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Sadness
Depressed
Short term memory loss
Mood swings
Memory loss
Clumsy
Forgetfulness
Short temper
Feeling dizzy when lying down and closing eyes
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Sleep deprivation occurs when the quantity or quality of sleep is insufficient, often due to medical conditions, psychological factors, or lifestyle changes such as shift work or jet lag, thereby impacting ability to function when awake. Narcolepsy is characterized by excessive daytime sleepiness, which is also a common symptom of chronic sleep deprivation, making accurate diagnosis and tailored treatment essential to address both conditions effectively.
Your doctor may ask these questions to check for this disease:
The best solution is getting enough sleep. Sleep hygiene techniques might help, such as having a dark, quiet room, enough daily physical activity, and using the bed only for sleeping. Occasionally, supplements or medications might be needed to restore a healthy sleep cycle. If symptoms persist, schedule an appointment with a sleep specialist.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Yu Shirai, MD (Psychiatry)
Dr. Shirai works at the Yotsuya Yui Clinic for mental health treatment for English and Portuguese-speaking patients. He treats a wide range of patients from neurodevelopmental disorders to dementia in children and participates in knowledge sharing through the Diversity Clinic.
Content updated on Aug 5, 2025
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Q.
Always Tired? Why Your Brain Lacks Dopamine & Medically Approved Steps
A.
Persistent fatigue can reflect low dopamine activity that reduces motivation, focus, and movement, but it is usually intertwined with sleep loss, chronic stress, inadequate protein or iron and B vitamins, depression or ADHD, and medical issues such as anemia, thyroid or other hormonal disorders, sleep apnea, or Parkinson's. There are several factors to consider; see below to understand more. Medically supported steps include prioritizing high quality sleep, regular exercise, nutrient dense foods and correction of deficiencies, stress reduction, limiting overstimulating habits, and timely medical evaluation for treatable conditions or medications when appropriate, with urgent care for red flags; full guidance and specific next steps are detailed below.
References:
* Pardo, J. V., & Chaudhuri, A. (2019). The Role of Dopamine in the Regulation of Physical and Mental Fatigue. *Frontiers in Psychology*, *10*, 1787.
* Miller, A. H., & Raison, C. L. (2014). Dopamine and Reward Dysfunction in Chronic Fatigue Syndrome. *Psychosomatic Medicine*, *76*(6), 395-397.
* Chaudhuri, A., & Behan, P. O. (2012). Targeting dopamine pathways for the treatment of fatigue. *QJM: An International Journal of Medicine*, *105*(7), 639-646.
* El Koumi, M., Al-Hashel, J. Y., & Opara, R. A. (2020). Dopamine D2/D3 Agonists for the Treatment of Fatigue in Multiple Sclerosis: A Systematic Review. *Multiple Sclerosis and Related Disorders*, *45*, 102434.
* O'Connor, L., & Miller, A. H. (2011). Dopamine in the Regulation of Energy Homeostasis. *Cell Metabolism*, *13*(6), 598-601.
Q.
Stuck in "Brain Fog"? Why Diphenhydramine Drains Your Mind & Medically Approved Next Steps
A.
Diphenhydramine, a sedating first-generation antihistamine, can trigger brain fog by blocking acetylcholine, slowing thinking and memory, and increasing confusion and fall risk in older adults, nightly users, and those on other anticholinergic drugs. Medically supported next steps include switching to a non sedating antihistamine for allergies, avoiding it as a long-term sleep aid in favor of CBT-I and sleep hygiene, reviewing your full medication list, and knowing red flags and recovery timelines; there are several factors to consider, so see the complete details below.
References:
* Nishimura M, et al. Anticholinergic Burden and Cognition: A Systematic Review. J Am Geriatr Soc. 2019 Jun;67(6):1300-1307. doi: 10.1111/jgs.15858. Epub 2019 Apr 1. PMID: 30933390.
* Wong, J. S., & Wong, G. W. (2020). Over-the-Counter Sleep Aids in the Elderly: What Is Safe?. Drugs & Aging, 37(10), 711-719. doi: 10.1007/s40266-020-00788-5. PMID: 32808064.
* Ruiz S, et al. Anticholinergic drug burden and incident dementia in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2021 Mar;66:101235. doi: 10.1016/j.arr.2020.101235. Epub 2020 Dec 21. PMID: 33359146.
* Hajjar, E. R., Hanlon, J. T., & Sloane, P. D. (2009). Reversible Cognitive Impairment Caused by Anticholinergic Medications: A Systematic Review. Annals of Pharmacotherapy, 43(9), 1324-1335. doi: 10.1345/aph.1M098. PMID: 19690130.
* Rajan, S. D., et al. Defining and managing brain fog in older adults: An emerging clinical problem. J Gerontol A Biol Sci Med Sci. 2023 Jul 26:glad177. doi: 10.1093/gerona/glad177. Epub ahead of print. PMID: 37493215.
Q.
Wide Awake? Why Your Brain is Stuck on High & Medically Approved Next Steps
A.
Feeling wide awake at night is often due to hyperarousal keeping the brain on high, overriding your sleep drive and circadian rhythm, and it can stem from stress, depression, poor sleep habits, medical problems, medications, or other sleep disorders. Medically approved next steps center on CBT-I, optimizing sleep hygiene and relaxation to calm the nervous system, selective short-term medications when appropriate, and evaluation for conditions like sleep apnea, with several factors to consider, so see below for key details that can guide your personal next steps and when to seek urgent care.
References:
* Myers, B., & Sapey, E. (2021). The effects of chronic stress on the brain. *Annals of the New York Academy of Sciences*, *1488*(1), 5–18.
* Pace-Schott, E. F. (2013). The neurobiology of fear and stress in the context of sleep and its disorders. *Current Topics in Behavioral Neurosciences*, *14*, 141–172.
* Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. (2019). How effective are cognitive behavior therapies for anxiety disorders? A meta-analysis. *World Psychiatry*, *18*(2), 209–217.
* Garakani, A., Murrough, J. W., Freire, R. C., Phillips, K. A., Masand, P. S., & Mathew, S. J. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. *Frontiers in Psychiatry*, *11*, 592030.
* Feder, A., D'Aversa, L. P., Ravichandran, L., Yehuda, R., & Charney, D. S. (2019). Psychobiology and pharmacotherapy of resilience. *Molecular Psychiatry*, *24*(12), 1735–1748.
Q.
Wired But Tired? Why Your Cortisol Won’t Reset & Medically-Proven Fixes
A.
Feeling wired but tired usually points to a disrupted cortisol rhythm from chronic stress, sleep loss, late-day caffeine, blood sugar swings, overtraining, or sometimes medical conditions, which can make you exhausted by day and alert at night. Medically proven fixes include morning light, consistent sleep schedules, a calming evening routine, balanced meals, moderate caffeine, smart training, and mindfulness or CBT, with red flags like rapid weight gain, severe depression, or long-lasting insomnia needing a doctor’s review; there are several factors to consider, and the complete, step-by-step guidance is detailed below.
References:
* Chaves-Maciel, G., Morim, A. A., & de Carvalho, J. F. (2022). Cortisol awakening response and its associations with stress, sleep, and health in young adults: A systematic review and meta-analysis. *Psychoneuroendocrinology*, *142*, 105797.
* Guo, H., Deng, S., Zhang, S., Liu, C., Yang, J., Chen, Z., ... & Lin, Y. (2023). Impact of Mindfulness-Based Stress Reduction on Salivary Cortisol Diurnal Rhythm in Individuals With Chronic Stress: A Systematic Review and Meta-Analysis. *The Journal of Nervous and Mental Disease*, *211*(5), 416-427.
* Nishat, K., & Raison, C. L. (2018). Hypothalamic-Pituitary-Adrenal Axis Dysfunction and Stress System Pathology in Chronic Fatigue Syndrome. *Psychiatric Clinics*, *41*(2), 241-255.
* Miller, G. E., & Chen, E. (2021). Lifestyle interventions to improve the regulation of the hypothalamic-pituitary-adrenal axis. *Annals of the New York Academy of Sciences*, *1501*(1), 160-170.
* McEwen, B. S., Akil, H., & Nestler, E. J. (2020). Chronic Stress, HPA Axis Dysregulation, and Fatigue: Clinical Implications and Therapeutic Strategies. *Trends in Neurosciences*, *43*(9), 670-681.
Q.
12 Hours is Not Enough: Why Quantity Doesn't Equal Quality
A.
Sleep quality matters more than hours: even 12 hours can leave you exhausted if your sleep cycles are disrupted by sleep apnea or other breathing problems, restless legs, depression, chronic stress, poor sleep habits, or oversleeping. There are several factors to consider; see below to understand more, including practical fixes like a consistent schedule, a better sleep environment, light and caffeine timing, and when red flags such as loud snoring with gasping or severe daytime sleepiness mean you should see a doctor.
References:
* Liu Y, Wheaton AG, Chapman DP, et al. Sleep duration and quality: health consequences and intervention for quality improvement. Sleep Med. 2017;32:108-112.
* Patel P, Thaker D, Patel C, et al. Fatigue and Patient Safety in Healthcare: A Scoping Review. Cureus. 2023 Mar 15;15(3):e36195.
* Medic G, Wille M, Ehrmann L. The effect of sleep deprivation on cognitive performance. Neuropsychiatr Dis Treat. 2017;13:2623-2632.
* Harris R, Ciminelli P, Corrao S, et al. Impact of 12-hour shifts on nurse and patient outcomes: A systematic review. Int J Nurs Pract. 2021 Feb;27(1):e12891.
* Parikh S, Singh B, Singh M, et al. Sleep duration and quality and their association with health outcomes. Postgrad Med J. 2022 Sep;98(1163):702-707.
Q.
Blink and You Miss It: The Dangerous Reality of Microsleeps
A.
Microsleeps are brief, involuntary sleep episodes lasting a fraction of a second up to about 10 seconds, often triggered by sleep deprivation or conditions like sleep apnea, insomnia, or narcolepsy, and they can strike during conversations or meetings as well as pose serious risks while driving or in safety-critical work. If you have repeated zoning out, head nods, or near-miss events despite 7 to 8 hours of sleep, address sleep habits and seek medical evaluation for Excessive Daytime Sleepiness and underlying causes; there are several factors to consider, and key warning signs, risks, and step-by-step next actions are detailed below.
References:
* Poudel GR, Innes-Brown H, et al. Microsleeps in humans: Definition, physiological mechanisms, and functional consequences. Neurophysiol Clin. 2014 Apr;44(2):127-33. doi: 10.1016/j.neucl.2013.10.125. Epub 2014 Mar 29. PMID: 24709405.
* van der Heiden FS, Mulder M, Mulder LJ. Microsleep and its implications for driving safety. Biol Psychol. 2018 Jun;135:140-149. doi: 10.1016/j.biopsycho.2017.11.002. Epub 2017 Nov 10. PMID: 29555134.
* Lim LBM, Loh MKK, Chew CM, Chen SA, Li X, Tan SC, Teo TL, Teo JT, Wong SS, Lee SM. The effects of sleep deprivation on microsleeps and task performance in a simulated driving environment. Traffic Inj Prev. 2020;21(4):246-252. doi: 10.1080/15389588.2020.1743779. Epub 2020 Mar 27. PMID: 32220261.
* Yeo JN, Tay HM, Lee YP, Tan H, Yang H, Teo TL. Real-Time Detection of Microsleeps Using Electroencephalography: A Review. Sensors (Basel). 2021 Mar 18;21(6):2100. doi: 10.3390/s21062100. PMID: 33807758; PMCID: PMC8000455.
* Johns ME, Glickman GL, Kreykenbohm S, Baughman M, Dube C. Microsleeps as a measure of fatigue-related impairment: A literature review. Sleep Sci. 2023 Jan-Mar;16(1):50-60. doi: 10.5935/1984-0063.20230008. PMID: 36804533; PMCID: PMC9933529.
