Insomnia: Not Something to Lose Sleep Over by Dr. James Pearce, M.D.

ImageWe all dream of the perfect night sleep and waking up fully restored and ready to face the following day. Sleep is as important to your health as a balanced diet and regular exercise. It can affect you both physically and mentally. However, as many as 40% of adults experience insomnia each year with the direct cost of treatment as well as indirect cost (including lost productivity) adding up to $30-$35 billion annually. One in ten American adults experience chronic or persistent insomnia.

Insomnia is defined as a subjective experience of inadequate or poor quality sleep. It may include difficulty falling asleep, difficulty maintaining sleep, waking up too early, or waking up feeling unrefreshed. It may be classified as transient, short term, or chronic depending on the duration of symptoms.

Causes of insomnia may include stress, medication side effects, anxiety, depression, changes in environment or work schedules, and a variety of medical problems. Other behaviors may exacerbate the problem: excessive caffeine, alcohol, or smoking before bedtime, worrying, napping during the day, or irregular sleep/wake schedules. It is found in males and females of all age groups, although it seems to be more common in females and the elderly.

A variety of treatments are available including behavioral modifications and medications. Keeping a sleep diary can greatly help you and your doctor determine the best treatment for you. The sleep diary will help track when you go to bed, estimate time to fall asleep, estimated number of awakenings during the night, what time you wake in the morning, and to rate the quality of your sleep and how rested you feel.

General sleep hygiene measures include:

  • Avoid caffeine after lunchtime (coffee, colas, teas, and yes even chocolate!)
  • Avoid tobacco and alcohol prior to bed
  • Physical exercise everyday, but not 3-4 hours prior to bedtime
  • Use your bed for sleep and sexual activity only
  • Establish a set bedtime and wake-up time including on weekends
  • Avoid or limit napping during the day
  • Leave the bed after 20 minutes if unable to sleep and do something relaxing and non-stimulating. Return back to bed only when you begin to feel sleepy.
  • Keep your bedroom dark, cool and quiet
  • Try to relax and unwind before your retire and not take your problems with you to bed

If these general sleep hygiene measures don’t help enough, you may be tempted to try over-the-counter (OTC) medications such as Benadryl ( Tylenol PM) but these medications should be avoided in people over the age of 65 or for people with certain health conditions secondary to their side effects and safety. Other supplements available include melatonin or valerian, but their results are mixed and additional research is needed and under investigation to better assess their safety and whether they are effective sleep aids.

If you continue to have persistent problems with sleep you should visit your doctor and discuss your concerns and treatment options. Your doctor may recommend keeping a sleep diary to chronicle and track your seep regimen and habits. They should also review your medical history and medications and discuss potential underlying and treatable medical or psychological problems that may be interfering wit your getting a good night’s sleep.

There are also a variety of prescription sleeping polls that may be very helpful in some cases. They are best used for temporary relief as regular use can lead to rebound insomnia, but newer medications are now available which have the indication for chronic and long-term use. Cognitive Behavioral Therapy (CBT) should also be included in the management of chronic insomnia. Another option may be to order specialized sleep studies if a primary sleep disorder is suspected such as Obstructive Sleep Apnea (OSA), Restless Leg Syndrome (RLS), or another Periodic Limb Movement Disorder.

Insomnia is a very prevalent and widespread problem. It can be successfully managed in conjunction with your doctor after assessing your medical and sleep history. Many behavioral and pharmacological therapies are available for both acute and chronic insomnia. If your insomnia interferes with your daily activities, you should discuss this issue with your primary care physician.

Adult Immunizations by Dr. Margaret Umah, M.D.- Family Physician

Dr. MArgaret Umah, M.D.

Vaccination programs for children have a proven track record. Few of us can remember epidemics of polio, measles, and other often fatal diseases. The overwhelming majority of young children receive the CDC recommended immunizations. However, the adult population often remains under-immunized. This may occur because many adults do not know that they would benefit from vaccines. While the adult vaccine schedule does not have as many immunizations as the child schedule, there are several vaccines that adults can benefit from to optimize their health.

