Minding Your Health

My spouse has cancer: now what?

183:763387473 (JoAnne Epping-Jordan) — Mon, 20 Jul 2020 21:05:10 GMT

Spouses or other loved ones of people who have cancer face their own set of demands. Yet these challenges are often ignored or disregarded in the wake of the multiple stressors faced by patients themselves.

Spouses face a unique set of concerns. This can include the burden of becoming the sole breadwinner for the family, balancing their own work demands with the patient’s increased needs, dealing with the concerns of children, and coming to terms with the possibility their spouse might die and they will be alone. Often, cancer treatment can lead patients to be less interested in sex, which can cause additional stress in the relationship.

A common problem is spouses “putting on a brave face” despite these stressors. They might assume that they need to appear strong and in control for their loved one who is sick. Or, they might think that their feelings or concerns are unimportant in comparison to the person who has cancer. This can lead to impaired communication in the couple, and increasing resentment in the spouse.

The truth is that sadness, fear, and anger are a normal part of the cancer experience - for both patients and spouses. It is not necessary for spouses to ‘stay positive’ and in fact, many with cancer find it invalidating or tone-deaf when their partners respond in this way.

The key to successfully navigating cancer is to communicate openly within the couple. This involves each person allowing and making room for the other’s thoughts and feelings. And recognizing that the suffering of the person with cancer does not invalidate the suffering of the spouse.

American Cancer Society

Stanford Medicine

Stressed? It’s time to go to Vagus!

183:763387473 (JoAnne Epping-Jordan) — Mon, 06 Jul 2020 18:43:50 GMT

The power of diaphragmatic breathing and the Vagus nerve

Regular readers know that I am fascinated by “body hacks” – the term I use to describe the use of precise physical techniques to reduce stress and anxiety. These techniques harness current knowledge of human neurophysiology.

The Vagus (not Vegas) nerve is a key player in many body hacks. It is a nerve that runs between the brain and the heart, lungs, and gut. When activated by the brain, it contributes to reduced heart rate, slowed breathing, and anti-inflammatory effects. But interestingly, the Vagus nerve also contains fibers that go from the body to the brain. Certain signals from the body through the Vagus nerve further reinforce the relaxation effect.

Slow, diaphragmatic (belly) breathing is a key method for activating the Vagus nerve. And it’s particularly helpful to shift to longer exhalations compared to inhalations. Breaths don’t need to be forceful, but rather, natural and slow. This type of breathing has been taught in various religious and spiritual traditions across millennia and is now widely advocated by mental health and wellness professionals to reduce stress and anxiety. Babies and toddlers do it naturally – just watch them the next time you have a chance.

In my clinical practice, I’ve observed that many people who are chronically stressed are habitual chest breathers, meaning that they tend to take shallow and relatively short breaths. If you are a chest breather, you might encounter some difficulty breathing diaphragmatically at first. In general, it’s easiest to learn initially by lying on your back. Standing is next, followed finally by sitting. It might take some practice, but you will get there with persistence. And you don’t have to believe in it, you just have to do it.

I have listed below some resources to get you started. Although dated in visual presentation, the breathe2relax app contains great instructional information and a customizable interface. And it’s completely free of charge.

Breathe2relax app for apple

Breathe2relax app for android

Scientific background info on the Vagus nerve and diaphragmatic breathing

Hair loss due to chemotherapy: tips for coping

183:763387473 (JoAnne Epping-Jordan) — Fri, 26 Jun 2020 15:15:45 GMT

You have cancer, and you are worried about losing your hair. Rest assured, you are not alone. A recent scientific review found that hair loss was consistently rated as one of the most distressing aspects of cancer treatment. Health-care providers, who are focused on treating the cancer itself, often underestimate the psychological impacts. Patients can be left feeling that they are being silly for worrying about something as trivial as their appearance.

There is nothing silly or strange about dreading hair loss. Our hair is a key aspect of our identity and the way we communicate that self-concept to the world. A glance at someone’s hairstyle helps us understand whether that person is classical or edgy, carefree or meticulous, young or old, healthy or sick.

We tend to associate a full head of hair with youth, health, and vibrancy. It’s perhaps not surprising then that people who lose their hair – for any reason – are often concerned about their attractiveness. People who lose their hair due to chemotherapy share those concerns and in addition, feel freakish or the center of attention if appearing in public without some sort of coverage. “I don’t want people to pity me,” is another comment I hear frequently about why people elect to wear hair pieces, wigs, or scarves. Even just looking in the mirror is a continual reminder of the cancer.

