Problems with your “Z’s”: New research on treatment of persistent insomnia – help is more than just medication.

The May 20th issue of JAMA (Journal of the American Medical Association) includes an article on treatments for persistent insomnia. Insomnia is the most common of all the sleep disorders and is described as having problems with the ability to gain sufficient sleep or to feel rested and characterized by difficulty getting to sleep or staying asleep. Insomnia may be situational, recurrent, or chronic. Most people know if they have problems with sleep, and most of us have had personal experience with occasional bouts of insomnia.

Lack of adequate sleep over time, or persistent insomnia, can have a very big impact on daily functioning; it will lower your quality of life and can contribute to various health and emotional problems. When untreated, insomnia can also contribute to major depression and other physical problems. When you get behind the wheel with not enough quality sleep, you not only put your life at risk, but those around you as well. A large number of auto accidents are attributed to driving while drowsy. Although it may be tempting to use alcohol as a sleep aid, it will work in the opposite way and create insomnia and other health-related issues as well. And…of course this will not help your driving either!

Here are some sleep-promoting tips that can work well to help you get into a healthy sleep routine:

1. Maintain a regular bedtime and awakening time schedule including weekends. Get up about the same time every day, regardless of what time you fell asleep.
2. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime many include a warm bath or shower, aroma therapy, reading, or listening to soothing music.
3. Sleep in a room that is dark, quiet, comfortable, and cool; sleep on comfortable mattress and pillows.
4. Use your bedroom only for sleep and sex. Have work materials, computers, and TVs in another room.
5. Finish eating at least 2-3 hours prior to your regular bedtime.
6. Avoid caffeine within 6 hours; alcohol & smoking within 2 hours of bedtime.
7. Exercise regularly; finish a few hours before bedtime.
8. Avoid naps.
9. Go to bed only when sleepy. Lay in bed only for sleeping, not for work or watching TV.
10. Designate another time to write down problems & possible solutions in the late afternoon or early evening, not close to bedtime.
11. After 10-15 minutes of not being able to get to sleep, go to another room to read or watch TV until sleepy.

This latest research in JAMA shows that CBT (Cognitive Behavioral Therapy), a structured form of psychological treatment that focuses on modifying thoughts and behavioral patterns, was effective for treating persistent insomnia. The addition of a sleep medication to CBT treatment like zolpidem (generic name for a prescription sleep medication) produced some benefits, although such benefits were modest to treatment outcomes. Such findings suggest CBT may provide an added benefit in treatment of insomnia.

Since you are awake anyway, sign on and leave a comment about how your sleep is going. All comments from those who are sleep-deprived and others are always welcome. Sweet Dreams!

The Measure of a Life Well Lived

When it’s all said and done, when the piper has played his last note, the farm is well and truly purchased, the bucket come to rest, and the fat lady’s final lyrical note but a fond memory, what is the yardstick we use to measure the worth of our lives? Do we tally up bank accounts to see who won? There will always be someone whose net worth is greater than the next guy’s. Mine, unfortunately will not even be a contender for that particular prize. Maybe we could compare the grandeur of our cars. Mine is a clunker well past its warranty, but it holds a lot of good memories. My car’s value is not in its blue book value, but in the memories it holds. So if memories are more important as a measure of a life well lived than monetary possessions, how do we measure memories?

We should measure the worth of our memories by those who will carry them on after we are long gone. How many people have you positively touched in your life? How many of those were a lasting, memorable touch? How many of those went on to touch others because of your actions? This is your measurement. This is your legacy.

Randy Pausch touched millions while he lived, and continues to have a positive impact on people’s lives today. I’ve included a video clip of his address to the graduates of Carnegie Mellon University. I think everyone should watch this clip at least once in their lives. And stay tuned through the end when he carries his wife off stage and gives her a beautiful kiss behind the stage. Your relationships with the special people in your life are what really matter when it’s all said and done. This is what people will remember. Not the degree you earned, not the handy little nest egg you managed to build, not even the size of your office - although it seems very important now.

