We are what we eat and that doesn't just refer to food and drink. It also includes any herbal, prescription, over-the-counter, vitamin, mineral or illicit medication or drug that enters your body. Any or all of them might be affecting your ability to sleep or to feel alert, either alone or in combination. You have to look at the big picture and your local pharmacist is often the best healthcare person to help you do that. However, make sure that he/she must know all the substances that you are taking. There can be interactions not only between two or more prescription medications but also between prescription medications and alcohol, food, caffeine, herbal preparations or even sunshine.
Insomnia and/or sedation are probably two of the leading side effects of commonly used drugs. Below find a very broad breakdown of medications that could be causing you to have trouble falling asleep, trouble staying asleep, trouble getting back to sleep or trouble waking up. The medications are listed by their chemical or generic names with their brand names in parentheses.
Be aware that the so-called "natural" herbal supplements are not clinically tested, regulated or approved by the Food & Drug Administration (FDA). Therefore, there are no requirements, standards or regulations set regarding their proven safety, effectiveness, purity, recommended safe dose, recommended maximum dose, etc.
MEDICATIONS THAT CAN CAUSE INSOMNIA
ANTIHYPERTENSIVES
BETA-BLOCKERSMedications used to treat high blood pressure and
St. John's Wort (may also delay REM onset and/or cause PLMS)
ginkgo biloba
gInseng
caffeine-containing preparations
MEDICATIONS/SUBSTANCES USED TO TREAT INSOMNIA
HYPNOTICSPrescribed to help people fall asleep. Some are short-acting, others aren't. All are for short term use only (7-10 days). Hypnotics may reduce the quantity of delta sleep.
chloral hydrate
flurazepam (Dalmane)
lorazepam (Ativan)
temazepam (Restoril)
triazolam (Halcion)
zaleplon (Sonata)
zolpidem (Ambien)
ANTIDEPRESSANTSFrequently prescribed (off-label) for sleep. They may delay
REM sleep onset &/or cause insomnia and PLMS.
paroxetine (Paxil)
venlafaxine (Effexor)
sertraline (Zoloft)
fluoxetine (Prozac)
imipramine (Tofranil)
trazadone (Desyrel)
amitriptyline (Elavil)
doxepin (Sinequan)
fluvoxamine (Luvox)
mirtazapine (Remeron)
nefazodone (Serzone)
ANTI-ANXIETY MEDS May reduce the quantity of delta sleep & delay the onset of
REM sleep.
lorazepam (Ativan)
alprazolam (Xanax)
NARCOTIC PAIN MEDICATIONSMay reduce the quantity of delta sleep and may
depress the respiratory drive, causing lower oxygen levels and higher
carbon dioxide levels during the night.
oxycodone (Percocet, Percodan, Tylox)
morphine (MS Contin, Roxanol)
codeine
ANTIHISTAMINESMay cause residual drowsiness
astemizole (Hismanal)
chlorpheniramine (ChlorTrimeton, Pedia Care Allergy Formula)
BARBITURATESMay be highly addictive and may depress the respiratory drive,
causing lower oxygen levels and higher carbon dioxide levels during the night.
amobarbital (Amytal)
mephobarbital (Mebaral)
pentobarbital (Nembutal)
phenobarbital (Luminal, Phenobarbital)
secobarbital (Seconal)
thiopental (Pentothal)
ANTI-CONVULSANTS Can cause drowsiness and less frequently, insomnia
phenytoin (Dilantin)
acetazolamide (Diamox)
carbamazepine (Tegretol)
clonazepam (Klonopin)
diazepam (Valium)
gabapentin (Neurontin)
OTHER SEDATING AGENTS
diphenhydramine (Tylenol PM)
OTHER NON-PRESCRIPTION PREPARATIONS Keep in mind that products such as these are not clinically tested, regulated or approved by the Food and Drug Administration (FDA). Therefore there are no standards or regulations set regarding their proven effectiveness, purity, recommended dosage, etc.
melatonin
valerian root
chamomile
catnip
hops
lavender
OTHER POTENTIAL SIDE EFFECTS OF MEDICATIONS/SUBSTANCES USED TO TREAT INSOMNIA
They may help you fall asleep but may also interfere with the quality of your sleep.
Some of them may make you so sleepy that you are groggy or "hung over" the next
day or more prone to a fall if you get up during the night.
