Sleep Care

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Sleep Onset Insomnia (Can’t Fall Asleep)

What Is It?

Sleep-onset insomnia is a disorder that causes you to have trouble falling asleep. Most people with this problem take longer than 30 minutes to fall asleep, and sometimes it may take hours before sleep is achieved. Probably one of the most common forms of insomnia, sleep-onset insomnia can be occasional or chronic. Occasional insomnia will come and go, but often does not happen on a regular basis. Chronic insomnia is a sleep pattern that persists for months and sometimes years. This type of insomnia can stop you from getting the rest you need to live your life normally. People who have insomnia often find it difficult to get up for work in the mornings and often have to use caffeine or other stimulants to get through the day. Occasional vs. Chronic Occasional sleep-onset insomnia is fairly common. Difficulty falling asleep can often be caused by stress, worry, caffeine, medical conditions, heart problems, acid reflux, medications or daytime naps. When insomnia is only experienced a few times, our bodies can often recover from the fatigue. However, chronic sleep-onset insomnia (lasting for months or years) can be harmful to your health and have many negative side effects. People who have trouble falling asleep often are not able to get enough sleep before having to be awake in the morning. Lack of sleep can have serious side effects, such as daytime fatigue, poor work performance, difficulty concentrating, slow reaction time during driving, weight gain, and other medical conditions. If you frequently have trouble falling asleep you should talk to your doctor about the best way to treat your insomnia. Delayed Sleep-Phase Syndrome/Advanced Sleep-Phase Syndrome Delayed sleep-phase syndrome causes a person to have trouble maintaining a normal sleep schedule, preventing him or her from falling asleep until much later than desired. Usually this means an inability to fall asleep before two or three o’clock in the morning. This type of sleeping disorder is classified as a circadian-rhythm disorder. Circadian rhythm is the normal sleep-wake cycle. Our bodies naturally tend to become tired in the evenings and wake in the mornings. When this cycle is out of balance the person can have trouble falling asleep and waking up at normal times. Once asleep, however, the person is able to sleep for the normal amount of time and wake feeling well rested. Most people with this disorder don’t seem to have any trouble with lack of sleep, unless a conflict arises in their schedule and they have to wake early. This disorder can, however, be very difficult for people with early-morning commitments like work and school. When a person suffers from advanced sleep-phase syndrome, he or she is often unable to remain awake in the evenings and ends up falling asleep before the normal bedtime. With this disorder a person will usually fall asleep around six in the evening and wake around two in the morning. Many people with this disorder have found it physically impossible to keep a normal sleep schedule. This cycle will generally persist for longer than three months. People suffering from this circadian disorder will still be able to get a full night of sleep; they just cannot seem to control their bedtime. This can cause them to have many problems participating in social situations. Many people with this disorder find it difficult to go out in the evenings or participate in social activities. Long-term therapy is often necessary to solve this problem. Treatments Light Therapy: Light therapy is the use of an artificial “sun-like” light source to change the natural sleep-wake cycle. To do this, the patient would set up a bright-light box and set aside a period of time everyday to be exposed to the light. The idea behind this treatment is to slowly trick the body into a more acceptable sleep-onset time. For example, if you had delayed sleep-phase syndrome and you were unable to fall asleep until late at night, you could use the light to mimic the sun early in the morning, causing you to wake earlier in the day. This

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would then shorten your sleep time and cause you to be more tired in the evening. If you are more tired in the evening you are more likely to fall asleep earlier, therefore resetting your natural rhythm. The light used in this therapy is an artificial extreme bright white light. This light causes the body to react as it would to the sun, but without any UV radiation. The body undergoes several chemical reactions when in sunlight. These chemical reactions determine our circadian rhythm, so

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when they are altered our sleep-wake cycle is also altered. By slowly tricking the body, we can establish a new bedtime and wake time. Normal artificial light bulbs will not produce the same effect. A special bright-light box must be purchased. Chronotherapy: Chronotherapy is a behavioral therapy that can allow a patient to reset his or her current sleep-wake cycle by expanding the day from 24 hours to 27. This therapy can be very effective in treating all forms of sleep-phase syndromes. To do this, a person is put on an extended sleep-wake schedule, allowing a normal night of sleep followed by a longer wake time. This therapy is usually done in 3-hour segments as shown below. 1st night: sleep at 4 a.m., wake at 12 p.m. (advanced sleep phase) 2nd night: sleep at 7 a.m., wake at 3 p.m. 3rd night: sleep at 10 a.m., wake at 6 p.m. 4th night: sleep at 1 p.m., wake at 9 p.m. 5th night: sleep at 4 p.m., wake at 12 p.m. 6th night: sleep at 7 p.m., wake at 3 a.m. 7th night: sleep at 10 p.m., wake at 6 a.m. (normal sleep cycle) As you can see, by pushing each day back 3 hrs, you can try to establish a normal sleep schedule. It is important to the success of this therapy that the patient adheres to it strictly and does not push his or her bedtime later into the evening. If the new bedtime is not kept, more than likely the patient will return to the sleep-disordered schedule.

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