August 2006 Archives

Did the sleep deprivation of the the lone air traffic controller have anything to do with the Comair crash? A federal investigator said the controller on duty the morning Comair Flight 5191 crashed had only two hours of sleep before starting work on the overnight shift.

National Transportation Safety Board (NTSB) member Debbie Hersman said the controller had only nine hours off between work shifts on Saturday. That was just enough to meet federal rules, which require a minimum of eight hours off between shifts, Hersman said.

"He advised our team that he got approximately two hours of sleep," Hersman said on Wednesday.

The commuter jet crashed on Sunday morning, in the final hours of the controller's shift, while trying to take off from Blue Grass Airport.

Federal officials have been looking for explanations why Flight 5191 mistakenly tried to take off from a runway that was too short, crashing in a nearby field and killing 49 of 50 people on board.

Read

Stone beds, popular among some people in Korea in the 1990s, seem to have found their way to America, possibly introduced by people of Korean origin.

These beds are like a flat bench,  and stone makes up just the top layer of an approximately 4-inch sleeping platform. The beds can be made of quartz, mica, topaz and several varieties of jade, and feature embedded heating coils that give off a low, radiant heat.

Another popular version of the bed - not quite as hard, but still very solid - has a vinyl surface covering a layer of specially formulated hardened mud.

Fans of the beds report that they help, rather than hurt, their backs, and can tick off their benefits: their radiant heat soothes muscles, they're hypoallergenic, they'll last forever.

And doctors can find no reasons to avoid these stone beds.

Timothy Radomisli, an orthopedic surgeon in Manhattan, said softer mattresses don't necessarily keep the spine aligned, and there's no definitive evidence that firmer mattresses are worse or better.

Read

The Howstuffworks page about sleep is really interesting, and answers questions like why we all need to sleep, or what causes dreams. The article goes on to explain, with the help of a diagram, the 5 stages of the sleep cycle. Also, lucid explanation of other concepts, such as REM sleep, and what happens when we don't get enough sleep.

For all of us who would like to know the scientific explanation of sleep, explained in a language that we can understand, this is a valuable source.

Dreaming about purple elephants holding flowers with their trunks? Or about snakes in your soupbowl? Well, there are a number of sites that claim to help you to interpret what these dreams are supposed to signify. Obviously, dreams are manifestations of our subsconscious thoughts, but whether they are also premonitions or insights, is a matter of debate.

Of all the dream interpretation sites, one I found quite interesting was the Dream Doctor which gives some information about this 'science' and also promises to interpret your dreams if you submit them.

The Dream Doctor is actually Charles McPhee, host of the nationally syndicated Dream Doctor Radio Show. McPhee holds a master’s in communication management and has received his board certification to perform polysomnographic testing for the diagnosis and treatment of sleep disorders in 1992.  Whether this qualifies him to interpret my dreams is unclear, but submitting them to him probably beats relating them to my partner while he tries to read the newspaper.

On the Shut Eye site, I found some helpful relaxation techniques that can be used for winding down before bedtime.

The instructions are accompanied by audio presentations that include a soothing musical selection.

I did find these helped me to relax, and plan to use them again, specially when you are home after a late night,  getting straight into bed does not help sleep. It's better to spend about half an hour unwinding and then attempting to sleep.

Another good muscle and mind relaxation technique is the Yoga posture 'Shavasana' - the Corpse Pose.

Hospitals are supposed to help patients to relax and recover, but in reality, noise levels may prevent patients from getting rest. Now the Montefiore Hospital in New York has initiated a new program to reduce noise levels and help patients sleep better.

The sources of noise were abundant at Montefiore, including ringing telephones, blaring televisions, hospital alarms, intercom announcements, and carts balancing on squeaky wheels.

"Studies have shown there is a relationship between excessive noise and a slowing of the healing process. Noise also contributes to increasing stress and anxiety levels." Nurse Margaret Amato-Hayes, clinical director of nursing at Montefiore, said. "Noise is not only an irritant, but an obstacle to healing." 

The hospital is trying out a new program called "Silent Hospitals Help Healing" (SHHH).

"All equipment, from IV poles to medication carts, is sent for lubrication and inspection," Nurse Elodia Mercier, the administrative nurse manager who implemented the program, said.

