Madeeha Syed

If you feel sleep deprivation, despite sleeping, you might not be following your biological rhythms. Follow your circadian rhythms for a deep, sound sleep.

Are You Sleeping On Your Sleep Cycle?

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Can't Go To Sleep? Here’s Why And How To Fix It

Overview

You&rsquo;re lying in bed, trying to fall asleep. You&rsquo;ve tried everything: reading a book, taking a bath, meditating, nothing seems to work. If this sounds like you, don&rsquo;t worry, I&rsquo;m here to help. In this article, we&rsquo;ll explore some of the most common reasons why people can&rsquo;t fall asleep and what you can do about them. 
&nbsp;

trick your body into sleeping

It&rsquo;s hard to shut down the mind, but if you can allow yourself to be free of all thoughts, worries and overthinking, it&rsquo;s easier to get a good night&rsquo;s sleep. This is why meditation has become so popular as a way to relax and clear your mind.

If you are having trouble going to sleep at night because you have too much on your mind, try focusing on relaxing exercises, such as taking deep breaths for 10 minutes or listening to calming music before bedtime.

If you feel like there is simply too much for your mind to process before bedtime, try not to think about anything at all until after midnight (or whenever you plan on falling asleep). That means no worrying about things that happened earlier in the day or what needs doing tomorrow morning&mdash;just let everything go until it&#39;s time for bed!

&nbsp;

Your environment can also influence the quality of your sleep. If you are sharing a bed with a partner who snores, or have pets that are noisy at night, this can affect your ability to get into REM and deep sleep stages of sleep. If you suffer from these problems, try to keep your pets out during night time.

&nbsp;

If you nap during the day, this can make it harder to fall asleep at night. This is because napping reduces your total sleep time and delays your internal circadian rhythm. In other words, it makes for a long period of time with reduced sleep quality and quantity, which makes falling asleep at night even more difficult.

Napping during the day also makes you feel groggy when it&rsquo;s time to go to bed. It&rsquo;s like drinking coffee in the morning. Once the caffeine has worn off, you may find yourself struggling to stay awake until lunchtime, instead of the usual 3pm!

If you want an afternoon nap but don&rsquo;t want these side effects on your nighttime slumber, consider power naps (naps lasting between 15 minutes and 1 hour), instead of full-on snoozing sessions (which can last longer than 90 minutes). Naps are great if they help improve alertness or performance, however, they shouldn&#39;t be used as a substitute for nighttime sleep if that&rsquo;s what you need most!

&nbsp;

You may have heard that it&#39;s important to go to bed at the same time every night and wake up at the same time every morning. This is true, but even more important is your schedule on weekends and weekdays. If you get enough sleep every night, then it doesn&rsquo;t matter if you sleep in on Saturdays or stay up late on Sundays, your body will adjust to these changes when they happen.&nbsp;

However, if you&rsquo;re not getting enough sleep overall, especially if it&rsquo;s because of inconsistent nighttime habits, then your body might have trouble adjusting to irregular schedules.

&nbsp;

Imagine this scenario: you go to bed at 10pm as usual, but you&rsquo;re not tired. You try and get comfortable, but you can&rsquo;t stop thinking about all of the things that happened during the day &mdash; the conversations you had with colleagues, how much work is left to do tomorrow, or what your friends are doing right now. You start worrying about them and then feel guilty because they don&rsquo;t have time for a phone call when they could be sleeping.&nbsp;

Then another thought pops into your head: did I switch off my iron? Should I check? Now we all know that checking whether an appliance is turned off isn&rsquo;t going to help us sleep any better than worrying if our friends are safe (unless there&rsquo;s a fire nearby somewhere), but this process repeats itself over and over again until suddenly, it&rsquo;s 2am, and there&rsquo;s no hope for rest tonight either!

So how can we avoid these situations? The key is finding something else, anything else, to occupy our minds instead of keeping track of every single little thing that crosses our minds throughout the day.

&nbsp;

Pillow size is another important consideration. Your pillow should be firm enough to support your head and neck, but soft enough to mold around your head and neck as you sleep. A proper pillow will also allow you to keep your spine in alignment while sleeping on either side or on your back, which helps with good posture.

If you have been using the same old pillows for years, it may be time for an upgrade. If a new pillow doesn&rsquo;t work right away, try adjusting its height (keep adding or removing stuffing) until you find one that works for you 
&nbsp;

Don&rsquo;t forget about the other side of the bed - do not share a bed with someone if that person snores heavily. Snoring can really affect quality of life. If a partner snores loudly enough at night that it keeps other people awake or keeps them from getting enough sleep themselves, then this could lead to fights between couples over who gets up earlier so they don&rsquo;t disturb their spouse&#39;s slumber. This problem can be resolved by setting up separate bedrooms for each person or getting rid of noisy beds altogether by buying two twin mattresses instead!

&nbsp;

If you can&rsquo;t get to sleep, it could be for any number of reasons. There are a lot of things that can keep you from drifting off into blissful slumber.

<ul>
	<li>You have too much going on. If there&rsquo;s something weighing on your mind, or if you&rsquo;re in an environment that&rsquo;s too stimulating (like a loud restaurant or party), try taking a moment to reflect on everything that&rsquo;s stressing you out and how it might affect your sleep quality. Try jotting down some notes and setting aside time tomorrow to talk over those issues with someone else so they&rsquo;re not still bothering you when it&rsquo;s bedtime.</li>
	<li>You napped during the day or had too much caffeine/food/alcohol before bedtime. When we nap during the day, we tend to wake up feeling more alert than usual, and while this can be helpful if we have somewhere important to go after work and need the extra boost, it can also hinder our ability to fall asleep at night when all we want is rest.</li>
	<li>Your sleep schedule is off-kilter or irregularly shifted throughout the week due to travel changes etcetera. This will make it harder for us humans whose bodies are programmed over thousands of years by evolution just like all animals&rsquo; bodies, except ours has evolved way faster so now sometimes ours needs work done on them sometimes too. Thus, needing proper rest does matter, so here are some tips. 
	&nbsp;</li>
</ul>

If you are listening to music, watching TV, or playing video games, shut it off! Your brain may be losing focus and this makes it hard for you to sleep.

If you can&rsquo;t sleep, get up and do something else before going back to bed. The more time spent lying awake in bed the more difficult it becomes to fall asleep again.

&nbsp;

On a personal note, I have always <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle" target="_blank">struggled with sleeping</a>. When I was younger, I had to have my mom read me bedtime stories to help me fall asleep and would still be up way past midnight reading under my covers. These days, it&rsquo;s not as bad but there are still nights where my mind won&rsquo;t shut off and I find myself lying awake for hours. Sometimes it&rsquo;s because of something that happened earlier in the day or week; other times it&#39;s just a matter of getting enough rest.

As you can imagine, this can be frustrating when you want nothing more than to turn off your brain and go to sleep! But there are ways you can get better at falling asleep faster, and even staying asleep all night long if you want.

&nbsp;

Bottom Line

If you have tried all of these tricks and still can&rsquo;t sleep, there&rsquo;s nothing left to do but wait it out! Just remember, sometimes things happen in life that are out of our control. If you are lying there tossing and turning, just try to breathe deeply and stay calm. It may take some time for us humans to get back into a <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle">regular sleeping cycle</a> again, so don&rsquo;t be discouraged if you&rsquo;re stuck in bed all day without any hope of going anywhere else anytime soon!

Umna Salah

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Float Away From Your Troubles: Sensory Deprivation Tank Therapy

Introduction

Also known as floating or float therapy, sensory deprivation tank therapy is commonly used by people to destress their bodies, relieve pain, and improve their <a href="https://merisehat.pk/article/mental-health-awareness">mental health</a>. The concept was developed in 1954 by Dr. John C. Lilly, a neuropsychiatrist<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Understanding Of Sensory Deprivation Tank Therapy And Its Effects

The float tank or sensory deprivation tank therapy starts off with a large enclosed fiberglass tank filled with Epsom salt and water. The tank is heated to the person&rsquo;s skin temperature. The supersaturated salt solution allows the person to float on the water with the back of their head being partially submerged in water. Due to the size of the tanks, it is easy to fully stretch and relax as the therapy begins.

The sensory deprivation part comes not from floating but from the changes in the surroundings:

1. The tank is soundproof and dark. This allows the individual to calm and destress, and meditate while floating.&nbsp;

2. The salts present in the solution draw out the toxins from the person&rsquo;s body and have a soothing effect<a href="#accordion">[2]</a>. 
&nbsp;

Sensory deprivation therapy helps with stress relief by reducing cortisol levels in the body. Cortisol is a hormone that is released in response to stressors such as long hours at work or family obligations. When the level is too high for too long, it can result in heart disease, diabetes, and even depression.

