If You Can’t Fall Asleep In Under 20 Minutes, It Could Be A Sign Of These 9 Health Issues

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Some nights it’s easier to fall asleep than others. But for certain people, needing over 20 minutes to fall asleep every night is a given — and sometimes others have to wait hours more. The causes of insomnia can be due to all sorts of physical and medical health conditions, so it’s important to examine all of the factors that may be creating your difficulty falling asleep.

Falling asleep can say a lot more about what’s going on with your body than just how tired you are. “The amount of time it takes to fall asleep is known as ‘sleep latency,'” Conor Heneghan, lead research scientist at Fitbit, tells Bustle. “A normal amount of sleep latency is approximately 15-25 minutes, which is considered the ‘sweet spot’ for your body to drift into light sleep stages. However, sleep latency is impacted by [a variety of] factors.” These factors can be anything from what you’ve eaten that day, or whether you’ve altered your bedtime routine, to a more serious underlying medical condition that’s making it difficult for your body to rest at night.

And while having trouble falling asleep can be caused by a myriad of health issues, falling behind on sleep can cause sleep debt and add to these problems. So if you realize you’re taking more than 20 minutes to fall asleep every night, asking your doctor about this problem may get you some relief.

Here are nine health issues that not being able to fall asleep in 20 minutes could be a sign of, according to experts.

1GERD

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GERD, or gastroesophageal reflux disease, can cause symptoms that aren’t quite apparent until you lie down to try to fall asleep.

“When lying down, it’s easier for stomach acids to flow up your esophagus, causing heartburn,” Terry Cralle, RN, clinical sleep educator and sleep consultant for Saatva, tells Bustle. “Heartburn, in turn, can disrupt falling and staying asleep. That’s why many people with GERD experience an increase in symptoms at nighttime and may have trouble finding a comfortable position for sleeping.” Avoiding GERD trigger foods like spicy food, coffee, and alcohol, in the hours before bed, may provide some relief.

2Anxiety

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Anxiety doesn’t exist solely in the mind. If you’ve been dealing with feelings of stress and nervousness in your daily life, it may be building up and causing it to be difficult for you to fall asleep.

“Those who experience anxiety have a complex relationship with sleep,” Dr. Sujay KansagraMattress Firm’s sleep health expert, tells Bustle. “Anxiety can not only prevent someone from falling asleep but it can also be worsened once a person experiences the effects of sleep deprivation.” Dr. Kansagra recommends talking to your doctor if stress or anxiety may be affecting your ability to fall asleep.

3Asthma

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If falling asleep regularly takes more than 20 minutes for you, and you also experience respiratory symptoms, this could be caused by asthma.

“Asthma symptoms often worsen at night, [including symptoms of] nighttime coughing, chest tightness, wheezing and breathlessness: a condition referred to as ‘nocturnal asthma,'” Cralle says. Check in with your doctor if you realize that these sorts of symptoms tend to come along at night.

4“Social Jetlag”

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Keeping a completely different sleep schedule on weekdays and weekends can make falling asleep more difficult in general.

“Another major factor that may contribute to longer sleep latency is ‘social jetlag,’ brought on by the shift in sleep schedules that many experience on days off compared to workdays,” Heneghan says. This issue with your circadian rhythm can be addressed by keeping a more consistent bedtime and wake up time throughout the week.

5Arthritis

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If you have general aches and pains, and they worsen at night enough to make it difficult for you to fall asleep — you may have undiagnosed arthritis. And arthritis doesn’t only affect older people.

“It is estimated that as many as 80 percent of people with arthritis have difficulty sleeping,” Cralle says. “Pain makes it hard to get comfortable and to fall — and stay — asleep. Since sleep deprivation makes pain worse, it’s critical that arthritis sufferers get enough quality sleep.” So talking with your doctor both about your pain and your sleep problems can be a step in the right direction.

6Menopause

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Like arthritis, menopause is associated with aging but can show up in young peopleas well. Since you may not realize this is possible, you may not be connecting the dots between potential gynecological issues and lack of sleep.

