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Are you sleeping enough?

Your Health DR GITA MATHAI

Sleeping away one third of our life may seem like a waste of time. But it is essential for growth as during this time our body rejuvenates and maintains and repairs itself. In the long run, insufficient sleep has a negative impact on health. The hours of sleep we need varies with age and the individual. Infants may sleep up to 14 hours a day, growing children nine to ten hours and adults an average of seven to eight hours. Teenagers, who are still growing actively, need their sleep. More than 70 per cent in this age group suffer from chronic sleep deprivation owing to schoolwork, tuitions, television, and social media. As we grow older, our sleep requirement may decrease and be broken up into shorter segments with daytime naps. Some people seem to manage efficiently on four to six hours sleep. Long standing sleep deprivation occurs as an occupational hazard in shift workers. Sleep deprivation can be due to medical conditions such as obstructive sleep apnoea (when a sensation of choking repeatedly wakes the person) or restless legs. Inadequate sleep causes a “tired look”, stress, irritability (short fuse), forgetfulness and a tendency to repeat sentences. Academic performance can deteriorate. Burning the midnight oil may result in an inability to recall what was learnt the night before. Any repetitive task or dark environment (movies, lectures, conferences) may bring on an overwhelming desire to sleep. Driving or operating machinery becomes dangerous as “nodding off” can cause fatal accidents. Lack of sleep causes the weight to climb up slowly and inexorably. This is because the balance between sleep and appetite hormones gets reset. The feeling of fatigue is ineffectually combated by eating more. Obesity sets in, closely followed by lifestyle diseases such as diabetes and hypertension. Strokes and heart attacks are more common in the sleep deprived. Sleep can be elusive if there have been changes in schedule, venue or if there are unresolved tensions. Eating too much or too little food close to bedtime is also disruptive. Drinking too much fluid means nighttime trips to the toilet. Smoking stimulates the body, as does caffeine (coffee, tea, cola), making us awake and alert. Alcohol may initially help sleep to set in but the wearing off of the effect later leads to nighttime awakening. To ensure adequate sleep, try to go to sleep at the same time every night. Sleep in a darkened room with the television and computer switched off. If you do not fall asleep after half an hour, get up and drink some warm milk or water and try again. Awakening from sleep should be natural and will occur spontaneously when the duration of sleep has been sufficient. If an alarm is used, try to set it to the latest possible time, giving your body time to wake spontaneously before it goes off. Daytime naps interfere with nighttime sleep. It is better to avoid naps. If inevitable, sleep mid afternoon and not more than 30 minutes. You may get caught in a vicious cycle of daytime naps, sleeping later at night, leading to longer naps in the daytime and finally, insomnia. Physical and mental fatigue has to set in for proper sleep. Exercising aerobically for 40 minutes a day by walking, jogging, running, swimming or cycling will tire the muscles. After the exercise they need to be stretched for 10 minutes for relaxation to set in. Exercise must be completed at least an hour before bedtime. Otherwise the chemicals released will jolt you awake. One of the proven ways to overcome sleep is to jump up and down or skip! Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

all that rage

http://www.telegraphindia.com/1140714/jsp/knowhow/story_18611110.jsp#.U8YwJJSSya8 All that rage Your Health DR GITA MATHAI Millions of people all over the world watched in horror as a player bit his opponent during a FIFA World Cup 2014 match. The question uppermost in people’s minds was why. Why bite? Biting is a primitive and aggressive expression of anger, frustration or fear. Anger occurs in an area of the brain called the amygdala. In a quarter of a second it releases the chemicals arginine-vasopressin, dopamine, noradrenalin, and corticotropin-releasing hormone and lowers serotonin levels. These chemicals make our bodies ready for a “fight or flight” reaction. The heart rate and blood pressure go up, pupils dilate and sweating occurs. Almost immediately, the blood supply to the frontal lobe of the brain increases. It reacts, releasing other chemicals like serotonin. As its levels rise, reason sets in and higher functions take over. Angry reactions are suppressed. When intense anger takes over, you can either leave the scene (probably an appropriate and safe response), or respond with physical or verbal aggression. If serotonin levels are low, unreasonable anger and aggression take over. During sports, especially contact sports such as football and wrestling, the body is already fine- tuned to win, and, if necessary, be aggressive towards the opponent. This reaction often makes the difference between winning and losing. For the rest of us, lashing out verbally or physically is not a viable option. “Anger management” is essential to make us productive, functioning members of society. People can “feel the heat” as anger builds up in the body. Three responses are possible at this point. The emotion can be vented out, suppressed or attempts can be made to calm down. Expressing anger to a superior or an authority figure may not be the wisest path. Suppression of anger, especially if the aggravation is continuous and long term, can have negative effects. The blood pressure can go up, it can precipitate a stroke or heart attack and it can result in overeating and obesity with its attendant problems or depression. Calming techniques have to be learnt, as they do not come naturally. As soon as you feel your heart pounding in anger, count mentally to 10 before retorting verbally or physically. This gives time for the frontal lobe to counter the amygdala. At the same time take a few deep breaths. Sometimes a word like peace or shanti repeated mentally several times can help with control. Yoga and meditation are time-tested ancient techniques. Logic defeats anger. Considering and analysing occurrences can often defuse anger. Listening to the other person, thinking things through, walking in the other man’s shoes, are all practical ways to tackle the problem of anger. Regular aerobic exercise such as walking, jogging, running, cycling or swimming for 40 minutes or more a day has profound effects on physical and psychological make up. Chemicals are released from the muscles and these elevate serotonin levels. Anger does occur in people who exercise regularly, but the chemicals released by the body tend to put a “brake” on violent, irrational anger. Toddlers sometimes throw tantrums. During these they may bite. The problem is compounded by frustration at the inability to make themselves understood. As the brain matures, the higher centres (frontal lobes) encourage social norms. If there is dysfunction in the frontal or temporal lobes of the brain, uncontrolled, aggressive and biting behaviour may persist into adult life. This can be picked up with EEG or MRI scans. Human bites are dangerous even if accidental or self-inflicted, if there is a break in the skin. The mouth contains a large number of viruses and bacteria that can cause infection. The wound should be thoroughly cleaned with soap and water and a topical antibiotic cream applied. Booster injections of tetanus toxoid and hepatitis B should be taken if they are due. The HIV virus can be transmitted through a human bite. Appropriate blood tests may be required. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in http://www.telegraphindia.com/1140714/jsp/knowhow/story_18611110.jsp#.U8YwJJSSya8 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