In addition to helping with stress relief and reducing cortisol levels, sensory deprivation therapy also helps with pain management. Studies show that people who undergo sensory deprivation therapy report feeling less pain than those who don&#39;t undergo the treatment.&nbsp;

The premise of the treatment is a phenomenon known as REST or Restricted Environmental Stimulation Therapy. The theory focuses on isolating the person and putting them in a unique state of relaxation where their body is at proper rest<a href="#accordion">[3]</a>. 
&nbsp;

Strong research and individual results are evidence enough that the therapy works. While the surreal experience on its own sounds tempting, the therapy packs a bunch of long-lasting benefits, which include:

<ul>
	<li>No headaches or migraines</li>
	<li>Stress relief&nbsp;</li>
	<li>Tension relief from body muscles</li>
	<li>Detoxification</li>
</ul>

Tank therapy is quite helpful in treating mental issues, like anxiety, and relaxing tense muscles. It gives a feeling that is very similar to zero gravity. People also experience better sleep after good therapy. The magnesium in the salts aids in boosting heart health and strengthening bones. In some cases, it has also been observed to increase insulin sensitivity<a href="#accordion">[3]</a>.

&nbsp;

Due to the simplicity of the treatment, float therapy does not have a lot of side effects. However, it is common for people to experience discomfort in terms of:

<ul>
	<li>Boredom:&nbsp;Imagine getting into a tank and after settling down, the mind jumps to the next question: &ldquo;Okay, now what?&rdquo; There is nothing to do. For some people, this stage could stimulate their mind into overthinking, increase their heart rate or increase restlessness as they try to clear their minds. In a situation like this, it&rsquo;s very difficult to not feel anxious, however, this is a completely normal thing to experience for some people.&nbsp;</li>
	<li>Motion Sickness:&nbsp;Even though it is not a common occurrence, it is a possibility that people should consider before opting for this therapy. Floating can trigger motion sickness and if someone believes that it can happen to them, then it is always better to plan it strategically or take medications before hopping into the tank to minimize the effects. Remember, it is normal to feel nauseous when trying out float therapy for the first time.&nbsp;</li>
	<li>Ear Plugs:&nbsp;It may cause some discomfort to some people to have salt water get into their ear cavity and many people use ear tubes for that. Ear plugs are much more comfortable but the water tends to leak into the ear<a href="#accordion">[5]</a>.&nbsp; 
	&nbsp;</li>
</ul>

When it comes to the risks, very limited risks have been reported even after extensive research. It was found that the isolating aspect of the therapy often triggers psychosis-like hallucinations. However, this does not occur with everyone; people who are likely to hallucinate are the only ones who experience it. The hallucinations tend to stop once they leave the tank.

It is also common to get scared and feel suffocated in a dark enclosed space especially if there&#39;s a lot going on in the mind. The isolation is not necessarily an enjoyable experience for everyone<a href="#accordion">[4]</a>.&nbsp;

Another risk, especially in Pakistan, is the lack of its popularity. Not having much awareness coupled with the fact that not many places offer float therapy means there are not many choices out there if one opts for it. The places that do exist may not be well equipped or experienced enough to provide the desired therapeutic experience.&nbsp; 
&nbsp;

It sounds very tempting to consciously just let go of the body and float on the water, canceling out whatever is going on in the surroundings, alone in a soothing calm environment. Beware, this therapy is not for everyone, especially people who have: <ul><li>Open wounds&nbsp;</li><li>Any skin condition that worsens with the salt interaction&nbsp;</li><li>Any infectious disease&nbsp;</li><li>Seizures or epilepsy</li><li>Claustrophobia&nbsp;</li><li>Low blood pressure</li><li>Kidney issues </li></ul>

Conclusion

While it is great to try new things to help your mind destress, it’s essential to keep in mind that these therapies are not a one-size-fits-all. Everyone has their own experiences - some people benefit a lot from it whereas some people do not experience anything at all. The key is to go in with a positive mindset in order to let the placebo effect kick in and trick the body into getting better. At the very least, the therapy could inculcate the habit to stay in the present.

[1] Admin. The history of Floatation Therapy. Just Float, The World's Largest Float Therapy Center.

[2] Float tanks, floatation therapy, and more. WebMD.

[3] hortonj4. Float therapy: Is it right for you? Cleveland Clinic.

[4] Floatation therapy experts report on health benefits and emerging mark. PRWeb.

[5] Desk F. Are there any negative side effects of floating? Float Harder.

Online Consultation

Iqra Mazhar

Back Pain And Sleep Problems - What’s The Connection?

Back pain and <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle">sleep</a> problems can be a vicious cycle. However, there are ways to alleviate both issues and promote better overall health.

&nbsp;

Understanding the link between Back Pain and Sleep Issues

Back pain and sleep problems are two of the most common health issues that affect millions of people worldwide.

In particular, low back pain, which is considered a primary cause of disability worldwide, is a widespread condition and it affects individuals of all ages<a href="#accordion">[3]</a>. Based on the 2015 Global Burden of Disease Study, the global prevalence of activity-limiting low back pain was 7.3%, which means approximately 540 million individuals were affected at any given time<a href="#accordion">[3]</a>.

Low back pain is more likely to occur in individuals who have certain lifestyle habits, such as engaging in physically demanding occupations, smoking, and having low levels of physical activity.

Back pain and sleep issues are often interconnected, with one affecting the other. When a person suffers from back pain, it can be challenging to get a good night&#39;s sleep. The lack of sleep can then exacerbate the pain, leading to a vicious cycle of pain and sleeplessness. Lack of sleep can also affect mood and energy levels, making it harder to cope with pain. 
&nbsp;

<h5>Understanding Back Pain</h5>

Back pain is a common problem that can be caused by a variety of factors, including injury, poor posture, and aging. The pain can range from mild discomfort to severe. Moreover, it can be localized or radiating to other areas of the body.

Some common symptoms of back pain include stiffness, muscle spasms, and difficulty moving or standing.

A study conducted on 9,611 participants using cross-sectional methodology has shown that inadequate sleep duration and poor sleep quality are linked to low back pain<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Understanding Sleep Problems</h5>

Sleep problems can be caused by a variety of factors, including stress, anxiety, depression, and physical pain.

When a person experiences back pain, falling asleep and staying asleep can be difficult. Certain sleep disorders like sleep apnea can also cause back pain due to abnormal sleeping positions. 
&nbsp;

Fortunately, several strategies can improve both back pain and sleep problems. Here are some tips: 
&nbsp;

<ol>
	<li>
	<h5>Exercise</h5>
	</li>
</ol>

Regular exercise, especially low-impact activities, like walking, swimming, or yoga, can help strengthen the muscles supporting the spine and improve overall fitness. This can help reduce back pain and improve sleep quality. 
&nbsp;

<ol start="2">
	<li>
	<h5>Improve The Sleep Environment</h5>
	</li>
</ol>

Make sure the mattress, pillows, and bedding are comfortable and supportive. Keep the bedroom dark, quiet, and cool, and limit screen exposure before bedtime. Here are some additional tips for better sleep patterns with back aches. 
&nbsp;

Choosing The Right Mattress And Pillow

<ul>
	<li>Use a supportive mattress</li>
	<li>Use a cervical or ergonomic pillow to support and align the neck and spine 
	&nbsp;</li>
</ul>

Sleep Position

<ul>
	<li>Avoid sleeping on the stomach</li>
	<li>Place a pillow between the knees when sleeping on the side</li>
	<li>Use a pillow to support the spine when sleeping on the back 
	&nbsp;</li>
</ul>

Practice Good Sleep Hygiene

<ul>
	<li>Develop a consistent sleep routine, i.e., going to bed and waking up at approximately the same time every day.</li>
	<li>Avoid caffeine and nicotine in the hours leading up to bedtime</li>
	<li>Avoid large meals close to bedtime 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>
	<h5>Try Relaxation Techniques</h5>
	</li>
</ol>

Meditation, deep breathing, or progressive muscle relaxation can help reduce stress and promote relaxation, which can help improve sleep quality and reduce back pain. 
&nbsp;

<ol start="4">
	<li>
	<h5>Consider Physical Therapy</h5>
	</li>
</ol>

A physical therapist can help develop an exercise program tailored to the individual needs of the person to help reduce pain and improve flexibility. 
&nbsp;

<ol start="5">
	<li>
	<h5>Consider Alternative Therapies</h5>
	</li>
</ol>

Acupuncture, chiropractic care, or massage therapy may also help reduce back pain and improve sleep quality. However, it&rsquo;s important to consult a healthcare professional before trying any alternative therapies. 
&nbsp;

<ol start="6">
	<li>
	<h5>Manage Stress</h5>
	</li>
</ol>

Stress can exacerbate back pain and disrupt sleep, so find ways to manage stress. This includes scheduling a specific time of the day to worry about everything going on in life.

Another technique is to form a habit of journaling. Writing down worries, especially anything that triggers anxiety before sleep, helps them get out in the open so that it can be addressed.

