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Insomnia - Common But Not An Epidemic

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Insomnia: it is common, but it's not as big an epidemic as you think.

Whenever I do a talk show or a speech, someone always asks me if I have any special tips for how to deal with insomnia, a condition that means chronically having insufficient sleep to function effectively.

We don't necessarily need eight hours of sleep all at once. Many people, even from the early years of childhood, need only a few hours of sleep to function well. An image of a very sleepy person Most adult need less sleep as they grow older. In these individuals adding more hours of rest to their schedule adds nothing to their energy levels, and indeed may make them feel worse.

Examples of true insomnia do exist, such as when one has a snoring spouse, a crying baby, or a medical disorder such as a prostate or thyroid problem. People with these conditions are totally exhausted during their day, can't function well at all, and do require medical attention. However, the vast majority of people who think they are insomniacs can, and should, be treated without any medications.

I have had countless elderly patients request sleeping pills, or take the non-prescription variety on their own, because they are fed up with lying in bed wide awake, staring at the ceiling. Especially if they can function well, or could catch up on sleep with a short nap, It is foolhardy for these people to risk the side effects of drugs to fight off a disease they don't even have. Rather than feeling hard done by, those who only need a few hours of sleep should be grateful for having the gift of extra years on their lives. If you don't feel sleepy until two or three in the morning, don't go to bed. If you wake up hours before the rest of the world, get out of bed, and get busy using those extra hours to make the rest of your day's schedule a little more productive.

Winston Churchill credited his legendary stamina to his ability to take brief naps, and exist on only a few hours sleep. So if you can't get all your sleep at once, then try to take brief naps when you can. Don't let a little thing like insomnia keep you awake nights.

Here's an action tip:

Before you reach for help in pill form, consider handling insomnia through simpler means, such as organizing your time management (to allow an uncluttered sleep), using hypnosis tapes, and avoiding heavy meals, alcohol, and caffeine before bedtime. Get into the habit of bedtime relaxations, such as having a hot bath or drinking hot milk.

Taken from a recent post on how our modern life styles have created an environment where it's more difficult to relax and sleep, here are a few suggestions that may help:

  • Turn out the lights, turn off the distractions of television, music, Blackberry/iphone and the web.  If needed, turn off the main power bar, so all the little lights won't beckon from your equipment!
  • Try a hot bath, but do it in a low-tech way.  Aromatic bath salts like lilac are very relaxing, as are scented candles.  Use the darkness as a comforting backdrop, and let your body's natural rhythms take you into deep sleep.  Once you are out of the deep bath, naturally.
  • Invest in black-out curtains, or, if your windows are too big, then a good blindfold. 
  • Allow yourself to relax, and not think of sleep as the only goal here.  Even just keeping your eyes closed will offer some help, and, as long as you don't get impatient, sleep will eventually follow.
  • When you need to get up for your next day's work, turn on all the lights, turn up the sounds, and let all the stimulations jump-start your body into full action.

 

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Stress and Sleep Disorders

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Insomnia is very often a simple disorganization of ones time, diet, or habits. But for many, the lack of sleep makes them look terrible, and feel even worse. An image of not getting enough sleep

Naturally, when I see a patient with insomnia I prefer to start the treatment with the least offensive weapons possible, and escalate the attack only as required. This means that for many, simple harmless treatments such as investing in a better mattress, using a natural wool pad on top of the mattress, or buying a more comfortable pillow may be enough. For others, especially those on shift work, ear plugs and an eye mask may be needed to sleep through ambient distractions.

Hypnosis, the relaxation response, yoga, and hot baths may also be the answer. However, these harmless treatments may not work for everyone. People who have a snoring spouse, a noisy neighbor, or a dripping tap may truly be at their wits end due to fatigue. Others with a crying baby may be totally exhausted, yet unable to take any medications for fear of sleeping through a neonatal emergency. Still others may be plagued by medical disorders that make sleep difficult.

In many of these cases, the use of medications may indeed be appropriate for a very short term. Often, once the patient has been given a couple of good night's sleep they can recover their energy levels, and may only be given medication sporadically after that. In more severe cases, medication may be needed every night. However, it is always wise to do everything possible to avoid the latter choice, as the cure may be just as bad as the disease. Once the association has been made between sleep and a pill, there is always the potential for Hypnosis, psychological or chemical addiction.

