Sleep is essential to a person’s wellbeing.

Does it often take you more than 30 minutes to fall asleep at night? Or do you wake up frequently during the night — or too early in the morning — and have a hard time going back to sleep? When you awaken, do you feel groggy and lethargic? Do you feel drowsy during the day particularly during monotonous situations?

If you answered "yes" to any one of these questions, you may have a sleep problem that is affecting you in ways you don’t even realize. And, you aren’t alone.  However, few recognize the importance of adequate rest, or are aware that effective methods of preventing and managing sleep problems now exist.

Many people suffer from problems with their sleep. This can be especially true for those who have witnessed or experienced one or more traumatic events such as rape, military combat, natural disasters, beatings, or neighborhood violence. Some individuals exposed to traumatic physical or psychological events develop a condition known as Posttraumatic Stress Disorder (PTSD). It is well known that a problem with sleep is one of many problems for those with PTSD. Sleep problems, such as difficulty falling asleep, waking frequently, and having distressing dreams or nightmares, are common to those with PTSD. In fact, sleep disturbance can be a normal response to past trauma or anticipated threat.

Why Do You Need Sleep?

Sleep is not merely a “time out” from our busy routines; it is essential for good health, mental and emotional functioning and safety. For instance, researchers have found that people with chronic insomnia are more likely than others to develop several kinds of psychiatric problems, and are also likely to make greater use of healthcare services.

People suffering from a sleep disorder called sleep apnea are at risk for high blood pressure, heart attacks, stroke and motor vehicle crashes if left untreated.

Even occasional sleeping problems can make daily life feel more stressful or cause you to be less productive. You may have trouble concentrating, accomplishing required tasks and handling minor irritations. Overall, sleep loss has been found to impair the ability to perform tasks involving memory, learning, and logical reasoning. This may contribute to mistakes or unfulfilled potential at school or on the job and strained relationships at home, an increased inability to deal with emotional stress, loss of appetite.

How Much Sleep Is Enough?

Sleep needs vary. In general, most healthy adults need seven to nine hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can’t perform at their peak unless they’ve slept ten hours. And, contrary to common myth, the need for sleep doesn’t decline with age (although the ability to get it all at one time may be reduced).

So, how do you measure how much sleep you truly need? If you have trouble staying alert during boring or monotonous situations when fatigue is often "unmasked" you probably aren’t getting enough good-quality sleep. Other signs are a tendency to be unreasonably irritable with co-workers, family or friends, and difficulty concentrating or remembering facts.

Is All Sleeping the Same?

It may surprise you to learn that during the hours you seem to be "out cold," a lot is actually happening. Normal sleepers have a relatively predictable "sleep architecture" the term used to describe an alternating pattern of REM (rapid-eye-movement) and non-REM sleep. REM sleep is when you dream, and is characterized by a high level of mental and physical activity. In fact, your heart rate, blood pressure and breathing are similar to what you experience when you are awake. Non-REM sleep is a much deeper dreamless sleep.

Scientists define the best sleep as having the right mix of REM and non-REM sleep. Getting enough sleep without interruptions from your environment or from internal factors such as your breathing is more likely to maintain your natural sleep architecture and result in restful and restorative sleep.

Who's At Risk For Poor Sleep?

Virtually everyone suffers at least an occasional night of poor sleep. However, research implies, certain individuals may be particularly vulnerable. These include students, shift workers, travelers, and persons suffering from acute stress, depression, or chronic pain. And employees working long hours or multiple jobs may find their sleep less refreshing. In particular people who have suffered a traumatic experience or are on heavy medications

Older adults also have frequent difficulty with sleep problems, but inadequate sleep is not an inevitable part of the aging process. The total amount of sleep needed isn’t reduced.

Teenagers can have difficulty falling asleep until late at night and awakening early in the morning.

Many young adults keep relatively irregular hours and as a group they report higher rates of dissatisfaction with the sleep they are getting.

Being overweight increases the risk for sleep apnea.

Severe psychological or physical trauma can cause changes in a person’s basic biological functioning. As a result of being traumatized, a person with PTSD may be constantly hyper-vigilant, or "on the lookout," to protect him- or herself from danger. It is difficult to have restful sleep when you feel the need to be always alert.

What are the biggest reasons for an inability to sleep?

Psychological Factors
Stress is considered by most sleep experts to be the No. 1 cause of short-term sleeping difficulties. Common triggers include school- or job-related pressures, a family or marriage problem, and a serious illness or death in the family, traumatic experiences in the past. Usually the sleep problem disappears when the stressful situation passes. However, if short-term sleep problems such as insomnia aren’t managed properly from the beginning, they can persist long after the original stress has passed.

