Introduction

Do you have?

• Inability to get enough sleep at night
• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Waking up feeling tired, even after a full night's sleep
• Daytime fatigue or sleepiness
• Daytime irritability

Common causes of sleep difficulty include:

Stress. Concerns about work, school, health or family can keep your mind too active, making you unable to relax. Excessive boredom, such as after retirement or during a long illness, may occur and also can create stress and keep you awake.

Anxiety. Everyday anxieties as well as severe anxiety disorders may keep your mind too alert to fall asleep.

Depression. You may either sleep too much or have trouble sleeping if you're depressed. This may be due to chemical imbalances in your brain or because worries that accompany depression may keep you from relaxing enough to fall asleep when you want to.

Stimulants. Prescription drugs, including some antidepressant, high blood pressure and corticosteroid medications, can interfere with sleep. Many over-the-counter (OTC) medications, including some pain medication combinations, decongestants and weight-loss products, contain caffeine and other stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing you to get up more during the night.

Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body's circadian rhythms, making you unable to get to sleep when you want to. The word "circadian" comes from two Latin words: "circa" for "about" and "dia" for "day." Your circadian rhythms act as internal clocks, guiding such things as your wake-sleep cycle, metabolism and body temperature.

Long-term use of sleep medications. Doctors generally recommend using sleeping pills for no more than four weeks, or until you notice benefits from self-help measures. If you need sleep medications for longer, take them no more than two to four times a week, so they don't become habit-forming. Sleeping pills often become less effective over time.

Medical conditions that cause pain. These include arthritis, fibromyalgia and neuropathies, among other conditions. Making sure that your medical conditions are well treated may help with your lack of sleep .

Behavioral lack of sleep . This may occur when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they're away from their usual sleep environment or when they don't try to sleep, such as when they're watching TV or reading.

Eating too much too late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a backflow of acid and food from the stomach to the esophagus after eating. This uncomfortable feeling may keep you awake.

Inherited condition. Some people have inherited poor sleep tendency. If that's your case, be extremely careful not to overexcite yourself, especially in the evening.
Lack of sleep becomes more prevalent with age. As you get older, changes can occur that may affect your sleep. You may experience:

A change in sleep patterns. After age 50, sleep often becomes less restful. You spend more time in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep, and stages 3 and 4 are deep (delta) sleep, the most restful kind. Because you're sleeping more lightly, you're also more likely to wake up. With age, your internal clock often speeds up. You get tired earlier in the evening and consequently wake up earlier in the morning.

A change in activity. You may be less physically or socially active. Activity helps promote a good night's sleep. You may also have more free time and, because of this, drink more caffeine or alcohol or take a daily nap. These things can also interfere with sleep at night.

A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, hot flashes that accompany menopause can be equally disruptive. Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night and then awaken. Restless legs syndrome causes unpleasant aches in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
Sleep problems may be a concern for children and teenagers as well. In addition to many of the same causes of lack of sleep as those of adults, younger people may have trouble sleeping because of conditions such sleepwalking, night terrors or teeth grinding (bruxism). In addition, some children and teenagers simply have trouble getting to sleep or resist a regular bedtime, often because their inherent (circadian) clocks are set later. When the clock on the wall says it's 10 p.m., their bodies may feel like it's only 8 p.m., because of their delayed clocks

Complications
Sleep is as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, lack of sleep can impact you both mentally and physically.
The impact can be cumulative. People with chronic lack of sleep are more likely than others to develop psychiatric problems such as depression and anxiety disorders. Long-term sleep deprivation may increase the severity of chronic diseases, such as high blood pressure and diabetes.
Insufficient sleep can also lead to serious or even fatal accidents. According to the National Highway Traffic Safety Administration, more than 100,000 crashes each year are due to drivers falling asleep at the wheel.

Coping skills No matter what your age, lack of sleep usually is treatable. The key often lies in changes to your routine during the day and when you go to bed. Try these tips:

Stick to a schedule. Keep your bedtime and wake time on a constant schedule.