Fatal overdose, expecially when combined with alcohol or with other drugs that impair
the central nervous system Impaired coordination, memory, driving skills, and
thinking.
Interference with breathing
Physical or psychological dependence (unable to sleep without the medication).
Tolerance (the need to take larger and larger doses to achieve the same effects).
Potential damage to the kidney, liver, and lungs.
Confusion, hallucinations, and similar disturbances, particularly for the elderly.
If you feel you are experiencing any side
effects, talk to your pharmacist or doctor
to see if there is an alternative medication.
Subjective Insomnia
"I didn't sleep a wink all night." "I saw every hour pass on the clock." In reality, the majority of people who make these statements actually do sleep. It may not be deep, restorative sleep, but it is sleep. Sleep comes in stages. Some of those stages are light sleep, some are deep. In light sleep, you will often be unaware of the fact that you are actually asleep and in one of the deep sleep stages known as REM (rapid eye movement) sleep or dream sleep, you may dream that you are awake. If you think you didn't sleep, you may think you have a sleeping problem such as insomnia. This may in turn cause you to worry about not getting enough sleep. If you worry long enough, you may fulfill that self-fulfilling prophecy. In reality, if you are able to function during the day without falling asleep unintentionally, chances are you are getting enough sleep. If you do tend to nod off easily during the day during quiet activities, chances are you do have a true sleep disorder and should take steps accordingly. Take a Quick Screening Test, order a Personalized Sleep Analysis, or talk to your doctor about seeing a sleep professional in your area.
Women and Sleep
Women have their own set of sleep issues due to the hormonal fluctuations of pregnancy, the hot flashes of menopause and the bloating, tender breasts, headaches and cramps often associated with the monthly menstrual cycle and/or PMS. Hormone replacement therapy, controversial for the possible link to increased heart problems and various cancers, was at least thought to help with insomnia by reducing hot flashes in menopausal women. That theory has also started to lose favor.
These issues are only now starting to get the attention they deserve. More research is needed into the association between the female hormones and sleep disorders, including sleep apnea. In the meantime, women should talk to their OB/GYNs and read up on natural treatments and nutritional supplements to determine their options and then find what works best for them.
Worrying about not sleeping is one of the best ways to guarantee that you won't sleep. It is a classic self-fulfilling prophecy. Know and remember that if your body needs sleep, your body will sleep, IF YOUR MIND WILL LET IT. Try a new attitude and trust your body to know what is best for you. Repeat this mantra: "I don't want to fall asleep. I don't want to fall asleep." Focus really hard on not falling asleep, rather than focusing on the fact that you can't fall asleep. Or tell yourself you have to get up in half an hour & just want to catch a few quick zzz's. It's all in the attitude.
Worrying about life and the curves it throws us is the other common cause of worry insomnia, one of the most common types of insomnia. If it is an ususual or short lived tendency, just ride it out. But if it becomes the norm, you must takes steps to alter your behavior. Recognize that there is a time and place for worrying and while you are lying in bed trying to sleep is not it. After your evening meal, establish a new routine that involves sitting down in a quiet place with a "Worry Book." Write down any issues (work, school, family, personal) that are bothering you, any 'to do lists' that need to be formalized, any social wrongs that needs to be righted and of course any solutions or suggestions you may have to fix or eliminate these worries, realistic or otherwise. Once they are down on paper and the Worry Book is closed, give yourself permission to forget them until the next day. The Worry Book is not an instant fix, and will not always work. You have to willingly give the Worry Book the power to free your mind so that your body can get the sleep that it needs.
Feeling stressed or anxious at bedtime creates an unfriendly environment for the Sandman. It is advisable to avoid situations before bedtime that are known to be stressful, but that is unreliable at best. If you find it difficult to rid yourself of stressful or anxious thoughts as the bedtime hour approaches, despite using the worry book, try and establish a regular bedtime routine that involves low lights, soothing music and possibly a relaxing warm bath or shower followed by a massage. No bright lights; no alcohol, caffeine or nicotine; no computer, TV or telephone; no political or religious or money debates; NO CONTROVERSY. Learning and using relaxation or self-hypnosis techniques can also be useful. FInd what works best for you and use it regularly. If the routine becomes routine before bed, it helps to send a signal to the brain that sleep is to follow. A warm bath or shower about 90 minutes before bedtime raises your core temperature. As you start to cool off and your temperature drops, that is a signal to the brain that sleep is to follow. If is timed with the natural drop in body temperature that usually happens about 10 pm, your mind will be hard-pressed to over-rule both your body and your brain. Sleep should rule. For more suggestions read The Guide to Better Sleep Naturally.
