Life expectancy for people with HIV approaching that of general population.


A new study suggests the life expectancy of Canadians and Americans who are HIV positive is closing in on that of the general population.

The study says that a 20-year old diagnosed with HIV today can expect to live into their early 70s.

A couple of decades ago, a diagnosis of HIV was a death sentence for most who received it.

But with the discovery and improvement of antiretroviral drugs, HIV has become a chronic disease for most who have access to and can afford the medication.

A leading HIV researcher, Dr. Julio Montaner, says the findings of the study are excellent news.

Montaner is director of the B.C. Centre for Excellence in HIV/AIDS, which led the research collaboration that produced the study, which is published in the journal PLoS One.

He says the longevity gains have been remarkable. In 2000, a 20-year-old newly diagnosed with HIV could expect to live another 36 years. By 2006, that figure had climbed to 51 years.

“I don’t think, in all honesty, that there has been an area of medicine that has undergone a revolutionary evolution over our lifetime as HIV has,” Montaner says.

Dr. Ann Stewart, medical director of Toronto’s Casey House, agrees.

Casey House started 25 years ago as a hospice for dying AIDS patients. As treatment has prolonged the lives of the community it serves, the facility has transitioned into a hospital that offers care for people living with HIV.

Stewart says the findings of the study mirror what Casey House staff see in their patient population. But she warned that the picture is not an “unclouded” one — HIV-positive people often develop the health problems of age faster than those who are not infected.

So heart problems, cancers and the onset of dementia that might be expected in the late 60s, 70s or even 80s in HIV-negative people can show up in the 50s for HIV-positive people, she says.

“It’s much better than it was, for sure. For sure. But it’s not without challenges,” Stewart says.

“You can have HIV and live a wonderful life. But there’s certain complications and challenges associated with it as there are with other chronic diseases that you’re going to struggle with. So it’s not an unclouded sky.”

Instead of the ER: Paramedics making house calls to chronic patients.


Emergency rooms — which can cost patients thousands of dollars each visit — have become the primary source of medical care for the uninsured and people with chronic illnesses.

A Minnesota health care provider is testing a new program in the hopes of reducing ER admissions and keeping people healthier: they’re sending paramedics on house calls to some of the area’s sickest patients who might otherwise end up in the ER.

The need for such out-of-the-box solutions is clear. In the last year, one in five Americans went to the ER at least once for an estimated 130 million visits. The cost of all those ER visits is staggering, considering that the price for treating some of the most common conditions can range from an average of $750 all the way up to $73,000.

“We don’t screen for insurance at the door,” said Dr. Joey Duren, an emergency physician with North Memorial Healthcare System in Minnesota. “So in our country now, a big thing is that the emergency department is a safety net for people who don’t have insurance.”

Patients with chronic conditions like asthma and diabetes can spiral out of control without regular monitoring and land in the ER multiple times in a single year. The number of repeat patients is often staggering; some of whom visit dozens of times each month, according to North Memorial’s chief medical officer, Dr. Kevin Croston.

“What’s really the biggest cost in health care are the chronic conditions where there are readmissions to the emergency department,” Duren said. “We realized we needed to create care that stopped that.”

That’s where house calls from the community paramedics came in. Since the program began last October paramedics have made more than 1,000 home visits, at a fraction of the cost for a trip to the ER. Although North Memorial doesn’t have data yet on the savings, officials believe the program will help reduce admissions.

“The role of this community paramedic is helping people get on top of their chronic disease processes so they aren’t getting so sick that they need to come to us in the emergency department,” Duren explained. “We’re controlling their diseases so they can be handled in an outpatient setting versus having to come here or be admitted to the hospital for multiple days because they’ve gotten so far behind in their insulin for their diabetes or their COPD has gotten out of control.”

Chris Anderson is among the first group of paramedics who were specially trained to make house calls. He quickly recognized the value of those home visits.

“It’s when you get to spend more time with [patients], you get to find out what’s going on, what’s truly bothering them, what they need the most help with,” Anderson said.

The house calls have been a life-saver for folks like 65-year-old Victoria Denbleyker, who suffers from multiple, hard-to-manage chronic conditions, like diabetes, congestive heart failure, and rheumatoid arthritis—problems that used to routinely send her to the ER.

With doctors, Denbleyker said, “you don’t have that much time to really talk to them, even if you get the maximum amount of time, which is half an hour. Sometimes there are too many things going on. “

Without consistent monitoring, Denbleyker’s condition can rapidly descend into the danger zone.

