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!

6 Tips for Freshmen Insomnia

Freshmen college students have many challenges as they adjust to their new environments, and sleepless nights in dorm rooms can trigger a downward spiral of fatigue, trouble concentrating, and poor grades...which leads to anxiety and more difficulty sleeping. What can students do to try and stop this cycle? Certainly there are multiple causes for insomnia, from roommate noise to seasonal allergies, to homesickness or academic stressors, but here are six basic steps to try first:

1. CONSISTENT SLEEP (& WAKE) TIMES- with MWF and T/Th schedules, often students have drastically different sleep and wake times each day, which doesn't jive with our body's internal clock. Getting up and going to bed at consistent times (within an hour's window) will help set your body on a schedule. Create a morning library study period for yourself on later start days that you treat as another class, or commit to an early exercise class.* (Daily aerobic exercise is a wonderful stress reducer, but because of the adrenaline it produces, make sure not to exercise within three hours of your normal bedtime.)
2. SLEEPING MASK- this is a great way to physically block out light in a shared space. Spend the extra few bucks for one that fits right, is easily washable and comfortable (usually around $15-$20). Side note- keep the mask ON during the night...resist the temptation to check the time. If you can't cover your eyes, cover the CLOCK. Our brains are clever, and can consistently wake us up at the exact time every night if we allow ourselves to look at the clock. 
3. BLOCK the NEW NOISE- like snoring roommates, hallway traffic or loud face-timing neighbors- with a combination of comfortable ear plugs or extra white noise from a portable fan (even if you have A/C). 
4.  GUIDED MEDITATION APP: consider one from Healthline's "Best Meditation Apps of 2016"
5. AVOID SCREENS at least the last hour or two before bed. Numerous studies have confirmed the detrimental affect of blue lights on sleep cycles. Students live on screens both socially and academically, so this is a tough one, but simple modifications include saving your actual book reading or off-screen math assignments for the end of your study evening, and taking your showers at night. And...not playing games or stalking social media as your "relaxation" time when you get in to bed. 
6. GO TO TUTORING. If academic stress is the primary source of your anxiety and subsequent insomnia, do not suffer in silence or wait till you "have" to talk to your professor! Almost everyone is initially overwhelmed by the volume and intensity of college courses, especially if you got in to your "dream" school. Learning to utilize study partners or groups, attending tutoring sessions, and discovering new interactive memorization techniques will help dramatically. Locking yourself in a room "until I finish", skipping fun activities as you try to force-feed yourself the information will be minimally productive, if at all. Alternating study locations, prioritizing sleep, and taking practice tests will improve your grades. All-nighters do not. 

BOTTOM LINE: College life is tough on sleep cycles- try these steps to start improving your chances of restful sleep, so your brain has the energy and focus to succeed!

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.

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!

ZZZZ: 20-1-7 Challenge Week #8

[Photo credit: L. Lampert & her precious puppy, Tucker]

Dr. Grimes' 20-1-7 CHALLENGE: 

• For the first TWENTY weeks of this year,
• Pick ONE healthy change every Sunday, and
• Commit to that change for SEVEN days.

ZZZZ: 20-1-7 Challenge Week #8 

How many hours do adults need to sleep at night? The throw down answer is eight hours, though it varies from 6-10 hours on an individual basis. However, with the introduction of electronic screens into our bedrooms, many of us are using screen time to wind down...which is at least a double whammy on our sleep. Social media sites can suck us in to story after story, and fully advertised "addictive" games like Candy Crush can easily steal an hour of precious sleep time. Meanwhile, staring at that blue-lit screen in the last hour or two before sleep is tearing down the quality of our sleep. SO- 20-1-7 challenge for week #8 is all about the Z's and improving both quality and quantity of sleep.

• First- I will use an app to make it easy to keep track of the actual time I am spending in bed (both awake and asleep). Fitbits work well for this, too
• Second- I will cover my clock so I don't check the time when I wake up (which I typically do several times/night).
• Third- I will turn the figurative clock back and read an actual, real-life book for 15-30 minutes before I head to sleep (and commit to no electronic screen in the hour before bed).

BOTTOM LINE: SLEEP restores our brains and our bodies, so this week will focus on assessing and improving my own "sleep hygiene". 

20-1-7 Challenge Week #1: COLOR

20-1-7 Challenge Week #2: Veggie Spiralizer

20-1-7 Challenge Week #3: Medication Dispenser

20-1-7 Challenge Week #4: Meditation

20-1-7 Challenge Week #5: WATER

20-1-7 Challenge Week #6: Exercise BOOST

20-1-7 Challenge Week #7: FLOSS FEEDBACK:  Honestly, putting a visual reminder with my pill dispenser worked like a charm for me- should have done this decades ago! 

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.

Is it summer yet?

In our house, we're finally down to the last week of school- yea! Both kids and parents (not to mention teachers!) are all really, really ready for summer. Even adults who continue to work full time throughout the summer have a sense of anticipation for some lazy summer days. Everyone should get outside and soak up some liquid Vitamin D sunshine- but not so much as to invite a sunburn!

Time flies faster each year (gee, our parents were right about that) and summer is no exception. If you don't set some family rules for summertime, before you know it your kids will be sprouting roots on the couch, permanently attached to their iTouch/laptop/other handheld electronic device.

The good news is that when electronics are time restricted, kids are amazingly creative with their "extra" time. From creating dances to painting rocks or playing board games, their are a million activities that kids don't have time for during the school year, yet should have plenty of time for in the summer.