Other Sleep Disorders
Generally speaking, if your bedpartner thrashes about a lot, is a restless sleeper or snores, snorts or stops breathing, he/she should be evaluated for obstructive sleep apnea. Check out the Quick Sleep Screening Test or Signs and Symptoms for other signs to look for. Many bedpartners lose sleep due to listening to make sure their partner starts to breathe again or elbowing them to turn over so they stop snoring. One woman I knew trained herself to fall aIsleep before her husband and to stay asleep because if she were to wake up she would be unable to fall back to sleep again because of his incredibly loud snoring. As a result, she suffered from frequent urinary tract infections due to retaining excessive urine in her bladder. After her husband started using CPAP for his obstructive sleep apnea, she was able to stay up long enough to empty her bladder before retiring for the night or could get up during the night to do so, if necessary, and she hasn't had a urinary infection since. If your partner only snores while on his/her back, buy a pocket t-shirt, put a tennis ball in it and have the snorer wear it backwards. Cheap and effective!
If your bedpartner's legs or arms jerk a lot while falling asleep or after falling asleep, he/she may have nocturnal myoclonus - uncontrollable leg or arm movements during the night. It is also known as PLMS or periodic limb movements in sleep. The specific cause is unknown but stress does tend to bring it out. Regular exercise (more than 4 hours prior to bedtime) and/or massage of the calves, thighs and buttocks at bedtime, help lessen or eliminate the jerking. As with sleep apnea, it is not unusual for the secondary victim of this syndrome to be the silent, suffering bedpartner. The afflicted person often sleeps right through the jerking while the bedpartner gets bounced, jossled and occasionally even bruised. The same is true if your bedpartner grinds his/her teeth. They may have headaches or radiating jaw pain the next day, while you are the tired one. Encourage them to investigate a bite block.
Chronic Pain or Stiffness
Generalized pain, pain due to arthritis, bursitis or disc issues, as well as migraine, cluster or frequent sinus headaches need to be evaluated by your primary care physician or a pain management specialist. It has been shown that a lack of sleep can bring on migraines as can too much sleep such as the "sleeping in" on weekends. There is a strong link between cluster headaches and the cyclically low oxygen levels of obstructive sleep apnea. While pharmacological treatments can help with the actual pain, they also can alter the actual quality of sleep. For example, opioids initially may cause insomnia in patients who are using them for the first time. Once a tolerance for the drug develops, the quality and quantity of slow wave (Delta) sleep as well as REM sleep will return to pre-treatment levels. Non-steroidal anti-inflamatory medications may increase the number of awakenings and delay the onset of slow wave (Delta) sleep. Using combinations such as tri-cyclic antidepressants and serotonin reuptake inhibitors should be carefully timed to maximize the sedating properties of the tricyclics and the alerting activities of the other. Antidepressant medications that increase norepinephrine and affect serotonin can help reduce the frequency of severe chronic headaches, as well as maintain continuous sleep for the entire night. Ask your doctor or pharmacist about these details. Relaxation techniques, biofeedback and self-hypnosis can often also be very helpful.
Stiffness or Pain in the Neck and/or Back
Pillow and mattress issues must be examined as potential culprits. Is your mattress or boxspring old, soggy or lumpy? Sometimes a sheet of plywood between the mattress and boxspring can temporarily postpone the need to purchase new ones. Is there enough room in the bed for you and your bed partner? Do you sleep better or worse when you sleep away from home? Are you using more than one pillow? The ideal sleep surface for most people is a mattress that is firm enough to keep your back in proper alignment and just one pillow. Too many pillows put your neck out of alignment. If you need to be propped up due to heartburn or reflux issues, put blocks under the head of your bed. If you need to be propped up due to shortness of breath, ask your doctor to write a prescription for a hospital bed and contact a medical supply company to deliver and set one up in your home. They will bill your insurance company accordingly.
