Three Drug-free Ways to Ease Headache Pain
By Amy Paturel
Headache is, without question, one of the most common ailments Americans face. In fact, nearly 90% of men and 95% of women have had at least one headache during their lifetime. And while it’s tempting to rely on nonprescription medications for relief, experts claim such meds could be part of the problem.
“Medicines that are taken over the counter to stop an attack, like aspirin or ibuprofen, if they’re taken more than 10 days a month, can have a paradoxical effect and increase the frequency of attacks,” says Stewart Tepper, MD, director of research at the Center for Headache and Pain in the Neurological Institute at Cleveland Clinic in Cleveland, Ohio. Migraine specific prescription drugs or “triptans” are very effective at relieving headaches and in general very well tolerated. However, in situations where using these medications is not feasible one could try one of these three drug-free strategies.
Take a supplement. Studies show that supplements like magnesium, riboflavin (or vitamin B2) and coenzyme Q10 can reduce the frequency and severity of headaches. “There’s very good evidence that magnesium supplementation can be helpful—especially for those who have aura or who have menstrual related migraines,” says Tepper. Magnesium is sorely lacking in the American diet, it’s depleted by stress, and it isn’t well absorbed by the body. Boost your intake by loading up on magnesium-rich foods like dark, leafy greens, nuts and whole grains. If you have a poor diet and can’t stomach broccoli, take 450 to 500 mg of magnesium daily for at least 3 months to prevent headaches. There’s also reasonable evidence to show that riboflavin (400 mg for 3 months) and coenzyme Q10 (300 mg for 3 months) can help prevent migraines.
Try acupressure. Acupressure, like acupuncture but without the needles, promotes healing throughout the body by stimulating channels of energy. According to ancient Chinese medicine, life energy (or chi) flows through imaginary lines called meridians. When you’re healthy, energy flows through the meridians seamlessly. But when your chi is blocked, headache is just one of many ailments that result. Stimulating pressure points can clear the meridians, get your chi flowing again and ultimately relieve your headache. “Sit comfortably, close your eyes and massage the webbed area between the thumb and forefinger on each hand,” says Donna Fremon-Powell, certified guided imagery therapist and certified hypnotherapist in La Habra, California. “Use as much pressure as you can tolerate and breathe easily and deeply.” Do this on both hands and repeat as needed.
Use your mind. When you’re worried or stressed out, the body’s natural pharmacy releases stress hormones. Breathing tightens, your heart rate accelerates, muscles contract and you end up with a tension headache. But according to Fremon-Powell, just 2 minutes of relaxed, focused breathing can release tension buildup before it takes hold. “Imagine that when you breathe in, you are gathering up any tension, discomfort or pain, and as you exhale, you’re releasing it—blowing it away.” Rather than allowing your anxiety to run the show, Fremon-Powell claims you can use your mind to solve your problems and promote confidence. Even just imagining yourself in a beautiful, safe, calming place allows your mind to slow down and come into balance with the body.
Five Tips for Preventing Pounding Headaches
1. Avoid foods like chocolate, aged cheeses and alcohol, especially if you’re taking monoamine oxidase inhibitors (MOAIs). These foods contain tyramine, a compound that causes the release of stored monoamines such as dopamine, norepineprhine and epinephrine that can overload the brain and cause headaches.
2. Get at least 8 hours of sleep each night. Studies suggest that sleepless nights may cause headaches.
3. Drink plenty of water. Dehydration triggers migraines.
4. Exercise. Physical activity releases feel-good chemicals in the brain like serotonin, which can help alleviate headache.
5. Eliminate caffeine. Caffeine may help initially, but you’ll need higher and higher doses for continued relief. Plus, caffeine exacerbates head pain over the long haul since it inhibits the absorption of magnesium (a critical mineral in the management of head pain).
Alternative Approaches to ADD/ADHD Treatment
Sometimes, medication alone is not always the answer. For those looking for a different method of ADD/ADHD treatment, read on.
Over the past two decades, diagnoses of attention deficit hyperactivity disorder (ADHD)/attention deficit disorder (ADD) have continued to rise. According to Blair Hammond, M.D., Pediatric Clerkship Director in the Department of Pediatrics at Mount Sinai School of Medicine, New York, this increase is “in part because doctors are more aware of the diagnosis, and also because parents are more aware of the condition and bring up the issue more frequently with their doctors/teachers.” It’s no wonder, then, that prescriptions for ADD/ADHD medications have also seen a sharp increase. In fact, more than half of children diagnosed with ADHD receive some form of prescription medication. Although experts claim the combination of behavioral intervention with prescription medication is the Cadillac treatment for ADD/ADHD, there’s some evidence for the effectiveness of several alternative therapies.
Meditative activities, guided imagery, and hypnosis. “Similar to biofeedback, imagery can help soothe, calm and focus an impulsive brain,” says Donna Fremon-Powell, a certified guided imagery therapist and hypnotherapist in La Habra, California. “Plus, since ADHD children spend a lot of time in theta brainwaves, repetitive positive affirmations — both audible and subliminal (like on a CD while they sleep) — are readily accepted by the subconscious mind.”
Creating an Environment of Healing
by Amy Paturel, M.S., M.P.H.
Tammy Rodriguez loves camping. Since her lupus affects her lungs, the fresh air, expansive space, and night sky help her to breathe easier. Trouble was, as soon as she would return to her home in Orange County, CA, she felt like someone was sitting on her chest. Her solution: moving 75 miles to Fallbrook, where she now lives on an acre of property with citrus, peach, apple, apricot, and pomegranate trees, and gardens she tends herself.
“Since lupus causes inflammation, it can make people feel constricted and closed in,” explains Donna Fremon-Powell,a Certified Guided Imagery Therapist. “But you can shift that energy by going to a calming place outdoors — a place that’s expansive and offers infinite possibilities.”
