I work certain shifts in the evenings until 1 am. I am a…

Thanks for that - I'll definitely give you some strategies, just trying to get a picture.

So, how stressed is work making you? Maybe you can rate it 0 (no stress) to 10 (high).

And is your main stress worrying about cases and clinical issues?

I'm also wondering - how much time do you spend relaxing/involve in leisure?

If you think there's any other key factors influencing your sleep, let me know eg. recent life changes.

Thanks for that.

I thought I'd explore stress - because stress keeps us awake.

So, not only are you working late:

- you have a clinically demanding role

- rumination about work matters keeps you awake

- you're working on major house renovations

- you're working non-stop

- your stress rating is 8/10 (almost a perfect score!)

Well, it's good we identified that.

If you mediate the stress (and the increased levels of the stress hormone cortisol that's keeping you awake), you can improve your sleep.

The stress in your life is too high.

Any ideas how you could reduce it?

I might also peruse some material on stress, to see if I can find something with useful strategies on stress and sleep that suits you. How does that sound?

I understand, it sounds like you have a lot to do.

I'd like to point out that the health literature does report a very strong stress-sleep link. I guess it's my duty to make you aware - even if you are super busy. Stress sounds like the major factor impairing your sleep and mental health.

Stress is modifiable.

If you modify the stress, you can regulate your sleep.

You say you can't reduce your stress, but maybe you can in many ways (do have a proper think about it before responding).

For example:

- maybe you could hire some people or some students to help you with the house

- maybe you could take some time off work

-  you said reading and sleep podcasts help (we just need to explore some strategies to keep you asleep, or to help you get back to sleep quickly)

- listening to worry-reducing meditation recordings on the way home from work can reduce stress (doesn't take up extra time)

Just ideas for you to consider.

Anyway, I'll see if I can find anything useful in the research on circadian rhythms and middle insomnia (waking up int the middle of the night) for you - and get back to you.

Hi again - I've reviewed the health literature specialising in middle/maintenance insomnia (waking after falling asleep) as well as circadian rhythms. I've summarised strategies for middle of night insomnia for you:

*How To Deal With 3 AM Insomnia (Sound Sleep Health)

If you fall asleep, then find yourself wide awake at 3:00 or 4:00 in the morning, you may have sleep maintenance insomnia . Its troublesome but there are ways to deal with this sleep disturbance.

---What causes sleep maintenance insomnia (trouble staying asleep)?

Underlying medical causes, including :

Depression

Chronic pain

Hormonal fluctuations

Gastrointestinal issues

Low blood sugar

Sleep apnea (central sleep apnea or obstructive sleep apnea)

Restless leg syndrome

Or environmental triggers like:

Sounds (eg smartphone, computer, or tablet chimes and notifications)

Temperature - too warm (turn on the A/C or a fan, use lighter blankets)

For most insomniacs, 3:00 A.M. awakenings are caused by stress and anxiety. If you can learn to manage your stress and reduce your anxiety, you can decrease periods of wakefulness or at least have an easier time going back to sleep.

Why 3:00 A.M.?

Sleep cycles may have something to do with it; at 3:00 you may be entering a lighter phase of sleep, which makes disruptions and awakenings more likely.

Some researchers speculate that during times of stress, excess adrenaline is stimulating your nervous system, keeping you awake.

Tips for 3 a.m. insomnia

If you have maintenance insomnia, you need to minimize the risk of awakenings and use techniques that help you get back to sleep more easily.

Before you go to bed:

Exercising moderately on a daily basis , preferably in the early morning or early afternoon. This improves sleep in people with insomnia. If it helps you to relax and shed stress, light stretching or yoga before bed can also promote a better sleep.

Don’t nap in the day. If you’re not sleeping well at night, the temptation is to make up for what missed by sleeping during the day. However, too much napping can disrupt your sleep schedule.

Avoid stimulants and alcohol. Don’t drink, eat, or take caffeine after early afternoon. Stay away from smoking, vaping, and drinking alcohol within a couple hours of bed, too. These behaviors are linked to fragmented sleep and middle-of-the-night awakenings, and some interfere with REM sleep. Caffeine and alcohol are dehydrating, which can disrupt your sleep cycle and wake you due to thirst.

Avoid diuretics. At night, limit liquids to avoid nighttime awakenings to urinate. Take care consuming diuretic foods, drinks, and medications, which stimulate the kidneys and increase bathroom visits. Examples of diuretic foods include coffee, caffeinated soft drinks, some herbal teas, asparagus, and watermelon.

Keep your room sleep-friendly. Darken your bedroom, keeping out all light, including the blinking or glowing lights from digital devices. Turn your alarm clock to the wall if seeing the time makes you feel anxious. Block out distracting sounds with white noise machines, fans, or earplugs. Keep the temperature cool, between 65 and 67 degrees.

After you awaken:

If you’re anxious, try a breathing exercise to calm your mind and cue your body to relax. Inhale a deep breath and hold it for a count of four, then release it for a count of four. If it helps, you can add a meditation phrase. For example, Inhale, breath; exhale, rest. Practice different breathing techniques.

