A Patient’s Guide to Insomnia

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By Elaine K. Howley

If you’ve ever lain awake at night wishing for sleep, then you’ve likely experienced some form of insomnia. For those who struggle with this common sleep disorder regularly, the feeling of missing out on sleep can be excruciating. And the paradox of it is that the more you try to sleep the further away the sweet embrace of slumber seems to slide.

As awful as sleeplessness might feel, if there is strength in numbers, then you can take some small comfort in the fact that you’re far from alone. “The data shows that between 20 and 30 percent of people will be affected with insomnia during the course of their lives,” says Dr. Alex Dimitriu, a sleep medicine specialist who’s double board-certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine in California.

Although we know that sleep is critical to maintaining health and wellness for all of us, in some people, the drive to sleep is weaker than in others. “Not everyone has the same propensity to go to sleep,” says Dr. Jerald H. Simmons, a neurologist who’s triple board-certified in neurology, epilepsy and sleep medicine and founder of Comprehensive Sleep Medicine Associates, a clinical practice with offices in Houston and Austin. This so-called sleep drive can vary, as does each individual person’s sleep rhythm. This is why some people are night owls while others are morning people. And in some people, a weaker sleep drive is easily disrupted by any number of factors, which can lead to the development of insomnia.

Insomnia is the most common sleep disorder, but not all cases of insomnia are the same. Generally speaking, there are two major categories of insomnia – difficulty falling asleep initially and difficulty staying asleep throughout the night. And the two may be quite different in how they’re addressed. “Don’t confuse going to sleep with staying asleep,” Simmons says. “You can’t lump them all into one category and say, ‘This is the medicine I use for insomnia patients.'” Rather, many people struggling with insomnia are going to need a treatment approach tailored to their specific problem.

Insomnia – More General Information

Sleep Disorders and Chronic Pain
Cognitive Behavior Therapy for Insomnia
Sleep Deprived? You’re Not Alone
Best Doctor for Sleep Problems?
How Sleep Disorders Affect Us – and How to Lay Them to Rest
How to Fall Asleep – and Stay Asleep – the Natural Way

“In most people who have insomnia, it’s caused by something,” says Dr. Jesse Mindel, assistant professor of medicine and neurology at The Ohio State University Wexner Medical Center. And there are many factors that can cause both short-term and chronic insomnia including:

  • Changes to your work or travel schedule. Jet lag and frequent changes to your work schedule, as can happen with shift work, can induce insomnia in some people.
  • Concerns over work, school or health issues. There’s a reason why the saying “to lose sleep over it” exists. Concerns about any number of aspects of your life can lead to disrupted or poor sleep.
  • Concerns about not sleeping enough. Simmons says some people “develop performance anxiety” about sleep and their insomnia is exacerbated by that anxiety. “They’re so worried they can’t fall asleep that they can’t fall asleep,” and it becomes a self-perpetuating problem.
  • Poor sleeping habits. Engaging in stimulating activities in bed or being inconsistent in your sleep-wake pattern can lead to insomnia.
  • Food and drink. How much, what and when you eat can also disrupt the quality of your sleep. Substances such as caffeine, nicotine and alcohol can have an outsized impact on your sleep quality, especially if you’re using them in the evening or just before bed.
  • Age. Some people tend to have more trouble sleeping as they age, and many post-menopausal women report experiencing insomnia or a shift in sleeping patterns that’s related to changes in their hormone levels.
  • Medical conditions. Some medical conditions, such as sleep apnea – a breathing issue that wakes you up multiple times a night – can disrupt your sleep and lead to insomnia. Restless leg syndrome is another condition that can turn you into an insomniac.
  • Mental health disorders. Anxiety and depression can both greatly impact the quality of your sleep and your ability to fall or stay asleep.
  • Medications. Some medications, particularly certain anti-depressants, steroid medications used for asthma, allergy medications, weight loss drugs and some blood pressure medications can cause insomnia as a side effect.

For many people, insomnia is a consequence of modern life. “A lot of insomnia is related to just being forced into a schedule that’s not natural,” Dimitriu says. Busy, stressful lives filled with electric lights and electronic devices that are constantly demanding attention and shedding blue light that disrupts the body’s natural signals to sleep are all implicated in our collective inability to just get some sleep. “LED lights produce a blue light that suppresses melatonin,” a hormone that governs when we feel sleepy, and this can impact your ability to both fall asleep and stay asleep. “There’s evidence that (after exposure to LED light) melatonin is suppressed through the whole night, so late-night phone play messes up the quality of the sleep for the whole night.”

The ubiquity of these screens and their ability to become a detriment to our sleep cycle is a growing problem for many people, especially those who are prone to insomnia. “We’re living in a very tech-heavy world with clocks and other built-in hard stops” to our natural rhythms. “We’re not adjusting to that,” and the evidence of that disconnect between the demands of the waking day and the inadequacy of sleep to meet those demands becomes vastly obvious when you look at the length of the line at your local coffee shop each morning, Dimitriu says.

Most people who have insomnia are well aware of the difficulties they’re having sleeping. Common symptoms include:

  • Difficulty falling asleep.
  • Waking up during the night and having difficulty returning to sleep.
  • Waking too early in the morning.
  • Not feeling refreshed after sleeping.
  • Grogginess or tiredness during the day.
  • Depression, anxiety and irritability.
  • Cognitive issues such as difficulty focusing or concentrating on tasks.
  • Making lots of mistakes in your work or noticing an increase in accidents or clumsiness.
  • Anxiety about not getting enough sleep.

If you’re experiencing symptoms of sleeplessness, it might be time to visit your doctor for an evaluation. There can be a lot of factors contributing to your specific experience of insomnia, and your doctor will likely perform a physical exam and take a medical and sleep history to understand what’s going on.

You may also be administered a sleep test, which sometimes can be done at home but in other cases may need to be conducted in a sleep lab. These tests typically involve sleeping with sensors attached to your body to monitor your vital signs and look for other indications of physical disruption, such as changes in breathing or heart rate that could be causing you to wake up throughout the night. These tests monitor what you do in your sleep and are often helpful in diagnosing obstructive sleep apnea, restless leg syndrome and other conditions that can disrupt sleep.

