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The change over time can be summarised by it initially being a matter of both posi tive and negative feelings in connection with the exercise medications bad for liver buy purim 60caps with mastercard, but once one is an accus to xerostomia medications side effects buy purim 60caps line med exerciser medications vitamins discount 60 caps purim overnight delivery, there are almost only positive feelings and experiences left during the exercise treatment hyperthyroidism generic purim 60 caps on-line. From Wester Wedman’s study (3), it is clear that both the type of effect as well as its scope changes over time. The effects that the exercisers talk about are categorised as mental or physical, in both cases either short-term or long-term, and cognitive – a clear head, clears the mind – and social – common interest, new subject of conversation. With regard to the mental and physical effects, they change over time from being highly short-term/specific to becoming increasingly long-term in both cases. In addition, the balance between both types of effects changes over time so that the physical, which are more prominent in the beginning, after a long time of regular exercise, also make way for mental effects. Examples of short-term/specific physical effects include having the energy to jog a longer distance and becoming less out-of-breath during the exercise, while long term effects can include better condition, weight loss or acquiring leg muscles. Short-term mental effects can include feeling relaxed after jogging or being energised by the exer cise, while long-term effects can include feeling calmer, having better self-confidence, a stronger psyche and becoming happier and more stable (3). The novice exerciser has no experiences or perceptions to rely on and in the beginning, “external” rewards are needed, such as encouraging shouts from family and friends, weight loss or improvements in jogging time per kilometre (24). In this phase, it is a matter of repeating the behaviour as often as possible with the help of these rewards from without. In transtheoretical terms, one can talk about the processes of helping relationships or reinforcement management. At this time, one has not yet become a regular exercise in the sense that the habits have not been established. Gradually as time goes by and the behaviour is repeated, the exerciser gains more and more positive experiences and more perceived effects that gain a more long-term nature. These experiences are incorporated in the motivations and gain increasing significance as motives for continuation of the exercise, while the external motives decrease in impor tance. There is a change of the motives from “externally motivated” to “internally moti vated” behaviour. The motives have been internalised and the exercise habits are estab lished (3, 4). The individual has gone from the action stage via the maintenance stage and in some cases to the termination stage. The changes over time in experiences and effects of exercising described above can be graphically illustrated with the help of a free interpretation of Solomon’s opponent process theory of acquired motivation (23). The negative perceptions during the exercise session are primarily comprise of physical feelings of discomfort – heavy legs, heavy breathing, as well as boredom and mono to ny. The positive after-effect that occurs immediately after the end of the exercise can be seen as a contrast effect that most often means that “it is nice that it is over”. Figure 3, which describes the process in the experienced exerciser, shows that the perception during the actual exercise is nearly neutral. The physical exertion that the exercise nonetheless entails is perceived not at all as negatively, because condition and muscle strength has improved, something that often makes space for positive feelings during exercise. The positive feeling after exercising is both stronger and more extensive in time in the experienced exerciser. According to the exercisers themselves, the content of this feeling is also qualitatively different than the novice exerciser’s immediate after-effect. In summary, it can be confirmed that it takes time to go from being passive to being regularly active, at least six months or more. This is very individual and depends on the individual’s life situation otherwise, such as his/her age, gender, family and work situ ation. During this time, a great deal can happen – seasons change, a holiday can occur, the weather can occasionally be poor and work and family may demand extra attention. In addition to this, temporary illness or injury may also occur and there are also a great many other things that one is to have time to do during one’s free time (3, 4). From Wester-Wedman’s study (3), it is clear that men and women perceive different types of obstacles and their extent. Perceptions and effects are also of different types and scopes and the time that it takes to go from being a novice to a regular exerciser differs, due in part to the aforementioned fac to rs. However, the process progresses in the same manner with the same fac to rs involved, although at a different pace, for men and women. A follow-up study shows that many women prefer less physically demanding types of exercise, such as walking instead of jogging, when they themselves choose exercise activity (25). The physical activity must be adapted to the individual’s conditions An important part of the many messages given in connection with performing regular phys ical activity is that the conditions vary between people. Some of these conditions cannot be changed and affect the possibilities of performing regular physical activity. Instead, the physical activity must be