Tuberculosis

Stalked by TB http://www.telegraphindia.com/1140630/jsp/knowhow/story_18564453.jsp#.U7fQGI2Sx2A

Your Health DR GITA MATHAI

Tuberculosis (TB) is an insidious disease that creeps up on an unwary person. The symptoms are vague — just a feeling of being exhausted and low-grade fever. “Night sweats” can occur, with the person waking up at night drenched in sweat, but in these days of power outages that can be explained away! Even a persistent hacking cough and gradual but perceptible weight loss are such vague symptoms that they are ignored. Eventually, as the disease progresses and sputum becomes blood stained, a physician is consulted. The bacteria that causes TB (mycobacterium tuberculosis) is a very slow growing organism that can hide in the human body without causing disease (latent tuberculosis). The person may never develop the disease (or pass it on) or TB may rear its head if the body’s immune system is ever compromised. Typically, we connect a hacking cough with blood-stained sputum to TB but it takes a long time for the disease to progress to this level. Also, the disease can manifest itself anywhere in the body — the covering of the brain, the heart, eyes, ears, throat, bones, urinary tract, any of the abdominal or pelvic organs or the reproductive system in males and females — and not only in the lungs. If left untreated, it can cause complications such as paralysis, coma, heart failure, intestinal obstruction and sterility. TB spreads through breathing in or swallowing the air-borne bacteria. So only if a person has lung TB does the infection spread. If such a patient is left untreated, he or she can infect 10 people in a year. Children suffer from a form of the disease called “primary complex” which is non infective. India (closely followed by China) has the highest number of persons with TB. The World Health Organization estimates that 3.1 million people have the disease while it is latent in 4 per cent of the population. They can either remain in that state or progress to active disease. Our body’s immune system attacks the tuberculosis bacteria and prevents progression of the disease. If immunity is compromised — as can occur in diabetes, cancer, medications (steroids), organ transplantation with follow up immunosuppressant medication, HIV infection, long-term regular alcohol or tobacco use — the risk of developing the disease increases. It spreads when there is overcrowding and lack of ventilation and fresh air. Diagnosis of tuberculosis is easy if the bacteria is found in the sputum or body fluids. Otherwise, based on the symptoms, a series of diagnostic tests, skin tests, blood tests, X-rays and scans have to be done to establish the diagnosis. The good news about TB is that it is treatable. The government provides the medication for free. It places patients on a supervised programme called DOTS where the medication is administered by a government health care worker. The medicines can also be purchased with a prescription. A combination of drugs has to be used for six months or longer. The medicine has to be taken daily, regularly and never “forgotten.” For maximum effectiveness, one of the drugs, rifampicin, needs to be taken on an empty stomach. The medication can produce side effects such as nausea, vision disturbances, photosensitivity and tingling of the hands and feet. These can be tackled effectively if reported immediately. If medication is taken irregularly, discontinued or “stopped and restarted” there is a high possibility of the bacteria becoming resistant to the medicine. This MDR (multi drug resistant) tuberculosis requires prolonged treatment with powerful, expensive medication. It is better to take the medicine properly the first time around. Scientists are working on a vaccine to prevent TB. The BCG (Bacille Calmette-Guerin) vaccine available now is administered to all children at birth, free of cost, by the government. It was developed to prevent the spread of tuberculosis but is only partially effective. It does prevent progression to serious life-threatening forms of the disease. A healthy lifestyle with nutritious food, a well-ventilated home or working environment, avoiding tobacco and alcohol and exercising regularly in the fresh air will go a long way to maintaining a healthy immune system and preventing disease. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in