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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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Manage Your Stress and Enjoy Better Health

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Studies show that the more stressed you are the less likely you are to fight back against a visiting flu virus, and, once infected, the course of the disease is likely to be longer and more severe.

An image of a healthy family having fun

In my 25+ years of family practice, it was remarkable how certain individuals seemed to never get sick, while others never missed a flu virus, or should I say the virus never missed them. Well, a recent study confirms that this is not just a fluke and that there are reasons for this.

Dr. Lorne Becker, an assistant professor of family practice at the University of Toronto, organized questionnaires that asked patients about two areas of their family life. First, family cohesion, or support an individual felt from family members, then adaptability, or flexibility. In a scientific way, he was really asking for a measure of happiness. The results indicated that rigid, inflexible families, who were fragmented and non-supportive of each other had fifty per cent more flu infections than those who had balanced, happy family lives. Mind you, even the most convivial of households were not immune, and still had a 22% rate of infection in flu season, but this is significantly better than the 33% rate for their more miserable neighbors.

None of this would have been any surprise to the Late Dr. Hans Selye, Canada's great pioneer in stress research. A half a century ago, Dr. Selye noted that when laboratory animals were stressed by controlled shocks or punishments, their lymph glands shriveled up, and the rest of their immune systems went into steep decline. This means that a stressed person is less likely to be able to fight back against a visiting flu virus, and, once infected, the course of the disease is likely to be longer and more severe.

Stress can also affect your health in a number of other ways and inhibit your ability to cope. Under stressful condition your response may be eating high-fat, high-calorie comfort foods, smoking, drinking too much, not sleeping, and not exercising. The combination of changes in your body from the way you respond to stress, combined with other behavioral and emotional responses may lead to chronic health problems. These include:

  • Obesity. In many people, stress can lead to overeating. But that's not all. High levels of stress may increase the risk for visceral fat. This type of fat develops around waist and the organs in the abdomen, causing metabolic changes that can lead to diabetes and heart disease.
  • Cardiovascular disease. Stress does not directly cause heart disease. However, stress can put a strain on the heart and blood vessels, thereby contributing to heart disease.
  • Diabetes. Stress can make it hard to follow your diabetes treatment plan, which can lead to poor health. Stress also directly increases glucose levels, especially in people with type 2 diabetes.
  • Anxiety and depression. It's no surprise that ongoing stress can wear you down mentally, and if severe, lead to anxiety and depression.
  • Asthma. Stress does not cause asthma, but it can trigger asthma attacks and worsen symptoms.
  • Skin conditions. Stress can trigger or aggravate skin symptoms in people with psoriasis and eczema. Stress management may help control these conditions.
  • Stomach problems. No, stress does not cause ulcers. But it can worsen symptoms of ulcers and irritable bowel syndrome.
  • Acne. One large study confirmed what many teenagers already know: high levels of stress makes acne worse in teens.

Here's an action tip:

Stress doesn't cause infections, for that you still need a bacteria or a virus. But stress does interfere with your defenses to any disease. So workaholics beware, if you don't invest enough time and energy in building strong support at home, you may be headed for an avoidable illness. 

It’s also impossible to completely avoid stressful situations. But you can learn t manage the stress you do encounter:

  • Get enough sleep and eat a healthy diet. Get 7 to 8 hours of sleep a night so you have the energy to cope with stressful situations. Fill up and fuel your body with healthy choices rather than getting bogged down by high-fat comfort foods.
  • Nurture close relationships. Often, we don't appreciate how important friends and family can be for good health.
  • Learn to let go. Remember, the sky won't fall if you wait another day to do laundry, clean the bathrooms, or write that thank-you note.
  • Try new ways to relax. Some studies have found that yoga, meditation, and relaxation exercises may help reduce stress in people. Yoga will also help build strength and flexibility.
  • Get help if you need it. If you can't get seem to get relief from under stress and nothing seems to help, talk with your family physician or a counselor.

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Google-itis: The Hypochondriac's Dream!

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The only disease that hypochondriacs NEVER think they have is Hypochondriasis. It is the one condition that all doctors can identify, for a very good reason.As medical students, we all suffered hypochondriasis.Got a headache while you are studying rare cancers? Well, we must have a brain tumour! Get a dark sun spot on your arm while you are studying Dermatology? Must be a Melanoma! Bit of a night fever during Tropical Disease Clinics? Has to be Malaria, no less! One of the worst examples was our first lecture on Tapeworms. Complete with gory details and horrible photos, our professor ended his first slide show by writing the symptoms for tapeworms on the board.“Symptoms = None”. No symptoms at all Hey, we all have no symptoms…so we must ALL have TAPEWORMS!!!

