lipid profiles

a part. If there is no such family history, lipids should be evaluated for the first time at the age of 20. If the results are “desirable”, the next reading can be taken after five years. In an older person (over 45 in men and 55 in women) the values need to be checked every year. The blood should be taken after a nine-hour fast (water can be consumed). There should be no fever, infection, inflammation or pregnancy as these can alter the values. Everyone has fat deposits under the skin, where it serves as insulation against heat and cold. Cholesterol is a fat that is produced by the liver and is essential for normal metabolism. It is not soluble in blood, it is transported through the body by LDL (low density lipoproteins), HDL (high density lipoproteins) and VLDL (very low density lipoproteins). Of these HDL is a “good” lipid as it transports excess cholesterol to the liver for excretion. VLDL and LDL transport cholesterol from the liver back into the blood. As long as blood cholesterol remains in the normal range, the blood circulates freely. When levels are elevated, it precipitates in the blood vessels, forming obstructive deposits called plaques. This eventually leads to high blood pressure, heart attacks and strokes. TGL or triglycerides are different from cholesterol. They are derived from food when the calorie intake is greater than the requirement. It combines with cholesterol and gets deposited in the blood vessels. A person with elevated lipids may develop a yellow deposit of cholesterol under the skin, usually around the eyelids. They may also have a crease on the earlobes. A fat deposit (lipoma) can appear as a painless mobile lump just under the skin anywhere in the body. When multiple, it is a hereditary condition called multiple lipomatosis. These are not markers for elevated lipids. The lumps are not cancerous but may be cosmetically unacceptable. They do not respond to the lipid lowering medications and need to be surgically removed. An elevated lipid profile can often be reversed by changes in lifestyle. Quit smoking immediately and drink in moderation only — two drinks a day for men and one for women. The much publicised cardio protective actions of alcohol are outweighed by the other problems of regular drinking. Try to achieve ideal body weight and bring down the BMI (body mass index, which is found by dividing the weight by the height in metre squared) to 23. This can only be achieved with a combination of diet and exercise. Try to stop snacking, especially on fried items and “ready to eat” snacks. Increase the consumption of fruits and vegetables to 4-6 helpings a day. Walnuts, almonds and fish are rich in protective omega -3 fatty acids and Pufa (poly unsaturated fatty acids). Oats contains dietary fibre. Lower oil consumption to 300ml per month per family member. Try to use olive oil. If that is not practical or feasible, use a mixture of equal quantities of rice bran oil, sesame oil, mustard oil and groundnut oil. Exercise aerobically (walking, running, jogging or swimming) for 60 minutes a day. This need not be done at one stretch but can be split into as many as six 10-minute sessions. If lipids are still elevated after 3-6 months despite these interventions, speak to your physician about regular medication. The “statin” group of drugs are very effective. They lower cholesterol, prevent its deposition and stabilise the plaques in the blood vessels. They can be combined with other drugs like ezetimibe (which limit the absorption of cholesterol), or bile acid binding resins, or niacin or fibrates. Natural supplements of fish oil or pure omega-3 fatty acid capsules also help. Lipid lowering medications are usually well tolerated and very effective. 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