Moreover, a to-do list for the following day can help instill a sense of achievement as well as deal with all the worries before bedtime. 
&nbsp;

Back pain and sleep problems are two of the most common health issues that affect people worldwide. These issues are often interconnected, with one affecting the other. Practicing good sleep hygiene, using proper sleeping positions, engaging in regular exercise, stretching before bed, and seeking professional help can improve both back pain and sleep problems. Remember, caring for the body is essential for a healthy and fulfilling life. 
&nbsp;

Key Takeaways

<ul>
	<li>Back pain can make it difficult to get comfortable in bed, leading to sleep problems.</li>
	<li>Poor sleep can worsen back pain by causing muscle tension and reducing the body&#39;s ability to heal and repair itself.</li>
	<li>Common causes of back pain and sleep problems include poor sleeping posture, an uncomfortable mattress, a sedentary lifestyle, stress, and medical conditions.</li>
	<li>To improve sleep and reduce back pain, it&#39;s important to prioritize healthy sleep habits and address any underlying issues.</li>
</ul>

[1] Murase K, Tabara Y, Ito H, et al. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study. PLoS One. 2015;10(10):e0140058. Published 2015 Oct 7. doi:10.1371/journal.pone.0140058.

[2] Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the global burden of disease study 2015. The Lancet. 2016;388(10053):1545-1602. doi:10.1016/s0140-6736(16)31678-6.

[3] Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356-2367. doi:10.1016/s0140-6736(18)30480-x.

Neelam Asad

Ismail Munir

Circadian Rhythms - A Top-Notch Health Concern

There could be a plethora of reasons why we would want to reset our circadian rhythm. It could be that we&rsquo;re feeling less productive during the workweek. Being late to work and being unable to meet deadlines does us no good. But it&rsquo;s not just the work; this misalignment creeps in and affects our daily lives. We know who or, rather, what to blame; it&rsquo;s the irregular sleep schedule we&rsquo;ll claim. But the issue is that why, as young, apparently responsible adults, can&rsquo;t we sleep and wake up on time? What&rsquo;s amiss?&nbsp;

&nbsp;

Is it due to jet lag? Is it because we stayed up late on that one weekend &ndash; only to regret it throughout the week? A never-ending cycle of why we&rsquo;re failing to keep up with our commitments &ndash; both personal and professional &ndash; that fuels our stress further until we&rsquo;re back to square one: can&rsquo;t sleep, therefore can&rsquo;t wake up.&nbsp; 
&nbsp;

Ugh! It&rsquo;s exhausting! No one&rsquo;s happy, ourselves included, and on top of it even our health is suffering.

&nbsp;

The positive news is that a circadian reset is possible. Yes, just like we reset the morning alarms on the phone, we can control the time that our body sleeps and wakes up. Given our current scenario, this means we have this power to literally change the time we sleep and wake.

&nbsp;

Feeling doubtful? Let&rsquo;s read on to find more about circadian rhythm, what it is and how to achieve it.

<div>&nbsp;</div>

Understanding the Basics of Circadian Rhythms

According to the National Institute of General Medical Sciences (NIGMS), circadian rhythms are the body&#39;s natural internal clock that follows a 24-hour cycle<a href="#accordion">[7]</a>.

&nbsp;

All the physical, mental, and behavioral changes that our body undergoes during this period are influenced by the amount of light and darkness in our surroundings. This includes the infamous sleep-wake pattern; even our bodies are attuned to sleep at night and be awake during the day.

&nbsp;

Besides light, factors like age, physical activity, social behaviors, and hormones (e.g., melatonin) influence our body&rsquo;s internal clock as well. Almost every organ and tissue in our bodies have these biological clocks or proteins to regulate the circadian rhythms.

&nbsp;

According to the NIGMS, animals, plants, and microorganisms follow the cycle of circadian rhythms as well. It&rsquo;s what instructs nocturnal animals to not go out during the day. It&rsquo;s also why flowers open and close at the right time.&nbsp; 
&nbsp;

On average, a person needs 6-9 hours of sleep in a day. Due to these individual differences in our circadian rhythms, it&rsquo;s possible that some people&rsquo;s internal biological clocks run shorter than 24 hours as compared to others. 
&nbsp;

<h5>Male vs Female</h5>

A number of studies on sleep patterns and wakefulness were examined by researchers who found that males are more likely to be active at night, while females are more likely to wake up early and be more active throughout the day. In addition, females were more immune to interruptions in their regular circadian rhythm than males, making them less susceptible to disruptions when they were sleeping. In contrast, men tend to nap more frequently in the afternoon<a href="#accordion">[9]</a>. 
&nbsp;

<h5>Infants vs Adults&nbsp;</h5>

The circadian rhythm&#39;s components develop after delivery in a newborn baby<a href="#accordion">[3]</a>. Cortisol rhythms start to emerge at 8 weeks of age, whereas melatonin and sleep efficiency rhythms emerge at around 9 weeks followed by body temperature rhythms, and circadian gene rhythms emerge at around 11 weeks<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

The newborn has a shaky sleep-wake pattern, closely linked to the mother and develops further as the baby grows. Timing, length, and quality of sleep are just a few of the changes linked to aging.&nbsp;

&nbsp;

In adults, the human circadian period ranges between 23.5 and 24.5 hours. It is synchronized to the 24-hour day by signals received from the surroundings<a href="#accordion">[6]</a>. Adults aged 60 and above experience a shift known as a phase advance, which causes them to function more in the morning and to nod off earlier in the evening<a href="#accordion">[6]</a>. 
&nbsp;

There is a fairly symbiotic relationship between exercise and sleep<a href="#accordion">[1]</a>. A good sleep-wake cycle enables us to have more endurance and strength while exercising and, vice versa, i.e. appropriate exercise increases our sleep quality.&nbsp;

&nbsp;

Working out too close to bedtime, though, is not helpful; it leaves us too alert and stimulated to sleep. Exercise is definitely useful if we are not getting enough nighttime sleep and would like to realign our circadian cycle. However, timing is crucial; it&rsquo;s better to avoid exercising 1-2 hours before we intend to go to bed<a href="#accordion">[8]</a>. 
&nbsp;

<h5>How does Diet help Maintain Good Circadian Rhythms?</h5>

A common mistake is to confuse circadian rhythm disorder with night eating disorder (NED). Remember, these are two separate conditions. NED is primarily an eating disorder that causes people to wake up during the night to eat; they are unable to fall asleep again if they don&rsquo;t eat. Circadian rhythm is when our body&rsquo;s natural clock is messed up and you feel tired, hungry, and alert at odd hours throughout the day; it may cause NED, but it&rsquo;s not the same since it affects all systems of our body. 
&nbsp;

Dietary recommendations to maintain good circadian rhythm comprise of the following:

<ul>
	<li>Minimize large meals</li>
	<li>Avoid consuming excessive fluids before bed</li>
	<li>Focus on healthy weight loss 
	&nbsp;</li>
</ul>

<h5>Caffeine</h5>

This warrants a separate section because of its excessive consumption. For shift workers, jet-lagged travelers, and other people who feel sleepy, caffeine works as a powerful albeit brief stimulant. It makes them feel alert, energetic, and even confident. However, caffeine intake for a healthy adult, has a half-life of 5 hours, which means our bodies typically take 5 hours to excrete half the quantity consumed<a href="#accordion">[2]</a>. Therefore, they need to start the day with a modest amount of coffee and stop at least 5-7 hours before night to achieve the best outcomes.&nbsp; 
&nbsp;

A social or environmental cue known as a &quot;zeitgeber&quot; (German for &quot;time giver&quot;) affects and synchronizes our biological cycles. It acts as a trigger to start or stop the biological clock.

&nbsp;

Natural sunshine is the most significant zeitgeber, but meal times, body temperature, and exercise are also significant zeitgebers. Alarm clocks and schedules for school/work that are intended to keep us on a fixed schedule could also be regarded as zeitgebers. 
&nbsp;

<h5>Seasons</h5>

The biggest seasonal effects on wake time and sleep length are typically observed during the spring season. We tend to wake up earlier during spring as compared to the winter season. A small reduction in sleep time occurs as days get longer, i.e., between the winter and summer solstice<a href="#accordion">[10]</a>. 
&nbsp;

Evidence reveals that circadian rhythms and sleep quality have an impact on a number of hormones and metabolic processes. Sleep and circadian rhythmicity are found to be strongly linked to growth hormone, leptin, cortisol, melatonin, and ghrelin among other hormones<a href="#accordion">[11]</a>. 
&nbsp;

Getting up at the same time each day is important in this regard. When we maintain a consistent sleep schedule, we&rsquo;re able to reset our circadian clock. Our bodies learn to adapt to the new rhythm when we start going to bed and getting up at the approximately same time on a regular basis.&nbsp; 
&nbsp;

Pro Tip:&nbsp;Schedule an alarm so you can wake up at the designated time even if you can&#39;t fall asleep at the time you&#39;d like to. This will help you maintain your rhythm. 
&nbsp;

Bright artificial light exposure has a significant control over our circadian rhythms. For shift workers or those whose work schedules involve late nights and/or early mornings, timed exposure is very effective<a href="#accordion">[13]</a>. There are various light treatment tools out there, such as light boxes, desk lamps, and dawn simulators<a href="#accordion">[12]</a>.&nbsp; 
&nbsp;

Note:&nbsp;Always consult a qualified sleep medicine physician about the amount of light therapy and the periods of the day that are most appropriate to your unique circadian rhythm before you invest in the devices. 
&nbsp;

There are a few tiny nuclei right at the center of our brains known as suprachiasmatic nuclei (SCN). They act as command posts for all the other brain regions and together, they regulate various bodily processes, including circadian rhythms. The duration of a full cycle is close to 24 hours for the majority of people.

