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Eating a small snack a few hours before bedtime may help. There are no specific foods that help you sleep. But, it’s a good idea to avoid certain foods late in the day. Here are a few things to keep in mind:
•Don’t go to bed hungry. A light snack before bedtime can keep hunger pangs from waking you up. For example, have a bowl of oatmeal, cereal with low-fat milk or yogurt with granola. If you have diabetes, discuss nighttime snacks with your doctor.
•Avoid large, high-fat meals late in the day. Also avoid garlic-flavored and highly spiced foods. These foods can make you uncomfortable or cause heartburn.
•Avoid alcohol and caffeine. Both can interfere with sleep. Keep in mind, it can take up to eight hours for the stimulating effects of caffeine wear off.
•Don’t drink too much liquid. Drinking lots of fluids before bed can cause you to wake up repeatedly to use the bathroom.

Everyone has trouble sleeping from time to time. But if you frequently have insomnia, see your doctor to find out what steps you can take to improve your sleep.

Waking up in the middle of the night is called sleep maintenance insomnia, and it’s a common problem. Midsleep awakenings often occur during periods of stress. To help stay asleep through the night, try some of these strategies to relieve insomnia:
•Establish a quiet, relaxing bedtime routine. For example, drink a cup of noncaffeinated tea, take a warm shower, or listen to soft music.
•Stretch or do some gentle yoga. This can ease tension and help tight muscles relax.
•Put clocks in your bedroom out of sight. Clock-watching causes stress and makes it harder to go back to sleep if you wake up during the night.
•Avoid caffeine after noon, and limit alcohol to one drink several hours before bedtime. Both caffeine and alcohol can interfere with sleep.
•Get regular exercise. But keep in mind, exercising too close to bedtime may interfere with sleep.
•Go to bed only when you’re sleepy. If you aren’t sleepy at bedtime, do something relaxing that will help you wind down.
•Wake up at the same time every day. If you go to sleep later than usual, resist the urge to sleep in.
•Avoid daytime napping. Napping can throw off your sleep cycle.
•If you wake up and can’t fall back asleep within 20 minutes or so, get out of bed. Go to another room and read or do other quiet activities until you feel sleepy.

In some cases, insomnia is caused by a physical condition such as sleep apnea, restless legs syndrome or chronic pain. Treatment for an underlying condition may be necessary for insomnia to get better.

Insomnia can be linked to mental health disorders, particularly depression. Both depression and insomnia may improve with medications such as antidepressants or psychological counseling.

If you keep having sleep problems, talk to your doctor. In order to determine the cause and best treatment for insomnia, you may need to see a sleep specialist. Over-the-counter sleep aids rarely offer significant help for this problem. Your doctor may prescribe medication and have you try some other strategies to get your sleep pattern back on track.

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Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

Insomnia is a serious disorder, and effective treatment can be crucial to getting the sleep you need. Explore safe, effective, nondrug insomnia treatments.

Insomnia is a common problem characterized by trouble falling asleep, staying asleep or getting restful sleep, despite the opportunity for adequate sleep. Cognitive behavioral therapy for insomnia, often called CBT-I, is an effective insomnia treatment for chronic sleep problems.

Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

To make effective changes, it’s important to understand sleep cycles and learn how beliefs, behaviors and outside factors can affect your sleep. To help decide how to best treat your insomnia, your sleep therapist may have you keep a detailed sleep diary for one to two weeks.

How does cognitive behavioral therapy for insomnia work?

Cognitive behavioral therapy for insomnia aims to improve sleep habits and behaviors. The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. For instance, this may include learning how to control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

Depending on your needs, your sleep therapist may recommend some of these CBT-I techniques:
•Stimulus control therapy. This method helps remove factors that condition the mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can’t go to sleep within 20 minutes, only returning when you’re sleepy.
•Sleep restriction. Lying in bed when you’re awake can become a habit that leads to poor sleep. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
•Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
•Sleep environment improvement. This offers ways that you can create a comfortable sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view.
•Relaxation training. This method helps you calm your mind and body. Approaches include meditation, imagery, muscle relaxation and others.
•Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Paradoxically, worrying that you can’t sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
•Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension and shows you how to adjust them. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep.

The most effective treatment approach may combine several of these methods.

Cognitive behavioral therapy vs. pills

Sleep medications can be an effective short-term treatment — for example, they can provide immediate relief during a period of high stress or grief. Some newer sleeping medications have been approved for long-term use. But they may not be the best long-term insomnia treatment.

Cognitive behavioral therapy for insomnia may be a good treatment choice if you have long-term sleep problems. You may want to try it if you’re worried about becoming dependent on sleep medications, if medications aren’t effective or if they cause bothersome side effects.

Unlike pills, CBT-I addresses the underlying causes of insomnia rather than just relieving symptoms. But it takes time — and effort — to make it work. In some cases, a combination of sleep medication and CBT-I may be the best approach.

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When doctors believe someone has antisocial personality disorder, they typically run a series of medical and psychological tests and exams to help determine a diagnosis. These evaluations generally include:
•Physical exam. This is done to help rule out other problems that could be causing symptoms and to check for any related complications.
•Lab tests. These may include, for example, a complete blood count (CBC), a thyroid function check, and screening for alcohol and drugs to determine if there are other causes for symptoms.
•Psychological evaluation. A doctor or mental health provider explores thoughts, feelings, relationships, behavior patterns and family history, which may include psychological tests about personality. He or she asks about symptoms, including when they started, how severe they are, how they affect daily life and whether similar episodes have occurred in the past. The doctor also asks about thoughts of suicide, self-injury or harming others.

A person with antisocial personality disorder is unlikely to provide an accurate account of his or her signs and symptoms. Family and friends may be able to provide helpful information.

Pinpointing the type of personality disorder

It’s sometimes difficult to determine if symptoms point to antisocial personality disorder or another personality disorder because some symptoms overlap more than one disorder. A key factor in diagnosis is how the affected person relates to others. Someone with antisocial personality disorder is likely to have an accurate — sometimes superior — understanding of others’ thinking with little awareness or regard for their feelings. This leads the person to act out and make other people miserable — with no feeling of remorse.

Diagnostic criteria

To be diagnosed with antisocial personality disorder, a person must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.

Symptom criteria required for a diagnosis of antisocial personality disorder include:
•Being at least 18 years old
•Having had symptoms of conduct disorder before age 15, which may include such acts as stealing, vandalism, violence, cruelty to animals and bullying

•Repeatedly breaking the law
•Repeatedly conning or lying to others
•Being irritable and aggressive, repeatedly engaging in physical fights or assaults
•Feeling no remorse — or justifying behavior — after harming others
•Having no regard for the safety of self or others
•Acting impulsively and not planning ahead
•Being irresponsible and repeatedly failing to honor work or financial obligations

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It’s the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of these factors:
•Genetics. These inherited tendencies are aspects of a person’s personality passed on by parents, such as shyness or having a positive outlook. This is sometimes called temperament.
•Environment. This means the surroundings a person grows up in, events that occurred, and relationships with family members and others. It includes such life situations as the type of parenting a person experienced, whether loving or abusive.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some people may have genes that make them vulnerable to developing antisocial personality disorder — and life situations may trigger its development.

There may be a link between an early lack of empathy — understanding the perspectives and problems of others, including other children — and later onset of antisocial personality disorder. Identifying these personality problems early may help improve long-term outcomes.