Brief Answer: Described in detail below. Detailed Answer: Hi XXXXX, Welcome back! It is nice to know that you are doing well. I expect that even the sleep problem will go away in a few more days. Although the total duration of sleep seems to be good enough, around 8 hours, the break is indeed unwelcome. The first thing that needs to be seen is if this is medicine related. If you are taking Cipralex in the evening, try shifting it to the morning to see if it makes a difference. It causes insomnia in some people and somnolence in others. Bupropion is always taken in the morning as it is stimulating. If you are taking Rivotril in the evening, Rivotril may also be implicated as there is a break in sleep when the amount of the medicine in the blood falls. For example, if you are taking Rivotril at around 8 pm, shifting it to 10 pm or around half an hour before you sleep may take care of the problem. Even if none of these medication related issues are implicated, there are other things that can be done. Just check if your sleep hygiene needs to be improved or not. For this, there are a few suggestions. These do not just help in depression related sleep problems but are applicable to all people at all times. 1) Get into a routine with your sleep times. Get up at the same time each morning, even if you have not had a good night's sleep. Don't sleep during the day, and don't go to bed early to try and get more sleep. 2) Take some physical exercise during the day. This helps to make your body more tired in the evening and makes it easier to get to sleep. Exercise is good for you physically, and there's also research that suggests that exercise can itself be antidepressant. 3) Avoid exercise two hours before bedtime. This is because exercise 'activates' the body, which can make it difficult to get off to sleep. 4) Avoid watching disturbing or violent films prior to bedtime. 5) Avoid drinking caffeine (tea, coffee, cola) in the evening after 6 pm. Caffeine is a stimulant and can prevent sleep. Drink no more than four cups of tea, or of coffee, or cans of cola in a day. Drink warm milk or milky drinks such as Horlicks in the evening as milky drinks have been shown to be as good as sleeping tablets for many people. 6) Avoid heavy meals at least two hours before bedtime. It can be extremely difficult to get off to sleep with a full stomach. 7) Avoid alcohol in the evening. While alcohol is sedative, it does not lead to normal restful sleep. In addition, alcohol causes one to pass increasing amounts of urine, which further disrupts sleep. 8) You should associate your room with sleep: avoid having a TV or radio in your bedroom. If you do have them in your bedroom, turn them off at least half an hour before you lie down to sleep. 9) Your bedroom should be warm and familiar with a comfortable bed and duvet, etc. Ideally, the room should be decorated in a relaxing way. This all helps in associating the room in your mind with restful sleep. 10) Use aromatic oils in the bath or on your pillow, such as lavender, which can help relaxation. 11) Use relaxation techniques, like yoga or progressive muscular relaxation exercises. Reading in bed helps some people, but it can prevent others from getting off to sleep. If you do read in bed, only read light books or magazines which do not stimulate your mind. Regarding yoga exercises for back and sleep, here are a few: 1) Shavasana (the corpse pose) is very good for relaxation. 2) Viparita Karani (legs up the wall pose) involves putting the legs straight up either with the support of a wall or unsupported. It is good for both back and sleep, and relieves fatigue. 3) Bhujangasana (cobra pose). It is easy to do and very good for the back. It also relieves stress and fatigue. 4) Paschimottanasana (the seated forward bend pose). Stretches the entire back and the hamstrings and good for internal organs. 5) Anulom Vilom Pranayam. It is not a yoga pose but a breathing exercise and is very good for the nervous system. There are many more yoga exercises that would help but I have listed only those that are very easy to do and effective as well. I have not included detailed instructions for these yoga exercises as images would be more helpful and these are easily available on the internet. Just google each one and you will get both instructions and pictures describing how to do these. Last but not the least, please have a look at Jacobson's progression muscular relaxation exercise. It is very good for anxiety, depression and sleep. Detailed instructions are available at many sites. Here is a link for a pdf which you can print out ( WWW.WWWW.WW . It takes time to master but gives very good results. Hope you are able to sleep well soon! Let me know if you need any other information. Best wishes. Dr Preeti Parakh MD Psychiatry

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