Jet lag

Jet lag is a circadian rhythm sleep disorder that is also called time zone change

syndrome. It involves a mismatch in the timing of your natural tendency to be asleep

and the time when you are naturally awake. It occurs due to travel by airplane across

many time zones. The long trip quickly puts you in a place where you need to sleep

and wake at a time that is different than what your internal body clock expects.

This clock controls the “circadian rhythms” in your body. The word “circadian” means

to occur in a cycle of about 24 hours. These rhythms make you feel sleepy or alert at

regular times every day. Your internal clock tells your body when it is time to sleep at

night. It also tells your body when it is time to be awake during the day. Your body

clock does not have time to adjust right away to a new location due to the speed of the

travel. Complaints related to this include the following:

• disturbed sleep

• being less alert

• being unable to function normally during the day

• mild sickness

• stomach problems

• menstrual symptoms in females who travel often

Jet lag is a temporary condition. Signs of it appear one to two days after air travel

across at least two time zones. How severe it is and how long it lasts depends on the

number of time zones you cross. It is also related to the direction of travel. Flying east

tends to be harder to adjust to than flying west. Estimates are that it takes one day

per time zone for your body clock to adjust to the local time. Crossing more than six

time zones can require even more time for your body to adapt. Some people are able

to adjust more quickly than others to rapid shifts in time zones.

Jet lag can be made worse by the following:

• loss of sleep due to the travel

• a long time of sitting in an uncomfortable position

• air pressure and quality

• stress

• too much caffeine and alcohol use

Who gets it?

Jet lag affects males and females of all age groups. Pilots, flight attendants, and

business travelers are most likely to have it. This is because of how often they fly. The

elderly are likely to have a more severe problem with it. They may need much more

time to recover than younger adults.

How do I know if I have it?

1. Do you have trouble sleeping or are you very sleepy during the day?

2. Is this problem due to jet travel across at least two time zones?

3. Do you have at least one of the following problems within one to two days after

travel? These problems include:

• You are unable to function normally during the day.

• You have a general feeling of mild sickness.

• You are having stomach problems.

If your answer to each of these questions is yes, then you might have jet lag.

It is also important to know if there is something else that is causing your sleep

problems. They may be a result of one of the following:

• another sleep disorder

• a medical condition

• medication use

• a mental health disorder

• substance abuse

Sleep Inducing Music and Sounds

Music and sound are excellent resources in the quest for sleep and relaxation.

For as long as anyone can remember, the lullaby has been an effective

tool for easing the sleep-hindering tension of even the most tense of babies and adults alike.

Nearly everyone can remember a time when our mother lulled us to

dreamland by softly singing our favorite sleepy time anthems, followed by the

gentle humming of the self same tune until finally even the crankiest of us

were slumbering away as peaceful as can be.

There are many different types of compact discs and sound making

devices on the market that can assist in the relaxation process.

Here are a few ideas to get you started:

Classical music CDs/tapes are a great way to unwind and put yourself in the mindset for a good night’s sleep. Brahms’s “Lullaby”, Mozart’s “Baroque Music”, and “Waltzes” by Strauss are just a few examples of some of the most relaxing classical music out there.

Ambient Electronica (sometimes referred to as “downtempo” or “chillout”) CDs/tapes are another excellent choice for “music to snooze by”. This particular genre of electronic music eschews the pulsating beat of techno and house for non-linear progressions, soothing melodies, syncopated rhythms and gentle sound effects. Some great examples of this type of music are The Orb, Future Sound of London, Aphex Twin and Brian Eno.

New Age/Tribal music CDs/tapes are similar in sound and

composition to Ambient Electronica, but feature more organic sounds and diverse non-electronic instruments such as didgeridoos, flutes, harpsichords, chimes and bells. This type of music often uses rhythmic drumming (similar to the beats found in a tribal drum circle), chanting or throat sounds.

• Sound Effects CDs/tapes are a bit different in that they are not necessarily “music” at all. You can buy prerecorded media that has various soothing relaxation-oriented sound effects such as waterfalls, babbling brooks, wind, rain, whale songs, water drops, and other natural sounds. Recordings of other types of sounds are also available such as busy city streets, fire engines, airplanes and other noise, which are great for city dwellers who find themselves somewhere out of their element where it is just too quiet.

