I see a lot of adults and teens in my clinic who are chronically tired and have troubles sleeping — both falling asleep and staying asleep. There are many reasons for sleep problems, but I do see some common causes:

Stress and overwork. Many people lead stressful lives and cannot turn off their brains when they try to sleep, as they continue to think and worry about the day’s problems. This is very difficult to manage for many, but it is crucial to stop daytime-related issues at least 2 hours before bedtime, simply to allow your brain and body to relax. ​

Too much non-sleep activity in bed. It’s important not to spend hours in bed doing activities such as watching TV or playing computer games. This sets a bad pattern which makes it difficult​ for some to actually fall asleep once the lights are finally out. It’s healthier to read, watch TV or play computers in other rooms, and only spend about 20 minutes in bed before trying to sleep. Some scientists believe that the background lights in iPads and laptops can alter our sleep patterns and recommend not using these before bedtime, and while there is little actual evidence of this, you’re welcome to try this change and see if it helps.

Here are my tips for sleeping well:

Exercise often — but early. Exercise has been shown to improve sleep habits, but only if done at least 4 hours before bedtime. Otherwise, you still may have too much metabolic energy and will have trouble falling asleep. This is also a good tip for kids who are having sports practices late into the night.

Avoid alcohol and smoking before sleeping. Alcohol is a major cause of insomnia for many. Drinks will certainly make you sleepy, but your body will rebound and wake you up in the middle of the night. It’s far better to have only a drink or two, at least 2 hours before bedtime. Smoking causes the same problems; that initial relaxation quickly wears off and the nicotine stays in your system for hours.

Caffeine is another major cause of poor sleep. As we get older, we cannot handle the triple-shot cappuccinos which we had in college, and it’s very common to have poor sleep with any caffeine drinking after lunchtime. So if you’re having light sleep, definitely take a look at your caffeine habits first; any tea, sodas or coffee after lunch may be keeping you awake. If you must have your afternoon coffee, at least try to switch to decaf.

Other tips include not staying in bed if you can’t sleep. If you can’t fall asleep, after 20 minutes of trying you should get up and try to relax in another room. Staying longer in bed generally makes you more anxious, making it even harder to fall back asleep.

What about natural medicines and non-prescription pills? Many people use over the counter pills such as Tylenol PM. It does work well, in the short term, for many people — but I strongly advise not taking it regularly, as the Tylenol component is totally unnecessary and can cause liver problems if taken chronically. If you must use this medicine, please buy only the active ingredient, diphenhydramine (Benadryl) separately and only use that. As for natural medicines, melatonin works for some types of insomnia but is rarely very effective. Others may consider an herbal capsule with valerian and other compounds such as passionflower, hops or lemon balm. You can read more evidence-based information about herbal medicines for insomnia from the Natural Medicines Comprehensive Database, at http://goo.gl/hIQvu

If you follow these tips and still have troubles sleeping, please do not hesitate to see your family doctor. Our counselors and psychologists can also help via special therapies which may include biofeedback, light boxes, or medicines for depression and anxiety. Their behavioral interventions ​are especially useful for your child’s sleep difficulties.

 

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(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)

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