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"Mary Kator, 48, can't count the number of nights she's spent tossing and turning, trying to get a good sleep. It's a problem the Oakville, Ont., resident has struggled with for years, and it didn't just take a toll on her energy level. The lack of sleep also had an impact on her physical and mental health," writes Carly Weeks in Sleepless nights more harmful for women then men.

"Many Canadians are all too familiar with how difficult it can be to get the amount of sleep required to function properly. But researchers have found new evidence that shows women face far greater risks of health problems than men as a result of sleep deprivation."

That may be true, but both men and women know the exhaustion sleepless nights can cause. Dr. Charles Samuels, medical director of the Centre for Sleep and Human Perfomance in Calgary, took your questions on sleep.

His answers are now available at the bottom of this page.

Dr. Samuels is the medical director of the Centre for Sleep and Human Performance (CSHP) in Calgary. Dr. Samuels spent several years practicing Family Medicine in rural Alberta, where he became interested in sleep medicine. He turned his clinical practice and research focus on the effect of sleep deprivation and disruption on human health and human performance. Specifically, Dr. Samuels' expertise is the effect of sleep on weight control and obesity, alteration in mood, and cognitive processing including memory and concentration.

Editor's Note: globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Alistair McLaughlin, Canada: Dr. Samuels, What is your opinion on the effectiveness of bright light therapy to help regulate one's sleep/wake cycle? I've had trouble with what is described as a 'delayed sleep phase' since I was a kid (I'm 38 now), and I've heard that bright light therapy can be helpful to reset one's circadian rhythm. Are the so-called 'blue light spectrum' light boxes any more effective than the regular ones?

Charles Samuels: This is a very interesting physiological phenomenon that is partly genetically based and subsequently environmentally reinforced. I often described delayed sleep phase syndrome (dsps) as "permanent jet lag" because the brain's biological clock is set at a different time zone. Yours is likely on the west coast if you live in To. The brains biological clock dictates the entire bodies circadian rhythm which can effect specific functions such as hunger. Most "night owls" do not like eating breakfast and this delays caloric consumption subsequently increasing the amount of caloric consumption late in the day and increasing the propensity toward difficulty controlling weight. Bright light therapy (10,0000 Lux in the range of 450-550 nm) is the most potent "phase shifting" intervention to correct the sleep phase. Additionally Melatonin (synthetic) 1-3mg 4-5 hours before sleep onset for 1-2 weeks has been shown to adjust the sleep phase in dsps. But more importantly adjusting the eating schedule reinforces the phase shift (eating at a regular schedule and in the morning) and improves weight control. There are many types of SAD lights simply find one that meets the specifications mentioned.

Jimmy Smits, Oakville: This is difficult to explain, but it's a problem that I've had since I was 13 years old. Every time I try to go to sleep, my brain start firing on all cylinders. I just can't stop thinking. Granted, I seem to solve a lot of problems this way. This never happens when I try napping during the day. How can I shut my brain off!?!?!?!

Charles Samuels: This is probably one of the most common problems that presents to family physicians and sleep physicians and is a form of insomnia. However two problems converge: one is that you may be a bit of a night owl and you are trying to go to bed before your brain is ready. This then results in difficulty relaxing and settling into a sleep state. If you are a bit of a mentally active individual you will start to "think" and this creates a psychological barrier to the onset of sleep. And/or you could simply be an anxious, type A, perfectionistic, obsessional person (the typical personality profile) who has great difficulty calming down and at night you finally have time to go over your day etc. Then in the afternoon you are so sleep deprived you just fall asleep. The afternoon sleep will definitely affect your ability to fall asleep at night as well. I strongly recommend a good self help book called "Say Goodnight to Insomnia" by Gregg Jacobs. If that doesn't work you should see your family physician and possibly get a referral to a sleep specialist of which there are many in your area.