Now the pictures of horrible diseases is no longer restricted to medical student’s “eyes-only”. Because of the magic of Google, the whole world can enter any symptom, and immediately find a thousand reasons they will be dead before dawn. So the whole world of patients, not just their doctors-in-training, has the potential to be just as paranoid as we used to be!

 While Google is a fabulous search engine, it would be good to be a bit more selective when it comes to self-diagnosis. It took us a few years after medical school’s “fright lectures” to realize that sometimes a headache is just a headache. So if you, reader, have convinced yourself that your nasal promontory cellulitis is a rare form of Tsutsugumuchi fever, relax. It is probably just a zit on the end of your nose.

In the world of cell phones with apps, a whole new epidemic of over-diagnosed symptoms brings anxious patients to medical offices everywhere.

It is in order to help these patients that we have established our site, here at Stressipedia. Instead of being in the front row at the gory slide shows, we have already filtered the realistic probabilities, and condensed each subject into a manageable bite.Takes under two minutes to read each blog post, yet one can drill down to greater details by simply clicking on a link. Even doctors are loving the concept.No longer do they have to give a list of dozens of “do’s” and “don’ts” when they tell their patients how to reduce their cholesterol.They can simply refer them to the Stressipedia blog, and the patient will retain much more of the detail. Then, just before going to the grocery store, the patient can click on the link for which foods to avoid or buy, then read their cell phone whilst they are standing in front of the Bok Choi display.

By all means, we encourage our patients to do their research, and to stay informed. No better way exists than the internet. But if you are finding it scary sitting that close to the edge of medical disasters, consider seeing your doctor first for a real diagnosis, then use the internet for followup resource material.

The danger lies in making your own diagnoses first hand. The rule in medicine is : A doctor who treats himself for one problem now has created two problems;

1. He has a Fool for a Patient

2. He has a Fool for a Doctor!

So enjoy the internet for its millions of reasons, but don’t add stress to your life by self-diagnoses. Leave it to us, and to your doctors, then use the internet to plan your next hobby, vacation, or career!

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Acupuncture: An old treatment gets to the point!

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Acupuncture is now being used in modern medicine, but it is certainly not new. 

Starting with moxabustion, surface stimulation dated back thousands of years,  at least 4,000.   Sparks from the campfire that may have landed on specific points on the bodies surrounding the fire, and then symptoms were noted to improve.  Some accounts postulate that arrows in battle could have curative powers when they landed on certain precise points of the body.  Soon the local medicine men  were mapping the spots on the skin that corresponded with various symptoms, from headaches to back pain, insomnia,  and even asthma. 

 Medical acupuncturists today use sterile needles made of surgical quality stainless steel, then dispose of each needle after a single use.  Placement is done into precise points of anatomy, as indicated by the clinical findings, or images from appropriate X-rays, sonograms, or MRI’s.   If a problem is superficial then a shallow needle placement is sufficient; if the problem is several inches beneath the surface, then a correspondingly longer needle is needed.  Deep needle techniques are best left to those MD’s or chiropractors who are fully trained in the underlying anatomy.

One of the great uses for acupuncture is to treat modern stress, including anxiety, or burn-out.

How does it work?  By releasing endorphin from the pituitary gland, acupuncture provides an excellent pain relief.  This chemical is natural, and is supposed to be released every day to help us overcome pains.  When severe injuries occur, then the body is overwhelmed, and natural endorphin production wilts.  Acupuncture quickly restores this, and gives a surge of even higher levels than normal.  This explains why surgery can be done on patients using just a couple of acupuncture needles for anesthesia.

In addition, acupuncture also promotes the release of the body’s own anti-inflammatory, cortisone.  (This by the simultaneous release of ACTH and endorphin from the pituitary; the latter goes to the adrenal glands to release natural cortisone).  That finally explains why acupuncture can dramatically save an asthmatic from needing more intervention for an acute episode.   It also explains why acupuncture can lead to a complete cure of many pains, because it also cures the underlying inflammation that causes the pain.  Much better than just a few hours of relief from codeine, and without any addictive properties or other side effects.

 

So the next time your doctor suggests acupuncture for you, keep an open mind.  It seems that alongside modern diagnostic and therapeutic tools, acupuncture needles indeed have a point!

 

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Stress Unplugged: The Value of Nothing

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There are times when a busy agenda can keep us young, as we discussed in an earlier post: Stress - The Fountain of Youth.  There are other times, we should note, when there is a tremendous value in doing nothing.  As an example, after a series of weeks filled with deadlines, pressures at work, and the excitement of preparing for holidays, it can be a great strategy to block out time to do nothing at all.  If you have the time for it, a whole day of nothing is a great stress-reliever.  And by nothing, that means unplugged:  no alarm clock, no wrist watches, and the freedom to read, go back to bed for a nap, or wander around for a few aimless hours just to get some fresh air. 