There’s no doubt Mother Nature is a powerful force, but until recently scientists didn’t realize that spending time amid trees, fresh air, and natural l
ight actually promotes healing. The research is so compelling that architectural design teams are incorporating the natural environment into health care facilities — building hospitals with gigantic windows that offer views of nature, ensuring that natural sunlight flows throughout the hospital, and creating healing gardens on hospital grounds.
The link between views of nature and healing was first uncovered in 1984 when a landmark study in the journal Science found that patients who had rooms with windows overlooking trees recovered more quickly and required fewer painkillers than those who had views of a brick wall — even though all 46 patients had the same type of gallbladder surgery. Since then, countless studies have confirmed the benefits of surrounding ourselves with nature. One study found that placing trees next to freeways and roads reduced drivers’ stress levels. Others have found that viewing nature reduces anger and anxiety and enhances feelings of pleasure.
“It’s amazing when you are feeling so sick how the sunshine, plants, and the sound of water help take your mind off your pain and problems,” says Beth Jones, a 50-year-old Florida resident who has been living with lupus since 1998.
Even if you can’t go outside physically or view nature through windows or pictures, you can get the same benefits by using your imagination to transport yourself to a favorite outdoor destination. In fact, a routine part of Fremon-Powell’s guided imagery practice involves having clients imagine themselves in a calming place outdoors. This exercise takes place one-on-one in her office, over the phone, or through personalized CDs people can take home.
“Since stress exacerbates lupus, it’s important for people to know how to calm themselves,” says Fremon-Powell. “Spending even two minutes a day imagining yourself walking in a beautiful meadow or standing under a warm waterfall enhances the body’s natural healing abilities.” And when you imagine your favorite place outdoors, you can paint the scene any way you like.
For Rodriguez, that picture-perfect destination is a beautiful beach in Hawaii. “I call it my happy place,” she says. “When I close my eyes and imagine myself on that beach with the waves lapping against the sand, it has an instant calming effect.” Today, Rodriguez’s lupus is in remission. She attributes much of her healing to being able to calm her system when needed and consistently using guided imagery and relaxation CDs.
Playing with the Earth
Other people feel better when they get down and dirty in the earth (think gardening). And studies show that while imagining nature and spending time in a healing garden improves health and well-being, the greatest benefits come from actual gardening.
“There’s just something about toiling in the earth to create something alive,” says Paula Black, R.N., and mother of 23-year-old Brittany Black, who has lupus. Black’s gardens extend beyond potted plants and beautiful flowers to healthful herbs she incorporates into recipes. “Brittany uses the rosemary from the garden in cooking and for medicinal purposes,” says Black. “The scents of rosemary and lavender calm my whole house and really create an environment of healing.”
Gardening also gives Black a chance to soak in natural light, which has been linked to improved mood and increased immunity. One recent study found that people who were exposed to more sunlight reported less stress and less pain — and took less analgesic medication. When you have lupus, the best times for gardening are early morning and late afternoon or evening.
“I’ve created this garden that brings me so much joy — that’s powerful,” says Black. She gets a sense of accomplishment from working in the garden, but says that her real joy comes from sharing the fruits of her labor with her daughter.
“Even just a vase with a beautiful sprig of rosemary can make Brittany feel a little better,” says Black. “Sometimes, that’s all she needs.”
Energy Healing
The note taking and incessant typing were taking a debilitating toll on my right hand. At first, I could tolerate the pain, but when the base of my thumb started aching while I was lounging on the couch, I knew I needed help.
I bypassed physical therapy and went straight to “energy healer” Donna Fremon-Powell. Energy healing is a centuries-old technique similar to acupuncture in using the body’s meridians/energetic pathways, but without needles. Healers scan your body for blockages, lay their hands on (or above) your body, and coax the energy to resume its natural flow.
My session began on a massage table that felt like a plush bed. “Just relax,” Fremon-Powell said as she placed a gigantic feather pillow under my head. Even though my eyes were closed, I could sense her standing over me rubbing her hands together to create friction and heat. She began at my feet, her strong fingers sandwiching the top and bottom of my soles. Her touch was firm and confident.
By gripping my feet, Fremon-Powell said she could feel where the energy was moving through my body—and where it was stagnant. She gradually worked her way up to my head, her breath deepening as she approached areas of tension, like my hips. Her hands bore into my body like she was kneading dough, alternately tugging, pulling, and digging her knuckles, fingers, and palms into my muscles. When the energy was extremely blocked (like in my hand), she grumbled and made sounds while I struggled not to laugh.
“That ought to scare my energy into flowing,” I thought. In between the knead-fests, she held her hands still on my body as my breath deepened. I felt her energy encapsulating me—like she was holding my body in the palm of her hand. But later I learned that she had already left the room. I was feeling the residual effects of the energy pulsating through me.
Fremon-Powell said the effects I experienced immediately after rising from the table—wooziness, relaxed and tingly muscles—were normal and that I may feel a slight vibration in my body as the energy continued to balance over the next seventy-two hours.
Sure enough, three days later my hands were flying across the keyboard as I typed a new story. And my hand has remained pain-free. As a born skeptic, I struggle to make sense of how this happened. Was it the energy flowing through her hands that healed me? Was it a placebo effect? Perhaps it doesn’t matter. My hand is operating at full capacity—and that’s enough to make me a believer in the healing power of energy.
HL&S Recommendation: High
—Amy Paturel
Jan/Feb 2008
Aging with Attitude
By Amy Paturel
At 83 years young, Madeleine Gough is in superb health. She lives by herself, carries a full schedule, and mentally, she’s at the top of her game. How is she able to maintain this lifestyle at her advanced age? No one ever told her she couldn’t. “I was always taught that I could do anything I wanted,” says Gough. “So, I did.”
In between managing all of the John Hancock offices west of the Mississippi, practicing voice and earning a doctorate in metaphysics, Gough found time to get married, develop long-term friendships and volunteer for causes that are important to her. At age 58, when most people consider retirement, Gough changed careers and became a Hypnotherapist. Since then she has maintained a full time practice seeing clients in her home office five days a week.