Hair loss due to chemotherapy isn’t limited to the scalp. Depending on the specific medications used, chemotherapy also can result in losing your eyebrows, eyelashes, and pubic hair. Hair loss in these body areas can be more devastating to people than simply losing the scalp hair.

So what can you do? The good news is that you get to decide the response that suits your personality and priorities. In my career, I have seen a wide range of responses: from labor-intensive cold caps (or scalp cooling) to minimize hair loss, head shaving in advance of/or at first signs of hair falling out, use of wigs, hats and/or scarves, and my personal favorite: rocking baldness with bad-ass earrings and a moto jacket. (Don’t forget sunscreen if you opt to go au naturel.) Eyebrows and eyelashes can be approximated with pencils and falsies – or not. It’s really up to you. The point is that you can – and should - continue to claim and express your identity even as you lose your hair.

In time, your hair will start growing again. It might not look the same as before. For most people, this is temporary, and their usual color and texture return in time. This period is another opportunity to express yourself or maybe try something new. Some people decide that they like wearing their hair short, and they continue with this style even though they had long hair in the past. Others experiment with fun colors like pink, blue, or green while their hair is in the early grow-out stages. Once again, there is no right or wrong – it’s your body, and it’s your choice.

American Cancer Society

Mayo Clinic

The virus doesn't care how you feel

183:763387473 (JoAnne Epping-Jordan) — Thu, 18 Jun 2020 23:42:29 GMT

We’ve recently passed the three-month mark for mandated closures related to COVID-19 in Washington State. My last day in the office was March 12th. I remember a sense of being in a bad disaster movie as I hastily packed my things that day in anticipation of working from home. Fear permeated my body. The following weeks were a surreal blur as I tried to get my head around what was happening in my city and around the world. During this period, I often found myself thinking about my personal safety and wondering whether I was going to get through this crisis. But like most people, I soon adapted.

Instacart groceries, Zoom get togethers, and face masks started to seem normal. My heightened feelings of fear lessened. I was – and still am – terrified of getting COVID-19, but it was not a preoccupation the way it had been in early days. And three months into this new world, a different feeling has emerged: fatigue.

I am a homebody, so staying at home has been easier for me than for many others. Nonetheless, even I have limits. I find myself growing increasingly tired of the monotony. A heaviness under the weight of numerous societal stressors has contributed to this weariness.

A friend described this psychological phenomenon as fear vs. fatigue. At first, fear was the dominant feeling for many of us, and so our natural urges involved avoiding others and preparing for the worst (hence the national run on toilet paper). Over time, our fear has been steadily replaced by fatigue, boredom, and monotony. The dominant urge is now to leave our homes, socialize, and resume fun and adventure.

But here is the problem: SARS-CoV-2 (the coronavirus) doesn’t care how we feel. It also doesn’t care about our economic difficulties, growing family strife under lockdown, political views on mask wearing, or reasons for protesting in the streets. It just does what it does: infect, replicate, and spread. And infect, replicate, and spread. And infect, replicate, and spread.

We must continue to take precautions as the economy reopens. If not for ourselves, then for society at large and those whom we love. More than 455,000 people have already been killed by SARS-CoV-2. Countless more have survived but are suffering longer-term effects such as blood clots, ongoing lung insufficiency, and exhaustion. Let’s not add to these numbers through needlessly taking risks in response to our boredom and restlessness.

Surviving 2020

Sat, 13 Jun 2020 22:25:32 GMT

As we approach the mid-point of 2020, I wonder what else might happen in this already calamitous year. Who would have thought as we rang in 2020 that it would bring a global pandemic, the end of our day-to-day lives as we knew them, massive unemployment, countless lives lost and many more disabled from COVID-19 complications, American culture wars and political dysfunction, unthinkable brutality and abuse of power captured for the world to see, and now protests around the world against systemic racism and police violence. I am exhausted just thinking about all of it.

It’s no wonder that stress and anxiety are at record levels. But it’s not just that … many people are also feeling depressed and hopeless.

No doubt you have already been flooded with self-help tips for coping with the stress of everything. In my view, taking care of your body is fundamental to everything else you might try. That means regular physical activity, healthy food choices, and sufficient sleep (at least 7-8 hours for most people). My next major piece of advice is to keep a regular schedule. Set regular bedtimes and get out of bed at around the same time every day. If you are working from home, create designated workspaces and dress for the workday as though you were still going into the office.