 To get the best out of your "nothing" time, it is even good to turn off the high tech world for the day, to remind you what life was like before the cell phone, before the facebook, and before television.  Time with your significant other, your pet, or just yourself. 

One doesn't need to find a remote beach to do nothing, we can carve out our own part of any given weekend.  Take a look at your month's agenda, and see where you are likely going to need a break.  Black it out on your calendar, so nothing can get booked.  Then book it.

When the day comes, you might still wake up at the normal time.  If so, then feel free to get up, have a coffee, and take it back to bed.  If you don't feel like sleeping in, just lie there to read, or do a crossword, and before you know it you might dose into at least a lower pace of metabolism.  Remember, try to do this unplugged, just like the rock stars do with their acoustic concerts. 

In the deep salt mines of Russia, scientists did research into circadian rhythms unaffected by daylight, time clocks, external communications. 

Read more about this circadian study here....

Volunteers were left to sleep as often as they wished, and most took advantage by taking cat naps.  But the total hours of sleep needed actually surprised the researchers.  Instead of sleeping more, the volunteers slept less total hours than usual.  It seems the value of "nothing" was inherently restorative.

To be sure, we understand that stress in the long term keeps us young.  But there is great value in a "recess" formula between busy classes, and a "recharge" formula between busy sections of our calendars.

By all means, keep a busy shedule during your down time, but at least once in a while break the busy with the calm.  So see what you can do to clear the decks for a proper day of nothing.  Farm out the kids for the day, unplug the computer, television, and phone, and enjoy at least one day of unstructured time.  Then when you've had your day of nothing, you will be ready for the next segment of your busy calendar. 

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Low Back Pain: Some Simple Strategies

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Back pain has become more common in the computer age than it was in the agricultural age. This may appear puzzling, because we are no longer working the land, we are now working the hand. Or at least both hands, at a keyboard. So how does the modern worker contract back pain while literally lifting nothing more than a finger at a time? Let's take a look...

Lower back pain is more common today that it was a few generations ago

The human body was designed (and evolved) for movement. Hunting, gathering, hacking and hewing. The daily activities of work in the old days kept our core muscles toned, and kept our legs in top shape to support us. Most back pains were muscular in nature, and would heal with a bit of rest.

The daily activities of modern work, by contrast, keep our core muscles slackened,, and our legs folded underneath us like a card-table. As a consequence, we are now seeing a significant rise in the number of cases of back pain associated with desk jobs. Even in young people.

To be sure, we can hurt our backs with too much lifting or twisting, such as clearing a heavy snowfall from your driveway. But most of the pains we now see are from too little movement, and need a whole new strategy.

Take a look at the ergonomics of your work area. If, like most people and you are sitting at a desk, then make sure the height of your computer screen is high enough so your eyes can look at just below the horizon when you are sitting upright. Then, make sure your hands are at the right altitude so you can type without bending your wrists. In other words, don't use your laptop for more than short time periods. If you have the keyboard down at a comfortable lap-level, then you have to look sharply down with your head. If your head and neck are comfortable with a higher screen placement, then your wrists are bent acutely to let your fingers reach the keys. I usually rig up a wireless keyboard along with a separate screen, and run both via my laptop.

Take a look at the time. We need to move, and a timer can be a huge help. Every fifteen minutes, set a timer (or a feature on your computer) to alert you. Give your arms a shake, roll your shoulders, and, if you can, try to stand and pace or twist for a few moments. At the very least, try to flex and extend your legs while you are still at your desk. Otherwise the computer can be a time-hog, and hours can pass without you moving any major muscles at all.

 

Take a look at the chair. On most chairs, you can fall asleep. That's because you need no muscle tone to stay sitting. That's why the legs get weaker, and the core muscles around the spine and trunk get more atrophic. Try a Pilates ball instead of a chair. First get the right size, so when you are sitting you will be able to bend your knees to 90 degrees and still have your thighs parallel to the ground. Take your first try with the ball almost against the corner, to protect you if you roll away. Build up your tolerance, starting with five or ten minutes an hour. Once you get the hang of it, you will be impressed that you cannot slouch or even doze. Muscles are used from the toes to the knees, the inner and outer thighs, the hip flexors, abdominals, and the remainder of the core muscles. Your head will naturally be in line, like a Dressage rider.

Now that we have invented the modern workplace, we need to be inventive in our strategies. If you have pains in your back, or if you simply want to prevent them from starting, take a look at your ergonomics and your time. You can be "on the ball" in more than one sense of the word!

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Are Time-Bandits Holding Up Your Stress Levels?

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Famine is rare in the western world.  If anything, our health is more threatened by too much food instead of too little.  But now we have created a huge time famine

Our bodies were programmed to work from dawn til dusk, and the only time management was to hurry up with the plowing before daylight faded.  Now our work day could extend to all twenty-four time zones.  Our lap-tops and cell phones are blinking around the clock with new information that might need our prompt response.  So a strategy is needed, and the science of time management enters the picture. 