&nbsp;

Ideally, the older we get, the more likely we&rsquo;re to go to bed around 7 in the evening and wake up around 3-4 in the morning. However, a lot of us choose to delay going to bed for hours rather than giving in to our innate desire to sleep. So, when their body clock takes over and sends a wake-up call to the body at 3 a.m., it disrupts their sleep schedule.

&nbsp;

Thus, we&rsquo;ll see older people around us complaining of poor sleep quality, i.e., they have more light sleep (5 hours or less) and very little deep or REM sleep. Moreover, they tend to wake up 3-4 times during the night, which gives them the perception that they have been awake for the entirety of the night. 
&nbsp;

The following are some methods to stop disorders of the circadian rhythm:

<ul>
	<li>Implement sound sleeping practices</li>
	<li>Control sleeping environment and limit exposure to light and dark</li>
	<li>Adjust schedules to the local time before traveling in case of jet lag issues</li>
	<li>Rotate the timetable counterclockwise for shift employees as it is more tolerable 
	&nbsp;</li>
</ul>

Our circadian rhythm is significantly influenced by light and darkness. However, there are other influences at work as well, some of which are internal while some are external.&nbsp;

&nbsp;

Unbalanced circadian rhythm-related sleep issues are more frequent than we can imagine. It&rsquo;s important to consult a medicine practitioner who can guide us regarding the lifestyle changes we need to make for a holistic approach to better sleep. 
&nbsp;

Key Points

<ul>
	<li>The circadian clock, a tiny area of the brain, synchronizes the body with day and night.</li>
	<li>The circadian clock controls bodily activities, like heart rate, blood pressure, temperature, digestion, and brain activity.</li>
	<li>Shift workers are more likely to have health issues, such as digestive upsets, <a href="https://merisehat.pk/disease/obesity">obesity</a>, heart disease, and accidents, due to excessive daytime sleepiness.</li>
	<li>Maintaining a good rhythm is very important for health and social life.</li>
</ul>

[1] Wang C-Y. Circadian rhythm, exercise, and heart. Acta Cardiol Sin. 2017;33(5):539.

[2] of Medicine (US). Committee on Military Nutrition Research I. Caffeine for the sustainment of mental task performance: formulations for military operations. National Academy Press; 2001.

[3] Brooks E, Canal MM. Development of circadian rhythms: role of postnatal light environment. Neurosci \& Biobehav Rev. 2013;37(4):551–60.

[4] Joseph D, Chong NW, Shanks ME, Rosato E, Taub NA, Petersen SA, et al. Getting rhythm: how do babies do it? Arch Dis Childhood-Fetal Neonatal Ed. 2015;100(1):F50--F54.

[5] Gooley JJ, Chamberlain K, Smith KA, Khalsa SBS, Rajaratnam SMW, Van Reen E, et al. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. Endocr Rev. 2014;155–6.

[6] Duffy JF, Zitting K-M, Chinoy ED. Aging and Circadian Rhythms. Sleep Med Clin. 2015 Dec;10(4):423–34.

[7] Circadian rhythms. National Institute of General Medical Sciences.

[8] Exercising for better sleep. Exercising for Better Sleep | Johns Hopkins Medicine.

[9] Miller K. Males and females have different circadian rhythms, study finds. Verywell Health.

[10] Mattingly SM, Grover T, Martinez GJ, et al. The effects of seasons and weather on sleep patterns measured through longitudinal multimodal sensing. Nature News.

[11] Kim TW, Jeong J-H, Hong S-C. The impact of sleep and circadian disturbance on hormones and metabolism. International journal of endocrinology.

[12] Bright light therapy. Sleep Education.

[13] JJ; G. Treatment of circadian rhythm sleep disorders with light. Annals of the Academy of Medicine, Singapore.

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Shame: The Most Toxic Emotion

Shame is an unpleasant emotion in which you feel inadequate, powerless, worthless and have negative thoughts about yourself. Our personal insecurities, secrets, mistakes and judgement can all lead to it. It’s more common in women and adolescents since they are burdened by so many expectations, rules and judgments.&nbsp;In her book, Atlas of Heart, Brené Brown describes shame as, “The intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love, belonging, and connection.”It is such a universal emotion and experienced across all cultures and social backgrounds that our first reaction is to side step the discussion as the mention of shame alone can make us feel uncomfortable in our skin.&nbsp;Shame is not as openly talked about as it should be, given its prevalence and negative impact. This is how it simmers and becomes bigger than it needs to be.&nbsp;Brené Brown, the American author who dedicated much of her career to studying shame, much to her peers’ and mentors’ chagrin, also says that it needs three things to fester: secrecy, silence and judgement.&nbsp;It then tends to hide behind other behaviours that are adapted to compensate for persistent feelings of inadequacy. Some people become perpetually rude and defensive in order to hide their shame.&nbsp;

Where does Shame Come from?

&nbsp;Every society has a certain set of rules for how to behave and even though they might not be right, they get ingrained into us from our childhood.&nbsp;

This means we associate certain behaviours and ways of being with intense feelings of guilt and shame simply because they aren&rsquo;t the norm.&nbsp;

People can and will publicly lash out at you for not sticking by these rules. However, most of the time, only perceived or imagined judgement is enough to make us feel this terrible emotion.&nbsp;

People who experience chronic and persistent feelings of shame might benefit from revisiting their childhood and how they were raised. The origins of this emotion can almost always be tied back to past experiences of feeling criticised and rejected by those around us.&nbsp; 
&nbsp;

If, while growing up, you were constantly criticised and told that your behaviour is wrong and harmful to others, no matter how true or false it was, chances are that you internalised it.&nbsp;

This leads to shame associated with the self where the individual starts viewing themselves in a negative light and as someone who is prone to doing the wrong thing hence incurring the judgement and wrath of the people around them.&nbsp;

Children also tend to internalise anything negative that happens to them as their own fault. They believe it&rsquo;s something about them that needs to be changed or that there is something wrong with them. This can also lead to immense shame where it becomes a part of their core identity.&nbsp;

Why is this an issue? Shame can have an everlasting negative impact and can ruin your life in all kinds of ways.&nbsp;

 
It can be toxic and destructive to you in the following ways:&nbsp;

<ul>
	<li>Leads to a pessimistic view of the world and your own future.&nbsp;</li>
	<li>You end up suffering from self-critical thinking where nothing is ever good enough.&nbsp;</li>
	<li>You might get caught up ruminating constantly about past mistakes and slights.&nbsp;</li>
	<li>You&rsquo;d be prone to underestimating yourself and your abilities.</li>
	<li>A lack of empathy, as all of the focus is shifted inwards instead of engaging fully with other people.&nbsp;</li>
	<li>Leaning towards social withdrawal to reduce the number of incidents that might lead to shame.&nbsp;</li>
	<li>You start suffering from feelings of powerlessness and helplessness.</li>
	<li>You might have physical symptoms such as upset stomachs and nausea.&nbsp;</li>
	<li>It can lead to feelings of numbness and a lack of connection with others.&nbsp;</li>
	<li>You are prone to hypervigilance and excessive self-consciousness.</li>
	<li>Irritability, impulsivity and moodiness.</li>
	<li>Much more likely to indulge in self-destructive behaviours such as substance abuse.&nbsp;</li>
	<li>Leads to excessive defensiveness.</li>
	<li>Risk avoidance and hence lack of growth opportunities. There is a feeling of being overwhelmed by the challenges of life.</li>
	<li>Self-sabotaging relationships and opportunities.</li>
	<li>Settling for the bare minimum since asking for more makes one feel uncomfortable.&nbsp;</li>
	<li>Misrepresentation of oneself to others in order to hide the underlying feelings of inadequacy.&nbsp;</li>
	<li>Not standing up for yourself when wronged.&nbsp;</li>
	<li>Constantly comparing oneself with others.</li>
	<li>Highly dependent on external validation. 
	&nbsp;</li>
</ul>

The problem with shame is that it turns our entire focus inwards and we end up painting ourselves in a negative light. When you are engrossed in these feelings of self-pity you are less inclined to make any changes in your behaviour or form meaningful connections.&nbsp;

Research has shown that shame is highly correlated with addiction, depression, bullying, aggression, suicide, <a href="https://merisehat.pk/disease/binge-eating-disorder">eating disorders</a>, social anxiety, personality disorders and low self-esteem.&nbsp;

On the other hand, people with better self-esteem tend to experience less shame. It can also lead to developing a defeatist attitude about life. Instead of viewing mistakes as natural mishaps that can be corrected they view their entire self negatively. This can be quite debilitating and attack one&rsquo;s sense of self.&nbsp; 
&nbsp;

Even though it has been found to serve an evolutionary purpose as well where individuals tightly adhering to the pre-set norms of the group (or the pack) ensured increased chances of survival.&nbsp;

However, in the modern world we don&rsquo;t need to adhere to every single tradition and convention. Most of these expectations are unrealistic and contrary to each other and you can never please everyone across the board.&nbsp;

If you have been told to &lsquo;be yourself&rsquo; and then criticised for it in the same breath then you know how it feels.&nbsp; 
&nbsp;

How to Deal with it?