The AMA, AAP (Amer. Academy of Pediatrics) and the AAFP (Amer. Academy of Family Physicians) ALL agree that the MAXIMUM amount of total daily screen time should not exceed 2 HOURS.

So, remind your kids they have a watch, or get them a stop watch so they can keep track of their own screen time. TV shows are easy to count, but get that clock running when they plop down with their lap top or iTouch...

Bottom Line: LIMIT SCREEN TIME this summer, and you'll find your kids enjoying a larger variety of activities and stimulating more corners of those wonderful developing brains!

CLUTTER CONTROL: 20-1-7 Challenge Week #12

                           *"AFTER" Pic of my Closet                *Roll up Magazines for Boots

Dr. Grimes' 20-1-7 CHALLENGE: 

• For the first TWENTY weeks of this year,
• Pick ONE healthy change every Sunday, and
• Commit to that change for SEVEN days.

CLUTTER CONTROL: 20-1-7 Challenge Week #12: 

My family is NOT inherently neat and tidy. Paper clutter engulfs our kitchen counters, home office and dining room table ten times faster than I can sort, record, and recycle. Scientific studies have well documented that visual clutter ADDS significantly to stress/anxiety, and that LACK of clutter does the reverse. I tend to be an all or nothing person, so when I start to spring clean, I obsessively purge one closet or room, taking the entire day. Point in case- in January, I literally took every single thing out of my walk-in bedroom closet (which had not been emptied since we moved in 20 years ago!), and then re-filled starting from scratch. It took NINE HOURS...but I am happy to report it has stayed beautifully neat with relative ease, especially since I donated an SUV carload to charity, considerably thinning out my wardrobe. Every morning, my clean closet makes me smile, and even motivated me to clean the adjoining bathroom drawers and linen closet- but I never reached beyond the master bath. 

So- this week's challenge canNOT be to clean a room every day, because like the rest of you, I can't spend a ton of hours on this! Since I have an "ahem" SLIGHTLY competitive nature, I decided to go with a ten minute, stopwatch (phone timer) controlled cleaning/organizing spree per day, racing the clock to see how much I can accomplish. I realize I have drawers that can't be touched in ten minutes, but I'm betting I can find at least 7 areas in my home that concentrated 10 minute purging can make a significant impact. 

What method should you use? Right now, the Marie Kondo method is certainly sweeping my Facebook pages, and I'll admit though I laughed at the "does this item spark joy" approach initially, I actually have found it to be very liberating, allowing me to "release" many things- especially clothing- to new owners, rather than tucking that old beloved shirt back into my stuffed drawer. I will confess that I now have three boxes set aside to mail off to create t-shirt quilts for our girls (yes, there's a groupon for that! I will no longer save this in the garage for that day that I take up this new craft.) As I cleaned, I ironically unearthed  The Clutter Diet from my clothing shelves- and found useful tips there as well, like using a rolled-up magazine to make your boots stand up (great use for my journals!) Whatever works for you!

BOTTOM LINE: This week I will challenge myself to daily 10-minute cleaning attacks on my clutter clusters, in the hope of decreasing visual clutter to decrease stress!  (*and I will actually DO last week's YOGA challenge. Typing this to hold myself accountable!)

20-1-7 Challenge Week #1: COLOR

20-1-7 Challenge Week #2: Veggie Spiralizer

20-1-7 Challenge Week #3: Medication Dispenser

20-1-7 Challenge Week #4: Meditation

20-1-7 Challenge Week #5: WATER

20-1-7 Challenge Week #6: Exercise BOOST

20-1-7 Challenge Week #7: FLOSS

20-1-7 Challenge Week #8: ZZZ 

20-1-7 Challenge Week #9: RESIST

20-1-7 Challenge Week #10: No W(h)ining

20-1-7 Challenge Week #11: YOGA FEEDBACK: 

Well, once I started vacation, I completely dropped the ball on this one. No point in lying, right? LOL! Good news is I am making the rules, so...I am actually adding the yoga challenge to this week's challenge, doubling up. Sometimes we all need "do-overs!" 

Do-Over! New Year's Resolutions: Take 2

Welcome to the second Monday in January! Have you "blown" your New Year's resolutions already? If so, you are not alone, and better yet: take a "Do-Over"! Why not let January 10th be another January 1st?

Quite honestly, I'd rather you start over EVERY Monday than simply chunk your resolutions. However, this time, really focus on something SIMPLE and CONCRETE that you can definitely attain. If you have been inactive, for example, don't commit to heading to the gym 5 days per week! Instead, if you have joined a gym, commit to going "on Wednesday mornings, with your buddy, who joined with you." Mind you, I'm not saying to AVOID the gym the other days, but make sure your resolution is something that is possible to keep, so you can feed on your success.

If weight loss is your goal, make sure that you have set realistic goals. It takes a negative 500 calories per day (either eating less or burning off more) to lose ONE POUND PER WEEK. And that is excellent weight loss! I can't tell you how many of my patients feel dejected if they "only" lose 2 or 3 pounds in a month, despite the fact that medically, this is terrific weight loss. Shows like "The Biggest Loser" are motivational, but realize that those participants are more than 100 pounds overweight to begin with, and have chefs and trainers round the clock. If you are only 20 or 30 pounds overweight, plan to lose that in ONE YEAR.

BOTTOM LINE: Keep prioritizing healthy food choices (MORE Fruits and Veggies) and MORE exercise, and 2011 will be a year of success and good health!

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.