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prediabetes

Sweet news for pre-diabetics Your Health Dr Gita Mathai A healthy life is a universal goal. Disease is inconvenient, it affects the quality of life and shortens your life span. Illness does not mean just infections or accidents. It includes chronic lifestyle diseases such as obesity, diabetes and hypertension. These diseases form a group, with one (usually obesity) appearing first and then rapidly progressing to the other two. Combined, they are responsible for more morbidity and mortality than infections. Twenty per cent of our children and 15-40 per cent of adults are obese. They have a body mass index (BMI) of over 30. The highest levels are in the urban areas. In addition, 10-15 per cent of the population over the age of 30 is either frankly diabetic or in the pre-diabetic stage. There are no obvious signs of pre-diabetes. It is suspected in:  A person with a family history of diabetes  Women who developed diabetes during pregnancy or delivered a big baby (more than 4kg) or who have been diagnosed with polycystic ovarian syndrome (PCOS), which is manifested by a obesity, acne, hirsuitism and irregular periods  A person who is relatively inactive. This means less than one and a half to two hours a week of leisure time (not work) activity such as walking, jogging, running, swimming or cycling  A person whose sleep rhythm is disturbed. It is either excessive (more than nine hours a night) or insufficient (less than six hours). These are only average values as healthy sleep habits vary widely  A person whose skin at the neck, elbows, knees, armpits and knuckles become dark and velvety, a condition called acanthosis nigricans. It looks like dirt but it is a change in the skin itself. No amount of scrubbing removes the colour, nor does talcum powder mask it  A person with a BMI of more than 30  A person whose blood pressure has been found to be high (more than 135/90) on three occasions  A person with abdominal obesity who has a waist-hip ratio above 0.90 if male and above 0.85 if female. The waist can be measured at its narrowest point, and the hip at its widest Pre-diabetes is confirmed when the glycated haemoglobin test (A1C) in the blood shows a value between 6-6.5 per cent, fasting blood sugar is between 100-120mg, the two-hour post prandial value is between 140-190mg. Additional abnormalities are high-density lipoprotein (HDL) cholesterol below 35 milligrams per decilitre (mg/dL) and triglyceride level above 250 mg/dL. As soon as the biochemical abnormalities occur, damage to the blood vessels and internal organs like the eyes, heart and the kidney are set in motion. The early diagnosis is a warning, a wake up call. There is a 10-year window period to reverse the trend. The good news — a “pre-diabetic” has a good chance of turning back the clock, reversing the metabolic changes that have occurred and becoming biochemically normal. The first step is to control the weight, by eating a sensible 1,500-2,000 calorie diet with less refined carbohydrates and at least 4-6 helpings of fruits and vegetables. Reduce the salt intake to 5gm (1 level teaspoon) a day. Avoid salted snacks and deep-fried items. Oil consumption should be reduced to 500ml per person a month. If the lipid profile does not return to normal ask your physician about low dose medication (usually the statin group) to control it. Physical activity plays a very important role. The minimum requirement is one and a half hours a week. This will not give you a six pack or help you run a marathon, but it will slow your progression to diabetes. The ideal amount of exercise is an hour a day, seven days a week. If you can only spare the minimum amount of time, the intensity of the exercise (pace) needs to be increased. Aim to reach your target heart rate, which is 80 per cent of 220-age. There are various schedules for this high intensity interval training (HIIT). The simplest (requiring no equipment at all) is continuous stair climbing for 10 minutes at a time. Exercise can also be split into 10-15 minute segments spread out during the day. There will be days when the weather is not conducive to going out doors, you just don’t feel up to it, or social commitments preclude activity. Exercise is more likely to be adequate and consistent if “rest days” are unplanned inevitable events. These simple lifestyle changes can drastically bring down the risk of progression to diabetes and the risk of strokes, heart attacks and other complications by more than 50 per cent. 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

marriage in india

Take a shot at marriage Your Health DR GITA MATHAI Almost everyone in India gets married (95 per cent men of and women by the age of 35). Either they find someone or their friends, relatives, neighbours, marriage brokers and media advertisements pitch in. Society does not condone remaining single. Having children is the next step, and anyone who does not procreate within a year or two of marriage is viewed with consternation and pity. The ideal age for marriage is debatable. Much anthropological data have been collected but there is no clear consensus. The age of maximum and healthy fertility in women is between 18-32 years; men remain fertile longer. The legal age of marriage for a girl is 18 years. By that time, her body is mature enough to cope with the rigours of pregnancy, childbirth and child rearing. But she would barely have finished high school at that age; it is probably better to wait for her to have acquired a college degree or vocational training. This helps the bride to be more mature, physically and mentally. She will also be able to bring up her children better as she will be able to read about advances in childcare, do home tutoring and follow the complicated immunisation schedule. A great deal of money is spent arranging a wedding. It would probably be better if some of it is invested in ensuring that the girl’s health status is satisfactory and her immunisations complete. The MMR (measles mumps rubella) vaccine prevents the mother from acquiring these infections inadvertently during pregnancy. The rubella virus can infect the foetus at any stage of pregnancy but during early pregnancy (before the sixteenth week) it results in malformations in the baby. Common abnormalities seen soon after birth are hearing loss, mental retardation, heart and eye defects. As the child grows, (if it survives) diabetes, thyroid problems and glaucoma may appear. The mother-to-be can be protected if she takes two doses of the vaccine, one at around 15 months and the second along with the DPT booster at five years. It can also be given later as two doses eight weeks apart. Almost all adults in India (99 per cent) have had chicken pox. Usually, it is a mild attack with no after effects but it can be dangerous during pregnancy. If the mother is infected in the first 20 weeks, the child can develop skin and bone defects, abnormal limbs, eye defects and mental retardation. If it occurs close to the date of delivery, the baby can develop a life threatening infection. Again, chicken pox is totally preventable with two doses of the varicella vaccine. Hepatitis B is be life-threatening and can pass directly from mother to baby. It can result in chronic liver disease and the eventual death of the baby. It is easily preventable with three doses of hepatitis B vaccine. The government has now started to give this vaccine free to newborns. It is combined with the DPT or triple antigen. Older children and teenagers have been missed in the free government schedule. They need to get immunised before marriage. Even if these immunisations have been missed, “catch up” immunisation can be given to complete the schedule before marriage. Folic acid (a vitamin) is essential to prevent defects of the brain and spine in babies. Unfortunately our diet is woefully deficient in it. Supplements (5mg per day) need to be started as soon as the engagement occurs and continued for the first five months of pregnancy. It is also important to achieve and maintain the ideal basal metabolic rate of 23. It should be done with a judicious combination of diet and exercise. A balanced diet combined with aerobic activity (running, jogging, walking, cycling, swimming) for an hour a day most days of the week along with yoga, flexion and strengthening exercises for 20 minutes is ideal. Marriage is a partnership. Unimmunised men can bring infections home. An unhealthy lifestyle with obesity, tobacco abuse and excessive drinking reduce sperm count and quality. It can contribute to infertility. Regular exercise is essential to prevent development of lifestyle diseases such as diabetes and hypertension. This will go a long way towards a long, secure and happy married life. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