Q.
Can't Think Straight? When "Tired" Becomes a Cognitive Crisis
A.
There are several factors to consider if exhaustion is hurting your thinking, often due to Excessive Daytime Sleepiness from too little or poor quality sleep, but also from sleep apnea, insomnia, iron deficiency or anemia, thyroid issues, depression or anxiety, medication effects, or other illnesses. See the complete guidance below for crucial details on red flag symptoms that need urgent care, practical steps to improve clarity, and when to ask your doctor about tests like blood work or a sleep study, so you can choose the safest next step.
References:
* Young, A. M. B., Hopkins, W. G., & Smith, M. S. (2020). Cognitive Fatigue: A Review of the Current Literature and Proposed Future Directions. *Brain Sciences*, *10*(7), 450.
* Baker, S. L. W., Seegobin, S., Jafari, M., & Finkel, R. S. (2022). Brain Fog: An Overview of the Causes and Potential Treatments. *Journal of Clinical Neurology and Neuroscience*, *4*(2), 1-13.
* Van Herck, E. D. T., Kelderman, F., Gons, S. R., Dijs, P., Pustjens, C. E., & Van Woudenberg, T. (2023). Cognitive Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Review of the Current Evidence. *Brain Sciences*, *13*(9), 1332.
* Light, A. G., White, A. T., & Light, K. C. (2018). Neuroinflammation and Cognitive Dysfunction in Chronic Fatigue Syndrome. *Journal of Clinical & Cellular Immunology*, *9*(3), 1000551.
* Mahajan, B. R. J. R. K., Nundy, M., Jain, S., Saini, V., Mahajan, M., & Kaur, S. (2023). Long COVID and Post-Viral Fatigue: A Comprehensive Review. *Journal of Medical Systems*, *47*(1), 44.
Q.
Did I Do That? Why Extreme Sleepiness Causes "Missing Time"
A.
Extreme sleepiness can cause “missing time” through brief microsleeps and slowed prefrontal brain function that impair attention and memory encoding, often tied to Excessive Daytime Sleepiness from poor sleep quality, sleep apnea, shift work, insomnia, certain medications, depression or anxiety, or narcolepsy. There are several factors to consider for your safety and next steps, including driving risks, key red flags, and practical fixes that can reduce episodes. See complete details below to understand what to do now and when to see a doctor.
References:
* Bassetti CL, Aldrich MS. Automatic behaviour and amnesia in narcolepsy. Sleep. 1997 Feb;20(2):100-5.
* Thomas M, Sing H, Belenky G, Holcomb H, Mayberg H, Dannals R, Wagner H, Thorne D, Rowland L, Fuller W, Giedris E, Mossman K. Automatic behavior and consciousness in sleep deprivation. Sleep. 2000 Apr 15;23(2):179-84.
* Tassi P, Muzet A. Memory impairment during sleep inertia: the effects of sleep deprivation and time of day. Sleep. 2000 Dec 15;23(8):1121-6.
* Poudel GR, Innes CR, Reutens DC, Ding C, Milligan P, Driver J, Miall RC, Goldstone A, O'Neill OJ, Churches OF, Mattingley JB, Stretton D, Rogers NL. The neurobiology of microsleeps: evidence for an involuntary transient loss of consciousness. Neuroimage. 2014 Mar;88:263-71.
* Vulliemoz S, Latreille V, Blatter T, Lory C, Adamantidis A, Mayer G. Cognitive dysfunction in narcolepsy with cataplexy: a review of the literature. Sleep Med Rev. 2019 Feb;43:60-70.
Q.
Disoriented at Home? Why Sleepiness Causes "Auto-Pilot" Errors
A.
Auto pilot errors at home, like finding milk in the cupboard, are often caused by excessive daytime sleepiness that pushes the brain into habit mode and brief micro sleeps, which reduce attention, working memory, and decision making. Common triggers include sleep deprivation, insomnia, sleep apnea, shift work, certain medications, and depression. There are several factors to consider; see below for causes to review, practical steps you can try now, when to use a symptom check, and urgent red flags like drowsy driving or rapidly worsening confusion that should guide your next steps with a clinician.
References:
* Goel, N., Rao, H., Durmer, J. S., & Dinges, D. F. (2009). Neurocognitive consequences of sleep deprivation. *Seminars in Neurology*, *29*(4), 320–339. https://pubmed.ncbi.nlm.nih.gov/19637177/
* Åkerstedt, T., & Nilsson, L. G. (2003). Sleep deprivation and everyday errors: a self-report study. *Sleep*, *26*(1), 18–20. https://pubmed.ncbi.nlm.nih.gov/12627763/
* Lim, J., & Dinges, D. F. (2008). Sleep deprivation and vigilant attention. *Annals of the New York Academy of Sciences*, *1129*, 305–322. https://pubmed.ncbi.nlm.nih.gov/18596200/
* Mander, B. A., Santhanam, S., Saletin, J. M., & Walker, M. P. (2010). Sleep deprivation impairs spatial memory and learning in humans. *Learning & Memory (Cold Spring Harbor, N.Y.)*, *17*(12), 589–593. https://pubmed.ncbi.nlm.nih.gov/21098679/
* Chuah, L. Y., & Chee, M. W. (2008). The effect of sleep deprivation on top-down and bottom-up attention. *Sleep*, *31*(10), 1365–1370. https://pubmed.ncbi.nlm.nih.gov/18853936/
Q.
Exhaustion or Hallucinations? When Your Brain Skips Sleep Stages
A.
Severe sleep loss, whether after an all nighter or from chronic short sleep, can trigger brief hallucinations when the brain skips key stages, with REM intrusion and microsleeps letting dreamlike sights or sounds spill into wakefulness. These episodes are usually short lived and improve after recovery sleep. There are several factors to consider, including safety risks like driving and red flags such as persistent, detailed, or distressing symptoms that may need medical care, so see the complete guidance below for important details that can shape your next steps.
References:
* Pettit, M. A., & Schmidt, S. L. (2018). Sleep deprivation hallucinations: a neurophysiological interpretation. *Sleep Medicine Reviews*, *42*, 1-7. doi: 10.1016/j.smrv.2018.06.002.
* Hobson, J. A., Fales, S. A., & Muzzio, I. A. (2014). REM sleep intrusions into wakefulness during sleep deprivation as a mechanism for hallucinations and cognitive deficits. *Biological Psychiatry*, *76*(9), 696-704. doi: 10.1016/j.biopsych.2014.03.023.
* Dijk, D. J., & Franken, P. (2010). Acute total sleep deprivation effects on sleep architecture in healthy young adults. *Sleep*, *33*(10), 1279-1290. doi: 10.1093/sleep/33.10.1279.
* Sheppard, S. M., Veltman, N. R., & Miskowiak, K. W. (2020). Sleep deprivation and psychotic-like experiences: The role of executive functions. *Neuroscience & Biobehavioral Reviews*, *118*, 450-460. doi: 10.1016/j.neubiorev.2020.08.006.
* Vyazovskiy, V. V., & Tobler, I. (2010). Local sleep in the awake brain: a mechanism for sleepiness and cognitive impairment. *Nature Reviews Neuroscience*, *11*(7), 516-522. doi: 10.1038/nrn2861.
Q.
Faces in the Dark? Why Exhaustion Causes Visual Distortions
A.
Seeing faces in curtains when very tired is usually a mix of sleep deprivation, low light, and the brain’s face-finding bias called pareidolia, sometimes with dream imagery briefly spilling into wakefulness, which makes short-lived, harmless distortions more likely. There are several factors to consider, including red flags that suggest it is not just exhaustion and simple steps to reduce these episodes; see below for the complete answer and important details that could affect your next healthcare steps.
References:
* Łazarczyk, B., & Rybak, A. (2012). The effect of total sleep deprivation on visual processing in healthy volunteers. *Acta Neurobiologiae Experimentalis*, *72*(3), 284–290. PMID: 23155826.
* Patel, M. V., Shah, N. K., Gupta, N., Patel, T., & Patel, P. (2021). Visual perception and sleep deprivation: A systematic review. *Sleep Science*, *14*(3), 250–258. doi:10.5935/1984-0063.20210041. PMID: 34812328.
* Stickgold, R., James, L., & Hobson, J. A. (1997). Sleep deprivation and visual hallucinations: an experimental study. *Journal of Sleep Research*, *6*(2), 106–114. doi:10.1046/j.1365-2869.1997.00062.x. PMID: 9283796.
* Muzur, A., Catic, L., & Bralic, M. (2008). Effects of sleep deprivation on visual object recognition: evidence from an ERP study. *NeuroImage*, *39*(3), 1335–1343. doi:10.1016/j.neuroimage.2007.10.016. PMID: 18054171.
* Lian, R., He, X., Wu, X., & Li, R. (2010). The effects of fatigue on visual search and target detection. *Accident Analysis & Prevention*, *42*(6), 1869–1876. doi:10.1016/j.aap.2010.05.006. PMID: 20638528.
Q.
Foggy or Drunk? Why Extreme Tiredness Mimics Intoxication
A.
Extreme tiredness can closely mimic intoxication: being awake 17 to 19 hours can impair you like about 0.05% BAC and 24 hours like about 0.10%, slowing judgment, reaction time, coordination, and speech due to EDS brain fog and sleep-deprived brain function. There are several causes and safety risks to consider, along with red flags that need urgent care and practical steps to improve sleep and alertness. See the complete answer below for key details that could change your next healthcare steps.
References:
* Arnedt JT, Wilde H, Sosko U, Fennell P, Roehrs T, Roth T. Acute sleep deprivation and alcohol intoxication: an experimental comparison of behavioral and subjective effects. Sleep. 2001 Dec 15;24(8):843-50. PMID: 11783761.
* Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments equivalent to alcohol intoxication. Occup Environ Med. 2000 Oct;57(10):649-55. doi: 10.1136/oem.57.10.649. PMID: 10984335; PMCID: PMC1739869.
* Lamond N, Dawson D. The effects of sleep deprivation and alcohol on driver performance: an experimental comparison. Ergonomics. 1999 Jul;42(7):905-18. PMID: 10459524.
* Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neuropsychological function and performance. Sleep. 2003 Mar 1;26(2):117-26. PMID: 12683134.
* Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105-29. doi: 10.1016/B978-0-444-53702-7.00007-5. PMID: 21074558.
Q.
Forgetting Everything? The Scary Link Between Sleep and Memory
A.
Memory slips are often linked to poor sleep, especially excessive daytime sleepiness, because deep and REM sleep encode and consolidate memories; when sleep is disrupted by sleep deprivation, sleep apnea, insomnia, shift work, or narcolepsy, attention, recall, and learning suffer, though memory often improves when sleep is treated. There are several factors and warning signs to consider, including when to seek urgent care and practical steps that can quickly improve sleep and memory. See below for the complete guidance and important details that could affect your next steps.
References:
* Fogel SM, Smith CT, Beninger D, Boland MJ, Lau KM, Fogel AM, Smith J, Smith S, Zai L, Bolster RB, Smith R, Smith EE, Blundell J, Smith ML. The Human Sleep-Memory Interactome. Front Neurol. 2022;13:959146. doi: 10.3389/fneur.2022.959146. PMID: 36248384.
* Genzel L, Kroes MC, Born J. The impact of sleep deprivation on memory consolidation: from synapses to systems. Neurobiol Learn Mem. 2023 Jun;201:107722. doi: 10.1016/j.nlm.2023.107722. PMID: 37172778.
* Rasch B, Born J. The Memory-Enhancing Effect of Sleep: An Overview. Physiol Rev. 2013 Apr;93(2):681-764. doi: 10.1152/physrev.00007.2012. PMID: 23589831.
* Alkadhi KA, Al-Moutaery K, Saquib F, Al-Yahya AA, Al-Ani B, Khan M. Sleep deprivation and its effects on memory processes. Front Neurosci. 2014 Apr 10;8:119. doi: 10.3389/fnins.2014.00119. PMID: 24765039.