Gough’s combination of pursuits, interests and activities would tire out the average 30-year-old, but they’re evidence that a large part of aging (and the limitations that come with it) is in our heads. Indeed, most of the biological decay we call aging is the body’s natural response to the convenience-driven, fast food lifestyle of the 21st century.
“Seventy percent of aging is voluntary,” says Chris Crowley, co-author of Younger Next Year. “Some things you’re stuck with – your basic maximum heart rate goes down a little each year, your skin and hair gets drier, your libido goes down – but 70 percent of aging you can manage by how you live your life.” Things like how much you exercise, what you eat, how you stimulate your brain and how involved you are with other people, are the fundamental signals that run every cell in your body and brain. In fact, experts claim your “real age” is how old you are biologically based on how well you’ve maintained your body – not your age according to the calendar (see box for details).
Eat for Life
Think of your body like an engine – a machine. The higher-octane fuel you put into it, the better it’s going to run. So consider what your internal machinery might look like two hours after you eat a Double-Double with fries and a chocolate milkshake: painfully slow blood flow, hardened arteries, sludge-like movement. It’s not pretty!
Instead of dieting, which most people fail at anyway, just quit eating the obvious culprits and start loading up on fruits and vegetables. Sure, it’s easier said, than done, but it is possible. “People who have four cups of fruits and vegetables a day can demonstrably lower their blood pressure and reduce their risk of cardiovascular disease,” says Ralph Felder, M.D., Ph.D., author of the Bonus Years Diet.
Felder’s book focuses on seven foods (red wine, dark chocolate, fruits, vegetables, garlic, fish and nuts) that work both individually and synergistically to reduce the risk of heart disease. Eat these foods regularly, he claims, and you can add an average of six years to your life.
“The dark chocolate and fruits and vegetables lower your blood pressure. Garlic and nuts lower LDL cholesterol. Fish helps protect against cardiac arrhythmias, blood clotting and inflammation,” says Felder. “Together these foods help protect the endothelium (the Teflon-like coating around your blood vessels) and reduce the risk of heart disease.”
And while eating heart-healthy foods won’t make you look like Paris Hilton, it will reverse the aging process internally. “With enough money, you can always look good on the outside,” says Felder. “Reversing the aging process internally is much more difficult.”
Get Moving
Research shows that most women gain one to two pounds every year after 30. Unfortunately, that’s not the only figure change that sets in as we age. Muscles get flabby (remember Aunt Edna’s wings?), balance and coordination gets shaky, and jeans become increasingly snug. The good news: you can stave off – and even reverse – some of these changes if you work out and build resistance.
“If you exercise hard six days a week, plus a few other things, you can be functionally the same person at 50 almost until you die,” claims Crowley. “Hard exercise sends different messages to your body – messages that override the default to decay.”
Think of muscle like a Ham Steak with intramuscular marbling. The more you reduce that marbling, the better blood can circulate throughout your body and to your organs where it’s needed most. What’s more, when your heart rate jumps to 60 percent, your blood chemistry changes, becoming anti-inflammatory instead of inflammatory, which helps prevent everything from heart disease and stroke to cancer and diabetes.
Just don’t forget to strength train. “Every year after 40, we lose an average of 0.3 to 0.5 percent of our bone mass,” says Crowley. Using your muscles to lift weights, perform squats or do sit-ups stresses the bones in a controlled manner, preventing demineralization. And when your belly and back muscles are strong, you’re more likely to maintain your balance on an uneven sidewalk, to say nothing of the effects on your posture (and propensity to shrink as you get older).
Mind Games
Perhaps the best way to walk tall into your senior years is to fill yourself with positive energy and emotions. In fact, a growing body of research shows that putting a positive spin on any situation floods the body with feel-good chemicals that actually boost your immune system. Of course, negative energy has an equal and opposite effect, wreaking havoc on your health and taking years off your life.
“Nothing ages a person faster than a negative attitude,” says Donna Fremon-Powell, certified Guided Imagery Therapist in La Habra, California. “Anger, jealousy, hate, resentment, all of these emotions, produce a chemical that’s very similar to arsenic. Simply put, your negative emotions are poisonous.”
Fremon-Powell isn’t suggesting you ignore difficulties and walk through life with your head in the clouds. Rather, pay attention to where you direct your energy. Instead of focusing on traffic, your growing debt and your never-ending to-do list, take a deep breath and when you exhale release the stress or upset by blowing it out. Then, imagine yourself in a beautiful, soothing place or with someone you love. A routine part of Fremon-Powell’s Guided Imagery Practice involves having clients imagine themselves in a calming place that brings them joy and pleasure.
“One of the easiest ways to create feelings of peace, gratitude and wellness is by using your imagination,” claims Fremon-Powell. “Stress promotes aging and cell death, so it’s important for people to know how to calm themselves. Spending even two minutes a day imagining yourself walking in a beautiful meadow or standing under a warm waterfall enhances the body’s natural healing abilities.” And when you imagine your favorite place, you can paint the scene any way you like.
Let’s Talk About Sex
With dwindling hormones, given a choice between sex and vacuuming, for most seniors, the carpet wins. But if you can effectively sidestep your vacuum, sex can boost your immune system, reduce stress and keep you trim and healthy to boot. And studies show that for men, ejaculating more than five times a week can reduce the risk of prostate cancer.
“Your sexuality is part of your general health – if you don’t use it, you will lose it,” claims sex educator and internationally best-selling author Lou Paget. As the author of the best-selling book, How to be a Great Lover, Paget helps people of all ages use their sexuality for optimal health. Her argument: we take care of our health with food, vitamins, even unnecessary medications, but touch is a huge part of what it means to be human. Our tissues need to be stimulated to promote blood flow and lubrication.