In addition to inspecting equipment, nursing managers are monitoring hallway conversations. Staff is advised to turn phones and beepers on vibrate. Even the intercom volume was decreased.

"The effects of SHHH have been remarkable," Mercier said. Noise within her unit was as high as 78 decibels. Now the levels are around 55, similar to that of a library. Overall decibels levels have fallen significantly since the program started.

"Within two weeks, patients said they were sleeping better, and staff told us they felt less stressed," Mercier said.

Read

A new research study conducted by the John Hopkins University shows a link between apnea in kids and brain impairment that could hinder their ability to learn new tasks. Children with apnea, often manifested as a habit of snoring, perform significantly worse on IQ tests and tests to measure verbal working memory and verbal fluency.

Using a special type of magnetic resonance imaging (MRI), the researchers found that those children with sleep apnea had significant changes in two brain regions associated with higher mental function: the hippocampus and the right frontal cortex. They also determined that the children had altered ratios of three brain chemicals -- N-aceytl aspartate, creatine and choline -- which are indicative of brain damage.

"Executive function is the ability to take an old memory and put it to use in a new situation," said Dr. Ann Halbower, medical director of the pediatric sleep disorders program at the Hopkins' Children's Center in Baltimore. "It's what makes smart people smart. The clinical implications are that doctors need to understand that sleep apnea is more of a problem that we thought it was. It's not just a disease of old people."

Because untreated sleep apnea appears to impair brain chemistry, its effects could be permanent, Halbower added.

"We can only assume that it could turn an otherwise smart kid into a mediocre kid, which could mark him for life," she said.

But it's also possible that these effects are reversible. Halbower's next study will try to determine whether sleep-apnea treatment can restore normal brain chemistry and cognitive function.

The standard treatment for sleep apnea in children is surgical removal of enlarged tonsils and adenoids, which can obstruct breathing. Other treatments include removal of excess tissue in the back of the throat or nose and the use of continuous positive airway pressure (CPAP) machines to maintain normal airflow during sleep.

Read

A bedtime story is just the thing for your superactive kid, helping her to wind down and get into sleep mode. It can also be a good feeling for you, to read the story, see her delight, snuggle her into the covers and turn the lights off.

Here is a site that can help you to really make this quality time, and take both you and your kid to sweet-dreams land. The Bedtime-Story site has selected talented authors and paired them with gifted illustrators. The result is the stuff pleasant dreams are made of. The criteria for a tale's inclusion on the Bedtime-Story site, is that the story must be as pleasant for an adult to read, as it is for a child to hear.

With all of us needing to calm down and unwind after a terribly busy day, it may not be a bad idea to read some of the Bedtime-Story website stories, even if there's no kid around.

Here is an innovative solution to apnea and snoring, especially for people who are uncomfortable with the CPAP. A Kissimmee, Florida based company has created the Sona Pillow, designed to prevent snoring and apnea by getting the user to sleep in the side position, and inclining the head so that the jaw is pulled forward by gravity. This stops the jaw from falling backwards and causing an obstruction in the throat.

The Sona Pillow may be utilized as an alternate to CPAP, mandibular devices and surgical procedures for the treatment of snoring and sleep apnea.

This pillow seems to hold promise, as it is the only product other than the CPAP to be certified by the FDA as an over-the-counter remedy for apnea.  It can be ordered on the site, at $ 69.99, and I certainly plan to get one for my loud sleep companion.

Just read a very interesting account of an insomniac's journey to better sleep through a complete treatment program.

Mindy Clawson writes about being a periodic insomniac for many years and reaching a point of being unable to sleep without medication.  She was already doing what was advised in every article about insomnia; going to sleep at the same time every night, cutting out caffeine and alcohol, no TV in the bedroom etc. And yet she often woke in the middle of the night, unable to go back to sleep.

Clawson then describes her treatment at the Vermont Regional Sleep Center, which involved a combination of therapy, exercises, breathing exercises and self hypnosis. Most importantly, she was asked to maintain a sleep log, recording what time she felt tired, if she took alcohol, or a sleeping pill and what time she got out of bed.

She was told that if she woke during the night, and was awake for over 20 minutes, she was to get out of the bed, and do something else until she became tired.

One of the things that I found very interesting in Clawson's story, and could relate to it with my own experiences completely, was her diagnosis of waking up and not being able to go back to sleep.  Her doctor explained to her that everyone has "awakenings" each night, but most people simply drop back off to sleep, sometimes not even knowing they've woken up. For people who operate at high speed during waking hours, once the body comes out of deep sleep, the brain revvs up to full-operational mode.