The most common sleep disorders include:

  • Insomnia: Ongoing, long-term trouble with falling asleep
  • Bruxism: Involuntarily grinding or clenching of the teeth while sleeping.
  • Delayed sleep phase syndrome (DSPS): inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms
  • Hypopnea syndrome: Abnormally shallow breathing or slow respiratory rate while sleeping.
  • Excessive daytime sleepiness (EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate times.
  • Night terror: abrupt awakening from sleep with behavior consistent with terror or fear.
  • Periodic limb movement disorder (PLMD): Sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs.
  • Rapid eye movement behavior disorder (RBD): Acting out violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self
  • Restless legs syndrome (RLS): An irresistible urge to move legs. RLS sufferers often also have PLMD.
  • Sleep apnea: Obstruction of the airway during sleep, causing lack of sufficient deep sleep, often accompanied by snoring. 
  • Sleep paralysis: is characterized by temporary paralysis of the body shortly before or after sleep.
  • Sleepwalking or somnambulism: Engaging in activities that are normally associated with wakefulness, which may include walking, without the conscious knowledge of the subject.
  • Somniphobia: A cause of sleep deprivation. Somniphobia is a dread/ fear of falling asleep or going to bed.

Managing Stress for Better Sleep

  • Assess what is stressful: The first step in getting a handle on stress is to figure out what is causing it. Take a good look at your physical condition and your daily activities. Do you suffer from pain? Are you overloaded at work? Once you identify your stressors, you can take steps to reduce them.
  • Seek social support: Spending time with family and friends is an important buffer against stress. It can be helpful to share your problems with people who care for you.
  • Practice thought management: What we think, how we think, what we expect, and what we tell ourselves often determine how we feel and how well we manage rising stress levels. You can learn to change thought patterns that produce stress. Thoughts to watch out for include those concerning how things should be and those that over generalize sets of circumstances (for example, "I'm a failure at my whole job because I missed one deadline.") Many commercial audiotapes and books can help you learn thought management exercises.
  • Exercise: Exercise can help you blow off steam thereby reducing stress. In addition, flexible, loose muscles are less likely to become tight and painful in response to stress. If you have a medical condition or are over the age of 50, it’s best to check with your doctor before beginning an exercise regimen.
  • Eat a healthy diet: Junk food and refined sugars low in nutritional value and high in calories can leave us feeling out of energy and sluggish. A healthy diet, low in sugar, caffeine, and alcohol consumption, can promote health and reduce stress.
  • Get adequate sleep: A good night's sleep allows you to tackle the day's stress easier. When you are tired, you are less patient and easily agitated which can increase stress. Most adults need 7-8 hours of sleep per night. Practicing good sleep hygiene along with stress-lowering tactics can help improve your quality of sleep.
  • Delegate responsibility: Often, having too many responsibilities can lead to stress. Free up time and decrease stress by delegating responsibilities.

Here's an action tip:
If you are chronically pooped, and think your problem is the result of poor sleeping habits, please see your doctor. If there are no physical reasons for your condition, then ask your doctor to recommend some alternatives to medication, such as the relaxation response, or hypnosis. If medications prove necessary, try to give yourself as little as possible, and to periodically have drug-free week-ends to help clear your system of the metabolites. Make sure your doctor is aware of all drugs, both prescription and otherwise, that you are taking. Most of all, try to aim for safe sleep.

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Dry Eyes - How to make them less stressful

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Dry eyes are more than a modest problem.  They can be the cause of great stress.

Sufferers wake up with scratchy eyes, and have to take drops frequently just to avoid discomfort.  

 

When untreated, dry eyes are more likely to get infections or redness, and their owners are more likely to be irritable. 

Let's take a look at the problem, and consider solutions.

1. What are tears?

Tears are really a mixture of three layers over the surface of the eye; water, oil, and mucous.  The water layer is closest to the cornea, while the oil or lipid layer is secreted by the mebomian glands of the lids.  The lipid layer keeps the water from evaporating.  The mucous layer on the top is there to protect the other two layers from blasts of air and particles that might prove irritating.  The final protective layer of the eyeball is the lids, which blink to renew the spread of the three layers, and to refresh the eyeball surface.  Tears are produced inside and along the edges of the lids, and drain out through the punctum or hole in the inner margin of each of our upper and lower lids, close to the nose.  The tear ducts then carry them away into the nose.  This is why crying is also associated with blowing your nose!