“My system can change in a heartbeat,” she said. “I never know what is coming next. So the fact that they know what is going on with me means a lot.”

The Minnesota project started last October. To figure out which patients might benefit from the program, the hospital searched for anyone who had used the ER nine or more times in a year.

Nine was “the number we had to land on for our own survival mode,” said North Memorial’s Croston.

Think that’s a lot?

“We’ve had some patients that were here 23 times in a month,” he said.

Croston said, “readmission rates are down for us as a health system, and that’s largely due to the fact that we’re intervening once they leave the hospital or once they leave the emergency department.”

Barb Andrews, who runs the program, says it’s a new way of thinking about health care.

“It gives us, as paramedics, an opportunity to be proactive rather than reactive,” she said. “The community paramedics empower [patients] to be able to manage their own health better in the home.”

And ultimately, she said, that can “keep them out of the hospital, keep them out of the nursing home.”

Exercise is Statistically as Good as Pharmaceuticals to Treat Diseases.



A recent study 
published in BMJ found that physical activity is as effective as drug interventions for patients with existing cardiovascular diseases and other chronic conditions such as diabetes.

In the few conditions where the life-saving benefits of exercise have been studied, physical activity was often found to be as effective as drugs at reducing the risk of death, according to the first study to aggregate and assess the comparative benefits of drugs and exercise for reducing mortality in a wide range of illnesses.

 

“We were surprised to find that exercise seems to have such powerful life-saving effects for people with serious chronic conditions,” said Huseyin Naci, an HMS visiting fellow in population medicine at the Harvard Pilgrim Health Care Institute, and a graduate student at the London School of Economics. “It was also surprising to find that so little is known about the potential benefits of physical activity for health in so many other illnesses.”

Regular physical activity has been shown to reduce the morbidity and mortality from many chronic diseases. Millions suffer from chronic illnesses that can be prevented or improved through regular physical activity. This include heart disease, heart attack, type 2 diabetes, obesity, colon cancer, hip fractures, stroke and high blood pressure. On average, people who are physically active outlive those who are inactive.

Despite the well-known benefits of physical activity, most adults and many children lead a relatively sedentary lifestyle and are not active enough to achieve these health benefits. A sedentary lifestyle is defined as engaging in no leisure-time physical activity (exercises, sports, physically active hobbies) in a two-week period.

Study Details

In addition to providing guidance for patients and clinicians about the importance of discussing the potential benefits of exercise, the researchers highlighted the importance of continuing to research the value of exercise for health.

The researchers argue that more trials comparing the effectiveness of exercise and drugs are urgently needed to help doctors and patients make the best treatment decisions. In the meantime, they say exercise “should be considered as a viable alternative to, or alongside, drug therapy.”

“We’re not saying people who have had a stroke should go off their medication and head to the gym,” Naci said, “but having a conversation with their physician about incorporating exercise into their treatment might be beneficial in many cases.”

Preventable illness makes up approximately 80% percent of the burden of illness and 90% of all healthcare costs. Preventable illness accounts for eight of the nine leading categories of death.

In the United States, 80 percent of people 18 and older failed to meet the recommended levels of aerobic and muscle-strengthening physical activity in 2011, according to the CDC. What’s more, the average number of retail prescriptions per capita for calendar year 2011 was 12.1, according to the Kaiser Family Foundation.

For people with chronic ailments, exercise used to be viewed as asking for trouble. However, current evidence suggests that in both health and disease, the overall prognosis is better for the exerciser than for the sedentary. For example, a recent study showed that intensive workouts can not only slow the progress of coronary disease, but actually restore lost coronary function when the disease is still stable.

“We’ve yet to find a disease state where exercise isn’t helpful.” said Miriam Nelson, Ph.D, from Tufts University.

For the current study, the researchers analyzed the results of 305 randomized controlled trials involving 339,274 individuals and found no statistically detectable differences between exercise and drug interventions for secondary prevention of heart disease and prevention of diabetes.

Exercise Often More Effective Than Drugs

Among stroke patients, exercise was more effective than drug treatment.

The authors point out that the amount of trial evidence on the mortality benefits of exercise is considerably smaller than that on the benefits of drugs, and this may have had an impact on their results. Of the nearly 340,000 cases analyzed, only 15,000 patients had had exercise-based interventions.