blunt injuries

Ouch! That hurt Your Health DR GITA MATHAI Injuries occur unexpectedly all the time. You may walk into a door, slip and fall or be thrown against the dashboard as a vehicle brakes suddenly. Any blunt trauma (as differentiated from a sharp injury that may cause bleeding) to the muscles and bones immediately causes an inflammatory reaction. The area becomes red, swollen and painful. The appearance may mimic an acute infection but differentiated from it by the history of trauma and the absence of fever. The injury may be a contusion, the result of trauma to the belly of the muscle, tendon or bony prominence. Blood coagulates in the affected area forming a discoloured bruise. Untreated, this can eventually form scar tissue. Sprains and strains occur in areas where a ligament is attached to the bone, such as the back, knee, ankle or elbow. The injury is mild when there is only over stretching and a few microtears. If there is a partial tear, the joint may become loose and unstable. Emergency first aid must be given for traumatic inflammation even before obtaining a medical opinion. Ignored and delayed, (while awaiting a medical consultation), it can lead to stiffness, pain and loss of normal function. As soon as possible the RICE principle should be followed. R is for rest. The part should immediately be placed at rest. This means minimal weight bearing till the pain subsides. Usually 2-3 days are sufficient. I is for ice. Ice should be placed in a plastic bag and applied to the affected area. It should be left on for 20 minutes at a time every hour for the first hour and then continued three times a day for 3-4 days until total relief is obtained. Faster and greater pain relief may be obtained if the ice is actively massaged on the swollen area. Ice reduces the swelling, numbs the pain, decreases muscle spasm and helps accumulated blood to renter circulation. C is for compression. Swollen areas can be compressed with an elastocrepe bandage. This should initially be applied by trained personnel. Faulty and tight application can cut off blood supply to the affected limb. Once the technique is learnt, bandaging can be done at home. E stands for elevation, a neglected step. Swelling reduces rapidly if the injured part is placed above the level of the heart. Blunt injury causes pain. This can be relieved by medication like paracetmenol, brufen and diclofenac and other Nsaids (non-steroidal anti inflammatory agents). These are commonly available over the counter (OTC) either as single agents or combination tablets. They relieve pain but cause side effects. There may be nausea, vomiting or symptoms of heartburn. A pre-existing ulcer may be aggravated. Long term use and overdosage are dangerous. Some like diclofenac has been associated with kidney damage. If there is no improvement after 2-3 days, see a doctor. If there is no serious injury, after the swelling has subsided reconditioning of the injured area has to be done. This will help to regain flexibility, endurance and power. Joints and muscles can be strengthened with targeted exercise. Flexibility is equally important. A weak or relatively immobile joint is prone to re-injuries with much less trauma. The joint may also become unstable and weak. Physiotherapy is important to tackle all this. Even without an injury, there may be a sudden cramp in the muscle. This occurs when muscles are overused in hot and humid conditions. It can also occur due to calcium deficiency. The muscles contract and the limb gets painfully fixed. The muscle needs to be stretched to relieve the pain. This can be done in the calf by keeping the leg straight and pushing the foot (not the leg) towards the head. In the thigh the knee should be bent with the foot touching the buttocks. Water, lightly salted limejuice, buttermilk or tender coconut water should be given. A fall or accident may also lead to broken bones. If the bones are already weak as a result of osteoporosis or repeated stress, even a slight injury is enough to result in a fracture. There is severe pain, inability to bear weight on the bone and a localised tender area. Fractures are diagnosed using X-rays and should be treated by an orthopaedic surgeon. Either POP (plaster of Paris) casts are applied or surgery needs to be done. Bones do not heal with medication alone. Neither is it advisable to go to unqualified “bone healers” as they immobilise the bone using cloth and a poultice. Since the treatment is not based on X-rays, it may not be wise to pursue this line of treatment. 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

