I was reading a blog today when I was taking a break from studying. It talked about the idea of RTs going after continuing education in order to be acute care practitioners like nurse practitioners. There were quite a few people who did not see the value of continuing their education. They felt they knew enough already. Why would anyone not want to extend their knowledge. I have been in the field for over 20 years I would never imagine not needing to learn more. In sleep there are oral appliances, better relaxation techniques, non invasive ventilation and the use of CO2 monitoring to better evaluate ventilation. In Respiratory there is so much more such as changing medications, advanced imaging reading, the many forms of ventilation, better sedation and interaction of all medications and the new studies about genetics and medications.
For the last several months I have played the role of the caregiver. It feels like somewhere along the line you get lost among the myriad of medications, doctor’s appointments and just the general care and cleaning up. Then there is the isolation and loneliness that comes with it. I did not realize how it sneaks up on you and overcomes you.
As my husband got ready for his surgery and his ultimate progression of his illness to one where he is almost not able to care for himself, I have put my life on hold and forgot to take care of me. It started with little things, putting off exercising then there was not going out to activities and finally I stopped even eating healthy and instead tried to find my pleasure in food. I was so tired at the end of the day trying to do everything for everyone in my family I would fall into bed exhausted only to remember there was more to do.
But what kind of help can I be if I hate coming home, I feel sick all the time and I am always exhausted. This is no way to live a life. There has to be at least a little balance. Sleep cannot be secondary, exercises cannot be secondary and healthy eating and sunlight cannot be secondary. All these things will give the caregiver strength to help those that they love and are helping.
I know today I got up and went for my 1.5 mile wog. I am not fast enough to call it a jog but it made me feel better. It gave me more energy and it reminded me that I need to feel good. I need to feel healthy. I need to sleep better. I need to be able to study for my classes and bring a positive attitude to my students and patients.
Being a caregiver is a hard job. But remember you cannot give what you do not have. Do not stand alone. Reach out and remember there are others out there to help you or at the very least cheer you on.
There was an article recently that stated that 9 million people are receiving prescriptions for sleeping pills. This shows the true issue with healthcare in America. We want an instant solution and we do not want to do any work. We also do not consider that medication does not give us the same type of sleep natural sleep gives the body.
The issue is why do we need to take pill to sleep and is there another solution that works just as well as a pill? I am not saying that there is not a reason for some people to take sleep medication. But it should not be the first choice to treat, poor sleep and fatigue. The physician treats disease and disorder they do not promote wellness. It is most likely that your doctor is as tired and has as poor sleep habits and is walking around as fatigued as their patients.
The first step is to decide if you have a sleep disorder? If you have an answer to the STOPBANG survey of greater than 3 than you need to talk to your doctor:
1. Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?
2. Do you often feel TIRED, fatigued, or sleepy during daytime?
3. Has anyone OBSERVED you stop breathing during your sleep?
4. Do you have or are you being treated for high blood PRESSURE?
5. BMI more than 35?
6. AGE over 50 years old?
7. NECK circumference > 15.75 inches?
8. Male GENDER?
The next step is to look at your sleep routine. Our brains are computers in that they need a routine to slow down and allow our body to release the hormones that promote sleep. A routine is not put on my pajamas and go to bed. It should be 20-45 minutes prior to going to bed. It also should generally occur 7 days a week at the same time each night. Our brain does not know weekdays and weekends it just knows the 24 hours of the day. Choose a specific bedtime. Do the same activities each night for the 45 minutes prior to going to sleep. These should be activities that will help you to unwind. I do ten minutes of yoga because it helps me to relax and allows me to concentrate on my breathing so my mind will stop racing with ideas. Create a routine that works for you that does not include television or computers.
Electronics are the new biggest issue to increase our inability to sleep. Cell phones need to be away from the bed. The light stimulates the brain to not release Melatonin. In order for our brains to transition from wake to sleep we need exposure to dark. Cell phones prevent that. When we check our cell phones during the night we again stimulate the brain confusing it as to whether they it is supposed to be awake or asleep.
