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An Article on Psychiatric Times is the best-detailed version of what and how sleep is affected by stress and anxiety. If you are not one who enjoys reading the thesis and medical papers, I recommend that you print it out and read it in bed. I swear by Hypnos, The god of sleep and the son of Erebus and Nyx, It will serve you better than any sleeping pill man ever invented. If you are not aware, reading in bed reduces stress and its recommended that you read something boring to bed and I have just provided you with the material. Whatever said (and nothing is done yet), The article is still the best and the most detailed on sleep and anxiety.

Yes, Anxiety is a problem and sleep does get affected with anxiety. Mental conditions are known to create insomnia in patients and its one of the key factors in determining mental conditions. Both anxiety and insomnia are linked. Treating one without the other is usually not effective. Both sleep and anxiety has to be treated simultaneously and requires professional help. So if you think that reading this article is going to rid you of anxiety or insomnia, i am sorry to disappoint you but not totally. 

There are a few things about anxiety and sleep which you can correct. Certain lifestyle problems do create anxiety and sleep deprivation. These can be easily corrected in a few days. For most people, this should be enough. If you still do not find the rest you need, we suggest that you get medical help. There is no shame in getting help when you need it and the only reprieve may be medical help.

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Simple strategies for healthy sleep habits

Mindfulness meditation, yoga, and breathing exercises.

While many swear that there is no benefit to Meditation, There is evidence that your brainwaves slow down significantly when you meditate. During Meditation, Theta waves are more active on the frontal lobe. Meditation is known to be far more beneficial than simply relaxing and a study on how meditation affects your brain is available on Science Daily. 