Use guided visualization. Close your eyes and use your imagination to place yourself somewhere calm and soothing. Perhaps you love the sound of a waterfall in the forest. Maybe you like to envision your troubles as leaves floating down a river, away from you. You can have a vision ready for stressful moments, or you can plug in earbuds and listen to an audio track, gentle music, or a book on tape. The key is to stop your mind from dwelling on your anxiety about being awake. Refocus on relaxing thoughts.

If you cant fall back to sleep within 20 minutes, its best to get up and leave your bed. Sit in a chair, lie on the floor, or go to the couch. Keep the lights dim and engage in a relaxing, distracting activity that occupies your mind (like reading). When you feel drowsy again,return to your bed to try sleeping.

*When to see a doctor

If your insomnia is chronic or recurring and is preventing you from feeling rested and healthy, tell your doctor. A sleep specialist can help you determine if your insomnia has an underlying cause like sleep apnea, depression, or other health condition. The first step to treating insomnia is to see a professional to understand what’s causing it.

(https://www.soundsleephealth.com/tips-for-how-to-deal-with-3-am-insomnia/)

*How to go back to sleep after waking up in the middle of the night

If you’re having trouble getting back to sleep after waking up, avoid doing anything mentally stimulating and focus on doing relaxing things.

1. Get rid of bright lights or loud sounds

If you’re having trouble falling back asleep, look for any lights in your bedroom that may be disturbing you. LED lights from electronics and light coming through your window may it more difficult to fall back asleep.

If a disturbing sound is coming through your window from outside, try shutting your window to block it out. Using earplugs, turning on a fan, or listening to white noise can also help you drown out disturbing sounds.

2. Get out of bed and move

Many sleep experts recommend getting out of bed and going to a different room if you’re unable to fall back asleep within about 20 minutes.

Moving into a different room and doing something relaxing to distract your mind for a few minutes may make it easier to fall back asleep when you return.

3. Avoid staring at the clock

Staring at the clock may make you feel anxious about not sleeping, especially if you already experience anxiety.

4. Avoid checking your phone or other screens

Screens from smartphones and other electronics emit blue light that may suppress your body’s melatonin production. Melatonin is a hormone made by the pineal gland in your brain that helps regulate your circadian rhythm and sleep cycles.

While it’s best to avoid checking your phone at night because of the potential for mental stimulation, there are some ways to reduce your exposure to blue light.

Many devices offer a nightshift mode that changes your screen to a warmer tone. Glasses with amber lenses are also an inexpensive way to block out blue light.

5. Meditate or try breathing exercises

Performing breathing exercises or meditating may help calm your mind and induce sleep. These techniques may also distract you from worrying about falling asleep.

One exercise you can use is called the 4-7-8 breathing technique. With this technique, you inhale through your nose for 4 seconds, hold your breath for 7 seconds, and exhale through your mouth.

6. Relax your muscles

One technique that helps people to sleep is performing a full-body body scan.

Close your eyes and breathe slowly.

Focus on your face and think about relaxing each of the muscles.

Move to your neck and shoulders and think about relaxing them too.

Continue relaxing muscles in different parts of your body until you make it to your feet.

7. Keep your lights off

Even if you get out of bed, resist the temptation to turn on your lights. As with phone screens, the bright light can interfere with your body’s production of melatonin and stimulate wakefulness.

8. Focus on something boring

Any variation of the classic “counting sheep” technique, or a boring task that occupies your mind, may help distract you and make falling asleep easier. Reading a boring article or book may also work.

A part of your brain called the nucleus accumbens plays a role in motivation and pleasure. This part of your brain might explain why people fall asleep when bored.

9. Listen to relaxing music

Relaxing music may help relax your mind and coax you to sleep. It can also block sounds that may be disrupting your sleep. You may want to experiment with several different types until you find one that works for you.

10. Try sleep apps

Many people find that sleep apps help them fall asleep faster by making them feel relaxed. There are many sleep apps that offer relaxing stories, music, or sounds. Find one that works for you.

(https://www.healthline.com/health/how-to-go-back-to-sleep#tips)

Make your bedroom a sleep sanctuary. Reserve it for sleep, intimacy, and restful activities such as meditation and reading for pleasure. Keep it cool, dark, and quiet. To block out noises, use a fan or other appliance that produces a steady "white noise."

Set a regular sleep schedule. Try to go to bed and wake up at the same time every day, which helps synchronize your sleep-wake cycle.

Limit awake-time in bed. If you don't get back to sleep within 20 minutes after waking up in the middle of the night, get out of bed and do something relaxing until you feel sleepy again.

Stay away from stimulants. Avoid caffeinated beverages (coffee, many teas, chocolate, and some soft drinks) after 1 or 2 p.m.—or altogether, if you're especially caffeine-sensitive.

Get regular exercise. Aerobic exercise such as walking, jogging, or swimming can help you fall asleep faster, get more deep sleep, and awaken less often during the night.

(https://www.health.harvard.edu/sleep/awake-at-3-am-strategies-to-help-you-to-get-back-to-sleep)

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A range of behavioural strategies to stabilise your natural circadian rhythm can be found here:

https://www.healthline.com/health/healthy-sleep/how-to-fix-sleep-schedule#keep-it-regular

You can read about melatonin supplements to aid circadian rhythms, as well as controlling noise and light:

https://www.webmd.com/sleep-disorders/melatonin-dos-donts

Well, I hope this response has been useful.

Kind Regards