Sleeping Positions
Whether you spend the night on your back, side or stomach is usually beyond your control. But most people have a favorite position in which they try and fall asleep. If you lie on your back, try and keep your knees bent or use a pillow under them so your back stays properly aligned. If you lie on your stomach, make sure your pillow isn't too stiff or high so that your neck is out of alignment. Also try and turn at the waist slightly
so that you can bend one leg. If you choose to lie on your side, you run the least
chance of back and neck problems, and some find that for both adults as well as
babies, sleeping on the left side, helps lessen heartburn or GERD.
Snorers often snore less if they stay off their back. Try the pocket t-shirt remedy: buy a pocket t-shirt. Put a tennis ball in the pocket. Have the snorer wear the shirt backwards while they sleep. It will usually keep the wearer off their back.
Occasional or Seasonal Headaches
Occasional or seasonal headaches might really be due to allergies, sinus congestion or dryness and can often be eased by the liberal use of an over-the-counter saline nasal spray, use of a room humidifier to increase the humidity in the bedroom to 30-40% or identification and removal of irritating or allergy causing triggers. Ask your doctor whether you might benefit from the use of prescription anti-histamines or anti-inflammatory nasal sprays.
Leg pain, cramps or jerking movements
Waking up with sore leg muscles can be the result of a couple of different activities that you might unknowingly be taking part in while sleeping. You may be experiencing leg cramps - a painful tightening of the calf muscle(s) that may or may not wake you up. If you are losing quality sleep over it, look into increasing the amount of regular excercise you get as well as the amount of calcium, potassium, magnesium and Vitamin C in your diet. Good sources might be bananas, oranges, grapefruits, salmon, sardines, soybean products, almonds, sesame seeds and dairy products such as yogurt and cottage cheese. These recommendations also are helpful for the two syndromes below, PLMS and RLS.
Sleep starts - leg or body spasms or jerks just as you are falling asleep, are normal and should not leave the legs sore or affect the ability to fall asleep or the quality of sleep. But if the legs (or less commonly arms) jerk periodically at regular intervals during sleep (and occasionally while awake), you may be experiencing PLMS (periodic limb movements in sleep) or nocturnal myoclonus, uncontrollable leg or arm movements during the night. While the afflicted person often sleeps right through the jerking, the bedpartner gets bounced, jossled and occasionally even bruised. This rhythmic jerking of the limb (in severe cases as often as every 30 seconds) happens during the first half of the night during NREM sleep and will prevent the restorative quality of the sleep. If the jerking is violent enough, there may be residual soreness. Of greater impact, is that someone with moderate to severe PLMS usually ends up with the primary symptom of a sleep disorder: excessive daytime sleepiness. Some antidepressant medications can make PLMS worse; ask your pharmacist if this could be a possibility. The specific cause of this syndrome is unknown but it affects about 5% of the general population, but 35% of adults over age 65. Men and women are equally susceptible, usually only after the age of 30, and stress does tend to bring it out. Regular exercise (more than 4 hours prior to bedtime) and/or massage of the calves, thighs and buttocks at bedtime, helps lessen or eliminate the jerking.
Restless Leg Syndrome (RLS)
A syndrome characterized by tingling, itching, creepy, crawly, pulling, aching sensations in the legs and occasionally the arms when sitting still or lying down, especially at bedtime. The uncomfortable sensations stop when the legs are moved, such as getting up and walking around, but they generally return when the motion stops. When enough sleep is lost from these sensations, the person can sleep until enough sleep debt is paid off and insomnia will again rule. It is only present in 5% of the general adult population, yet nearly 20% of pregnant women exsperience RLS, especially in the third trimester. 30% of the people with RLS will find it is hereditary and unfortunately harder to treat. The other 70% may be blamed on poor circulation in the legs, low iron level or anemia, vitamin or other mineral deficiencies, muscle disorders, alcoholism or kidney disease. Roughly 80% of the people with RLS have PLMS, as well. Caffeine, smoking, fatigue, sleeping in too warm a room or prolonged exposure to cold temperatures have been found to trigger the syndrome. It can occur at any age but usually is seen in middle age or older. Recommended treatments are hot baths, a heating pad, leg massages, ice packs, regular exercise or elimination of caffeine intake. Supplemental vitamin E or calcium have been found to be helpful. There are no medications that have been approved by the Food and Drug Administration specifically for the treatment of RLS, but several drugs have been studied. www.rls.org can give you more information about this frustrating syndrome.
