Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Common causes of poor sleep (insomnia) in your case may be:
-Poor sleep hygiene
-Anxiety
-Depression
-Excessive stress
-Substance use if present
-Primary insomnia

Common symptoms of anxiety and depression are:
anxiety, low mood, decrease talk and interaction with others, nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, negative thinking, palpitation and dry mouth.

Let me know if you are having some of the above symptoms with duration. Apart from that, chronic insomnia also lead to anxiety and depression.

Irrespective of cause, below principles of sleep hygiene which will help you in long term:
•     Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
•     Avoid napping during the day
•     Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
•     Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime
•     Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep.
•     Use comfortable bedding.
•     Find a comfortable temperature setting for sleeping and keep the room well ventilated.
•     Block out all distracting noise, and eliminate as much light as possible.
•     Reserve the bed for sleep. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.
•     Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.
•     Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.
•     Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
•     Getting Up in the Middle of the Night :Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.
•     A Word About Television: Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

Follow these steps for 2 weeks, if you do not improve, you can seek psychiatrist help for medical treatment to relieve sleep problem.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

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Hello again,
Thanks for follow up.

From further information it appear that, you have depressive symptoms moderate to severe in intensity. Sleep problem is common symptom of depression. There is need to manage depression in your case.

Depression occur due to neurotransmitters imbalance in brain most commonly involving serotonin neurotransmitter.

Apart from that depression can occur in thyroid hormone imbalance and vitamins deficiency. It is better to get evaluated for serum T3/T4/TSH and serum B12/folic acid level.

There is need for treatment, if symptoms cause significant personal distress or affect personal/professional life. Both drug and non drug treatment like cognitive behaviour therapy (form of psychotherapy) are used for treatment. Choice of treatment depends on severity of symptoms, personal preference and availability of treatment.

In drug treatment for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect. This medicine is prescription medicine and given after in person examination by physician. For that, you can visit nearby psychiatrist.

All these process is complex. I have just simplified it to make you understand it.

Apart from above advice following simple measures will help you:
-Decrease worrying by keeping yourself busy and distracted from worrisome thoughts by talking to family members or watching T.V. or counting back (100 to 0).
-Healthy diet: Milk and fruits in diet.
-Daily morning walk
-Follow steps of sleep hygiene as mentioned in primary reply.
-Breathing exercise, yoga and meditation (which you can learn from some expert in person)

Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards

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