First, we should be more clear in our terms.  We all have the same 168 hours per week.  The question is  "how much do we accomplish"; not "how much do we do?".  If  you finish your day before you finish your tasks, then stress will be the result.  Thus the viscious circle of insomniacs: sleep will be interrupted by unfinished business, and  business will be interrupted by unfinished sleep.  Let's take a look at some solutions:

1. PLAN your time.  Write down all you wish to accomplish the next day, and place a time estimate on each task.  Make sure to allow for a realistic time to set up or travel between tasks.   Do this also for your spare time, including weekends.  If you have an endless list, and if the time for each task excedes the hours in a day, then clearly you will not get finished.  

2.  PRIORITIZE your tasks.  Some are urgent and cannot possibly be delayed.  Others are trivial, or just filler, and could easily be punted to another day or week.  Like the difference between showing up for a client meeting, or noodling around on the internet to read the same chat rooms you read an hour ago.  On personal time, priority is high for time to exercise, buy groceries, and enjoy your relationships.  But one is not watchful, the computer screen could take over, exercise is put off for another day, the fridge gets empty, and friends are left unvisited.  So enjoy your recreation, but not until you have accounted for your essentials.

3. PAMPER your self.  Time and priority management may seem dry, so take care to include elements that are both fun and restorative.   A hot bath at the end of the day is a good example.  Deep water, aromatic salts, candlelight, soothing music, and a toy navy.  Well, not the submarines.  To the pure time manager, a shower is certainly more efficient.  But as a stress reliever, a shower is no better than hosing yourself off in a phone booth.   Also try to overlap some of your priorities.  For example, time spent with your significant other doing a brisk walk could be fun, provide good conversation, and also get your excercise out of the way.  Never underestimate the importance of your spare time.  To maximize work efficiency, take the time to maximize your own restoration time, to recharge and reboot your energy for the next day. 

So if you are feeling overwhelmed by the time famine in your life, start planning, prioritizing, and pampering.  The Three "P"s will bring forth peace! 

For more information on time management, check these links;

http://www.prioritymanagement.com/

http://store.franklinplanner.com/store/

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Depression and stress: More than meets the eye

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In a recent post, we discussed common stress complaints from real patients in our clinic. (see Top 10 Ways Stress Can Hurt You).  Over half of our stressed patients admitted to depression as one of their problems. 

depression

But, contrary to what the Prescription Drug Cartel would like us to believe, not everything is caused by the lack of a 

brand-name drug.  On the other hand, drugs certainly do belong on the overall menu.  Let's take a look at the big picture of what might make us depressed. 

1.  External Stress:   This is depressing (the adjective).  The rescuer could come from many disciplines.  A wardrobe makeover could be the key (see What Not To Wear).  A lawyer could spring for bail, a trucker could pull one's stranded car out of a snowbank.  If sadness comes from winter darkness (see  Seasonal Effective Disorder ) then a travel agent could offer just the cure.  If the stresses are financial, a financial planner could solve the problems, albeit much more slowly.  In any event, this is not a disease unto itself, but simply a normal reaction to unhappy circumstances. 

2.Internal Stress: This is depression (the noun).  Nothing in the external world makes any difference.  For example a person could be financially secure, in good health, and have good relations with family and friends.  But they could also be feeling a crushing daily sadness.  This is the chemical imbalance inside the brain that deserves full consideration of medical science. The rescue menu here is much different, involving a medical work-up, councelling, and often medications.   

The problem arises when the public assumes that all who are depressed should start with drug therapy.

 

Here are a few areas to review before seeking medication:

1. Diet: Depression is made worse by the inappropriately named "comfort" foods.  It would be counterproductive to have an antidepressant pill in one hand, and a bag of cookies or a soda in the other.

2. Sleep: Rest is a weapon for the next day's battles.  Insomnia can be beaten (see Insomnia: Is It Worth Losing Sleep Over?).

3. Exercise: Runners speak of the endorphin "high" that comes with their daily exercise, and of feeling depressed when they stop for a few days.  Exercise in any form is excellent for mood elevation. 

4. Time management: If you are feeling overwhelmed and depressed by today's time "famine", then get a grip on your time management.  Start writing things down in one trusted place (organizer book or cell phone).  Learn to prioritize, and be selective about which of tomorrow's activities are really important.  The lesser items could be put off, or done if time emerges.  Then when you do get a ten minute gap, you won't fritter it away. 

 

If you are feeling depressed, don't assume that relief is only a pill away.  Take a look at your circumstances, and consider your responses to diet, sleep and exercise.  If you are still blue, by all means see your doctor for further advice.

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