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The first generation of wearables (such as Jawbone UP, Fitbit tracker original, Fitbit Ultra, Fitbit Flex, and Misfit Shine) could, using motion sensors, roughly tell when someone was asleep or awake. However, the major problem was that you could be awake--but not moving--in the middle of the night, and the device would classify that as sleep. A new generation of sleep trackers that can record more aspects of your physiology, for example, skin temperature, skin conductance and heart rate. Some may, or will eventually, have the ability to detect changes in the pattern of heart beats, called heart rate variability. Such measures, in combination with motion sensors, could, in the future, potentially improve the identification not only sleep and wakefulness, but also distinguish light sleep (N1 an N2), REM, and deep sleep (N3). At this time, the testing of these devices indicates they're able to detect light sleep and REM but are not so good with deep sleep and wake. [2021] - Judith R. Davidson

For more in-depth examination of sleep by scientists or sleep medicine clinicians, special equipment is used to track sleep stages and cycles through the night. To determine sleep stages, three main measurements are used: brain waves, eye movements, and muscle tone. [2021] - Judith R. Davidson

L-tryptophan doesn't appear to have troublesome side effects, morning "hangover," or tolerance. It may help induce sleepiness and help some people who have mild difficulty falling asleep and who are otherwise healthy (having no medical or mental health problems). Several studies were done in the 1980s and their results were mixed--sometimes L-tryptophan was better than a placebo and sometimes it wasn't. A published review of research on valerian concluded that it's relatively safe, but not effective for insomnia. The term "natural" product doesn't mean the same thing as safe. Some can have dangerous side effects, for example, kava kava can cause liver toxicity. [2021] - Judith R. Davidson

Standard (immediate-release) melatonin can sometimes be useful for the prevention of east-bound jet lag and for certain shift work schedules, and it may be helpful in the short term (up to 1-2 weeks) for sleep difficulty. Immediate-release melatonin is generally not useful for chronic insomnia. [2021] - Judith R. Davidson

Sometimes, instead of prescribing a BzRA for sleep, physicians prescribe a low does of an antidepressant (such as trazodone) or antipsychotic medication. It's debatable whether this type of low-dose treatment of insomnia is better than treatment with BzRAs. Stopping these medications after months or years of taking them is usually more straightforward than stopping BzRAs, although they should be gradually reduced, rather than stopped abruptly, over weeks. [2021] - Judith R. Davidson

After about 2-4 weeks of nightly use, BzRAs (benzodiazepine receptor agonists such as zopiclone) typically become less effective due to "tolerance." This means the dose you have been taking starts to have less effect; therefore, you need a higher dose to get the same effect. This can lead to dependence, which occurs when you have great difficulty sleeping without the medication. "Rebound insomnia" is sleep difficulty that occurs if you've been taking a BzRA every night for a while and then you suddenly stop taking it. If you have been using the medication every night for more than 4 weeks, ask your healthcare professional or pharmacist for advice on how to reduce the dose in a step-by-step way to avoid withdrawal effects. [2021] - Judith R. Davidson

Insomnia usually goes along with depression. Sleep lab studies show some changes in rapid eye movement (REM) sleep: It tends to start earlier in the night, and there's more than usual in the first part of the night. The amount of deep (slow wave) sleep is usually reduced. With some types of depression, a different pattern occurs-one of hypersomnia (excessive sleep). For example, with seasonal affective disorder, which is depression that occurs with winter darkness and lifts with longer hours of daylight, people often sleep more than usual and have trouble waking up in the morning. [2021] - Judith R. Davidson

Even though CBT-I hasn't yet been tested with all medical conditions, it probably works well to reverse insomnia regardless of the presence of medical conditions if you have the energy, strength and motivation to do it. [2021] - Judith R. Davidson

In general, people with bed partners report that they sleep better when the partner is present compared to when that person is away. They hold this belief although, when their sleep is measured by electrodes or movement sensors, their sleep is actually better when they sleep alone! [2021] - Judith R. Davidson

Contrary to traditional cautions against exercising within 3-4 hours of bedtime, we now know that exercise within 3 hours of bed is unlikely to interfere with sleep. In fact, it may be helpful. Regular strength workouts are associated with improved sleep quality according to people's ratings. Mind-body exercises such as yoga and tai chi are also associated with improved sleep quality ratings. Overall, people feel their sleep is improved when they exercise, regardless of the type of exercise. The sleep benefits of exercise may not be so evident if you have chronic insomnia. If you have persistent insomnia, combine your regular exercise program with CBT-I and insomnia doesn't have a chance. [2021] - Judith R. Davidson

