and is offered by a London-based company, also incorporates cognitive therapy. And it was also found in a
randomized study to have good results.
Both incorporate the techniques of cognitive behavior therapy for insomnia, an approach therapists have been using
successfully for years. Some of those techniques date back decades. One is called sleep restriction, in which people set
a regular sleep window and work to stick to it. Another is called stimulus control, an attempt to break the association
between lying in bed and activities like streaming video and eating.

Finally, the therapy aims to undermine self-defeating assumptions about sleep, like Without a good nights sleep, I
cant function the next day or Medication is probably the only solution to sleeplessness. The program prompts
people to log in daily and record each nights sleep in some detail; it then tailors weekly sessions based on those
Ms. Love Callons problem, for example, still wakes up in the middle of the night, at 4 a.m. or thereabouts. The online
program, she said, instructed her to get out of bed when that happened, and sit and read for 40 minutes which is
more likely to induce sleepiness than, say, shopping online. And it has worked, she said. I get drowsy while
reading and have been able to go back to bed and fall asleep.
The research team tracked the participants, assessing their sleep quality every several months, using standardized
questionnaires. After a year, 57 percent of the people using the online therapy program were sleeping normally,
compared with 27 percent of those who had gotten only advice and education.
We continued to see improvement from the six-month assessment through the end of the year, even though people
had stopped using the program, Dr. Ritterband said. So, thats a very good sign.
According to Dr. John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center
and Harvard Medical School, there are about a dozen online programs on the market using cognitive behavior therapy
techniques for a variety of conditions, including depression which also have rigorous evidence behind them.
There are maybe ten thousand or so mental apps out there, and the number is increasing way faster than the evidence
base, Dr. Torous said, so its good to see someone doing careful studies.
Dr. Torous said the one caveat for all of them is adherence. When you stop paying people to be in a study, when they
stop getting reminder phone calls, they often stop doing it, he said. Its like a gym membership that way; people
may do it twice and then let it go.
Nonetheless, the potential of online therapies to reach huge numbers of people makes it likely that they will become
first-line therapy in many cases, some experts say.
Despite reasons for restraint, it seems inevitable that internet CBT-I will be increasingly used as a first-line insomnia
intervention, concluded an editorial accompanying the study in the journal. It also seems likely that the medical
community may have little influence on whether, when, and how this occurs.

1. Nowadays there are different online therapies that can help people to stop their
insomnia and for o a big part of them, this method is successful and they started to
sleep well.


A new study says that more than half of chronic insomniacs who used an online
therapy program reported improvement in some weeks and then sleep normally.
b. There are a lot of the digital psychiatry program that can help the insomniacs, like
SHUTi, Sleepio and others, and their number is increasing fast.
c. Near 60 percent of people who participate in this online therapy programs were
sleeping better after a year, in comparison with 27 percent who had gotten only
professional advices.


An interesting point of this article is Cognitive behavioral therapy (CBT) that includes behavioral
changes, in fact is an approved method for treating insomnia without the use of sleeping pills. CBT-I is a
safe and effective means of managing chronic insomnia and its effects. Cognitive behavioral therapy for
insomnia includes regular, often weekly, visits to a clinician, who will give you a series of sleep
assessments, ask you to complete a sleep diary and work with you in sessions to help you change the way
you sleep. After the treatment, most of the people had improved sleep quality.


To Keep Teenagers Alert, Schools Let Them Sleep In

COLUMBIA, Mo. Jilly Dos Santos really did try to get to school on time. She set three successive alarms on her
phone. Skipped breakfast. Hastily applied makeup while her fuming father drove. But last year she rarely made it into
the frantic scrum at the doors of Rock Bridge High School here by the first bell, at 7:50 a.m.
Then she heard that the school board was about to make the day start even earlier, at 7:20 a.m. I thought, if that
happens, I will die, recalled Jilly, 17. I will drop out of school!
That was when the sleep-deprived teenager turned into a sleep activist. She was determined to convince the board of a
truth she knew in the core of her tired, lanky body: Teenagers are developmentally driven to be late to bed, late to rise.
Could the board realign the first bell with that biological reality?
The sputtering, nearly 20-year movement to start high schools later has recently gained momentum in communities
like this one, as hundreds of schools in dozens of districts across the country have bowed to the accumulating
research on the adolescent body clock.
In just the last two years, high schools in Long Beach, Calif.; Stillwater, Okla.; Decatur, Ga.;, and Glens Falls, N.Y.,
have pushed back their first bells, joining early adopters in Connecticut, North Carolina, Kentucky and Minnesota.
The Seattle school board will vote this month on whether to pursue the issue. The superintendent of Montgomery
County, Md., supports the shift, and the school board for Fairfax County, Va., is working with consultants to develop
options for starts after 8 a.m.
New evidence suggests that later high school starts have widespread benefits. Researchers at the University of
Minnesota, funded by the Centers for Disease Control and Prevention, studied eight high schools in three states before
and after they moved to later start times in recent years. In results released Wednesday they found that the later a
schools start time, the better off the students were on many measures, including mental health, car crash rates,
attendance and, in some schools, grades and standardized test scores.
Dr. Elizabeth Miller, chief of adolescent medicine at Childrens Hospital of Pittsburgh, who was not involved in the
research, noted that the study was not a randomized controlled trial, which would have compared schools that had
changed times with similar schools that had not. But she said its methods were pragmatic and its findings promising.
Even schools with limited resources can make this one policy change with what appears to be benefits for their
students, Dr. Miller said.
Researchers have found that during adolescence, as hormones surge and the brain develops, teenagers who regularly
sleep eight to nine hours a night learn better and are less likely to be tardy, get in fights or sustain athletic injuries.
Sleeping well can also help moderate their tendency toward impulsive or risky decision-making.
During puberty, teenagers have a later release of the sleep hormone melatonin, which means they tend not to feel
drowsy until around 11 p.m. That inclination can be further delayed by the stimulating blue light from electronic