A person’s thoughts can also contribute to problems with sleep. For example, thinking about the traumatic event, thinking about general worries and problems, or just thinking, "Here we go again, another night, another terrible night’s sleep," may make it difficult to fall asleep.

That’s why it’s a good idea to talk to a physician about any sleeping problem that recurs or persists for longer than one week.

Your doctor can help you take steps early to control or prevent poor sleep. Since insomnia can also be brought on by depression, evaluation by a healthcare professional is essential.

Lifestyle Stresses
Without realizing it, you may be doing things during the day or night that can work against getting a good night’s sleep. These include drinking alcohol or beverages containing caffeine in the afternoon or evening, exercising close to bedtime, following an irregular morning and nighttime schedule, and working or doing other mentally intense activities right before or after getting into bed.

Trying Too Hard
Trouble falling asleep, the most common form of sleep disturbance, may be brought on simply by going to bed too early. Sleep cannot be forced. You should not go to sleep until you are sleepy. If you turn in too early--even if you do fall asleep--you could experience a disturbed night's rest or could wake early without feeling refreshed. If you go to bed when you feel sleepy but find that you can't fall asleep, don't stay in bed brooding about being awake. It is best to get out of bed. Leave the bedroom. Read, sew, watch TV, take a warm bath, or find some other way to relax before slipping between the sheets once more.

Naps
Although many people feel like napping between 2 and 4 p.m. (siesta time), most sleep better if they don't nap during the day. Naps should not be used as a substitute for poor sleep at night. However, there are exceptions to this general rule. Many older people, in particular, do sleep better at night when they take daytime naps. But if you are a napper who sleeps poorly at night, your nighttime sleep might improve if you skip the naps.

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Bedtime Snacks
If hunger keeps you awake, a light snack might help you sleep, unless it causes problems with digestion. Avoid heavy meals, alcohol, and caffeine-containing coffee, tea, and cola. For those who can tolerate milk that old, time-tested remedy may work best.

Smoking at Bedtime
Nicotine stimulates the nervous system and can interfere with sleep. In one sleep laboratory study, smokers experienced greater difficulty than nonsmokers. Sleep patterns also improved significantly among chronic smokers when they abstained from smoking.

Alcohol
The effect of alcohol is deceiving. It may induce sleep, but chances are it will be a fragmented sleep. The sleeper will probably wake up in the middle of the night when the alcohol's relaxing effect wears off.

Shift Work
If you are among shift workers, sleep may be particularly elusive. Shift work forces you to try to sleep when activities around you — and your own "biological rhythms" — signal you to be awake. One study shows that shift workers are two to five times more likely than employees with regular, daytime hours to fall asleep on the job.

Jet Lag
Still another sleep stealer is jet lag, an inability to sleep caused when you travel across several time zones and your biological rhythms get "out of sync."

Environmental Interferences
A distracting sleep environment such as a room that's too hot or cold, too noisy or too brightly lit can be a barrier to sound sleep. And interruptions from children or other family members can also disrupt sleep. Other influences to pay attention to are the comfort and size of your bed and the habits of your sleep partner. If you have to lie beside someone who has different sleep preferences, snores, can't fall or stay asleep, or has other sleep difficulties, it often becomes your problem too!

Physical Factors
A number of physical problems can interfere with your ability to fall or stay asleep. For example, arthritis and other conditions that cause pain, backache, or discomfort can make it difficult to sleep well. Sleep apnea, which is recognized by snoring and interrupted breathing, causes brief awakenings (often unnoticed) and excessive daytime sleepiness. If suspected, a person having signs of sleep apnea should see a doctor.

Disorders that cause involuntary limb movements during sleep, such as Restless Legs Syndrome, break up the normal sleep pattern and are also likely to make sleep less refreshing and result in daytime sleepiness.

For women, pregnancy and hormonal shifts including those that cause premenstrual syndrome (PMS) or menopause and its accompanying hot flashes can also intrude on sleep.

Medications
In addition, certain medications such as decongestants, steroids and some medicines for high blood pressure, asthma, or depression can cause sleeping difficulties as a side effect.

Difficulty staying asleep

Distressing Dreams or Nightmares
Nightmares are typical for people with PTSD. Usually, the nightmares tend to be about the traumatic event or some aspect of it. For example, in Vietnam veterans, nightmares are usually about traumatic things that happened in combat. In dreams, the person with PTSD may also attempt to express the dominant emotions of the traumatic event; these are usually fear and terror. For example, it is not uncommon to dream about being overwhelmed by a tidal wave or swept up by a whirlwind.

Night Terrors
These are events such as screaming or shaking while asleep. The person may appear awake to an observer, but he or she is not responsive.

