Sunday, October 26, 2008

Can't sleep? Try this...

Insomnia. We've all had the occasional night or two when no matter what we try, we simply cannot fall sleep. Usually those sporadic nights have an identifiable stressor- a test, a job interview, or maybe it's related to travel. For theses infrequent situations, I have no problem with my patients taking a sleep aid (prescription or over-the-counter.) 
Chronic insomnia, however, is a whole different ball game. Every night becomes a challenge and by 3:00am you're beginning to panic realizing there is no way you'll be able to function well the next day. People fall into patterns of heavy caffeine intake in the morning to "get them going", then a "pick me up" afternoon coffee or soda, and then as bedtime approaches, a glass or two of wine to "relax and wind down" from the day. Most people recognize caffeine is a stimulant (and therefore disrupts sleep, even if consumed hours before bed). Alcohol, though a sedative, may help people relax and fall asleep, but realize that it disturbs the quality of sleep. So how can you break this pattern? Here are a few ideas that might help.
Start your day with exercise. Even a quick fifteen minutes of brisk walking will release adrenaline and help decrease your need for caffeine. Regular exercise is a wonderful way to release tension. Did you know exercising 30 minutes daily yields the same amount of mood enhancement as a low dose of an antidepressant? (Don't exercise just before bed, though, because as noted above, that adrenaline release will keep you up!)
Create a bedtime routine. If you have children, you know how important this is, and it works for adults as well. Take a warm bath or shower, appeal to your senses with relaxing aromatic bath soaps or gels, and then GO TO BED. Do not pass GO and collect $200. This means no stopping to unload the dishwasher, fold clothes, check email or watch television. If you want to read or watch t.v., do it before your shower. Get in bed, close your eyes, and consider some form of relaxing breathing or meditation. 
Cover your alarm clock. Check it three times before you cover it if you need to, but if it's covered, you'll break that habit of waking up at exactly 2:17am each night. Yes, you might wake up, but if you're not seeing the clock, it's easier for your brain to go back to sleep because you're not gearing up all the emotions that come with seeing that dreaded early morning time.
BOTTOM LINE: For the once a month sleepless night, go ahead and use a sleep medicine if you'd like, but when you've developed a pattern of needing sedatives every night and stimulants every day, recognize the habits that are aggravating the problem and make some healthy changes! If you're still not seeing improvement, talk with your doctor because it may be a sign of an underlying issue such as sleep apnea, restless leg syndrome, or depression.

Wednesday, October 8, 2008

From Indi-GES-tion to GERD!

Okay, we grew up calling it "indigestion" or "heartburn" (remember the peptobismal commercial?), but thanks to drug companies and the media, we now have patients coming in with the chief complaint of "GERD"- Gastro Esophogeal Reflux Disease. Not only do they say they have "GERD", but that they'd like a prescription for a purple pill, because it's cheaper than paying for the over-the-counter version. 
So, what causes GERD? Pain comes from the stomach acid sloshing back up into the food tube (the esophogus), because the muscle (sphincter) that usually squeezes down to keep the acid in the stomach is relaxed too much. What relaxes that sphincter? Well, think about when you've eaten way too much food at a nice restaurant, and you're "stuffed". What are we trained to do? People smoke ciggarettes, have an after-dinner drink of alcohol or coffee, and grab a peppermint on the way out the door. Nicotine, alcohol, caffeine and mints all relax that sphincter, allowing food and acid to go backwards up into the esophagus and making us feel less like our stomach is about to explode. 
The problem is that the stomach lining is prepared for acid, because it has a mucus coating over it, while the esophagus has more skin-like covering, and acid is damaging to it. When the acid "burns" the lining in the esophagus, you feel "heartburn", aka. GERD. 
So, yes, there are pills on the market that reduce or neutralize the amount of acid- from the inexpensive antacids (TUMS), to the mid-range (Tagamet) H2 blockers to the expensive proton-pump inhibitors (Prilosec). All of these medicines work, and for the occasional episode, pick your favorite pill.
However, for chronic symptoms, instead of taking a pill to reduce acid every day, (risking side effects such as decreased calcium absorption and subsequent osteoporosis) why not address the cause of the problem?
BOTTOM LINE: If heartburn has become a part of your everyday life, make changes that will stop causing acid to go the wrong direction: limit or eliminate nicotine, alcohol, caffeine and excessive mints (for those chronic breath mint poppers out there) instead of chasing them with pills.