Amy Nelson, Toronto: Dear Dr. Samuels, I am a 29-year-old media professional, very active (work out 3-5 times per week, walk to and from work 3-4 times per week), who eats well and limits caffeine intake (two cups of tea or coffee in the morning, c'est tout!). I work hard, do have a fairly stressful job in sales, active social life, and I just can't seem to turn it off at night. Rather, I can't seem to keep it off! I'm absolutely exhausted by 9:30 or 10pm, fall asleep quite easily, but then wake up between 1-4am, and fall back asleep just before my alarm rings. This pattern has been established over the past year-and-a-half, certainly is stress related, but I can't seem to get over this hump! Help! Tired in Toronto (sorry, that was quite lame). Amy Nelson

Charles Samuels: Ahhhhhhhhhhh the media professional! You are not alone, the most common presentation of sleep difficulty to a family physician is yours! While it is frustrating to hear that you can't "burn the candle at both ends" and sleep, this is the truth. It has to do with your brain's response to stimulation. As you stimulate yourself to excess (common in the media industry in the 30 y/o crowd) your brain responds by becoming more stimulated and less able to achieve a sleep state. So you need to understand that there is a difference between "being exhausted" and "being sleepy." Exhaustion does not beget sleep necessarily. The pattern you have developed is now reinforced by your lifestyle and will become quite entrenched leading to Chronic Insomnia (you don't want that). This puts you at higher risk for comorbid conditions such as depression, anxiety disorder, chronic pain syndromes. So once again I recommend the book "Say Goodnight to Insomnia" by as a self help approach. I am a firm advocate of yoga and meditation to begin the process of learning to calm your mind. Behavioural management of insomnia is the foundation of treatment followed by medication if necessary. If these things do not work then see your family physician and consider a consultation with a sleep specialist.

Heather Wilkey, Calgary: Dr. Samuels - My problem is not falling asleep, it's staying asleep. Three to four nights a week I awaken from a sound sleep in the middle of the night for no apparent reason, and then have trouble falling back asleep. I usually start the week well rested, but get less and less sleep as the week goes on, so that I am nearly a zombie by Fridays. I have tried cutting back on afternoon coffee and evening activities, to no avail. I am a busy mom, and any suggestions you have to help me get a full nights rest would be appreciated! Thanks very much

Charles Samuels: This is a very common variation on other descriptions of psychologically reinforced insomnia however it is important to determine the trigger that wakes you. If this is psychologically reinforced there is no trigger you simply wake at a sleep stage transition and then have difficulty returning to sleep. As a "busy mom" if you are busy right up to bedtime this will definitely affect the quality of sleep you get and your ability to sustain sleep through the night. This type of sleep difficulty should be evaluated by your physician or a sleep specialist because there may be something wake you in your sleep that needs to be addressed. Especially if you have tried the standard lifestyle interventions. The daytime fatigue is a concern when parents are driving children because this affects attention and concentration while driving and can be a safety issue. In addition there is a quality of life issue because the accumulation of fatigue over the week affects your ability to enjoy free time with the family on the weekends.

Karen S, Halifax: How do you really know when 'troubled sleeping' is bad enough to seek medical advice? I've never slept through the night, but now it's at the point where I fully wake out of a dead sleep every couple of hours every night. I never feel well-rested, but I don't feel terrible either. I figured I inherited my parents' insomnia, but with all of the recent media attention on sleep, I'm starting to wonder if I actually have a problem. Thanks!