Ruling out underlying medical conditions should be a primary goal of any visit you make to a sleep specialist. “First and foremost, I want to rule out any other causes that could be feeding into the insomnia,” Dimitriu says. These other conditions may include:

  • Depression.
  • Anxiety.
  • Restless leg syndrome.
  • Sleep apnea.
  • Thyroid problems.
  • Use of substances such as alcohol or drugs.
  • Other medical conditions.

“As a physician, first I need to eliminate all treatable medical issues. Then I look at substances” and other extenuating circumstances such as living too close to a source of late night noise or light. “Once you’ve eliminated those variables, you discover some people just have pure insomnia. This may be schedule-related or circadian rhythm related. Once we’ve eliminated all the scary stuff that could be treated medically, using a little medication or behavioral intervention can get people sleeping again,” Dimitriu says.

Treating insomnia and making sure that you’re getting enough sleep is an important aspect of overall health and wellness. While there are many things you can do to help ease yourself to sleep, one of the most important things is habituating your body to sleep and the ritual of sleep. “Rhythmicity is key, so having a regular bedtime and wake time and not deviating from that at all,” says Dimitriu. That, alas means “no sleeping in on the weekend, and no napping during the day.” The idea is that by forcing your body to stay awake during the day and adhering to a strict bedtime and wake time regardless of what else is going on, you can retrain your body to accept sleep when it’s most appropriate.

Simmons says many people who deal with insomnia have “poor sleep hygiene,” which means “they’re doing all the wrong things. They’re drinking caffeine in the evening. They’re taking naps in the middle of the day if they have the opportunity to,” and so on. Those sorts of actions “throw their biologic rhythm off. Those individuals need to wake up at a regular time in the morning. They shouldn’t sleep in and they need to get bright light exposure that will lower melatonin levels.” You want to increase the naturally occurring levels of melatonin in your brain at bedtime, and then help them drop in the morning when it’s time to get up and get going.

Other elements of good sleep hygiene include winding down from the day and creating a ritual around bedtime that helps your brain get ready to sleep. Switch off the television and step away from any other screens. Keep your bedroom cool, dark and quiet.

Simmons also recommends taking a hot bath shortly before bedtime to help you relax and get ready for sleep. “As we get drowsy our body temperature drops, and you’re going to sleep better in a cool room. So, if you take a hot bath before bed, that enhances that change in body temperature.” Just be sure to make it the last thing you do before bed. “That window of opportunity where the cooling will help is only 45 minutes to an hour,” he says.

If you’re still having trouble sleeping, it might be time to see a sleep specialist for further testing or more specific treatment. Simmons says that for some people, particularly those who engage in shift work, a consultation with a sleep specialist might help them develop a good strategy for dealing with or avoiding insomnia. “Seek out a consultation with a psychologist or physician who is well versed in sleep disorders to work on a unique plan that’s tailored to your needs,” he says.

Sleep medicine was only recognized as a specialty field of medicine in 2007. Although the science is still young it is expanding, and today there are a growing number of specialists who can help you with sleep problems with a variety of techniques. Simmons says some sleep specialists are now using cognitive behavioral therapy, an approach common in treating mental health problems that can retrain the brain to sleep properly.

Another technique called neurofeedback is a form of “biofeedback using brainwave activity (to) train someone to put themselves into a state conducive to falling asleep,” Simmons says. Using this approach, patients “learn how to relax and we train the brain through this feedback process on how to wind down and go to sleep without medication.” It’s a process that’s similar to meditation. In fact, Simmons says “I jokingly refer to it as meditation on steroids.”

Dimitriu uses similar CBT and meditation techniques to help patients retrain their bodies and brains to accept sleep. The challenge with some of these approaches is that they take time and practice. But tired people aren’t generally well known for being the most patient among us, especially when it comes to sleeping more. “A lot of people say, ‘I slept well last night, why am I still tired?’ The answer is sleep debt takes time to replenish – on the order of about one to two weeks.” That’s why it’s important to keep at it and not give up if you don’t seem to have solved your insomnia problem after just a few nights. Think of it like dieting – it takes a while for your efforts to add up to results, but if you stick with it, you’ll likely see an improvement.

That’s why Dimitriu says it’s important to keep practicing and trying to sleep without the assistance of medication as much as possible, especially when the stakes are low. “It’s easier to practice driving in the parking lot than to practice driving on the highway. By the time you have a big meeting the next day and you can’t fall asleep, meditation can help, but you’d better be good at it by then.” Therefore, he says it’s best to “practice when it’s easy” and you don’t have that pressure of getting to sleep immediately.

There’s a multitude of meditation and sleep-inducing apps and programs available online these days, or a sleep specialist can design a program specific to your needs. And remember to be patient. “If you can learn to meditate, you’re pretty likely to solve your insomnia problem, but that takes time and effort,” Dimitriu says.

Science says it’s better to sleep next to a dog than a human

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If you’ve got a dog, you’ll know that there’s nothing quite like a snuggle on the sofa while binge watching Ru Paul’s Drag Race. They look adorable when they’re sleeping, our entire camera roll is basically delfies, and they give the best cuddles.

But did you know that sleeping next to your cute canine is actually really good for you? A study by The Mayo Clinic found that you get a better night’s sleep when you snooze next to your pet pup.

Researchers found that the 40 healthy individuals involved in the study slept better when next to a dog, no matter how big or small the pet in question was, or how much it moved in the night.

The Mayo Clinic’s Lois Krahn said: ‘Most people assume having pets in the bedroom is a disruption. We found that many people actually find comfort and a sense of security from sleeping with their pets.

‘Today, many pet owners are away from their pets for much of the day, so they want to maximise their time with them when they are home. Having them in the bedroom at night is an easy way to do that. And, now, pet owners can find comfort knowing it won’t negatively impact their sleep.’

Another study found that we love dogs more than we love other humans (true), and even newer research shows that you get a better night’s sleep when you sleep next to a dog rather than a partner (true again).

The scientific study by Dr. Christy L. Hoffman, a professor in Animal Behaviour, Ecology, and Conservation at Canisius College in New York tracked sleeping habits to find out whether sleeping next to a pet affects women’s sleep patterns.

And the results showed that those who slept next to a dog reported a better, more restful sleep than those who slept next to a cat, or another human. Apparently, dogs are less disruptive and we experience feelings of comfort and security when cuddling a pet pooch.

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Dr. Hoffman told Broadly that the ‘keyword here is perception, this study is based on individuals self-reporting how they feel their sleep is affected.’