• Sound generating machines are common and available in a wide variety of price points. These devices are usually about the size and shape of a standard alarm clock (and occasionally come built into alarm clock/bedside radios) and usually come with a variety of preset noises that are conducive to sleep and relaxation. Some of these gadgets simply have recorded waveforms that loop continuously, but some models include features such as auto fading after a preset amount of time or the ability to set alarms that gently rouse the sleeper awake. When shopping for sleep sound noise machines, it is important to consider whether the

device can play randomly synthesized sounds or can only playback recorded samples. The former, although a bit more expensive, are typically much better at inducing the sleep state rhythms than the latter, due to the fact that they mimic their natural counterpart

more closely.

The effectiveness of music as a therapeutic tool in dealing with insomnia varies from individual to individual.

Depending on the patient and type of insomnia, what works for one person will not necessarily work for another. Some people will have better results with rhythm and gentle percussion, while others will respond more positively to melody or non-linear compositions.

Some will react to constant repetition, while others benefit from randomness.

Even to this very day, science is exploring the potential of music and sounds effect on sleep patterns, dream states and consciousness in general.

On the ultra high tech side of things, researchers at the sleep clinic of the University of Toronto's psychiatry department and the University Health Network's Toronto Western Hospital are studying the ability of "brain music" --EEG recordings converted into musical compositions in a computerized process -- to assist in relaxation and improvement in the overall quality of sleep.

Essentially, the researchers create custom soundtracks for each individual sleeper by studying a person's brain waves to determine which

rhythmic and tonal sound patterns create a condition conducive to sleep in each individual subject.

The data is then fed into a computer program developed by the researchers which then generates unique "meditative" music that will create those same brain wave patterns when the individual is trying to sleep later.

Studies have shown that this “brainwave soundtrack” has the potential to alleviate brain conditions that result in anxiety and sleeplessness while not subjecting the patient to dangerous, potentially habit forming chemicals.

 

Exercise

The amount of physical activity that you expend during the day is a key ingredient to helping you sleep restfully at night. The more active your body is during the day the more likely you are able to relax fully at night and fall asleep easily.

With regular exercise your sleep quality is improved and the transition between the cycles and phases of sleep becomes smoother and more regular. Keeping up your physical activity during the day may also be help you deal with the stress and worry in your life.

Studies indicate that there is a direct correlation between how much we exercise and how we feel both emotionally and physically by changes in our brain chemistry that occur from regular exercise.

Try to increase your physical daily activity during the day. The goal here is to give your body enough stimulation during the day so that you are not restless at night.

Our bodies require a certain amount of physical activity in order to function in a healthy manner. It is important to note that you should not be exercising three to four hours before bed.

The ideal time for you to exercise is in the late afternoon or early

evening. You want to expend your physical energy long before it is time for your body to rest and ready itself for sleep.

Attempt to exercise at least three to four times a week for a continuous period of 20 to 30 minutes. This can include something as simple as walking or something as strenuous as running.

The goal is to increase your heart rate and strengthen your lung capacity. Adding a regular exercise activity to your daily schedule will improve your overall health and benefit you emotionally. This is can help promote a natural remedy for your sleeplessness.

Besides walking and running there are many physical activities that you can add to your life to increase your activity level. Aerobic exercises seem to work best to battle sleeplessness.

Your goal is to increase the amount of oxygen that reaches your blood. There are many types of aerobic activities to choose from. These include running, biking, using a treadmill, jumping rope, and dancing.

Some non-aerobic activities may be beneficial to you as you attempt to solve your insomnia problem. The following activities are relaxing and have other healing properties:

• Yoga has a stimulatory effect on your nervous system, particularly the brain. Yoga uses breathing techniques and yoga postures to increase blood circulation to the brain centre, promoting regular and restful sleeping patterns. Regular practice of yoga will relax you as well as

relieve stress and tension.

• Tai Chi is a form of breathing and movement that was developed by ancient Chinese monks. The movements involved in Tai Chi are precise and slow, which is ideal if you have joint pain or are unable to participate in high impact aerobic exercises. Studies have shown that Tai Chi may help people with insomnia by promoting relaxation.

If you find that you have no time to exercise on a regular basis try sneaking extra moments of activity into your daily schedule. Take the stairs instead of the elevator whenever possible.