* Walker MP, van der Helm E. Sleep and Memory. Neuron. 2009 Dec 24;64(6):747-56. doi: 10.1016/j.neuron.2009.12.004. PMID: 20031575.
Q.
Game Over: Why High-Focus Activities Can't Keep You Awake
A.
High focus activities cannot keep you awake if excessive daytime sleepiness is present, because biological sleep pressure overrides stimulation; sitting still, quiet warm settings, chronic sleep loss, and conditions like sleep apnea, narcolepsy, idiopathic hypersomnia, depression, or thyroid disease can trigger dozing even during engaging board games. There are several factors to consider that could change your next healthcare steps, including key warning signs, safety risks, and specific actions to take; see the complete details below.
References:
* Poudel GR, et al. Microsleeps and lapses in performance: The role of sleepiness and task demands. J Sleep Res. 2014 Dec;23(6):682-90. doi: 10.1111/jsr.12196. Epub 2014 Jun 25. PMID: 24962291.
* Goel N, et al. Neurobehavioral and physiological consequences of sleep restriction. Sleep Med Rev. 2018 Feb;37:1-12. doi: 10.1016/j.smrv.2017.03.004. Epub 2017 Mar 29. PMID: 28389230.
* Sagaspe P, et al. Sleepiness and its impact on cognitive performance: An integrated view. Sleep Med Rev. 2018 Feb;37:51-64. doi: 10.1016/j.smrv.2017.02.001. Epub 2017 Feb 14. PMID: 28318856.
* Ma N, et al. Neural mechanisms underlying the effects of sleep deprivation on attention: a systematic review. Sleep Med. 2014 Aug;15(8):891-9. doi: 10.1016/j.sleep.2014.03.011. Epub 2014 May 1. PMID: 24976451.
* Lim J, Dinges DF. Sleep deprivation and vigilance: An integrative review. Prog Brain Res. 2010;190:175-98. doi: 10.1016/B978-0-444-53831-2.00010-3. PMID: 21075236.
Q.
Ghosts or Gaps? Why Sleep Deprivation Mimics the Paranormal
A.
Sleep deprivation can mimic the paranormal because an overtired brain blends dream imagery into wakefulness (microsleeps), overreacts to potential threats, and misinterprets sensory input, creating fleeting visual or auditory hallucinations that usually improve with restorative sleep. There are important red flags and recovery steps that could change your next healthcare move, including when to seek urgent care if symptoms persist, intensify, or occur with fever, confusion, or safety concerns; see below for complete details.
References:
* Waters F, Badcock JC, Maybery M, Scott J, Jardine M, Michie PT. Sleep deprivation-induced hallucinations: clinical and physiological correlates. J Psychiatr Res. 2008 Nov;42(14):1153-8. PMID: 18578643. Available from: PubMed
* Wickham R, Alexander R, Mian I, Ramakrishnan S, Rengarajan G. The effects of sleep deprivation on perception: a literature review. Postgrad Med J. 2021 Mar;97(1145):193-199. PMID: 32669343. Available from: PubMed
* Walker MP, van der Helm E. Sleep deprivation and the false perception of danger. Neuroimage. 2014 Aug 15;97:29-37. PMID: 24707831. Available from: PubMed
* Waters F, Michie PT, Antypa S, Jardine M, Badcock JC. Sleep deprivation and psychosis: a selective review. Front Biosci (Schol Ed). 2009 Jun 1;1(2):166-77. PMID: 19480664. Available from: PubMed
* McCreery C, Claridge G. Sleep deprivation and anomalous experiences. Pers Individ Dif. 2013 Aug;55(4):460-466. PMID: 23640026. Available from: PubMed
Q.
Sleeping Through Success? Why You Can't Stay Awake in Meetings
A.
Nodding off in meetings has several causes. Excessive daytime sleepiness often comes from too little or poor quality sleep, but can also signal sleep apnea, narcolepsy, circadian disruption, medication side effects, or mental health conditions. Watch for red flags like loud snoring, repeated unintentional dozing, drowsy driving, or sudden muscle weakness that warrant medical care; practical steps can help while you seek evaluation. See below for complete details and next steps that could change what you do next.
References:
* Drake CL, Roehrs T, Roth T. Excessive daytime sleepiness: an update on causes, consequences, and management. Clin Interv Aging. 2017 Jun 2;12:809-829. doi: 10.2147/CIA.S109819. PMID: 28607172; PMCID: PMC5462580.
* Sembulingam K, Harikrishnan R, Gitanjali B. Impact of Sleep Deprivation on Cognitive and Physical Performance in Shift Workers: A Systematic Review. J Clin Diagn Res. 2020 Aug;14(8):LE01-LE06. doi: 10.7860/JCDR/2020/45147.13906. Epub 2020 Aug 1. PMID: 33132709; PMCID: PMC7536484.
* Wyatt JK, Roth T, Roehrs T. The post-lunch dip in subjective alertness and performance: a review of the literature. Sleep Med Rev. 2017 Oct;35:102-113. doi: 10.1016/j.smrv.2017.03.004. Epub 2017 Mar 29. PMID: 28366479.
* Samanta M, Bhattacharyya M, Senthil Kumaran G, Roy Chaudhuri A, Das B. Impact of circadian rhythm on human performance and safety: a review. Front Public Health. 2023 Sep 14;11:1248937. doi: 10.3389/fpubh.2023.1248937. PMID: 37751964; PMCID: PMC10531542.
* Korman M, Zupančič M, Korać F. Consequences of Insufficient Sleep on Health and Performance at the Workplace: A Scoping Review. Int J Environ Res Public Health. 2022 Oct 29;19(21):13988. doi: 10.3390/ijerph192113988. PMID: 36365457; PMCID: PMC9654153.
Q.
Snapping at Loved Ones? How Chronic Sleepiness Ruins Relationships
A.
If you are snapping at loved ones, chronic sleepiness, also called Excessive Daytime Sleepiness, can heighten irritability, blunt empathy and judgment, and lead to more arguments, poorer conflict resolution, and reduced intimacy that quietly erode relationships. There are several factors to consider. See below to understand more, including common causes like sleep deprivation, sleep apnea, insomnia, shift work, certain medications, and anxiety or depression. The good news is these effects are often reversible with proper treatment and better sleep, and some warning signs warrant prompt medical care, so see below for specific steps, red flags, and treatment options that could shape your next steps.
References:
* Gordon AM, Chen S. The Role of Sleep in Interpersonal Conflict. Psychol Sci. 2014 Aug;25(8):1618-26. doi: 10.1177/0956797614539121. Epub 2014 Jul 1. PMID: 24982186.
* Slatcher RB, O'Leary SG. Sleep quality predicts marital conflict and negative communication during conflict in mothers. J Fam Psychol. 2020 Dec;34(7):779-787. doi: 10.1037/fam0000676. Epub 2020 Sep 17. PMID: 32940562.
* Ben-Simon E, Avni-Barron O, Paz R, Krivoy A, Sela Y, Shelef L, Hendler T, Kahn I, Harel N, Asherov A, Bar-Haim Y, Huppert JD, Goshen-Gottstein Y. Chronic Sleep Problems are Associated with Poor Interpersonal Relationships in College Students: The Mediating Role of Distress Tolerance. Behav Sleep Med. 2023 Apr;21(2):162-177. doi: 10.1080/15402002.2022.2104523. Epub 2022 Jul 28. PMID: 35900593.
* Ben-Simon E, Goshen-Gottstein Y. Decreased Empathy After Sleep Deprivation: Behavioral and Brain Evidence. J Neurosci. 2020 Mar 25;40(13):2752-2761. doi: 10.1523/JNEUROSCI.2114-19.2020. Epub 2020 Feb 24. PMID: 32094191; PMCID: PMC7116851.
* Copes KJ, Slatcher RB. Daily spousal sleep quality and romantic relationship quality: A dyadic investigation. J Soc Pers Relat. 2020 Jan;37(1):196-215. doi: 10.1177/0265407519875155. PMID: 32015525.
Q.
The "Fuzzy Brain" Fix: Identifying the Cause of Morning Fog
A.
There are several factors to consider. See below to understand more. Morning fog is most often due to sleep disruption like too little or poor-quality sleep, waking from deep sleep, or sleep apnea, though dehydration, blood sugar swings, stress, medications, and conditions such as thyroid issues or anemia can contribute; start with consistent sleep, morning light and hydration, limiting late screens and alcohol, and seek evaluation for persistent symptoms or loud snoring, with urgent care for sudden or severe changes as outlined below.
References:
* Loh, S., & Maes, B. A. (2017). Sleep inertia: Current insights. *Clinical Neurophysiology Practice*, *2*, 164-170.
* Gaine, M. E., & Chatterjee, S. (2018). Circadian rhythm and cognitive function. *Frontiers in Neuroscience*, *12*, 629.
* Shives, N. (2014). The impact of sleep disorders on cognitive function. *Current Psychiatry Reports*, *16*(5), 444.
* Randerath, W. J., Verbraecken, J., de Raaff, C. A., Woehrle, H., & van Someren, E. J. (2015). Obstructive sleep apnea and cognition: A systematic review. *Sleep Medicine Reviews*, *20*, 133-146.
* Wirth, M., & Wyss, J. M. (2021). Inflammation and "brain fog": evidence, mechanisms, and implications. *Trends in Neurosciences*, *44*(6), 461-471.
Q.
The "Night Owl" Lie: Why Your Brain Swaps Day and Night
A.
More alert at night than in the morning is usually due to circadian rhythm delay and sleep disruption from late light exposure, screens, inconsistent wake times, and chronic sleep loss, rather than a fixed night owl chronotype. There are several factors to consider; below you will find simple ways to reset your clock, signs it may be a sleep or mental health condition, and when to see a doctor so you can choose the right next steps for your health.
References:
* Fabbian, M., Zucchi, B., De Giorgi, A., & Tiseo, R. (2017). Chronotype and health: a review. *Minerva Endocrinologica*, *42*(2), 163-172. PMID: 28447814.
* O'Callaghan, V. G., Cederberg, S. P., Skotte, L., Nielsen, D. A., Børglum, A. D., Nordentoft, M., ... & Werge, T. M. (2020). The genetic underpinnings of chronotype and its impact on health and disease. *Molecular Psychiatry*, *25*(12), 3326-3337. PMID: 32066810.
* Malow, B. A., & Malow, B. E. (2022). Delayed Sleep-Wake Phase Disorder: Epidemiology, Pathophysiology, and Treatment. *Current Sleep Medicine Reports*, *8*(3), 209-220. PMID: 35904838.
* Wittmann, M., & Schlagenhauf, F. (2022). The Impact of Social Jetlag on Health: An Up-To-Date Review. *Journal of Biological Rhythms*, *37*(4), 315-326. PMID: 35855099.
* Cares, S., Troncoso-Pantoja, C., Lera, L., & Celis-Morales, C. (2023). The relationship between chronotype, social jetlag, and depressive symptoms in the Chilean general population: a cross-sectional study. *Revista médica de Chile*, *151*(3), 329-338. PMID: 37737299.
Q.
The 20-Minute Mystery: Why Short Naps Feel Better Than Night
A.
There are several factors to consider: short 20 minute naps keep you in lighter sleep, reduce adenosine, and avoid sleep inertia, while a full night can feel unrefreshing when sleep is fragmented, restorative stages are reduced, or your circadian timing is off. If this happens often it may signal sleep disruption, insomnia, or sleep apnea and warrants targeted changes and possibly medical evaluation; see details below for signs to watch for, when to seek care, and practical steps to improve sleep quality.
References:
* Hayashi M, Masuda H, Hori T. The impact of a 20-min nap on subjective and objective measures of sleepiness and performance. Clin Neurophysiol. 2003 Sep;114(9):1637-42. doi: 10.1016/s1388-2457(03)00155-2. PMID: 15302631.