devices, which tricks the brain into sensing wakeful daylight, slowing the release of melatonin and the onset of sleep.
The Minnesota study noted that 88 percent of the students kept a cellphone in their bedroom.
But many parents, and some students, object to shifting the start of the day later. They say doing so makes sports
practices end late, jeopardizes student jobs, bites into time for homework and extracurricular activities, and upsets the
morning routine for working parents and younger children. At heart, though, experts say, the resistance is driven by
skepticism about the primacy of sleep.
Its still a badge of honor to get five hours of sleep, said Dr. Judith Owens, a sleep expert at the Childrens National
Medical Center in Washington. It supposedly means youre working harder, and thats a good thing. So there has to
be a cultural shift around sleep.
Last January, Jilly decided she would try to make that change happen in the Columbia school district, which sprawls
across 300 square miles of flatland, with 18,000 students and 458 bus routes. But before she could make the case for a
later bell, she had to show why an earlier one just would not do.
She got the idea in her team-taught Advanced Placement world history class, which explores the role of leadership.
Students were urged to find a contemporary topic that ignited their passion. One morning, the teachers mentioned that
a school board committee had recommended an earlier start time to solve logistical problems in scheduling bus routes.
The issue would be discussed at a school board hearing in five days. If you do not like it, the teachers said, do
Jilly did the ugly math: A first bell at 7:20 a.m. meant she would have to wake up at 6 a.m.She had found her passion.
She seemed an unlikely choice to halt what was almost a done deal. She was just a sophomore, and did not
particularly relish conflict. But Jilly, the youngest of seven children, had learned to be independent early on: Her
mother died when she was 9.
And she is energetic and forthright. That year, she had interned on a voter turnout drive for Missouri Democrats,
volunteered in a French-immersion prekindergarten class, written for the student newspaper, worked at a fast-food
pizza restaurant and maintained an A average in French, Spanish and Latin.
Its about time management, she explained one recent afternoon, curled up in an armchair at home.
That Wednesday, she pulled an all-nighter. She created a Facebook page and set up a Twitter account, alerting
hundreds of students about the school board meeting: Be there to have a say in your school districts decisions on
school start times!
She then got in touch with Start School Later, a nonprofit group that provided her with scientific ammunition. She
recruited friends and divided up sleep-research topics. With a blast of emails, she tried to enlist the help of every high
school teacher in the district. She started an online petition.
The students she organized made hundreds of posters and fliers, and posted advice on Twitter: If you are going to be
attending the board meeting tomorrow we recommend that you dress up!
The testy school board meeting that Monday was packed. Jilly, wearing a demure, ruffled white blouse and skirt,
addressed the board, blinking owl-like. The dignitaries faces were a blur to her because while nervously rubbing her
eyes, she had removed her contact lenses. But she spoke coolly about the adolescent sleep cycle: You know, kids
dont want to get up, she said. I know I dont. Biologically, weve looked into that. The board heatedly debated the
issue and decided against the earlier start time.