Exercise is another factor to help sleep. Studies show that exercise over the long term helps to increase sleep and its quality. That means that if you work out in the morning it might not help with that particular night’s sleep but that if you work out three days a week for a month your sleep will start to improve. You have to decide what exercise you can fit into your life. There is no right or wrong it is about increased movement.
There are many other ways to help you improve your sleep without turning to a pill as your first resource. It is essential that we look at healthcare for what it is disease management not wellness management. It is important for you to do your research and to understand how important it is for you to make an informed decision about healthy sleep and how you can achieve it. If ultimately you need it than a sleeping pill might help. Just remember pills have side-effects you may not be aware of.
It was a typical night where I was trying to avoid homework from work and from school. Dr Oz has a guest on who was talking about yet another controversial idea about medicine and sleep. It included several different products to help sleep. He did talk a little about routine but again focused on foods and supplements and homeotherapy. In the end the information was not complete and did not take into account lifestyle and the overall goal of helping people sleep.
When we look we should truly be talking about routines. Sleep routines just like when we were raising our kids help to create a good night sleep. This does not include electrics such a television and cell phones. And every routine needs to be individual to the person creating it. It needs to be easy and it needs to help at the same time each night. It also has to take advantage of the exposure to darkness that allows the body to secrete Melatonin.
If we look at a child’s routine we see the bones of it. You set a bedtime, usually a reasonable one, which will allow them to get enough sleep to be successful the next day. You do a bath routine. You know the things that tell a child it is bed time like brushing teeth, washing his face. They change into comfy sleep clothes and climb into an inviting bed with 1 or two stuffed animals but no more. Then you put a glass of water on the nightstand to help eliminate a complaint, you take time to help relax him or her by reading a story or singing a song, sometimes both. You give a hug and keep to leave the child feeling loved and secure.
So how do we move our life to this without making it boring? I think that it depends on the person. My mind tends to wander and get stuck in the worry mode. For me I use one of three routines. On bad days where I have anger or frustration that needs to be processed I will do yoga because deep breathing and movement helps me to unwind and relax. However, if I am stressed about school and work than yoga does not work and I will try progressive relaxation because it helps me relax the muscles that tend to stay tense. Finally if all else does not work I will listen to a guided imagery because sometimes I need to be led and that works for me. I always read before bed because my brain likes to learn.
Overall it helps to put your routine in words and adjust it until you find what the best is for you. Than you have to do it. The results will help you to sleep better with a shorter sleep onset time. Ultimately better sleep will give you more energy during the day and increase your memory and improve your mood.
One of the most helpful practices is the use of progressive relaxation to deal with the stress at the end of the day. This will help reduce your desire to munch, wine or stair at the ceiling all night. This is not hard to learn and will be an enjoyable part of your sleep routine.
I first learned to do this in a test taking class in high school many moons ago. I later taught my children this as a way to relax. My daughter used it to fall asleep and to help her when her creativity has a momentary block. My son used it when his anger would get out of control. It help me survive their childhood with my sanity.
The first step is to get that comfortable spot. Some people sit up and some lie down. It is a personal preference. It always starts at your feet and tighten them as tight as you can and hold for 10 seconds then relax for 10 seconds. Move to your ankles and do the same thing flex for 10 seconds than relax for 10 seconds. Move up your legs to your bottom. That is a large muscle and will really help you to relax. Move up your abdomen and chest to your shoulders. Then you need to move down your arms. Always tighten for 10 then relax for 10. Finally you need to do your face than your scalp. That is where I start to do visualizations if I am going to.
Visualization is not my strong suit but I imagine a soft while glowing ball growing from the middle of my chest all the way out to my toes and fingers. I see the light heal any soreness and weakness I might have. It is my light so I can make it do what I want.