Brené Brown’s Shame Resilience Theory (SRT) can help you deal with this toxic emotion:&nbsp; <ul><li>Acknowledge and recognise the feeling of shame no matter how tiny or big.&nbsp;</li><li>Work through it constructively, avoiding self-criticism and learn from the experience.&nbsp;</li><li>Build more meaningful connections.&nbsp; </li></ul>It’s not a switch you can flip off, but rather, it’s a whole process where you are expected to move through your feelings of shame and work with resilience, empathy, self-compassion and mindfulness to come out on the other side unscathed.&nbsp;However, if it’s still overwhelming and affecting your daily life to the point of paralysis then it might be time to seek professional help.&nbsp;

Dr. Safia Mehmood

Understanding And Managing Common Sleep Disorders Such As Insomnia And Sleep Apnea

<a href="https://merisehat.pk/article/how-you-sleep">Sleep </a>is a fundamental aspect of our well-being, providing us with the necessary rest and rejuvenation to function optimally. Unfortunately, many individuals experience sleep disorders that disrupt their ability to obtain quality sleep. Two of the most common sleep disorders are <a href="https://merisehat.pk/disease/insomnia">insomnia and sleep</a> apnea. In this article, we will delve into the causes, symptoms, diagnosis, and management strategies for these conditions. 
&nbsp;

Insomnia

Insomnia refers to a persistent difficulty in falling asleep, staying asleep, or experiencing restful sleep. It can have various causes, including stress, anxiety, depression, medications, medical conditions, or poor sleep hygiene. Insomnia can be classified into two types: acute insomnia, which lasts for a short duration, typically triggered by a stressful event, and chronic insomnia, which persists for at least three nights a week for three months or longer.

Symptoms of insomnia may include difficulty falling asleep, waking up frequently during the night, waking up too early in the morning, feeling tired upon waking, daytime sleepiness, irritability, and difficulty concentrating. 
&nbsp;

<h5>Diagnosis</h5>

To diagnose insomnia, healthcare professionals typically rely on a thorough evaluation of the patient&#39;s medical history, sleep patterns, and symptoms. They may also employ sleep logs or actigraphy, a method of monitoring sleep-wake patterns using a wristwatch-like device. In some cases, a sleep study, known as a polysomnography, may be recommended to rule out other underlying sleep disorders. 
&nbsp;

<h5>Management</h5>

The management of insomnia involves both non-pharmacological and pharmacological approaches. Non-pharmacological interventions include improving sleep hygiene practices, such as establishing a regular sleep schedule, creating a comfortable sleep environment, avoiding stimulating activities before bedtime, and managing stress through relaxation techniques or therapy. Cognitive-behavioral therapy for insomnia (CBT-I) is a highly effective psychological intervention that helps individuals address the underlying thoughts and behaviors that contribute to sleep difficulties.

In some cases, short-term use of prescription sleep aids or over-the-counter sleep aids may be recommended, but their long-term use should be avoided due to the risk of dependence. It&#39;s important to consult with a healthcare professional to determine the most appropriate treatment plan based on individual circumstances. 
&nbsp;

Sleep Apnea

Sleep apnea is a sleep disorder characterized by interruptions in breathing during sleep. The most common type of sleep apnea is obstructive sleep apnea (OSA), where the airway becomes partially or completely blocked, leading to reduced airflow and repeated episodes of shallow breathing or complete cessation of breathing. <a href="https://merisehat.pk/disease/sleep-apnea-91">Central sleep apnea (CSA)</a> is less common and occurs when the brain fails to send proper signals to the muscles responsible for breathing.

Symptoms of sleep apnea may include loud snoring, gasping or choking during sleep, daytime sleepiness, <a href="https://merisehat.pk/disease/cluster-headaches">morning headaches</a>, difficulty concentrating, irritability, and restless sleep. 
&nbsp;

<h5>Diagnosis</h5>

If sleep apnea is suspected, a sleep study is usually conducted to confirm the diagnosis. A polysomnography is the gold standard for diagnosing sleep apnea and involves monitoring various physiological parameters during sleep, including brain waves, eye movements, muscle activity, heart rate, and breathing patterns. 
&nbsp;

<h5>Management</h5>

The management of sleep apnea can vary depending on the severity and underlying causes. Lifestyle modifications such as weight loss, regular exercise, avoiding alcohol and sedatives, and sleeping on the side instead of the back can help alleviate symptoms in some cases.

Continuous positive airway pressure (CPAP) therapy is the most common and effective treatment for moderate to severe obstructive sleep apnea. It involves wearing a mask over the nose or nose and mouth during sleep, which delivers a continuous flow of air to keep the airway open. Other treatment options include oral appliances that reposition the jaw and tongue, and in some cases, surgery may be recommended to remove obstructions in the airway.

For central sleep apnea, addressing the underlying medical conditions, such as heart failure or neurological disorders, is crucial. Treatment options may include medications to stabilize breathing patterns or the use of adaptive servo-ventilation devices that provide positive pressure to support breathing.

It&#39;s important to consult with a sleep specialist or healthcare professional to determine the most appropriate treatment plan based on the individual&#39;s specific needs and circumstances. 
&nbsp;

Insomnia and sleep apnea are common sleep disorders that can significantly impact an individual&#39;s quality of life and overall health. Understanding the causes, symptoms, diagnosis, and management strategies for these conditions is essential in ensuring effective treatment and improved sleep.

Non-pharmacological interventions, such as improving sleep hygiene, implementing relaxation techniques, and adopting cognitive-behavioral therapy, are crucial for managing insomnia. In the case of sleep apnea, lifestyle modifications, CPAP therapy, oral appliances, and, in severe cases, surgery may be necessary.

Seeking professional help from sleep specialists, such as sleep medicine physicians or pulmonologists, can provide a comprehensive evaluation and personalized treatment plan. By addressing these sleep disorders effectively, individuals can regain control over their sleep patterns, enhance their overall well-being, and improve their daily functioning.

&nbsp;

Why Do You Feel Sleepy All Day Long?

Sleep is a part of our human design that gives our body that much-needed rest from the hustle bustle of everyday life. It’s supposed to be restorative and re-energizes you for a new day. Unfortunately, however, some of us struggle with this exact thing.&nbsp;Instead of reaping the benefits sleep is supposed to provide us, we wake up tired and exhausted, wanting to either hit the snooze button or just go right back to bed again.&nbsp;Occasionally waking up tired is not a cause for concern, but if it’s been like this for as long as you can remember and now it feels like you’re running on fumes, it might be wise to take a look at why this is happening.&nbsp;

Sleep Inertia

One common reason for feeling tired right after waking up could be sleep inertia. This means that you continue to feel groggy after you have gotten up as it takes your body a little while to adjust to the waking state. It can last for over 15 to 60 minutes, but can last longer for some people.&nbsp;

Having sleep inertia leads to having slower motor and cognitive skills and can be annoying for those who need to be on high alert as soon as they wake up such as a security guard or an on-call doctor. We don&rsquo;t really understand why this happens but it&rsquo;s postulated that our prefrontal cortex, part of the brain that controls higher mental functions, takes a while to come back online after waking up.&nbsp;

Our bodies also ensure we wake up naturally by slowly releasing cortisol into the system at the end of the sleep cycle. This allows all your organs to get acclimated to the waking state and <a href="https://merisehat.pk/page/sehat-scan/">your blood pressure</a> and breathing get to slowly adjust as well.&nbsp;

However, when a loud alarm wakes us up, it can happen when you are in deep sleep. This means you never get enough time to adjust and are thrust into consciousness all of a sudden. This is another reason why it feels like you didn&rsquo;t catch a wink all night even after you have gotten enough sleep.&nbsp; 
&nbsp;

Gastric Reflux

It’s entirely possible that you simply didn’t get enough sleep. This could be due to reflux that gets exacerbated upon lying down flat and is the reason behind a whole night of tossing and turning. Other than visiting your GI specialist you can tackle this issue by sleeping with more than one pillow under your head, by sleeping on your side and also by avoiding heavy meals right before bed.&nbsp;

Bad Sleep Hygiene

Bad sleep hygiene is common and is the leading cause behind why some folks don’t ever feel fully rested no matter how much sleep they get. Sleep hygiene refers to healthy practices associated with bedtime such as turning down bright lights, avoiding tea, coffee and bright screens and not taking any naps throughout the day. This ensures your body naturally shuts off at bedtime instead of a whole night of disrupted sleep.&nbsp;

Other Medical Causes

Other reasons for waking up tired can include medical causes such as anemia, chronic fatigue syndrome, depression, diabetes or hypothyroidism. All of these conditions can make you feel fatigued and lead to sleep related issues.