  1. Breathing exercise usually is Boring. No one wants to count their breath. Breathe in, Breathe out. But this is the technique which is used to relax your mind and it really works. Deep Breathing not only allows maximum lung capacity but also keeps you from thinking of other tasks. Your mind is programmed to think only one thing at a time. Yes, it jumps from one thing to another and if you are able to concentrate on something like your breathing for long enough, you tend to put away other matters of though for the next day. Breathing is also boring for many and that’s probably one of the few reasons to practice breathing exercises in bed. Boredom usually puts people to sleep.
  2. Yoga is known to have a lot of benefits. From Great flexibility, Strength, improved agility, Mental health and even sexual health. Its probably one of the few forms of exercises which are known to benefit your entire system if done right. Few forms (or poses as they call it) are known to induce sleep, reduce stress and keep you peaceful. A few yoga poses can also be practiced just before bed and they could be of benefit. An article By Harward lists all the poses which may help you get to bed and another by Yoga journal lists all the poses you can practice to reduce anxiety. Doing both can be beneficial to your sleep and anxiety.
  3. oga is not a practice which will help you overnight. You will see results in a week or sometimes in a fortnight. You will need patience, but many swear by yoga and its benefits for it has worked for them. 
  4. exercise: Exercise, in general, is one of the best things you can do (apart from drinking a lot of water). Exercise activates endorphins, Dopamine and a lot of other good stuff in your body. Dopamine sounds a lot like a dope and you are right. It does create a happy feeling and its secreted every time you get a good workout. A short run, a couple of push-ups and anything which can get your heart rate high will start your dopamine secretion. If you are anxious, Your doctor is going to give you something to make you happy. They don’t prescribe dopamine supplements but if you are serious about your anxiety, you should give workouts and exercise a try. Just keep in mind that Being happy and excited is not how you want to get to bed. So Try to workout 2-3 hours before bedtime. A good workout between 2 and 3 pm or early in the morning is advised.
  5. Don’t lie in bed awake: For kids, bedtime is 8 PM and they do go to bed. They don’t suffer from Anxiety (at least most of them don’t I hope) or worry about bills to pay and meetings to attend the next morning. It’s a good habit you should get to practice yourself. But if you cant get to sleep in 15 minutes in bed, get up and do something. No Screen time though! Read a book (A Physical one for God’s sake, not on your mobile), listen to slow music (below 60 beats per minute), try to meditate. You may need to get a lot more creative these days to do something which does not involve screen time and I am sure you will find a few options. Personally I have read to bed and its usually passive.
  6. Limit screen time: This is one of the most common factors in recent times to affect sleep. 95% of all teenagers go to bed with mobile phones near them. Almost all of them check their phones at night before they go to bed. The bright light coming from a mobile phone, television or computer screen is similar to white light which prevents sleep. Sleep is activated by Melatonin which becomes active during the night and especially when it’s dark. With bright light hitting your face, melatonin secretion is slow and it takes more time to fall asleep. Reduce screen time after 7 pm. Relax your eyes for at least 2 hours before bedtime. Avoiding screen time also ensures that you are not looking at social media posts and news articles which may create stress or anxiety. 
  7. Put your to-dos on paper: Most people carry work back home. There are others who take it a step further and take work to bed. Your Bedtime is bedtime. Not think of time. What you have to do tomorrow can be done tomorrow. Write down a list of things that needs to be done the next day and the day after tomorrow. Write it down for the next 20 years. But when you get to bed, don’t think about things which you have to do tomorrow. Your to-do list will remind you of the tasks you need to get done. Put it there and forget it for the day. 
  8. Take at least half an hour to play quiet music, take a bath, or read a book: There are a few things which can make you feel luxurious even without spending a dime. A good bath and music accompanied. Think about Julia Roberts in “Pretty woman” singing Kiss while she is in a bathtub full of bubbles. That’s Luxury and it really pays off to be a bit luxurious. Get a good bath. Lukewarm water, not too hot, not too cold. Soap up, feel clean and pretty. Listen to some slow music. Romantic ones are great and ones without lyrics really soothes your mind. And if you can get a Book in hand… it closes the deal perfectly. 
  9. Scientifically, A bath will reduce your body temperature a little and help you fall asleep. Reading calms your mind and music will help your brainwaves be steady. You will be able to concentrate on that book rather than WAndering (Mentally) while reading. 