Beyond this, it is helpful to find ways to incorporate relaxation, social connection, and moments of fun and lightness into your routine. And although the world might be turned upside down, flowers are still blooming, baby birds are hatching and fledging, and sunrises and sunsets are as beautiful as ever. Seek opportunities to ground yourself into the rhythms of nature that remain unchanged.

New guidelines on how to prevent dementia

Tue, 14 May 2019 22:10:38 GMT

In a nutshell: exercise more, eat better

The World Health Organization (WHO) has just released guidelines that recommend specific things people should do to reduce their risk of cognitive decline and dementia. Foremost among their recommendations: getting regular exercise. Other actions that will reduce risk: not smoking, avoiding harmful use of alcohol, and eating a healthy diet. A Mediterranean diet in particular (eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts, some fish and poultry, little red meat, and lots of olive oil) has the strongest evidence for its association with reduced risk of dementia.

Also of interest were the things that did not make the grade - or in other words, that lacked sufficient scientific evidence to support a role in dementia prevention. Chief among these: brain games or other cognitive training apps. Although heavily-marketed to the boomer generation, the evidence that brain training staves off cognitive decline is, "Very low to low," according to WHO. The guidelines also found insufficient evidence to support the use of dietary supplements such as such as B vitamins, antioxidants, omega-3 and ginkgo.

The take home messages of these guidelines are clear: if you want to protect your cognitive function as you age, stop wasting your time (and money) playing brain games, and engage in regular physical exercise instead. In addition, pay attention to what you are consuming, with an emphasis on a Mediterranean diet, limited alcohol use, and no smoking.

WHO press release
WHO guidelines

Workism: our new religion?

Fri, 08 Mar 2019 01:28:25 GMT

I cannot stop thinking about Derek’s Thompson latest feature in The Atlantic. Entitled Workism is Making Americans Miserable , Thompson posits that segments of our modern culture are being overtaken by a potent new trend. Increasingly, college-educated elite are valuing their work as the centerpiece of their identities and life purpose. Beyond being seen as a source of income, Americans are turning to their work as the main source of what makes their lived meaningful. They worship at the altars of their desks, seeking transcendence through their career accomplishments.

Thompson notes that while our average workweek is declining overall, rich, college-educated people work more than they did decades ago. This defies all historical norms, he writes. Throughout the ages, people worked because they had to. Those that had financial security (for example, the landed gentry) did not work, but rather spent their days in leisurely pursuits. For many of today’s rich, there is no thing as ‘leisure.’ Amassing more and more wealth and status is the closest thing they have to a hobby or a passion.

When is enough enough? Never, if your religion is workism. Your money, status, accolades and accomplishments might sate you for a time, but soon enough you will be seeking anew. It’s like a running a marathon that does not have a finish line.

Have a read of this thought-provoking article , and then consider you own views. To what extent do you believe that your identity, your value, or your purpose are inextricably linked to your work? And, what would happen if you made your career less central to how you define yourself? What anxieties or old scripts arise? What might you gain from making this change? It’s an interesting thought experiment, if nothing else.

Why 80% of New Year's resolutions have already failed

Mon, 11 Feb 2019 18:03:41 GMT

It’s February. How are you doing with the New Year’s resolutions you made this year? Despite our good intentions, most of us (around 8 in 10) will have already abandoned whatever we resolved to do differently in the New Year.

Why do we fail? In a nutshell, it's because we don't have a real plan. Most of us do not define what we really want to accomplish in clear, measurable terms. On top of this, most of us don't know how we will get there. We haven't thought about how we will deal with challenges or barriers to meeting our goals, or on the other hand, how we can reorganize things in our lives to make it easier to keep our resolutions.

Fear not: help is available. One of the best sources for clear, concise guidance is a book written by my colleagues, Sheri Pruitt and Josh Klapow. Living SMART: Five Essential Skills to Change Your Health Habits Forever is focused on health behavior like losing weight, or stopping smoking. But its core recommendations can be applied to any type of resolution that involves changing what you do on a daily basis.

Living SMART uses the acronym S-M-A-R-T to describe the skills needed for success. I have taken the liberty of summarizing each of the skills below.

Setting a goal involves translating a general health goal to a target behavior. For example, “I need to relax” could be translated into “I will practice relaxation exercises for 10 minutes, three times per day, and five days per week.” One key aspect of goal setting, according to this approach, is to start with a target that is small and achievable, and then build slowly on success.