“Women are twice as likely to suffer from insomnia than men, according to the National Sleep Foundation, and their sleepless nights have been linked with hormonal changes —especially during menopause, when hormone levels are erratic,” Dr. Kent Smith, founding director of Sleep Dallas, tells Bustle. Making sure you regularly see an OB/GYN, and always tell your doctors about changes to your health, can help you stay on top of these potential issues.

7Restless Leg Syndrome

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Tossing and turning doesn’t have to be something that you ignore. Health issues like restless leg syndrome could be seriously impacting your ability to fall and stay asleep.

“Approximately one in 10 adult Americans suffer from Restless Leg Syndrome, according to the National Sleep Foundation,” Dr. Smith says. “This sleep-related movement disorder causes overwhelming and often unpleasant urges to move the legs while at rest, often making it difficult for sufferers to drift off to sleep.” If you find it particularly hard to lie still at night, it may be best to get in touch with a doctor.

8Sleep Apnea

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While sleep apnea is known to cause disruptions during sleep, it can cause difficulties during the process of falling asleep as well. And since sleep apnea can be difficult to diagnose, you might not connect the dots on this sleep disorder immediately.

“Sleep apnea, a condition in which a person ceases to breathe multiple times per hour when they sleep, can inhibit a person’s ability to fall asleep,” Dr. Smith says. “The brain detects that it is receiving less oxygen during sleep, so, in a life-preserving attempt, it actively prevents the sufferer from falling asleep.” If you have difficulty falling asleep, plus other signs of sleep apnea, then it’s important to see a sleep specialist and seek treatment.

9Vitamin Deficiency

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Sometimes, the root cause of your difficulty falling asleep can be hard to pinpoint but relatively straightforward to treat. One of the examples of this is vitamin deficiency.

“Several common vitamin deficiencies can lead to sleep disturbance,” Arielle Levitan, M.D., co-founder of Vous Vitamin LLC, tells Bustle. “[…] Determining which vitamins to take and in which safe and proper doses is important.” Particular deficiencies like magnesium and iron can cause difficulty falling asleep, Levitan says. To find out if this is a problem, the first step is to speak with your doctor and potentially have them perform blood tests to check for deficiencies.

In order to protect your physical and mental health, it’s important not to normalize your difficulty falling asleep. Taking note of why you may be struggling to fall asleep within 20 minutes or so, and how you feel the next day, may provide you some of the data you need to discuss this issue with your doctor — and find a treatment that works for you.

How Can I Get on a Better Sleep Schedule?

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Sleep schedules vary a lot from person to person. Some are naturally “larks”—early to bed and early to rise—while others are “night owls.” Schedules shift with development, too, with babies typically being larks compared to older children; adolescents in particular often are on a later schedule, which can make it difficult to accommodate early classes.

Thankfully even night owls generally can align their schedules with the rest of the world. However, at times they may find themselves stuck in a cycle of late to bed, late to rise that’s hard to get out of.  For example, college students may go to bed and wake up later and later during winter break, and need to shift their schedule to one that’s compatible with academics as the new semester approaches.

If you find yourself in this situation, here are some recommendations for effectively getting on an earlier schedule.

1. Start in the morning.

Most people who try to change their sleep habits start by trying to go to bed earlier. Since sleep has a beginning and an end, it makes sense intuitively that we should adjust the start time. Unfortunately this approach is very likely to fail.

The problem is that you won’t have been up for enough hours in order to fall asleep easily, and so you’re likely to lie in bed for hours; the next morning you’ll probably stick to your typical wake time. There’s also a good chance you’ll get stressed out about not sleeping, which can lead to insomnia as your bed becomes associated with anxiety.

The better method is to think of being awake as having a start and an end, and adjusting when you start being awake. In other words, start by getting up earlier.

Ideally you can make this change gradually, so it’s not too difficult. For example, if you’ve been getting up at noon, start by setting an alarm for 11:30 AM. Gradually shift your wakeup time 15-30 minutes earlier as your body adjusts.

2. Get natural light early in the day.

One of the most effective ways to shift your 24-hour internal clock (or circadian rhythm) is to have exposure to bright light at the right time of day. For moving to an earlier schedule, that means getting natural light early in the day—preferably as soon as you wake up.