For chronically ill individuals, the psychological as well as physical benefits of exercise can be profound. Even ten minutes of light exercise a day, can help most chronically ill patients feel more vibrant, energetic and alert.

“Exercise is empowering and energizing, and it increases your sense of control over the situation. You’re never too sick or too old to get started exercising,” stated Bess Marcus, Ph.D, of Brown’s University.

The researchers argue in the paper that this “blind spot” in available scientific evidence “prevents prescribers and their patients from understanding the clinical circumstances where drugs might provide only modest improvement but exercise could yield more profound or sustainable gains in health.”

Participation in regular physical activity– at least 30 minutes of moderate activity on at least five days per week, or 20 minutes of vigorous physical activity at least three times per week–is critical to sustaining good health. Youth should strive for at least one hour of exercise a day. Regular physical activity has beneficial effects on most (if not all) organ systems, and consequently it helps to prevent a broad range of health problems and diseases. People of all ages, both male and female, derive substantial health benefits from physical activity.

Regular physical activity reduces the risk of developing or dying from some of the leading causes of illness in the United States. Regular physical activity improves health in the following ways:

·         Reduces the risk of dying prematurely from heart disease and other conditions;

·         Reduces the risk of developing diabetes;

·         Reduces the risk of developing high blood pressure;

·         Reduces blood pressure in people who already have high blood pressure;

·         Reduces the risk of developing colon and breast cancer5;

·         Helps to maintain a healthy weight;

·         Helps build and maintain healthy bones, muscles, and joints;

·         Helps older adults to become stronger and better able to move about without falling;

·         Reduces feelings of depression and anxiety; and

·         Promotes psychological well-being. 


Exercise v.s. Diet v.s. Drugs

Exercise v.s. diet v.s. drugs is often the debate that many health professionals evaluate. By examining each disease through clinical trials, we can better determine the efficacy of both exercise and diet in the treatment of many common ailments. Diet, for example, is the cornerstone of diabetes care, but if diet is combined with exercise, diabetics dramatically improve their condition by more than 45% than with diet alone.

CONDITION

TYPE OF EXERCISE

MAXIMUM IMPROVEMENT WITH EXERCISE

MAXIMUM IMPROVEMENT WITH DRUGS

MAXIMUM IMPROVEMENT WITH DIET

High Blood Pressure

Aerobic

15%

9%

11%

Diabetes

Strength training, flexibility, low-impact aerobic

52%

5%

38%

Stroke

Strength training, flexibility, low-impact aerobic

28%

7%

Heart Disease

Aerobic

33%

11%

26%

High LDL cholesterol

13%

20%

Low HDL cholesterol

Aerobic

15%

High Blood Sugar

Aerobic

15%

11%

30%

Arthritis Pain

Strength training, flexibility, low-impact aerobic

40%

12%

Low Bone Density

Weight bearing

3%

2%


Regular physical activity is associated with lower mortality rates for both older and younger adults. Even those who are moderately active on a regular basis have lower mortality rates than those who are least active. Regular physical activity leads to cardiovascular fitness, which decreases the risk of cardiovascular disease mortality in general and coronary artery disease mortality in particular. High blood pressure is a major underlying cause of cardiovascular complications and mortality. Regular physical activity can prevent or delay the development of high blood pressure, and reduces blood pressure in persons with hypertension.

Despite this uncertainty, the authors claim that based on the available data physical activity is potentially as effective as many drug interventions and more trials to address the disparity between exercise and drug-based treatment evidence are needed.

 

“What we don’t know about the benefits of exercise may be hurting us,” Naci said.

Sources:
bmj.com
nlm.nih.gov
preventdisease.com
medicalnewstoday.com

Rate of Chronic Disease Increasing Exponentially.


 

A growing global epidemic of chronic disease, such as heart disease, stroke, cancer and diabetes, will cause at least 35 million deaths this year, costing the world economy billions of dollars, even though medical science has identified the principal causes and knows ways to prevent it, experts said at a AAAS seminar in Washington, D.C.

 Speakers at the first Philip Hauge Abelson Advancing Science Seminar said that twice as many premature deaths are caused worldwide by chronic diseases as by all infectious diseases, maternal and perinatal conditions and nutritional deficiencies combined. And while the toll from infectious diseases is declining globally, deaths from chronic disease are expected to increase by 17 percent in the next 10 years.