Monitoring progress is perhaps the most overlooked component of success. Self-monitoring, using a simple chart, can be used to track virtually anything you do, including exercising, eating, spending money, etc. Research has shown that self-monitoring has an impact, in and of itself, on the target action. Watching progress visually on a chart becomes a type of reward in itself.

Arranging the environment for success means modifying the home or work environment to encourage new habits that you want to cultivate, and/or to discourage old habits that you want to decrease or eliminate altogether. For example, if you want to stop drinking sodas, remove these drinks from the home refrigerator and storage pantries. Or alternatively, if you want to walk more frequently, place walking shoes at the front door as a reminder. The possibilities for arranging the environment are almost endless and require simply thinking about ways in which your desired actions can be prompted while undesired actions can be made more difficult.

Recruiting a support team involves seeking the positive influence of family, friends, and others to help meet your goals. Identify buddies or peers, meaning people who who want to achieve similar goals, to provide camaraderie along the way. Supporters, meaning people who are not necessarily making changes themselves but who agree to support your efforts, also can be helpful.

Treating oneself involves setting rewards for meeting your desired goals. Rewards should be decided in advance, and should occur frequently at the beginning. They don’t need to be large or expensive - bubble baths or watching a favorite show are examples of small treats that can be used. Over time, feelings of accomplishment and satisfaction often become rewarding in themselves.

This is a quick summary only. Sheri and Josh's book goes into much greater detail about each of these skills and how to apply them. I encourage you to read it in order to learn more about these concepts.

The research is clear: if you want to keep your resolution, you need a real plan. Your plan must define your target behavior in clear terms, include how you will change your surroundings to encourage your resolution, involve the support of others, allow you to self-monitor your progress, and reward your actions along the way.

Getting what you want from your doctor’s visit

183:763387473 (JoAnne Epping-Jordan) — Mon, 24 Dec 2018 01:28:56 GMT

Today I am writing about how to communicate effectively with your doctor* (*which could mean your physician, nurse practitioner, or anyone else you are seeing for medical advice and help).

Too many patients and too little time

Today’s doctors are in a big hurry. In many cases, doctors are contractually bound to limit the amount of time they spend with each patient (typically ranging from 10 to 15 minutes) for the purpose of meeting total caseload quotas. Doctors who do not see the number of contractually stipulated patients can be penalized financially or in other ways. Although this system has been criticized heavily from all sides (not least of all, by the doctors themselves), it is the reality under which many health care providers are now seeing patients.

Get clear in your own mind

If you have only 10-15 minutes with your doctor, you need to be thoughtful and organized about your time. You also need to realize that it is as much—or arguably more—your job, as opposed to your doctor’s job, to ensure that you get what you need from your appointment.

You must plan in advance. First, define what you really want from the appointment. If you are seeing your doctor for a rash, for example, you might want to know whether it’s contagious; or alternatively, you might want a prescription to stop the itching; or maybe you really just want piece of mind that it’s not bed bugs from your recent trip to Paris. The point is: get clear in your own mind what will make the appointment a ‘success’ for you.

Write it down

It never fails to amaze me how often smart, capable people fail to go to their doctor with a written list of issues and questions. (They also fail to bring pen and paper or any type of a recording device, to take note of what is discussed and recommended. But that is a different topic.) With a written list, you will be less likely to become distracted and more likely to get what you want from the appointment.

Communicate succinctly and effectively

Once you are clear about why you are at the doctor’s office, communicate your goals clearly and repeatedly, before and during your appointment. The essential formula is: “I am here for X issue or problem, and I would like your help via Y action.” Tell the medical assistant or nurse who brings you into the exam room, and repeat it to the doctor. If you plan in advance, it should take you no more than 10 seconds to communicate this information.

For example: “I am here today about this rash. I would like to know if it’s contagious.” Or, “I have been more short of breath lately, and I’d like the doctor to go over my medications and see if there is anything else that can be done to address my asthma.” Practice in advance.

Dealing with multiple issues in one visit

If you have multiple issues you want to address within a single appointment, you might consider starting by saying something like, “I have four things on my list to discuss with you. I am not sure you will have time for all of them. The things I want to cover, in my personal order of priority, are a) a new rash on my chest, b) my ongoing knee pain, c) my ongoing neck pain, and d) new shortness of breath since yesterday.”