Your body changes as you age – hormone levels dip, lubrication dries up and sensation falls flat. And more often than not, outside influences (like medication or a stagnant marriage) also interfere with our sex drives. “Part of great sex, and great aging, is being willing to experiment, try new things and continue learning about yourself and those around you,” says Paget. “There are many things people can do in a partnership – whether it’s with toys or just new ways of being together.”
Think of your sexuality as an appetite – much like your appetite for food. “There’s comfort food and there’s comfort sex,” says Paget. “But you don’t want to always feed your body the same thing.” Your taste buds in your mouth dictate what will take care of that appetite and the nerve endings in your skin and body will tell you how to take care of your sexual appetite. Sometimes – especially as you get older – you’re just not hungry, and that’s okay, too.
Social Hour
Far more important than an active sex life, is building and maintaining social networks. “We’re hard wired to be connected,” says Crowley. “Every advanced structure in our brain depends on interaction with other people.” And yet society is making it increasingly easy to live in isolation – a surefire way to age fast. Crowley’s solution: Default to yes. When someone invites you to do something or asks for help, say yes.
That’s one strategy Gough has down pat. Even at her seemingly advanced age, Gough is constantly out in the world, making new friends, trying new things and re-discovering herself. So whether she’s being asked to manage offices all over the country, sing on stage in front of a packed theater or help someone overcome their self-esteem issues, Gough’s response is usually yes.
“This world is a school and every person you encounter offers an opportunity to learn a new lesson,” she claims. “If you look at life on Earth that way, aging brings enlightenment – and the wrinkles just make you look more astute.”
Amy Paturel is a health writer in Los Angeles, California, and a columnist for AOL’s Diet and Fitness Channels. She holds masters degrees in nutrition and public health, both from Tufts University in Boston, Massachusetts.
PATUREL, AMY M.S., M.P.H.
Getting a good night’s sleep is hard enough. Don’t let multiple sclerosis turn your bed into the enemy.
Even before Glenn Scott was diagnosed with multiple sclerosis (MS), he was pounding his mattress in frustration. I was waking up at 2 a.m. and was lucky if I could sleep until 4 a.m., he says. I was living on four to five hours of sleep a night. And with a career in information technology in Austin, TX, and a huge software implementation project in Europe, Scott couldn’t afford to keep losing sleep.Research suggests that most adults need eight hours of sleep to function well. Sleep is critical for learning, memory, and problem solving, to say nothing of its effects on the body’s internal systems (especially the heart, lungs, and hormones). And yet, in today’s time-crunched society, up to 47 million Americans don’t get enough ZZZZs. Toss a disease like MS into the mix and restful slumber can seem like a pipe dream-especially after you’ve taken a five-day course of steroids.
DOES MS CAUSE SLEEP PROBLEMS?
Every night MS patients like Glenn lie awake, suffering in silence. Beyond the stress of battling a potentially crippling disease, MS involves physical symptoms such as numbness, muscle spasms, and debilitating pain that can make sleep nearly impossible. Beyond the physical symptoms of the disease, six percent of MS patients have a diagnosable sleep disorder. Some suffer from involuntary twitches and kicking, called sleep-related movement disorder. Others require frequent trips to the bathroom (nocturia) or have ongoing ringing in the ear (tinnitus).It’s like an alarm clock that you can’t turn off, Glenn says of his tinnitus. You can disregard it during the day with the ambient noise and distractions. But at night, when you try to lie quiet and still, it’s impossible to ignore.
Along with the numbness and pain, the constant ringing makes sleep really difficult. Glenn uses a white noise machine at night to distract him from the tinnitus, but a full night of rest is still rare.Among veterans treated in the VA health system, sleep disorders are twice as [common] among MS patients than they are among the general population-5.9 percent vs. 2.7 percent, says Christopher Bever, M.D., professor of neurology, pharmacology, and physical therapy in the department of neurology at the University of Maryland.In Dr. Bever’s study of 206 MS patients, presented at the American Neurological Association’s annual meeting in 2008, 75 patients had a sleep-related movement disorder, meaning that they had involuntary movements interfering with sleep. The remaining 131 patients suffered from other sleep disorders, including obstructive sleep apnea (in which the tissues of the throat interfere with breathing during sleep); central sleep apnea (in which the parts of the brain that regulate breathing slow down); rapid eye movement (REM) sleep behavioral disorder (where patients act out their dreams); and narcolepsy (which often causes patients to fall asleep unexpectedly and at inappropriate times during the day).As to whether MS is the cause of these sleep disorders or simply a co-existing condition, Dr. Bever says it’s likely a mix. Either way, they should be discussed with your doctor. Some of these sleep disorders, like sleep-related movement disorder and central sleep apnea, may be caused by the location of MS lesions, which are areas of damage within the brain.
In his study, 65 percent of patients with sleep-related movement disorders had lesions in the primary and supplementary motor cortex areas. Other sleep disorders, such as obstructive sleep apnea, are caused by upper airway obstruction and are less likely to be caused by the MS.Unfortunately, many neurologists aren’t aware of the association between MS and sleep disorders. As a result, patients like 45-year-old Veronica Pittaluga of Winter Haven, FL, subsist on little or no sleep for years before their physicians suggest a formal sleep evaluation.I told my doctors that I’d had trouble sleeping and had been taking sleeping pills on and off for years, she says. I always chalked it up to stress, perimenopause, or pain in my legs from spasticity. Pittaluga was diagnosed with MS in 1996, but she wasn’t diagnosed with sleep apnea until 2008.The consequences of delaying diagnosis can be serious. While the most immediate problem associated with sleep disorders can be daytime fatigue-which is a bad thing-sleep disorders can also have important medical consequences like high blood pressure and heart problems, says Dr. Bever. It’s important for MS patients with daytime drowsiness to ask their physicians about sleep disorders and determine whether referral to a sleep center would be appropriate.