Charles Samuels: This is an excellent question because media attention while important does have the tendency to create anxiety and fear regarding health issues. I am and will remain the eternal skeptic when it comes to sleep and health. However the familial pattern and personal sleep history you describe is typical of people who develop chronic insomnia. The question is whether your insomnia is affecting your quality of life. As researchers we measure sleep quality and quality of life with respect to sleep to determine if it is "clinically significant". The most important thing to understand is that we all have a predetermined "sleep requirement" and if we continually get too little sleep this will catch up with us and it will have a negative health implication. Insomniacs tend to require less sleep to function normally and have a good quality of life but they also tend to be more distressed by the insomnia which in return disturbs their sleep. So we focus on helping insomniacs cope with their sleep difficulties and really to minimize their self induced stress over the sleep issues. This is often very effective and they find that with 6 - 7 hours of sleep per day they do very well. As for you the fact that you "never feel well-rested" is important because for the most part we should feel well rested most days if we get a good nights sleep. However you probably are accommodated to feeling "tired all the time" and I often find that when we help people they begin to see that they really were not feeling well but they just accepted it. Its not that you have a problem you just need help managing your sleep issue more effectively. Once again self help books, counselling around sleep with a good psychologist or seeing a sleep specialist would be helpful.

Darlene Yee, Ottawa: Is it better go without sleep for a couple nights or take a Rx sleeping aid to help you get a good night sleep?

Charles Samuels: It is better to get your sleep issues addressed properly and we do not recommend the use of over the counter (OTC) sleep aids, which for the most part are antihistamines. The only OTC sleep aid (sedative) that has been studied and shows some efficacy is Valarien root, to my knowledge. My guess is that if this is your pattern you can probably treat your sleep problem behaviorally not with medication or sleep aids. Again find a good self help book on sleep and learn about how sleep happens and what we do to impair sleep mechanisms through our activities of daily living and lifestyle choices.

Zerah Lurie, Toronto Canada: Hello. I am a consummate night owl - always able to stay up late and having the most energy past 10 pm. Normally, this doesn't cause any problems and I enjoy the late night hours quite a lot but I just started a new job that requires me to wake up very early and now I am never getting enough sleep. I know I should go to sleep earlier but I never seem to be tired at night even though I am always tired when I wake up (and during most of the day). Is there any way for a night owl to become a morning person?

Charles Samuels: This is similar to one of the other questions and of course your "night owl" tendencies are no problem until you have to wakeup! Early morning light therapy with the bright lights used to treat Seasonal Affective Disorder (30-60 minutes of light exposure within one hour of waking up) will adjust your clock to the new time. Melatonin (synthetic) 1-3 mg 4-5 hours before bedtime has been shown to be effective in phase shifting the biological clock. I see many patients with your history and we can very easily and effectively shift your clock however it requires immense discipline and determination on your behalf to stick to a routine. And YOU MUST EAT BREAKFAST! (notice my emphasis)

Gary MacDonald, Red Deer, AB: Dr. Samuels, I go to bed and get up consistently through the week. The environment is good. I take 5-10 minutes to get to sleep and average 6 hours of sleep, usually ending about 6:30 a.m. I seldom feel tired until well into the evening. The problem is this: often I awaken for 5-10 minutes around 5:30 a.m., then sleep another hour. Given that I am tired enough to be able to sleep that last hour, why would I awaken? How can I extend my sleep toward 7 a.m.?

Charles Samuels: First of all who cares! If you sleep that well, no worries, why do you want to sleep till 7? The awakening you have at 5:30 AM is normal and reinforced by looking at the clock, so stop that! The most important marker in sleep is "spontaneous awakening in the morning". So if you wake spontaneously at 630 feeling rested and finished with your sleep and are able to get through the day without fatigue and sleepiness you are the luckiest guy I would ever see. Now if you feel you need to sleep longer then that is different and you are sleep deprived and actually need more sleep than you think. Sleep is like "money in the bank" you gotta put it back in or you run out and can't pay the bills. So you need to figure out your sleep requirement if it is 6 hours no sweat but if it is 7-8 you need more sleep. So the "last hour" is your brain saying "I need more sleep." The awakening is due to a sleep stage transition which is a normal point of arousal in sleep. Of the dozen questions you have the most normal sleep, congratulations, enjoy!