All of this take about 10-15 minutes and helps me feel very relaxed. It is a tool I am using frequency while I am working and going to school and raising children. It is a great tool for focus and does not require anything special except maybe some music. I have used Jeff Gold’s music to help with my exercise and to relax at night. He has a gift for the beauty that music can lend a relaxation technique.
I had the epiphany that my health has been and always will be in my hands. This realization brought me to an understanding that no amount of support from the outside will allow me to change the way I need to to become healthy and energetic. There is no one but myself how is there to inspire me. I do need role models and mentors of which I do have some of the former and have yet to find the latter.
I bring this up because I have the opportunity to work this week with a young lady who had her child’s life disrupted and she needed a little support to do what she already know needed to be done but was not sure how to best achieve her goal of her child sleeping through the night.
We has two lovely talks about what was going on and I made some suggestion of what might work for her child in changing her disrupted sleep routine. She did start with some of my ideas and the child showed improvement and I gave her a couple more suggestions I have hoped has helped.
The take away is that she is a very dedicated mother. That we do not have mentors and support systems in place anymore to help young mothers, and that I can think of nothing better than to share my knowledge with this young woman in helping her to get a good night sleep.
In my case I am looking for the weight loss mentor. I have role models and the one who currently I can see as where I want to be is Mark Bittman. His idea that we do not eat enough who food, fruits and veggies is true. He believes you need to simply make the decision to be healthy and that the goal is not weight loss but to be healthy. I also read a great deal from Jamie Wicks of Peertrainer.com and JJ Virgin. He devotion to her family is amazing.
So what does this have to do with sleep? Well I had the opportunity to mentor and truly enjoy it but a great mentor will have their own mentor to move forward on their own issues. I do have a spititual and business mentor named Dwight Bain who has changed my life but I believe I need a person who can mentor me to become the body I know I should have.
Now I want to offer to mentor you of you feel the need to change a small part of your life. I will help those who want to sleep better, help their children sleep better or who want to know how to blog. I have received so much from you my followers I want to give it back while I search for my new mentor.
We talk about living healthier, exercising and eating whole foods. We still do not take sleep and a sleep routine seriously. We are still looking for the instant pill or the idea that will say that less sleep is better. What the studies say is that poor sleep contributes to health issues across the board.
· The studies that lead to contribution to colon, prostate and breast cancer all involve both sleep deprivation and sleep disorders that prevent sound sleep. These to conditions can be helped with therapy and possible treatment of a sleep disorder.
· Studies have shown that children have difficulty learning and learning proper behavior due to poor sleep, lack of sleep and snoring. We really do need to teach our children and teens that sleep is as important to health and good grades as studying.
· Studies have proved that we still only help 20% of those with sleep disorders. However that does not include the family that was affected by the disorder. If husband or wife cannot sleep because of loud snoring, leg movements or acting out dreams than you have more than one person affected and we need to consider all who are affected as patients. Sometimes the treatment may be time and space.
· Weight and sleep are interconnected. This is the vicious cycle the higher your weight the worse sleep disorder breathing will be, the worse the sleep disorder breathing the more difficult the body has at maintaining weight.
With all those issues you would think insurance companies and doctors would be asking more sleep questions and explaining proper sleep. The issue is they are not educated in the importance of proper sleep. In fact if you look at a medical student’s time you will see they do not live what they preach. This is a time where you need to take control. You need to go to your doctor with written questions, maybe a three to four day diary with symptoms.
Explain your desire to not just take a pill but to truly fix the problem and you may get some strong feedback. Doctors like to know a straight ahead question they can fix and that would be a sleep disorder.
The change has to start with an informed patient or at the very least a patient with relevant questions. This way we are able to work with the insurance company. Our goal ultimately is to get a good night sleep with the least amount of medication. I believe we can achieve that if we work as a team.