"Sleeping In"
Why do both school-aged kids and adults alike look forward to weekends? So they can sleep in! It is practically a national pastime and one of the biggest causes of insomnia and the monday morning blues. Our bodies are regulated by an internal clock or circadian rhythm. It is approximately a 24 hour cycle and generally controls our sleep-wake cycle. Unless we override it by sleeping in. If you tend to have problems falling asleep and want to make up for lost sleep, the recommendation is to go to bed earlier but to still get up at the same time in the morning, every morning. Including weekends, holidays and vacations. That way your circadian clock stays in the same time zone. If you push it forward an hour or two by getting up later on Saturday morning and then push your bedtime forward an hour or two as well (it is after all the weekend, so of course you stay up later) and then also repeat this on Sunday, it is only natural that you will be tired on Monday when you revert to your early risetime. It is like a mini jet lag. Your circadian rhythm is still on weekend time.
Because it is bedtime
If you tend to have problems falling asleep, going to bed just because it is bedtime and then lying there because you are not actually sleepy, is a habit that needs to be re-examined. Do not go to bed unless you are sleepy. No matter what time it is. If you have not fallen asleep within 15 to 20 minutes, get up. Leave the bed and the bedroom. Go to another room and do something relaxing in low light. Read a boring book, listen to soothing music. Do not balance your checkbook, read a murder mystery or go on the internet. Go back to bed only when you are sleepy. Repeat this process every time you are not asleep within 15 to 20 minutes.
Leave naps for the nursery set
Traditional naps can do more harm than good by paying back just enough of your sleep debt to leave you refreshed for a short time. But then leaving you either not able to fall asleep in time to get in enough sleep before you have to get up the next morning or preventing you from getting enough uninterupted sleep that night. If you tend to have problems falling asleep, it is best to resist the urge to nap. Especially if it is after 3 pm. Instead, distract yourself with stimulating activities such as exercise, until the urge to nap passes.
The Second Wind
Some people think that going to sleep is like catching a wave. And if you don't catch the first one, there will be another one coming along in another hour or so. The problem is, that if you don't catch the first one at around 10 pm, there may not be another until midnight or later. And if you have to get up at 6 am, that is only 6 hours of sleep, when most people need more than that. If you tend to have problems falling asleep, it is important to pay attention to those waves and be ready for sleep when the first one comes along.
Don't count too many of those sheep
If you tend to have problems falling asleep and can't fall asleep within 15 or 20 minutes, get up. Leave the bed and the bedroom. Go to another room and do something relaxing in low light. Read a boring book, listen to soothing music. Do not balance your checkbook, read a murder mystery or go on the internet. Go back to bed only when you are sleepy. Repeat this process over and over if you are not asleep within 15 to 20 minutes. It is better to get out of the bedroom and be not sleeping than to associate being in the bedroom with not sleeping. The bed and bedroom should be for sleep and sex only.
Let Mellow Rule
If you tend to have problems falling asleep, it is a good idea to develop and stick to a bedtime routine to set the scene for sleep. To let the body and mind know that sleep is to follow. The routine should be just that: routine. Something to do every night, without fail. The purpose of the routine is to slow you down and set the mood for sleep. Avoid anything stimulating after dinner except for sex. Avoid arguments, controversial topics, money matters, school work or work work. Keep the lights low. Avoid the TV or computer for at least an hour before bedtime; listen to soothing music or read a book instead. Take a warm bath or shower about 90 minutes before bedtime. If you have a cooperative partner, convince them to give you a soothing massage. Except for the massage or sex, all the other activities should take place outside of the bedroom.
Exercise the mind and body
There is probably nothing more helpful to good sleep than exercise. It tends to help deepen your sleep and help you fall asleep faster. But the timing of the exercise is very important. Vigorous physical exercise should be done at least four to six hours before bedtime; mild to moderate exercise at least two to four hours before bedtime. In other words, all exercising should be done prior to the evening meal. It should also be done on a regular basis, ideally at least four days a week and for a total of at least twenty minutes per day. The intensity of the workout is up to you. Something as basic as walking is helpful for better sleep. But it is important that you don't just exercise the body. The mind must also be stretched and challenged, preferably on a daily basis. Balance the checkbook; read the newspaper editorials; do crossword puzzles, jigsaw puzzles or cryptograms. Search the internet. Study and memorize sports statistics. Play Trivial Pursuit, bridge, chess or cribbage, Join a book club. Working the "grey matter" helps keep it flexible and young and improves the quality and quantity of sleep.