Excessive daytime sleepiness, loud snoring, waking with snorts or gasping for air, and waking up with a headache are all possible symptoms of a sleep related breathing disorder and they warrant a trip to your family physician as soon as possible. [2021] - Judith R. Davidson

Sometimes we try too hard to sleep. Once we look too hard for it, it eludes us. For some people, this anxiety is lifted when they actually reverse what they're trying to do. Rather than trying to sleep, they try to stay awake. This is called "paradoxical intention." If you feel you "must sleep or "have to get to sleep" or you are "trying" hard to sleep, then give paradoxical intention a try, and see how long you can stay awake. [2021] - Judith R. Davidson

For Week 2, if your sleep efficiency (total sleep time / total time in bed) is 84% or less, set your threshold bedtime 15 minutes later but always give yourself at least 5.0 hours in bed; if your sleep efficiency is 85-89%, keep the same threshold bedtime; if your sleep efficiency is 90-94%, set your threshold bedtime 15 minutes earlier; if your sleep efficiency is 95% or greater, set your threshold bedtime 30 minutes earlier. If your sleep efficiency hasn't improved over 2 weeks, don't continue to restrict your sleep. Otherwise, repeat in Week 3 using the new sleep efficiency. This technique should be doing its work by Weeks 3-4. Your optimal sleep duration is reached when you're getting quite solid sleep (e.g., about 85% sleep efficiency) and you're not feeling overly sleepy during the daytime. [2021] - Judith R. Davidson

Get out of bed as soon as you wake up in the morning. This applies to the situation of waking up in the mooning earlier than your threshold rise time. Avoid driving and other potentially dangerous activities while sleepy. If sleepiness is overwhelming, you may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 pm and 4:00 pm. [2021] - Judith R. Davidson

For Week 1, set a "threshold bedtime" and "threshold rise time" that will limit your time in bed (sleep restriction): 1) Pick a rise time that you can maintain 7 days per week; 2) Take your total sleep time in hours (to the nearest half hour). If this number is less than 5.0 hours, then replace it with 5.0; 3) Take your threshold rise time and subtract your total sleep time. E.g. if your threshold rise time is 6:00 am and your total sleep time is 6.0 hours, your threshold bedtime will be midnight. Go to bed only when sleepy and not before your threshold bedtime. Leave the bed if you can't fall asleep or go back to sleep within 10-15 minutes. Return when sleeping. Repeat this step as often as necessary during the night. [2021] - Judith R. Davidson

Although the sleep information obtained from consumer wearable devices is appealing, these trackers are not yet ready for use in Sleep Therapy. They tend to misclassify wakefulness during the night, and they're untested in people with insomnia. [2021] - Judith R. Davidson

One night of sleep loss doesn't significantly or obviously impair our health system. Staying awake overnight, rather than sleeping, is accompanied by only subtle changes or even enhanced immunity in the short term. There is no clear evidence that a full night awake makes us any more susceptible to infection or disease. When we lose sleep one night, we can recover most of what we've lost the next time we sleep. [2021] - Judith R. Davidson

With insomnia, reaction time may be slower, problem solving, and some aspects of memory may be affected. However, we can usually get the job done--whether it be schoolwork, housework, or job work--although we may feel that it takes extra effort. We are functional, but tired, sad, and irritable. [2021] - Judith R. Davidson

When insomnia occurs at least 3 nights per week and lasts for 3 months or longer, it's technically called "chronic" insomnia (Don't be put off by that label, chronic doesn't mean irreversible!). [2021] - Judith R. Davidson

Although CBT-I is the best and most durable treatment we have for insomnia, it can have side effects. When people carry out "Sleep restriction therapy", which is a component of CBT-I, they sometimes experience excessive sleepiness, reduced vigilance and slowed reaction time. These effects are especially likely to occur at the beginning of the program, and they disappear when sleep is no longer restricted. Sleep restriction therapy is also meant to be used for a short time (usually 2-4 weeks), and should not be continued if your sleep has not improved substantially in that time. [2021] - Judith R. Davidson