Thrashing Movements
Because of overall hyper-arousal, active movements of the arms or legs during bad dreams or nightmares may cause awakening. For example, if one were having a dream about fleeing an aggressor, one might wake up because of the physical movements of trying to run away.

Anxiety (Panic) Attacks
Attacks of anxiety or outright panic may interrupt sleep.

Hearing the Slightest Sound and Waking Up to Check for Safety
Many people with PTSD, especially combat veterans, wake up frequently during the night. This can be for various reasons. However, once awake, a "perimeter check," or a check of the area, is often made. For example, a Vet may get up, check the sleeping area, check the locks on windows and doors, and even go outside and walk around to check for danger. Then the Vet may stay awake and vigilant and "stand guard;" he (or she) may not return to sleep that night.

So, What's The Secret To Good Sleep?

If you are having a sleep problem or feel sleepy during step. Your doctor will first want to ascertain whether attributing to or causing your sleep problem.

In many cases, your doctor will be able to recommend in mind that what works for some individuals may not what’s effective for you and stick with it. In general, try to build into your schedule time for eight hours of sleep, and follow this routine as regularly as possible. Even on the weekends. Here are a few tips many people have found to be useful. Some may work some may not it is about finding what works for you.

▪ Avoid caffeine, nicotine and alcohol in the late afternoon and evening. Caffeine and nicotine can delay your sleep, and alcohol may interrupt your sleep later in the night.

▪ Exercise regularly, but do so at least three hours before bedtime. A workout after that time may actually keep you awake because your body has not had a chance to cool down.

▪ Don't use your bed for anything other than sleep or sex. Your bed should be associated with sleep.

▪ If you have trouble sleeping when you go to bed, don’t nap during the day, since it affects your ability to sleep at night.

▪ Consider your sleep environment. Make it as pleasant, comfortable, dark and quiet as you can.

▪ Establish a regular, relaxing bedtime routine that will allow you to unwind and send a "signal" to your brain that it’s time to sleep. Avoiding exposure to bright light before bedtime and taking a hot bath may help. The best way to sleep better is to keep a regular schedule for sleeping. Go to bed at about the same time every night, but only when you are tired. Set your alarm clock to awaken you about the same time every morning--including weekends and regardless of the amount of sleep you have had. If you have a poor night's sleep, don't linger in bed or oversleep the next day. If you awaken before it is time to rise, get out of bed and start your day. Most insomniacs stay in bed too long and get up too late in the morning. By establishing a regular wakeup time, you help solidify the biological rhythms that establish your periods of peak efficiency during the 24-hour day.

▪ If you can’t go to sleep after 30 minutes, don’t stay in bed tossing and turning. Get up and involve yourself in a relaxing activity, such as listening to soothing music or reading, until you feel sleepy. Remember: Try to clear your mind; don’t use this time to solve your daily problems.

Often following abuse people can find it hard to sleep, due to powerful nightmares and flashbacks.

Something that may help is to in your mind create a safe place, this can be anywhere, you create it, and you are in charge of what is there. Is there a waterfall, are there animals, is your favorite duvet or teddy bear there, and is there a large tub of ice cream? Are you on a beach or in the woods, in a cozy room? You choose.

In your mind walk to your safe place one by one leaving all your bad memories behind you, picture yourself throwing them away.

When you get there talk yourself through relaxing, take deep breaths, feel the sunshine warm your body from your toes to your head, relax allow the goodness and the safety of the happy place to fill you up

You are in charge of your happy place no one and nothing can get in there without your say so that includes everything from bad people to bad thoughts its your safe place.

Allow yourself to go deeper and deeper into the good feelings and hopefully you should drift off to sleep without the nightmares and things. It does take practice and it may sound cheesy at first but it can really help

▪ Night time comforts – find something that helps you feel safe, a teddy, a special duvet, your favorite jumper, take it to bed, snuggle up with it, it may help you feel safe.

▪ Relaxing and unwind before you go to bed, have a long bath, put your feet up with a cup of tea, listen to relaxing music

▪ Clear your mind before bed time, empty it of bad thoughts write them down, fill your head with good thoughts, read your favorite book or watch your favorite happy movie.

▪ Start your dreams off, replay a happy event in your mind as you are drifting off to sleep, remember happy times and people you love.

▪ If you struggle with reoccurring nightmares, when you are in a good place allow yourself to go through the nightmare but change the ending, even write different endings to the nightmare focus on them read them through it can help you to rewrite your nightmare to a different ending when you are asleep.

▪ Reassure yourself, look after yourself after a bad night, tell yourself that even though the dreams seem real and are painful they can’t hurt you.

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