Sleep is a basic human need like food and water. Sufficient sleep is essential for long-term health and performance in all areas of life (academics/work, social/interpersonal, athletic, emotional, physical). Though sleep needs vary from person to person, you should regularly be getting enough sleep to awaken without an alarm clock feeling refreshed and energized throughout the day. Most people need 7-9 hours of good-quality sleep every night. Occasional sleepless nights cause only mild impairment in functioning the next day and are of little concern. Long-term lack of sleep, whether because of poor habits or a medical condition, results in chronic sleep deprivation. A chronic pattern of poor sleep – whatever the underlying cause – is problematic and needs to be addressed.

Consequences of chronic sleep deprivation include:

• Daytime sleepiness
• Impaired memory
• Difficulty concentrating
• Depression
• Anxiety
• Slow thinking
• Irritability or erratic behavior
• Sexual dysfunction
• Poor health

Poor sleep hygiene (habits) accounts for most sleep deprivation among Carleton students. The culture at Carleton often promotes staying awake very late into the night, sleeping fewer than 7-9 hours per night, keeping erratic sleep hours, and using chemicals (caffeine, alcohol and other drugs) that interfere with the natural sleep cycle. These habits can result in chronic sleep deprivation, which in turn can lead to more severe sleep disturbances.

True sleep disorders include three basic types of insomnia:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking up too early

Insomnia can be categorized as:

• Transient insomnia - lasting for a few nights
• Short-term insomnia - two or four weeks of poor sleep
• Chronic insomnia - poor sleep that happens most nights and last a month or longer

Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following:

• stress and worry
• environmental noise or temperature problems
• sleep/wake schedule problems such as those due to jet lag
• medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders such as Obstructive Sleep Apnea. One of the most common causes of chronic insomnia is depression. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles that accompany shift work or other nighttime activity schedules; and chronic stress. The following behaviors have been shown to perpetuate insomnia in some people:

• Poor sleep hygiene in general
• Expecting to have difficulty sleeping and worrying about it
• Ingesting excessive amounts of caffeine or using other stimulants (nicotine, street drugs), especially near bed time
• Drinking alcohol before bedtime
• Excessive napping in the afternoon or evening
• Irregular or continually disrupted sleep/wake schedules

Healthy Sleep Hygiene Guidelines

• Keep Regular Hours
  • Go to bed at the same time and get up at the same time every day, even on weekends. Getting up at the same time is most important.
  • Get bright light (from the sun or a light box) at a regular time in the morning, to help you feel sleepy at the same time every night.
  • Establish a regular bedtime ritual. This routine "conditions" your body and mind, telling them you are preparing for sleep and moving them to a restful phase conducive to sleep.
• Control Environmental Factors
  • Avoid bright lights shortly before bedtime. Try using a lower-voltage light (15 watt) for bedtime reading.
  • Try to maintain a cool, comfortable room temperature for sleeping (ideally 65 to 70 degrees F).
  • Use a comfortable mattress and bedding. Straighten out your sheets and pillows before getting into bed to make it more comfortable and relaxing.
  • Aim for a dark room while sleeping, but try to maximize sunlight in the morning when you want to wake up.
  • If there is environmental noise, try using a white noise generator (a fan works) or some other sound system (relaxing nature sounds, soothing, non-lyrical music, etc.)
• Behavioral Choices: Do’s and Don’ts
  • Don't go to bed hungry. Have a light snack, but avoid a heavy meal before bed.
  • Limit fluid intake at bedtime to avoid having to void your bladder during the night.
  • Stay away from stimulants like caffeine (found in sodas, tea and coffee, chocolate, and some medications), which delay sleep and increase arousal during the night. If you take caffeine, do so in the morning.
  • Avoid nicotine (a stimulant) or other stimulating "recreational drugs," especially near bedtime.
  • Avoid excessive alcohol. Alcohol may help you to get to sleep initially but impairs normal sleep brain wave patterns and will cause you to awaken throughout the night.
  • Exercise in the morning or early afternoon, but avoid exercising in the evening.
  • Avoid stimulating activities close to bedtime (video games, exciting TV programs, etc.)
  • Take a brief nap (less than one hour) during your afternoon "slump" when possible. Do not nap within 6 hours of your desired bedtime, even briefly, as this disrupts your sleep schedule.
  • Set aside a "worry time" to sort through your difficulties of the day, then put them aside so they don’t keep you awake at night
  • Don't stress if you feel you are unable to get to sleep. It will just make matters worse. Remember, the occasional sleepless night won’t hurt you.
  • Avoid looking at the clock if you wake up in the middle of the night, as this may cause anxiety.

If you think you may suffer from sleep deprivation, The Wellness Center can:

• Teach you about sleep disorders and sleep deprivation
• Explore and diagnose the cause(s) of your sleep deprivation
• Teach you better sleep hygiene skills
• Provide specific therapies to enhance sleep

Behavioral/Medical Therapies for Sleep Disorders

• Relaxation Therapy. There are specific and effective techniques that can reduce or eliminate stress, anxiety and body tension, frequent causes of insomnia. These techniques allow your mind to stop "racing" and your muscles to relax so restful sleep can occur. It usually takes initial guidance and regular practice to learn these techniques effectively.
• Sleep Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. You may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.
• Reconditioning. Environmental and behavioral control is used to recondition people to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex (some experts even say using the bed for sex call cause performance anxiety which could lead to insomnia). As part of the reconditioning process, you are advised to go to bed only when sleepy. If you can't get to sleep for over 30 minutes, get out of bed and do something boring (not computer games or checking email!) in dim light until you are sleepy, and then return to bed. Throughout this process, avoid daytime naps and maintain a regular schedule of going to bed and waking up in the morning. Eventually your body will be conditioned to associate the bed and bedtime with sleep.
• Light Therapy. If you are having trouble getting to sleep early enough at night it will help to wake up at the same time every morning and try to get as much bright light in the morning as possible. This resets the internal clock to an earlier time at night for sleep. If you are having trouble staying awake in the evening and waking up too early in the morning, then try to get bright light in the evening. This resets the internal clock to go to sleep later and wake up later. You may want to avoid early morning light using this method until you have stabilized your sleeping pattern.
• Medication. As a last resort, sleeping aids (hypnotics or other medications) may be prescribed for short-term treatment of sleep problems. Taken long term, they lose their effectiveness and actually contribute to disordered sleep by interfering with the deepest, most restorative stages of sleep. A person taking sleeping aids, whether prescribed or over-the-counter, should be under the supervision of a physician to evaluate effectiveness and minimize side effects. You generally have to wean yourself off sleeping pills slowly so you don’t experience "rebound insomnia" when not taking them. Again, follow-up with a medical provider is recommended when discontinuing sleep medications that have been taken for more than a couple days.

For further information

The Wellness Center has many books that discuss sleep and sleep hygiene; these may be checked out at no charge. Additionally, the following websites have excellent information on sleep, sleep disorders, and sleep solutions:

• www.thesleepsite.com
• www.sleepnet.com
• www.sleepquest.com
• www.nlm.nih.gov/medlineplus/sleepdisorders.html