She added that it is ‘important to note that this is based on aggregated data and an average of responses, so getting a dog won’t solve everyone’s sleep problems.’

If you haven’t got a dog, don’t worry – this is probably the most perfect excuse to get one.

Couples are getting ‘sleep divorces’ – and it could save your relationship

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It’s becoming what’s known as a ‘sleep divorce’ and far from being a sign of a relationship in trouble, experts are saying it could be a good thing.

Perhaps one of you is a night owl, while the other is an early bird. If one partner often has disrupted sleep, then this can impact the other. Other reasons people sleep apart include different schedules, snoring , co-sleeping and even the temperature of the room.

“Poor sleep also can have negative effects on relationships,” PT reports.

“Lack of sleep may diminish the positive feelings we have for our partners. Researchers found people with lower quality sleep demonstrated lower levels of gratitude, and were more likely to have feelings of selfishness, than those who slept well.

“People who slept poorly showed less of a sense of appreciation for their partners.

“What’s more, poor sleep on the part of one person in the relationship had a negative effect on feelings of appreciation and gratitude for both partners.”

If this sounds like something you could both benefit from: “Tell your partner that you really love them but you’d be [less resentful of their sleeping habits] if you slept in separate beds.

“Suggest trying it for one or two nights a week and see how it goes.”

15 Things To Avoid Doing When You’re Sleep Deprived, No Matter How Tired You Are

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If you missed a few hours of sleep, you’re definitely going to feel tired the next day. And with that fatigue will likely come all sorts of ideas for staying awake, such as guzzling caffeine, taking a long nap, or going to bed super early. But even though it all seems like a good idea when you’re tired, these are things you should avoid at all costs.

The only real cure for fatigue is getting a good night’s sleep, every single day. And that means creating a healthy sleep schedule, one night at a time. “Resetting your sleep schedule or establishing good sleep hygiene is a process and takes more than a few days,” licensed psychologist Nicole Issa, PsyD, tells Bustle.

And yet, the sooner you can start, the better. “It will begin with having a consistent wake up time and sticking to it,” she says. “Your bedtime will gradually shift to an earlier time to allow you to get enough rest.”

Creating a relaxing evening routine can come in handy, too, such as slowing down, putting away your phone, reading a book, and even getting ready for bed beforeyou’re tired. As Dr. Issa says, “That way you can just go to bed when you are ready and not get woken up by washing your face, brushing your teeth, etc.”

These are things you should do for good sleep, as opposed to the things listed below, which experts say you should try to avoid if you’re tired.

1. Drinking Tons Of Energy Drinks

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Even though they can give you a quick boost of energy, it’s not a good idea to load up on these drinks as a way to stay awake.

“[They] often have a lot of B vitamins, which can be stimulating, and then cause insomnia, which perpetuates the cycle of being tired and reaching for more energy drinks,” Catherine Darley, ND, from the The Institute of Naturopathic Sleep Medicine, tells Bustle.

Instead, stick to one caffeinated drink in the morning, so it has plenty of time to wear off before bed, when you can officially catch up on your rest.

2. Taking A Nap

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If you can, try to resist the urge to take a nap. Or at least try to time it right.

“Avoid taking a nap longer than 30 minutes to ‘catch up,'” Doug Hale, a sleep expert from Brooklyn Bedding, tells Bustle. “Just as important, don’t take a nap late in the day as that will disrupt your normal sleep cycle, leading to insomnia at night.”

3. Going To Bed Super Early

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While it might be tempting to pass out the moment the sun goes down, try to stay awake as long as possible, or until your usual bedtime.

“Going to bed too early […] can result in what is essentially a long nap late in the evening,” Dr. Darley says, “which then causes the inability to sleep through the night.”

Do this, and you’ll likely wake up at 3 a.m., and be just as tired the next day.

4. Staying Inside

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When you’re tired, you might want to hide away from the blinding light of the sun. But stepping out can actually be a good thing.

“Get outside in bright sunlight for 20 minutes soon after getting up, then continue with light bursts of 10 minutes every couple hours,” Dr. Darley says. “Full spectrum light naturally increases alertness.” And that can help get you through the day.

5. Doing A Strenuous Workout

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“It might seem like a good idea to burn off energy in order to get a restful sleep, but working out later in the day can cause cortisol to spike which can prevent some people from being able to fall asleep,” health coach Rachel MacPherson tells Bustle. Instead, do your workout in the morning. Or skip it entirely until you’ve caught up on sleep.

6. Snacking To Stay Awake

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Fatigue can make you feel hungrier than normal, and lead to cravings for simple carbohydrates. And while that’s fine, keep in mind that eating sugary snacks can crash your blood sugar, and make you feel even worse. Instead, “eat a healthy balanced diet so your blood sugar levels remain steady,” Dr. Darley says.

7. Drinking A Night Cap

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A night cap may seem like a good idea, if you want to fall asleep faster. But if you want that deep sleep, you may want to stick with water.

“Alcohol interferes with your deep sleep cycles and REM cycles,” Jason Piper, a sleep and nutrition coach, tells Bustle. “These are the restorative phases we go through at night. Alcohol keeps you mainly in a light sleep phase.”

8. Cramming For A Test

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If you have a big test tomorrow, and plan to stay up all night studying, it may be smarter to just go to bed. “You may feel like you are making progress, but when you finally go to sleep and it is a short duration, you will miss out on a lot of your REM sleep,” Piper says. “REM sleep is when the brain moves short-term memories into long-term memory, so a lot of what you were studying becomes lost.”

9. Sleeping In

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Just like going to bed early, sleeping in always seems like a good idea in the moment. And yet, “it can shift [your] circadian rhythm for the day, making it harder to fall asleep at night,” Piper says.

Basically, sleeping in — even for just one hour past your usual wake time — throws off the timing of the sleep hormone, melatonin. It’s best to stick to your normal sleep and wake times, to help your body get back on track.

10. Eating Right Before Bed

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While it’s OK to have a light snack before bed, keep in mind that eating a big meal can make for a rough night.

“Your body needs to digest the food,” Piper says. “So it will raise your internal core [temperature] as it metabolizes the food and also will divert energy away from sleep to digesting the food.”

With all that going on, it’ll be hard for the body to slip into a deeper, more restorative sleep cycle, Piper says, and you’ll feel even more tired come morning.