The Bottom Line

According to the American Academy of Sleep Medicine, adults should be getting at least seven hours of sleep each night.&nbsp; Our circadian rhythms or internal body clocks decide whether we are night owls or morning people. Yes, you’re naturally predisposed to be either one or the other and unfortunately we don’t get to choose which one we are thanks to thousands of years of evolution.&nbsp; However, you can still do certain things to train your body to go to bed early and wake up on time. Practice better sleep hygiene by ensuring you sleep in a cool and comfortable room, avoid stimulants or heavy meals right before bed, incorporate some form of exercise in your daily routine or some light stretches right before bed and start going to bed at the same time every night.&nbsp;These are some of the things that can help you have better sleep hygiene. Things like using your phone before sleeping can also disturb the production of melatonin, a hormone that controls sleep. So, stop using any screens an hour or two before bed.Also, having a good filling breakfast consisting of whole grains, nuts, and proteins like eggs or oatmeal can help you get rid of the early morning fatigue and charge you up for the day. At the end of the day most of these measures can fix your problem of waking up already tired.&nbsp;

What Is Sleep Deprivation And What Can It Do To Your Body?

You will feel worn out if you&rsquo;ve had little sleep. You&rsquo;re sleep deprived when you don&rsquo;t get the required amount of sleep your body needs. This has an impact on your overall body and health.

You should be concerned about what will happen if you don&rsquo;t get enough rest. You may be concerned about the long-term effects that lack of sleep will have on your body. Let&rsquo;s read and find out what sleep deprivation can do to your body. 
&nbsp;

long-term effects of Sleep Deprivation

Sleep deprivation occurs when your body doesn&rsquo;t get enough sleep. It can either be a short-term sleep deprivation, i.e., when you haven&rsquo;t slept properly for a day, also known as acute sleep deprivation. Chronic sleep deprivation is when you haven&rsquo;t slept properly for a long period of time consistently. 
You can become sleep-deprived over a period of days, months or years. If you are used to getting nine hours of sleep and you are only able to get eight hours over a long period of time, this would be counted as sleep deprivation. 
&nbsp;

<h5>How Much Sleep Do You Need</h5>

According to the National Sleep Foundation, most individuals require seven-to-nine hours of sleep each night to feel rested. Adults over the age of 65 may only require seven-to-eight hours of sleep each night. 
Lack of sleep for a consistent period can take a toll on your physical and mental health. Some effects start showing up right away while others can show up after years. 
&nbsp;

<h5>The Effect, Lack Of Sleep Can Have On Your Body</h5>

Lack of sleep can have detrimental effects on the brain and other reflexes. Seizures, pain, changes in hormone levels, and tiredness are common side effects of sleep deprivation.&nbsp; 
&nbsp;

<ul>
	<li>According to research, lack of sleep can have similar effects on the brain as driving under the influence of alcohol.</li>
	<li>Some common attributes of not having enough sleep are:</li>
	<li>Sleep deprivation can make you cranky and short-tempered. In the long run, it can lead to anxiety and depression.&nbsp;</li>
	<li>Lack of sleep can weaken your <a href="https://merisehat.pk/article/how-an-over-prescription-of-antibiotics-affects-your-immune-system">immune system</a>. This makes you more susceptible to catching a cold and flu.</li>
	<li>Your ability to concentrate and think critically is not at its best.</li>
	<li>During sleep, connections are formed in the brain that improves overall memory. Lack of sleep over a long period of time can affect these connections which can lead to memory loss.</li>
	<li>If you don&rsquo;t sleep well, this leads to poor balance and coordination. You are more likely to trip and fall. 
	&nbsp;</li>
</ul>

Your body needs sleep just as it needs food and water. Consistent lack of sleep can dramatically reduce the quality of your sleep. Make sure you get enough sleep as this will help you avoid sleep deprivation the best. For most adults that is anywhere between seven to nine hours.

Namwer Rao

All About Circadian Rhythm

One of the most fascinating things about being alive means you have all these senses to facilitate your growth and development. You&rsquo;re not just living in a limbo, are you? You are aware of your needs, of your surroundings; you can think, make decisions, eat, breathe, reproduce. Basically, you do more than just exist. And as much as you like to complain that &lsquo;there&rsquo;s not enough time&rsquo; for you to be able to do everything you want to do, each and every movement you make is guided by time, a special 24-hour innate clock that governs your bodily systems and ensures you don&rsquo;t over exert yourself.&nbsp;

&nbsp;

When you think you&rsquo;re procrastinating too much, you&rsquo;re actually comparing your productivity to someone else&rsquo;s and that&rsquo;s where you&rsquo;re doing yourself and your body a great disservice. Because this internal clock (called circadian rhythm) is unique to each person. It&rsquo;s a 24-hour cycle that helps you manage your sleep routine. That is, thanks to your circadian rhythm, you manage to sleep and wake up at roughly the same time every day and your body manages to perform all its functions duly. 
&nbsp;

The circadian rhythm varies because it&rsquo;s easily influenced by external factors. For instance, the degree of light and darkness in your environment wherein light equates to day, the time you need to be active; this stimulus makes your brain activate hormones that control your metabolism. You feel a change in your body temperature soon after you wake up, right? Or, alternatively, when it&rsquo;s night, doesn&rsquo;t your body get this sudden urge to rest? That&rsquo;s your circadian rhythm, too, sending you a message that you&rsquo;re exhausted and need a good night&rsquo;s sleep.

&nbsp;

So, if we have this built-in clock at our service all the time, literally, then what&rsquo;s stopping us from achieving it all? What&rsquo;s the catch here? It&rsquo;s known as circadian rhythm disturbance. Nearly 7-10% of people who have trouble sleeping are diagnosed with this condition<a href="#accordion">[5]</a>. In adolescents, in particular, the prevalence is nearly 7%. Again, this issue can develop due to environmental influences that cause sleep issues and, consequently, disturb the circadian rhythm. But they are environmental factors, which means you can control them. You can still be in control. You just need to adapt to your body&#39;s natural rhythm better by upholding healthy behaviors.

&nbsp;

How do you do that? Read on to find out. 
&nbsp;

Understanding Circadian Cycle & Its Effects

Your body&#39;s intrinsic 24-hour clock or circadian rhythm aids in maintaining a regular schedule for bodily functions. It is composed of 4 distinct biological rhythms in your body &ndash; namely, the cells in your body, hormones like cortisol and melatonin, metabolism, and body temperature &ndash; each of which is in charge of regulating the natural cycle of your bodily functions and chemical changes.&nbsp;

&nbsp;

Circadian rhythm is the most well-known and the most significant factor in maintaining a cycle that encourages sound sleep and function. It tracks alterations in the environment (such as variations in light and darkness) and then informs and instructs the brain when it&rsquo;s time to sleep or wake up. 
&nbsp;

The need for sleep is a universal biological necessity that has been maintained across species despite evolution. Factors like duration, continuity, and intensity (depth) of sleep with no disruption to the circadian rhythm need to be ensured to be able to enjoy high levels of attention and cognitive functioning throughout the wake period.&nbsp; 
&nbsp;

So, in case of any circadian rhythm disturbances, be ready to experience changes to vital bodily processes, like:

<ul>
	<li>Hormone regulation</li>
	<li>Body temperature</li>
	<li>Pattern of eating and metabolism 
	&nbsp;</li>
</ul>

For instance, the hormone responsible for sleep, melatonin, is produced under the direction of the suprachiasmatic nucleus (SCN). The optic nerves transmit the data from your eyes to your brain, providing crucial information like the intensity of incoming light to it. When there is less light, the SCN will instruct the brain to produce more melatonin, which will make you sleepy.

&nbsp;

But a possibility is that you&rsquo;re simply cooped up in a relatively dark room while it&rsquo;s day outside. Or it could be that it&rsquo;s night outside, but you&rsquo;re up studying for an exam. Your body gathers data from the immediate surrounding, and interprets it accordingly. These incidents mess up your circadian rhythm.&nbsp;

&nbsp;

Short-term, this disruption can cause lethargy, attention loss, and overall poor health; long-term, there can be a lot of pathological issues, like diabetes, obesity, cancer progression,<a href="https://merisehat.pk/disease/anxiety"> anxiety</a>, and psychiatric disorders<a href="#accordion">[2]</a>. 
&nbsp;

Do you know there&rsquo;s a whole list of circadian rhythm sleep-wake disorders that experts have classified according to their symptoms and causes? Some of them are<a href="#accordion">[6]</a>: 
&nbsp;

<ul>
	<li>Jet Lag Disorder</li>
</ul>

This happens when a person travels through several time zones quickly. You must have experienced it &ndash; or heard about it from a friend or a relative &ndash;after an international flight. And these jet lag sleep issues and exhaustion continue until the circadian rhythm adjusts to the day-night cycle of the new location. 
&nbsp;