The next day Jilly turned to campaigning for a later start time, joining a movement that has been gaining support. A
2011 report by the Brookings Institution recommended later start times for high schools, and last summer Arne
Duncan, the secretary of education, posted his endorsement of the idea on Twitter.476
Should high schools adjust their start times out of concern for students health? How would any changes impact your
familys schedule? Join in the discussion.
The University of Minnesota study tracked 9,000 high school students in five districts in Colorado, Wyoming and
Minnesota before and after schools shifted start times. In those that originally started at 7:30 a.m., only a third of
students said they were able to get eight or more hours of sleep. Students who got less than that reported significantly
more symptoms of depression, and greater use of caffeine, alcohol and illegal drugs than better-rested peers.
Its biological the mental health outcomes were identical from inner-city kids and affluent kids, said Kyla
Wahlstrom, a professor of educational research at the University of Minnesota and the lead author of the study.
In schools that now start at 8:35 a.m., nearly 60 percent of students reported getting eight hours of sleep nightly.
In 2012, the high school in Jackson, Wyo., moved the first bell to 8:55 a.m. from 7:35 a.m. During that academic year,
car crashes by drivers 16 to 18 years old dropped to seven from 23 the year before. Academic results improved,
though not across the board.
After high schools in the South Washington County district, outside Minneapolis, switched to an 8:35 a.m. start,
grades in some first- and third-period classes rose between half a point and a full grade point. And the study found that
composite scores on national tests such as the ACT rose significantly in two of the five districts.
Many researchers say that quality sleep directly affects learning because people store new facts during deep-sleep
cycles. During the rapid-eye-movement phases, the brain is wildly active, sorting and categorizing the days data.
The more sleep a teenager gets, the better the information is absorbed.
Without enough sleep, said Jessica Payne, a sleep researcher and assistant professor of psychology at the University
of Notre Dame, teenagers are losing the ability not only to solidify information but to transform and restructure it,
extracting inferences and insights into problems.
Last February, the school board in Columbia met to consider later start times. It is really reassuring to know that
students can have a say in the matter, Jilly told them. So thank you, guys, for that.
The moment of decision arrived at the boards next meeting in March. Jilly sat in the front row, posting on Twitter, and
addressed the board one last time. I know its not the most conventional thing and its going to get some pushback,
she said, referring to the later time. But it is the right decision. The board voted, 6 to 1, to push back the high school
start time to 9 a.m. Jilly kicked it over the edge for us, said Chris Belcher, the superintendent.
It is now seven months into the new normal. At Rock Bridge High School, the later end to the day, at 4:05 p.m., is
problematic for some, including athletes who often miss the last period to make their away games. After doing
homework, it gets to be 11:30 p.m. pretty quickly, said Brayden Parker, a senior varsity football player. I would
prefer to get home by dark and have more time to chill out.
The high schools in the district have tried to adjust, for example by adding Wi-Fi access to buses so athletes can do
homework on the road. Some classes meet only one or two days a week, and are supplemented with online instruction.
More sports practices and clubs convene before school.
Some parents and first-period teachers are seeing a payoff in students who are more rested and alert.At 7:45 a.m. on a
recent school day, Rock Bridge High, a long, one-story building with skylights and wide hallways, was sun-drenched
and almost silent.

Then, like an orchestra tuning up, students gradually started arriving, some for debate club and choir, others to meet in
the cafeteria for breakfast and gossip. Laughter crackled across the lobby, as buses dropped off more students, and
others drifted in from the parking lots. The growing crowds could almost be described as civilized.
At 8:53 a.m., Jilly burst through the north entrance door, long hair uncombed and flyaway, wearing no makeup,
lugging her backpack. Even when I am late to school now, she said, dashing down a corridor to make that 8:55 bell,
its only by three or four minutes.

1. The main idea of this article is that many schools have an early first bell ring and a lot of children
disagree that, together with the heroine of this paper-Jilly who tries to change this and makes the day
start later because this has a good influence on students.
A. The quality sleep has an important impact on learning because people store new information
during deep-sleep cycles.
B. Adolescents who regularly sleep eight to nine hours per night, learn better and this moderate
their tendency toward impulsive and risky decision-making. Without sleep they are losing the ability
not only to understand information but to transform and restructure it in another way
C. Jilly got what he wanted and the high school start time to 9 a.m.
3. Teenagers have a later release of the sleep hormone melatonin.
Melatonin is the hormone that plays a crucial role in the health of the body and in a normal circadian
rhythm. Imbalances in the production of melatonin can cause devastating effects like depression and
life expectancy diminished. his can be caused by stimulating blue light from electronic devices,
which slowing the release of melatonin and the onset of sleep. The Minnesota study noted that 88
percent of the students kept a cellphone in their bedroom and near their head what provoke a bad
sleeping and a diseased condition of the body.


How to Get a Better Night's Sleep

Most people know they need to eat right and exercise to be healthy. But what about sleep? We spend about onethird of our lives asleep, and sleep is essential to better health. But many of us are struggling with sleep. Four out
of five people say that they suffer from sleep problems at least once a week and wake up feeling exhausted. So
how do you become a more successful sleeper? Grab a pillow, curl up and keep reading to find out.

How Much Sleep Do You Really Need?

If you wake up tired, chances are youre not getting enough sleep. These strategies may help you determine your
sleep needs.
The best person to determine how much sleep you need is you. If you feel tired, you probably need more sleep. But
science does offer some more specific guidance. People who sleep seven hours a night are healthier and live
longer. Sleeping less than seven hours is associated with a range of health problems including obesity, heart disease,
depression and impaired immune function. But sleep needs vary greatly by individual. Age, genetics, lifestyle and
environment all play a role. The National Sleep Foundation recently updated its sleep recommendations based on age.