Clawson reports that it took about 7 sessions with the sleep specialist, spread out over two months, for her to start to get seven hours and 45 minutes of sleep time consistently.

Read

About 5,600 people are killed each year in the U.S. in crashes involving commercial trucks. Many of these crashes happen when the driver falls asleep at the wheel.

Researchers at the University of Pennsylvania School of Medicine examined truck drivers and studied patterns of sleep and fatigue.

The study found that drivers who routinely slept less than five hours a night were likely to fare poorly on tests designed to measure sleepiness, attention and reaction time, and steering ability. Drivers with severe sleep apnea, a medical condition that causes a poor quality of sleep, also were sleepy and had performance impairment.

Allan Pack, MB, ChB, PhD, who headed the study, said the tired truck drivers had impaired performance similar to that of drivers who are legally drunk. "We identified some very impaired people," said Pack, a sleep expert who directs Penn's Center for Sleep and Respiratory Neurobiology.

Nearly five percent of the truckers had severe sleep apnea (a condition in which someone stops breathing often during sleep), and about 13 percent of the drivers got fewer than five hours of sleep a night on a regular basis. "There are daytime neurobehavioral performance impairments that are found commonly in commercial drivers, and these are more likely among those who get an average of five or less hours of sleep a night and those who suffer from severe obstructive sleep apnea," the researchers concluded.

Penn researchers are now suggesting specific steps for the Federal Motor Carrier Safety Administration to take to improve safety:

• Develop strategies to identify impaired drivers through objective testing.
• Implement programs to identify and test drivers with severe sleep apnea and monitor that they stick to their treatment.
• Introduce programs to assess and promote longer durations of sleep among commercial drivers.

Read

A recent Ipsos-Reid survey reveals that 58% of Canadians prefer a good night's sleep to a good night of sex. The Nutritional Health Review Magazine survey found that 47% of women over the age of 45 would rather ger more sleep than sexual activity. A 2001 survey by Durex showed that a majority of people in Thailand prefer sleeping to sex.

Internationally, it seems to be emerging that naptime is often preferred over sex. Couples are so exhausted dealing with work related or children related demands that there is little energy left for sexual activities.

This seems to be most common for couples between the ages of 25 and 35, who are always busy commuting, traveling, working, taking care of kids and housework, or surfing the net.

We reported in a previous post about Winston-Salem and Forsythe County schools starting later to enable kids to sleep better.

Now, North Kingstown schools will start later in the fall so that students can get the sleep they need.

Concerned about student performance, officials approved changes in timings so that the high school starts 25 minutes later this year. The School Committee Wednesday approved the new 7:30 a.m. start time, compared to the previous 7:05 start. Students will get out at 2 p.m.

Studies have shown that teenagers have different sleep patterns than adults, and often cannot fall asleep until after 11 p.m. In March, the National Sleep Foundation polled teenagers and found they were napping in class and feeling depressed -- all because they weren't getting enough sleep.

"Who can do math at 7 in the morning?" asked School Committee member Denise A. Coppa. A local study shows that first-period math students don't do as well as students in later classes, she said.

During a May School Committee meeting, more than a dozen students urged the committee to start school later. In the winter, students walk to school in the dark and slurp coffee to wake up, they said.

Middle school students will also start school 25 minutes later, at 8:30 a.m. The Forest Park and Quidnesset Elementary Schools will  start 45 minutes later. At Davisville and Hamilton Elementary Schools, students will start school 10 minutes later.

Only students at the Stony Lane and Fishing Cove Elementary Schools will go to school at the same time as last year: 9:20 a.m.

Read

About.com's Interior Decorating section has some valuable tips on selecting the right pillow.

The function of the pillow is to support your head and keep your spine as straight as possible.  If you sleep on your back you need something fairly flat, while side sleepers should have something more substantial that can support their heads.

When choosing a filling, choose a down pillow if you like one that can be squished around. If you prefer one that will not shift around during the night, a firm foam pillow is right for you.

Check the firmness, and buy a firmer pillow if you sleep on your side, and a flatter, softer one if you sleep on your stomach.

You can expect a foam pillow to last for about two years, while a down one may last upto ten years.