DRUG TREATMENTS
Depending on the type of sleep disorder you have, a variety of medical treatments are available to help you return to restful slumber. For sleep-related movement disorders, medications are usually the first line of defense. Traditionally used for Parkinson’s disease, dopaminergic agents like ropinirole (Requip) and pramipexole (Mirapex) increase dopamine, a neurotransmitter that regulates muscle movements.
Benzodiazepines and narcotics may also be helpful for sleep-related movement disorders. Patients with narcolepsy also respond well to medication-usually stimulant and antidepressant drugs.In addition to pain meds (especially narcotics) and anti-convulsant drugs such as gabapentin (Neurontin), many MS patients take sleep medications like zolpidem (Ambien, Ambien CR), eszopiclone (Lunesta), and even anti-anxiety medications such as alprazolam (Xanax). Patients like Glenn often can’t function without them. My neurologist prescribed Ambien CR, which was good at knocking me out. I was still waking up at 2 a.m., but without the medication, I wouldn’t get any sleep at all. Still, experts advise against relying on sleep medications. Beyond the addictive nature of these drugs and their impact on sleep patterns-often for days after patients take them-such medications may also interact with other prescriptions. What’s more, the meds wear off within six hours for most people. After that, their legs hurt, their feet burn, they have pins and needles everywhere, and they can’t fall back asleep. Every time I turn over in my sleep, I wake up, says 35-year-old Beki Rhein of Springfield, MO. My hips or my legs hurt and then I can’t fall back to sleep. To prevent awakening in the wee hours, many patients try to stave off slumber for as long as possible. But that launches them into a vicious cycle of lying awake at night and then trying to stay awake during the day.I had a month where the fatigue was so debilitating that I couldn’t get off of the couch, says Rhein. That’s when I started taking Provigil. Modafinil (Provigil) promotes wakefulness and is approved for narcolepsy.
Some patients with MS find it helps them battle fatigue too. However, at $12 a pill, Provigil isn’t an option for the average American, especially since most patients need about 2 pills a day-$8,760 over the course of a year. The drug company tripled the cost of the medication as it became more widely prescribed, says Mark Mahowald, M.D., director of the Minnesota Regional Sleep Disorders Center in Hennepin County, MN, and professor of neurology at the University of Minnesota Medical School. I don’t recommend the medication for two reasons. First, scientific studies show it isn’t effective for fatigue caused by MS. Second, the price is unconscionable. Some patients who have MS may also have narcolepsy; modafinil may work for them. Nevertheless, Dr. Mahowald recommends seeing your doctor for an appropriate prescription since the drug is so expensive.
OTHER MEDICAL TREATMENTS
The most widely recommended treatment for moderate to severe obstructive sleep apnea is continuous positive airway pressure (CPAP), which provides patients with pressurized air to prevent the airway from collapsing. Even though most CPAP units are the size of a tissue box and many are available with a built-in humidifier for comfort, many patients still have trouble wearing the mask while they sleep. In some cases, your doctor may prescribe BPAP instead of CPAP for obstructive sleep apnea. BPAP or BiPAP is short for bilevel positive airway pressure. It functions the same way as a CPAP, but provides two different levels of pressure. The machine mimics normal breathing by providing a higher pressure when you’re breathing in and a lower pressure when you’re breathing out. Even so, many patients have a hard time using the machine. It’s not natural to lay down with a mask and have air blowing up your nose, Pittaluga says. And for people like Glenn Scott who tend to feel claustrophobic in confined spaces, the mask may not be an option. That’s where surgery comes in.Uvulopalatopharyngoplasty (also known by the abbreviations UPPP and UP3) is a surgical procedure used to remove tissue in the throat and widen the airway. The procedure allows air to move through the throat more easily when you breathe, which helps reduce snoring. Trouble is, the results of the surgery are somewhat disappointing. Breathing may improve immediately following the surgery, but improvements tend to deteriorate after about two years. Studies suggest that UPPP, as a stand-alone procedure, is effective in less than 40 percent of patients. My surgeon was very good about setting expectations and explained that the surgery didn’t have a very high success rate-and that some patients may come out worse off than they were before, says Scott, whose surgery was ineffective. Another procedure called the Stanford Protocol is essentially a cocktail of surgeries aimed at addressing the entire airway. The Protocol operation involves two phases: a soft tissue surgery including UPPP; and maxillomandibular advancement, a surgery that anchors the tongue muscle to the chin and pulls the tongue forward as well. If the procedure is effective, the tongue will no longer block the airway when the patient sleeps.
SLEEP: IMAGINE THAT!
Instead of letting sleepless nights wreak havoc on her life-or relying on sleeping and waking medications to function-Pittaluga incorporates lifestyle strategies that promote restful slumber. She turns off the TV and the computer at a reasonable time, stops eating several hours before bed, and avoids caffeine. When it’s time for bed, she tries to get as comfortable as possible. I have a pillow that supports my neck. It helps with the BPAP mask when I’m lying on my side, she says. I also place a pillow in between my legs to alleviate pain in my hips and legs. Experts also recommend aerobic exercise, both for daytime fatigue and sleeplessness. It’s a paradox, says Jeffrey Cohen, M.D., staff neurologist and director of the experimental therapeutics program at the Cleveland Clinic’s Mellen Center in Cleveland, OH. People are completely exhausted and we’re telling them to exercise. But it really does boost their energy level. In fact, several studies show that regular aerobic exercise helps combat daytime fatigue, which can make it easier to sleep at night.
And don’t forget alternative remedies like hypnosis, guided imagery, and progressive relaxation. Your typical waking and sleeping times are programmed in your mind.