<ul>
	<li>Shift Work Disorder</li>
</ul>

A person&#39;s circadian rhythm can be severely disturbed by work requirements. For instance, sometimes your job requires you to work in shifts. As a result of this rotation, you sleep during the day and work during the night. Journalists often operate in this manner. Freelance workers, serving a client from the other end of the world suffer from this disorder too. Yes, work&rsquo;s important, money&rsquo;s important; but, at the end of the day you struggle just to stay awake &ndash; or fall asleep &ndash; because there&rsquo;s a conflict within your body and you&rsquo;re acutely aware of it. 
&nbsp;

<ul>
	<li>Advanced Sleep Phase Disorder</li>
</ul>

You should go visit a doctor if you tend to fall asleep quickly in the evening and wake up relatively early as well. Yes, that&rsquo;s a sleep disorder, too. If you have an advanced sleep phase disorder, you won&rsquo;t be able to stay up longer at night or sleep later in the morning, even if you want to. But it&rsquo;s not a frequent ordeal given that it affects only 1% of the population in the world, particularly the older people. This one&rsquo;s a hereditary issue, though; a change of environment may reduce the impact but it won&rsquo;t end it effectively. 
&nbsp;

<ul>
	<li>Delayed Sleep Phase Disorder</li>
</ul>

This kind of disruption of the circadian rhythm is the opposite of advanced sleep phase disorder. It is commonly seen among the &rsquo;night owls,&rsquo; people who stay up late and sleep in late. This affects a handful of the population, too &ndash; only 1-2 people out of every 1,000 people. However, zooming in on the problem, you&rsquo;ll find out that nearly 16% of the affected population are teenagers.&nbsp;

&nbsp;

So, you might be up all night, staying in and trying to finish the rerun of FRIENDS or going out with friends and partying hard; don&rsquo;t force yourself to do something, anything, to stay awake when your body would rather be at rest. However, consult a doctor when you feel things are spiralling out of your control and you can&rsquo;t help but stay awake at night for no reason. It is also important to consult a doctor since some studies suggest this disorder stems from some underlying health issues and it may be hereditary, too. So, don&rsquo;t ignore it.&nbsp; 
&nbsp;

<ul>
	<li>Non-24-Hour Sleep Wake Disorder&nbsp;</li>
</ul>

You may be able to observe this one in a loved one who is blind. Since they won&rsquo;t be able to get light-based cues for their circadian rhythm, they&rsquo;ll be especially vulnerable to develop this kind of disorder. The interesting thing to note here is that, even though their sleeping schedule keeps changing, moving backwards by a couple of minutes or by hours, their body is able to maintain its 24-hour cycle.&nbsp; 
&nbsp;

<ul>
	<li>Irregular Sleep-Wake Rhythm Disorder</li>
</ul>

Given its symptoms, it&rsquo;s kind of hard to believe that this disorder is rare. Irregular sleep-wake rhythm disorder is a term for those people who take numerous naps or experience brief intervals of sleep spread throughout a 24-hour day. Sounds familiar? Don&rsquo;t just self-diagnose, yet. This disorder is related to brain disorders, such as dementia or traumatic brain injury, which impair proper functioning of the circadian rhythm in the hypothalamus<a href="#accordion">[3]</a>. Yes, you see it now, don&rsquo;t you? If in doubt still, it&rsquo;s better to consult a doctor.&nbsp;&nbsp; 
&nbsp;

As the list shows, there can be a number of reasons why you have circadian rhythm problems:

&nbsp;

<ul>
	<li>It can be due to personal/professional reasons, like working or traveling.&nbsp;</li>
	<li>It can be due to an underlying problem that impairs your capacity to recognize or process environmental cues that control your body&#39;s internal clock.&nbsp;</li>
	<li>It can be a genetic factor.&nbsp;</li>
	<li>It has no known cause. 
	&nbsp;</li>
</ul>

If you made it this far, good for you! What you need to understand now is that irregular circadian rhythm is primarily managed through behavioral therapies. At this stage, it&rsquo;s important to differentiate between acute and chronic circadian rhythm disorders, and primary and secondary illnesses since this will have an impact on the development of evaluation and treatment strategies. 
&nbsp;

The following are some examples of circadian rhythm disruption treatment<a href="#accordion">[7]</a>:

<ul>
	<li>Behavioral therapy</li>
	<li>Chronotherapy</li>
	<li>Bright light therapy</li>
	<li>Lifestyle changes</li>
	<li>Enhancing environmental cues</li>
	<li>Mixed modalities</li>
	<li>Pharmacotherapy</li>
	<li>Nonbenzodiazepine hypnotics (e.g., eszopiclone, zolpidem, zaleplon)</li>
	<li>Orexin receptor antagonists (e.g., suvorexant)</li>
	<li>Benzodiazepines (e.g., triazolam, flurazepam, estazolam, temazepam, quazepam</li>
	<li>Melatonin receptor agonists (e.g., ramelteon, tasimelteon, melatonin) 
	&nbsp;</li>
</ul>

Without awareness and conscious efforts to change your behavior, your lifestyle can continue to impede a restful night's sleep. Don’t worry; it’s totally feasible and requires only minor tweaks to your sleeping environment.&nbsp; <ul><li>Screens</li></ul>Screen exposure is one of the toughest habits to break. The strong white-blue light from your devices inhibits melatonin production, while increasing the production of cortisol. Make sure to restrict your screen time after sunset. <ul><li>Electromagnetic Fields (EMF)</li></ul>Wi-Fi routers, smartphones, the interior base of a wireless phone set, outside cellular antennas, and maybe nearby smart meters all emit EMFs. Avoid sleeping with your phone in or adjacent to your bed; if necessary, try using airplane mode on the phone at night. Also, relocate the wireless phone base and Wi-Fi router to a different room. <ul><li>Light</li></ul>Your body and mind require darkness when you sleep, so try to block as much light from the room as possible. You can try blackout curtains if the streetlights outside your window are too bright.&nbsp; <ul><li>Other Considerations&nbsp;</li></ul>There are two more lifestyle modifications that can enhance your sleep. One, you should avoid drinking liquids (e.g. coffee, water) before bed. And, two, just like we do it for the newborns, create a regular sleep routine for yourself to ensure you get a good night’s rest.&nbsp;

Your body naturally maintains a 24-hour body clock (also known as circadian rhythm) that influences (and, consequently, is influenced by) your sleep&ndash;wake cycle. You can preserve this vital function through a healthy and active lifestyle, which includes adequate rest.

&nbsp;

If you persistently have trouble falling asleep or feel excessively tired during the day, you should consult a doctor to learn how to reestablish your circadian rhythm and receive the rest you need. 
&nbsp;

<ul><li>Your circadian rhythm is a combination of physiological changes that occur over 24 hours.</li><li>The degree of light and darkness in your surroundings will impact this cycle, affecting your health, sleep and eating patterns, and brain function.</li><li>There are numerous aspects of contemporary life that hamper a healthy circadian rhythm, but you can take concrete steps to maintain your own sleep-wake cycle.</li></ul>

[1] Roenneberg T, Merrow M. The circadian clock and human health. Curr Biol. 2016;26(10):R432--R443.

[2] Serin Y, Tek NA. Effect of circadian rhythm on metabolic processes and the regulation of energy balance. Ann Nutr Metab. 2019;74(4):322–30.

[3] Barion A, Zee PC. A clinical approach to circadian rhythm sleep disorders. Sleep Med. 2007 Sep;8(6):566–77.

[4] Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al. National Sleep Foundation’s sleep quality recommendations: first report. Sleep Heal. 2017;3(1):6–19.

[5] Mary E Cataletto MD. Sleeplessness and circadian rhythm disorder. Practice Essentials, Background, Etiology.

[6] Circadian rhythm. Sleep Foundation.

[7] Melinosky C. Circadian rhythm disorder (exams and tests). WebMD.

Is It The Djinn Or Sleep Paralysis?

For centuries, sleep paralysis has been attributed to an “evil” presence, especially in the Indian subcontinent. Throughout history, several cultures have narrated tales of evil creatures that terrify helpless humans. However, recently, researchers have published multiple studies on sleep paralysis and the accompanying feelings of terror.&nbsp;

Understanding Sleep Paralysis

Sleep paralysis is described as a type of parasomnia with a brief loss of muscle control, which happens just after falling asleep or waking up. Episodes of sleep paralysis are characterized by both elements of sleep and wakefulness. This is one of the reasons why sleep paralysis comes off as exceedingly distressing. Moreover, people may also experience a feeling of suffocation or hallucination.

Parasomnias are abnormal sleep behaviors related to the rapid eye movement (REM) stage of sleep. Standard REM sleep is characterized by vivid dreaming and atonia (temporary paralysis of arms and legs). Under normal circumstances, the atonia ends upon waking. Thus, you&rsquo;re not conscious of this inability to move. Researchers believe that sleep paralysis is an amalgamation of wakefulness and REM sleep. However, this imagery of REM sleep persists even when a person is aware and awake.&nbsp;

While much about sleep paralysis is still unknown, the types, symptoms, and causes of sleep paralysis can help in understanding and preventing the condition better.