Pic courtesy www.flickr.com

Researchers at the Mayo Clinic have found that frequent headaches in children appear to be associated with sleep problems.
More than two-thirds of children studied who suffer from chronic daily headache also experience sleep disturbance, especially delay in sleep onset. For children with episodic headaches, one-fifth had sleep problems.

"What's novel in our study is the finding that a high percentage of patients with headache have sleep disturbance," says Kenneth Mack, senior study investigator. " The number of patients who have headaches and also sleep disturbance surprised us. They also have the same sleep disturbance: a delay in sleep onset."

The researchers undertook this study to scientifically study their observation in the clinic that many children suffer from both headaches and sleep problems.

The investigators do not yet know which problem comes first, sleep problems or headache, as sleep problems make the headaches worse, and vice versa. They could have a common cause, or one problem could be an early sign of the other.

Treatment must be simultaneous for both conditions, using medicine and non-medicine approaches, says Mack. " It's going to be hard to control the headaches till you get the sleep problems under control either with medication or non-medication treatment," he says.

Key non-medication treatments include attention to maintaining routine in the child's schedule and developing good sleep hygiene, according to Lenora Lehwald, study investigator. These include - making the child's bedroom a relaxing place and avoiding exciting stimuli like TVs and video games in the bedroom, and having a routine for calming down in the last hour before bedtime. Activities like reading make children drowsy and help prepare for bedtime.

If a child with both headache and sleep problems requires medicine, Mack prefers migraine medication that also helps with sleep issues.

Read

Pic courtesy www.flickr.com

Dr. Sean Drummond, a Department of Defense-funded researcher, has studied the effects of sleep deprivation on the brain, namely in decision making, as well as how long it takes to recover from periods of no sleep. These studies have been on for nearly four years, in an effort to understand the effect of sleep deprivation on the military as well as civilians.

"We can't keep as many things online at any one time when we're sleep deprived. Sleep deprivation significantly impairs attention, working memory performance, our ability to drive. It has the same effect as alcohol does," said Drummond, who works with the University of California San Diego and the Veterans Affairs San Diego Healthcare System.

Sleep deprivation can affect military personnel, as reported by a pilot on mission in Iraq, who says he made potentially accident-causing mistakes because of too many missions with too little sleep.

The researcher and his team recruited 40 volunteers with good sleep habits who agreed to live in a lab for six days. For their stay, volunteers lived two normal days and nights, stayed awake for 64 hours and then were allowed again to sleep so the team could observe the recovery process.

During the volunteers' awake hours, they underwent half-hour long learning, memory and decision-making tests every two hours to see how well they fared at different stages of sleep deprivation. One test, for example, had the volunteers memorize lists of nouns. Drummond and his team also used functional magnetic resonance imaging in the morning and evening to map the brain's reaction. The imaging technique looks at oxygen use in the brain, so whatever part of the brain is being used, it needs more oxygen.

"The brain is a system, a network of areas, all of which work together to get a task done," he said.

The researcher found that volunteers' working memory wasn't affected after 36 hours without sleep, not because they were all healthy and had an average age of 24 years, but because other regions of the brain jumped in to help.

"The brain can actually compensate for this level of sleep deprivation. Areas that don't normally turn on when a person is well rested came online when the person was sleep deprived," Drummond said. "The better they're able to engage them, the better they're able to do after sleep deprivation."

After 60 hours, though, most volunteers didn't fare as well on their tests as they had at the 36-hour mark. After two and a half days without sleep, their brains could not recruit help.

"I think it will be important to use these data to try to better predict and understand who is going to be resilient to sleep loss and who is going to be vulnerable," Drummond said. "The benefits will come in better understanding the consequences of sleep deprivation for more complex types of cognitive functions - as opposed to simple attention, for example - as well as better understanding how long the recovery process takes."

Drummond's team also found that recovering from 64 hours of sleep loss wasn't as simple as getting a few good nights' rest.

"We found on some tasks that people aren't back at the baseline level even after two full nights of sleep, given that they only lost two nights of sleep," he said. "Given the pervasiveness of inadequate sleep in the military and civilian worlds alike, there is clearly a need to understand what this is doing and can it be counteracted."

Read

Pic courtesy www.flickr.com

A new study by Spanish researchers has found that elderly people with severe sleep apnea face more than twice the risk of stroke than people with mild sleep apnea or none.