The 8 December seminar included speakers from the World Health Organization (WHO), from pharmaceutical and medical device manufacturers and from university research labs. It was the inaugural event in a series named for Abelson, a researcher in physics, biology and other sciences, and the editor for 22 years of Science, which is published by AAAS. Abelson died last year at the age of 91.

Alan I. Leshner, AAAS chief executive officer and executive publisher of Science, said the seminar series would address major societal challenges and focus on the frontiers of science and technology.
Robert Beaglehole, WHO’s director of Chronic Diseases and Health Promotion, said in the keynote address that the toll of premature death from chronic disease is increasing worldwide principally because of unhealthy diets, physical inactivity and the use of tobacco and the aging of populations in almost all countries.

Diet and the lack of physical activity is contributing to a growing pattern of obesity, a key risk factor for diabetes and early heart disease. And it’s not just happening in the rich countries, such as the United States and South Africa, where recent reports show that 75 percent of women aged 30 and over are overweight. A “very frightening statistic,” said Beaglehole, is that in countries both rich and poor, about 22 million children worldwide under the age of five are already obese.

“We’ve done a lot to observe the emergence of this problem,” he said. “We have done practically nothing to solve it.”

Beaglehole said that common misunderstandings about chronic disease have affected policy decisions and slowed the worldwide response to the emerging epidemic.

For instance, he said it’s widely believed that premature heart disease, stroke, diabetes and other chronic diseases are mostly a plague among the elderly and among the rich in high-income countries.
Actually, said Beaglehole, 80 percent of deaths from chronic diseases are in low- and middle-income countries. A WHO report found that poor people, in all but the least developed countries, are more likely than the rich to develop chronic diseases and are more likely to die early. And it is not just the elderly who are victims. The WHO report found that almost half of the deaths from chronic diseases occur in people under 70 years old.

“A very dangerous misunderstanding is that chronic disease is the result of unhealthy lifestyles under the control of individuals,” Beaglehole said. “The reality is that poor people and children have very limited choices, and it is unfair to blame them for the environmental conditions in which they suffer.”
There’s also the belief by many that chronic diseases and premature deaths cannot be prevented.
“The reality is that approximately 80 percent of premature heart disease, stroke and type 2 diabetes is preventable, as are 40 percent of all cancers — many of which result from tobacco consumption,” said Beaglehole. “A few known risk factors explain the vast majority of premature chronic disease deaths.”

A global effort to attack the causes of chronic disease could reduce death rates by 2 percent a year and save 36 million lives within a decade, he said. Ninety percent of the lives saved, said Beaglehole, would be in low- and middle-income countries. Slowing the epidemic of premature death from chronic diseases will have to involve policy issues beyond the health field, he said. For instance, farm subsidies often affect the type of food available in some countries. An example: The consumption of full fat milk is encouraged in schools in some European countries because of subsidies, said Beaglehole. Excessive fat, sugar and salt in the diet lead to obesity, type 2 diabetes, heart disease and stroke.

Other specialists at the Abelson seminar reported recent findings that offer new hope for treatment and management of heart disease, high blood pressure, obesity, diabetes and cancer.
Eric J. Topol, provost of the Cleveland Clinic Lerner College of Medicine, said studies of families with heart attack have demonstrated specific genes that are causative or induce susceptibility. This will allow strategies of lifestyle and individualized therapy early in life to prevent heart attacks decades later.

The battle against the growing epidemic of obesity will require fundamental changes in attitudes toward food and exercise, said Holly Wyatt, the program director at the Centers for Obesity Research and Education at the University of Colorado Health Sciences Center. In American society, she said, “we’ve had a lot of pressures to not expend more energy than we have to and we had a lot of pressure to eat more than we need.”

To change the behaviors that lead to obesity will require encouragement from virtually every element in society — employers, schools, churches, community centers and retail stores, she said. Such programs have worked in the past to discourage tobacco use and encourage using seat belts in cars. Without such an effort, Wyatt said that by 2008 about 75 percent of Americans will be at a body weight that negatively affects health.

Basic research on how the kidneys regulate salt in the body has given medical science a new understanding of the causes of high blood pressure, a major risk factor for heart attack, stroke and kidney failure, said Rick Lifton, Sterling Professor and chairman of Genetics atYale University School of Medicine. He said there are biological pathways and gene mutations that cause the kidneys to sequester sodium, leading to increases in blood pressure. Drugs to counter these effects could lead to dramatically improved treatments for hypertension, a disorder that affects a billion people world wide and is linked to about 5 million deaths annually.