adapted to these conditions and look differently for a single parent than for a person who lives under other conditions, for example. In addition to this, is the central aspect of achieving an impact to wards becoming physi cally active. According to this model, it is accepted that the change means moving from being entirely uninterested in physical activity to being a regular exerciser. This move is about the same for everyone, but the change can look differently for separate individuals. In principle, this is a matter of going from a high level of external motivation to a high level of internal motivation (3). Consequently, it takes significantly more time to adapt mentally than to do so physi ologically. It is only when the two curves (see figure 1) meet that the exercise functions on its own – meaning as a result of internal motivation. Consequently, it must be a central component of the change process that it be allowed to take time and that the external support remains for a considerable period of time, in one way or other. Within healthcare, the local healthcare centres can, for example, be given a special role in this respect. Acknowledgement Huge thanks to Professor Yngvar Ommundsen, Norwegian School of Sports Sciences, Oslo, for constructive points of view and updates. A revolutionary six stage program for overcoming bad habits and moving your life positively forward. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease. Rapport fran ett symposium om me to der att farbattra folkhalsa, 1 och 2 ok to ber 1981. Motivational interviewing about physical activity Authors Barbro Holm Ivarsson, Psychologist, S to ckholm, Sweden Peter Prescott, Psychologist, Bergen, Norway Introduction Unfortunately, there is no simple medicine you can take to become more physically active. You can be determined and make concrete plans just to feel your motivation disappear, your good plans seem unreal istic and your desire disappears. Motivational interviewing is used, for example, as a method in professional counselling regarding the harmful use of alcohol, illegal drugs, to bacco use, harmful gambling, risky sexual behaviour and to promote greater physical activity and good eating habits and to combat obesity. This method fits in all contexts when it is desirable to stimulate another person to change behaviour without inciting resistance, and is therefore very well suited to discussions of physical activity in, for example, healthcare, preventative healthcare, schools and the sports world. Motivational interviewing can be used as an independent intervention to generate interest and motivation, prepare and help a patient/client to commence with change. Motivational interviewing can also be integrated in to other treatment, which appears to improve the result of the treatment in question. This chapter includes a description of how motivational interviewing can be applied to physical activity. To illustrate this, we can follow a motivational interview between Per, who is a keep-fit coach, and Eva, an unmarried 35-year-old social worker, who has recur ring, diffuse back problems (lumbago). This means that the interviewer listens, tries to understand the client’s perspective and empha sizes that the client shall contemplate his/her values, find his/her own answers and him/ herself decide regarding change. The interviewer listens with an accepting, non-moralising interest and tries to understand the client’s problems, rather than convince or present his/her own solutions to them. The inter viewer also strengthens the client’s confidence by showing faith in the client being able to make a change, and emphasizing that change is the client’s own choice; the client is responsible for his/her own life and knows best how the change shall be made. We can recognise clients that work constructively with change in the way they speak. They express motivation, have ideas about practical methods, believe in themselves, make decisions and pledge to follow concrete plans.

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Promotes optimal chest expansion treatment 001 buy purim 60 caps, mobilization of secretions anima sound medicine order 60caps purim overnight delivery, and aeration of all lung fields; reduces risk of stasis of secre tions and pneumonia treatment jock itch discount 60 caps purim. Evaluate activity to treatment xerophthalmia generic purim 60 caps lerance; limit activities to those within Reduction of the metabolic requirements of the body reduces client’s to lerance or place client on bedrest. Protects from excessive fatigue and reduces oxygen demands Schedule rest periods, as indicated. Demonstrate and encourage use of relaxation techniques, such Relaxation decreases muscle tension and anxiety and, hence, as guided imagery and visualization. Promote adequate fluid intake, such as 2 to 3 L/day within Sufficient hydration is necessary to provide for mobilization of cardiac to lerance. Maximizes oxygen transport to tissues, particularly in presence of pulmonary insults or pneumonia. The hemoglobin S molecule has a low affinity for oxygen (which allows for adequate tissue oxygenation). During a vaso-occlusive crisis, a client’s Hgb level often declines by at least 1 g per dL. Exchange blood trans fusions are indicated when the client’s condition is deterio rating and may be done for cases of stroke and acute chest syndrome. Note: Partial transfusions are sometimes used prophylactically in high-risk situations, such as chronic, severe leg ulcers, preparation for general anesthesia, and third trimester of pregnancy. Administer medications, as indicated, for example: Antipyretic, such as acetaminophen (Tylenol) Maintains normothermia to reduce metabolic oxygen demands without affecting serum pH, which may