Be realistic

You must be realistic about what can be covered within the allotted time. If you don’t know how much time is available for your appointment, ask in advance or while there. Prioritize your list and if necessary, schedule a follow-up appointment to deal with topics that could not be covered fully.

In some cases, your priorities will not match the priorities of your doctor. For example, it is highly likely that any doctor hearing the list outlined in the scenario above would deal first and foremost with your new shortness of breath. That’s because shortness of breath is potentially a life-threatening condition and might indicate a major medical event in progress, such as a heart attack or a blood clot. In situations like these, you need to trust that your doctor is using his/her expertise to reprioritize your list for your overall health.

Finally, it is important to understand that competent doctors practice within the scope of evidence-based medicine, even if that means denying you something you think you want. Good-quality doctors, for example, will not prescribe an advanced imaging test for acute, uncomplicated low back pain, nor will they prescribe an antibiotic for a presumably viral infection. They should, however, explain to you the reasons why this is the case.

***

In summary, getting what you want from your doctor’s visit is up to you. Plan in advance, write it down, and communicate clearly.

Resources

Before Your Appointment: Questions Are the Answer. Agency for Healthcare Research and Quality. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/questions-before-appointment.html

How Can You Get the Most Out of Your Doctor's Appointment? Center for Advancing Health. http://www.cfah.org/prepared-patient/communicate-with-your-doctors/getting-the-most-out-of-doctors-appointment

Minding your pain

183:763387473 (JoAnne Epping-Jordan) — Mon, 17 Dec 2018 20:20:21 GMT

Pain is an inevitable part of the human condition. And for many of us, pain becomes chronic at various points in our lives.

When pain is chronic, we often create an inner dialogue about what we are experiencing. “I am so out of shape, it’s no wonder I threw out my back.” “Maybe something is really wrong that the doctors have missed.” “I don’t know how much more of this pain I can take.”

Emotions also are often overlaid onto pain. Sadness, fear, and my specialty, anger, are common responses.

So pain becomes more than pain. It turns into the sensory experience plus the running inner dialogue plus the negative emotions. No wonder we find it so exhausting!

What is the solution? In the words of Jon Kabat-Zinn, founder of the Mindfulness Based Stress Reduction program, you need to “put out the welcome mat” for your pain. Not because you’re masochistic, but because your pain is already there. You might not like your pain, but learning to accept its presence (because it’s already there) is the first step in disentangling your sensory experience from all the negative thoughts and emotions.

Try this. The next time you have pain, find a quiet place to sit or lie for a few minutes. Take a few breaths to center yourself and quiet your mind. Next, turn your attention to the area of your body where you are experiencing the pain. As objectively as possible, observe the pain you are experiencing. First, try to identify its precise location. Where exactly in your body do you feel the pain? Zoom your attention to its center. Next, try to identify its borders. Where does the boundary lie between pain and no pain? Does this boundary change with time?

After you have located your pain, turn your attention to its qualities. Is it dull or sharp? Steady or throbbing? Do its qualities change over time? Go inside your pain. Observe it moment by moment, staying non-judgmental all the while. Think of yourself as a scientist or an explorer of the inner world of your pain.

Stay with your pain for a few minutes more, observing its location and qualities as they unfold over time. You will probably find that your pain is not static, but rather dynamic, transforming in character and intensity even within the few minutes of this exercise.

According to Jon Kabat-Zinn, if you move into pure awareness in the midst of pain, even for the tiniest moment, your relationship with your pain is going to shift right in that very moment. By seeing the pain for what it really is, stripped of the negative thoughts and feelings that usually accompany it, it becomes immediately more manageable, more livable. The sensory experience of pain might still be present, but the suffering is diminished. Directing conscious attention towards softening and releasing the area of pain (even by the tiniest fraction) in these moments often brings additional benefits.

Some people resist trying this exercise. The notion of paying attention to the very thing that causes them so much suffering seems overwhelming at first. This response is understandable: humans have a natural tendency to push away from their pain. This exercise, in contrast, calls for the exact opposite response. It invites people to get close to your pain, indeed, to inhabit their pain and recognize it for its true nature in that moment.

What does the evidence say? A recent study found that participants in a single session of a mindfulness-based body scan reported less pain related distress and less interference of pain on social relations, compared with matched controls who did not participate. A different systematic review of the effects of Mindfulness Based Stress Reduction interventions on chronic low back pain revealed similar and interesting results. Pain intensity did not decrease consistently as a result of the interventions, but pain acceptance did. My reading of this evidence is that exercises similar to that described above do not necessarily reduce pain, but they do help people suffer less. In the words of the Dalai Lama, "Pain is inevitable, suffering is optional."