And when it is your time and they record the important stuff on your tombstone, what will it say? Your name that your parents chose, you didn’t have anything to do with that. Your birth date, again, more your parent’s business than yours. And your death date. You shouldn’t decide that either. No, the only thing you have to show for an entire life is the dash between the dates. And how many of us make it a hard, fast dash to the finish line? So this entire life that is summed up by a mere dash etched in granite is where we insert the memories of the relationships, the love, the life, the passion, the person.

“Even though our culture puts a strong emphasis on attaining wealth and fame, pursuing these goals does not contribute to having a satisfying life. The things that make your life happy are growing as an individual, having loving relationships, and contributing to your community," says co-author Edward Deci in a news release about his article, Achieving Fame, Wealth, and Beauty are Psychological Dead Ends.

So when it’s all said and done, let’s have no regrets on our way to the top of the ivory tower of our choice. Let us be remembered as a person who had a positive impact on others, who loved and lived life to the fullest, and made the most of the time we had. Play on piper. Ours will be a mighty dash. We’ll measure up just fine.

When Pigs Fly: Dealing with the Swine Flu Jitters

Remember the old adage, "that'll happen when pigs fly"? Well, the swine flu is floating around.... Does that count?

If so, we have nothing to worry about with the swine flu; it's merely a symptom. The real things you need to worry about are all of the "that''ll never happen" things that are about to come true. Like Carrot Top winning a Nobel Prize or the Rams winning the Superbowl, or a black man being elected president. Oh wait, that's already happened and I voted for him. See? It's already started. What will happen next? Will Angelina stop adopting kids?

I think it's time to put the swine flu epidemic in perspective. According to a recent WebMD article: In a typical U.S. flu season, an average of 36,000 people die of flu or flu complications, and about 200,000 people are hospitalized.

Swine flu hasn't come anywhere close to that. Swine flu has sickened at least 141 people in the U.S. and 365 people worldwide, according to the CDC and World Health Organization's tally of lab-confirmed swine flu cases as of Friday, May 1.

Here in Arkansas at UAMS there has been such a run on Tamiflu prescriptions, an anti-viral medication, that all physicians have been requested to think very carefully before giving in to patient hysteria when prescribing this medication. Predictions are that much of the Tamiflu prescribed will never be taken, but it is removing significant numbers from pharmacy shelves which may be detrimental in the future should we need it. So far, there are no reported cases in Arkansas.

So how do you stay informed without letting the hysteria take over your life?

Adopt Rational Measures

· Hand washing. Mom always said, “Wash your hands” because she knew it prevents more illness than any other single proactive thing you can do to keep yourself healthy. But we don’t want to tip the scales into obsessive compulsive behavior. Wash your hands as needed relative to your situation and exposure. If you have minimal contact with others at work, you are not at as great a risk as someone in the health, school, nursing home or daycare industry.

· Cover your mouth. Another gem from Mom. It is common courtesy to cover your mouth when coughing or sneezing, then go back to the first example given here and wash your hands.

· Avoid sick people when you can. You can’t avoid your sick husband or two year old, but if someone is hacking up a lung in isle three, use isle seven to get to the milk.

· Go home if you’re sick. Don’t expose everyone else in the office just because you have to update your spreadsheet. It is much more cost effective for you to miss a day than the entire office.

Restrict Media Exposure

· A little bit can go a long way. The best way to scare yourself about anything is to become an expert on the subject. Too much information can generate its own anxiety. Only read what you need and leave the technical stuff to the experts who get paid to worry.

· Be a good role model for your children and grandchildren. Your role is to take care of them and make their world a safe and secure place. So if they see you watching CNN all day long willing to drop everything when they announce an update, children will take that fear you are demonstrating and multiply it out of orbit. Do not transfer your fear into your child’s anxiety. Unless you like staying up with a four year old too afraid to go to sleep because the swine flu might get them.

The bottom line is stay informed, but stay sane in how you go about it. Keep your update watching in moderation and take normal precautions with the health of yourself and your family. Yes, moderation works for swine flu fear too.

And since we are in Arkansas and our favorite football team is the Razorbacks, I’d like to add that the only swine you should fear is on the football field, “GO HOGS!”