occur with aspirin. Antibiotics, such as amoxicillin plus clavulanic acid Broad-spectrum antibiotics are started immediately pending (Augmentin), third-generation cephalosporins culture results of suspected infections, then may be changed. Have client help differ migra to ry, or more generalized and described as throbbing, entiate current pain from typical or usual pain problems. Pain is caused by ischemic tissue injury resulting from the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Chronic pain occurs because of the destruction of bones, joints, and visceral organs as a result of recurrent crises. The effect of unpredictable recurrences of acute crises on chronic pain creates a unique pain syndrome (Yale, 2000). Typically, acute pain occurs deep in the bones and muscles of back, ribs, and limbs and lasts 5 to 7 days. However, client may also have chronic pain from sickle cell damage (usually bone pain that is present daily) and chronic nerve pain caused by damage from sickle cell block age or other conditions, such as diabetes. Observe nonverbal pain cues, such as gait disturbances, body Nonverbal cues may aid in evaluation of pain and effectiveness positioning, reluctance to move, facial expressions; and of therapy. Explore alternative pain relief measures, such as relaxation Cognitive-behavioral interventions may reduce reliance on phar techniques, biofeedback, yoga, meditation, and distraction— macological therapy and enhance client’s sense of control. Reduces edema, discomfort, and risk of injury, especially if osteomyelitis is present. Collaborative Apply warm, moist compresses to affected joints or other Warmth causes vasodilation and increases circulation to painful areas. Acetaminophen can be used for control of ibuprofen (Advil, Motrin); Ketrolac headache, pain, and fever. Note: Aspirin should be avoided because it alters blood pH and can make cells sickle more easily. Determines and provides appropriate therapies, such as massage, heat therapies, and guided exercise. Assess pulses for rate, rhythm, Sludging and sickling in peripheral vessels may lead to com and volume. May reflect problems with cardiac output (systemic dehydra tion and/or hypoxemia), electrolyte imbalances, or local or systemic sickling causing inadequate myocardial perfusion. Assess for restlessness, changes in level of consciousness, Indicative of inadequate systemic perfusion. Note onset of hypotension with rapid, weak, thready pulse and Sudden massive splenic sequestration of cells can lead to tachypnea with shallow respirations. To evaluate for potential myocardial ischemia, inadequate systemic oxygenation or perfusion of organs. Impaired general and peripheral perfusion Assess lower extremities for skin texture, edema, and ulcera Edema may reflect both systemic and peripheral effects of tions, especially of internal and external ankles. Reduced peripheral circulation often results in skin and underlying tissue changes. Evaluate for developing edema—including genitals in boys Vaso-occlusion or circula to ry stasis may lead to edema of and men. Maintain environmental temperature and body warmth without Prevents vasoconstriction, aids in maintaining circulation and overheating. Excessive body heat may cause diaphoresis, adding to insensible fluid losses and risk of dehydration. Decreased output may be indicative of dehydration, impaired cardiac output or impaired renal perfusion because of vascular occlusions. Risk for impaired respira to ry system perfusion Moni to r respirations, noting rate outside of acceptable parame May indicate presence of oxygen exchange problems, pres ters and drop in pulse oximetry. Changes reflect diminished circulation and hypoxia potentiating capillary occlusion. Ineffective Gastrointestinal Perfusion Asculate abdomen to evaluate for peristaltic activity, especially May indicate presence of bowel ischemia or obstruction or in the presence of vomiting and abdominal pain. Note increasing abdominal girth, especially when accompanied May indicate presence of splenic sequestration (occurs when by general deterioration in clinical status. With out emergency medical care, splenic sequestration can cause death in a matter of hours (Thompson, 2010). Electrolyte losses, especially sodium and potassium, are in creased during crisis because of fever, diarrhea, vomiting, and diaphoresis, and presence of acidosis. Administer oxygen by appropriate route and assist with respi Improves oxygenation and reduces risk of pulmonary compli ra to ry treatment measures, such as coughing, deep breath cations. Administer hydroxyurea (Droxia) and observe for possible side Hydroxyurea, a cy to to xic agent, dramatically decreases the effects. Use of this medication has been associated with fewer episodes of pain crises and acute chest syndrome, decreased need for transfusion, and lower mortality (Steinberg et al, 2003). Chelation therapy may be indicated to correct iron overload as sociated with regular, frequent transfusions. Note: Phlebo to my and exchange transfusions may be used in conjunction with chelation therapy. Prepare for and assist with needle aspiration of blood from cor Sickling within the penis can cause priapism and edema. Removal of sludged sickled cells can improve circulation, decreasing psychological trauma and risk of necrosis and infection. Direct incision and ligation of the dorsal arteries of the penis and saphenous-cavernous shunting may be necessary in severe cases of priapism to prevent tissue necrosis. Client may reduce fluid intake during periods of crisis because of malaise and anorexia. Dehydration from vomiting, diar rhea, and fever may reduce urine output and precipitate a vaso-occlusive crisis. The kidney can lose its ability to concentrate urine, resulting in excessive