People with sleep apnea experience episodes when their breathing stops during sleep. Previous studies of the link between stroke and sleep apnea have focused on middle-aged people, but it's older people who have the greatest incidence of stroke, according to study lead researcher Dr. Roberto Munoz, a neurologist at the Hospital de Navarra, in Pamplona, Spain.

Patients with severe sleep apnea had a 2.5-fold increased risk of stroke than patients with no apnea, mild apnea or moderate apnea, Munoz's team found.

"Sleep apnea is two to three times more common in the elderly compared to middle-aged people," Munoz said in a prepared statement. "However, typical symptoms of sleep apnea, such as loud snoring or excessive daytime sleepiness, are less prevalent in the elderly compared to middle-aged people. We should be aware of these symptoms, and specifically look for the presence of repetitive breathing pauses in our patients and relatives."

Read

A national survey this year on the sleep patterns of adolescents (ages 11-17) by the National Sleep Foundation shows that most do not get the optimal amount of sleep for top performance and good health. Now some schools in Winston-Salem and Forsyth County are taking cognizance and making variations in school schedules to help kids get more sleep.

Here are some of the highlights of the survey:

• Just one in five gets the optimal nine hours of sleep on school nights.
• Sleep deprivation increases as adolescents get older. Sixth-graders get an average of 8.4 hours of sleep on school nights, and 12th graders get 6.9 hours.
• Over the course of a week, high-school seniors miss 11.7 hours of sleep.
• More than one-quarter (28 percent) of high-school students fall asleep in school, 22 percent fall asleep doing homework, and 14 percent arrive late or miss school because they overslept.
• More than one quarter (28 percent) of adolescents say they're too tired to exercise.

Why are America's teens so sleep-deprived?

When children reach adolescence, their internal clocks, or circadian rhythms, change so that they naturally fall asleep later at night and wake later in the morning, according to the NSF.

More than half (54 percent) of high-school seniors go to bed at 11 p.m. or later on school nights, according to the NSF survey. Yet most still get up at 6:30 a.m. to get to school on time, according to the survey.

Four years ago the Winston-Salem/Forsyth County Schools moved the start time for high schools from 7:45 a.m. to 8:50 a.m. so students could sleep later in the morning.

It seems to be working.

"We have analyzed it very extensively," said Marty Ward, the system's program-evaluation manager. "We have surveyed all the students in our high schools every spring for the last four years, and we have found that they are sleeping a little more, 34 minutes, a night."

"What research has shown is that the students don't change the time they go to sleep when you change things like what time school starts," Ward said. "But they will sleep as long as they can in the mornings."

Read

Pic courtesy www.flickr.com

At several points during the night, rapid eye movement (REM) sleep occurs. Most people experience three to five intervals of REM sleep per night, and brainwaves during this period speed up to awake levels. If you ever watch a person experiencing REM sleep, you will see their eyes flickering back and forth rapidly.

In many dogs and some people, arms, legs and facial muscles will twitch during REM sleep. Periods of sleep other than REM sleep are know as NREM (non-REM) sleep.
REM sleep is when you dream. If you wake up a person during REM sleep, the person can vividly recall dreams. If you wake up a person during NREM sleep, generally the person will not be dreaming.

You must have both REM and NREM sleep to get a good night's sleep. A normal person will spend about 25 percent of the night in REM sleep, and the rest in NREM. A REM session - a dream - lasts five to 30 minutes.

Medicine can hamper your ability to get a good night's sleep. Many medicines, including most sleeping medicines, change the quality of sleep and the REM component of it.

From the HowStuffWorks section on sleep.

Restless legs syndrome (RLS) is a discomfort in the legs which is relieved by moving or stimulating the legs. This feeling is difficult to describe and commonly referred to as a crawling, tingling or prickling sensation.

Most patients experience symptoms during a period of inactivity, such as reading, watching television or riding in a car.  The symptoms can be temporarily relieved by getting up and walking around, or taking a hot shower, or rubbing the legs.

Medications have been found useful in the treatment of RLS.

Sleepnet's RLS homepage has a number of useful links providing information about RLS.

Two new studies by University of Michigan Health System researchers have found that  chemical imbalances in the brain may be partly to blame for certain life-disrupting sleep disorders. In a report published in the journal Neurology, the team reported apparent links between deficits in brain chemistry and obstructive sleep apnea (OSA) and REM sleep behavior disorder (RBD).