It doesn’t have to be for a long time (even 15 minutes helps), and you don’t need the Florida sun—being outside on an overcast day or sitting near a south-facing window can be enough. The light will signal to your brain that it’s time to be awake, and will suppress the production of melatonin, the hormone that tells your body and brain when to expect sleep.

On the flip side, avoid bright lights late in the day, like the glow of your tablet or phone, which can turn off melatonin production right when you need it.

3. Avoid caffeine later in the day.

If you’re getting up earlier, chances are you’re going to be sleepy at times during the day. The temptation to use caffeine to cope can be strong, especially around the mid-afternoon slump. However, it’s likely to keep you awake at bedtime, pushing your wakeup time later and delaying your ability to change your schedule.

What’s “later in the day”? A safe rule of thumb for most people is to avoid caffeine after lunchtime. If you’re sensitive to caffeine, it may need to be even earlier. (Of course, if your sleepiness is a safety concern—like while driving—do what you need to do.)

Instead of caffeine, try something like going for a brisk walk or doing calisthenics. If you’re able to go without it after lunch, you’re more likely to be ready for sleep come bedtime.

4. Be careful about naps.

Napping can have a similar effect to caffeine, making it harder to fall asleep when you’d like to. Our drive for sleep depends on how long we’ve been awake, and naps reduce that drive.

As with caffeine, the time of the nap is important; a 7:00 PM nap is going to be a bigger problem than one at 2:00 PM. If you do nap, aim to keep it short—no more than 20-30 minutes. And again, nap for safety reasons when needed.

5. Go to bed when sleepy.

Finally, be careful not to go to bed too early. It’s best if you feel like you could fall asleep relatively quickly once you lie down, to avoid spending a long period of time trying to wrestle your brain to sleep (see the first point, above).

On the other hand, you may be able to go to bed earlier than you think. Many people find that they get a “second wind” if they stay up past a certain hour, even if they were ready for bed earlier in the night. So take care not to push though sleepiness at night. By going to bed when your body is ready, you’ll have a better chance of getting up when your alarm goes off.

Some individuals on a late sleep schedule could have a condition like a Delayed Sleep Phase Circadian Rhythm Sleep-Wake Disorder that may require consultation with a professional. As always, consult a qualified medical professional before making major changes to your sleep. 

Earlier in my life, I didn’t have difficulties with falling asleep. However, with age, I’ve noticed that it’s harder to go straight to bed when you still, for instance, have so much on your mind. After I got married, together with my husband, we noticed that there are things we do each and every day, […]

via 5 Tips For a Better Sleep — simple Ula

Struggling To Sleep? Share Your Experiences

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Woman in bed with illustrated sheep drawn above her head
 Counting sheep has been suggested for those who struggle to sleep. Photograph: Garo/Phanie/Getty Images/Passage

The Guardian is planning a new video project about sleep.

According to a study by health insurers, two thirds (67%) of UK adults suffer from disrupted sleep, and around 16 million say they have insomnia.

We’re hoping to understand more about how people are affected by sleep problems and would like readers to tell us how they navigate sleepless nights.

How to take part:

We want to include first-person video testimony from our readers. If you’re interested in getting involved, or would like to find out more about the project, please fill in your details below – and let us know a little bit about how sleep disruption affects you. We’ll contact you with instructions about how to submit your video contribution.

*author article has sign up page!

8 Bizarre Sleep Habits From Around The World

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Would you sleep on the job?

Are your sleep habits ruining your daily life? It might be worth taking a nap on the job!

To celebrate World Sleep Day on March 15, Brother UK has taken an in-depth look at the most bizarre sleep habits from countries around the world to see if they could have an impact on productivity.

Research via the National Sleep Foundation (NSF) suggests that lack of sleep can have a negative impact on emotion. Could naps of 20-30 minutes make for a more productive workforce, and have a positive impact on mood, concentration and attention?

Struggling to sleep? READ: How to sleep better – simple ways to get a good night’s rest

Sleep habits

1. China – Bring your bedroom to work

In factories and offices across China, the lines between bedroom and workspace are becoming increasingly blurred. Due to longer working hours, many employers now advocate a short nap after lunchtime to increase concentration. Certain offices have even installed temporary or permanent sleeping and washing facilities in their office spaces to encourage employees to stay round the clock.