Pain: Our BFF

183:763387473 (JoAnne Epping-Jordan) — Sun, 09 Dec 2018 20:24:01 GMT

Amidst the rush of this holiday season, let's all pause for a moment, reflect on the many positive aspects of our lives, and give thanks for our special Best Friend Forever (BFF): pain.

Pain is a wonderful adaptation that helps human survival. It tells us - in an intense and immediate way - that we are doing something that is harmful and that we had better STOP right now if we know what's good for us. Think of the feeling of touching a hot stove, or over stretching our muscles. ain also tells us when something is wrong inside our bodies, like appendicitis. People who cannot feel pain because of genetic disorders or neurological damage lead dangerous lives. They have been reported to suffer from bitten tongues, scaldings, and serious infections without knowing it.

The main problem for most of us is when our pain becomes chronic. At that point, we have received the message loudly and clearly that something is wrong: we don't need additional pain to understand the warning. We might have sought medical advice and undergone physical exams, MRIs, and other tests to pinpoint the source. And, our doctors might have told us that while they understand what is causing our pain, there is nothing that they can do to treat the underlying problem.

Sound familiar? You are not alone. According to the American Academy of Pain Medicine, chronic pain affects more Americans than diabetes, heart disease, and cancer combined. More than 1.5 billion suffer from chronic pain worldwide. Many will live with varying levels of daily pain for the rest of their lives.

While it isn't always possible to treat the underlying problems, there are many proven methods for managing pain itself. Upcoming blog posts will examine some promising strategies.

In the meantime, the next time you have pain, stop and ask yourself what else you are thinking and feeling, in addition to the pain itself. Perhaps you will detect frustration, sadness, or vulnerability.

Anger is my 'go to' emotion when I experience pain. I get mad that I have the problem in the first place, that I cannot do the physical things I want to do, and that there is next to nothing I can do to change the situation. Of course, my anger does nothing to help the situation. In fact, it just makes the pain worse.

Paying attention to your internal chatter about your pain is an important first step towards managing it better. Eventually, you can learn how to separate pain sensations from all the thoughts and other feelings that tend to go along with it. This technique, too, will be examined in greater detail in future blog posts.

Getting a good night's sleep

183:763387473 (JoAnne Epping-Jordan) — Thu, 06 Dec 2018 22:04:33 GMT

In a recent blog post, I wrote about the importance of sleep. I touched on some of the compelling evidence about its effects on mood, concentration, and a range of physical conditions. I also wrote about the tendency for people to tell themselves that they can get by with six or fewer hours of sleep. According to sleep researchers, the vast majority of these people are kidding themselves. Their caffeine dependence, afternoon sleepiness, difficulty staying focused and marathon sleep catch-up sessions reveal the truth about their true sleep needs.

I hope that my last post convinced you to take sleep seriously. Today, I provide some tips for getting a good night’s sleep.

Cut out caffeine 10 hours before bedtime. When you enjoy a cup of coffee or other caffeinated drink, it takes about five to seven hours to eliminate half the caffeine from your body. After eight to 10 hours, around 75% of the caffeine is gone. For most people, a cup of coffee or two in the morning won't interfere with sleep at night. But a mid-afternoon pick-me-up is a different story.
Limit alcohol. A drink before bedtime might help you fall asleep, but it will disrupt your sleep in the middle of the night. You might find yourself lying awake at 2AM, wondering what you did to deserve this sleeplessness. Chances are likely that your nightcap was at least partly to blame.
Exercise during the day. Regular aerobic exercise leads to better sleep quality, researchers have found. But be careful about exercising too late in the day. Some (but not all) people find evening exercise makes it difficult to get to sleep.
Create an evening ritual for relaxing before bedtime. My ritual involves drinking herbal tea. Other people listen to music or take a bath. Find a way to involve your senses in the process of relaxing, whether it be taste (tea), hearing (music), touch (a hot bath) or something else.
Go to bed at the same time each night and get up at the same time each morning. This teaches your body a predictable rhythm for sleeping and waking. It is important to keep to the same schedule even if you didn’t get a good night’s sleep. Oversleeping or daytime napping to compensate for insomnia the night before only fuels the problem.
Make your bedroom a relaxing and comfortable place. Do not bring work into the bed with you.

