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Why am I unable to sleep properly?

Q: I am 34 years old and having a problem sleeping. I am unable to sleep continuously i.e. my sleep gets disturbed frequently in the night and because of this I don't feel energetic when I get up in the morning. I feel drowsy and lethargic. I also have obsessive compulsive disorder (OCD) and I am on medication. Could you please find a solution to my problems?

A:Many of the medications as well as anxiety disorder are associated with sleep disturbances. In addition, you might have sleep disturbance independent of any disorder/medications. It is difficult to say from the brief description what might be causing your sleep problems. In addition, many cases (more than 50%) of them have underlying mood or anxiety disorders leading to sleep disturbance. In any case you need to have a thorough evaluation preferably by a psychiatrist to figure out a good treatment approach. Currently, there are several medications as well as other methods of treating sleep disturbances. Even before you approach a psychiatrist you might want to follow good sleep hygiene and other methods (see below), which might be beneficial. Sleep hygiene instructions 1. Use the bedroom only for sleep or intimacy. Do not work or do other activities in bed that can lead to prolonged arousal. 2. Keep your room dark, quiet, well ventilated, and at a comfortable temperature throughout the night. 3. Avoid unfamiliar sleep environments. 4. Take a hot bath to raise your body temperature 2°C for 30 minutes within 2 hours before bedtime. A hot drink might help you relax as well as warm you. 5. Get regular exercise each day, preferably 40 minutes each day of an activity that causes sweating. It is best to finish exercise at least 6 hours before bedtime. 6. Restrict sleep period to the average number of hours you have actually slept each night in the preceding week. Quality of sleep is important. Too much time in bed can decrease quality of sleep on the following night. 7. Keep a regular time out of bed 7 days a week. 8. Get at least one half hour of sunlight within 30 minutes of your out-of-bed time. 9. Do not expose yourself to bright light if you have to get up during the night. 10. Avoid naps, except for a brief 10-to-15 minutes nap, 8 hours after arising; but check with your physician or sleep specialist first, because in some sleep disorders, naps can be beneficial. 11. Do not eat or drink heavily for 3 hours before bedtime. A light bedtime snack might help. 12. If you have trouble with reflux/regurgitation, be especially careful to avoid heavy meals in the evening. Do not retire too hungry or too full. The head of your bed might need to be raised. 13. Do not smoke to get yourself back to sleep. 14. Do not smoke after 7:00 p.m. (ideally give up smoking entirely). 15. Limit caffeine use to no more than three cups. 16. Alcohol can fragment sleep over the second half of the sleep period. Stimulus control instructions 1. Lie down intending to go to sleep only when you are sleepy. 2. Do not use your bed for anything except sleep; that is, do not read, watch television, eat, or worry in bed. Sexual activity is the only exception to this rule. On such occasions, the instructions are to be followed afterward, when you intend to go to sleep. 3. If you find yourself unable to fall asleep, get up and go into another room. Stay up as long as you wish and then return to the bedroom to sleep. Get out of bed if you do not fall asleep immediately. Remember the goal is to associate your bed with falling asleep quickly! If you are in bed more than about 15 minutes without falling asleep and have not gotten up, you are not following the instructions. 4. If you still cannot fall asleep, repeat Step 3. Do this as often as necessary throughout the night. 5. Set your alarm and get up at the same time every morning irrespective of how much sleep you got during the night. This will help your body to acquire a consistent sleep rhythm. 6. Do not nap during the day.


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