2. Japan – Inemuri

Taking a nap at work could well be perceived as a sign of laziness, but not in Japan. The hectic lifestyle of Japan’s city dwellers has led to the wide-scale uptake of “inemuri”, or “sleeping whilst present”. Thanks to inemuri, Japanese workers can nap on public transport, at their desk or even during meetings – and it’s commonly seen as a sign of hard work.

Sleep habits

3. Spain – Siesta

Originating in Spain and parts of Latin America, the siesta is perhaps one of the most well-known daytime snoozing traditions across the globe. This practice might be under threat, however, with new business laws introduced in 2016 limiting how late employees can work, and effectively reducing the time they have to squeeze in an afternoon nap.

4. Italy – Riposo

Where the Spanish have a siesta, the Italians have “riposo”. Commonly taking place after lunch, riposo can last anywhere from 2-4 hours. Get us to Italy now! Frustratingly for tourists, this means that many attractions are closed throughout the day.

5. Norway – Napping outside

Take a stroll through Oslo, Helsinki or another Nordic town, and you might well see some infants taking a nap in temperatures as low as -5 degrees Celsius. Don’t worry – they haven’t been abandoned; sleeping outdoors in the daytime is actually believed to be very good for their health.

Sleep habits

6. Indonesia – Fear sleep

Stresses of work getting you down? The ominously named ‘fear sleep’ might be the solution. Locally referred to as “todoet poeles” – the practice of fear sleep enables people to nod off instantly to avoid feelings of excessive anxiety and stress. Nodding off when your boss walks in might not be the best solution, but regular naps could well help avoid work-related worry.

7. Botswana – Sleeping on your own schedule

You should sleep when it’s dark, correct? Not quite. At least, not in Botswana. The country’s native Kung hunter-gatherer tribe are well known for sleeping only when tired, regardless of the time of day. With an increased uptake of flexi-time, rise in self-chosen hours and growth of contract-based work, could businesses be embracing the way of the Kung sooner than we think?

Sleep habits

8. USA – Silicon Valley sleepers

Though it’s not a national custom just yet, sleeping on the job is widely being embraced by some of the USA’s biggest employers. Technology and software companies are leading the napping revolution, with firms like Google going so far as to have purpose-built sleeping pods installed in their offices to help employees rest and refresh.

How to Calm Your Racing Mind so You Can Sleep

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You long for sleep. You may even feel tired before going to bed. But as soon as your head hits the pillow, it happens again. You’re wide awake. You can’t stop thinking. It’s the worst.

I regularly speak to groups about the necessity of sleep for the prevention of burnoutmanagement of stress, improvement of mood, and a host of other benefits. Almost every time I do, someone comes up to me and says:

     “I know I need more sleep. But what do I do if I can’t fall asleep? I get into bed early enough to get eight hours, but then I just lie there with my mind racing.”

I also frequently hear this from coaching clients and patients. When I do, I start asking questions. And usually find the answer.

Here are the questions, for you to ask yourself:

1. Do you take your phone to bed?

First of all, the light from the phone is stimulating to the brain and can suppress melatonin release (melatonin helps you sleep). The best solution is to not look at your phone after 9 p.m. (or an hour or two before bed), but lots of people aren’t ready to give up that habit. If that’s you, use a blue light-blocking mode, like “Night Shift” on iPhones, and turn your screen brightness down as far as it can go.

2. What are you reading, or doing in bed, before you go to sleep?

This is my second point about the phone. I once heard a sleep expert at Harvard say that texting at bedtime is a bad idea. The thought processes that you use are too stimulating to your brain. Obviously, checking work emails (or any email) at bedtime is a really bad idea, especially if you come across something stressful. You may not even want to read the news, in case there’s a headline that stimulates thoughts or concerns.