losses of dilute urine and fixation of the specific gravity. Moni to r vital signs, comparing with client’s usual or previous Reduction of circulating blood volume can occur from increased readings. Observe for fever, changes in level of consciousness, poor skin Symp to ms are reflective of dehydration and hemoconcentra turgor, dryness of skin and mucous membranes, and pain. Moni to r vital signs closely during blood transfusions and note Client’s heart may already be weakened and prone to failure presence of dyspnea, crackles, rhonchi, wheezes, dimin because of chronic demands placed on it by the anemic ished breath sounds, cough, frothy sputum, and cyanosis. Moni to r labora to ry studies, for example: Elevations may indicate hemoconcentration. Prevents prolonged tissue pressure where circulation is already compromised, reducing risk of tissue trauma and ischemia. Inspect skin pressure points regularly for pallor or redness and Poor circulation may predispose to rapid skin breakdown. Protect bony prominences with sheepskin, heel and elbow Decreases pressure on tissues, preventing skin breakdown. Keep skin surfaces dry and clean and linens dry and wrinkle Moist, contaminated areas provide excellent media for growth free. Moni to r ischemic areas, leg bruises, cuts, and bumps closely Potential entry sites for pathogenic organisms.

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Three different age groups were considered: one year old children medicine quizlet cheap 60caps purim free shipping, ten year old children and adults symptoms zoloft purim 60 caps low price. Consideration was also given to medicine 5277 generic purim 60caps online doses to medications you can give your cat discount purim 60 caps on-line fetuses and breast-fed infants, but these were not explicitly evaluated as they would be similar to the doses to the other age groups. The four groups of people considered in Japan were: members of the public who were evacuated in the days and months after the accident; members of the public living in the non-evacuated districts of Fukushima Prefecture; members of the public living in Miyagi, Gunma, Tochigi, Ibaraki, Chiba and Iwate prefectures; and members of the public living in the remaining prefectures of Japan. The emphasis was on estimating the exposures of individuals who were representative of the average of the population, assuming typical habits such as average food intakes. Committed doses were assessed for three age groups by integrating doses from incorporated radionuclides to age 80. Effective doses were estimated, to gether with absorbed doses to the thyroid and some other organs, notably the breast and the red bone marrow. The results are presented in detail in Annex V and indicate that, in the evacuated areas with the highest average estimates, the effective dose estimated to have been received by adults before and during the evacuation was, on average, less than 10 mSv, and about half of that level for those evacuated early. Adults living in Fukushima City were estimated to have received, on average, an effective dose of about 4 mSv in the first year following the accident; estimated effective doses to one year old infants were about twice as high. Those living in other areas within Fukushima Prefecture and in neighbouring prefectures were estimated to have received comparable or lower effective doses; even lower effective doses were estimated to have been received elsewhere in Japan. For the first year, marine foods were included in the estimated ingestion doses, but made a minor contribution [5]. In subsequent years, the doses from radionuclides in the marine environment were estimated to be very low (less than 1 µSv/y), and they were lower than those from radionuclides in the terrestrial environment. However, this estimation did not make any allowance for the effects of remediation, and it was therefore recognized that in many cases the actual doses could be lower. Approach adopted in this assessment As noted, the focus of this assessment was to gather further information to assess radiation doses for the public using personal dosimetry data, where available. To do this, a distinction was made between external and internal radiation exposure pathways (see Fig. In the latter cases, doses need to be reconstructed by accounting for an individual’s location and movements. In the first few months following the accident, personal dosimeter results were not available for the public, and therefore an approach based on environmental measurements had to be used. Around 2 056 000 residents and visi to rs in Fukushima Prefecture from 11 March 2011 were contacted to provide information on their movements in the four months following the nuclear accident. Around 26% of the to tal population (about 532 000 people) had responded to the postal survey by 31 March 2014, but 24 response rates were higher in areas of greater radionuclide deposition. Detailed studies were carried out later focusing on people living in specific locations in Fukushima Prefecture using personal dosimeters, which also allowed the results from the two approaches to be compared. For assessing internal exposures, there are three main measurement methods for determining the intake of radionuclides to the body and hence estimating radiation doses. These are whole body counting, thyroid moni to ring (primarily for radioiodine uptake) and analysis of radionuclides in urine. In addition to these measurement methods, atmospheric dispersion simulations are also useful to construct maps of radionuclides in air for different times and locations for use when the available data are not sufficient. They are used for determining the levels of radionuclides that emit gamma radiation of sufficient energy to be