• Limit your time in bed. Too much time in bed can promote shallow, unrestful sleep. For two weeks, try to cut the time you spend in bed by one hour and see if it helps you sleep.
• Avoid trying to sleep. The harder you try, the more awake you'll become. Read or watch television until you become very drowsy, then go to bed to sleep. Get up in the morning at the same time as usual.
• Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all clocks in your bedroom. The less you know what time it is at night, the better you'll sleep.
• Exercise and stay active. Get at least 20 to 30 minutes of vigorous exercise daily, preferably at least five to six hours before bedtime.
• Avoid or limit caffeine, alcohol and nicotine. Caffeine after lunchtime and using nicotine can keep you from falling asleep at night. Alcohol can cause unrestful sleep and frequent awakenings.
• Reset your body's clock. If you fall asleep too early and then wake up too early, use light to push back your internal clock. During times of the year when it's light outside in the evenings, go outside for 30 minutes or sit near a very bright light.
• Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your lack of sleep . Also check the labels of over-the-counter products to see if they contain caffeine or other stimulants, such as pseudoephedrine.
• Don't put up with pain. If a painful condition bothers you, make sure the pain reliever you take is effective enough to control your pain while you're sleeping.
• Find ways to relax. A warm bath or light snack before bedtime may help prepare you for sleep. Having your partner give you a massage also may help relax you.
• Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can't get by without one, try to limit a nap to no more than 45 minutes in bed and to 30 minutes asleep.
• Minimize sleep interruptions. Close your bedroom door or create a subtle background noise, such as running a fan, to help drown out other noises. Keep your bedroom temperature comfortable, usually cooler than during the day. Drink less before bedtime so that you won't have to go to the toilet as often.

ABOUT MELATONIN

Melatonin
Circadian rhythm sleep disorders. Taking melatonin orally helps improve circadian rhythm sleep disorders in blind children and adults. Melatonin has FDA orphan drug status for this indication (1082,1691,1744,1749,6585).
Sleep-wake cycle disturbances. Taking melatonin orally is helpful for sleep-wake cycle disturbances in children and adolescents with mental retardation, autism, and other central nervous system disorders (1056,1745,1746,1747,1771). Melatonin also appears to improve the time to fall asleep in children with developmental disabilities, including cerebral palsy, autism, and mental retardation (9707). Melatonin treatment seems to subjectively improve secondary lack of sleep associated with various sleep-wake cycle disturbances (1053,1729,8240,8245).

After a typical oral dosage, an average of 30-60 % of the melatonin is rapidly metabolized by this first pass effect

N-acetyl-5-methoxytryptamine

Lack of sleep . For primary lack of sleep , short-term melatonin treatment appears to modestly reduce the time it takes to fall asleep (sleep latency). This reduction in sleep latency appears to amount to only about 12 minutes and might not be considered clinically relevant. Melatonin does not appear to significantly improve sleep efficiency (15005). Despite lack of objective improvements, some patients report minor improvement in subjective feelings of sleep quality (1070,1083,12226). More evidence is needed on the long-term effects of melatonin for primary lack of sleep .
Some evidence suggests that melatonin might be most beneficial for lack of sleep in elderly patients who could be melatonin deficient compared to younger adults or children (1072,1729,1738,1754,7081,15005).
Sustained-release melatonin preparations might to be better for improving sleep maintenance (1738,1754), and immediate-release preparations might to be more beneficial for decreasing sleep latency (1738).
In children with lack of sleep due to delayed onset of sleep, melatonin seems to shorten the time that it takes to fall asleep and increase the duration of sleep (9708).
There is contradictory evidence about the effectiveness of melatonin for secondary lack of sleep (14283). Some evidence suggests that melatonin improves secondary lack of sleep related to depression (1053,1729), schizophrenia (8245), Alzheimer's disease (1729), hospitalization (9709), and lack of sleep termed "ICU syndrome" referring to sleep disturbances while in the intensive care unit (8240). However, a pooled analysis of studies of melatonin for secondary lack of sleep suggest that it might not be effective for decreasing the time it takes to fall asleep (sleep latency). But it might modestly increase sleep efficiency (14283