updated 2/5/2004 12:58:39 PM ET 2004-02-05T17:58:39

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Question:This past year I've had trouble sleeping. When I go to bed at night, maybe 5 out of 7 days a week I won't fall asleep for at least 1 1/2-2 hours. I am often woken up early in the morning by one of my roommates, who leaves pretty early, and then I fall back asleep for maybe an hour or so.

I just feel I don't get a restful sleep, which stresses me out. Although I feel tired when I go to bed, I just can't fall asleep. Any advice?

Answer:Sleep deprivation is individually determined, but in general it means less than 5.5 hours a night and can be for weeks, months, or years.

Sleep deprivation has been shown in the research to slow the thinking process, slow reaction time, and decrease certain neurotransmitters, which help you think in general, it also seems to effect memory, concentration, attention, and emotions. Alcohol combined with sleep deprivation only makes things MUCH, MUCH WORSE.

Certain hormones are secreted mostly during sleep; about 80% of growth hormone comes in 1 or 2 large pulses during stages 3 and 4. However, the research shows a recovery in these levels once sleep begins again.

To combat insomnia, concentrate on improving your "sleep hygiene." Here are some suggested ways to do that:

Caffeine is a stimulant and should be discontinued four to six hours before bedtime. Caffeine is in coffee (100-200 mg), soda (50-75 mg), iced tea, chocolate, and various over-the counter-medications (it helps speed medicine through the blood stream). Remember, it builds up throughout the day, so two cups at dinner and some chocolate ice cream can be close to 500 mg of caffeine. It is a little-known fact that caffeine stays in your system for up to 12 hours! Thus, try not to have any past lunchtime, and drink decaffeinated coffee after dinner. Be careful if you are a big caffeine person and you cut yourself off too quickly. You will get headaches, which of course will keep you awake.

Nicotine is also a stimulant and should be avoided near bedtime and upon night awakenings. Thus, having a smoke before bed, although it feels relaxing, is actually putting a stimulant into your bloodstream. Recent research has shown that if you must have a smoke, take long, slow drags and pause between puffs, as this method produces the least stimulating effects, as opposed to short, quick puffs. (I am not recommending smoking, but if you must smoke, follow these suggestions for better sleep). Also, cut back before bed: During the four hours before bedtime, have fewer cigarettes, and have none 30-45 minutes before bedtime.

Alcohol is a depressant; although it may facilitate sleep onset, it causes awakenings later in the night. As alcohol is digested your body goes into withdrawal from the alcohol, causing nighttime awakenings and often nightmares. Excessive alcohol use can lead to dependence, and the withdrawal from alcohol dependence is worse on your sleep.

A light snack may be sleep inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates. Research has shown that small snacks rich in carbohydrates may help improve sleep. In addition, milk and dairy products have been shown to be sleep inducing. Milk has L-tryptophan in it, which has been shown to help people go to sleep. So milk and cookies (without chocolate) may be useful and taste good as well. But be careful: A small weight gain has often been associated with snoring or even sleep apnea.

Do not exercise vigorously just before bed. If you are the type of person where exercise arouses you, it may be best to exercise late in the afternoon (preferably an aerobic workout, like running, walking, or aerobics). Some studies have shown that exercise right before bed is not as bad as was once thought, unless you are the type of person who becomes more alert with exercise.

Minimize noise, light, and excessive temperature during the sleep period with earplugs, window blinds, or an electric blanket or air conditioner. Both noise and light have been shown to disrupt falling asleep. Interestingly, if your room is too hot (above 75 degrees) or too cold (below 54 degrees) it can affect your sleep as well.

Try not to drink fluids after 8 p.m. Often, awakenings are to go to the bathroom (once or twice a night as you get older is normal).

Michael J. Breus, Ph.D., ABSM, is board certified in clinical psychology and sleep medicine. He has been involved in sleep research since 1990 and is on the faculty of the Atlanta School of Sleep Medicine.

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