11. Checking The Clock

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If you ever find yourself in bed, tired, and yet unable to fall asleep, do yourself a favor and avoid staring at the clock. Or worse, wondering when (or if) you’ll ever fall asleep.

“Doing this isn’t going to change anything,” Dr. Issa says. “In fact, it will only make you feel more anxious which will increase your physiological arousal and make it harder to fall asleep.”

12. Relaxing With Your Phone

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However tempting it may be, don’t lay in bed and scroll through you phone, as the “blue light from it will interfere with your ability to fall asleep,” Dr. Issa says. If you want to fall asleep easily, and wake feeling rested, avoiding electronics before bed will be key.

13. Willing Yourself To Sleep

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Have you ever had that moment where, despite how tired you feel, you just can’t fall asleep? When that happens, it’s actually best to get out of bed, instead of lying there wishing for sleep.

“Doing that will probably come with a lot of other thoughts about your lack of sleep,” Dr. Issa says, including anxiety about how tired you’ll feel the next day.

“Instead, get out of bed and take a break,” she says. “Get up and go in a different room until you start to naturally feel tired. Then go back into your bed.”

14. Making Important Decisions

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If a big decision can wait, do yourself a favor and wait. “Whether financial, relationship, or anything important, you would be much better off making that decision in the morning when your mind and body are fully rested,” Bill Fish, certified sleep science coach and co-founder of Tuck, tells Bustle. When you’re fatigued, you just won’t have the capacity to think clearly.

15. Soaking In A Hot Bath

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In order to fall asleep quickly, it may be a good idea to avoid warm showers and baths right before bed, and instead opt for a quick (and cool) rinse.

According to MacPherson, since your core body temperature drops at night in preparation for sleep, taking a hot bath can disrupt that cycle, increase your heart rate, and make it difficult to sleep.

Even though it often seems like a good idea, doing these things when you’re tired tends to be anything but helpful. The best and only way to feel less fatigued is to get a good night’s sleep, which includes sticking to a bedtime routine, and getting the right amount of rest every day.

The 11 Best Dog Breeds For People Who Don’t Get Deep Sleep

In news that surprises no one, the Centers for Disease Control and Prevention says a third of us don’t get enough sleep. It’s easy to see why: We work too much, stress too much, and the final season of Game of Thrones has us all on edge (bend the knee!). If you’re having to endure too many sleepless nights, keep reading for the 11 best dog breeds for people who don’t get deep sleep.

I never would have thought that a dog could help you sleep better, considering my own pup’s gas issue that can wake me up from the most peaceful slumber. They’re bed hogs, they bark at every noise (or, you know, nothing at all), and at 5 a.m., they are wide awake and ready to play with their favorite squeaky toy.

It might not be that simple, though. One study published in Anthrozoös found that dogs make better cuddle buddies, compared to cats and even humans. Further research published in Mayo Clinic Proceedings said that 41% of pet owners polled find that their furry friend doesn’t hurt their sleep, and even sometimes benefits it.

All of this is to say that if you’re struggling with a lack of deep sleep, a pupper might be the perfect next step. Here are 11 breeds to consider.

1. Bernese Mountain Dog

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The American Kennel Club lists this as one of the calmest dog breeds. They’re also large and incredibly floofy, leading me to believe they make ideal cuddle buddies. Originally bred to drive dairy cattle (moo) and be loyal companions to their farmer friends, they’re gentle and easygoing.

2. Boxer

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Boxers are that kind of dog that forget how enormous they are. Although they do indeed have energy and love to be silly and playful, Rover says they also want to be close to their owners 24/7. They’re true guardians, grow very close to their family, and want nothing more than to be your little spoon.

3. Newfoundland

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Newfoundlands might be the perfect dog to help you get your beauty sleep. Dogtimenotes that not only are they generally quiet doggos, but they’re also known for their sweet disposition. Look at that face and tell me you wouldn’t love to snuggle with that fluffball at night. Go on.

4. Great Dane

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Yes, they grow to be the size of small horses, but according to Bark Post, great danes are also some of the most affectionate dogs. They’re excellent companions, full of unconditional love, and will be perfectly content having Netflix marathons with you at night.

5. Golden Retriever

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Can we please talk about how perfect golden retrievers are in every single way? This might be an especially perfect breed for you if it’s anxiety keeping you up at night, according to K9 of Mine. Plus, as the United Kennel Club says, they’re friendly, calm, they get along with most people and dogs, and they’re eager to learn — meaning they’re typically fairly easy to train.

6. Cavalier King Charles Spaniel

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These puppers are the best of both worlds. They have just enough energy to go for a walk or play at the park, but as Rover says, they’re also very calm and simply love to be your companion. They’re outgoing and even pretty chill around strangers, so just don’t expect them to be your guard dog.

7. Basenji

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Dogtime describes this breed as “barkless.” They’re typically friendly, straightforward to train, and can adapt to almost any environment. If sleeping problems are bugging you and you want a companion to help you relax at night, a basenji might be a great fit.

8. Corgi

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Imagine waking up to that beautiful face every morning. K9 of Mine reminds us that they do have a good deal of energy, but they’re also affectionate, devoted, friendly, smart, easy to train, and therapeutic. A corgi friend will be certain you get the sleep you need.

9. Collie

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If you don’t mind having zero personal space, a collie is perfect for you. Bark Postsays this breed is all about giving you affection and unconditional love. They might be a bit of a blanket hog, but really, collies just want to give you all the snuggles at night.

10. Bulldog

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You’ve never met a bigger pile of love than the bulldog. American Kennel Club points out how calm and easygoing they are, and they tend to form strong bonds with kids, too. Clearly, a bulldog would make your nights so much more restful.

11. Shih Tzu

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iHeartDogs says that shih tzus love to sleep, so maybe some of that will rub off on you. To make things even better, they’re hypoallergenic and quite the smarty-pants.

5 Habits That Make You More Likely To Dream At Night

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Some people remember their dreams more than others, as you’ll well know if you have that one friend who wants to tell you about her dreams without realizing that they’re boring to anyone besides herself. (Or, if you are that friend.) But, there are some habits that could make you more likely to dream and more likely to remember your dreams. The thing is, some of the habits that could cause you to rememberdreams more often don’t really promote a good night’s sleep and won’t necessarily cause more dreams.