  10. stay away from heated social media exchanges, and skip the evening news. Social media and News media are 2 industries that have been successful in reverse engineering a human brain. They know exactly how to get you hooked. You end up in social media thinking that you will just look through the latest posts by your friends and the next minute you are looking through cat videos, cooking tips and a bunch of useless things. Fast forward 30 minutes, you are still scrolling on your phone and you know you could do it a few years and still, you will not come to the end of the page. News articles too are similar. One news follows another and there are interesting links to click on and after a few hours, you realize that you started with Tax policies in your state and ended up reading the sex life of Kanye West and Kim K. KEep away from News and social media after 5. If you can manage to check social media 5 minutes in the morning, its the best. Mornings are usually busy and news and social media are not a priority for most of us. We will push it aside much more easily than if we were to check it in the evening.
  11. Tailor your environment – Control light, sound, and temperature. A bedroom should be dark. Preferably no lights at all and if you are one who wants to get a 0-watt bulb in your room, go for it. Ensure that the room is silent too. This means put your phone on silent or switch it off completely. Set your alarm for the next morning and check your room temperature to your comfort. The room should be comfortably cool. A cool room should help you fall asleep faster. Too warm or too cold and your chances of falling asleep will be delayed.
  12. Limit caffeine and alcohol : 3 PM is usually my last coffee and I don’t consume alcohol at all. No wine, no beer, No whiskey, brandy, rum. Alcohol makes you feel drowsy, not sleepy. Most people think that alcohol helps you fall asleep but in reality, alcohol impairs sleep. It creates drowsiness and deep sleep is usually a problem.
  13. Review Your existing medication: Certain medications are known to make you drowsy and tired during the day. Anxiety medications especially are known to control your mood and they have side effects. Not just anxiety medicines, a lot of other medications do create problems related to sleep. Talk to your doctor and let him know about the problem. Chances are that the medication can be changed to something less interfering with your sleep patterns.
  14. Get some real sunlight. : Sitting in a room with artificial light may be comfortable but it gives you less of the real sunlight. Getting at least half an hour of sunlight every day is important for the circadian cycle to work efficiently. Try to get some early morning sunlight. Its the most beneficial and has the least UV Rays. Early morning sunlight will benefit your skin too and you will feel a lot better in the evenings. Try to take a walk or even sit on a bench reading your emails on the phone. 
  15. Smoking is one of the worst habits i have come across. I am a smoker. I have been smoking for the past 25 years and i find it horribly hard to quit. Its a habit and not an addiction. If I am busy throughout the day and meeting people nonstop, I don’t feel the urge to smoke. The moment I am alone for a few minutes, I pull out a cigarette. Most people can’t quit because of its a habit. Whenever you get a coffee you find an urge to smoke. Or maybe when you walk through a particular area. We all have triggers for smoking. Try to avoid those triggers and don’t create new ones. Smoking interferes with Anxiety and Sleep. It’s not a pretty scene inside your lungs either and you are not going to have the best lung in the world when they cut you open for a surgery … or autopsy! Quit smoking. At least try. I am down to 3 or 4 cigarettes per day from 1 pack. It’s possible and it helps you get some good sleep.
  16. Large meals at dinner: Keep your largest meal for breakfast. You may even have a good lunch but when it comes to supper or dinner, keep it light. Just enough to keep you content. If you ever feel the urge to eat a bit more, schedule your supper to earlier. It’s a known fact that digestion decreases after sundown. Try to get a good meal before Sundown. You will still have a lot of time to process the food before bedtime.
  17. Avoid Food that’s spicy or Acidic: A lot of food that creates acid reflux should be avoided for dinner. These foods create problems in sleep and you tend to wake up more often due to thirst or heartburn.  Drinking too much fluid will make things worse because you will have to visit the washroom more often to relieve yourself. The fluid after 5 pm should be limited. Too much fluid will hamper your sleep and wake you up several times at night. Some people do find it hard to get back to sleep once they wake up, no matter what time of the night it is.
  18. Use your bedroom as a bedroom and not for work or watching tv.Many of us have the habit of watching television in the bedroom. Screen time is bad, but television in the bedroom will give you one more reason to watch the next show or jump through the next news channel. Don’t watch television in your bedroom. The bedroom is for sleep. Anything apart from sleep and Sex is forbidden here. Surely not work. Work is not a real bedtime talk!
  19. Get rid of the Clock in the bedroom. It’s ok to have an alarm clock in your bedroom as long as it does not light up and shows time every time you wake up. Avoid checking the time on your phone (of course, we hope your phone is switched off when in bed or at least it’s on silent). You need to sleep not watch time pass by. Shut up, close your eyes and sleep for heaven’s sake.
  20. Ask for help. If you have managed to even get 20% of the recommendations done, you should see the difference in your sleep habits. If you find it hard to sleep still, You need help. Find a professional who can help you remedy your condition. Do not take sleep deprivation or Anxiety lightly or feel ashamed about it. Stress is natural, you can fight it and there is help available. 
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Sleep Disorders and other Health Issues

