Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


There probably are thousands of articles and books about sleeping, insomnia and various other variations of sleep. It has been estimated that about 30 million people have some kind of sleeping problem. What is normal? Well, from 6 to 9 hours has been quoted. But more important is how one feels -- rested or alert or not. Many tips have been given and I am including but a few at this time and without mentioning any specific medications.

It's helpful to have a routine -- go to a comfortable bed at about the same time each night. Reserve the bed for sleep and sex. The use of TV is arguable -- some find it boring and helpful to initiate sleep. Others find it counterproductive and especially if an exciting movie or event keeps them awake Some more specific thoughts follow.

*The timing of fluid intake may be important. Sometimes it is helpful to curtail fluids after a certain time -- for example, 5 or 6 p.m. This may help reduce the necessity to urinate at night and the sometimes troublesome effort to regain sleep. It is also true that some health problems cause one to get up at night : a man may have a difficult prostate problem, or diabetes or some other health problem for example. Any medical problem causing discomfort may interfere with sleep and this should be corrected.

*Maintaining good health is important with proper exercise several times a week, weight control, avoidance of nicotine in all forms and also by avoiding excessive alcohol intake.

*Caffeine use is very important. It occurs in number of forms: about 80 to 90 mgm in a cup of coffee and about half that in a cup of tea. Cola and chocolate also have caffeine. Once in a while an individual may be exquisitely sensitive to caffeine and even one cup of coffee in the morning may disturb sleep that night. The best way to find out is to eliminate all forms of caffeine for a couple of weeks to see if one's sleeping pattern improves.

*Alcohol may also be crucial. In this situation an individual sometimes will go to sleep easily and then awaken in the middle of the night and find it difficult to resume sleep. Again it may be helpful to totally abstain from alcohol for couple of weeks to see if a change occurs in the sleeping pattern.

Some suggest reading for awhile if one awakens at night - while others do not. The same may be said about watching TV. I suppose there is considerable variability in an individual's response. There's also a difference of opinion about the afternoon nap - some are for it and some experts are against it. I would think that if an individual has an afternoon nap and then cannot sleep well at night that it would be worthwhile to avoid an afternoon nap for a while in order to see if it has any effect on the night sleeping pattern.

If difficult sleeping is chronic then it is worthwhile to see your physician in case there is a medical problem(e.g., sleep apnea) as the root cause. Among many medical problems that occur depression can be one. At times it is a medication that disturbs one's sleep pattern. In any event is worthwhile to be evaluated. Also it is worth seeing your doctor before taking any medication and listening to his advice.

For further information it may be worthwhile to contact the National Center on Sleep Disorders Research in Bethesda ,Md., or the National Sleep Foundation in Washington D.C.

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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