Dr. Gerald I. Shulman, an investigator of the Howard Hughes Medical Institute and professor of internal medicine and cellular & molecular physiology at Yale University, said that new, non-invasive studies using magnetic resonance spectroscopy have demonstrated that the development of insulin resistance in type 2 diabetes is directly related to the build-up of fat inside muscle and liver cells where it disrupts normal insulin signaling and action in these organs. Studies in transgenic and knockout mice as well as in humans have shown that removing this excess intracellular fat can restore insulin sensitivity and cure type 2 diabetes. The results from these studies provide new targets for novel therapies that might be developed to reduce intracellular fat levels and reverse insulin resistance in patients with type 2 diabetes, said Shulman.

Copyright 2005. American Association for the Advancement of Science

Source: oasisadvancedwellness.com

Unhealthy behaviours and disability in older adults: Three-City Dijon cohort study.


Abstract

Objectives To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among older French adults and to assess the role of potential mediators, assessed repeatedly, of these associations.

Design Population based cohort study.

Setting Dijon centre of Three-City study.

Participants 3982 (2410 (60.5%) women) French community dwellers aged 65 or over included during 1999-2001; participants were disability-free at baseline when health behaviours were assessed.

Main outcome measure Hierarchical indicator of disability (no, light, moderate, severe) combining data from three disability scales (mobility, instrumental activities of daily living, basic activities of daily living) assessed five times between 2001 and 2012.

Results During the 12 year follow-up, 1236 participants (861 (69.7%) women) developed moderate or severe disability. Interval censored survival analyses (adjusted for age, sex, marital status, and education) showed low/intermediate physical activity (hazard ratio 1.72, 95% confidence interval 1.48 to 2.00), consuming fruit and vegetables less than once a day (1.24, 1.10 to 1.41), and current smoking/short term ex-smoking (1.26, 1.05 to 1.50) to be independently associated with an increased hazard of disability, whereas no robust association with alcohol consumption was found. The hazard of disability increased progressively with the number of unhealthy behaviours independently associated with disability (P<0.001); participants with three unhealthy behaviours had a 2.53 (1.86 to 3.43)-fold increased hazard of disability compared with those with none. Reverse causation bias was verified by excluding participants who developed disability in the first four years of follow-up; these analyses on 890 disability events yielded results similar to those in the main analysis. 30.5% of the association between the unhealthy behaviours score and disability was explained by body mass index, cognitive function, depressive symptoms, trauma, chronic conditions, and cardiovascular disease and its risk factors; the main contributors were chronic conditions and, to a lesser extent, depressive symptoms, trauma, and body mass index.

Conclusions An unhealthy lifestyle is associated with greater hazard of incident disability, and the hazard increases progressively with the number of unhealthy behaviours. Chronic conditions, depressive symptoms, trauma, and body mass index partially explained this association.

Source: BMJ

Helpful Tips for Sleeping Better This Summer.


Story at-a-glance

  • Nearly 41 million US adults are sleeping just six hours or less each night, which recent research has linked to an increased risk of chronic inflammation and heart disease in women
  • Men with restless legs syndrome have a 40 percent higher risk of total mortality. According to the researchers, one of several potential mechanisms that might account for this increased mortality risk is disturbed sleep
  • Sleeping pills have been linked to a wide variety of health hazards, including a nearly four-fold increase in the risk of death, along with a 35 percent increased risk of cancer
  • Tips for better sleep are discussed, including the critical elements of your sleeping sanctuary, when to exercise to promote sleep, foods and beverages to avoid before bedtime, and the effect of electronic gadgets
  • Using EFT and/or increasing your melatonin can usually offer help when nothing else seems to work.
  • Man sleeping

If you’re like most Americans, you’re likely not getting enough sleep. Nearly 41 million US adults are sleeping just six hours or less each night, which recent research has linked to an increased risk of chronic inflammation and heart disease in women.1

Over the course of the five-year long study,2 women who slept poorly—quantified as sleeping less than six hours per night—had 2.5 times higher increases in inflammation levels compared to men who slept poorly. As reported by the featured article:3

Researchers speculated that the gender difference may be due to lower estrogen levels in the study’s post-menopausal female subjects, whereas men were protected by higher levels of testosterone.”

But regardless of gender-based hormonal differences, summertime can be a time of year when sleep becomes harder to come by, courtesy of rising temperatures. This is just one of a whole host of factors that can have an adverse effect on your sleep. Restless legs syndrome is another ailment that can prevent you from getting sufficient amounts of shut-eye.