If you like to read to wind down, choose a book (the printed kind). Ideally, that book should not be too thought-provoking or stimulating. It shouldn’t be disturbing. It also probably shouldn’t be so incredibly captivating that you can’t put it down…

3. What do you do with your evenings?

If you have trouble winding down to sleep, take care not to wind yourself up over the course of the evening. Good rules of thumb:

  • Avoid challenging conversations with your spouse in the evenings if possible. Definitely avoid starting a difficult conversation close to bedtime.
  • If you must work in the evening (i.e., answering emails), try to do so earlier versus later, so you have time to wind down your mind before bed.
  • Working out in the evening makes it harder to wind down and fall asleep. Do it earlier in the day.
  • If you go out on a work night, plan to get home at a reasonable hour so that you have time to wind down and still get into bed on time.

Notice what “winds you up” in the evenings. Either avoid it, or schedule it much earlier.

4. What lighting do you use at night?

This is another key to winding down. People used to sleep an average of nine hours a night before the advent of widespread electricity. The lights we have on at night in our homes are stimulating and can also suppress melatonin secretion.

Feel the difference between two late evening scenarios:

A) All the lights are on. The TV is blaring. You’re sitting at a table catching up on emails, while simultaneously conducting a logistical discussion with your spouse. You feel stressed and don’t even want to go to bed. You’ll need at least an hour of Netflix to wind down from this (not a good idea, because of the screen involved, and also if it’s a really well-written show, it will be hard to turn off in time for bed).

B) All the lights are off, except a warm yellow lamp in the corner of the room. Soft music is playing. You and your spouse are quietly reading. As you read, the inevitable happens. Your eyelids start to droop. Your head bobs as you fall asleep for a split second. Even though it’s earlier than you’d planned, you get up and head over to the bathroom to start getting ready for bed.

5. Is there something specific you’re worried about?

Perhaps there’s a stressful situation you can’t stop worrying about that’s keeping you awake. In this case, I’d recommend a variety of approaches:

  • If it’s serious, get professional counseling support to help you problem-solve the situation and/or your response to it.
  • Journal before going to bed to get your worries out of your head and onto the page.
  • Learn a relaxation practice, such as a simple relaxation breathing meditation, to quiet your mind and body before bed. If I can’t fall asleep, I focus on a three-line scripture about peace as I breathe slowly in and out; it almost always works. One of my coaching clients, a former figure skater, skates in her mind until she falls asleep.

6. How are you using your bed?

Leverage the strategy of “stimulus control.” If you do lots of different things in bed (e.g., watch movies, answer emails, take phone calls, etc.), your body and mind get confused about the purpose of bed. If you have insomnia, it’s best to only use your bed for sleep. For the same reason, if you can’t fall asleep, get out of bed, and go do something quiet and relaxing until you start to feel sleepy, and then head back to bed.

7. How much caffeine are you drinking?

The sleep expert I mentioned earlier also said that if you struggle with insomnia, you should eliminate caffeine (and any other stimulants) completely and see if that helps. If that feels impossible, start by eliminating caffeine in the late afternoon or evening. Sources of caffeine include coffee, non-herbal teas, chocolate, and some supplements.

Elena Rostunova/Shutterstock
Source: Elena Rostunova/Shutterstock

Note: Some people who can’t sleep have a bigger issue, such as Generalized AnxietyBipolar Disorder, or other medical concerns. If your sleeplessness is extreme or doesn’t respond to simple interventions, it’s important to talk to your doctor about it.

Copyright 2019 Dr. Susan Biali Haas

Night Owls May Experience ‘Jet Lag’ On A Daily Basis

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Some people declare themselves to be morning larks, or early risers, and they effortlessly wake up at the crack of dawn and fall asleep earlier in the evening.

Others, however, are night owls, or evening people, who stay up until the early hours of the morning and wake up later in the day, if left to their own devices.

Previous research has shown that the night owls face some health risks due to their daily rhythms. These include a tendency towards poorer dietary habits, which, in turn, can increase the risk of metabolic conditions, such as diabetes.

Now, a study led by investigators from the University of Birmingham in the United Kingdom has found out how activity patterns in the brains of night owls are different from those of morning people. The study also highlights how these differences can impact their lives and levels of productivity in a world that typically favors early risers.