Eat, Drink and be Merry
But not too close to bedtime. Avoid caffeine after noontime if you are at all sensitive to it. As you probably know, caffeine is a stimulant and therefore tends to wake you up. It can effect some people's ability to fall asleep for 10-12 hours after ingesting it, while most are only affected for six hours. The effect caffeine has on you is individual to your tolerance and often directly related to how much of it you are used to consuming. Some big coffee drinkers can go right to sleep after a cup of coffee, due to a personal tolerance. The only way to test your tolerance is to eliminate all sources of caffeine after lunch for a few weeks and see if you sleep better. And remember that is caffeine in all its forms: coffee, tea, soft drinks and chocolate.
Avoid alcohol within 4 hours of bedtime. It may start out as a stimulant but then becomes a depressant. The all too common nightcap may enable you to fall asleep faster and deeper, but only for a couple of hours. Then it tends to make you wake up more often for the rest of the night. As with caffeine, avoid alcohol within 4 hours of bedtime for a couple of weeks and see if the quality of your sleep improves.
Avoid nicotine within 4 to 6 hours of bedtime. Like caffeine, nicotine is a stimulant. When a smoker goes to sleep, they go into nicotine withdrawal which makes their sleep lighter and more disturbed. Research has found that nicotine is linked to difficulty falling asleep as well as difficulty staying asleep. There may also be a higher occurence of nightmares in smokers than non-smokers. Quitting smoking will have an immediate negative impact on your sleep, but the long-term effect on both your sleep and your general health will be a positive one.
Avoid fatty (fried foods such as potato chips, french fries), sweet (chocolate, peppermint), acid (tomato products, orange juice), or spicy (hot peppers, curry) foods within 2 to 4 hours of bedtime if you are at all prone to heartburn. In fact, avoid lying down at all within 2 hours of a meal as lying down makes heartburn worse. Elevating the head of your bed and lying on your left side are other helpful anti-heartburn measures. Most importantly, turn into a detective. Use the same tactics as when searching for the cause of an allergy. Eliminate all suspect foods and then re-introduce them one at a time every few weeks.
Drinking too much of any liquid can cause you to wake up more at night in order to urinate, especially as you get older. Avoid or limit drinking any liquids within 1 to 2 hours of bedtime.
While eating or drinking too much can negatively impact your sleep, going to bed hungry can also effect the quality of your sleep. If you tend to wake up in the middle of the night feeling hungry, eating a small snack before bed may be what you need. Good suggestions are foods containing tryptophan, an essential amino acid which helps us sleep, such as a small glass of warm milk, a banana and a teaspoon of peanut butter or other nut butter; or half a grapefruit. Other foods that are high in tryptophan include dates, figs, white rice, oatmeal, tuna, turkey, cottage cheese and yogurt.
The Sleeping Environment
TEMPERATURE Keep the room temperature on the cool side. Open windows, use a fan or an air conditioner. Use bed covers for warmth. Try a down duvet with a cotton cover for year round comfort. If your bed partner has a different temperature preference, try an electric mattress pad.
NOISEKeep it quiet. Use ear plugs, a fan or a white noise machine to block out noise.
LIGHTKeep it dark. Get room darkening shades and/or a sleep mask.
HUMIDITYKeep the humidity at 30-40% via a humidifier or dehumidifier, if
necessary. Dryer air than that dries out and irritates the nasal passages which can cause nose bleeds or a stuffy nose. Moister air than that encourages the growth of molds and mildew which can trigger allergies, sinus congestion and headaches, asthma and mucous formation, often accompanied by wheezing, coughing and
It is vital that the association between the bed, bedroom and sleep be a positive one. If you tend to have trouble falling asleep in your bed, but no problem at all falling asleep on the sofa or in the recliner, you may have developed a negative association between sleep and your bed. Do you tend to balance the checkbook or watch TV while in bed: It is advised that you not read, eat or watch TV in bed, or even in the bedroom. The bedroom should be used for sleep and sex only. Otherwise there can be confusion about whether you should be alert of sleeping when you are in the bed. You should read, snack or watch TV in another room. Better yet, you should design a bedtime routine that does not include TV, because it tends to be too stimulating.
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