Restless Legs Keeping You Awake?

Do your legs ache, squirm, feel antsy and seem to want to MOVE to get comfortable when you try to go to sleep at night? How about during the day- do you need to get up and walk around to relieve that same irritating sensation in your legs when you are supposed to be sitting in a meeting or parking yourself in front of a computer? Does walking around or at least moving your legs relieve the discomfort? If so, you may be one of the estimated 3-15% of the population with a disorder known as restless leg syndrome (RLS).

This disorder can be a sign of underlying issues such as iron deficiency, pregnancy, kidney problems or  drug side effects, but also may be an isolated medical problem. About half of the time, there is a family history of other blood-relatives having the restless leg syndrome. The incidence increases with age, and is more common in Caucasians.

How is RLS diagnosed?
Restless leg syndrome is primarily diagnosed by your history, with focus on four issues:

• Strong urge to move your legs
• Symptoms worse at rest
• Symptoms worse at night
• Urge relieved by movement, but come back quickly with rest

Your doctor may need to do blood tests to determine if you have a low iron level (ferritin) and/or low red blood cell count (anemia), and occasionally a formal sleep study may be necessary to fully identify RLS.

How is RLS treated?
If there is an identified cause, such as a medication or iron deficiency, then the treatment obviously targets that trigger. Medications that are more likely to cause RLS include antihistamines and decongestants, antidepressants, anti-nausea medications, seizure medications and stimulants.

If no cause can be identified, then there are several different medications which your doctor may try.
For very intermittent symptoms, a drug traditionally used for Parkinson's disease (Sinemet) can be taken on an "as needed" basis. For people who suffer from symptoms the majority or every night, other neurologic medications (Requip, Mirapex, Neurontin, Lyrica, or Neupro) may be tried on a nightly basis.

What about alternative therapies? There's always SOAP...

BOTTOM LINE: If your squirming legs are keeping you from restful sleep, don't suffer in silence- talk to your doctor and find out if you have restless leg syndrome!

Can't Sleep? You're Not Alone...

One in ten American adults have suffer from insomnia (defined as inability to adequately sleep for at least fourteen consecutive nights). Whether it is trouble with falling asleep or difficulty staying asleep (waking up either multiple times or simply way too early), this lack of restorative sleep leads to more than simply daytime fatigue. Sleep deprivation causes trouble with concentration and memory, irritability and other mood disturbances, and actually can lead to higher rates of infection, diabetes, heart disease, and cancers. As such, I'm going to spend the next several blog entries talking about insomnia issues and solutions.

While some sleep disturbances (such as sleep apnea and restless legs) will definitely require medical interventions, the good news is that a great deal of sleep issues can be significantly improved or solved with some behavioral modifications. What can you do?

Sleep Hygiene Improvements:

• Eliminate or greatly reduce caffeine- even morning coffee affects the quality of your nighttime sleep. (You can keep the coffee- but wean to decaf!)
• Exercise in the morning (or at least a few HOURS before bedtime)
• Avoid "screen time" in the two hours before bed- do your dishes/laundry/non-screen chores if necessary, read a book, play with your pets or enjoy the lost art of conversation
• Take a warm shower or bath just before going to bed
• Use ALL your senses to relax during that bath- smell, sight, sound (think lavender soaps, soft music or nature sounds, and candle light- there is a reason SPA's use all these!)
• Go STRAIGHT to bed after the shower- don't get sidetracked by housework or electronics
• Make your bedroom dark and cool (consider blackout shades and ceiling fans)
• COVER THE CLOCK (no peeking at your phone or clock to watch the minutes tick by one after another!)
• Until you are sleeping WELL again, move the pets OUT of the bedroom. 

BOTTOM LINE: If you suffer from insomnia, talk to your family doctor to try and identify the cause, and include these sleep hygiene tips along with any necessary medications to maximize your long-term success.

MORE Losing Holiday Weight

Tip number two for losing that holiday weight is another common sense solution- GET SOME REST! A study published in the Annals of Internal Medicine this year compared weight loss between a group that followed a low calorie diet and had only an average of 5.5 hours of sleep per night versus a group that followed the same diet and averaged 8.5 hours of nightly sleep.
It may surprise you that not only did the people with more sleep had more weight loss, but they also had greater reduction in body fat and in HUNGER.

Scientists are not sure of exactly how more sleep resets your hunger thermostat or changes your metabolism, but we certainly know that less sleep stresses your body, which is not conducive to better health. If you struggle with INSOMNIA as the reason for your lack of sleep, make sure you are having good sleep hygiene (keeping a regular bed time, not watching tv or doing computer right before bed, etc.) and limiting or avoiding caffeine and alcohol. Check out my blog on covering the clock, and make an appointment with your doctor if you cannot restore good sleep on your own.