It seems logical then, that Selmedica Healthcare, a Memphis based company, has launched a new pill called 'Diavad' that helps you to sleep by restoring your body's  chemical and hormonal balance.

Diavad allows your body to achieve balance and permits you to maintain a normal, healthy sleep pattern, a company spokesman said.

“Diavad does not cause you to fall asleep, instead it restores your body’s own crucial chemical and hormonal balance which re-establishes a more natural and healthier sleep pattern,” the spokesman said. “We call it revolutionary because Diavad fights your sleeplessness symptoms from the inside - from every angle. It attacks the emotional, physical, and the psychological causes of sleep deprivation. You are actually receiving a system that is attacking your inability to sleep, overactive mind, and restlessness from every aspect.”

Read

From the ehow site, here are some good guidelines on selecting the right pillow.

A good pillow feels comfortable and provides good support to the neck and back. Before you go shopping for a pillow, you should decide if you need a soft, medium or firm pillow.

The site gives these steps, tips and warnings for selecting a pillow:

Steps: 

1. Read labels to determine what a pillow is made of. Pillow fills can be polyester, foam, goose down or a combination of feathers and down. Down is usually more expensive. It's very soft and is easy to shape or mold to your head and body. Polyester, which is less expensive, is comfortable too, depending on the quality, but it won't fluff up the way down does. 
2. Check the amount of fill in the pillow (how full it is). The more fill, the firmer the pillow. 
3. Select a soft pillow if you sleep on your stomach or frequently move around. This will prevent you from straining your neck. 
4. Buy a medium pillow for good support if you sleep on your back. 
5. Try a firm pillow for maximum support if you sleep on your side. 
6. Choose a cover fabric that's soft and breathable. 
7. Make sure the pillow's seams are tightly sewn to prevent fill leakage. 
8. Look for labels that say "hypo-allergenic" if you have allergies to certain types of pillow fill. Most manufacturers make "allergy-free" pillows now. 
9. Purchase a pillow cover with a zipper if you suffer from allergies. It goes under your pillowcase and helps protect you from dust mites.

Tips: 

• Pillow costs vary by manufacturer but are generally determined by the type of fill, the thread count of the cover (a 310 thread count is the most expensive), and the quality of the stitching. 
• Most allergy sufferers find they're allergic to down and may want to purchase a pillow made of polyester or foam. 
• If you're allergic to down, note that some pillow manufacturers are now making pillows that separate the down into pockets or channels that keep the feathers from moving around. 
• Pillows stuffed with buckwheat hulls are gaining in popularity. The hulls are said to provide good neck and back support and are supposed to stay warm in winter and cool in summer. 

Warning: 
Replace your pillow if it's lumpy, flat, or stained or has a bad odor. 

Pic courtesy www.flickr.com

Although more than half of older Americans have trouble sleeping and accept it as a normal part of aging, this need not be so.

"Sleep requirements and patterns change throughout life, but sleep problems in the elderly are not a normal part of aging," says Dr. Julie Gammack, assistant professor of geriatrics at Saint Louis University.

It's important to attempt to solve sleep problems, which can be a health risk and have a negative effect on quality of life.

"Sleep disturbance in the elderly is associated with decreased memory, impaired concentration and impaired ability to function. It contributes to an increased risk of accidents, falls and chronic fatigue," said Gammack, the author of a review article published in July's American Journal of Medicine.

The first step for elderly people with sleep problems is to keep a diary for a week or two that tracks: usual wake-up and bedtimes; timing and size of meals; amount of exercise; medications; and descriptions of how much and how restful sleep was each night.

This information will help a doctor establish whether a person truly has insomnia.

Here are some other suggestions:

• Increase exposure to bright light and natural light during the day and early evening.
• Avoid napping after 2 p.m. and limit yourself to one half-hour nap a day.
• Check the effect of medications on sleep.
• Wait until you're sleepy to go to bed.
• Avoid heavy meals before bedtime. If you're hungry, eat a light snack.
• Limit liquids in the evening.
• Keep a regular schedule.
• Rest and retire at the same time each day.
• Eat and exercise regularly.
• Manage stress by discussing worries long before bedtime and by using relaxation techniques.

Read