While these numbers are useful guidelines, they really dont tell you anything about your individual sleep needs,
which are largely determined by genetics and strongly influenced by your habits.
This simple question is the best way to determine if youre getting adequate sleep. If you often feel tired at work, long
for a nap or fall asleep on your morning or evening commute, your body is telling you that its not getting enough
sleep. If youre getting seven or eight hours of sleep a night but still feeling tired and sleep-deprived, you may be
suffering from interrupted sleep or a sleep disorder and may need to talk to a doctor and undergo a sleep study.
Even if you think youre getting enough sleep, you may be surprised once you see your sleep patterns in black and
white. Some of the new activity trackers will monitor your sleep patterns for you, but you can also do it easily
yourself. For the next week, keep a sleep diary:
1. Write down the time you go to bed and the hour you wake up.
2. Determine the total number of hours you sleep. Note whether you took naps or woke up in the middle of the night.
3. Note how you felt in the morning. Refreshed and ready to conquer the world? Or groggy and fatigued?
Try it yourself: Download and print our sleep diary worksheet.
Not only will a sleep diary will give you important insights into your sleep habits, but it will be useful to your doctor if
you think you are suffering from a sleep disorder.
Want to really identify your individual sleep needs? Try this sleep vacation experiment. To do this, you will need
two weeks when you dont have somewhere to be at a specific time in the morning. If you have a flexible job, you can
do this any time, or you may have to wait until a vacation.

The experiment requires a little discipline:
1. Pick the same bedtime every night.
2. Turn off your alarm.
3. Record the time you wake up.
Chances are, you will sleep longer during the first few days, because you are catching up on lost sleep, so the first few
days of data wont be useful. But over the course of a few weeks, if you stick to the scheduled bedtime and allow
yourself to wake up naturally, youll begin to see a pattern emerge of how many hours of sleep your body needs each
Once you determine your natural sleep needs, think about the time you need to wake up to get to work or school on
time and pick a bedtime that allows you enough sleep to wake up naturally.

Morning Lark or Night Owl?

Do you pop out of bed bright and early, ready to take on the world? Or do you find yourself making friends with
the snooze button after staying up all night?
Do you wake up hungry? Whats your best time of day? Those and other questions are part of a test commonly used
by sleep experts to determine whether you are a lark, a night owl or somewhere in between.
You can take this quiz to find out what type of person you are.
Like most creatures on earth, humans come equipped with a circadian clock, a roughly 24-hour internal timer that
keeps our sleep patterns in sync with our planet at least until genetics, age and our personal habits get in the way.
Even though the average adult needs eight hours of sleep per night, there are so-called shortsleepers, who need far
less, and morning people, who, research shows, often come from families of other morning people. Then theres the
rest of us, who rely on alarm clocks.
For those who fantasize about greeting the dawn with a smile, there is hope. With a little focus, discipline and
patience, you have the ability to reset your own internal clock. But be warned, its not easy. Changing your sleep
pattern requires commitment, and it means changing old habits. No more TV-watching marathons late into the night.
Changing your internal sleep clock requires inducing a sort of jet lag without leaving your time zone, and sticking it
out until your body clock resets itself. And, most importantly, not resetting it again.
Heres how to become more of a morning person.
Step 1: Set a goal for your wake-up time.

Step 2: Move your current wake-up time by 20 minutes each day. For example, if you regularly rise at 8 a.m., but
really want to get moving at 6 a.m., set the alarm for 7:40 a.m. on Monday. On Tuesday, set it for 7:20 a.m. and so on
until you are setting your alarm for 6 a.m.
Step 3: Go to bed when you are tired. Avoid extra light exposure from computers or televisions as you near bedtime.
Step 4: When your alarm goes off in the morning, dont linger in bed. Hit yourself with light open your shades,
turn on the lamp.
Step 5: Go to bed a little earlier the next night. In theory, you should get sleepy about 20 minutes earlier each night.
A word of warning: While this method works for many, it doesnt work for everyone. Very early risers and longtime
night owls have a hard time ever changing.
If you are struggling to wake up in the morning, sleep experts suggest a few simple ways to train your body.
Buy a Louder Alarm: It may sound silly, but if you regularly sleep through your alarm, you may need a different
alarm. If you use your phone alarm, change up the ring tone and set the volume on high.
Sunlight: One of the most powerful cues to wake up the brain is sunlight. Leaving your blinds open so the sun shines
in will help you wake up sooner if you regularly sleep late into the day.
Eat Breakfast: Eating breakfast every day will train your body to expect it and help get you in sync with the morning.
If youve ever flown across time zones, youll notice that airlines often serve scrambled eggs and other breakfast
foods to help passengers adjust to the new time zone.
Dont Blow It on the Weekend: Besides computer screens, the biggest saboteur for an aspiring morning person is the
weekend. Staying up later on Friday or sleeping in on Saturday sends the brain an entirely new set of scheduling
priorities, so by Monday, a 6 a.m. alarm may feel like 4 a.m. Its tough, but stick to your good sleep habits, even on the
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Sick and Tired

Tired people are not happy, healthy or safe. Here are some of the things that go wrong when you dont get
enough sleep.