measured. These counters cannot differentiate between internal and external contamination, so care must be taken to ensure that individuals are free from external contamination on the body or clothing before measurements are performed. For accidental releases of radioiodine, such as that following the Fukushima Daiichi accident, thyroid 131 moni to ring was also conducted to directly measure I content in the thyroid. Calibration fac to rs were developed to convert measured count rates to activity in the thyroid for children and adults. Fac to rs were also developed to convert the measured count rate to committed effective dose and thyroid dose equivalent for various age groups. With regard to whole body counting, it is necessary to take in to 131 account the time and route of intake. Because of the short half-life of I of eight days, it is desirable for measurements to be taken as soon as possible after intake. It is again important that individuals are free from external contamination before measurements and that suitable allowance is made for background radiation levels, which is not always straightforward. If such knowledge is not available, assumptions need to be made regarding these fac to rs. Some uncertainty arises in the dose estimate if the mode and timing of intake are not well known. As described in the following sections, a number of studies have been carried out which produced results used in this assessment. However, there are some limitations of the measurements used to estimate public exposures, including the fact that: fi Measurements were carried out by many different organizations and public bodies without a common moni to ring pro to col. In particular, there were different approaches to dealing with low doses below the limits of detection. In some cases, they were ignored, while in others they were all grouped to gether. For statistical analyses, it may be better to report the to tal doses and then the likely range in background doses for comparative purposes. These limitations reflect the fact that the majority of the measurements were carried out for screening purposes that aimed to reassure the public and not to generate data for subsequent dose assessment studies. Labora to ry measurements may also be performed to determine if radioactive material has been absorbed, ingested or inhaled. This typically involves collecting samples of urine to determine the presence of a particular radionuclide. For individuals who received higher radiation exposures in a very short period of time, blood tests such as chromosome analyses may be conducted to determine if any biological effects from exposure, such as abnormalities in chromosomes, are detected. Some chromosome analyses were performed for a number of workers considered to have received the highest doses, as described in Section 4. Any measurements of ambient dose equivalents made during the period when releases were continuing included doses from both components. Personal dosimetry of members of the public is not normal practice, and the nature of the reac to r accident and tsunami made such measurements particularly difficult. Estimates of external doses to the public have been based on a combination of modelling, particularly for the early period, and personal measurements, where such data are available. The studies that are of particular relevance for external doses are summarized in 25 Table 4. In this system, the external exposures of the residents can be calculated based on information on the movements of the residents after the accident as recorded in the survey sheets, and on the dose rate maps of days in the four months following the accident, constructed from the measured dose rates and simulation data. Information on the shielding effects of houses or buildings from the radioactive plumes and from the radionuclides on the ground was based on Ref. The background exposure before the accident was estimated based on the available data and was subtracted from the calculated external exposures. For babies or children, the smaller body sizes compared with those of adults were considered, and the conversion coefficients for effective doses were applied. To examine the range of doses, 18 evacuation scenarios for the residents were assumed by considering actual evacuation information, as described above. The estimated cumulative effective doses from external exposure for the four month period between 11 March and 11 July 2011 have been published on the Fukushima Prefecture’s web site. Ninety-five per cent of residents were estimated to have received doses of less than 2 mSv. The estimated individual effective doses from external pathways received in the first four months following the accident have been published [212] and the results for Fukushima Prefecture are shown in Fig. It can be seen that for the majority of people in Fukushima Prefecture external doses are low. A number of estimates of the individual effective doses due to external exposure in the first four months have been published [204, 210, 213, 214]. For example, in the Soso area (which includes the evacuation zone and the Deliberate Evacuation Area), these doses were below 5 mSv for 98. In Fukushima Prefecture as a whole, including the evacuation zone and the Deliberate Evacuation Area, the doses were below 3 mSv for 99. Estimated individual effective doses from external radiation for all residents of Fukushima Prefecture for the first four months following the accident [212]. These results were further analysed using a log-normal fitting process (see Section 4. This analysis to ok account of the fact that: fi Some measurements were aggregated in such a way that the datasets reflected the number of people who received a dose within specific intervals (bins).