2. What makes eyes go dry?

There are many factors that lead towards dry eyes.  These include staring too long at computers, tablets or cell phones, where the eyes are trying to stay open for focus and concentration.  The same can happen with prolonged study of books, or staring at the road while driving on a long trip.   LASIK surgery (to restore normal vision to people who need glasses) can also be drying in later years.  People with certain skin diseases like acne rosacea and Sjogren's syndrome may suffer from dry eyes.  Even birthdays can cause dry eyes, starting at about the age of 50.  In younger people, makeup and facial soaps can add to the problem, as can wearing contact lenses for excessive periods of time (even if the manufaturer promises you can leave contacts in overnight).  Ambient dust or other small particles can also bedevil the dryness problem.  Certain medications can also cause dryness as a side effect; be wary of drops that "remove redness" as these too can make the problem worse.

3.  What can I do about it?

Try to establish root causes.  If your room air is dusty, try to control it with air filtration or other measures.  If you wake up with dry eyes, make sure your pillow is not a bag of dust by washing or dry-cleaning it.   If makeup is a problem, use hypoallergenic products, and learn how to apply them properly.   If you stare for hours at computers, then try to take your breaks outside, and focus on distant objects to give your eyes a break from the short distance stare.  If non-prescription drops are not sufficient, please see your doctor.  While your family doctor can initiate investigations, including for general health issues, you will need to see a specialist to further examine the eye, including to measure the production of tears with a strip of litmus paper and stained eye drops.  As you will see on our post on the subject, it is important to have the full array of modern tools to examine the eye, not just a hand-held light with an eye chart at the end of the room.  Once the doctor assesses the problem, then a menu of options apply. 

 Punctal plugs can be inserted into the drain holes of each lid, commonly the lower ones.   If you have tried non-prescription drops, make sure you use them often and correctly. (see our article on Eye Drops Made Easy)   

 If the problem is with dry wax in the meibomian glands of the edges of each lid, then try to use warm compresses such as a face-cloth.

Press firmly over each eye for a minute or so, and the dry balls of wax in each gland opening will melt away.  Shampoo in the eyes, (almost!) can also be effective in dissolving the waxy gland material; use a gentle shampoo like Baby Shampoo, and rub it into each eye, almost opening the lids.  After leaving it for a minute, then rinse under the shower. 

Use regular drops like Refresh or Systane, just for lubrication and moistening. 

 

Above all, make sure you have your eyes examined regularly, and protect them with sunglasses, or appropriate goggles for handywork or sports. 

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GERD: There's a Fire Down Below!

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Is stress getting you right in the breadbasket? Here are some tips to put out that “fire in your belly”!

A generation ago, people would associate stress with stomach ulcers.  In cartoons and family sitcoms, the children would cause some stress of the week, the father would rise to the bait, and the mother would caution: “Henry, watch your ulcer”.  Often, this would be followed by the automatic response of a glass of milk.  Ulcers didn’t seem to be happening to women, and the male victims were always being told to “calm down”, or advised to sidetrack their careers to something less stressful.  If the ulcers persevered, most patients would end up with major surgery to cut the vagus nerve, leaving behind a huge scar on the abdomen.  My, how things have changed!

Now ulcers are diagnosed much more easily, and treated much more simply.  To diagnose one of the common causes, a blood test for helibacter pylori is a good start.  If this bacteria is present in the stomach (its antibodies show up on a regular blood test), then the doctor simply reaches for a prescription of antibiotics to kill the offending organisms for good.

If the ulcer needs images for diagnosis, these can be easily arranged, but often yield to the more definitive scoping down through the esophagus and into the stomach itself.  Here the ulcer can be spotted, photographed, and biopsied to rule out malignancy and check for infections. Once diagnosed, the treatment is done effectively with drugs, such as Nexium and others.  Surgeons have basically been written out of the equation, and, thankfully ulcers are not much of a real threat any more.