Try parking your car around the corner and walking that extra block to your appointment. There are many small ways that you can incorporate some added activity into your life. Your goal is to have a healthy, well balanced life.

 

Bedtime Routine

It is essential that you establish a bedtime routine that works for you and stick with it. Your body and mind need to have consistency at this time so that you can learn to fall asleep naturally.

Once you have read this book you should decide on a course of action and stick with it for at least a week or two before making changes to your routine.

Write down your plan of action, including bedtime and waking time. Keep a list of the herbs and vitamins that you have tried as well as what teas you prefer.

Stick to your routine and after a week or two has passed and you are still experiencing difficulty sleeping make appropriate adjustments. The key here is to be consistent and determined.

Your goal should be to establish a regular sleep schedule. Wake up each morning at the same time and try not to oversleep. Sleeping longer in the morning will only make you feel groggy and disoriented.

Sleep experts believe that you should get an average of seven to eight hours of sleep each night. You can’t make up for sleep that you lose during the night by sleeping in later in the morning.

Simply do your best during the day and try to get back to your sleep schedule that night.

Try to get ready for bed at the same time each night. Once you have established what hours work best for you then try to be consistent.

It is important to realize that a regular bedtime routine is imperative to your goal of achieving natural sleep. Create a routine that will prepare you for sleep.

The routine can include many of the suggestions found in this book or they can be as simple as brushing your teeth or reading a book. Whatever routine you decide on it will be a way of telling your unconscious that it is time to fall asleep.

Try to make sure that your routine is relaxing and not stimulating so that your mind can rest.

Make sure that daytime naps are not part of your daily routine!

If you allow yourself to sleep during the day, even if it just for a few minutes, you will confuse your body's ability to differentiate between day and night sleeping.

Make an effort to try staying active when you are feeling tired during the day and eat a small piece of fruit to increase your energy level.

Remember that natural remedies work differently for each individual.

Think positive thoughts as you design a sleep routine that is right for you. Don’t become discouraged if you have to change and alter your

nighttime routine after a couple of weeks.

With perseverance and determination you will achieve natural sleep.

 

PRE - SLEEP AND WHEN YOU WAKE

The following suggestions are in general and can help you have a good night’s sleep.

 •            Keep a regular schedule. Try to go to bed and wake up at the same time everyday, even on the weekends. Keeping a regular schedule will help your body expect sleep at the same time each day. Don’t oversleep to make up for a poor night’s sleep – doing that for even a couple of days can reset your body clock and make it hard for you to get to sleep at night.

 

 •            Incorporate bedtime rituals. Listening to soft music, sipping a cup of herbal tea, etc., cues your body that it ' s time to slow down and begin to prepare for sleep.

 

 •            Relax for a while before going to bed. Spending quiet time can make falling asleep easier. This may include meditation, relaxation and / or breathing exercises, or taking a warm bath. Try listening to recorded relaxation or guided imagery programs.

 

 •            Don’t eat a large, heavy meal before bed. This can cause indigestion and interfere with your normal sleep cycle. Drinking too much fluid before bed can cause you to get up to urinate. Try to eat your dinner at least two hours before bedtime.

 

 •            Bedtime snacks can help. An amino acid called tryptophan, found in milk, turkey, and peanuts, helps the brain produce serotonin, a chemical that helps you relax. Try drinking warm milk or eat a slice of toast with peanut butter or a bowl of cereal before bedtime. Plus, the warmth may temporarily increase your body temperature and the subsequent drop may hasten sleep.

 

 •            Jot down all of your concerns and worries. Anxiety excites the nervous system, so your brain sends messages to the adrenal glands, making you more alert. Write down your worries and possible solutions before you go to bed, so you don ' t need to ruminate in the middle of the night. A journal or " to do " list may be very helpful in letting you put away these concerns until the next day when you are fresh.

 

 •            Go to sleep when you are sleepy. When you feel tired, go to bed.

 

 •            Consider avoiding " over - the - counter " sleep aids, and make sure that your prescribed medications do not cause insomnia. There is little evidence that supplements and other over - the - counter " sleep aids " are effective. In some cases, there are safety concerns. Antihistamine sleep aids, in particular, have a long duration of action and can cause daytime drowsiness. Always talk to your doctor or healthcare practitioner about your concerns!