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This common condition is often first noticed in the teen years but men and women of any age can have it medications related to the lymphatic system discount 60caps purim with visa. Sleep talking can involve complicated dialogues or monologues lanza ultimate treatment generic 60 caps purim mastercard, complete gibberish or mumbling medications like abilify cheap purim 60caps otc. Anyone can experience sleep talking medicine 750 dollars purchase purim 60 caps visa, but the condition is more common in males and children. Sleep-talkers are not typically aware of their behaviours or speech; therefore their voices and the type of language they use may sound different from their wakeful speech. Little is known about the content of the sleep talking: some talking makes no sense at all and some of it may relate to past events, experiences, and relationships that no longer have current relevance or emotional impact. Although not physically harmful, sleep talking can cause embarrassment and can annoy a bed partner, roommate, or be disruptive in group-sleeping situations. Occasional teeth grinding, medically called bruxism, does not usually cause harm, but when teeth grinding occurs on a regular basis, the teeth can be damaged and other complications can arise, such as jaw muscle discomfort or pain. Stress reduction and other lifestyle modifications, including the avoidance of alcohol and caffeine, may also be helpful. Sleep disorders, including snoring, sleep apnea, insomnia, sleep deprivation, and restless legs syndrome, are common. Whether they are caused by a health problem or by to o much stress, sleep disorders are becoming increasingly common. However, when these issues begin to occur on a regular basis and interfere with daily life, they may indicate a sleeping disorder. Depending on the type of sleep disorder, people may have a difficult time falling asleep and may feel extremely tired throughout the day. The lack of sleep can have a negative impact on energy, mood, concentration, and overall health. Insomnia Insomnia is the most common type of sleep disorder where the person has poor quality sleep, not enough sleep and wakes up for long periods during the night. It is the inability to fall or remain asleep over a period of several nights and may be due to stress, anxiety, hormonal changes, lifestyle, environmental fac to rs, physical ailments, or psychiatric illness. People with insomnia have one or more of the following symp to ms: fi Difficulty falling asleep fi Waking up often during the night and having trouble going back to sleep fi Waking up to o early in the morning fi Feeling tired upon waking There are also two types of insomnia: fi Primary insomnia: this is where the person is having sleep problems that are not directly associated with any other health condition or problem. Page 30 | Sleep: A Basic Introduction It has been suggested one in ten people suffer from some form of insomnia with the most common causes being stress, medication and other stimulants, pain, anxiety and depression. The most likely groups of sufferers are older people with ill health and shift workers, due to the constant changing of the sleep patterns. Importantly though, sleeping pills and other prescribed medication are only temporary cures and their effectiveness will decrease over time. This condition usually begins between the ages of 35 and 60 and leads to their death a few months later. Sleep apnea can be a very dangerous condition which has been linked to heart disease, high blood pressure and strokes. It is characterised by pauses in breathing or instances of shallow or infrequent breathing during sleep, commonly caused by snoring. Billy Connolly, the Scottish comedian and ac to r, is a high-profile sufferer of sleep apnea and tells some very funny s to ries about trying to cure the problem, but for people unaware they are suffering this chronic condition, the results can be tragic. It is also more prevalent in people who are either obese or overweight and smoking and alcohol consumption increase the risk of developing the condition. The person may snore very loudly and sometimes s to p breathing for short periods throughout the night. The sleeper wears a special mask over nose and mouth during sleep whilst a Page 31 | Sleep: A Basic Introduction breathing machine pumps a constant stream of air to keep the airway open. For some people, symp to ms may cause severe nightly sleep disruption that can significantly impair their quality of life. Research suggests that having extra magnesium, vitamin B, vitamin E and iron may help and eating foods such as wholegrain, nuts, seeds and pulses. Narcolepsy Narcolepsy is a chronic neurological disorder that is caused by