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pica and eating mud

When you crave mud
DR GITA MATHAI

Hyhyhyhy
“My child does not eat” moaned the mother, “she refuses food.”

“Have you tried to figure out what she likes to eat?”

“I don’t think I can give her what she likes. I don’t think a diet of uncooked rice, mud and newspapers is healthy.”

Her logic cannot be faulted. Her daughter is a classical case of “pica,” the correct medical term for a perverted appetite, in which the person consumes non food items such as dirt, clay, raw rice, slate and chalk, paint, plaster, coffee grounds, cigarette ashes, cigarette butts, burnt match heads, rust, glue, hair, buttons, paper, sand, toothpaste, soap, sea shells, and even broken crockery. Pica is diagnosed if such items are eaten for a month or longer, after the age of two, by a mentally normal person unable to rationally control his or her behaviour.

Pica is not confined to India. It is an international phenomenon affecting 10-30 per cent of people of all ages and both sexes. It tends to be more common in the underprivileged, uneducated, mentally challenged and psychologically handicapped. It is aggravated by a lack of supervision.

In some areas, pica is culturally accepted. Consumption of clay and chalk is believed to protect against diseases such as jaundice, diarrhoea and morning sickness. Sometimes, it is believed to confer mystical powers, if eaten at the right time, like during a full moon. Another misconception is that it runs in families, with all members eating chalk or lime.

Many of these items are indigestible. Over a period of time they can get trapped inside the body, usually in the stomach or intestine, forming a hard lump called a bezoar. This has to eventually be surgically removed. Dirt and clay can lead to infection and parasitic infestation. Paint and newspapers can cause slow lead poisoning. Toothpaste damages intestinal villi. Even crunching ice and eating refrigerator frost damages teeth enamel. Lack of a nutritious diet can end in anaemia and malnutrition. Fatigue, palpitations, pallor, thinned out spooned concave nails, flattened tongue papillae, superficial erosions in the mucosa of the mouth and fissuring at the angles of the lips are the other effects.

Pica is different from bullemia nervosa, in which there are periodic intervals of binge eating. Unusually large amounts of a particular food item are consumed, with the feeling that the eating is out of control. The difference is that in bullemia edible items are consumed whereas in pica non-edible ones are eaten.

Children lack subtlety and openly exhibit their strange food preferences. They put everything into the mouth to feel its texture. This oral fixation is usually outgrown by the age of two but it can persists and metamorphise into adult pica.

Pregnancy has long been associated with accepted but peculiar food cravings, which unfortunately, is also accepted as the norm. Such cravings may be hidden from doctors, ignored by patients and condoned by family members.

Nutritional deficiency of iron, zinc or calcium may trigger appetite- regulating brain enzymes and specific cravings. The non-food items consumed in an effort to assuage this do not supply the deficient minerals, and the person is caught in a vicious cycle. The more they eat, the more they crave.

Geophagia (eating clay and mud) may become a habit, like having a cigarette in the morning. It may be an acquired behavioural response to unexpressed stress. It may be learned in childhood by watching other family members. It can in itself cause iron deficiency, aggravating the problem.

Emotional disturbances causing pica are more difficult to tackle, especially if the person is autistic, mentally challenged or has a psychiatric illness. Corporal punishment and ridicule only aggravates the problem, and is eventually self defeating.