People who get less than seven hours of sleep a night are more likely to have chronic health problems like obesity,
heart disease, diabetes, high blood pressure, stroke, depression and premature death.
While the long-term health risks of bad sleep are enough to keep you awake at night, theres more bad news. Youre
also more likely to catch a cold. In one surprising study, researchers found 164 men and women who were willing to
take nose drops that exposed them to the cold virus. (And thats not the most surprising part of the story.) You might

think that everyone who willingly puts a cold virus in their nose would get sick, but they dont. A healthy immune
system can fight off a cold. But not a sleep-deprived immune system. The people most likely to get sick from the
cold-infused nose drops? Those who got six or fewer hours of sleep.
A tired brain is not a wise brain, and people who are sleep deprived make more mistakes. The American Insomnia
Survey, published in 2012, estimated that 274,000 workplace accidents were directly related to sleep problems. The
bill for these sleep-deprived mistakes? $31 billion annually.
Why does this happen? While the body goes into rest mode during sleep, the brain becomes highly active. Think of
your brain like a computer or a smartphone that uses the nighttime to back up all your data. One of its big jobs
is to consolidate memories, link with old memories and create paths for you to retrieve memories. It also forms
connections between disparate thoughts and ideas. Thats why sometimes, when you wake up, a big idea suddenly
pops into your head. And its why, when you dont sleep, your thinking and memory are fuzzy. Some research
suggests that when you dont sleep (like when students pull an all-nighter), your ability to learn new information drops
by almost half.
Another important function of sleep is that it allows the brain to do some mental housekeeping. Yes, sleep helps you
clean up the cerebellum, polish the parietal and flush the frontal lobe. Sleep cleans out the toxic junk in your
brain. In mouse studies,researchers found that during sleep, the space between brain cells gets bigger, allowing the
brain to flush out toxins. While more study is needed, the research suggests that not sleeping can allow toxins to
accumulate and may be linked with brain diseases like Parkinsons and Alzheimers.
Drowsy driving is as much of a safety risk as drunk driving or texting and driving. Studies show that going without
sleep for 20 to 21 hours and then getting behind the wheel is comparable to having a blood alcohol level of about .08
percent, the legal limit in most states. If youre awake for 24 hours and then try to drive, youre at a blood alcohol
equivalent of 0.1 percent, which is higher than the legal limit in all states.
You are at risk for drowsy driving if you get less than six hours of sleep at night. Another risk factor is snoring.
Snorers also are at risk for drowsy driving because snoring is a sign of sleep apnea and interrupted sleep. (See our
section below, Call a Doctor, for more on sleep apnea.)
In 2009, an estimated 730 deadly motor vehicle accidents involved a driver who was either sleepy or dozing off, and
an additional 30,000 crashes that were nonfatal involved a drowsy driver. Accidents involving sleepy drivers are more
likely to be deadly or cause injuries, in part because people who fall asleep at the wheel either fail to hit their brakes or
veer off the road before crashing.
Groggy drivers often blast the radio or roll down the window to stay awake, but those measures dont really work, say
experts. Coffee or a caffeinated drink may help, but some individuals dont get much of an effect. The best advice if
you find yourself sleepy at the wheel: Pull over for a quick cat nap.
For years researchers have known that adults who sleep less than five or six hours a night are at higher risk of being
overweight. Among children, sleeping less than 10 hours a night is associated with weight gain. Some research even
shows that losing just a few hours of sleep a few nights in a row can lead to almost immediate weight gain.

Part of the reason may be that sleep-deprived people eat more. Staying up late and skimping on sleep leads to more
eating in general, and a hankering for carbohydrates.In one study, sleep-deprived eaters ended up eating more
calories during after-dinner snacking than in any other meal during the day. By the end of the first week the sleepdeprived subjects had gained an average of about two pounds. Over all, people consumed 6 percent more calories
when they got too little sleep. Once they started sleeping more, they began eating more healthfully, consuming fewer
carbohydrates and fats.

Sleep Habits
The first step toward better sleep is better sleep hygiene daily habits that train your body for sleep.