Basically, there’s a difference between dreaming because you sprayed around some lavender essential oil and chose to go to bed with a book rather than a laptop, and remembering a dream because you ate too much queso dip and aren’t sleeping as well as you could be. So many things you do during the day can affect your sleep (Did you exercise too late? Did you take a nap? Drink too much caffeine?), and in turn, these factors can have an effect on dreaming.

Here are some common habits that can make you more likely to remember your dreams or to actually dream more. Before you eat a giant cheese plate at 11 p.m. to try to have otherworldly dreams, you’ll want to take a few things into account and maybe just try taking a bath instead.

Eating Foods That Upset Your Stomach

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One of the foods most commonly thought to cause more dreaming — particularly bad dreams — is cheese. But it seems likely that eating cheese before bed isn’t causing the dreams, but rather causing people or remember their dreams.

According to Psychology Todaya study showed that of people who believe certain foods affect their dreams, many attributed it to dairy or to spicy foods. While the site points out that this could be because of the foods themselves (“due to general effects of food on mood and cognition”, as is the case while awake, too), it could also be that the foods are “influenc[ing] dreams indirectly due to poor metabolism or digestive intolerances.”

Sleep.org similarly explains, “certain foods can upset your body and wake you up throughout the night, helping you remember your vivid dreams more.”

Eating Late At Night

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As with eating certain foods, eating late at night can also affect metabolism and the state of one’s stomach, which could cause more waking in the middle of the night.

“Dining on a big meal just before turning in for the night boosts your body’s temperature and metabolism — two consequences that result in more brain activity during the REM stage (a.k.a. when you dream),” Sleep.org explains.

Drinking Alcohol Before Bed

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According to Cleveland Clinic, Jessica Vensel-Rundo, MD says drinking alcohol before bed “creates more fragmented sleep.” She explained, “There’s more disruption. Deep sleep decreases during the second half, and REM, or dreaming, sleep increases.” It could also lead to more vivid dreams or nightmares, and an increased risk of sleepwalking or acting out dreams.

That said, having vivid or bad dreams after drinking alcohol isn’t really desirable. In this case, yes, you are dreaming, but not exactly due to sleeping well.

Lacking Sleep

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In 2007, Scientific American published an article called “Strange but True: Less Sleep Means More Dreams,” which explains “REM rebound.” This is a phenomenon in which a lack of sleep one night will lead to increased time in REM during the next appropriately lengthy sleep. Neurologist Mark Mahowald explained, “When someone is sleep deprived we see greater sleep intensity, meaning greater brain activity during sleep; dreaming is definitely increased and likely more vivid.”

Doing Things To Help You Sleep Well In General

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If rebounding from a bad night of sleep leads to more time in REM and more dreams, then it also makes sense that just sleeping well overall can lead to better sleeps with more time to dream. According to HuffPost, Dr. Shalini Paruthi, the director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children’s Hospital, said that getting a good night of sleep is “the most important thing” one can do to dream.

As HuffPost explains, achieving this includes all the classics, like sleeping in a dark room with a cool temperature, reading a book, taking a bath, meditating, not exercising too late in the day, and not eating too much too close to bedtime. (This is in contrast to the items about food above. In those cases the food caused remembering the dreams, more than actually contributing to better sleep and more time to dream.)

Maybe recognizing whether you have some of these habits will come in handy, whether you want to stop remembering bad dreams or want to sleep more peacefully.

The Powerful Link Between Insomnia and Depression

Author Article

When one has difficulty sleeping, the waking world seems opaque. On top of feeling tired and fatigued, those who experience sleep disturbances can be irritable and have difficulty concentrating. When one has more severe cases of insomnia, one also faces a higher risk of developing heart disease, chronic pain, hypertension, and respiratory disorders. It can also cause some to gain weight.

Sleep disruptions can also have a major impact on one’s emotional well-being. A growing body of research has found that sleep disturbances and depression have an extremely high rate of concurrence, and many researchers are convinced that the two are biconditional—meaning that one can give rise to the other, and vice-versa. A paper that was published in Dialogues in Clinical Neuroscience concluded, “The link between the two is so fundamental that some researchers have suggested that a diagnosis of depression in the absence of sleep complaints should be made with caution.” The paper’s lead author, David Nutt—the Edmond J. Safra Chair in Neuropsychopharmacology at Imperial College London—found that 83 percent of depressed patients experienced some form of insomnia, which was more than double the amount (36 percent) of those without depression.

Bei Bei, Dpsych, PhD, from the Monash School of Psychological Sciences in Clayton, Australia, said the inverse was true, as well: “If a person does not currently have depression but goes through extended periods of time with sleep disturbances or insomnia, the sleep disturbances can potentially contribute to a mood disturbance or to even more severe depression.”

The Mechanisms Behind the Two Diseases

The sleep-wake cycle is regulated by what is known as the circadian process. When working properly, the circadian process operates in rhythm with the typical cycle of a day. One gets tired as the light of the day fades and the body prepares for sleep. One awakes as it becomes light again. The internal mechanisms behind the circadian cycle involve a complex orchestration of the neurochemical and the nuerophysiological presided over by the hypothalamus.

Depression, meanwhile, is a medical condition and a mood disorder. While there are several possible antecedents to depression, as genetic and environmental factors can lead to a depressive episode, the neurophysiological causes of depression pertain to a deficiency of chemicals in the brain that regulate mood: serotonin, dopamine, and norepinephrine.

However, these neurotransmitters do far more than just regulate mood. They have also been found to be integral to sleep efficiency. Disruptions in these brain chemicals can lead to disturbances in sleep, particularly REMsleep, and can also lead to more restlessness during typical times when one should be in bed. This can create a vicious cycle wherein the more severe one’s depression becomes, the more severe one’s insomnia becomes. The inverse can also true: The more severe one’s insomnia becomes, the more severe one’s depression becomes.

Evaluation and Treatment

Because these concurrent afflictions reinforce one another, medical professionals need to address both simultaneously for optimal treatment. However, there is not one cookie-cutter response that can eliminate both depression and insomnia. Many variables, including improper medication, can contribute to insomnia and different symptoms indicate different causes, which is why it is important to provide your mental health professional with any information that can give them with more insight about your condition. Describing your symptoms to your doctor allows them to narrow down the list of likely culprits and prescribe medications with greater precision. For example, letting your doctor know that you wake up in the middle of the night, and then have difficulties falling back to sleep is a distinct symptom from having difficulties falling asleep in the first place.