Instead of counting sheep, try re-setting the program, suggests Donna Fremon-Powell, certified guided-imagery therapist and hypnotherapist in La Habra, CA. Both guided imagery and hypnosis bring your brain into a deeply relaxed state. Plus, during this time, the mind may be more willing to accept suggestions such as ‘I will sleep soundly through the night and wake fully refreshed and alert in the morning. ‘Experiencing hypnosis or guided imagery-or listening to a relaxation CD as you fall asleep-can help you change negative sleeping patterns and invoke more restful slumber. Many patients find they can be lulled into sleep after visualizing themselves in a tranquil environment, such as with a babbling brook or peaceful palm trees swaying in the breeze.If you awake in the middle of the night and put the CD back on, you’ll usually fall asleep again without any trouble, says Fremon-Powell. She suggests selecting a CD that’s approximately 45 minutes so it coincides with your natural sleep patterns (hers is available at gladheartproject.com).Another useful tool is repetition. Repeating phrases like ‘toes go to sleep, feet go to sleep, heels go to sleep,’ and working your way all the way up to the top of your head, often works well for people with severe sleep issues, says Fremon-Powell. When you mentally put each part of your body to sleep, you’re more likely to relax and release anxious thoughts-including whether or not you’ll fall asleep tonight.
Sleep Disorder or MS Symptom?
With up to 87 percent of MS patients reporting fatigue, it can be difficult to determine whether sleep problems are a symptom of MS or whether the patient has a diagnosable sleep disorder.Fatigue is ubiquitous with MS patients. It’s almost intrinsic to the disease, says Mark Mahowald, M.D., director of the Minnesota Regional Sleep Disorders Center in Hennepin County, MN, and professor of neurology at the University of Minnesota Medical School. Unfortunately, the medical profession doesn’t understand fatigue very well. We don’t know what causes it, we can’t measure it, and we can’t treat it. In some cases the exhaustion is so overwhelming that patients can’t get off the couch. I feel like a noodle and I just have to relax, says Rhein. It’s tempting to blame everything on the MS, but not every sleep issue is related to MS. That’s one of the most frustrating things about the disease. If you’re fatigued during the day and can’t seem to get a full night of sleep, ask your partner or spouse whether you twitch, jerk, and move during your sleep or whether you snore loudly-two indications of a diagnosable sleep disorder. If there’s some suggestion that you have a sleep disorder in addition to the MS, ask your doctor for a formal sleep evaluation, says Dr. Mahowald.
A DoZZZZen Tips
1. Wake up and go to bed at the same time every day, even on weekends. If you sleep in, you might not be able to fall asleep the next night. The reason? You have to be awake for a certain amount of time before you’ll be sleepy enough to fall asleep again.
2. Create and stick to a nightly bedtime ritual. Instead of balancing your check book, turn to soothing activities like taking a warm bath, meditating, or reading.
3. If you can view a clock from your bed, move it. If you’ve just woken up and you look to see what time it is, you have to take yourself from transitional sleep to full awakening, and you’ve made it harder to fall back asleep.
4. Create a safe haven where you sleep. Sleeping soundly requires the right environment: dark, quiet, comfortable, and cool. While some potential sleep saboteurs are beyond your control, blackout shades, earplugs, humidifiers, and fans can help.
5. Watch what and when you drink. Tea, soda, chocolate-they all contain caffeine and stay in the body for three to five hours. Eliminate caffeine after noon, and try not to drink liquids before bed, especially if you have nocturia.
6. Get moving, just don’t do it right before bedtime. Study after study shows that people who are more physically active get better sleep.
7. Use your bedroom for sleep and sex only. Reserving the bedroom for only sleep and sex actually helps strengthen the association between bed and sleep. Reading in bed is fine IF it helps you fall asleep.
8. Use your mind. Visualization and imagery can help calm both the mind and the body, which allows sleep to set in more naturally.
9. Time your meds carefully. Ingesting medication-just like ingesting food-kick starts your metabolism. Take medications, herbal supplements, or other remedies early in the day
10. Don’t drink to fall asleep. Alcohol may make you feel sleepy initially, but it actually makes it harder for you to stay asleep.
11. Immerse yourself in daylight. Getting sufficient exposure to light during the day can help you stay awake and alert during the day, and prepare you for a good night’s sleep.
12. Write it down. Instead of ruminating over the day’s dramas right before bed, set aside a worry time earlier in the day. If your sleep problems persist, keep a sleep diary, noting the type of problems you’re experiencing and when they occur. It’s a useful tool to have when you talk to your doctor.
Amy Paturel, M.S., M.P.H., is a health and nutrition writer who frequently contributes to
such publications as Health, Cooking Light, Natural Health, and Neurology Now. Visit her at amypaturel.com.
Neurology Now Magazine: January/February 2009 – Volume 5 – Issue 1 – p 24-28
10 Tips for Managing Adult ADD/ADHD
Stay on Course
Once considered a disorder of the elementary-school years that children “outgrew,” attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) now affects about 9 million adults. That’s a problem, since experts argue that ADHD is responsible for reduced productivity in the workplace — to say nothing of its effects on household chores. And in addition to those with true ADD/ADHD, an increasing number of adults are showing similar symptoms because they are simply overstimulated. “We’re seeing more and more ‘attention deficit trait,’ which mimics ADHD, but is really a situation in which adults are overworked, overtired, and overstimulated by technology and various demands and can’t sustain focus,” says Caroline Miller, positive psychology and goal-setting specialist and author of several books, including the forthcoming Creating Your Best Life: The Ultimate Life List Guide(Sterling, January 2009). If you’re among the growing number of Americans who have a hard time completing tasks, give one or more of the following strategies a try.
Once considered a disorder of the elementary-school years that children “outgrew,” attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) now affects about 9 million adults. That’s a problem, since experts argue that ADHD is responsible for reduced productivity in the workplace — to say nothing of its effects on household chores. And in addition to those with true ADD/ADHD, an increasing number of adults are showing similar symptoms because they are simply overstimulated. “We’re seeing more and more ‘attention deficit trait,’ which mimics ADHD, but is really a situation in which adults are overworked, overtired, and overstimulated by technology and various demands and can’t sustain focus,” says Caroline Miller, positive psychology and goal-setting specialist and author of several books, including the forthcoming Creating Your Best Life: The Ultimate Life List Guide (Sterling, January 2009). If you’re among the growing number of Americans who have a hard time completing tasks, give one or more of the following strategies a try.
