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

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/Height² ( 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

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.

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BONE HEALTH IN AGING

We all know that bone health is one of the most neglected factors in our daily routine life, especially in older individuals. As one grows out of childhood, bones acquire bone mass, which gives strength to the bone. This continues till 30 years of age, after which there is continuous decline in bone strength and mass. In women, post-menopause (cessation of menstruation) there is sudden and rapid decline in bone mass, which lead to increased frequency of osteoporosis in them. However, after 70 years of age, both men and women are at equal risk of developing osteoporosis.

What are the reasons for osteoporosis?

There are few common causes that lead to osteoporosis:

1. Menopause is an important cause of osteoporosis. Due to loss of protective estrogens there is rapid bone loss and women with premature ovarian failure at young age develop it to a greater extent.

2. Inadequate intake of vitamin D and calcium. Studies have shown that vit. D deficiency is rampant in India and that leads to calcium loss and bone demineralization, as calcium is not available through meals

3. Lack of physical activity leads to decrease muscle bulk and increase bone Calcium loss. Hence, regular exercise schedule is must to prevent osteoporosis.

4. Smoking and alcohol intake are detrimental to bone health and lead to increase chances of fracture.

5. Other endocrine disease, bone related diseases and chronic medications like steroids may lead to decrease in bone mass and increase fracture risk.

How can it be diagnosed?

Osteoporosis might stay hidden have till there is a fracture. While vertebral fractures are common, patients may present with complain of backache, forward stooping of back or with more severe hip fracture, which increase risk of death in person and cause movement restriction. Hence, the recommendation that every woman more than 65 years of age and men more than 70 years of age should under go testing for osteoporosis using a DEXA Scan of hip and spine which may detect incidental fractures also.

What are the treatment options available?

Treatment is simple

• Adequate physical activity 
• Nutritious food rich in vitamin D and calcium  
• Lifestyle modification: Quitting smoking and alcohol is of utmost importance.
• Women with early menopause (before 40 years) should be treated with hormone replacement therapy to prevent bone loss in consultation with their treating expert.
• Medication: both oral and injectable forms are available. But drugs have their side effects and should be taken under supervision of endocrinologist.

Is it possible to prevent osteoporosis?

A healthy lifestyle, and regular intake of calcium and vitamin D starting from younger age group helps in achieving a good bone mass and prevention of osteoporosis.   

Dr Vineet Surana

MD, DM Endocrinology

Consultant Endocrinology

Metro Heart Institute and Hospital

Delhi.

GUIDE TO A HEALTHY MENOPAUSE

There are three important hormonal milestones in any woman’s life cycle: 

• Puberty 
• Pregnancy 
• Menopause. 

Puberty and pregnancy are instrumental in defining womanhood. These hormonal events are responsible for continuation of mankind and make women biologically distinct and superior to their male counterparts. This positive hormonal balance continues till age of 45 to 55 years and comes to an end at, what we call, menopause.

Why this discussion about Menopause?

Menopause is an important milestone in any woman’s health cycle. Female hormones viz. estrogens and progesterone are responsible for maintaining cyclical menstrual bleeding and thus fertility in women. These hormones, especially estrogen, have been shown to have a tremendous positive impact on health of other organs like bones, heart and brain. At menopause, secretion of these hormones gets halted. This predisposes the women towards poor health outcome in form of disruption in sex life, osteoporosis (weak bones), heart problems and also increased risk of dementia (decreased thinking power).

How do you identify impending menopause?

Menopause happens usually between 45 and 55 years, but, the average age of menopause is 51 years. In general, you can expect to have menopause at approximately same age as your mother or sister had., Changing hormonal milieu can lead to some of the symptoms of menopause even years before you stop having menstrual periods. The most common symptoms are irregular periods, hot flashes, night sweats, mood changes, sleep problems, and vaginal dryness.

Can we discuss Hot-Flashes in little detail?

Hot flash:

Hot flashes are experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes, ending with chills and shiver.  The sensation of heat usually begins in the face or chest and it can spread throughout the whole body. Hot flashes may be associated with a feeling of anxiety or heart palpitations during the hot flash. The hot-flashes may happen few times each week or every few minutes throughout the day. Hot flashes are often more frequent and more intense during hot weather or in an overheated room. When hot flashes happen during sleep, they are called night sweats.

Does every woman with menopause needs treatment?

Menopause is a normal physiological event in any woman’s life. In view of positive impact of female hormones on all body function, there had been a great enthusiasm towards treating every woman with these hormones in past. But, recent studies have suggested that benefit of this treatment is not uniform and great and may even harm woman. But, this does not mean that a woman with menopausal symptoms have to suffer. We have safe and established treatments to alleviate these symptoms and thus improving quality of life during menopausal transition. Even hormonal replacement for short term periods has been shown to be safe. But, individualization of treatment is of paramount importance in management.

Apart from symptomatic management, what are the health issues requiring specific attention?

Heart and Bones. 

Osteoporosis is one issue, importance of which cannot be overemphasized. Every woman should get a DXA scan (bone density test) done ten years post menopause and get it evaluated by their hormone specialist (Endocrinologist). As diabetes is becoming more prevalent in our society, heart problems in post-menopausal age are becoming more and more common. So getting your blood sugars and cholesterol tested would be good idea. Another health issue which should not be overlooked is depression and anxiety. 

All these little things can help you to continue your life as before. 