Even though the cause is unproven, and varied, treatment is successful. Pica responds dramatically to iron, zinc, multivitamin and calcium supplements supported by regular deworming.

While administering these supplements, certain principles have to be kept in mind so that they are optimally absorbed. Zinc and iron compete for the same absorption sites in the intestine. They cannot be administered together as they “lock” the absorption site, and both are eventually not absorbed but eliminated. They need to be given separately on different days or at least 12 hours apart. Calcium precipitates with iron and zinc and prevents its absorption. It should be given separately. Manufacturers forget these principles and recommend the administration of a “hotchpotch” to patients, usually an elixir, tonic or capsule containing iron, zinc, calcium, vitamins and trace elements all mixed together. It offers little benefit.

After a satisfactory response to pica, no further treatment is required. However a close watch, for recurrence of the symptoms, may have to be kept on the individual for a couple of months by an involved and motivated caregiver.

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

gout

Out with gout

Your Health
DR GITA MATHAI

“Them that can eat have no meat and them that have meat cannot eat!” said Henry VIII who suffered from gout. Gout was then considered a disease of aristocrats, as they were the only people who could afford red meat and alcohol. Excessive consumption of the two was for centuries considered to be precipitating factors for the disease. Today, we know that it is due to high uric acid levels in the blood (more than 7 mg /dl). The incidence of gout is increasing, with the highest rates of change being in India, China and Thailand. Gout now affects 0.3 per cent of the Indian population.

Uric acid is a product of purine metabolism found in all living cells with high concentrations in protein rich foods such as red meat, fish, yeast, broccoli, cabbage, cauliflower and some beans. Beer too has a high purine content while other liquors elevate uric acid levels in the blood as they are metabolised.

The levels of uric acid can increase despite a normal diet if there is increased cell destruction in the body as in leukaemia and sickle cell disease. The levels may also go up as a side effect of certain medications.

Typical gout starts abruptly — in the middle of the night when the temperature dips. Sharp shooting pains appear in the big toe, ankle or knee. The joint becomes red and swollen. There may be fever. This may initially lead to a mistaken diagnosis of inflammatory arthritis.

With or without treatment, the pain may subside 48-72 hours later, and then disappear forever in a lucky few. In others, it re-appears after months or years. Eventually, if left untreated, it may progress to chronic gout, with swollen and deformed joints. Crystallised uric acid may be deposited under the skin as visible “gouty tophi” on the ear, fingers and toes. These appear as movable lumps which eventually grow larger, become painful and interfere with joint movement. The kidney tries to excrete the excess uric acid, which may precipitate there to form stones. It can eventually lead to kidney failure.

Uric acid levels may increase if the body has a problem with eliminating normal quantities of uric acid. This occurs in the obese, the diabetic and those with abnormal lipid levels. Genetically predisposed males develop gout in the forties. Women are protected till menopause, after which their uric acid levels can go up.

Not everyone with high uric acid levels exhibits symptoms. Some people remain asymptomatic all through life.

The diagnosis of gout is confirmed by blood tests to estimate blood uric acid levels, aspiration of fluid from the joints to demonstrate crystals, X-rays or a synovial biopsy.

During an acute attack of gout, the pain can be relieved with medication. Some non steroidal anti-inflammatory agents work better in some people than others. Indomethecin and Nalidixic are particularly effective. Injections of steroids into the affected joints may also be needed. Later, once the acute attack has subsided, drugs like allopurinol may have to be taken regularly to lower blood uric acid levels.

Although medication is the mainstay of gout treatment, for faster pain relief soak the affected joint in hot water with rock salt in it. Then apply ice.

Lifestyle modifications can help to reduce the severity and frequency of attacks.

• Maintain ideal body weight. Although a BMI (body mass index) of 23 is ideal, gout is precipitated when BMI goes above 35.

• Reduce alcohol intake. Beer and binge drinking increase the likelihood of attacks.

• Increase your consumption of carbohydrates. Reduce red meat. If you are vegetarian, remember that some vegetables too contain a lot of purine.

• Coffee reduces blood uric acid levels.

• Vitamin C reduces uric acid. Eating more than 500mg a day as tablets can cause side effects. It is better to get your requirements by squeezing half a lime into every glass of water.

• Eat 2-3 bananas a day.

• Drink 4 litres of water a day. This will help wash out the uric acid and prevent it forming stones in the kidney.

• Exercise for an hour a day. It will correct obesity, metabolic derangements in sugar and lipid levels and help to maintain ideal body weight.