Interestingly, a recent observational study4 found that men with restless legs syndrome have a whopping 40 percent higher risk of total mortality. This finding was independent of other known risk factors, including a variety of chronic diseases. As reported by MedPage Today:5

“The relationship between restless legs syndrome and all-cause mortality was stronger for men who had symptoms 15 or more times per month compared with those who had symptoms five to 14 times per month.”

According to the researchers, one (of several) potential mechanisms that might account for this increased mortality risk is disturbed sleep. Previous research has also found that people with chronic insomnia have a three times greater risk of dying from any cause.

summer-sleep

Sleep Deprivation Takes a Serious Toll on Your Health

You can have the healthiest diet on the planet, doing vegetable juicing and using fermented veggies, be as fit as an Olympic athlete, be emotionally balanced, but if you aren’t sleeping well it is just a matter of time before it will adversely, potentially seriously affect your health.

Sleep deprivation is such a chronic condition these days that you might not even realize you suffer from it. Science has now established that a sleep deficit can have serious, far reaching effects on your health. For example, interrupted or impaired sleep can:

  • Dramatically weaken your immune system
  • Accelerate tumor growth—tumors grow two to three times faster in laboratory animals with severe sleep dysfunctions, primarily due to disruptedmelatonin production. Melatonin inhibits the proliferation of a wide range of cancer cell types, as well as triggering cancer cell apoptosis (self destruction). The hormone also interferes with the new blood supply tumors require for their rapid growth (angiogenesis)
  • Cause a pre-diabetic state, making you feel hungry even if you’ve already eaten, which can wreak havoc on your weight
  • Seriously impair your memory; even a single night of poor sleep—meaning sleeping only 4 to 6 hours—can impact your ability to think clearly the next day. It’s also known to decrease your problem solving ability

What You Need to Know About Sleeping Pills

While it may be tempting to look for a pill to quickly help you sleep, these will notaddress any of the underlying causes of insomnia. In fact, researchers have repeatedly shown that sleeping pills don’t work, but your brain is being tricked into thinking they do…

In one meta-analytic study, they found that, on average, sleeping pills help people fall asleep approximately 10 minutes sooner. From a biomedical perspective, this is an insignificant improvement. On average, sleeping pills increase total sleep time by about 15-20 minutes. But here is the catch: This study also discovered that while most sleeping pills created poor, fragmented sleep, they also createdamnesia, so upon waking, the participants could not recall how poorly they’d actually slept!

Worse yet, sleeping pills have also been linked to a wide variety of health hazards, including a nearly four-fold increase in the risk of death, along with a 35 percent increased risk of cancer.

Additionally, most people do not realize that over-the-counter (OTC) sleeping pills — those containing Benadryl — can have a half life of about 18 hours. So, if you take them every night, you’re basically sedated much of the time. Not surprisingly, they’re associated with cognitive deficits in the morning. Trust me, there are far better, safer and more effective ways to get a good night’s sleep…

Tips for High-Quality Shut-Eye from a Sleep Wellness Consultant

As previously discussed by Dr. Rubin Naiman, a leader in integrative medicine approaches to sleep and dreams, sleep is the outcome of an interaction between two variables, namely sleepiness and what he refers to as “noise.” This is any kind of stimulation that inhibits or disrupts sleep. In order to get a good night’s sleep, you want your sleepiness level to be high, and the “noise” level to be low. Under normal conditions, your sleepiness should gradually increase throughout the day and evening, peaking just before you go to bed at night. However, if noise is conceptually greater than your level of sleepiness, you will not be able to fall asleep.

n a recent CNN article, 6 sleep wellness consultant Nancy Rothstein offered up six tips to improve your sleep, wisely starting off by addressing environmental “noise” in your bedroom (for the rest of her suggestions, please see the original article):7

  • Create a sleep sanctuary. This means removing items associated with entertainment, recreation, work and hobbies, and turning your bedroom into a single-purpose space—one for sleeping. Of utmost importance: Make sure your bedroom iscool, dark and quiet. These three factors can have a major impact on your sleep.

With regards to temperature, studies show that the optimal room temperature for sleep is quite cool, between 60 to 68 degrees Fahrenheit, so keep the temperature in your bedroom no higher than 70 degrees.