Happy Menopause to you.

Dr Rajiv Singla

HOD and Consultant, Endocrinology Department

Kalpavriksh Superspeciality Clinic & Saket City Hospital

www.kvsc.in

Normal aging - a Myth

What do we understand by normal aging ?

Normal aging is a myth. Aging is a variable phenomenon that affects different individuals differently. The gradual wear and tear of any machinery depends on how well it has been maintained and taken care of. Till our youth the organs are growing and the regenerative capacity of our body organs is very active. But post youth the normal consequence of growth is the regenerative capacity decreases drastically because of genetic programming of cell death and the external environmental influences, which may hasten the process. The cell death lead to decreased capability to handle the environmental stress in return. The way we live, our diet, physical activity and the stress both physical and psychological causes a string of events in our body that would in the long run would determine the rate of decline in our normal functions. Added to this would be the illnesses that start appearing in the in the middle age and increase the burden of aging on the life quality.

What are the various changes that occur with aging?

Various organs show different physiological changes during aging. The table below summarizes the changes in a nutshell.

Organ	Aging changes
Skin	Skin becomes less elastic and more lined and wrinkled. Nail growth slows. The oil glands gradually produce less oil, making the skin drier than before.
Hair	Gradually become thinner. As hair pigment cells decline, gray hair growth increases
Face	Wrinkles, facial hair, bags under the eyes, double chin, longer ears, thinning cheek.
Hearing	High-frequency sounds become  harder to hear and changes in tone and speech less clear especially after 50.
Vision	Lenses in the eyes become less flexible (presbyopia). Night vision and visual sharpness to decline.
Nose	Ability to smell declines after age 65, amount of reduction varies widely between individuals.
Height	By age 80, it's common to have lost as much as 2 in. (5 cm) in height, posture and compression of joints, spinal bones, and spinal discs.
Body Weight	Weight declines between age 55 and 75, due mostly to loss of lean tissue, muscle mass, water, and bone.
Fat	Fat content and distribution change, storage increases
Sleep	Less sleep at night, and you may not sleep as deeply as you did when you were younger. Frequent midnight and early morning awakenings.
Brain	Gradual loss of brain tissue ( 5-10% by age 90), slow reaction, faltering memory, insomnia. Mental and physical responses to specific stimuli become slower.
Heart	Thickening of heart wall, gradual loss of effectiveness as a pumping machine.
Lungs	Lose elasticity and capacity (40% between ages 20 and 80), increasing difficulty to oxygenate blood.
Joints	Cartilage becomes cracks and frays, cushioning fluid gets thinner, tendons and ligaments are less resilient.
Bones.	Loss of bone cells accelerates at about age 35, bones become porous and brittle in the demineralizing process. Osteoporosis is common in women.
Metabolism and body composition.	Over time, the body typically needs less energy, and your metabolism slows. Hormone changes in the aging body result in a shift to more body fat and less muscle mass.
Abnormal Growth	Cancers, hyperplasia, and macromolecular aggregates become common.
Arteries	Cholesterol and calcium buildup, walls thicken, arteries harden, high blood pressure, risk of heart attack.
Blood	White blood cell and red blood cell count decrease.
Kidneys	Weight & volume of the kidneys shrink, marked reduction in the cleansing of impurities from the blood.
Bladder	Connective tissue weaken, lower capacity to store urine, and reduced efficiency of emptying content.
Prostate	Reduction in semen making after 60, enlargement in size may cause difficulty to urinate.
Reproductive System	Women go through menopause at ages of 45 - 50, reduced level of estrogen affects the whole body. Men's reproductive change with age is more like a reduction than a cessation.
Breast	Mammary (milk secreting) glands reduce in size, as does the breast.
Hormones	The level of several hormones, e.g., GH, DHEA, IGF falls with age, may be a major cause on ageing.
Immunity	Body's power to combat infection declines; auto-immune responses increase.
Muscles	Loss of muscular mass, partly due to un-use, other causes include loss of blood flow and energy supply.
Nerve	Demyelination - loss of myelin covering of nerve fibers, which is characteristic of neurological disorders.
Voice	Voice becomes weak and muffle
Tongue	Sense of taste loses only gradually with age, with equal reduction of all flavors.
Teeth	Teeth gum recession
Thermoregulation	Response to changes in environmental temperature becomes impaired.

What is Healthy aging?

Healthy aging is a way of lifestyle that may partially neutralize the deleterious effects of aging leading to a productive life for a longer life span. Even though genetic influences cannot be completely neutralized but the environment we create around us do influence the gene expression even when we are not able to appreciate those changes immediately in our body. Even minor changes in our lifestyle may lead to a happier and more satisfactory old age.

What is the role of preventive healthcare in healthy aging?

Preventive healthcare means actively intervening in the process of aging to look for illnesses, disabilities and stressful conditions so that they may be rectified at an early stage by lifestyle interventions. Preventive healthcare is a mindset that dynamically evaluates a lifestyle in terms of its long-term consequences both good or bad and finding where the problem lies and thereafter looking for the achievable solutions according to the individuals circumstances. This in the long term would decrease the load of chronic diseases in the old age and decreasing the economic burden due to health concerns of an individual and thence of a society.

More detailed overview of the different organs would be taken one by one in the next few posts.

Till then, stay healthy and stay ageless...

Dr Sweta Singla

Consultant Neurology

KVSC

www.kvsc.in