Like most creatures on earth, humans come equipped with a circadian clock, a roughly 24-hour internal timer that
keeps our sleep patterns in sync with our planet. At least until our personal habits get in the way.
Here are the key factors that matter for your sleep hygiene:
Bedtime: Go to bed at about the same time every night, including weekends.
Dont Sleep In: Keep your wake-up time consistent. Dont sleep in on the weekends.
Naps: Avoid naps. If you must take a nap, set the alarm so you dont sleep for more than an hour. Dont take a nap
after 3 p.m.
Keep to a Schedule: Schedules arent just about bedtime and wake-up time. It also means eating your meals, taking
medications, exercise and even watching television should occur about the same time every day to keep your body
clock in sync.
Avoid Screens: Turn off the tablet, the television and the phone. The blue light in your screen has the same effect on
your brain as sunlight, which means it wakes you up just when you want to be drifting off.
Think Spa Bedroom: Make your bedroom a pleasant, peaceful and relaxing getaway. Get rid of exercise equipment,
televisions, small children, etc.
Beds Are for Sleep and Romance: Dont use the bed for watching television, talking on the phone, doing homework
or eating and drinking.
Work Out Early: Strenuous exercise is not a good idea right before bedtime. Try yoga.
No Night Eating: Dont eat meals close to bedtime and avoid evening and late night snacking. If your body is
churning through a big meal, its certainly not going to get the rest it needs. And if youre overweight or prone to
digestion problems, youre likely to experience painful heartburn and reflux if you binge too close to bedtime.
Catch Some Morning Rays: Sunlight keeps your internal clock ticking. Go outside as soon as you wake up and
spend at least 15 minutes in the morning sun. (And if its a hot sun, use sunscreen.)

Keep It Cool: Cool bodies sleep better, but most people keep their bedrooms too warm at night, which can interfere
with sleep. Taking a hot bath before bedtime is a good idea, because once you get out of the bath, your body cools
down more quickly, which will help you drift off to sleep.

Call a Doctor
If you have adopted better sleeping habits and you are still suffering from chronic sleepiness, you may need to
see a doctor.
More than 40 million Americans suffer from chronic, long-term sleep disorders, and an additional 20 million report
sleeping problems occasionally, according to the National Institutes of Health. Here are some of the medical reasons
people are losing sleep at night.
Insomnia: If you regularly have trouble with falling asleep, staying asleep or waking too early, you suffer from
insomnia. Treatment includes behavioral therapy, strict sleep hygiene and medication.
Sleep Apnea: If you suffer from excessive daytime sleepiness, the cause may be sleep apnea. A person typically
doesnt know he or she has sleep apnea, and is usually alerted to the problem by a bed partner who must cope with the
loud snoring, snorts and gasps that are often associated with the disorder. A person with sleep apnea experiences
pauses in breathing while sleeping. These pauses can last for seconds to minutes and occur dozens of times in an hour.
Breathing restarts with a gasp, a choking sound or a snort. When this occurs, a person may not wake up, but he or she
moves from deep sleep to light sleep, and wakes feeling tired and fatigued.
Sleep apnea is unpleasant for a bed partner, and its risky to your health. If you think you have it, see a doctor.
Restless Legs Syndrome: An estimated 8 percent of the population has restless legs syndrome, a neurological
condition. There are four basic symptoms that occur with R.L.S.:
1. A strong urge to move your legs, sometimes accompanied by a burning sensation.
2. Your symptoms are worse when you body is at rest.
3. Symptoms improve when you move.
4. Symptoms are worse at night.
Anxiety: Anxiety can interfere with sleep. And feeling sleep-deprived can cause anxiety. Most psychiatric disorders
are linked with some type of sleep problem. And people with chronic insomnia are at risk for anxiety disorders.
Hot Flashes: Hot flashes arent limited to the daytime, and at night they can disrupt sleep and leave a menopausal
woman soaked in her own sweat, causing her discomfort or waking her up enough to prompt her to change clothes and
try to go back to bed. Hormone treatments and antidepressants may help, or a woman can just gut it out and hope she
is not a superflasher.
If you suffer from a chronic sleep problem or suspect you have sleep apnea, your doctor may order a sleep study.
There are three types of sleep studies.

Polysomnogram: This study, called a PSG, is requires an overnight stay at the sleep lab. Patients are fitted with
sensors and then allowed to sleep. During the night the study will record brain activity, heart rate, blood pressure,
oxygen levels, body movements and more.
Multiple Sleep Latency Test: An M.S.L.T. sleep study is performed during the day and measures daytime sleepiness.
Patients are given opportunities to nap for 20 minutes every few hours while your brain and eye movements are
Maintenance of Wakefulness Test: The M.W.T. is a daytime sleep study that measures alertness and your ability to stay
awake. Its used to assess sleep issues in a person where sleepiness is a safety issue, like a bus driver or train operator.
Sleep studies are a strange experience. Wires and electrodes are placed on your scalp and face, near the eyes and chin
to detect eye movements and chin movements caused by teeth grinding. Elastic belts may be placed around your chest
and stomach to measure breathing. A tube may be placed in the nose to measure breathing, and electrodes placed on
the legs to measure leg movement. EKG monitors are used to measure heart rate and a small microphone is placed on
the throat to detect snoring. While it sounds impossible to sleep under these conditions, most of the people who need a
sleep study eventually fall asleep at least long enough for the technicians to gather the data they need.
In addition to adopting healthy sleep habits, a number of other strategies are available to improve your sleep.