The chance of developing diseases is radically reduced by maintaining ideal body weight and exercising daily. Just putting one foot in front of the other and walking on the road for 40 minutes a day will increase your longevity and keep you healthy.

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

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sleep

Good night, sleep tight YOUR HEALTH Dr. Gita Mathai “I just can’t sleep.” At a conservative estimate, 10 per cent of the population voices this complaint to friends, relatives or busy practitioners. But the condition is seldom taken seriously, especially by those who sleep soundly, and sleeping tablets are prescribed as a temporary panacea. The sleep requirements of individuals vary, with infants and children sleeping 16 to 20 hours a day, adults (till 60) seven to eight hours and senior citizens approximately six hours. Some people get by on just four hours a day. The deepest and most refreshing kind of sleep diminishes with age, with the result that sleep in people over 60 becomes fragmented, with brief awakenings. A common misconception is that constant daytime drowsiness or early-morning awakening is a part of aging. Actually, older adults sleep less because of an inability to sleep, and not because their sleep requirement is reduced. Insomnia is present if there is difficulty in falling asleep, frequent or early awakening, daytime drowsiness, inability to function efficiently, absenteeism, inadequate performance, poor concentration and dysfunction in the workplace. Other symptoms are tension headaches, stomach upsets and constant worry about not getting enough sleep. It can be acute or chronic. Everyone has a normal sleep-wake rhythm, and this may become disturbed with “shift” work, frequent late nights, or travel to different time zones. Medical conditions like hyperthyroidism, the restless leg syndrome, bronchial asthma and hot flushes (menopause) can disturb sleep. An urinary tract infection or an enlarged prostrate can necessitate frequent trips to the toilet, particularly at night. Pain because of arthritis or a peptic ulcer can keep a person awake. Many prescription drugs, antidepressants, heart and blood pressure medications, allergy medications, stimulants (Ritalin) and corticosteroids cause insomnia. Some of these medications are prescribed. Others, (like cough suppressants containing pseudoephedrine) are over-the-counter (OTC) medications. Some herbal weight loss products contain thyroid extract, ephedrine or caffeine. They too can keep a person awake. Antihistamines may initially sedate, but they can increase your night-time loo visits. An alcoholic beverage before bedtime may appear to lead to good sleep, but it produces early awakening and reduces restful sleep. Caffeine, present in tea, coffee, chocolate and cola, is a stimulant that produces mild exhilaration and prevents sleep. Do not drink coffee or tea after lunch if you find sleeping difficult. Colas have a similar effect. Nicotine is a central nervous system stimulant found in cigarettes, beedis, chewing tobacco and snuff. Using these products within an hour of bedtime will compromise sleep. Psychological problems like grief, anxiety, depression and unresolved stress prevent sleep. The unsettled conflicts and images prey on the mind, preventing sleep. Exercise will contribute to good sleep but only if done 3-4 hours before bedtime. Exercise releases stimulatory chemicals from the leg muscles and it takes 3-4 hours for the chemicals to be removed from the body. Hunger can keep you awake. So having a light snack with warm milk (which contains the sleep inducer tryptophan) at bedtime is a good idea. A heavy meal on the other hand will make you feel bloated, uncomfortable and may cause acid regurgitation. All this contributes to insomnia. To tackle insomnia, try correcting all these factors. Exercise regularly for 40 minutes a day and combine it with yoga and meditation. Try to visualise your problems (financial, familial) as images instead of figures. Remove all distractions (computer, television) from the bedroom. If you cannot fall sleep in 30 minutes, get up and read a book. If nothing works, you can go to a sleep laboratory to rule out sleep apnea and do a test called a polysomnography (overnight sleep study). This is expensive and offered only at a few centres. Popping pills should be the last resort. Many sleeping tablets are addictive and habituating, requiring higher doses for the same effect. They can produce severe allergic reactions, or cause confusion, memory loss and bizarre behaviour. If the insomnia is due to depression, psychiatric help and antidepressants may cure it. If you’re having trouble falling asleep, wake frequently once you do fall asleep, or wake up earlier than you want to, try acupressure. Just maintain the pressure for a minute on the spirit gate, which is below the little finger at the wrist or the inner gate, which is two-and-a-half finger widths below the wrist at the centre. 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 Share on emailShare on printShare on facebookShare on twitterMore Sharing Services