“A huge number of people struggle to deliver their best performance during work or school hours they are not naturally suited to,” notes lead researcher Dr. Elise Facer-Childs, previously of Birmingham University and now based at the Monash Institute for Cognitive and Clinical Neurosciences in Melbourne, Australia.

“There is a critical need to increase our understanding of these issues in order to minimize health risks in society, as well as maximize productivity,” she emphasizes.

The researchers have now published their findings in a study paper featured in the journal SLEEP.

Brain activity in night owls

For this study, the research team recruited 38 healthy participants. They divided the volunteers into two groups, putting 16 early risers into one group and 22 late sleepers into the second.

The researchers split the participants into these two groups based on their melatonin and cortisol circadian rhythms — the natural circulation of these two hormones affect sleep and waking cycles.

The researchers monitored the participants’ sleeping and waking patterns, and the volunteers filled in questionnaires about their rhythms. On average, late sleepers went to bed at 2:30 a.m. and woke up at 10:15 a.m.

To assess brain activity patterns, the investigators asked the volunteers to undergo MRI scans. The researchers also tested the participants’ performance on various tasks they undertook at different times throughout the day to see how sleep-wake cycles affected daily functioning.

The team noticed a difference in brain activity patterns between the two groups, namely that night owls had lower resting brain connectivity in brain areas that scientists primarily associate with maintaining a state of consciousness. They correlated this with shorter attention spans, as well as slower reactions and lower energy levels.

Early risers performed better and had faster reaction times during morning tasks. They also declared themselves as being much less sleepy at that time.

On the contrary, as expected, late sleepers performed best and experienced the fastest reaction times around 8:00 p.m. However, even at the time when they were at their peak performance, night owls did not do much better than their early rising peers.

This suggests that throughout the day — or from around 8:00 a.m. to 8:00 p.m. — resting-state brain connectivity is affected in late sleepers, adversely impacting their productivity.

Social expectations ‘could be more flexible’

Dr. Facer-Childs likens the night owls’ state throughout the day to a form of constant jet lag, emphasizing that this may have a significant effect on their well-being in the long run.

This mismatch between a person’s biological time and social time — which most of us have experienced in the form of jet lag — is a common issue for night owls trying to follow a normal working day.”

Dr. Elise Facer-Childs

“Our study is the first to show a potential intrinsic, neuronal mechanism behind why night owls may face cognitive disadvantages when being forced to fit into these constraints,” she adds.

For this reason, the researcher argues that societies need to take a long, hard look at their organizational structures, chiefly in terms of working hours and how to become more accommodating to people’s individuals needs. This flexibilty should mean that night owls can put their best foot forward while avoiding adverse health outcomes.

“To manage this [situation], we need to get better at taking an individual’s body clock into account — particularly in the world of work,” Dr. Facer-Childs argues.

“A typical day might last from 9:00 a.m.–5:00 p.m., but for a night owl, this could result in diminished performance during the morning, lower brain connectivity in regions linked to consciousness, and increased daytime sleepiness,” she warns.

She further advises that “If, as a society, we could be more flexible about how we manage time, we could go a long way toward maximizing productivity and minimizing health risks.”

The Dangers of Sleep Deprivation

Why Being A Night Owl Might Be Damaging Your Mental Health

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woman sleeping in bed

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Not only is being a ‘night owl’ annoying when you have to get up for work the next day, it apparently affects more than just your body clock – it has a big impact on mental health, too.

According to a new study published in the journal Nature Communications, people who are naturally early risers are less likely to develop mental health problems than those who go to bed late and sleep in.

The large-scale genetics study, conducted at the University of Exeter, used data from 250,000 research participants signed up to the private genetics company 23andMe, and 450,000 people in the UK Biobank study. Participants were asked whether they were a “morning person” or an “evening person”, and their genomes were analysed, revealing certain genes people shared that appeared to influence sleep patterns.

Lead study author Samuel Jones, a research fellow studying the genetics of sleeping patterns at the University of Exeter, said:

“Part of the reason why some people are up with the lark while others are night owls is because of differences in both the way our brains react to external light signals and the normal functioning of our internal clocks.