 

 •            Get into a calming bedtime routine that you start 30 - 60 minutes before your desired bedtime. Avoid watching tense or scary movies, or other highly stimulating activities.

 

 Find some activities that you find calming, and that take your mind off of things that are bothering you. This could include using a relaxation CD, reading, taking a hot bath, having a warm drink ( such as decaf tea or milk ), or listening to music. Avoid using alcohol to feel drowsy — it tends to contribute to waking up in the middle of the night.

 

 •            Earlier in the evening, before you go to bed, make a list of things you will need to do tomorrow or in the near future. Once you have made the list, put it away and focus on relaxing. You can start working on your list again tomorrow, and you will have more energy to tackle your list if you get some sleep.

 When you wake in the middle of the night, you CAN get back to sleep.

 •            Do visualization. Focus all your attention on your toes or visualize walking down an endless stairwell. Thinking about repetitive or mindless things will help your brain to shut down and adjust to sleep.

 

 •            Get out of bed if unable to sleep. Don’t lie in bed awake. Go into another room and do something relaxing until you feel sleepy. Worrying about falling asleep actually keeps many people awake.

 

 •            Don ' t do anything stimulating. Don ' t read anything job related or watch a stimulating TV program ( commercials and news shows tend to be alerting ). Don ' t expose yourself to bright light. The light gives cues to your brain that it is time to wake up.

 

 •            Get up and eat some turkey. Turkey contains tryptophan, a major building block for making serotonin, a neurotransmitter, which sends messages between nerve cells and causes feelings of sleepiness. Note that L - tryptophan doesn ' t act on the brain unless you eat it on an empty stomach with no protein present, so keep some turkey in the refrigerator for 3am.

 

 •            Consider changing your bedtime. If you are experiencing sleeplessness or insomnia consistently, think about going to bed later so that the time you spend in bed is spent sleeping. If you are only getting five hours of sleep at night, figure out what time you need to get up and subtract five hours ( for example, if you want to get up at 6: 00 am, go to bed at 1: 00 am ).

 

 This may seem counterproductive and, at first, you may be depriving yourself of some sleep, but it can help train your body to sleep consistently while in bed. When you are spending all of your time in bed sleeping, you can gradually sleep more, by adding 15 minutes at a time.

 Our final chapter will deal with a problem that is very common – sleep disorders in children.

LIGHT FOR HEALING

The circadian rhythm is more a function of darkness and light rather than actual time of day. Bright light can discourage drowsiness, and darkness can cause sleepiness, day or night. Light therapy is a treatment used for people who suffer from circadian rhythm sleep disorders. Your body has an internal clock that tells it when it is time to be asleep and when it is time to be awake.

 

 This clock is located in the brain just above an area where the nerves travel to the eyes. This area is called the SCN. Your clock controls the “circadian rhythms” in your body. These rhythms include body temperature, alertness and the daily cycle of many hormones.

 

 The word “circadian” means to occur in a cycle of about 24 hours. Circadian rhythms make you feel sleepy or alert at regular times every day. Some people have a circadian rhythm sleep disorder. This causes their natural sleep time to overlap with regular awake activities such as work or school.

 Among other factors, your clock is “set” by your exposure to bright light such as sunlight. Exposure to bright light or “light therapy” is one method used to treat people with a circadian rhythm sleep disorder.

 

 The goal for treating patients who have circadian rhythm problems is to combine a healthy sleep pattern with an internal clock that is set at the right time. This will allow them to enjoy the benefits of good sleep.

 

 Light therapy can help someone “re - set” a clock that is off. Regular sleep patterns help to keep the clock set at the new time. Light therapy is only part of a treatment plan that should be guided by a doctor who is familiar with sleep disorders.

 The use of a special light box may be helpful.

 

 The procedure is noninvasive and simple. The patient sits a few feet away from a box - like device that emits very bright fluorescent light ( over 4, 000 lux ) for about 30 minutes every day. The following people might benefit from light therapy in specific ways.

 •            Shift workers. Light therapy should be maximized during hours they are at work and minimized when they need to sleep.

 •            Frequent travelers. Light therapy may be useful for adjusting to new time zones and reducing jet lag.