The relationship between exercise and better sleep is a bit complicated. Vigorous exercise before bedtime can wake up
the body, not put it to sleep. But research shows that regular exercise may lead to better sleep. The key here is regular.
One or two workouts may make you physically tired, but thats unlikely to lead to better sleep. But regular exercise
appears to create a gradual improvement in sleep. In one study it took four months for exercisers to see an
improvement in sleep, but the change was remarkable. Exercisers eventually gained at least 45 minutes of extra sleep
a night a much better result than many people get with drug treatments. The lesson: If you have insomnia and
dont exercise, start.
Some sleep problems are due to anxiety and stress, so calming the mind leads to better sleep. If youre having trouble
sleeping, try meditation, either on your own or by downloading an app. You can learn more about meditation from
the Well Meditation Guide.
Melatonin, a hormone, is sold as a dietary supplement and is a popular alternative remedy for sleep problems. In
general, melatonin works to relieve jet lag, but offers only modest benefits for insomnia. A 2013 analysis that
looked at 19 randomized controlled trials involving 1,683 subjects determined that on average, melatonin reduced the
amount of time it took to fall asleep by seven minutes when compared with placebos and increased total sleep time by
eight minutes.

Sleeping pills can be a useful tool for helping people get better sleep during a difficult time, such as the death of a
loved one or a stressful job change. But in general, doctors dont view sleep medication as a long-term
solution. Regular use can result in dependency and weird side effects. In addition to sleepwalking, there have been
reports of sleep-driving, sleep-eating and sleep-shopping. While the pills can be an essential treatment for people with
head injuries and serious sleep issues, most people are better off trying non-drug treatments like relaxation techniques,
cognitive behavioral therapy or exercise.
Several medical organizations have endorsed a treatment known as cognitive behavioral therapy for insomnia or
C.B.T.-I. In May, the American College of Physicians advised its members that C.B.T.-I. was the first treatment they
should offer patients with insomnia. The key element of cognitive behavioral therapy is cognitive restructuring, which
challenges you to reframe negative ways of thinking that can become their own self-fulfilling prophecies. So if youre
lying awake thinking about what a basket case youll be tomorrow because youre not asleep, well, that thought alone
will keep you awake.
C.B.T. asks you to look at the situation differently, and replace the negative thought with a positive one. Ill fall
asleep eventually. or I can handle this if it only happens a few nights a week.
You can try an online program or schedule an appointment with a trained C.B.T.-I. therapist.

1. Our daily habits, what we eat, what we do before sleeping, our state of mind, health, meditation and individual
preferences act directly on the quality of our sleep, as it is shown in this article, as well as how to improve our
A. People have a magic number of hours of sleep, depending on their age and it is better to respected that for
improving our health and spirit.
B. For determining natural sleep needs, we must think about the time we need to wake up and a good
solution is to make a sleep diary.
C. If you want to become a morning person and wakes up easier, with a little focus, discipline and
patience, you have the ability to reset your own internal clock, respecting some points.

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or
shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. In this case,
you can suffer from excessive daytime sleepiness and have sleep apnea. Most people who have sleep apnea
don't know they have it because it only occurs during sleep. A family member or bed partner might be the
first to notice signs of sleep apnea. If you think you have sleep apnea, you must see the doctor.


Night Owls May Face Special Challenges

Parents often worry about whether their children are getting enough sleep, about issues like young children who wake
too early and adolescents who resist waking at all.
But its worth remembering that the point of helping your child sleep soundly is to help that child function well when
awake, to be in tune with the opportunities and the requirements of the day.
Now a new study underscores just how important being in sync can be. It identified two factors that put teenagers at
risk for academic, emotional and behavioral problems, regardless of how many hours of sleep a child was actually
getting at night: greater daytime sleepiness, and the tendency to be a night owl.
Your body runs on a central clock, operating out of your brain, controlling the circadian rhythms, the internal 24-hour
cycles of sleeping and waking, eating and activity, and all the rest. Our clocks are individual and varied, and they
change as we grow. Researchers talk about chronotypes, a construct that attempts to describe differences in when we
tend to be alert or sleepy, when we prefer to be active, the daily peaks and troughs we all experience. We know that as
a group, we tend toward morningness in childhood, age into eveningness as we go from school age to
adolescence, and then back in the other direction toward morningness as we move toward older age.
These different chronotypes are partly explained by genetic variations, partly by habit and behavior, and the
underlying biology can be traced in the timing of hormonal ebb and flow, particularly the timing of surges in
melatonin, the so-called sleep hormone.
You can assess your own chronotype without doing blood tests with a morningness-eveningness scale questionnaire,
which has also been adapted for children and adolescents. That questionnaire was also used in the new study,
published recently in Pediatrics.
For the study, researchers asked more than 2,000 7th to 12th graders in the Fairfax County, Va., public schools about
sleep and daytime alertness or sleepiness, as well as things like task completion and planning. They were also asked
about a range of emotional and behavioral issues.
They found that shorter sleep duration was not directly related to problems in areas ranging from self-discipline to
social interactions (as it has been in other studies). Rather, greater daytime sleepiness or having the evening
chronotype were much more important for a childs emotional and behavioral well-being.
Other studies have shown that the eveningness chronotype is associated in adolescents with various kinds of risktaking behaviors, from drug and alcohol use to sexual and even financial risk-taking. In adults, the night owl
phenotype has also been found to be associated with health risks ranging from strokes and diabetes to mood disorders.
In the last 10 years weve come to recognize that there are circadian clocks or oscillators in every cell in the body,
and if youre misaligned with your circadian clock, thats going to affect all kinds of functions, said Dr. Judith
Owens, the director of sleep medicine at Boston Childrens Hospital and the lead author of the new study. Thats one
of the reasons you feel so lousy when youre jet-lagged, you have all kinds of physical complaints.
She and her colleagues suggest in their article that a major issue for the evening chronotype adolescents, and a
possible source of problems, is not just sleep deprivation (though these are likely to be the more sleep-deprived
adolescents, given the exigencies of early-start high school days) but also that they are not at their most functional and
alert biologically when demands are made, from driving themselves to school to taking tests.
To me, the biggest practical take home message is, its not only how much you sleep, its when you sleep and how
impaired you are by sleepiness, Dr. Owens said. Its like requiring an adult to get up five days a week at 3 a.m.
thats their circadian trough for adolescents to be expected to get up and function at a time when their circadian-