Though depression and insomnia are commonly linked, they can be independent of one another. Then again, they may be part of a larger array of comorbid disorders that require specific treatment plans to resolve. To determine the best course of action, your doctor may recommend a sleep study, medication, or a behavioral therapy.

Sleep Study

A sleep study is a test that measures how much and how well you sleep. During this test, you will be monitored by a team of sleep specialists who will be able to determine if there are any other disorders, such as restless leg syndrome or sleep apnea, that may be causing your insomnia. Even if the study does not reveal a definitive culprit, the sleep study will also allow your doctor to get a better picture about what is behind your insomnia.

Medication

Sleeping pills may help you fall asleep, but they are not long-term solutions to mental health. If you are suffering from a bout of insomnia that is related to a psychiatric disorder, you need to address that disorder to address your insomnia. Oftentimes, this will require a treatment plan that includes a pharmaceutical component. This component will be unique to each patient, as there is not a one-size-fits-all regimen of medication for optimal mental health. Furthermore, there are numerous comorbidities with depression, such as anxiety, that may be contributing to your insomnia and that may not be resolved by certain types of anti-depressants alone.

Another potential treatment involves a combination of medication, light treatment, and melatonin, a hormone that helps regulate the circadian process. The conditions of patients who receive light therapy in conjunction with antidepressant therapy tend to show more improvement than those who are prescribed antidepressants alone. This is true for patients with seasonal and nonseasonal depression.

Cognitive Behavioral Therapy for Insomnia

In other cases, some mental health professionals may recommend you see a sleep specialist to receive cognitive behavioral therapy for insomnia. Cognitive behavioral therapy for insomnia (CBTI) involves numerous non-drug techniques to induce sleep and it can be utilized before resorting to the use of pharmacological sleep aids with surprisingly good results.

Several studies have shown CBTI to be quite effective in treating insomnia and some forms of depression. A paper published in the Journal of Clinical Sleep Medicine in 2006 concluded that “The benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidalideation, among patients with baseline elevations.” A paper published in the International Review of Psychiatry in 2014 found that CBTI may help with other comorbidities beyond depression. These include anxiety, PTSD, and substance abuse issues.

The National Sleep Foundation notes that this type of therapy can still be quite intensive. CBTI requires regular visits to a clinician for assessment, keeping a sleep diary, and, perhaps most importantly, the changing of behaviors that may be felt as though they are firmly part of one’s routine. CBTI may also include some sleep hygiene education, where patients learn how different settings and actions can inhibit or promote sleep. It may also rely on relaxation training, where patients learn methods of calming their bodies and minds.

Concluding Thoughts

If you are struggling with either depression, insomnia, or both, treatments are available. The above studies demonstrate that there are holistic approaches, as well as pharmaceutical remedies, that can help induce sleep without the aid of sleeping pills. It is also a reminder that the most effective treatment plans are tailored to both the individual patient and the patient’s concurrent illnesses.

LinkedIn Image Credit: Kleber Cordeiro/Shutterstock

Can’t Fall Asleep? How To Create The Perfect Sleep Environment

Author Article

Canadians are not getting enough sleep — and we really need it.

“We are a chronically sleep-deprived society,” Alanna McGinn, the owner of Good Night Sleep Site, told Global News. “It really is a growing concern.”

Data shows that about one in four Canadians are dissatisfied with the quality of their sleep, and an even greater proportion of us have problems getting to bed.

According to a recent government report, 43 per cent of men and 55 per cent of women between the ages of 18 and 64 say they have trouble going to sleep or staying asleep sometimes, most, or all of the time. Experts say that stress, technology use and not going to bed early enough, are all playing a role.

READ MORE: Sleep deprived? What missing too much sleep might be doing to your body

This lack of sleep has serious consequences on our well-being, as sleep deprivation is associated with heart disease, diabetes and depression.

So what helps us hit the hay? Here, sleep experts share their tips on how to create a positive sleep environment that will foster quality rest.

Turn off technology

Many of us like to “unwind” by watching TV before bed, or have a tendency to stream shows on our laptops while tucked in.

But according to Dr. Reut Gruber, a sleep researcher and associate professor in the department of psychiatry at McGill University, using gadgets before bedtime is hurting us.

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Gruber said that devices like laptops and phones put us in a state of “hyper-arousal,” which makes it hard for our bodies to prepare for sleep. Checking our emails before bed is a bad idea, too, as this may increase our anxiety — which is also a sleep killer.

Then there’s the light that devices omit.

“The light from our devices is really harmful,” said Beth Wyatt, a GTA-based insomnia coach. “Staring at those devices all day and all night is really not helpful in transitioning into a peaceful slumber.”

READ MORE: How to wake up early without hating your alarm clock

Research shows that light affects our internal clocks (or circadian rhythm), as exposure to light may suppress the production of melatonin — a hormone that helps us sleep.

To combat this, experts say it’s important to avoid bringing devices into the bedroom. If you use your phone as your alarm, keep it on silent and face down so no alerts can wake you.

Fabrics matter

Our body temperatures can affect how well we sleep, Gruber said, and running too hot in the night may wake us.

McGinn said that cotton bedding or other breathable fabrics are best for sleeping, as microfibers — like fleece or plush — keep heat in.

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What you wear to bed can also play a role in how well you sleep.

McGinn said pyjama styles are a personal choice, and knowing how hot or cold you get in the night can help you pick out the right pair.

“If you’re a person who tends to sleep hot, you really want to focus on natural fibres that are going to help with perspiration,” McGinn said.

“A lot of people think if they’re hot, it’s better to sleep in nothing, but what tends to happen is they end up sweating into their sheets and being in wetness — which isn’t comfortable.”

READ MORE: Super Awesome Science Show — Disturbed sleep

Dark, cool and quiet

The spring and summer months bring more hours of light — which is great for waking up but not so great for falling asleep.

Experts say your bedroom should be cool and dark, as both help promote rest.

“When you turn out the lights and cover the windows at night, it should be pitch black,” Wyatt said. “Even the smallest light can affect our sleep.”

She suggests black-out curtains and adjustable lighting. “Choose light bulbs that have a soft, warm glow to them instead of bright, fluorescent blue,” she added.

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If you’re someone who is bothered by noise, you may want to try a white noise machine, McGinn said. Or, in the warmer months, running a fan to help regulate temperature and noise.