But with the routine of scopes inserted down into the stomach, doctors have become very familiar with a previously unheralded inflammation in the lower part of the esophagus.  This is popularly known as GERD, or Gastro-Esophageal-Reflux-Disorder, and it has replaced ulcers as the number one stomach complaint today.

In part, it is made worse by eating too much, eating too quickly, eating the wrong inflammatory foods (spices, sugars, junk foods), and by drinking too much (pop or alcohol). Just to make your sleep miserable, it is also made worse by eating too late.  Then the sufferer will be rolling in agony as dinner tries to repeat itself, with an acid backwash  into the throat, accompanied by nausea and sweats, and a racing heart.  This is even worse for the 60% of the population over age 60  who already have a hiatal hernia.   (http://www.emedicinehealth.com/hiatal_hernia/article_em.htm)

 A billion dollar industry has rushed into the breach.   And what a breach this is.  Currently one third of adult Americans suffer symptoms of GERD at least once a month.  That doesn’t get much better in many other western countries, including the UK and Europe.  It basically marches in step with obesity and fast food popularity. 

But note that not one case is caused by the lack of a brand name drug.  Almost all cases can be controlled by addressing the root causes:

1.       SLOW DOWN: Stop wolfing your food, and your GERD will thank you.  Swallowing fast will cause ingestion of air (aerophagia), in the same way that fizzy drinks, or drinks slurped through a straw will do.  For more on eating slower, visit our article here.

2.       SIT UP: This includes slouching at work, and certainly includes post prandial posture.  Obviously we would all expect GERD if we did a head-stand right after a thanksgiving dinner, but even lying flat right after a meal is tempting the stomach to spill its contents easily into the esophagus.  If you are having trouble sleeping, sit up on a “chair” of pillows at the head of your bed, or elevate the feet at the head of the bed on blocks or books to keep the stomach contents from washing back into the gullet.

3.       DON’T SMOKE: well, that is obvious for a dozen other reasons, but here is another good one to add to the litany! For more, read our stop smoking article here.

4.       DON’T OVERFILL:  Even gas stations admonish users to not overfill their tanks, as spillage will predictable follow.  How about trying that for your own stomach, or else it will also become a “gas” tank!

5.       DON’T EAT NAPALM: White sugars, as in that gooey dessert that topped off the meal, are hugely inflammatory.  Also spicy foods, or alcohol, and even good foods that contain gluten, if one is sensitive. If you can’t resist, make sure the portion is very small!

6.       SEE YOUR DOCTOR if the above doesn’t help.  You may indeed need investigations, and, ultimately, appropriate treatment.  But don’t go back to ignoring steps 1 through 5 above, or you will be right back to step 6!

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Tai Chi, a Sure Way to Balance your Health Defense

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Our bodies were designed, built, and programmed for movement.  Our joints need movement to self-lubricate through the bag of synovial membrane. 

This movement even feeds food and oxygen to the bloodless cartilage inside the joints, and carries away the products of metabolism.  Movement also benefits our muscles, by contracting, toning, and stretching them.  Even our stress defenses were wired to energetic  responses.

But now we have redesigned our ancestors' active workplace to remove most movements as we sit all day at a desk.   So the modern response to stress has gone from the “fight and flight” option to  a not-so-energetic “sit and stare” response.  

But new research is indicating that even more is at stake with our modern inactivity.  Mental functions are all sharper if we move, and duller when we sit.  Even our immune mechanisms are enhanced with movement.  Scientists have emphasized h that sitting still for 4 hours at a time is basically an “inflammatory”event, sort of like eating a donut.  (Worse, obviously, if you are sitting and eating for the same four hours!).  Not only do bones lose their density and muscles lose their mass, but our mental alertness suffers from this inactivity too.

 So our basic instincts of movement are correct, and we indeed need room to roam.  In other articles, I have reviewed posture at the office, as relates to carpal tunnel and low back pains

 But another solution comes from the world of Tai Chi.

 An interesting discipline, Tai Chi basically is a slow motion version of martial arts.  Speed up the film of people doing Tai Chi in the town square, and you get a Jackie Chan fight scene.  While it may look simple, it involves weight shifting, swaying, stretching and toning.  And, above all, balance.  Now doctors are appreciating how well it works with patients suffering from Parkinson’s as well as many other medical conditions.  See this link to learn more

Requiring no equipment, Tai Chi is easy to start.  While learning can be an infinite process, even a  beginner can benefit right away.