BOTTOM LINE: Make sure you are getting at least 8 hours of sleep to maximize your success with losing those extra holiday pounds!

Calcium: Adequate serum calcium is needed for fecal fat excretion. Observational data has shown that those who supplement their diet with calcium have lower levels of body fat. This systematic review found supplementation of about 1,200 mg of calcium per day leads to an increase in fecal fat excretion. Obes Rev 2009; 10(4): 475-86



Sleep: A very small pilot study compared a low calorie diet and either 5.5 hours of sleep vs 8.5 hours over 14 days. Those who slept more had greater loss of weight and body fat, and, among other things, less hunger. The authors postulate it was due to the neuroendocrine changes decreased sleep induces. Ann Intern Med 2010; 153: 435-441

Chronic PPIs: When used chronically, PPIs are associated with pneumonia, C. diff infection and other problems. This case control study found obesity developed in patients with GERD who were treated chronically with PPIs vs other treatments World J Gastro 2009; 15(38): 4794-4798.

Still Can't Sleep?

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 a change in time zones. For theses occasional 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 2:00am you're beginning to panic about how you'll be able to function in the morning. Patterns emerge of heavy caffeine intake in the morning to "get going", then an afternoon "pick me up" coffee or soda, followed by a glass or two of alcohol to "relax and wind down" from the day. Most people know caffeine is a stimulant, but did you know even morning coffee can impair your quality of evening sleep? Alcohol, though a sedative, may help people relax and fall asleep, but realize that it,too, disturbs the quality of sleep. So how can you break this pattern? Here are a few ideas that might help.
1. Start your day with exercise. Even a quick fifteen minutes of brisk walking will release adrenaline and help decrease your need for caffeine. 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!)
2. 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.
3. 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 still 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.
4. Consider an underlying medical issue.Medical causes of chronic insomnia include an underlying issues such as sleep apnea, restless leg syndrome, thyroid disease, anemia or depression. Make an appointment with your doctor to discuss it!

BOTTOM LINE: For the occasional sleepless night, go ahead and use a sleep medicine if you'd like, but if you're taking a sedative every night and stimulants every morning, recognize the habits that are aggravating the problem and make some healthy changes!

Time to decaffeinate?

How much caffeine is too much? Most of my patients would laugh and tell you I think any caffeine is too much, because I have asked so many of them to give it up (and, for the record, had very positive feedback from those who have!) In reality, though, here is my standard answer. Do you have headaches, insomnia, heartburn or fatigue? If you have any of those, I would advise you to completely decaffeinate, because caffeine aggravates all these problems. Yes, I understand that you drink your coffee because you are tired and need the "pick-me-up", but all that you are doing is perpetuating the cycle. The more caffeine, the worse quality of sleep, and the more tired you get.
So how do you wean? Many people get intense headaches if they abruptly quit caffeine. (Here's a hint- if you do get caffeine withdrawal headaches, this should be a clue you're consuming "too much" for you!) Start mixing your coffee with roughly a third decaf, then several days later go to half decaf/half regular, and then several days after that drop down to 1/3 caffeinated. By day 10, you should be fully decaffeinated without getting a headache. I have found that after a couple weeks of NO caffeine, most people begin to have more energy.
BOTTOM LINE: If you have no trouble falling asleep, wake up rested and energetic, and never have heartburn- enjoy your Starbucks guilt-free! BUT...if you have any of those issues, it's time to DE-caffeinate!

Cover the clock!

What is the most useful information you've ever received from a doctor? Well, I saw yet another patient today who told me this was the best advice I had given them, so I thought I should share it here. COVER THE CLOCK!
If you are having trouble sleeping, whether it's difficulty falling asleep or problems with waking up every morning at 3:17am (and isn't it amazing how accurate our internal clocks can be when they get stuck on a frustrating awakening time?), one simple piece of advice is to cover your clock. Cover it- turn it around- whatever it takes so you simply cannot see the time. You'll be amazed how well this works! You may still wake up, but without seeing the time, you don't start that whole cycle of "oh my gosh, it's 3:17am, and here I am awake again, and I'll never be able to function today, and I'm so tired, and look, now it's 3:19am..."
Of course, if you're like me, you'll need to double and triple check that your alarm is set before you turn the clock away from you (or cover it), but that's okay. It will likely take you several nights to break your cycle of awakening, but if you don't "cheat" and sneak a peak at the time, you'll be sleeping better before you know it.
BOTTOM LINE: COVER THE CLOCK to improve your sleep!