the brain’s inability to regulate sleep wake cycles normally. Some neuroscientists think narcolepsy may be due to a deficiency in the production of a chemical called ‘hypocretin’ by the brain. Occasional snoring is usually not very serious and is mostly a nuisance for your bed partner. However, habitual snorers can be at risk for serious health problems, including obstructive sleep apnea. Snoring occurs when the flow of air through the mouth and nose is physically obstructed. Air flow can be obstructed by a combination of fac to rs, including: fi Obstructed nasal airways Some people snore only during allergy seasons or when they have a sinus infection. Deformities of the nose such as a deviated septum (a structural change in the wall that separates one nostril from the other) or nasal polyps can also cause obstruction. Sleep expert Dr Irshaad Ebrhaim testified that tests showed Lowe to be sleepwalking at the time of the attack and in 2005 Lowe was acquitted. These tests can be crucial in determining the right course of treatment for sleep disorders. There are significant ongoing health problems which can result from chronic cases and you can end up causing injury to yourself and other people. Page 34 | Sleep: A Basic Introduction Treatment for sleep disorders can vary depending on the type of problem and underlying cause. We will explore ‘sleep hygiene’ and techniques to promote better sleep in part 3 of this booklet. Now we have explored what sleep is and the subsequent sleep problems that can potentially result, we can start to look at ways to deal with some of these issues, along with some useful hints and tips to promote good sleep. When we talk about ‘sleep hygiene’ we are looking at five specific areas, all of which contribute in some way to how well, or in most cases, how poorly we sleep, and simple adjustments can improve both the quality and quantity of sleep we can achieve: 1. Alcohol near bedtime is frequently discouraged by clinicians, because, although alcohol can induce sleepiness initially, the arousal caused by metabolizing alcohol can disrupt and significantly fragment sleep. Alcohol is also a diuretic which may mean we need to go to the to ilet more during the night which disrupts our sleep and it also dehydrates the body meaning sleep becomes fragmented. Both consumption of a large meal just before bedtime, requiring effort to metabolise it all, and hunger have been associated with disrupted sleep. However, don’t go to bed hungry either as this may lead to early waking and concentration on a rumbling s to mach. It is recommended that you consume foods that are rich in the amino acid tryp to phan, such as bananas, dates, nuts, butters, tuna, turkey, yogurt and milk, as these are useful in promoting the production of the sleep hormone – mela to nin – which will subsequently aid the sleeping process. As we explored during part 1 of this booklet, light regulates the internal body clock and so bright lights before bed can trick the brain in to thinking that it is in fact daytime and so the alertness centre of our brain keeps us awake and reduces the person’s drive to sleep. It is therefore recommended that you reduce light exposure at least 30 minutes before bed. Then in a morning when you wake, it is advised to obtain at least 30 minutes of sunlight shortly after arising as this will synchronise the body clock to the new day. Eliminating a visible bedroom clock to prevent us focusing on the time passing when we are trying to fall asleep is another recommendation that is frequently made. If you are a frequent clock watcher, it is advised to either eliminate alarm clocks from the bedroom or turn the clock faces away from you so they cannot be seen. It is important to associate the bedroom with calm, relaxation and sleep and make it a haven for sleep. People who exercise experience better quality of sleep than those who do not, but exercising to o late in the day can be activating and delay falling asleep. Trying purposefully to fall asleep may induce frustration that further prevents falling asleep, so in such situations a person may be advised to get out of bed and try something else for a brief amount of time. If we have disrupted sleep routines, for whatever reasons, that prevents us from getting to sleep at the time that we are used to and as a result we experience sleep deprivation. There is also an expectation on people these days to respond immediately or people are waiting for an immediate response from someone else. Negtaive thoughts such as “I will never get enough sleep”, “I need 8 hours of sleep to function” and “I will be to o tired to perform well at work to morrow” are not useful and in no way will help you get to sleep.

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