Medliorate

Improving medical students

Case Studies – Tackling Common Sleep Problems

Posted by medliorator on November 10, 2009

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The worrier

  • challenge:  “My sleep problems are definitely stress-related,” she says …She lies in bed thinking about work, making mental to-do lists, and even listening to random songs that play in her head.
  • advice: “She seems to have a predisposition for insomnia, and for people like her, whenever there are additional pressures, like a new job, the insomnia bubbles to the surface,” says Gary Richardson, M.D., a senior research scientist and a staff physician at the Sleep Disorders Center at the Henry Ford Hospital, in Detroit, Michigan …she needs to find ways to handle her stress better so that it doesn’t wake her up at night.
    • Distract her brain by trying a relaxation technique, like focusing on her breathing.
    • Working on keeping her sleep environment quieter, such as using an air conditioner or a fan, as well as blackout shades to block street light.

The night owl

  • challenge: She grows more alert late at night, then stays up until about 3 a.m., watching TV, reading, clearing out e-mail, and organizing things for her family.
  • advice: To start slowing down and readying herself for an earlier bedtime, psychologist Rubin Naiman suggests blocking blue light. “The blue end of the light spectrum — emitted by ordinary lightbulbs, televisions, and computer screens — suppresses melatonin,” says Naiman. Nicole might consider …reducing the amount of light in general. “Being exposed to too much light at night is the environmental equivalent of caffeine,” says Naiman. So at least two hours before bed, dim the lights. In addition, Nicole needs to find time earlier in the day for catching up on e-mail and organizing.

The slow riser

  • challenge: Elizabeth …struggles with an innate tendency is to stay up till midnight, then hit snooze so many times in the morning. “The clock has been known to give up,” she says. Even when she feels exhausted all day, she becomes more alert at night. When she does get into bed, it takes her up to an hour to fall asleep. Elizabeth has tried going to bed earlier so she’ll have less trouble getting up in the morning, but then she just lies awake. She doesn’t drink caffeine, and she reads when she gets into bed, does yoga three times a week, and uses an aromatherapy-oil diffuser in her bedroom.
  • advice: While avoiding caffeine in the afternoon and the evening is a wise move, physician and sleep researcher Gary Richardson says that having some first thing in the morning can be helpful for people like Elizabeth, who have trouble waking up.
    • Modulating her exposure to light could reset her internal clock gradually, according to Richardson. “Too much light at night will push her clock even later,” he says, so the key is to keep the lights dim the closer she gets to bedtime. Elizabeth should also maximize her light exposure first thing in the morning. If she can go outside in bright sunlight for some exercise, that would provide a double whammy of wakefulness.
    • Taking a melatonin supplement (0.3 milligram before bed) might help Elizabeth if light manipulation isn’t enough, Richardson suggests. It may help pull her internal clock to an earlier hour so she can get the sleep she needs

How to solve 9 sleep problems [CNN Health]

Correlate: Making Time for Sleep
Correlate: Sleeping Smarter
Correlate: Understand the Mechanics of Sleep

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