Once considered a disorder of the elementary-school years that children “outgrew,” attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) now affects about 9 million adults. That’s a problem, since experts argue that ADHD is responsible for reduced productivity in the workplace — to say nothing of its effects on household chores. And in addition to those with true ADD/ADHD, an increasing number of adults are showing similar symptoms because they are simply overstimulated. “We’re seeing more and more ‘attention deficit trait,’ which mimics ADHD, but is really a situation in which adults are overworked, overtired, and overstimulated by technology and various demands and can’t sustain focus,” says Caroline Miller, positive psychology and goal-setting specialist and author of several books, including the forthcoming Creating Your Best Life: The Ultimate Life List Guide (Sterling, January 2009). If you’re among the growing number of Americans who have a hard time completing tasks, give one or more of the following strategies a try.
Take Ten — and Think It Through
Adults with ADD/ADHD are more likely to blurt out statements they later regret. If you take ten seconds to think before you speak, you’ll be less likely to commit the unthinkable. “Naming your emotions as you feel them has the ability to neutralize your reaction,” says Miller. “So instead of being hijacked by your brain when you are swept away by emotion, you can step back and name your feeling before saying or doing something impulsive.”
Get Moving
Exercise may improve ADD/ADHD symptoms, claims Floyd Sallee, M.D., Ph.D., professor of psychiatry at the University of Cincinnati. “If you have blood pumping to your brain because you’re exercising, it does improve attention.” Some experts believe a workout can also enhance mood and make medication more effective. Incorporate some form of meditation into your regimen, and you may have a silver bullet for ADD/ADHD symptoms. Yoga, tai chi, or qi gong may be your best bets, but any form of exercise is likely to do the trick.
Get Some ZZZs
Many adults with ADD/ADHD suffer frominsomnia, which only exacerbates their attention problems. “Do not get involved in projects at night that will allow you to hyperfocus on something and then get the second wind that will cause you to stay awake past your limits,” says Miller. Instead, wind down with a bedtime ritual like a warm bath or a short, peaceful story. Still can’t sleep? You could try taking melatonin, a natural sleep hormone (3 to 5 mg before bed). Get your doctor’s okay before taking any supplement, though.
Eat a Power Breakfast
You’d be hard pressed to find anyone, with ADD/ADHD or not, who doesn’t lack focus a few hours after a doughnut-and-coffee breakfast. For adults who do have ADHD though, the repercussions can be severe. Instead of carb-loading at breakfast (bagel with cream cheese, anyone?), eat a few hard-boiled eggs and a banana, or granola mixed with plain yogurt. The combination of protein and fiber-rich carbohydrates will give your brain the fuel it needs to stay focused and on task.
Boost Your Odds of Success
“People who have ADHD can do well, but only with really explicit instructions,” says Sallee. “Leaving things to chance doesn’t work well for this group.” Once you have a solid set of instructions, make choices about where and how you work that fall in line with your particular weakness or strength. If you’re an early bird, get to the office first thing in the morning. At your best at night? Ask the boss if you can work from home part-time. Additionally, break up big projects with lingering deadlines into small, manageable chunks. And use a timer to remind you when you have to change tasks or get to an appointment.
Reward Yourself
If you don’t celebrate the small, everyday lifestyle changes, there will be times when your long-term goals are so far off, it will seem that there’s little payoff. Rewards can be as simple as a gold star or a smiley face in your notebook or calendar. Pick something that’s unique to you and makes you feel good. You might even plan a weekend getaway and put aside a little money toward your travel plans every time you achieve a short-range goal
Try Guided Imagery
“Both imagery and hypnosis bring your brain into a deeply relaxed state,” explains Donna Fremon-Powell, a certified guided-imagery therapist and hypnotherapist in La Habra, California. “In this alpha-brainwave state, the subconscious mind is more willing to accept beneficial suggestions, such as ‘You stay focused and complete tasks efficiently and easily.’” Experiencing hypnosis or guided imagery — even listening to an appropriate imagery CD as you fall asleep — can help you change negative patterns.
Ask for Help
“When the fallout of ADD/ADHD affects your quality of life, it’s time to look for assistance,” says Miller. Specialized coaches, organizational systems, medications, and therapists can all help, and books and Web sites can demystify the disorder. Furthermore, finding a role model who has ADD/ADHD has never been easier (consider Michael Phelps). In fact, many athletes, CEOs, and artists who have ADD/ADHD are active, bright, and successful. Rather than seeing their diagnosis as a liability, they have learned to appreciate it as an asset.
Amy Paturel
Everyday Health
March 19, 2007
A Dozen Tips to a Better Night’s Sleep
When responsibilities mount, sleep is the first thing to drop off the priority list. In fact, according to the National Sleep Foundation, as many as 47 million Americans are sleep-deprived (2002 Sleep in America poll). And that’s a problem since experts argue that getting adequate zzz’s is as important to health and well-being as diet and exercise. If you have a hard time falling asleep, wake up often in the night, or feel exhausted and doze off in the daytime, try the following tips for a more restful slumber.
1. Set a regular schedule for waking and sleeping times.
You’ve heard it time and time again – wake up and go to bed at the same time every day, even on weekends. Why is this so important? It all relates to circadian rhythms. “Sleep is a homeostatic process (a system that our bodies regulate automatically based on our patterns),” says Sonia Ancoli-Israel, Ph.D., professor of psychiatry at the University of California, San Diego and a Spokesperson for the National Sleep Foundation. “If you sleep in, it might affect your ability to fall asleep the next night since you have to be awake for a certain amount of time before you’ll be sleepy enough to go to sleep again.”