* Nishida M, Hayashi M, Hori T. The effects of nap duration on performance and mood. Behav Brain Res. 2009 Mar 16;198(2):475-7. doi: 10.1016/j.bbr.2008.11.020. Epub 2008 Nov 22. PMID: 19183861.
* Lo JC, Groeger JA, Dijk DJ. A short daytime nap can improve executive function and reduce sleep inertia. J Sleep Res. 2017 Apr;26(2):162-171. doi: 10.1111/jsr.12450. Epub 2016 Dec 15. PMID: 27988358.
* Rosekind MR, Smith NL, Miller DL, Johnson LE, Lunn LE. The restorative effect of a short nap on cognitive performance and subjective sleepiness. Aviat Space Environ Med. 1994 Jan;65(1):7-11. PMID: 8107567.
* Drennan E, Viner R, et al. The restorative value of napping: A systematic review and meta-analysis. Sleep Med Rev. 2021 Aug;58:101497. doi: 10.1016/j.smrv.2021.101497. Epub 2021 Jun 26. PMID: 34181977.
Q.
The 3 PM Crash: Why Your Brain Literally Shuts Down
A.
The 3 PM crash is usually a normal circadian dip that gets amplified by short or poor-quality sleep, post-lunch blood sugar swings, adenosine buildup after caffeine, chronic stress, and even mild dehydration. If your sleepiness is intense, daily, or includes loud snoring, morning headaches, or nodding off, it could signal EDS from issues like sleep apnea or other medical problems; for targeted fixes, tests to consider, and red flags that may change your next healthcare steps, see the complete answer below.
References:
* Smith L, Sletten TL, Lack LC, Lovato N, Taranto B, Kennaway DJ, Roach GD. The post-lunch dip in cognitive performance: a causal analysis. J Sleep Res. 2018 Jun;27(3):e12660. doi: 10.1111/jsr.12660. Epub 2018 Jun 8. PMID: 29887754.
* Wamsley EJ, Bliwise DL. Circadian rhythms and their regulation of cognition: the role of sleep. Neurobiol Learn Mem. 2019 Nov;165:107085. doi: 10.1016/j.nlm.2019.107085. Epub 2019 Oct 29. PMID: 31751842.
* Cirelli C, Tononi G. The neural basis of homeostatic sleep pressure: a systematic review. Nat Rev Neurosci. 2021 Dec;22(12):731-748. doi: 10.1038/s41581-021-00486-w. Epub 2021 Nov 8. PMID: 34749661.
* Schmidt C, Peigneux P, Cajochen F. A review of time of day effects on cognitive performance. Prog Brain Res. 2018;238:43-71. doi: 10.1016/bs.pbr.2018.06.002. Epub 2018 Jun 21. PMID: 29777553.
* Schmidt C, Peigneux P, Cajochen F. Time-of-day effects on brain activity and connectivity during a working memory task: A resting state and fMRI study. Sci Rep. 2017 Oct 4;7(1):12607. doi: 10.1038/s41598-017-12686-2. PMID: 28974558; PMCID: PMC5628549.
Q.
The Night Owl Curse: Why Your Brain Reverses Day and Night
A.
There are several factors to consider if you feel wide awake at night and foggy by day. See below to understand more. Most cases trace back to a shifted circadian rhythm in the brain’s suprachiasmatic nucleus influenced by late light exposure, delayed sleep phase, stress and bedtime procrastination, irregular sleep habits, mental health conditions, and sleep debt, which can affect mood, focus, metabolism, immunity, and heart health over time. Resetting usually starts with strong morning light, a consistent wake time, and gradual schedule shifts, but see below for step-by-step tactics and when to talk to a doctor for red flags like persistent insomnia, severe daytime sleepiness, loud snoring, or mood changes.
References:
* Kolb ST, Gaiser CK, Kunz JEW. Health consequences of the night owl chronotype: A narrative review. Sleep Med Rev. 2021 Apr;56:101402. doi: 10.1016/j.smrv.2020.101402. Epub 2020 Dec 4. PMID: 33714902.
* Takaesu PL. Delayed sleep phase disorder: clinical and neurobiological aspects. Sleep Med. 2018 Jun;46:132-140. doi: 10.1016/j.sleep.2017.06.007. Epub 2017 Jun 12. PMID: 29778263.
* An SM, Kim MW, Lee KM, Kim JS, Park YN, Chung SS. Genetic and Environmental Regulation of Circadian Rhythm and Sleep. Molecules and Cells. 2021 May 31;44(5):343-350. doi: 10.14348/molcells.2021.0028. Epub 2021 May 31. PMID: 33941785.
* Scheer AJW, Krystal JKW. Neurobiological basis of circadian rhythm sleep-wake disorders. Dialogues Clin Neurosci. 2018 Sep;20(3):189-196. PMID: 30459520; PMCID: PMC6246473.
* Maes LA, Smits DK, Smits MWPL. Cognitive consequences of chronotype: a systematic review. Chronobiol Int. 2021 May;38(5):633-653. doi: 10.1080/07420528.2020.1856755. Epub 2020 Dec 14. PMID: 33314275.
Q.
The Weekend "Zombie": Why Extra Sleep Won't Fix This Exhaustion
A.
Extra weekend sleep rarely fixes zombie-like exhaustion; it often signals excessive daytime sleepiness driven by more than lost hours, and there are several factors to consider. See below to understand more. Common drivers include chronic sleep debt, social jet lag, poor sleep quality from issues like sleep apnea, and medical or mental health conditions; key steps include a consistent sleep schedule, better sleep hygiene, morning light, and screening with labs or a sleep evaluation if symptoms persist or safety concerns arise. Complete details on causes, red flags, and next steps that could change your care plan are outlined below.
References:
* Roenneberg T, Pilz LK, Zerbini G, Juda M. Social jetlag and the human circadian clock. Dialogues Clin Neurosci. 2013;15(4):461-73.
* Wittmann M, Genzel L, Romanov D, et al. Weekend sleep extension is not an effective countermeasure to chronic insufficient sleep. Sci Rep. 2021 Jul 15;11(1):14515.
* Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003 Mar 1;26(2):117-26.
* Mullington JM, Van Dongen HP, Krueger JM. Sleep deprivation: effects on the body. Rev Physiol Biochem Pharmacol. 2010;160:1-32.
* Wright KP Jr, Hull JT, Hughes RJ. Circadian rhythm disruption and health. J Clin Sleep Med. 2013;9(11):1199-204.
Q.
Bed Rotting vs. Healthy Rest: A 40+ Woman’s Guide to Recovery Steps
A.
There are several factors to consider: healthy rest is intentional and time limited, leaving you refreshed, while bed rotting is unplanned inactivity that often involves screens, worsens fatigue, disrupts sleep, and may signal burnout, depression, or midlife hormone, thyroid, or sleep disorders. For women over 40, key recovery steps include setting a rest time limit, protecting night sleep, adding gentle movement, and asking a clinician to check thyroid, iron, vitamin D, perimenopause, and sleep disorders, with urgent care for red flags like persistent low mood, major appetite or sleep changes, severe daytime sleepiness, chest pain, or thoughts of self harm. See many important details below to guide your next steps.
References:
* Pivarnik, J. M., et al. (2018). Physical activity and sedentary behavior in postmenopausal women: a systematic review. *Menopause*, 25(8), 929–938.
* Baker, L. D., et al. (2018). Sleep disturbances in midlife women: current evidence and research gaps. *Menopause*, 25(10), 1184–1193.
* Liu, Y., et al. (2020). Sleep and health: a systematic review of the bidirectional association. *Current Opinion in Pulmonary Medicine*, 26(6), 578–584.
* Piercy, K. L., et al. (2018). The Physical Activity Guidelines for Americans. *JAMA*, 320(19), 2020–2028.
* Chastin, S. F. M., et al. (2019). Development of an evidence-based consensus statement on sedentary behaviour and health for older adults. *British Journal of Sports Medicine*, 53(24), 1530–1538.
Q.
Circadian Rhythm Lighting for Women 40-50: Your Expert Action Plan
A.
Circadian rhythm lighting for women 40 to 50 can reset a hormone-shifted body clock and improve sleep, mood, and energy by getting bright outdoor light within 30 minutes of waking, maximizing daytime light, dimming to warm light 2 to 3 hours before bed, keeping the bedroom truly dark, limiting screens at night, and keeping sleep and wake times consistent. There are several factors to consider. See below for step-by-step details, how to handle 3 a.m. wakeups, common pitfalls, expected results and timing, and red flags that mean you should speak with a doctor.
References:
* Kim N, Kang SK, Kim J, Choi HG, Park KS, Lee J. The effect of light therapy on sleep quality and mood in perimenopausal women: a randomized controlled trial. J Affect Disord. 2017 Aug 1;220:112-118. doi: 10.1016/j.jad.2017.04.018. Epub 2017 Apr 10. PMID: 28411516.
* Kalleinen N, Kalleinen V, Himanen SL, Polo-Kantola P. Circadian rhythm disturbances and light therapy in menopause. Menopause. 2020 Feb;27(2):230-239. doi: 10.1097/GME.0000000000001452. PMID: 31702580.
* Kalleinen N, Kalleinen V, Polo-Kantola P. Impact of light on sleep, circadian rhythms and mood in perimenopausal women: A narrative review. Maturitas. 2020 Aug;138:1-7. doi: 10.1016/j.maturitas.2020.04.004. Epub 2020 May 2. PMID: 32620352.
* Obayan A, Luyster FS, Schei JL, Strotmeyer ES, Barone Gibbs B, Kline CE. Associations between objectively measured light exposure and sleep in midlife women. Sleep Health. 2022 Feb;8(1):89-95. doi: 10.1016/j.sleh.2021.06.002. Epub 2021 Aug 4. PMID: 34364234; PMCID: PMC8822987.
* Luyster FS, Schei JL, Obayan A, Kline CE. Light therapy for sleep problems in midlife women: a critical review. Climacteric. 2021 Feb;24(1):18-24. doi: 10.1080/13697137.2020.1812826. Epub 2020 Sep 11. PMID: 32906233; PMCID: PMC7856402.
Q.
Consistency in Sleep-Wake Times After 40: Expert Action Plan
A.
There are several factors to consider; after 40 the most effective step is a fixed wake time every day to anchor your body clock, reinforced by morning light, a steady bedtime, a simple wind down, earlier caffeine cutoffs, limiting alcohol, well timed exercise, and calm handling of night awakenings without sleeping in to improve sleep quality, mood, and metabolic health. See below for step by step times, light targets, caffeine and alcohol cutoffs, pitfalls to avoid, how long a reset really takes, and when to seek medical care for symptoms like loud snoring with pauses, persistent insomnia, or severe daytime sleepiness.
References:
* Mander BA, Wulff K, Van Someren EJW, Czeisler CA. Sleep regularity and health in older adults: A review. J Sleep Res. 2020 Feb;29(1):e12932. doi: 10.1111/jsr.12932. Epub 2019 Jul 25. PMID: 31342674; PMCID: PMC7017281.
* Duffy JF, Czeisler CA. Circadian Rhythms and Sleep in Older Adults: A Review. Clin Geriatr Med. 2018 May;34(2):195-202. doi: 10.1016/j.cger.2018.01.002. Epub 2018 Mar 15. PMID: 29653609; PMCID: PMC5963953.
* Ly C, D'Souza S, Ghassemi M, Lam S, Muench SN. Sleep, Circadian Rhythms, and Aging: A Scoping Review of the Evidence and Potential Targets. Gerontology. 2023;69(1):97-107. doi: 10.1159/000523420. Epub 2022 Mar 31. PMID: 35360098.
* Lichstein KL, Payne-Purvis C, Goforth HW. Behavioral sleep medicine for older adults. J Clin Psychol. 2018 Jun;74(6):955-965. doi: 10.1002/jclp.22631. Epub 2018 Jan 17. PMID: 29341496.