As for light, even the tiniest bit of light in the room can disrupt your internal clock and your pineal gland’s production of melatonin and serotonin, hormones involved in your body’s circadian rhythm of sleep and wakefulness. So close your bedroom door, get rid of night-lights, and most importantly, cover your windows. I recommend using blackout shades or heavy, opaque drapes. Also cover up your clock if it has a lit display. Alternatively, you could wear an eye mask to block out any stray light.

  • Turn off your gadgets well before bedtime. Again, the artificial glow from your TV, iPad, computer or smartphone can serve as a stimulus for keeping you awake well past your bedtime by disrupting melatonin production. I recommend turning off all electronic gadgets at least one hour before bed. As Rothstein suggests, that time is far better spent reading a good old fashioned book, practicing relaxation techniques or meditating.

Some people find the sound of white noise or nature sounds, such as the ocean or forest, to be soothing and sleep-promoting. An excellent relaxation/meditation option to listen to before bed is the Insight audio CD. Another favorite is theSleep Harmony CD, which uses a combination of advanced vibrational technology and guided meditation to help you effortlessly fall into deep delta sleep within minutes. The CD works on the principle of “sleep wave entrainment” to assist your brain in gearing down for sleep.

  • Exercise to sleep better, but do it early! Exercising for at least 30 minutes per day can improve your sleep, but if you exercise too close to bedtime (generally within the three hours before), it may keep you awake instead.
  • Party-goers beware: alcohol tends to prevent good sleep… Summertime tends to spark party invitations, but as Rothstein warns, it would be wise to consider how a few drinks will affect your sleep pattern. Although alcohol will make you drowsy, the effect is short lived and you will often wake up several hours later, unable to fall back asleep. Alcohol can also keep you from entering the deeper stages of sleep, where your body does most of its healing.

The same applies to eating. Ideally, you’ll want to avoid eating or snacking at least three hours before bed. Especially troublesome are grains and sugars, as these will raise your blood sugar and delay sleep. Later, when your blood sugar drops, you may wake up and be unable to fall back asleep.

Two More Aces Up Your Sleeve When Sleep Becomes Elusive…

My personal favorite fix for insomnia is the Emotional Freedom Techniques (EFT). Most people can learn the basics of this gentle tapping technique in a few minutes. EFT can help balance your body’s bioenergy system and resolve some of the emotional stresses that are contributing to your insomnia at a very deep level. The results are typically long lasting and improvement is remarkably rapid.

Another strategy that can help is to increase your melatonin. Ideally it is best to increase your levels naturally, by exposing yourself to bright sunlight during daytime hours (along with full spectrum fluorescent bulbs in the winter) followed by absolute complete darkness at night. If that isn’t possible, you may want to consider a melatonin supplement. In scientific studies, melatonin has been shown to increase sleepiness, help you fall asleep more quickly and stay asleep, decrease restlessness, and reverse daytime fatigue. Melatonin is a completely natural substance, made by your body, and has many health benefits in addition to sleep.

If you decide to give melatonin supplements a try, start with a very small dose, about an hour before bed—as little as 0.25 mg can be sufficient for some.8 Many end up taking too much right off the bat, which could end up having the reverse effect you’re looking for. Taking too much could also result in side effects9 such as drowsiness, confusion, headache, nightmares, and more. So, start with a tiny dose, and if after three nights you notice no improvement, take a little more. The tips discussed so far are among the most important for a restful night’s sleep, but they are only the beginning. For more, please read my comprehensive sleep guide:33 Secret’s to a Good Night’s Sleep.

Improving Your Sleep Hygiene Pays Off in Health Dividends

There’s convincing evidence showing that if you do not sleep enough, you’re really jeopardizing your health. Everybody loses sleep here and there, and your body can adjust for temporary shortcomings. But if you develop a chronic pattern of sleeping less than five or six hours a night, then you’re increasing your risk of a number of health conditions, including heart disease.

To make your bedroom into a suitable sleep sanctuary, begin by making sure it’s pitch-black, cool, and quiet. Remember, even the tiniest bit of light can disrupt your pineal gland’s production of melatonin and serotonin. For this reason, I highly recommend adding room-darkening blinds or drapes to your bedroom, or if this is not possible wearing an eye mask to block out any stray light.

For even more helpful guidance on how to improve your sleep, please review my 33 Secrets to a Good Night’s Sleep. If you’re even slightly sleep deprived, I encourage you to implement some of these tips tonight, as high-quality sleep is one of the most important factors in your health and quality of life.