 •            Nursing home patients.

 •            People with delayed sleep - phase syndrome. ( These people have a natural tendency to fall asleep very late at night or in early morning hours, but then sleep normally. )

 Everyone should check with their physician before using light therapy. The following people should avoid it or use it only under a physician ' s direction:

 •            Anyone with eyes or skin that is highly sensitive to light.

 •            Anyone taking medications that increase the risk for photosensitivity.

 •            People with bipolar disorder.

 Timing of the therapy depends on the type of insomnia or sleep schedule of the individual. For example, in people who cannot get to sleep at night, light therapy in the morning and restricting bright light at night may be helpful. People who wake up early in the morning may benefit from light therapy performed in the evening, although a 2002 study reported that it had no effect in this group. Some light boxes have dawn / dusk simulators that help determine the correct brightness.

 Patients typically receive bright light therapy at home, with the use of a light box. The light box emits a standard dosage of 5, 000 to 10, 000 lux ( a measure of illumination ) of white light while you sit in front of the light, at a specified distance, for approximately 30 - 60 minutes after waking in the morning. Light therapy should always be used within the proper limits for light intensity and duration of exposure.

 Bright light therapy has not been known to show any major side effects. Some patients have reported minor side effects including: eye irritation and dryness, headache, nausea, and dryness of skin. To reduce the chance of experiencing these minor side effects, it is recommended that you begin light therapy very slowly and consult your doctor before use.

 Finally, there are some general tips that you can practice that can help with your insomnia.

OTHER ALTERNATIVES

Other techniques that can help you improve your sleep habits are stimulus control, paradoxical intention and sleep restriction. All three techniques have to do with changing your habits and reframing your current way of thinking about sleep. As you sleep better, you will create positive associations with sleep based on your new practices.

 •            Stimulus control

 

 Stimulus control therapy derives from the idea that a person with chronic insomnia associates bedtime and the bedroom with not being able to sleep. The technique limits the amount of time spent in the bedroom for non - sleep activities to retrain the brain to associate bedtime and the bed / bedroom with successful sleep attempts rather than sleeplessness. The general guidelines of stimulus control are:

 

 o            Go to bed only when you are sleepy.

 

 o            Don’t read, watch television, eat or do other non - sleep things in bed.

 

 o            If you are not asleep within 15 minutes, leave the bedroom and don ' t return until you are sleepy.

 

 o            If you are awake at night for more than 15 minutes, get out of bed.

 

 o            Have a consistent wake time every day, regardless of how much sleep you got.

 

 o            Avoid naps.

 

 •            Paradoxical intention

 

 Paradoxical intention is a psychological approach that is based on doing the opposite of what you want or fear and taking it to extreme. Some people who experience insomnia may continue to experience insomnia because they fear another sleepless night or they fear the thoughts and worries that accompany going to bed, and their fear keeps them awake.

 

 Paradoxical intention focuses on confronting, and hopefully, eliminating the fear so that it stops getting in the way of sleep. This approach is used for other fears as well. Rather than trying, unsuccessfully, to go to sleep night after night, try to stay awake and do something instead. Turning your attention to something else removes the fear of not being able to sleep and may allow you to relax and eventually go to bed.

 •            Sleep restriction

 

 Sleep restriction is based on the idea that people require different amounts of sleep, and that often, a person with insomnia stays in bed thinking that they will get more sleep, when staying in bed really just increases frustration and sleep difficulty. Sleep restriction therapy reduces the amount of non - sleeping time a person with insomnia spends in bed.

 

 To practice sleep restriction, you determine your average total sleep time by keeping a log of your sleep habits for two weeks. If you usually sleep 6 hours per night, but spend 8 hours a night in bed ( tossing and turning, watching TV, reading, staring at the ceiling for the other 2 hours ), sleep restriction therapy will only allow to spend 6 or 6 1 / 2 hours in bed at first.

 

 In the beginning, you might not sleep all of the time, but gradually, the time spent sleeping should increase. If you continue to have trouble sleeping, the time allowed in bed is further restricted to encourage sleep when you are in bed. The overall time spent in bed is adjusted as it becomes clear how much sleep you need.

 And then, there’s light therapy. Let’s re - visit the circadian rhythm and how light affects that rhythm.