I used to have anxiety issues because of my childhood and also I have problem in sleeping. I used to sleep around 5-6 am in the morning. Doctor gave me medications 1) depran-forte[escitalopram 20 mg; clonazepam ip 0.5 mg] 2) mirtee 15 mg 3) quel 25 mg 4) veegy 4g these medicines worked very well for me and now I have very less anxiety issues. But still I am not able to sleep at night. I smoke around 10-15 cigarettes a day. Does smoking hamper sleep? Is it because of smoking that these medications are not working for sleep? Plzzz help?

Mr. Saul PereiraPsychologist52yrs exp

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Yes, smoking can hamper sleep. Since you seem to have identified issues from childhood, have you thought of seeking the help of a counselor? If you have skewed your biorhythm by this extent, then you will need to give yourself some time before it returns to the normal cycle. Even if you feel less anxious visibly, there could be underlying factors to consider that may disturb sleep. You need to check on your prenatal history and early childhood for influencing factors. You must combine medication with therapy. This is extremely important for your anxiety and depression. Life is full of problems as a norm. Any attempts to escape will never help: you must learn to face these problems every day with good success. The counselor will help you in this regard. I also strongly believe that every crisis offers an opportunity for change, if you seek it and grab the opportunity. Please meet with a counselor and work on your emotions, particularly anger and fear. Exercise is very important but you have to build on it developmentally. I suggest you do the opposite of what this depression makes you feel like doing (actually, not doing): you will need to fight this condition. You must become active; stay upright during the daylight time; meet people; never sleep during the day, wake up by 6 am every day, play some active games, especially contact games, do physical exercises, talk to people and join some social clubs, attend yoga classes etc. Watch sitcoms on tv or comedies and cheer yourself up. Go for excursions in groups, for outings, camps, conferences, and religious conventions. Get a pet dog and spend time training it, exercising it and relating to it. Expose yourself to some sunlight every day, at least 30 minutes but not in the scorching heat. Whatever happens, please incorporate these three important adaptations in your life: always be responsible, be respectful, and be functional. If you did these three, lots of things will go well in life. Please pray and have faith in god to alleviate your sufferings. Don?t wait for others to help. Use your own motivation, which might be at its lowest, but persevere and win this battle. Above all to be really happy, you need to live in love and for love. Learn all about emotions and how to handle them and that will get you out of the depression rather easily and quickly. A counselor is there only to facilitate you, all the hard work must come from you, and your cooperation with that person is very critical for your success. Be positive every day and learn to be content with what you have. Whatever happens please cooperate with the therapy and do not discontinue until the condition is completely resolved. The lack of sleep, i.e. Sleep for less than 6 hours per night, is directly linked to about 86 diseases! so let us first focus on that. In your case particularly, do not sleep during the day; don?t even lie down. Go for regular exercise (breathing through your nostrils only) at a fixed time (at about 6 am) every day, whether you sleep or not. You must develop this habit of sleeping by 10 pm latest every night and wake up at a uniform time by 6 am every morning, even if you do not get sleep. If you do not get sleep, just lie down and if you have a bed lamp (or you could get one) lie down and read something light but not exciting. Your eyes will tire and you will fall asleep. If you like you may also put on light and soft music with the sleep function on. Depending on whether you are a visual or auditory person, you may watch tv in a lying down position until you feel sleepy. Have a warm bath before going to bed (for some people a cold bath at night seems to induce sleep! if you are one of them, please do so). Place the head side of your bed in a north-south position. The room must be as dark as possible and there should be no electronic items that give off even a light led glow. There must be ample ventilation in the room. Avoid strong odors, except lavender, on your body or in the room, or on your sheets and clothes. There should not be any live plants in your bedroom. Sleep with the lightest of clothes or without any clothing. When lying down to sleep, lie down on your left ear as much as possible. Do not sleep directly under an overhead fan. You must eat a good breakfast, a fairly light lunch, and an early dinner, which should be a very light meal. Whatever you eat in the other meals, have only a pure carbohydrate meal at night with any vegetables, and preferably before 8 pm. Do not drink much liquids after or near about dinner time. If you know emotional freedom technique or eft (check this out either on youtube or google), then please practice this too for sleep induction. Self-hypnosis and slow relaxation techniques, at night will be tremendously useful. Acupuncture or acupressure will both be very useful too. You can also try the 4-7-8 breathing pattern, which is to breathe in for four counts, hold your breath for 7 counts and exhale with a whoosh sound for 8 counts. This is to be done four times at a time first thing in the morning and last thing at night, and any number of times during the day. While doing this exercise place the tip of your tongue on the roof of your mouth. The effects will be seen after a few days. Pray last thing at night before you sleep.  

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