“The large number of people in our study means we have provided the strongest evidence to date that ‘night owls’ are at higher risk of mental health problems, such as schizophrenia and lower mental wellbeing, although further studies are needed to fully understand this link.”

The results found uncovered an apparent causal link between being a night owl and being more prone to depression, anxiety and schizophrenia – with evening types 10% more likely to develop the latter condition.

However, they found no increased risk of obesity and diabetes among night owls, despite what some earlier studies have said.

Samuel Jones said the conclusion is that night owls are more likely to have to work against their natural body clock in school and the world of work, which may have negative consequences on their mindset.

So, how can you go about adjusting your sleep schedule? Hope Bastine, sleep psychologist for high-tech mattress maker Simba, says we need to identify our individual sleep needs first.

“Experiment with your productivity and your performance rate and adjusting your time schedule to that,” she told Cosmopolitan UK. “Find a rhythm, a schedule, a lifestyle that really suits you, and that makes you feel in harmony with yourself. Make sure your sleep schedule is as non-negotiable as possible.”

Putting sleep first? Done.

Follow Abbi on Instagram.

12 Signs You Might Have an Anxiety Disorder

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What’s normal?

Everyone gets nervous or anxious from time to time—when speaking in public, for instance, or when going through financial difficulty. For some people, however, anxiety becomes so frequent, or so forceful, that it begins to take over their lives.

How can you tell if your everyday anxiety has crossed the line into a disorder? It’s not easy. Anxiety comes in many different forms—such as panic attacks, phobia, and social anxiety—and the distinction between an official diagnosis and “normal” anxiety isn’t always clear.

Here’s a start: If you experience any of the following symptoms on a regular basis, you may want to talk with your doctor.

Excessive worry

The hallmark of generalized anxiety disorder (GAD)—the broadest type of anxiety—is worrying too much about everyday things, large and small. But what constitutes “too much”?

In the case of GAD, it means having persistent anxious thoughts on most days of the week, for six months. Also, the anxiety must be so bad that it interferes with daily life and is accompanied by noticeable symptoms, such as fatigue.

“The distinction between an anxiety disorder and just having normal anxiety is whether your emotions are causing a lot of suffering and dysfunction,” says Sally Winston, PsyD, co-director of the Anxiety and Stress Disorder Institute of Maryland in Towson.

Sleep problems

Trouble falling asleep or staying asleep is associated with a wide range of health conditions, both physical and psychological. And, of course, it’s not unusual to toss and turn with anticipation on the night before a big speech or job interview.

But if you chronically find yourself lying awake, worried or agitated—about specific problems (like money), or nothing in particular—it might be a sign of an anxiety disorder. By some estimates, fully half of all people with GAD experience sleep problems.

Another tip-off that anxiety might be involved? You wake up feeling wired, your mind is racing, and you’re unable to calm yourself down.

Irrational fears

Some anxiety isn’t generalized at all; on the contrary, it’s attached to a specific situation or thing—like flying, animals, or crowds. If the fear becomes overwhelming, disruptive, and way out of proportion to the actual risk involved, it’s a telltale sign of phobia, a type of anxiety disorder.

Although phobias can be crippling, they’re not obvious at all times. In fact, they may not surface until you confront a specific situation and discover you’re incapable of overcoming your fear. “A person who’s afraid of snakes can go for years without having a problem,” Winston says. “But then suddenly their kid wants to go camping, and they realize they need treatment.”

Muscle tension

Near-constant muscle tension—whether it consists of clenching your jaw, balling your fists, or flexing muscles throughout your body—often accompanies anxiety disorders. This symptom can be so persistent and pervasive that people who have lived with it for a long time may stop noticing it after a while.

Regular exercise can help keep muscle tension under control, but the tension may flare up if an injury or other unforeseen event disrupts a person’s workout habits, Winston says. “Suddenly they’re a wreck, because they can’t handle their anxiety in that way and now they’re incredibly restless and irritable.”

Chronic indigestion

Anxiety may start in the mind, but it often manifests itself in the body through physical symptoms, like chronic digestive problems. Irritable bowel syndrome(IBS), a condition characterized by stomachaches, cramping, bloating, gas, constipation, and/or diarrhea, “is basically an anxiety in the digestive tract,” Winston says.