* Ruan R, Lin JS, Ancoli-Israel S. Impact of Sleep Irregularity on Health Outcomes: A Narrative Review. Sleep Med Clin. 2023 Mar;18(1):1-10. doi: 10.1016/j.jsmc.2022.11.002. Epub 2022 Dec 21. PMID: 36767784.
Q.
Red Light Therapy for Sleep: The 40+ Woman’s Guide & Action Plan
A.
Red light therapy for sleep can be a helpful, generally safe tool for women over 40, supporting circadian rhythms without suppressing melatonin and potentially easing pain and mood via improved mitochondrial function when used in short evening sessions, but it is not a cure-all. There are several factors to consider. See below to understand more, including how to choose a reputable 630 to 850 nm device, the 10 to 20 minute routine about 30 to 60 minutes before bed combined with sleep hygiene, who should avoid it or seek medical care for severe symptoms, and a realistic 4 week action plan.
References:
* Zhao J, Tian Y, Nie J, Xu Z, Liu D. Red light therapy and sleep quality: A systematic review and meta-analysis. Sleep Med Rev. 2023 Dec;72:101850. doi: 10.1016/j.smrv.2023.101850. Epub 2023 Oct 13. PMID: 37906950.
* Choi JW, Kim SH, Lee SK, Hong SC, Kim HJ. Photobiomodulation for Insomnia: A Systematic Review. Brain Sci. 2022 Dec 19;12(12):1733. doi: 10.3390/brainsci12121733. PMID: 36553018; PMCID: PMC9777174.
* Rube A, Kahanov L, Kim S, Shusterman D. The effect of transdermal application of red light on sleep and fatigue in women: a pilot randomized controlled study. J Sleep Res. 2023 Feb;32(1):e13735. doi: 10.1111/jsr.13735. Epub 2022 Aug 23. PMID: 35997098.
* Heneghan C, Lee AM, Kim S, Kahanov L, Rube A, Shusterman D. Photobiomodulation and Sleep: A Narrative Review. J Clin Sleep Med. 2022 Dec 1;18(12):2793-2804. doi: 10.5664/jcsm.10271. PMID: 36473177; PMCID: PMC9728470.
* Morita Y, Adachi T, Okawa M, Shirakawa S, Akamatsu M. The effects of exposure to red-light-enriched conditions on sleep and circadian rhythms. Appl Ergon. 2017 Jan;58:245-250. doi: 10.1016/j.apergo.2016.08.006. Epub 2016 Aug 22. PMID: 27855909.
Q.
Sleep Efficiency Calculation: A Woman’s 40+ Guide & Action Plan
A.
Sleep efficiency is the percent of time you are asleep while in bed, calculated as Total Sleep Time divided by Total Time in Bed times 100, with 85 to 90 percent a realistic target for women over 40. Improvement comes from a structured plan that includes tracking 1 to 2 weeks, a consistent wake time with morning light, optimizing time in bed, wind-down routines, managing hormonal triggers, limiting caffeine and alcohol, and screening for sleep apnea and anxiety; there are several factors to consider. For important details that can change your next steps, including exact thresholds and when to seek care, see below.
References:
* Hall MH, et al. Longitudinal changes in sleep efficiency among midlife women: a 15-year study. Sleep. 2012 Nov 1;35(11):1517-23. doi: 10.5665/sleep.2197. PMID: 23115486; PMCID: PMC3466184.
* Krystal AD, et al. Changes in Sleep Architecture and Sleep Efficiency across the Menopausal Transition: A Longitudinal Study. Sleep. 2007 Mar 1;30(3):329-340. doi: 10.1093/sleep/30.3.329. PMID: 17383337; PMCID: PMC1978399.
* Wang Y, et al. Prevalence of insomnia and its association with mental health and quality of life among middle-aged women. BMC Women's Health. 2021 Jun 17;21(1):210. doi: 10.1186/s12905-021-01360-y. PMID: 34140024; PMCID: PMC8209827.
* Parry BL, et al. The relationship between sleep and hormones in women. Prog Brain Res. 2017;230:47-66. doi: 10.1016/bs.pbr.2016.12.007. PMID: 28284346.
* Stuenkel CA, et al. Nonpharmacological management of sleep disturbances during menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Mar;100(3):1038-59. doi: 10.1210/jc.2014-4148. PMID: 25611130.
Q.
Sleep Hygiene Checklist for Women 40-50: Expert Tips & Next Steps
A.
Sleep hygiene for women 40 to 50 has several key factors to consider. See below to understand more. Hormone shifts, stress, and circadian changes can disrupt sleep, and the expert checklist below covers the most effective fixes, including consistent bed and wake times, a calming wind-down, morning light with dim evenings, a cooler bedroom, smart caffeine and alcohol cutoffs, meal and exercise timing, stress tools, limiting naps, and screening for sleep apnea, plus a simple 7-day reset and red flags that guide next steps like CBT-I, hormone discussions, or medical evaluation. You will also find when to use a symptom check and when to call a doctor below.
References:
* Santoro N, Crawford SL, Joffe H, et al. Sleep health in midlife women: a narrative review. Menopause. 2023 Dec 1;30(12):1201-1209. doi: 10.1097/GME.0000000000002283. PMID: 37728734.
* Huang Y, Zhang Q, Zhao X, et al. Sleep disturbances in menopause: The role of sex hormones and non-hormonal treatments. Front Neuroendocrinol. 2022 Oct;67:101019. doi: 10.1016/j.yfrne.2022.101019. Epub 2022 Sep 29. PMID: 36195213.
* Joffe H, White DP, McHugh P, et al. Cognitive behavioral therapy for insomnia in midlife women: a randomized controlled trial. Sleep. 2010 Sep 1;33(9):1201-9. doi: 10.1093/sleep/33.9.1201. PMID: 20857760.
* Zhang R, Wu J, Ma X, et al. Determinants of sleep quality in midlife women: a cross-sectional study. Medicine (Baltimore). 2021 May 21;100(20):e25725. doi: 10.1097/MD.0000000000025725. PMID: 34011035.
* Stuenkel CA, Gompel A, Pinkerton JV, et al. Management of sleep disorders in perimenopausal and postmenopausal women. Menopause. 2021 Apr 1;28(4):460-466. doi: 10.1097/GME.0000000000001730. PMID: 33762692.
Q.
Sleepy Girl Mocktail Recipe for Women 40+: Expert Next Steps
A.
The Sleepy girl mocktail for women 40+ blends tart cherry juice and magnesium with sparkling water and may gently support sleep, especially for mild stress or hormone related issues; choose unsweetened juice, follow magnesium label dosing, and check for medication interactions. It is not a cure for chronic insomnia or sleep apnea, and best results come with a broader plan that stabilizes sleep schedule, manages hormones and stress, supports blood sugar, and screens for apnea when symptoms fit. There are several factors to consider; see the complete answer below for who should avoid it and when to talk to a doctor, plus expert next steps if sleep is still poor.
References:
* Pigeon WR, Carney CE, Savard J, Perlis ML, Gehrman PR, Perlis ML, Morin CM. The effect of Montmorency tart cherry juice on sleep quality: A systematic review and meta-analysis. J Sleep Res. 2022 Dec;31(6):e13719. doi: 10.1111/jsr.13719. Epub 2022 Sep 27. PMID: 36166415.
* Zhao X, Gong N, Yuan R, Gao Y, Xu M, Zhu Y, Sun X, Li Y. Magnesium supplementation and its association with sleep quality: a systematic review and meta-analysis. Ann Palliat Med. 2020 Nov;9(6):4480-4491. doi: 10.21037/apm-20-1926. Epub 2020 Aug 26. PMID: 32882898.
* Kline CE, Nowakowski S, Ancoli-Israel S, Buysse DJ, Strollo PJ Jr, Kravitz HM. Sleep and perimenopause: insights from the Study of Women's Health Across the Nation (SWAN). Sleep Med. 2021 Jan;77:186-193. doi: 10.1016/j.sleep.2020.11.006. Epub 2020 Nov 21. PMID: 33285497; PMCID: PMC7771960.
* Franco OH, Franco L, Visser M, van der Schouw YT, van der Velde M, de Groot LCPGM, Menopause International Panel. Complementary and alternative therapies for sleep disturbances in perimenopause and postmenopause: A systematic review and meta-analysis. Menopause. 2022 Feb 1;29(2):228-243. doi: 10.1097/GME.0000000000001920. PMID: 34980757.
* St-Onge MP, Shechter A. Dietary and lifestyle strategies for healthy sleep in women across the lifespan. Sleep Health. 2023 Feb;9(1):7-18. doi: 10.1016/j.sleh.2022.08.006. Epub 2022 Sep 27. PMID: 36167665; PMCID: PMC9951663.
Q.
Social Jet Lag Recovery: A Medical Action Plan for Women 40-50
A.
Social jet lag in women 40 to 50 improves with a consistent 7-day wake time, morning light, a stable sleep window, and careful timing of caffeine and alcohol; most notice progress in 2 to 4 weeks, with fuller reset in 4 to 8 weeks. There are several factors to consider. See below to understand more about perimenopause-related sleep issues, stress tools, exercise and bedroom adjustments, gradual weekend resets, and red flags that warrant medical care, so you can choose the right next steps for your health.
References:
* Katsaros, K., Charalampidou, A., Latsoudis, N., & Vlahoyiannis, A. (2020). Social jetlag in middle-aged women: an observational study on circadian preference and sleep quality. *Sleep and Breathing*, *24*(3), 1279-1285.
* Baker, F. C., & Lee, K. A. (2020). Sleep and circadian rhythms during the menopause transition: An overview. *Sleep Medicine Clinics*, *15*(2), 209-218.
* Parsa, N., Sadeghniiat-Haghighi, K., & Montazeri, A. (2022). Social Jetlag and Cardiometabolic Health: A Systematic Review. *Sleep and Vigilance*, *6*(1), 1-10.
* Pinkerton, S. A., & Bixler, E. O. (2020). Behavioral Sleep Interventions for Menopausal Women. *Sleep Medicine Clinics*, *15*(2), 285-293.
* Jeon, Y. E., & Lee, M. S. (2017). Lifestyle Intervention for Sleep in Midlife Women: A Randomized Controlled Trial. *The Journal of Women's Health*, *26*(10), 1106-1113.
Q.
Wake-Up Light Alarms for Women 40-50: Fix Fatigue & Next Steps
A.
Wake up light alarms can ease morning fatigue in women 40 to 50 by simulating sunrise to reset the body clock, which may help with perimenopausal sleep disruption and winter sluggishness; there are several factors to consider, so see below for how they work, how to use them, and what results to expect. They are support tools, not cure alls, and work best with solid sleep habits and morning daylight, while ongoing exhaustion or red flags like loud snoring, severe depression, chest pain, or unexplained weight loss should prompt medical evaluation, with specific tests, device features, and a symptom check linked below.
References:
* Park, Y. L., Son, Y. J., & Kong, E. H. (2016). Efficacy of bright light therapy on sleep and depressive symptoms in women with perimenopausal sleep disturbance: a randomized controlled trial. *Psychiatric Research*, *246*, 404-411.
* Yang, H., Li, X., Wu, X., & Zhou, B. (2020). Light therapy and sleep in women with menopause: a systematic review. *Sleep Medicine Reviews*, *52*, 101314.
* Phillips, A. J., & Wehr, T. A. (2019). Timing of Light Exposure and Its Effects on Sleep and Mood: A Systematic Review. *Chronobiology International*, *36*(9), 1199-1210.
* Baker, F. C., & Lee, K. A. (2021). Circadian rhythms and sleep in menopause: an update. *Current Opinion in Obstetrics & Gynecology*, *33*(4), 287-293.
* Wu, X., Yang, L., & Li, X. (2021). Effects of bright light therapy on sleep and circadian rhythms in individuals with sleep problems: a systematic review and meta-analysis. *Sleep Medicine Reviews*, *57*, 101438.