2. Create – and stick to – a nightly bedtime ritual.
Engaging in a relaxing activity, preferably with dim lighting, helps separate sleeping times from times that elicit excitement, stress or anxiety. Instead of trying to balance your budget or trying to solve big family dilemmas right before bedtime, turn to soothing activities like taking a warm bath, meditating or reading. It doesn’t matter what you do claims Ancoli-Israel, as long as it relaxes you – just stay away from bright light because it signals the brain that its time to awaken, not to sleep.
3. Turn everything off (including the clock – or at least cover the face).
If you can view a clock from your bed, move it. In fact, according to Ancoli-Israel, getting rid of the clock is effective in 90 percent of the people who have difficulty sleeping. “If you’ve just woken up and you want to know what time it is, you have to take yourself from transitional sleep to full awakening – and you’ve made it harder to fall back to sleep,” says Ancoli-Israel. “Get rid of the clock and don’t even open your eyes if you awaken in the middle of the night because that will take you out of that transitional sleep.”
4. Create a safe haven where you sleep.
Sleeping soundly requires the right environment – dark, quiet, comfortable and cool. It helps if distractions are minimal, too, including exposure to light, uncomfortable temperatures or poor circulation, not to mention your hubby’s loud snoring. While some potential sleep saboteurs are beyond your control, blackout shades, earplugs, humidifiers and fans can help block out the major offenders.
5. Get your shuteye resting on a comfortable mattress and pillows (which may be topped with high thread-count sheets).
When it comes to sleep, comfort is key. If you have been lying on the same mattress for years on end, chances are, it may have exceeded its life expectancy (most “good” mattresses survive for about 10 years). Encasing yourself in comfort will make for more peaceful slumber. Ancoli-Israel points out that brand and price of these elements, whether sheets, pillows, bedding or a mattress, is irrelevant. It’s how they make you feel that matters most.
6. Watch what – and when – you eat.
Don’t eat anything two to three hours before your regular bedtime. The same rule applies to liquids. You don’t want to disrupt your slumber for a simple bathroom trip. Avoid eating a heavy meal too close to bedtime or spicy foods, which may cause heartburn and make it difficult to fall asleep. But you don’t want to go to bed hungry either. “Again, it’s doing what makes you feel comfortable,” says Ancoli-Israel. Then, you’ll rest easy.
7. Get moving.
Just don’t do it right before bedtime. Study after study shows that people who are more physically get better sleep. “When you exercise body temperature goes up and it takes about six hours for it to drop again,” says Ancoli-Israel. And since a cooler body temperature is associated with sleep onset, an ideal time for exercise is in the late afternoon.
8. Use your bedroom for sleep and sex (ONLY)
Keep work, computers, TVs and other distractions out of the bedroom. Reserving the bedroom for only sleep and sex actually helps strengthen the association between bed and sleep. Reading in bed, for example, is fine IF it helps you fall asleep. “It’s very individual,” says Ancoli-Israel. “What works for one person may not work for another.” She even suggests taking sex out of the bedroom if it isn’t relaxing for you and doesn’t promote sleep. Bottom line: When you’re in the bedroom, engage in activities that help you relax.
9. Try guided imagery (and stop counting sheep).
Your typical waking and sleeping times are programmed in your subconscious mind. Instead of counting sheep, try re-setting the program. “Both imagery and hypnosis bring your brain into a deeply relaxed state,” explains Donna Fremon-Powell, Certified Guided Imagery Therapist and Certified Hypnotherapist and creator of The Gladheart Project in La Habra, California. “In this alpha brainwave state the subconscious mind is more willing to accept beneficial suggestions such as ‘you sleep soundly through the night and wake fully refreshed and alert in the morning.’” Experiencing hypnosis or guided imagery – or even listening to a competent imagery CD as you fall asleep – can help you change negative sleeping patterns and invoke more restful slumber.
10. Stay away from nicotine, alcohol and caffeine.
If you need one more reason to stop smoking, here it is: Nicotine disrupts sleep. So too, does caffeine and alcohol – and the former lurks in more than just your morning cup of joe. Tea, soda, chocolate, they all contain caffeine, and they stay in the body for three to five hours. “People also need to be careful about what medications they’re taking, whether they’re over-the-counter or other medications,” claims Ancoli-Israel. Beyond the caffeine contained in some of these drugs is the fact that drugs, by definition, activate and mobilize your system – and that makes it harder for you to fall asleep. Take medications and herbal supplements or other remedies early in the day and don’t drink to fall asleep. Alcohol may make you feel sleepy initially, but it actually promotes less restful sleep.
11. Immerse yourself in daylight.
The body’s natural sleep hormone melatonin is secreted in darkness and inhibited in light. So getting sufficient exposure to light during the day can help you stay awake and alert. By the same token, keeping your bedroom as dark as possible at night can help promote the production of melatonin and the onset of sleep. And while you can buy melatonin over the counter as a supplement, Ancoli-Israel claims it isn’t the same as the melatonin produced by the brain. Still, taking one to three mg of melatonin half an hour before bed has proven helpful in some individuals, but Ancoli-Israel claims there’s no scientific evidence to support the use of melatonin as a sleep aid.
12. Write it down.
Instead of ruminating over the day’s dramas right before bed, set aside a worry time earlier in the day, suggests Ancoli-Israel. “It sounds silly, but if you take 10 or 15 minutes to sit and worry during the day (with the Blackberry and beeper off), it frees you up not to think about those concerns when you get in bed at night.” If your sleep problems persist, keep a sleep diary, noting the type of problems you’re experiencing and when they occur. It’s a useful tool to have when you talk to your doctor.
SOURCES
National Sleep Foundation:http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2419253/k.7989/Sleep_Facts_and_Stats.htm
Donna Fremon-Powell, Certified Guided Imagery Therapist, Certified Hpnotherapist
714-651-1964
donna@DonnaFremonPowell.com