IBS isn’t always related to anxiety, but the two often occur together and can make each other worse. The gut is very sensitive to psychological stress—and, vice versa, the physical and social discomfort of chronic digestive problems can make a person feel more anxious.

Stage fright

Most people get at least a few butterflies before addressing a group of people or otherwise being in the spotlight. But if the fear is so strong that no amount of coaching or practice will alleviate it, or if you spend a lot of time thinking and worrying about it, you may have a form of social anxiety disorder (also known as social phobia).

People with social anxiety tend to worry for days or weeks leading up to a particular event or situation. And if they do manage to go through with it, they tend to be deeply uncomfortable and may dwell on it for a long time afterward, wondering how they were judged.

Self-consciousness

Social anxiety disorder doesn’t always involve speaking to a crowd or being the center of attention. In most cases, the anxiety is provoked by everyday situations such as making one-on-one conversation at a party, or eating and drinking in front of even a small number of people.

In these situations, people with social anxiety disorder tend to feel like all eyes are on them, and they often experience blushing, trembling, nausea, profuse sweating, or difficulty talking. These symptoms can be so disruptive that they make it hard to meet new people, maintain relationships, and advance at work or in school.

Panic

Panic attacks can be terrifying: Picture a sudden, gripping feeling of fear and helplessness that can last for several minutes, accompanied by scary physical symptoms such as breathing problems, a pounding or racing heart, tingling or numb hands, sweating, weakness or dizziness, chest pain, stomach pain, and feeling hot or cold.

Not everyone who has a panic attack has an anxiety disorder, but people who experience them repeatedly may be diagnosed with panic disorder. People with panic disorder live in fear about when, where, and why their next attack might happen, and they tend to avoid places where attacks have occurred in the past.

Flashbacks

Reliving a disturbing or traumatic event—a violent encounter, the sudden death of a loved one—is a hallmark of post-traumatic stress disorder (PTSD), which shares some features with anxiety disorders. (Until very recently, in fact, PTSD was seen as a type of anxiety disorder rather than a stand-alone condition.)

But flashbacks may occur with other types of anxiety as well. Some research, including a 2006 study in theJournal of Anxiety Disorders, suggests that some people with social anxiety have PTSD-like flashbacks of experiences that might not seem obviously traumatic, such as being publicly ridiculed. These people may even avoid reminders of the experience—another symptom reminiscent of PTSD.

Perfectionism

The finicky and obsessive mind-set known as perfectionism “goes hand in hand with anxiety disorders,” Winston says. “If you are constantly judging yourself or you have a lot of anticipatory anxiety about making mistakes or falling short of your standards, then you probably have an anxiety disorder.”

Perfectionism is especially common in obsessive-compulsive disorder (OCD), which, like PTSD, has long been viewed as an anxiety disorder. “OCD can happen subtly, like in the case of somebody who can’t get out of the house for three hours because their makeup has to be absolutely just right and they have to keep starting over,” Winston says.

Compulsive behaviors

In order to be diagnosed with obsessive-compulsive disorder, a person’s obsessiveness and intrusive thoughts must be accompanied by compulsive behavior, whether it’s mental (telling yourself It’ll be all right over and over again) or physical (hand-washing, straightening items).

Obsessive thinking and compulsive behavior become a full-blown disorder when the need to complete the behaviors—also known as “rituals”—begins to drive your life, Winston says. “If you like your radio at volume level 3, for example, and it breaks and gets stuck on 4, would you be in a total panic until you could get it fixed?”

Self-doubt

Persistent self-doubt and second-guessing is a common feature of anxiety disorders, including generalized anxiety disorder and OCD. In some cases, the doubt may revolve around a question that’s central to a person’s identity, like “What if I’m gay?” or “Do I love my husband as much as he loves me?”

In OCD, Winston says, these “doubt attacks” are especially common when a question is unanswerable. People with OCD “think, ‘If only I would know 100% for sure whether I was gay or straight, either one would be fine,’ but they have this intolerance for uncertainty that turns the question into an obsession,” she says.

This article originally appeared on Health.com