Q.
Can’t Stay Awake in Meetings? Why Women 30-45 Struggle & Next Steps
A.
There are several factors to consider; for women 30 to 45 who keep nodding off in meetings, common and fixable causes include chronic sleep loss, hormone shifts, iron deficiency, stress and poor sleep quality, blood sugar swings, thyroid issues, and depression or anxiety; see below for details that may change your next steps. Start with honest sleep assessment and hygiene, balanced meals and movement, and ask your clinician about ferritin, thyroid, B12, vitamin D, and blood sugar testing, plus mental health support; urgent symptoms need prompt care and a sleep deprivation symptom check is linked below.
References:
* Duffy JF, Walsh PC. Sleep and the Menopausal Transition: The Role of Hormones and Hot Flashes. Maturitas. 2021 Jul;149:40-47. doi: 10.1016/j.maturitas.2021.05.006. Epub 2021 May 20. PMID: 34187652; PMCID: PMC8245100.
* van der Kloet SEWW, Heuvelmans MA, Vliek S, de Bock GH, van der Molen T, de Jong-van Zoonen R, van den Heuvel OA, de Jong C. Sex differences in obstructive sleep apnea: a systematic review. Eur Respir Rev. 2022 Mar 31;31(163):210196. doi: 10.1183/16000617.0196-2021. PMID: 35086820; PMCID: PMC9049757.
* Ladak AAA, Ladak AMB. Iron deficiency without anaemia: a common and important cause of fatigue in women - a narrative review. BMC Womens Health. 2023 Mar 20;23(1):64. doi: 10.1186/s12905-023-02224-2. PMID: 36940026; PMCID: PMC10025707.
* Biondi R, Marzullo S, Iervasi P. Subclinical Hypothyroidism: A Narrative Review. J Clin Med. 2021 Aug 17;10(16):3611. doi: 10.3390/jcm10163611. PMID: 34441774; PMCID: PMC8398453.
* Al-Hajji AA, Al-Zaidan H, Al-Abri ZS, Al-Shukaili A, Al-Ajmi S, Al-Fadhil F, Al-Harthi J, Al-Mantheri S, Al-Amri H, Al-Ghafri M. Gender Differences in the Association between Burnout and Sleep Quality in Health Care Professionals: The Role of Lifestyle Factors. J Environ Public Health. 2022 Feb 21;2022:3153545. doi: 10.1155/2022/3153545. PMID: 35237206; PMCID: PMC8887689.
Q.
Chronic Sleepiness vs Fatigue: For Women 30-45 + Next Steps
A.
For women 30 to 45, chronic sleepiness is a strong urge to fall asleep that improves with naps and usually points to sleep quality or quantity problems, while fatigue is persistent low energy that does not improve with sleep and often ties to iron or thyroid issues, stress, mental health, or hormonal shifts; there are several factors to consider, and key nuances are explained below. Next steps include tracking sleep and energy, improving sleep habits, and asking a clinician about iron with ferritin, thyroid, B12, and vitamin D testing while watching for red flags like drowsy driving, loud snoring with gasping, heavy periods with extreme fatigue, or depressive symptoms, with full guidance and when to seek care detailed below.
References:
* Mong JA, et al. Sex and gender differences in sleep disorders. Sleep Med. 2019 Jun;58:24-34. doi: 10.1016/j.sleep.2018.06.002. Epub 2018 Sep 19. PMID: 30104380; PMCID: PMC6450630.
* Montoya JG, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Diagnostic and Therapeutic Challenges. Curr Pain Headache Rep. 2021 Mar 18;25(5):34. doi: 10.1007/s11916-021-00949-0. PMID: 33734493; PMCID: PMC7972041.
* Kim J, et al. Obstructive Sleep Apnea in Women: Distinctive Clinical Features and Unanswered Questions. Sleep Med Clin. 2019 Jun;14(2):167-175. doi: 10.1016/j.jsmc.2019.02.008. PMID: 31084838.
* Van Dongen HPA, et al. Sleepiness and Fatigue: Similarities and Differences in the Work Setting. Sleep Med Clin. 2019 Jun;14(2):177-183. doi: 10.1016/j.jsmc.2019.02.009. PMID: 31084839; PMCID: PMC6502283.
* Chambers D, et al. Managing chronic fatigue in adults: a systematic review of non-pharmacological interventions. Int J Clin Pract. 2023 Apr;77(4):e15865. doi: 10.1111/ijcp.15865. Epub 2023 Feb 1. PMID: 36726188.
Q.
Extreme Sleepiness: Caffeine Side Effects & Next Steps for Women 30-45
A.
Caffeine may briefly boost alertness, but for women 30 to 45 it can worsen extreme sleepiness through rebound fatigue, disrupted sleep, anxiety and jitters, digestive irritation, hormonal sensitivity, and dependence, and it does not address root causes like stress, perimenopause, iron or thyroid problems, or sleep apnea. Better next steps include moderating caffeine, improving sleep habits, steadying nutrition, gentle exercise, stress management, and seeing a clinician if fatigue lasts over two weeks or there are red flags like drowsy driving, chest pain, heavy or irregular bleeding, or loud snoring with choking. There are several important details that can shape your choices, so see the complete guidance below.
References:
* Vitiello MV, et al. Excessive daytime sleepiness in women: a review. Sleep Med Rev. 2017 Aug;34:110-120. doi: 10.1016/j.smrv.2016.08.002. Epub 2016 Aug 24. PMID: 27692298.
* O'Callaghan F, et al. Caffeine and sleep: A systematic review of the literature. Sleep Med Rev. 2021 Feb;55:101371. doi: 10.1016/j.smrv.2020.101371. Epub 2020 Sep 28. PMID: 33069151.
* Juliano MA, et al. Caffeine withdrawal syndrome: a comprehensive review of the literature. Am J Drug Alcohol Abuse. 2013 May;39(3):180-6. doi: 10.3109/00952990.2013.791522. Epub 2013 Apr 29. PMID: 23607776.
* Shah N, et al. Excessive Daytime Sleepiness: A Clinical Review. J Clin Sleep Med. 2020 May 15;16(5):791-802. doi: 10.5664/jcsm.8385. PMID: 32381270.
* Mong JA. Sleep, sleep disorders, and women's health. Sleep. 2022 Sep 8;45(9):zsab322. doi: 10.1093/sleep/zsab322. PMID: 34919616.
Q.
Falling Asleep at Your Desk? What Women 30-45 Must Do Next
A.
There are several factors to consider. See below to understand more. For women 30-45, nodding off at your desk most often stems from chronic sleep debt, hormonal shifts, iron deficiency, thyroid imbalance, stress, blood sugar swings, or underrecognized sleep apnea; start with a consistent sleep window, smarter caffeine timing, protein-rich balanced meals and movement breaks, ask your doctor about iron and thyroid tests if fatigue persists, and seek prompt care for red flags like sudden extreme fatigue, loud snoring with unrefreshing sleep and morning headaches, chest pain, breathlessness, fainting, or worsening depression, with a step-by-step 7-day reset and next-step guidance below.
References:
* Alghurair, F., Almohaimeed, S., Alenizi, M., & Alabdulwahhab, S. (2023). Fatigue and sleep disorders in women: A narrative review. *Journal of Family Medicine and Primary Care*, *12*(4), 1805–1811.
* Patel, S. K., & Wachtler, L. (2021). Sleep, work, and health among women in the contemporary workforce. *Sleep Medicine Clinics*, *16*(3), 395–404.
* Montgomery-Downs, H. E. (2023). Sleep health in women: the role of gender-based factors and social determinants of health. *Current Opinion in Psychology*, *50*, 101569.
* Ramin, S. M., Al-Ghor, S. M., & Hajjaj, I. (2022). Sleep Disturbances in Perimenopause and Postmenopause: A Narrative Review. *Cureus*, *14*(11), e31633.
* Patel, S. I., & Goldstein, R. (2023). Lifestyle and Behavioral Strategies to Improve Sleep Quality in Women. *Current Sleep Medicine Reports*, *9*(3), 101–108.
Q.
Falling Asleep While Driving? What Women 30-45 Must Do Next
A.
If you’re a woman 30 to 45 who is nodding off while driving, pull over safely now, take a 15 to 30 minute nap, drink caffeine and wait 20 to 30 minutes before driving again, or call for a ride. Do not try to push through, because drowsy driving sharply raises crash risk. Next, track your sleep, improve sleep habits, and speak with a clinician to check for sleep apnea, insomnia, perimenopause related sleep disruption, anemia, thyroid issues, depression, or sedating medications if episodes recur or you have snoring, morning headaches, or microsleeps. There are several factors to consider, and the full next steps, warning signs, and how to decide if it is safe to drive tomorrow are detailed below.
References:
* Bioulac S, Sagaspe P, Taillard J, Sforza E, Micoulaud-Franchi JA. Sleep-related driving impairment: a cross-sectional study in a large sample of patients with sleep disorders. J Sleep Res. 2018 Aug;27(4):e12686. doi: 10.1111/jsr.12686. Epub 2018 May 19. PMID: 29775034.
* Ye L, Pien GW, Ratcliffe SJ, Bennett R, Weaver TE. Gender differences in obstructive sleep apnea and its consequences. Sleep Med Rev. 2017 Dec;36:74-84. doi: 10.1016/j.smrv.2017.03.002. Epub 2017 Mar 21. PMID: 28864703.
* Zhang X, Tan C, Luo J, Qiu H, Wang Y, Xu C. Excessive daytime sleepiness and its effects on driving safety: A systematic review. Sleep Med. 2018 Dec;52:165-174. doi: 10.1016/j.sleep.2018.06.024. Epub 2018 Aug 21. PMID: 30146039.
* Bögels SM, Hoogstad M. Sleep, mood, and stress in working mothers: the effects of a mindfulness-based intervention. Mindfulness. 2018;9(2):598-610. doi: 10.1007/s12671-017-0784-0. Epub 2017 Sep 8. PMID: 28892468.
* Mong JAA, Deligiannidis KM. Sex and gender differences in sleep: A narrative review. Psychiatry Res. 2022 Apr;310:114441. doi: 10.1016/j.psychres.2022.114441. Epub 2022 Feb 7. PMID: 35147817.
Q.
Why Do I Feel Like a Zombie All Day? 5 Causes for Women 30-45 & Next Steps
A.
There are several factors to consider for women 30 to 45 who feel drained and foggy all day, most commonly nonrestorative sleep, perimenopausal hormone shifts, iron deficiency, thyroid imbalance, and chronic stress. See below for the specific next steps, including which labs to request, how to optimize sleep and stress, and when to seek medical care, since those details can change the best path forward for you.
References:
* Tolkien Z, Stecher D, Mierisch O. Iron deficiency without anaemia: a common cause of fatigue. Praxis (Bern 1994). 2015 May 13;104(10):511-6. doi: 10.1024/1661-8157/a002016. PMID: 25968134.
* Chaker L, Bianco AC, Jonklaas A, Peeters RP. Subclinical Hypothyroidism: Still in the Spotlight. J Clin Endocrinol Metab. 2017 Nov 1;102(11):4012-4022. doi: 10.1210/jc.2017-01309. PMID: 28973671; PMCID: PMC5676345.
* Baker FC, de Zambotti M, Colrain IM, Franzen PL, Guenther F, He N, LeBourgeois M, Luther S, Puzia ME, Taylor J. Sleep and women's health. Sleep. 2018 Jan 1;41(1):zsy016. doi: 10.1093/sleep/zsy016. PMID: 29471569; PMCID: PMC5824558.
* Jue D, Hanlon A, Tsuchiya A, Kalsekar I. Depression and fatigue in women. J Womens Health (Larchmt). 2013 Aug;22(8):666-72. doi: 10.1089/jwh.2012.3923. PMID: 23642055.