“I find mornings are a lot louder in the spring and summer — birds are louder and chattier — so fans will help drown out those external sounds,” she explained.

Keep your bedroom clean

A cluttered room is not a sleep-positive room, experts say.

Gruber said your room should be “clear of anything that’s stimulating.” Research shows that clutter and mess can cause stress, and stress can hinder sleep.

READ MORE: Waking up early — are there benefits to being a morning person?

“An uncluttered, clean space is key,” Wyatt said. “When you’re looking out from your bed at all the things you need to get rid of, it’s not helpful.”

McGinn said it’s also important to keep our bedroom spaces for sleeping and sex only. The goal, she said, is to create a “sleep sanctuary” that promotes rest — not work.

“Our bedrooms can become our home office, our entertainment centre, our kids’ playroom … and we really want to work on strengthening that positive association between sleep and our bed,” McGinn said.

WATCH BELOW: Excessive sleep, lack of sleep can lead to cognitive impairment: study

Keep a sleep schedule

Going to bed at the same time and waking up at the same time fosters quality sleep, McGinn said.

Getting the right quantity of sleep — which is typically between seven to eight hours — is also key. “We really should be basing our bedtime off of our wake time, because when we wake in the morning is really dictated by our lifestyles,” McGinn said.

READ MORE: Why a regular bedtime is good for your health

This is especially important in the summer, McGinn said, as we often stay up later and get less sleep when the sun is out longer. “We all tend to go into the fall really sleep deprived.”

“Following consistently sleep patterns during the summer months can really help us start the new fall year better rested.”

Laura.Hensley@globalnews.ca

Getting A Good Night’s Sleep Doesn’t Have To Be A Distant dream

Author Article

Phoebe Smith calls herself an extreme sleep adventurer. She’s been enlisted by a sleeptime app to be a storyteller for the sleep app calm.com. CALGARY

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A good night’s sleep is something we all cherish, but in our 24/7 plugged-in world, slumber can be as elusive as winning the lottery.

Millions of Canadians who settle into bed have a tough time staying in dreamland bliss.

If we were thinking outside the box spring, perhaps the remedy to staying asleep is doing what Phoebe Smith does. She’s a travel writer and self-described “extreme sleep adventurer.”

“I sleep much better when I’m in the wilds, more than in my own bed,” says Smith, who has slept inside a glacier, suspended in a hammock in a tree, and on mountaintops.

Phoebe Smith says she sleeps better in nature than at home in bed. She’s been enlisted by a sleeptime app to be as a sleepteller. ADAM PLOWDEN /CALGARY

Her stories of sleeping in exotic places, such as on the Trans-Siberian Railway train, so captivated Michael Acton Smith, co-founder of the sleep app calm.com, that he asked her to be the app’s Sleep Storyteller in Residence. The 17-and-counting stories she has written are read by the soothing voices of such celebrities as author Stephen Fry and  have been listened to millions of times. Other stories found on the app are read by famous names such as actor Matthew McConaughey and British singer-songwriter Leona Lewis.

Smith, like all of us, has moments of insomnia when she’s not on the road.

“When you’re back in your bed, you’re worried about paying bills … that phone call, those emails … for work. But in the wilds, everything is put in perspective.”

Sleeping in nature untethered to tech is not something most Canadians can do on a regular basis. Clinically significant insomnia, a disorder requiring medical help, affects about six to 10 per cent of Canadians, says Dr. Charles Samuels, medical director of the Centre for Sleep & Human Performance in Calgary.

But a larger proportion of the Canadian population — around 30 per cent — struggle to either fall sleep or stay asleep. One of the causes, says Samuels, is our addiction to technology, a significant issue for teenagers.

He predicts the problem will persist.

“It’s going to keep me in business until I’m dead,” says Samuels. “This is a serious thing that people don’t really acknowledge as serious.”

Late night computer and cellphone use is leading to widespread sleep disruption and insomnia. And it’s not just among teens. TERO VESALAINEN / GETTY IMAGES/ISTOCKPHOTO

Samuels and his team see teenagers daily with severe anxiety causing insomnia. “That is exacerbated by their attachment to technology. The fascinating thing is that when you confront them, they sort of say ‘What’s the big deal?’ ”

Many have “terrible behaviours,” like sleeping with phones under their pillow, alerts buzzing all night long. Phones expose them to light, but it is the constant interaction that is more “devastating,” in his view.

Samuels has done years of sleep research for several organizations, including law enforcement and elite athletes.  Educating people about the negative impact of technology can be a big learning curve, he says.

Insomniacs often go to bed earlier and earlier because of fatigue. But that only makes them more anxious because they just lay there, fueling the insomnia. To change the behaviour, Samuels says, people actually need to go to bed later and later.

“Once they do it, within seven days they improve. It’s counterintuitive. It’s about improving sleep efficiency.”

Although technology is a cause of sleeplessness, it also has a role in treatment. Many people use trackers which claim to determine the amount of REM sleep achieved. Although Samuels’ clinic uses evidence-based trackers customized to each patient, he’s a skeptic of commercial models.

“These trackers are based on technology that uses movement to articulate sleep stage, but it has not been validated.”

They can be counterproductive. If a tracker indicates you only got four hours of sleep, it can cause more sleep anxiety. Other trackers feed information into an application and offer advice about how to improve sleep.

“If it’s helping a person, (then) fantastic,” Samuels says. “If not, (then) they really need to be seen by a sleep physician to be evaluated or their primary care doctor.”

He says Sleep IO and Shut-Eye are two commercial brands that have been studied and proven to be equally, if not more, effective than one-on-one treatments.

Bear in mind, he says, the foundation of treating insomnia is through behavioural therapy. It addresses the hyper-arousal afflicting people with insomnia — the inability to unwind, which some people are genetically predisposed to.

But what about sleep apps with dreamy stories, meditations and music, like calm.com or Headspace? Samuels says if it works for you, “Hallelujah, off you go.

“But that doesn’t mean it’s a pill for your insomnia. It just means you can relax and maybe that will improve your sleep. If you’re relaxing and still adopting poor sleep behaviours, it’s not going to work.”

Woman lying in bed suffering from insomnia. Getty Images/iStockphoto KATARZYNABIALASIEWICZ /GETTY IMAGES/ISTOCKPHOTO

The process of mindfulness — the practise of being in the present moment through meditation — is also gaining proponents among doctors, used to help insomnia and other illnesses.