So if you are getting stressed by your desk job, try to interject a few moments of Tai Chi into your breaks.  Remember to set a timer for every fifteen minutes, to remind yourself to move something.  For example, at least pull back your shoulders, neck and head away from the computer, and try to touch your shoulder-blades together in a “rowing” motion .  At the very least, make this a simple part of your routine for a few seconds.  If space and time permit, use one of your 15-minute breaks to stand up and try a few Tai Chi moves, and notice the difference.    Who knows, the whole office might join in!

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Top Ten ways Stress can Hurt You

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For the past year, I have been working in active Family practice, including busy walk-in clinics, as well as my private office.  Having seen thousands of new people in these past months, it is clear that Stress is still one of the major factors in our Health Care Crisis. 

Stressed Worker

Our headlines have never been more stressful, and are all about issues that are beyond the grasp of the individual reader, even though the effects are felt by all.  For example, the gulf oil spill, the worsening economy, the jobless "recovery", and, not to forget, our two wars that are claiming more lives, more treasure, and seem to be generating more corruption from the governments we are supposed to be saving.  To paraphrase the old saying: "if it weren't for bad news, we'd have no news at all". 

But bad news preys on the human body and mind.  Especially because we are bombarded with these disasters dozens of times a day (newspapers, emails, talk radio, 24-hour TV news, cell phones, twitter etc).  Granted, stations now try to lighten up with idiotic stories, like "Skippy the Squirrel Learns to Water Ski...with film at 10".  But the omnipresence of bad energy leads to predictable results.  The following is the result of a survey of over 500 patients whose health drove them in to see me in the last three months, and asks the question "What does Stress Do to You?".  Each patient could mention more than one choice, depending on their body's responses.

Let's take a look at the Top Ten Ways that Stress Hurts:

1.  Insomnia  (71%)  From having difficulty falling asleep, to having troubles staying asleep, this was the most common complaint.  Waking up refreshed was rare.

2.  Anxiety (65%)  Bad news contaminates our conversations, our dinner hour, and our "down time" that we try to carve out of our busy days.  People are developing white knuckles on their Blackberries and I-phones, consuming the latest iterations of horrible news.

3. Depression (52%) With so little control over these stressful stories, no wonder people are depressed.  Sales of Effexor have never been higher! (note, antidepressant medications are rarely the best line of defense here, but more about that in other blogs!) 

4.  Skin reactions (acne rosacea, excema etc) (38%) Breakouts of acne, including rosacea, as well as itchy patches of excema are very common as a manifestation of stress. 

5.  Cardiac effects: racing beat, increased blood pressure.   (23%)  Many people can "hear" their heart pounding, as the internal carotid arteries pump close to the ear mechanisms.  Palpitations are often felt in the chest, and people will often break into a sweat.  Blood pressures can also rise, along with heart rates.

6. Indigestion, stomach pains. (22%)Sales of medicine for heartburn, stomache aches, and acid reflux have never been better. 

7. Change of bowel habits (constipation or diarrhea)  (22%) Some respond to stress with diarrhea, while others seize up and get constipation. 

8.  Headaches (including tension, migraines)  (20%) Lasting anywhere from a few minutes to a couple of days, headaches are a powerful reminder of the mind-body connection. 

9.  Fibromyalgia  (17%) When you have pain in a joint, it is called "arthritis".  When you have pain between the joints (in the muscles and soft tissues) it is called "fibromyalgia".  No blood tests or X-rays will pick it up, but millions of Americans know it is sure real.

10. Obesity.  (60%)  While some respond to stress by cutting down their food intake, the majority are seeking comfort with "comfort foods".  Obviously badly named!  The "white death" of white sugar and white flour contributes to our epidemic of obesity, especially in our children.

While the Prescription Drug Cartel wants us to all believe that each of the above symptoms is caused by the Lack of a Brand-Name Drug, there are a host of ways to defend ourselves before reaching for a prescription pad.  We will discuss each of these in upcoming articles!

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