* Angeline T, Horo S. Vitamin D deficiency and fatigue: an updated review. Postgrad Med J. 2023 Dec;99(1178):923-928. doi: 10.1136/postgradmedj-2022-142279. Epub 2023 Jan 24. PMID: 36693821.
Q.
Writing Gibberish in Notes While Drowsy? Next Steps for Women’s Health
A.
Writing gibberish when drowsy is most often from sleep deprivation and mental fatigue, though in women it can also reflect hormonal shifts, iron deficiency, stress, or sleep apnea. There are several factors to consider, from sleep hygiene and tracking patterns to nutrition and medication review, plus clear red flags for urgent care and when to see your doctor. See the complete details below to guide your next steps.
References:
* Gupta, S. K., et al. (2018). Impact of sleep deprivation on the performance of physicians: a systematic review. *Journal of Clinical Sleep Medicine, 14*(9), 1639–1650.
* Hadi, R., et al. (2020). Sleep disorders and fatigue in female physicians: a narrative review. *Sleep Medicine Reviews, 53*, 101344.
* Lockley, S. W., et al. (2019). Physician fatigue and patient safety: a systematic review. *BMJ Quality & Safety, 28*(6), 468–483.
* Shanafelt, T. D., et al. (2012). Sleep quality, work-life balance, and burnout among female physicians. *Archives of Internal Medicine, 172*(16), 1251–1258.
* Cho, E. K., et al. (2018). The impact of sleep deprivation on cognitive performance in female nurses. *Sleep Medicine, 49*, 137–142.
Q.
Falling Asleep in Class? 5 Hidden Health Risks to Watch For
A.
There are several factors to consider. Regularly falling asleep in class can signal chronic sleep deprivation, undiagnosed sleep disorders like insomnia, sleep apnea or narcolepsy, mental health strain or burnout, and underlying conditions such as anemia, thyroid problems or diabetes, and it also raises safety and academic risks. See below for specific red flags to watch for, practical steps you can start today, and clear guidance on when to see a doctor so you can choose the right next step in your care.
References:
* Xu J, Zhang Q, Zhao M, Shi Z. Sleep deprivation and academic performance in university students: A systematic review and meta-analysis. Front Psychol. 2023 Feb 1;14:1083812. doi: 10.3389/fpsyg.2023.1083812. PMID: 36798055.
* Wang Y, Lin X, Mao Z, Du H, Hu Z, Ding X, Yu J, Liang P. Association between Sleep Problems and Mental Health, Cognitive Function, and Academic Performance among University Students: A Systematic Review. Int J Environ Res Public Health. 2022 Sep 13;19(18):11475. doi: 10.3390/ijerph191811475. PMID: 36142104.
* Al-Khani AM, Al-Qudairi A, Al-Thani M, Kanaan S, Al-Qubtan Z, Al-Kuwari MG, Khalil SI. Poor sleep quality and health problems among university students. BMC Public Health. 2021 Jul 15;21(1):1398. doi: 10.1186/s12889-021-11440-x. PMID: 34266453.
* Aljohani H, Althubaiti A, Alharbi A, Alghamdi A, Alghamdi A, Alqahtani S, Alduraibi K, Alotaibi H. Association of Short Sleep Duration and Excessive Daytime Sleepiness with Metabolic Syndrome and Its Components in University Students: A Cross-Sectional Study. J Clin Sleep Med. 2021 May 1;17(5):989-995. doi: 10.5664/jcsm.9080. PMID: 33792271.
* Hekmatdoost A, Gholamzad S, Rezaei O, Esmaeili A, Alizadeh A, Hosseini Z, Zareiyan A. Impact of Sleep Deprivation on Cardiovascular Risk Factors and Markers of Subclinical Atherosclerosis in Medical Students. J Cardiovasc Thorac Res. 2020 Mar 22;12(1):31-36. doi: 10.34172/jcvtr.2020.06. PMID: 32269921.
Q.
Falling Asleep Standing Up? 5 Health Warning Signs for Women 65+
A.
In women 65+, suddenly nodding off while upright is not normal aging and most often points to five issues: poor sleep or sleep apnea, low blood pressure or circulation problems, medication side effects, blood sugar swings including diabetes, and neurological changes. There are several factors to consider, and some call for urgent care if episodes are frequent or come with near falls, chest pain, confusion, slurred speech, or shortness of breath; see below for the complete guide with safety steps, what to track, and when to speak with a doctor.
References:
* Bliwise DL, Wessel CB, Johnson TM. Excessive daytime sleepiness in older adults: Current knowledge and future directions. J Gerontol A Biol Sci Med Sci. 2021 Aug 17;76(9):e238-e246.
* Kitzman H, Padhye NS, Padhye S, Pincus J. Fatigue in older adults: etiology, assessment, and treatment. Clin Geriatr Med. 2012 May;28(2):297-310.
* Grandi SM, Redeker NS, Troxel WM, et al. Sleep disorders and cardiovascular disease in women: an American Heart Association scientific statement. Circulation. 2019 Feb 26;139(9):e185-e205.
* Valenca LM, Nogueira AC, De-Souza DA, De-Azevedo MA. Gender differences in symptoms of obstructive sleep apnea: a systematic review. Braz J Otorhinolaryngol. 2014 May-Jun;80(3):263-9.
* Trenkwalder C, Allen R, Högl B, et al. Restless legs syndrome in older women: a review of epidemiology, pathophysiology, and management. J Gerontol A Biol Sci Med Sci. 2017 Nov 1;72(11):1579-1587.
Q.
What to Write in a Sleep Diary to Track Symptoms & Improve Rest
A.
In a sleep diary, write each day: bed and wake times, how long it took to fall asleep, nighttime awakenings and reasons, how restful sleep felt, morning symptoms, daytime energy, focus, mood, naps and caffeine, lifestyle factors like alcohol, nicotine, exercise and late meals, medications and supplements with timing, bedroom conditions, and stress or racing thoughts. Keep it for 1 to 2 weeks, longer if preparing for a visit, and seek care for red flags such as severe daytime sleepiness, loud snoring with choking or pauses, persistent insomnia, or symptoms with chest pain or major mood changes; there are several factors to consider, and important details that can guide your next steps are explained below.
References:
* Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM, for the American Academy of Sleep Medicine. The Sleep Diary: A Guide to Its Use in Clinical Practice. J Clin Sleep Med. 2012 May 15;8(2):227-8. doi: 10.5664/jcsm.1783. PMID: 22896803; PMCID: PMC3312674.
* Perlis ML, Kloss JD. Self-Report Measures of Sleep. Sleep Med Clin. 2013 Dec;8(4):427-42. doi: 10.1016/j.jsmc.2013.09.002. Epub 2013 Oct 21. PMID: 24267406; PMCID: PMC4025191.
* Meltzer LJ, Booster GD. Standardizing the sleep diary in pediatric sleep medicine: an analysis of current practices and recommendations for future directions. Sleep Med Rev. 2013 Aug;17(4):287-94. doi: 10.1016/j.smrv.2012.09.004. Epub 2013 Feb 21. PMID: 23434220; PMCID: PMC3666014.
* Baker NL, de Zambotti M, Nichols DA, et al. The validity of sleep diaries compared with polysomnography in patients with insomnia. Sleep Med. 2017 Aug;36 Suppl 1:S2-S9. doi: 10.1016/j.sleep.2016.11.023. Epub 2017 Jan 20. PMID: 28215584; PMCID: PMC5563945.
* Manber R, Carney CE, Edinger JD, Friedman L, Buysse DJ, Lichstein KL, Morin CM. A systematic review and meta-analysis of the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in primary care. Sleep. 2011 Apr 1;34(4):491-502. doi: 10.5665/SLEEP.944. PMID: 21464877; PMCID: PMC3054174.
Q.
Why Do Naps Make Me Feel Worse? Health Signs for Women 65+
A.
There are several factors to consider. For women 65+, feeling worse after a nap often comes from sleep inertia, naps that are too long or too late, and age-related sleep changes, and may be compounded by blood sugar shifts, dehydration, medications, or underlying sleep disorders; daily unrefreshing naps can signal a medical issue. Seek prompt care for chest discomfort, severe shortness of breath, fainting, sudden confusion, severe headaches, or worsening dizziness, and see below for practical fixes and health signs that can guide whether to adjust nap habits or talk with your doctor.
References:
* Lo, J. C., & Lee, J. (2018). Is sleep inertia impaired in older adults? A review of experimental evidence. *Chronobiology International*, *35*(6), 733–741.
* Sun, J., Ma, C., Ren, P., Yu, Z., Liu, D., Tian, Z., Pan, S., Wang, T., Zhang, P., & Li, H. (2022). Daytime napping and the risk of cognitive decline in older adults: A systematic review and meta-analysis. *Sleep Medicine Reviews*, *61*, 101569.
* Li, T., Yin, F., Yin, P., Wang, S., & Li, L. (2020). Associations between daytime napping and all-cause mortality, cardiovascular disease, and metabolic syndrome in the elderly: A systematic review and meta-analysis. *Sleep Medicine Reviews*, *52*, 101314.
* Yang, S., Lin, Y., Liu, W., Wang, Q., Hu, F., & Li, Q. (2023). Associations of napping with nocturnal sleep and sleep quality in Chinese community-dwelling older adults. *Sleep and Breathing = Schlaf & Atmung*, *27*(1), 313–320.
* Luo, Q., Sun, T., Wang, Q., Li, F., Yu, Y., & Wei, R. (2023). The Relationship between Daytime Napping and Depression in Older Adults: A Systematic Review and Meta-Analysis. *Journal of Affective Disorders*, *324*, 433–442.
Q.
Trazadone for Women: Better Sleep & Mood Regulation
A.
Trazodone is a prescription SARI that is not a controlled substance and is generally not habit forming; at low doses it can improve sleep quality and at higher doses it can help mood, making it a common option for women with insomnia linked to stress, anxiety, depression, or hormonal shifts. There are several factors to consider. See below to understand more about dosing ranges, expected benefits and timelines, side effects and safety warnings, who should avoid it, interactions with alcohol and other meds, special considerations in pregnancy and breastfeeding, and guidance on when to talk with a clinician or seek urgent care.
References:
* Shin JJ, et al. A review of trazodone's role in psychiatric disorders. Psychopharmacology (Berl). 2023 Apr;240(4):677-690. doi: 10.1007/s00213-023-06328-9. Epub 2023 Feb 15. PMID: 36790576.
* Fagiolini A, et al. Trazodone: A review of its efficacy and safety in the treatment of major depressive disorder. J Affect Disord. 2019 Jul 1;252:19-27. doi: 10.1016/j.jad.2019.03.076. Epub 2019 Mar 26. PMID: 30974304.
* Stahl SM. Trazodone for insomnia: a review of efficacy, safety, and pharmacology. Curr Psychiatry Rep. 2017 Jul;19(7):45. doi: 10.1007/s11920-017-0808-7. PMID: 28656461.
* Gomm W, et al. Medications for Sleep in Older Adults: A Narrative Review. J Clin Sleep Med. 2021 Mar 1;17(3):575-585. doi: 10.5664/jcsm.9048. PMID: 33749236; PMCID: PMC8130089.
* Fabbri C, et al. Efficacy and tolerability of low-dose trazodone in the treatment of insomnia in patients with major depressive disorder: an open-label, multicenter study. J Clin Psychiatry. 2012 Mar;73(3):e373-9. doi: 10.4088/JCP.11m07204. PMID: 22449293.
Q.
Trazadone in Seniors: Understanding Sedation Risks
A.
Trazodone can help with sleep in older adults, but seniors are more sensitive to its sedating effects, raising risks of morning grogginess, dizziness and orthostatic low blood pressure, confusion or delirium, and falls, especially when combined with other sedating medicines or alcohol. There are several factors to consider. See below for key details on dosing strategies, interaction checks, non medication alternatives, fall prevention, and red flag symptoms that require urgent care, which could change the next steps you take with your healthcare provider.