driven alertness is at its lowest point in 24 hours. She called moving high school start times later in the morning a
critical issue. According to the Centers for Disease Control and Prevention, only 17.7 percent of American public
schools start at 8:30 a.m. or later, and getting to school before 8:30 can mean a very early morning.
Monique K. LeBourgeois, a psychologist in the department of integrative physiology at the University of Colorado at
Boulder, is interested in the individual variations in chronotype that begin well back before adolescence. In 2014, she
and her colleagues published a study in which they measured melatonin levels in 48 healthy children ages 30 to 36
months. None of the children were considered evening types, but there were definite variations in how extremely
morning they were and those differences correlated with the time of melatonin release. In other words, even
young children vary significantly in their circadian physiology.
So understanding the circadian clock and its variations isnt just important for sleep problems, Dr. LeBourgeois said in
an email. A mismatch between the timing of the clock and the demands that kids face (or even opportunities for
learning and fun) could also result in behavior/emotional problems.
To recognize individual variations in the master clock is not to say that it is unalterably set for life; the clock is
affected by exposure to light, especially blue spectrum light, the kind that comes from LED lights and screens.
In recent research linking cellphone and tablet use and poor sleep in children, even having a turned-off device in the
bedroom meant poorer sleep. Thats why limiting and scheduling light exposure and screen exposure play major
roles when youre trying to reset the clock, for example with adolescents whose cycles have gotten so out of sync that
they are suffering from social jet lag.
Parents can work with pediatricians to help adolescents move their bedtimes earlier, limiting light exposure and screen
exposure in the evening and making sure there is light exposure in the morning.
Very extreme night owls, kids who cannot sleep until three or four in the morning, may have what is called delayed
sleep phase disorder, Dr. Owens said, and children with this diagnosis need help from sleep experts, which can involve
melatonin and light box therapy, along with manipulation of the sleep-wake schedule. Even after their cycles have
been reset, they may find themselves slipping back, unless theyre vigilant.
But even if a childs sleep is more in sync with what the world expects, that child still may be expected to perform in
school at the least alert times of day. Getting more sleep will help, but it wont completely revise that underlying
physiology, and parents need to help adolescent children map out their most effective, most alert times for studying,
concentrating and learning. Its worth thinking not just about good sleepers, at any given age, but also about when
your best waking function falls in your daily cycle, and how you can play to your strengths.
1. Circadian cycle is very important for our body, studies show us that it is individual for each person, being
especially affected at teenagers, who fall asleep very late- night owls.
A. For the study, researchers asked more than 2,000, 7th to 12th graders in the Fairfax County, daytime
alertness or sleepiness and find that greater daytime sleepiness or having the evening chronotype were
very important for a childs well-being.
B. Different chronotypes are explained by genetic variations, partly by habit, behavior, being individual,
even at healthy children ages 30 to 36 months.
C. New study identified two factors that put teenagers at risk regardless of how much hours of sleep a child
was getting : daytime sleepiness, and the tendency to be a night owl.
3. There is a problem if the child is an extreme night owl, kid who cannot sleep until three or four in the
morning. This can be called delayed sleep phase disorder. People who have a delayed sleep phase which
interferes with their routine often compensate by napping during the day, or sleeping excessively on weekends
to counterbalance the deprived sleep during the week. This can lead to temporary relief, but perpetuates the
delayed phase cycle. A formerly popular treatment, sleep phase chronotherapy, is intended to reset the
circadian clock by manipulating bedtimes.


Albina Alexandra
MD 1; GR. 1