Source: mercola.com

 

Earlier Mortality with Restless Legs Syndrome.


Results from a Health Professionals Follow-up Study analysis support an association.

To examine the controversial notion that restless legs syndrome (RLS) is associated with increased mortality, researchers tracked mortality among 18,425 participants in the Health Professionals Follow-up Study (HPFS) who answered a standardized questionnaire about the potential presence of RLS. Patients with diabetes, arthritis, or renal failure were excluded. The investigators documented deaths comprehensively using vital statistics, the National Death Index, family reports, and the postal system.

A total of 2765 deaths occurred between 2002 and 2010. After adjustment for age, RLS was associated with a significant increase in mortality (hazard ratio [HR], 1.39). The association was mildly weakened after adjustment for factors such as body-mass index, lifestyle, other chronic diseases, amount of sleep, and other sleep-related disorders (adjusted HR, 1.30). After excluding other chronic diseases associated with RLS (e.g., Parkinson disease), the association remained significant (adjusted HR, 1.92). Age, weight, short sleep duration, smoking, poor exercise, and a less healthy diet did not affect the association. The study did not include blood testing for iron deficiency.

Comment: Restless legs syndrome affects an estimated 5% to 10% of the population. Because of the association between RLS and chronic conditions such as renal disease, disentangling the mortality risk of RLS has been challenging. Strengths of the current study include accounting for all potential comorbidities such as diabetes, cardiovascular disease, and kidney disease, and establishment of the RLS diagnosis through the use of standardized questions. Not only was there an increased mortality with RLS in general, but this increased mortality occurred more commonly when there was concomitant respiratory dysfunction, endocrine disease, nutritional issues, or presence of metabolic disease or an immunologic disorder. Although observational studies do not prove causality, clinicians should be aware of the increased mortality risk in any patient presenting with RLS-type symptoms. This study was limited by the lack of information on use of dopaminergic medication, which is the best treatment for RLS. Neurologists and primary care doctors should to work together when treating RLS patients. Treating primary RLS symptoms and addressing sleep, blood pressure, cardiovascular, and other comorbidities could be helpful. However, we do not yet understand how to modify the increased mortality risk in patients with RLS.

Source: Journal Watch Neurology

 

Chronic Conditions Found in Nearly All Childhood Cancer Survivors.


Nearly all survivors of childhood cancer have chronic health conditions in adulthood, according to a JAMA study.

Researchers systematically screened 1700 adults (median age, 32) who were diagnosed with cancer as children. Roughly 25 years after diagnosis, 98% had a chronic health problem. Two thirds had a disabling or life-threatening condition. The most prevalent impairments were pulmonary abnormalities, cardiac problems, endocrine disorders, hearing loss, and neurocognitive impairment. Hematopoietic, hepatic, skeletal, and urinary tract dysfunction were less common.

The authors conclude, “These data underscore the need for clinically focused monitoring, both for conditions that have significant morbidity if not detected and treated early, such as second malignancies and heart disease, and also for those that if remediated can improve quality of life, such as hearing loss and vision deficits.”

Source: JAMA 

Improving the transition between paediatric and adult healthcare: a systematic review.


The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent services need to be improved, there is little empirical data on which policies can be based.

Objectives To systematically review the evidence of effectiveness of transitional care programmes in young people aged 11–25 with chronic illness (physical or mental) or disability, and identify their successful components.

Design A systematic literature review in July 2010 of studies which consistently evaluated health outcomes following transition programmes, either by comparison with a control group or by measurement pre-intervention and post-intervention.

Results 10 studies met the inclusion criteria, six of which showed statistically significant improvements in outcomes. Descriptive analysis identified three broad categories of intervention, directed at: the patient (educational programmes, skills training); staffing (named transition co-ordinators, joint clinics run by paediatric and adult physicians); and service delivery (separate young adult clinics, out of hours phone support, enhanced follow-up). The conditions involved varied (eg, cystic fibrosis, diabetes mellitus), and outcome measures varied accordingly. All six interventions that resulted in significant improvements were in studies of patients with diabetes mellitus, with glycosylated haemoglobin level, acute and chronic complications, and rates of follow-up and screening used as outcome measures.

Conclusions The most commonly used strategies in successful programmes were patient education and specific transition clinics (either jointly staffed by paediatric and adult physicians or dedicated young adult clinics within adult services). It is not clear how generalisable these successful studies in diabetes mellitus will be to other conditions.

Source: BMJ.