Archive for November, 2012

Sleep and How to Achieve It

It is estimated that about a third of our population suffers from some form of insomnia. For some, it is severe and chronic, and for others it is mild and due to obvious factors, such as pain, illness, anxiety or recent travel.

Insomnia can make us feel chronically tired, cranky and irritable. Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression.

Many insomnia sufferers will turn to drugs to help them sleep. Most begin with over-the-counter medications, which usually contain an antihistamine as the main ingredient. (Men with enlarged prostates should avoid use of antihistamines.) This ingredient causes drowsiness and may help one fall asleep. Such medicines are relatively safe but can cause a reduced level of alertness the next day.

Food supplements and herbal sleep remedies, such as melatonin and valerian, also may help, but they are unregulated and have unpredictable results.

If insomnia persists more than a week or two, you may want to consult with your doctor.

Before you do, it would be a good idea to keep a sleep log for a week. Here’s what you would want to record:

– The time you go to bed, the time you get up, and the approximate amount of time you were awake during the night

– Drugs you take, including use of alcohol, caffeine and tobacco

– Disturbing factors, such as pain, a newborn baby, a snoring bed partner or noise outside the bedroom

– Whether you feel rested upon arising

Treating insomnia with prescription medication is a common approach for sleep problems.

Common medications for the treatment of insomnia are called hypnotics and need to be prescribed by a doctor. They should only be taken when:

– The cause of your insomnia has been evaluated

– Sleep problems are causing difficulties with your daily activities

– Appropriate sleep-promoting behaviors have been tried

All hypnotics induce sleep, and some help maintain sleep. They work by acting on areas in the brain believed to be involved in sleep promotion. These are the drugs of choice, because they have the greatest benefit and lowest risk as sleep-promoting drugs.

Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

– Terry Hollenbeck, M.D., is an urgent-care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. Readers can view his previous columns on his website, valleydoctor.wordpress.com, or email him at valleydoctor@sbcglobal.net. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor.


Some additional tips for a good night’s sleep


These are some things you can do, aside from medication, to ensure a better sleep:

Try to maintain a routine sleep schedule, going to bed and arising at regular times.

Limit your use of alcohol, caffeine and tobacco.

Get regular daytime exercise, but don’t exercise at night.

Make your bedroom conducive to good sleep by having a comfortable mattress, keeping the room dark and cool and eliminating any extraneous noise.

Avoid excessive mental and physical activities before going to bed. Try reading a book, listening to music or meditating.

Use the bed only for sleep or sex; don’t do paperwork or eat in bed.

If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not particularly stimulating until you feel sleepy.


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There has been much attention given recently to the potentially serious injury to the brain from suffering a concussion.

For professional athletes, such as football players, the recovery goal has been to return to the game as soon as they are physically able.

But for schoolchildren — who are at significant risk of learning disabilities, emotional or behavioral changes and memory problems — the focus of recovery should be mental as well as physical rest.

From babies to high school students, children with concussions make nearly 144,000 visits to emergency rooms each year. A significant number of injuries also go unrecognized and are not reported. I personally see a number of concussion injuries in my practice each year.

Younger athletes may be at a greater risk of damage from a concussion, because their brains are not fully developed. When athletes take a hit to the head in football, are slammed by an elbow in soccer or fall from a bike or skateboard, the brain gets banged against the inner walls of their skulls, thus causing the injury commonly referred to as a concussion.

Common symptoms of a concussion are:

– Loss of consciousness, no matter how brief

– Headache

– Vomiting

– Memory loss or behavioral changes, especially confusion or feeling “foggy”

Children with the above symptoms, or any other symptoms that worry parents or adult guardians after a head injury, should prompt an immediate medical evaluation at a facility best suited for this, such as an urgent-care clinic or a hospital emergency room. The evaluating physician may order a CAT scan of the head, depending on how serious the signs and symptoms are.

It can no longer be acceptable for a head-injured athlete, young or old, to “shake it off” and get back into the game. Our young athletes must be instructed to immediately report any head injury.

Coaches and trainers have become more aware of the potential dangers, both short and long term, of traumatic brain injuries and are having the injured players seek immediate medical evaluation.

Especially dangerous is the “second-impact syndrome” when a player receives a second significant head injury within a short time after the first injury. This can lead to even more serious health consequences.

Those of us in the medical profession who deal with head injuries are using protocols to help return the young athlete to their routine activities. The focus of recovery is rest, both physical and mental. The injured athlete needs to be eased back into all routine activities, and a medical reevaluation should be performed before allowing a return to contact sports.

The bottom line is that head injuries in athletes need to be taken seriously because of both immediate and potential long-term consequences. Mental rest after the injury is just as important as physical rest.

Although this column focuses on sports-related head injuries, the principles I have discussed pertain to anyone with a head injury, no matter the age of the individual or the cause of the injury.

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