Dr. Nikhil Joshi, a physician, author and speaker, has developed an app called Medical Meditation, a guided series for a variety of conditions, including insomnia. It will be available in April.

Mindfulness is the idea that the brain is very active and always producing rational thoughts. “We have to slow down the part of the mind that is creating active thought. We need to evoke a change in our brainwaves to get a more restful sleep,” says Joshi, a Calgary-based doctor.

“Meditation is about preparing your mind for a deeper rest, activating a different part of the brain that is usually active in our day to day life.”

The irony that we’re using technology to treat insomnia isn’t lost on Joshi. “We … have to recognize that the improper use of technology can lead to emotional issues. But proper use of technology can help solve those issues. It’s a double-edged sword.”

Samuels says bedtime rituals are also important.

“The idea people have in their heads is, ‘I should just be able to fall asleep.’ No. That’s not the way the brain works.”

Obviously, it also means getting off tech.

“I tell people to put it away at 5 o’clock,” he says. “Of course, people are appalled.”

7 Things Your Dreams Can Tell You About Your Sleep Quality

Author ArticleDepending on how well you slept, you might be more likely to have certain types of dreams than others. Whether you had a vivid dream, and woke up remembering every bizarre detail, or sat up in bed sweating after a nightmare, it can all help reveal the quality of your sleep. And possibly even various other disorders and underlying issues.

While not all dreams types are created equal, they share the same characteristics. “Dreams are a collection of involuntary thoughts, visual images, and emotional responses that occur during sleep,” Rose MacDowell, chief research officer at Sleepopolis, tells Bustle. “Dreams usually happen three to five times each night during REM sleep.”

During a typical night, you’re likely to go through four different stages of sleep, with each cycle lasting about 90 minutes. “REM is the last stage of a sleep cycle, preceded by stage one (light sleep), stage two (when both the heart rate and body temperature decrease), and stages three and four (grouped together and often referred to as slow-wave sleep, or SWS),” dream expert Stephanie Gailing, MS, tells Bustle.

Depending on things like your physical health, mental health, and even how deeply you’re sleeping, you might be more likely to have certain types of dreams, than others. And knowing what to look for can be one way to figure out a little bit more about your sleeping self.

Read on below for the various types of dreams, as well as what the experts say they might reveal about your overall quality of your sleep.

1. You Don’t Dream At All

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While it can be difficult to remember dreams once you wake up, if it feels like you rarely dream at all, it could point to a disorder that causes restless sleep, known as sleep apnea.

“This is because sleep apnea tends to be worse during REM sleep (the stage in which we have the most vivid dreams) so this stage of sleep becomes very disrupted with frequent awakenings, thereby preventing dreaming,” Dr. Sujay Kansagra, Mattress Firm’s sleep health expert, tells Bustle.

Again, you might be someone who can’t recall their dreams, even though you did have them. But if your dreamlessness is accompanied by other signs of sleep apnea, such as loud snoring or waking up tired, it may require a closer look.

2. You Dream As Soon As You Fall Asleep

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Dreaming the moment you fall asleep could, in some cases, be a sign of a disorder called narcolepsy. “Narcolepsy sufferers fall directly into REM sleep, normally the fourth stage of sleep, and may spend more time experiencing vivid dreams,” MacDowell says.

If you tend to wake up after a dream, even though you’ve only just gone to sleep, this may explain why — especially if you have other signs of narcolepsy, such as persistent daytime sleepiness.

3. You Have Extremely Vivid Dreams

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Vivid or bizarre dreams — including the kind that stick in your mind long after you’ve woken up — are common among creative people and those who meditate right before bed, MacDowell says. And they can also occur when you have a fever.

As MacDowell says, “Elevated body temperature can cause neurotransmitters in the brain to transmit information at a faster rate, causing vivid dreams or even hallucinations.”

But because vivid dreams can also trigger startling or negative emotions, MacDowell says they may indicate you didn’t sleep as well as you thought.

4. You Lucid Dream

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Have you ever been asleep and dreaming, but still somehow in control of your thoughts? This is known as lucid dreaming, and it can be a sign you’re under a lot of stress — and thus probably not sleeping very well.

“In lucid dreams, consciousness and dreaming overlap, creating a sense of awareness during sleep,” MacDowell says. “Lucid dreaming appears to happen during transitions from one stage of sleep to another, or from REM sleep to waking up. Lucid dreams are associated with high levels of activity in the brain, which can sometimes result from stress or anxiety.”

If you keep having lucid dreams, let a doctor know. They might want to suggest ways to help you cope with excess stress and anxiety, so you can get better sleep.

5. You Experience Nightmares

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If you have frequent nightmares, MacDowell says there’s a good chance you aren’t sleeping well, since these types of dreams tend to cause sudden waking. But they can also be a sign of a deeper issue.

“Nightmares are experienced by 80 percent of post-traumatic stress disorder sufferers, and may be an indicator of psychological trauma,” MacDowell says. “Anxiety and depression are two common causes of nightmares, which can also be an early sign of mood disorders like schizophrenia or bipolar disorder.”

If you experience nightmares on a regular basis, let a doctor know so they can address the underlying cause.

6. You Have Recurring Dreams

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Recurring dreams are also associated with an unresolved emotional issue or trauma, MacDowell says. And unfortunately, that can impair your ability to sleep.

“Recurring dreams don’t always indicate poor quality sleep, but may if they result from an emotional disturbance or trauma that causes frequent awakening or stress,” she says.

For issues you’ve yet to overcome, therapy can help you learn how to address them, in a comfortable environment. You might find that processing through these emotions leads to better sleep.

7. You Have Multiple Dreams

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If you have more than one dream per night, it could be a sign you went through multiple sleep cycles, and woke up momentarily after each one — which is when you’re the most likely to remember what they were all about.

And yet, since REM is a part of each sleep cycle, Gailing says it’s possible to have multiple dreams per night, even if you don’t remember them.

Again, everyone is different when it comes to the types of dreams they have. And just because you experience these dreams doesn’t necessarily mean there’s a problem.

If you’re concerned, you can let a doctor know about things like nightmares, recurring dreams, or a total lack of dreams. But as long as you wake up feeling refreshed, you might want to consider your dreams just another — somewhat mysterious — part of life.

Editor’s Note: If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.