Monday, October 5, 2015

GOOD SLEEP HYGIENE - Sleeping Naturally



Insomnia (Sleeplessness) is a very common problem afflicting the modern world. Usually, there is underlying anxiety, depression, work habits, night shifts (that are way too frequent in today's world where the service sectors boast of 24X7 services for their customers). And the consequences of poor sleep are too many like uncontrolled hypertension, metabolic syndrome, more anxiety and poor concentration to name only a few. 

Insomnia is many a times simply a habit that we have got. And if modify few of the lifestyle habits we might be able to conquer the sleep upto quite an extent. So it makes sense to understand these good sleeping habits.  

Your Personal Habits

Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.

Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a "sleepy time." Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.

Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.

Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.

Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.

Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 4 hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.

Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.

Block out all distracting noise, and eliminate as much light as possible.
Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.


Getting Ready For Bed

Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.

Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.

Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.

Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, light & relaxing music can help you sleep.

Get into your favorite sleeping position. If you don't fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.

Take a hot bath 90 minutes before bedtime. A hot bath will raise your body temperature, but it is the drop in body temperature that may leave you feeling sleepy.

Use sunlight to set your biological clock. As soon as you get up in the morning, go outside and turn your face to the sun for 15 minutes


Getting Up in the Middle of the Night
Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.


A Word About Television
Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.


Boost Melatonin

Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.

Change your bright light bulbs. Avoid bright lights before bed, use low-wattage bulbs instead.

When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep. Cover electrical displays, use heavy curtains or shades to block light from windows, or try a sleep mask to cover your eyes.

Use a flashlight to go to the bathroom at night. If you wake up during the night to use the bathroom—as long as it’s safe to do so—keep the light to a minimum so it will be easier to go back to sleep.

Other Factors



Several physical factors are known to upset sleep. These include arthritis,
acid reflux with heartburn, menstruation, headaches and hot flashes.


Psychological and mental health problems like depression, anxiety and stress are often associated with sleeping difficulty. In many cases, difficulty staying asleep may be the only presenting sign of depression. A physician should be consulted about these issues to help determine the problem and the best

treatment.


Many medications can cause sleeplessness as a side effect. Ask your doctor or pharmacist if medications you are taking can lead to sleeplessness.


To help overall improvement in sleep patterns, your doctor may prescribe sleep medications for short-term relief of a sleep problem. The decision to take sleeping aids is a medical one to be made in the context of your overall health picture.


Always follow the advice of your physician and other healthcare professionals. The goal is to rediscover how to sleep naturally.


Q. When should one consult a Sleep Specialist/ Neurologist?
Consider scheduling a visit with a sleep doctor if, despite your best efforts at self–help, you are still troubled by any of the following symptoms:

  •  Persistent daytime sleepiness or fatigue
  •  Loud snoring accompanied by pauses in breathing ! Difficulty falling asleep or staying asleep
  •  Unrefreshing sleep
  •  Frequent morning headaches
  •  Crawling sensations in your legs or arms at night ! Inability to move while falling asleep or waking up ! Physically acting out dreams during sleep
  •  Falling asleep at inappropriate times 


Dr Sweta Singla
Consultant Neurology 
Kalpavriksh Superspeciality Center
www.kvsc.in

Thursday, February 19, 2015

UNDERSTANDING OBESITY PARADOX



Individual can be said to have excess weight if his weight is more than ideal weight for his/her height and person can be classified according degree of excess weight. For this categorization, we use Body Mass Index that adjusts your weight for your height and is calculated as:

BMI = Weight/Height( kg/m2 )


Category
BMI (kg/m2)
Underweight
<18
Normal
18-23
Overweight
23-30
Obese
>30
Super-obese
>40



Why do we gain weight at all?

Our ancestors were hunters and gatherers. They had no guarantee of future availability of food. This made ability to store fat i.e. gaining weight an evolutionary advantage. This trait has persisted till date and human body perceives gaining fat as survival instinct. But, when exploited beyond a limit everything becomes harmful and same is true for fat also.


What is the extent of obesity in world today?

Two third of people living in USA are either obese or overweight. Situation is little better in India, but people from middle and higher socioeconomic strata are almost as obese as our western counterparts. More disturbing fact is increased prevalence of obesity in childhood. Obese children are common sight in schools now days.


What are the treatment options for tackling obesity?

Lifestyle changes are cornerstones of obesity treatment. Doing enough physical activity and restricting calories can not be replaced by any other means including medications and surgery.

Now, we also have some reliable medications which can make you lose weight when used judiciously with lifestyle changes. But, selecting right people for these medications is crucial to avoid side-effects.

Bariatric surgery is now a matter of fashion in our society. Bariatric surgery is definitely a good option in selected patients especially in super-obese people. But, being an irreversible in nature in most cases, long term complications and implications need to be looked into. Moreover, people opting for bariatric surgery should realize that lifestyle changes would still be required after surgery. In short, there is no short-cut to lose weight.
Persistent hard work along with ethical medical guidance would be needed for long term care.


What are recent trends in management of obesity?

There has always been a paradox while understanding obesity: If obesity is so harmful then does human body still perceives it as survival advantage?   Well there are two aspects this statement.

Firstly, that evolutionary cycle is actually longer than our lifespans and harmful obesity is relatively recent phenomenon.

Secondly, it now seems that actual harmful effects of weight are due also to inactivity associated with obesity along with per se increased fat mass.
So, we as doctors, now place more emphasis on overall fitness of person irrespective of their actual weight!!

Dr RAJIV SINGLA
Consultant Endocrinology & Metabolism.
HOD, Endocrinology Department, Saket City Hospital & Kalpavriksh Clinic.
9968277369



Tuesday, February 10, 2015

OBESITY - THE RISING EPIDEMIC..


The irony is that in world so deprived, there are problems of excess. 

In the modern world, development has brought its share of problems and obesity is one such problem. 

Lifestyles have become indulgent and problems like obesity are adversely affecting the quality of life because we don’t know where to draw the line.

According WHO (2008 estimates), more than 1.4 billion adults, 20 and older, are overweight. And out of these, there are over 200 million men and nearly 300 million women come under the category of being obese, thus comprising 10% of the world’s adult population.

What is more alarming is the growing prevalence of childhood obesity with WHO 2013 data s/o 43 million obese children worldwide. In India too, gradually this problem is gaining a significant proportion with  approximately 6.57% percent of school children are found to be overweight.

Is it genetic problem, is it a behaviour issue and what are the other risk factors that lead to obesity?

What would be the long-term health consequences of this problem for us as an individual and us as a nation?

What can I do to avoid these consequences? 

With these questions in mind let’s find out next few posts, how we can face this challenge and emerge as a healthy nation.


Posted by:
www.kvsc.in