&nbsp;

Medical literature categorizes sleep paralysis into two types:&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Isolated Sleep Paralysis</h5>
	</li>
</ul>

Isolated sleep paralysis&nbsp;is not connected to narcolepsy or other sleep disorders. Narcolepsy is a neurological disorder in which the brain cannot properly control wakefulness, which often leads to daytime drowsiness and sleep paralysis.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Recurrent Sleep Paralysis</h5>
	</li>
</ul>

​​​​​​​In recurrent sleep paralysis, the affected individual will suffer from multiple episodes over time. In many cases, patients, who do not have narcolepsy, present with a combination of recurrent sleep paralysis and ongoing sleep paralysis.

&nbsp;

The exact cause of sleep paralysis is unknown. However, a study conducted on the Chinese population found a link between sleep paralysis and obstructive sleep apnea<a href="#accordion">[1]</a>. Obstructive sleep apnea (OSA) is a disorder in which breathing rapidly starts and stops. As per the study, 38% of people with OSA suffered from sleep paralysis<a href="#accordion">[1]</a>. Sleep paralysis is also prevalent in people with nighttime leg cramps<a href="#accordion">[2]</a>. Thus, researchers believe that several factors may trigger sleep paralysis.&nbsp;&nbsp;

Studies have also shown a correlation between sleep paralysis and excessive daytime sleepiness; and circadian rhythm disturbances, such as jet lag and shift work disorder<a href="#accordion">[3]</a>. Certain <a href="https://merisehat.pk/article/prevalence-of-allergies-in-the-west-and-pakistan-what-significance-does-crop-burning-have-w" target="_blank">mental health conditions</a> are also connected with sleep paralysis<a href="#accordion">[3]</a>. For example, post-traumatic stress disorder, exposure to childhood sexual abuse, and other types of physical and emotional traumas. Moreover, alcohol and antidepressant withdrawal may also increase the risk of developing sleep paralysis<a href="#accordion">[4]</a>.&nbsp;

There is also a higher risk of sleep paralysis in people with a family history of the condition<a href="#accordion">[5]</a>. However, there is no genetic basis to support this claim. There may also be a link between sleep paralysis, vivid nightmares, and lucid dreaming. Further research is necessary to better understand the causes and correlations of parasomnia.

&nbsp;

Sleep paralysis is a benign condition; the limited frequency of the episodes rarely leads to serious health problems. However, sleep paralysis may become bothersome for people who have more recurrent episodes. As a result, they may have negative thoughts around bedtime, which may provoke anxiety and make it more difficult to fall asleep. Sleep paralysis can further lead to daytime sleepiness and have a negative impact on a person’s overall health.

If you are struggling with sleep paralysis, the first step is to speak with a doctor. The doctor will help identify the underlying cause of the problem, and rule out any serious medical conditions, such as narcolepsy. While there is limited scientific evidence to support the ongoing treatment approaches for sleep paralysis, a few simple habits may help prevent the problem. These include:&nbsp;

<ul>
	<li>Set a routine by going to bed and waking up at the same time every day, including the weekends.&nbsp;</li>
	<li>Follow a&nbsp;pre-bedtime routine. For example, meditating, yoga, or anything else that would help you feel relaxed.&nbsp;</li>
	<li>Invest in a good quality mattress and pillows.&nbsp;&nbsp;</li>
	<li>Block light or noise in your bedroom.&nbsp;</li>
	<li>Avoid alcohol and caffeine later in the evening.&nbsp;</li>
	<li>Put away electronic devices at least half an hour before going to bed.&nbsp;</li>
</ul>

Other professional treatment approaches may include:&nbsp;

<ul>
	<li>Cognitive-behavioural therapy&nbsp;</li>
	<li>Medications that suppress REM sleep</li>
</ul>

&nbsp;

<ul>
	<li>Although sleep paralysis is not a serious medical health concern, it can be quite distressing for some people.</li>
	<li>While the exact cause of sleep paralysis is still unknown, consistently following a routine before bedtime can help reduce the frequency of sleep paralysis.</li>
	<li>However, before testing out any antidotes, speak with a doctor to rule out any serious health conditions that could be causing sleep paralysis.&nbsp;</li>
</ul>

&nbsp;

[1] Hsieh, S.W., Lai, C.L., Liu, C.K., Lan, S.H. and Hsu, C.Y., 2010. Isolated sleep paralysis linked to impaired nocturnal sleep quality and health-related quality of life in Chinese-Taiwanese patients with obstructive sleep apnea. Quality of Life Research, 19(9), pp.1265-1272.

[2] Denis, D., 2018. Relationships between sleep paralysis and sleep quality: current insights. Nature and science of sleep, 10, p.355.

[3] Singh, S., Kaur, H., Singh, S. and Khawaja, I., 2018. Parasomnias: a comprehensive review. Cureus, 10(12).

[4] Angarita, G.A., Emadi, N., Hodges, S. and Morgan, P.T., 2016. Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addiction science & clinical practice, 11(1), pp.1-17.

[5] Olunu, E., Kimo, R., Onigbinde, E.O., Akpanobong, M.A.U., Enang, I.E., Osanakpo, M., Monday, I.T., Otohinoyi, D.A. and Fakoya, A.O.J., 2018. Sleep paralysis, a medical condition with a diverse cultural interpretation. International Journal of Applied and Basic Medical Research, 8(3), p.137.

Staff Writer

The circadian rhythm is the internal biological clock that regulates the sleeping-and-waking time of every person. This rhythm is controlled based on the sleep-wake cycle, which is also called the light-dark cycle, and it&rsquo;s present in almost all life forms.&nbsp;

Additionally, the circadian rhythm is related to many physiological processes like mood, metabolism, body temperature, hormone secretion and more. Therefore, having a good sleep and waking up at the right time has many health benefits for all people.

The circadian rhythm refers to the physical and mental changes that occur within an organism throughout an approximately 24-hour cycle. This cycle is controlled by signals sent from various parts of the brain to control functions like body temperature, hormone secretion and more. 
&nbsp;

Circadian Rhythm

When you don&rsquo;t sleep enough or at appropriate times during the day (for example: staying up late on weekdays), this can throw off your circadian rhythm&nbsp; and affect your energy levels during waking hours too!

You may be asking yourself, why is sleeping on time so important? Well, there are many reasons for this. First of all, sleeping has a lot of benefits for the body and mind.

<ul>
	<li>Sleep As A&nbsp;Time For The Body To Rejuvenate: When you sleep your brain stops sending signals to your muscles and organs telling them what to do. This allows them to rest and recover from the day&rsquo;s activities. 
	&nbsp;</li>
	<li>Sleep As A&nbsp;Time For The Mind To Relax: While you&rsquo;re asleep, you don&rsquo;t think about anything or anyone else but yourself and your own needs. This can help reduce stress levels when done consistently with other relaxation methods (such as meditation). 
	&nbsp;</li>
	<li>Importance Of Sleep In Children: Children need at least 10 hours of sleep each night because they still have developing brains which require proper rest in order to grow properly into young adults who will eventually be able to function independently without assistance from parents or guardians. 
	&nbsp;</li>
</ul>

The first sleep is probably the most important part of the entire sleep cycle because it helps people fall asleep faster and have a longer rest throughout the night.&nbsp;

If a person doesn&rsquo;t get enough sleep during the first part of the night, that can have consequences during daytime as well. Some people may be more prone to falling asleep faster with two separate sleeps instead of one long one. This phenomenon is called &ldquo;first sleep&rdquo; or &ldquo;second wind&rdquo; and it occurs in humans as well as other organisms including fruit flies, rats and mice. 
&nbsp;

Lack of sleep can lead to a variety of health problems. The following are some common ailments that have been linked to a lack of sleep:

<ul>
	<li>Headaches</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a> and <a href="https://merisehat.pk/disease/anxiety">anxiety</a></li>
	<li>Weight gain and obesity (insulin resistance)</li>
	<li>Memory loss and cognitive impairment</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes type II (pre-diabetes</a>)</li>
	<li>Heart disease 
	&nbsp;</li>
</ul>

The Circadian Rhythm is an internal clock that tells your body when to sleep and when to wake up. Disrupting this clock may not seem to cause a lot of damage right now but overtime, the damage accumulates and starts showing up when it is too late.&nbsp;

The concept of beauty sleep is somewhat related to maintaining a good circadian rhythm. While you are sleep, your body takes this time to undo the daily damage done to your cells. In this case, the blood flow supplies the key nutrient to your exhausted cells. The same is the case with your other organs, they take the time to reset and repair.&nbsp; 
&nbsp;

Our body gets used to when we sleep so much that we immediately start feeling tired regardless of our hectic or slow day. Ignoring this signal causes your brain and body to work overtime during their off hours. Think of your own productivity levels when you have to work overtime in your office, you are just pushing yourself without energy to somehow get the work done and go back home as early as possible. Our bodies are no less than a machine that needs their time off in a timely manner.&nbsp;

Circadian rhythm is an important part of our life as it regulates our sleeping and waking time. If you want better health and well-being, make sure you have enough sleep at night and wake up on time in the morning. This will help your body recover from stress caused by work or school during daytime so that you can function better throughout the day.