SN, Toronto: There is a lot of confusion as to how much sleep one really needs. Examples are cited of physicians and surgeons who work so hard and so late that they get along pretty will with barely 4 -5 hours of sleep. Others argue that it is not how much you sleep but how well you feel refreshed and so 7-8 hours a night is just not a universal prescription. Can you explain?

Charles Samuels: Great question, this problem has been plaguing sleep science for decades and it was in the mid to late 90's that a landmark study done at the University of Pennsylvania was published and a great fuss was made over the fact that adults require 8 hours of sleep a night to function normally the next day and this was attached to concentration impairment and motor vehicle crashes. The same group has gone on to demonstrate exactly what you point out, that there is "interindividual variability" in the human response to different doses of sleep deprivation. However for the most part in humans if you keep them up for greater than 17-20 hours brain function and capacity to attend to tasks requiring concentration declines dramatically and has been shown to be similar to the impairment associated with being over the legal limit of alcohol intoxication. This is the focus of my field research with the Calgary Police Service and the Winter Olympic Team athletes. We study sleep deprivation thresholds to see who can tolerate more sleep debt and continue to perform at a high level. So we know that jet fighter pilots, surgeons, etc likely self select to these occupations because they can tolerate the accumulation of sleep debt. However there is a limit for humans and there are many people who continue to work in safety sensitive occupations who are "impaired" this is simply due to the demands of our 24/7 society. I recommend the book "The Twenty-four hour society: Understanding Human Limits in a World that never Stops" by Moore-Ede.

Paul Delaney, Ajax: Dr. Samuels. I am trying to stop taking my sleep medication drugs. I am presently taking 1 tablet of Apo-Temazepamm 15mg. before going to bed each night . I have been taking this medication for 7 weeks. I saw my doctor the other day and asked him to prescribe a medication that was a lighter dose and something that would be easier for me to wean myself off of. The name of the medication is Trazadone 50mg. Can you offer me some advice on what i can do to stop taking the sleeping aid medication.

Charles Samuels: I applaud your physician's approach. The only thing we would recommend is that the behavioural aspects of your insomnia be addressed as well with cognitive behavioural therapy with a therapist or with self help books such as the one I have recommended to others "Say Goodnight to Insomnia" by Gregg Jacobs.

Nature Lover, Two Hills Canada: My 18 year old son has always been a difficult sleeper. We have been to the doctor with him and the advise given was that he will grow out of it. His preferred time of wakefulness is between 3 pm and 4 am. Of course this affects his ability to have a job, as only certain jobs are available during these times. Now that he's an adult, I don't feel I have the right to trot him around to Drs. looking for a cure he doesn't seem to want or need. He's fine with this arrangement, which I believe is wrong, and cannot tolerate in our home. I fear there is an underlying, undiagnosed disorder that is the cause of this sleep preference. Any comments.

Charles Samuels: Yes, like two others in the list he likely suffers from delayed sleep phase syndrome and this is easily treated by a sleep specialist. Just see your family physician and have him referred to a sleep centre. Keep in mind night owls like being night owls so they have to be motivated to change their routine or nothing works.

Murray B, Regina: I snore. How would that typically affect the quality of sleep of my partner?

Charles Samuels: Great question and your partner is lucky you are even asking the question! I can't believe what bed partners of snorers put up with! First of all if the bed partner complains, it is true you do snore and it is disturbing to their sleep and can actually cause an insomnia that is devastating. What amazes me is that they don't leave the bedroom or use earplugs (two simple effective solutions). So what happens is that the snoring creates a disturbance that lightens the partners sleep quality and causes sleep fragmentation. Also if the snorer has sleep apnea (stops breathing in sleep and chokes while sleeping) this is very disturbing to both the snorer and the partner. So I strongly recommend that you have the snoring addressed by seeing your family physician and getting a referral for assessment of sleep apnea and snoring. Treatment of your snoring will vastly improve your partner's sleep.

Please note that Dr. Samuels' advice is based solely on the information provided in the questions amd should not be seen as a replacement for your own medical doctor's advice.