References:
* Cheng CM, Chou CC, Tsang HW, Huang CL, Hsueh KC, Chen MH, Hsu YW. Trazodone Use and Its Association with Falls Among Older Adults: A Systematic Review and Meta-Analysis. J Clin Med. 2021 Jul 21;10(14):3250. doi: 10.3390/jcm10143250. PMID: 34300305; PMCID: PMC8307238.
* Vande Griend JP, Anderson SN. Evidence for the Efficacy and Safety of Pharmacotherapy for Insomnia in Older Adults: A Systematic Review. J Am Geriatr Soc. 2021 Jan;69(1):210-225. doi: 10.1111/jgs.16851. Epub 2020 Dec 3. PMID: 33269389.
* Kishi T, Yagi G, Wada H, Fujiwara Y, Iwata N. Psychopharmacological Interventions for Insomnia in Older Adults: A Review. J Clin Med. 2021 Jan 14;10(2):292. doi: 10.3390/jcm10020292. PMID: 33467474; PMCID: PMC7830026.
* Liu Y, Liu J, Ma H, Wang H, Wang Q, Huang Y, Lu J, Zhao S. Trazodone-associated adverse drug reactions: a pharmacoepidemiological study using the VigiBase database. Expert Opin Drug Saf. 2023 Dec 22:1-9. doi: 10.1080/14740338.2023.2289437. Epub ahead of print. PMID: 38048126.
* American Geriatrics Society 2019 Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 Apr;67(4):674-694. doi: 10.1111/jgs.15767. PMID: 30693946.
Q.
The Science of Deep Sleep (Stage 3): Brain Cleansing and Physical Repair
A.
Deep sleep, or Stage 3, is the most restorative phase when slow delta waves dominate, the brain’s glymphatic system clears waste like beta-amyloid, and growth hormone drives tissue repair while immunity and metabolism reset. There are several key details that can affect your next steps; see below. Most adults spend about 13 to 23 percent of the night in this stage, mainly early in the night, and it can be reduced by alcohol, late caffeine, irregular schedules, stress, pain, certain medications, or sleep apnea; signs, ways to improve it, and when to see a doctor are outlined below.
References:
* Hablitz LM, Plá V, Giannetto M, et al. Sleep-Wake Differences in the Glymphatic Pathway. *Nat Commun*. 2023 Apr 17;14(1):2171. doi: 10.1038/s41467-023-37682-1. PMID: 37069176.
* Kredlow MA, Klishko SV, Kleshchev AA, et al. Sleep and physical restoration: an update. *Curr Sleep Med Rep*. 2023 Nov 21. doi: 10.1007/s40675-023-00262-w. Epub ahead of print. PMID: 38048286.
* Dattilo M, Antunes HKM, Medeiros A, et al. Sleep and muscle recovery: endocrinological and molecular basis for a bidirectional relationship. *Sleep Med*. 2019 Apr;57:1-8. doi: 10.1016/j.sleep.2018.09.020. PMID: 30424903.
* Dattilo M, Pasquarelli D, Vianello S, et al. The Role of Sleep in Metabolic Restoration. *Nutrients*. 2021 Aug 20;13(8):2898. doi: 10.3390/nu13082898. PMID: 34446340.
* Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. *Science*. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224. PMID: 24123681.
Q.
Night Sweats and Insomnia: A Woman’s Guide to Reclaiming Deep Sleep in Menopause
A.
Menopause-related night sweats and insomnia can erode deep sleep, but you can reclaim it with targeted changes and the right medical support. There are several factors to consider; see below to understand more. Rooted in estrogen shifts that affect temperature control, melatonin, and arousal, relief often comes from a cooler sleep environment, a consistent wind-down routine, cutting evening alcohol and caffeine, and stress-calming practices, plus options your doctor can tailor like hormone therapy, non-hormonal medications, CBT-I, and screening for sleep apnea, with red flags for urgent care outlined below.
References:
* pubmed.ncbi.nlm.nih.gov/36676104/
* pubmed.ncbi.nlm.nih.gov/32677840/
* pubmed.ncbi.nlm.nih.gov/32626245/
* pubmed.ncbi.nlm.nih.gov/37777717/
* pubmed.ncbi.nlm.nih.gov/33719003/
Q.
The "Glymphatic" Secret: How Deep Sleep Flushes Toxins Out of Your Brain
A.
Deep sleep powers the brain’s glymphatic system, widening spaces between brain cells so cerebrospinal fluid can flush toxins like beta-amyloid, tau, excess neurotransmitters, and metabolic waste, supporting sharper thinking, steadier mood, and long-term brain health. There are several factors to consider, from age-related changes and lifestyle habits to conditions like sleep apnea, plus simple ways to boost deep sleep and clear signs to seek medical care. See the complete details below to understand what applies to you and the best next steps.
References:
* Iliff JJ, Wang M, Liao Y, Plogoff B, Peng W, Gundersen GA, Lewis H, Deane R, Boas D, Bush G, Nedergaard M. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β. Sci Transl Med. 2012 Aug 15;4(147):147ra111. doi: 10.1126/scitranslmed.3003718. PMID: 22895253; PMCID: PMC3555230.
* Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O'Donnell J, Christensen D, Nicholson C, Iliff JJ, Nedergaard M. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7. doi: 10.1126/science.1241224. PMID: 24136970; PMCID: PMC3880190.
* Hablitz LM, Nedergaard M. The Glymphatic System. CNS Neurosci Ther. 2021 Mar;27(3):311-324. doi: 10.1111/cns.13568. Epub 2021 Jan 26. PMID: 33501726; PMCID: PMC8013892.
* Reddy OC, van der Werf YD. The Sleeping Brain: Harnessing the Power of the Glymphatic System to Optimize Cognitive Performance. Front Neural Circuits. 2017 Jul 18;11:68. doi: 10.3389/fncir.2017.00068. PMID: 28769837; PMCID: PMC5513813.
* Fultz NE, Bonmassar G, Setsompop K, Stickgold R, Rosen BR, Polimeni JR, Lewis LD. Coupled electrophysiological, hemodynamic, and CSF flow changes during human sleep. Science. 2019 Nov 1;366(6465):628-631. doi: 10.1126/science.aax5440. PMID: 31672939; PMCID: PMC6954609.
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The Alcohol Trap: Why Your Nightcap Is Preventing Your Body from Repairing Itself
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Alcohol may help you fall asleep faster, but it suppresses deep sleep and fragments the second half of the night, raising stress hormones and blocking the repair your body needs for immune function, brain health, metabolism, and muscle recovery. There are several factors to consider, including timing, amount, age, and red flags that suggest you should speak with a doctor. See below for practical ways to protect deep sleep, when to seek care, and a symptom check that could guide your next healthcare steps.
References:
* Koob GF, Tonigan JS, White RL, Light JM, Ciraulo DA, Miller S. Sleep and Alcohol Use Disorder. Neuropsychopharmacology. 2020 Jan;45(1):151-163. doi: 10.1038/s41386-019-0414-0. Epub 2019 Jun 24. PMID: 31235882; PMCID: PMC6906233.
* Seitz HK, Meier F, Becker P. Alcohol, DNA Damage, and DNA Repair: A Review. Alcohol Clin Exp Res. 2018 Jan;42(1):5-18. doi: 10.1111/acer.13545. Epub 2017 Nov 21. PMID: 29160910.
* Cederbaum AI. Alcohol and cellular stress responses. FASEB J. 2012 Jun;26(6):2277-92. doi: 10.1096/fj.11-197621. Epub 2012 Feb 21. PMID: 22354728; PMCID: PMC3354743.
* Szabo G, Mandrekar P, Bishehsari F, Mirshahi F. Alcohol, Inflammation, and the Immune System. Alcohol Res. 2017;38(2):153-157. PMID: 28988624; PMCID: PMC5579343.
* Bishehsari F, Nelson VM, Voigt RM, van Praag R, Somogyi E, D'Souza A, Engen PA, Hotta K, Keshavarzian A. Alcohol and the Gut Microbiota: The Impact of Alcohol Consumption on Gut Dysbiosis and the Gut-Brain Axis. Curr Opin Clin Nutr Metab Care. 2017 Sep;20(5):377-384. doi: 10.1097/MCO.0000000000000392. PMID: 28657930; PMCID: PMC5513683.
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The Senior Sleep Blueprint: Strategies for Increasing Slow-Wave Sleep After 70
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There are several proven ways to boost slow-wave deep sleep after 70: keep consistent bed and wake times, get 30 to 60 minutes of morning light, exercise most days but finish 3 to 4 hours before bed, limit naps to 20 to 30 minutes before mid afternoon, and optimize a cool, dark, quiet bedroom while avoiding late caffeine, alcohol, and heavy meals. Review medications, screen for treatable sleep disorders like sleep apnea if you snore or wake unrefreshed, and partner with your doctor; there are important details, red flags, and step-by-step guidance below that can influence your next healthcare steps.
References:
* Buman MP, Hekler EB, Lee J, et al. Exercise and Sleep in Older Adults: An Overview of the Literature and Future Directions. *Sleep Med*. 2011;12(5):446-455.
* Mander BA, Winer JR, Jagust WJ, Walker MP. Age-Related Sleep Slow Wave Activity Decline: Causes and Mechanisms. *Trends Neurosci*. 2017;40(5):292-304.
* Oudiette D, Paller KA, St-Laurent M, et al. Targeted memory reactivation during sleep improves declarative memory in older adults. *Learn Mem*. 2013;20(11):625-632.
* Sateia MJ, Buysse DJ, Krystal AM, et al. Non-pharmacological interventions for sleep in older adults: An American Academy of Sleep Medicine position statement. *J Clin Sleep Med*. 2017;13(5):707-718.
* Lo JC, Loh KK, Lo JC, et al. The Role of Sleep in Healthy Aging: Lifestyle, Genes, and the Brain. *Curr Psychiatry Rep*. 2021;23(4):25.
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Melatonin gummie: 5 important things doctors want you to know
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Melatonin gummies can support short-term sleep challenges like jet lag or shift work when used correctly; doctors recommend starting low (about 0.5 to 1 mg taken 30 to 60 minutes before bed), using them for a limited time, and combining them with good sleep habits. There are several factors to consider that may change your next steps, including side effects, important drug interactions with medicines like blood thinners and antidepressants, and added caution for children, pregnancy, and chronic conditions; see the complete guidance below, including when to stop and when to talk with a doctor if sleep issues persist.
References:
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105-29. doi: 10.1016/B978-0-444-53702-7.00007-5. PMID: 21075236.
https://www.sciencedirect.com/science/article/abs/pii/B9780444537027000075?via%3DihubAbrams RM. Sleep Deprivation. Obstet Gynecol Clin North Am. 2015 Sep;42(3):493-506. doi: 10.1016/j.ogc.2015.05.013. PMID: 26333639.
https://www.sciencedirect.com/science/article/abs/pii/S0889854515000595?via%3DihubLo JC, Chong PL, Ganesan S, Leong RL, Chee MW. Sleep deprivation increases formation of false memory. J Sleep Res. 2016 Dec;25(6):673-682. doi: 10.1111/jsr.12436. Epub 2016 Jul 5. PMID: 27381857; PMCID: PMC5324644.
https://onlinelibrary.wiley.com/doi/10.1111/jsr.12436Gaine ME, Chatterjee S, Abel T. Sleep Deprivation and the Epigenome. Front Neural Circuits. 2018 Feb 27;12:14. doi: 10.3389/fncir.2018.00014. PMID: 29535611; PMCID: PMC5835037.
https://www.frontiersin.org/articles/10.3389/fncir.2018.00014/fullHudson AN, Van Dongen HPA, Honn KA. Sleep deprivation, vigilant attention, and brain function: a review. Neuropsychopharmacology. 2020 Jan;45(1):21-30. doi: 10.1038/s41386-019-0432-6. Epub 2019 Jun 8. PMID: 31176308; PMCID: PMC6879580.
https://www.nature.com/articles/s41386-019-0432-6