The influenza (“flu shot”)vaccine is recommended for all adults, especially those with chronic disease (heart disease, diabetes), and pregnant women after the first trimester. The flu can lead to missed days of work or school, hospitalization, and in rare cases, death. Please discuss with your doctor if you have an allergy to eggs, as most vaccines have some small amounts of egg in the vaccine. Since the vaccine does not contain any live, or active virus, you CANNOT get the flu from the vaccine. If you get sick afterwards, it may be either an unrelated common cold, or you were already exposed to the flu virus before receiving the vaccine.

Every 10 years, it is recommended that adults receive a tetanus booster (Td vaccine) to prevent lockjaw. Because of recent outbreaks of whooping cough (a prolonged cough illness that can be fatal to infants), we now recommend that at least one tetanus booster be the form that also has a vaccine against whooping cough, or pertussis (Tdap vaccine). This Tdap booster is especially important for people who are around infants, such as young parents, grandparents, daycare teachers, and healthcare workers.

The shingles vaccine should be given to patients over 50 who have a history of chicken pox. It acts to decrease the chance of getting shingles, and may decrease the severity of a shingles outbreak if one still occurs.

Hepatitis is a contagious infection of the liver. It can lead to liver failure, and in extreme cases, liver cancer and death. Adults that are at risk for getting hepatitis include those who are in the healthcare industry, those in close contact with other with hepatitis, food preparers, homosexual men, and those who use intravenous drugs. Recent recommendations also encourage immunization of those with weakened immune systems, such as diabetics and people with heart disease.

There are other vaccines that may be indicated based on your personal medical history and profile. Please discuss with your primary care physician for a complete recommendation of immunizations needed.

IT’S THE SEASON TO AVOID ANOTHER UNNEEDED ANTIBIOTIC-By Karen Rakers, M.D., Family Physician

‘Tis the season for cough, congestion and runny noses. Many people will develop symptoms of an upper respiratory infection (URI) this fall or winter, especially around the holidays.
Of course, no one wants to be sick, so they will request antibiotics from their physician thinking they will get better quicker. But, will the antibiotics really help and is it always a good idea to take them?

Medical research shows that, in most instances, antibiotics are not indicated for acute URIs. Most URIs including sinusitis and bronchitis, are caused by viruses, which do not respond to antibiotics at all. These infections tend to run their course in about a week, so generally patients should treat their symptoms with cough suppressants, decongestants, and expectorants and wait to see if their symptoms are resolved. Even the presence of yellow or green nasal discharge does not always mean there is a bacterial infection, which is a common misconception.

Circumstances that usually warrant antibiotic use include:
*Sinusitis symptoms that have persisted for at least 10 days.
*Tonsillitis that is either clinically consistent with strep throat or has a positive rapid strep test.
*Symptomatic acute otitis media (middle ear infection).
*Bronchitis, only if the suspected cause is pertussis, commonly known as whooping cough.
*Influenza infection, which usually causes acute onset of fever and muscle aches, should be treated with antiviral medication if initiated within 48 hours of symptom onset.

Antibiotics are not indicated for cases of the common cold or laryngitis.

Any time someone takes antibiotics, the bacteria causing the illness are killed, but so are the good bacteria that are needed to keep us healthy.

This is a common cause of vaginal yeast infection in women, but can cause much more serious infections as well.

Allergic reactions to antibiotics are common and can be as serious as anaphylaxis (an acute allergic reaction to an antigen, like a bee sting), and in general, overuse of antibiotics leads to resistance. If your doctor does decide that you would benefit from a course of antibiotics, make sure you follow the directions closely and take the entire course of medication.

So, the next time you get the sniffles, cough or congestion, resist the urge to request an antibiotic right away.
Your doctor can make suggestions on how to feel better with a variety of over-the-counter and prescription medications and you can avoid taking another unnecessary antibiotic.

Hello from OakBend Medical Group

We welcome you to our new blog page. We hope that you will continue to visit and read our great articles that are to come. We will be providing an array of topics that will be interesting and educational to all. We aim at educating and getting to know all our blogging friends. Stay tuned to a great year of learning and getting to know one another! Cheers to 2013.