This is only a partial list. If you have recurrent insomnia, you probably will need to take additional measures. I list a few resources below.

Sleep well!

Additional resources on getting a good night's sleep:

National Sleep Foundation - What to know about insomnia

Stanford Hospital and Clinics - Cognitive behavioral therapy for insomnia

Yoga: what's behind the craze?

183:763387473 (JoAnne Epping-Jordan) — Mon, 03 Dec 2018 00:04:05 GMT

These days, it seems like everyone is doing yoga. Classes can be found just about everywhere: gyms, workplaces, neighborhood community centers, and nursing homes. Anyone with an Internet connection can access hundreds of free, full-length yoga classes via YouTube or iTunes.

What is behind this craze? In reality, yoga is far from a trend: yoga originated in India and has been practiced in different forms for thousands of years. That being said, it is true that yoga has has gained tremendous popularity in the USA and other Western countries over the past 10 to 20 years.

In the United States today, 'yoga' typically refers to some form of hatha yoga, which uses physical poses, or asanas, combined with breathing techniques meditation to achieve better health. Subtypes of hatha yoga that you might see advertised include Bikram, Baptiste, and Vinyasa yoga, to name but a few. All are variations of the hatha approach.

Anyone who has regularly practiced yoga can attest to its positive impact on muscle strength, flexibility and balance. According to the National Institutes for Health, current research also suggests that yoga reduces certain types of pain, improves quality of life; reduces stress; lowers heart rate and blood pressure; and helps relieve anxiety, depression, and insomnia.

Ready to get started? If you a beginner, try to find an instructor (as opposed to watching a video or reading a book). A qualified yoga teacher will teach you proper alignment and correct your positioning as needed. He or she also will teach you modifications for different poses if you have physical limitations or if you are at risk for an injury. Once you learn the basics, you can practice on your own (although many elect to continue with a teacher for at least some of their practices).

Anyone can practice yoga - regardless of age or level of physical disability. But pay attention to how you feel during your practices and never push beyond your edge. A key principle of yoga is to notice and respect your limitations. If you follow these suggestions, you will most likely find that you want to continue yoga because you it helps you feel so great.

Sleep: the often-forgotten health booster

183:763387473 (JoAnne Epping-Jordan) — Sat, 01 Dec 2018 20:36:27 GMT

In the course of my career, I have encountered many people who have an impeccably-healthy diet and who exercise daily, yet at the same time routinely deprive themselves of a complete night's sleep. In fact, it is not uncommon to hear colleagues bragging about how little sleep they have obtained in the past week due to a pressing work deadline or other seemingly-important priority. And, in our modern world it is literally possible for people to work through the night, night after night.

In our culture, many people believe that acknowledging any sort of natural limitation, such as needing eight hours of sleep per night, is a sign of weakness. Making the general statement that humans have these kinds of inherent limitations, or even worse, admitting that you have these limitations, is sacrilege in certain business and social circles. "When the going gets tough, the tough get going," or so the saying goes. In other words, you must be prepared to sleep less and work harder on demand. But for many people, "on demand" never ends.

The irony of this situation is that when people attempt to defy their natural limits by working longer and harder, they deprive themselves of exactly what they need to think clearly and perform well. They end up working longer, but not smarter. As a result, their performance frequently suffers. Common effects are poor concentration, depressed mood, and decreased ability to perform automatic, skill-based tasks.

Sleep deprivation also has many negative health effects. Hormonal and metabolic functioning is disrupted, leading to obesity, high blood pressure, heart problems, and diabetes. Total sleep deprivation is almost always fatal, and people who sleep less than 6 hours per night die at younger ages than those who sleep 6 to 8 hours per night.

People vary in how much sleep they need. According to the National Sleep Foundation, adults typically need somewhere between 7 and 9 hours of sleep per night. Nevertheless, it's important to pay attention to your own individual needs by assessing how you feel on different amounts of sleep.

There is no way to sugar coat the following fact: devoting more time to sleep results in less time for other activities. But the clear advantage to making this change is that, with adequate sleep, you can expect to be more efficient and productive during the time that you are awake. You will be able to accomplish more in less time, and make fewer mistakes.

Convinced? Future blog posts will provide research-based tips for getting a good night's sleep.

Additional resources on sleep:

National Sleep Foundation

Centers for Disease Control and Prevention