People with Sleep Disorders have a high risk of another condition including Heart ailments, high blood pressure, stroke, Obesity, Mood disorder, Anxiety, and diabetes. Below are some of the common diseases which are related to sleep disorders.

Diabetes: A study in 2012 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703752/) concluded that people suffering from diabetes had a high chance of sleep disorders. Diabetic patients High glucose level in your blood makes you sweat and uncomfortable for most people to stay asleep for long. Moreover, many diabetic patients feel thirsty and wake up to urinate during the night breaking their sleep cycle.

High Blood Pressure: A Study at the University of Arizona (https://www.sciencedaily.com/releases/2019/06/190604131159.htm) reveals that people tend to suffer from high blood pressure for 24 hours if they sleep less. The research reveals the risk of heart diseases, Stroke, heart failures, and even death in people who suffer from lack of sleep. Blood pressure is one of the key predictors for cardiovascular health and high or low blood pressure can indicate your heart health directly.

Obesity: While sleep disorders are related to mental health, grogginess, and poor alertness, obesity is one of the key problems faced by people who suffer from insomnia. People tend to eat more when they cannot sleep and they feel hungry faster. The lack of sleep also creates problems with metabolism which directly affects your weight.

 Sleep disorders and common Mental health issues associated with it

Schizophrenia: Schizophrenia produces a range of symptoms including day time sleepiness, wakeful nights and disturbed sleep patterns. A study reveals at least 1 kind of sleep disorder in 78% of all schizophrenic patients. Schizophrenic patients had the highest percentage of sleep-disordered individuals when compared to Bipolar disorders and other mental health patients.  

Bipolar Disorder: One of the most common symptoms of bipolar patients is Sleep disorder. Up to 78% of bipolar patients reported Hypersomnia or excessive sleeping. Sleep disorders are suggestive of the high suicidal tendencies in bipolar patients according to researches.

Major Depressive Disorder: With MDD insomnia is common in 88% of patients and hypersomnia in 27% of patients . Fatigue due to insomnia may be related to MDD suggests study.

While there are other mental health issues associated with Sleep disorder, the most common ones are schizophrenia, bipolar disorder and MDD.  According to the ADAA, research shows that sleep disorders occur in almost all psychiatric disorders. Limiting Sleep disorders to only these three psychiatric disorders would be overlooking a lot of other conditions. We list these three as they have a significant study backed by researches and studies.

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 Treatment for Anxiety with a sleep disorder

Before I go any further, this part is only educational and not professional help. Always go for a professional who is well versed in the topic of sleep and anxiety before trying to follow anything written further. With that said, Self-medication is foolish when it comes to anxiety. NEVER EVER SELF MEDICATE. PERIOD.

There are 3 models of treatment available. 

  1. Psychotherapy
  2. Medication
  3. Alternative medicine

Psychotherapy involves no drugs, no surgery and is researched extensively to be beneficial to sleep and anxiety. One of the most prevalent methods used to treat anxiety and sleep disorders is CBT or Cognitive behavior therapy. Cognitive Behaviour therapy helps patients understand their feelings and behaviors and make decisions based on them. To put it in simple terms its what is called mindfulness. CBT is used to treat a range of conditions including stress, anxiety, addiction, phobia and Destructive behavior. Patients are helped to identify triggers that start their attack and make decisions based on the triggers, sometimes controlling it, and at other times letting it pass.

CBT is not the only psychotherapy treatment available. Meditation can be considered as a method of psychotherapy though not formally approved.

Medication is the most commonly used treatment for anxiety and sleep disorders. Medication includes antidepressants, Benzodiazepines, NonBenzodiazepines and melatonin Supplements. While Benzodiazepines are known to be addictive and prone to misuse, other forms of medication are known to be coparitively safe. Medication for anxiety and sleep disorders are presciption based and not over the counter. For this reason, you will need to get a formal doctors perscrition. People with former substance abuses are requested to keep off medication as much as possible. Many of these drugs have a addictive nature.

Last but not least, alternative medicines are evolving. Many of these are not proven scientifically but are effective. For instance, an informal study of Lavender oil helps understand its effectiveness in helping people sleep (https://www.express.co.uk/life-style/health/1235261/how-to-sleep-lavender-essential-oil-bed) There are other methods used widely to control anxiety and alternative medication includes herbs, oils, meditation, and yoga. Most of these are not proven and have a difference in anxiety and sleep problems but should not be considered as a treatment if your sleep disorders are beyond control. A medical professional should guide you through the process of treatment when it comes to anxiety. 

Supplementation- Vitamin B12 has been proven beneficial for neurological functioning and is effective in treating mild anxiety. Deficiencies will manifest as irritability, memory impairment, depression, psychosis and heart irregularities. You can also consider taking a natural sleep supplement, such as chamomile tea, melatonin, valerian, St John’s Wort or kava-kava, before bedtime.

people with insomnia have greater levels of depression and anxiety than those who sleep normally. They are 10 times as likely to have clinical depression and 17 times as likely to have clinical anxiety.

In one study of nearly 19,000 people, those with obstructive sleep apnea were five times as likely to suffer from clinical depression.