Well we all survived Monday. We dealt with the stress of tax day and the news of the bombing in Boston. Now we have to deal with the lingering stress. The problem with this is that it will keep your mind rushing and rob you of sleep. That in turn will cause you to be more tired and more stressed and so the vicious circle goes.
I never bring up and issue without a plan to deal with the problem. In this case everyone is an individual and so you should pick and choose which items might help you.
Stress is part of everyday life. There are periods of time that we will experience increased levels that can interfere with your sleep. With a little planning and trying one or two new ideas can help you to sleep better tonight.
We all deal with pain at some point in our life. However, when we are dealing with chronic pain the issue becomes compounded because it will interfere with our sleep. This can cause the issue to become compounded and for the pain to increase.
The first issue with pain is the inability to get into deeper sleeps. Pain will actually interfere with the slower brain waves causing sleep disruptions that we may not be aware of. This slower wave sleep, also known as Delta Sleep, is when our body releases hormones such as Human Growth Hormone. If we are unable to reach that level of sleep then our body does not have the ability to heal itself or can take significantly longer than we expect it to.
The second issue is that sleep deprivation increases our perception of pain. There is really not much to say on this issue other than you can see the vicious cycle this can create for someone learning to deal with chronic pain.
The third issue is the side effect of many of the medications people take for pain. It can change the ability to sleep, the stages of sleep a person is able to achieve and the level of fatigue a person feels throughout the day. Many medication can also cause insomnia.
The last issue is that when we deal with pain it will limit our activity., This will limit our need for sleep. It will also cause napping during the day that will again cause difficulty going to sleep at night. This daytime fatigue will also limit our time outside and our exposure to the sun. This lack of sun will causes decreases in vitamin D. It has been found that low levels of Vitamin D causes us to experience increased levels of pain.
All these issues combined together will continue to increase the pain and health issues a person is experiencing rather than healing. Taking the time to take a short walk, get some sun and working with your doctor to manage your sleep will help you to get better than much faster.
This week I will be helping identify and talk about some of the interesting sleep disorders. The most common one is snoring. What the most recent studies have found is that snoring even if it is not associated with sleep apnea may be indication of health issues.
In children sleep apnea may not be present but snoring may be a sign that your child may need to be treated. Snoring alone can disrupt sleep, limit the amount of sleep your child may be getting or may just prevent your child from getting into the deeper sleeps needed to grow and to heal. If your child has symptoms of ADD or ADHD it may be due to that sleep disruption.
If you find that your child is snoring evaluation by their doctor is the best way to get to the bottom of the problem. Some dentists are also looking at sleep apnea, as they can visualize issues with their upper airway. The physician may have the child evaluated by an ENT or have them do a sleep study to evaluate the extent of the snoring and to see if their breathing is being affected.
In adults snoring is not just associated to obstructive sleep apnea. Snoring itself has been associated with high blood pressure and diabetes. They have also associated it with dementia and memory loss. Some people may only snore when they reach certain stages of sleep causing the disruptions to happen at approximately the same time each night. Usually during REM sleep, where we dream, are muscles are the most relaxed and this can bring on snoring and sleep apnea. Also it may be worse when someone is sleeping on their back because the tongue relaxes and moves to the back of the throat.
If you have snoring and you have been tested for sleep apnea with a mild or negative result than you may still want to treat it. An oral appliance made by a dentist who specializes in sleep would be your best option. Because different oral appliances work for different people I would make sure that the person you are working with knows how to create more than 1 appliance. You may also want to attempt to use positional therapy so you do not sleep on your back. You can use a wedge pillow which will allow you to sleep with your head elevated. The more productive way however is the tennis ball method, where you create a pocket on the back of a t-shirt, place a couple of tennis balls in them and sleep in it for about a month. This will help encourage you to stay off your back when you sleep.
Snoring, no matter how we look at it, is not a fun for the person who has it or the person who has to listen to it. You should do what you can to deal with it to keep yourself and your family as healthy and well rested as possible.