What is Parkinson’s Disease?
PARKINSON’S DISEASE: It is a brain disorder due to a decrease in the chemical (Dopamine) usually occurs around 60 years but few can have early onset that is before the age of 50. Symptoms Parkinson’s disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Parkinson’s signs and symptoms may include: Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may rub your thumb and forefinger back and forth, known as a pill-rolling tremor. Your hand may tremble when it’s at rest. Slowed movement (bradykinesia). Over time, Parkinson’s disease may slow your movement, making simple tasks difficult and time-consuming. Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion. Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease. Loss of automatic movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. Speech changes. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than have the usual inflections. Writing changes. It may become hard to write, and your writing may appear small. Causes In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. The cause of Parkinson’s disease is unknown, but several factors appear to play a role, including: Genes. Researchers have identified specific genetic mutations that can cause Parkinson’s disease. But these are uncommon except in rare cases with many family members affected by Parkinson’s disease.However, certain gene variations appear to increase the risk of Parkinson’s disease but with a relatively small risk of Parkinson’s disease for each of these genetic markers. Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small. Risk factors Risk factors for Parkinson’s disease include: Age. Young adults rarely experience Parkinson’s disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older. Heredity. Having a close relative with Parkinson’s disease increases the chances that you’ll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson’s disease. Sex. Men are more likely to develop Parkinson’s disease than are women. Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson’s disease. Complications Parkinson’s disease is often accompanied by these additional problems, which may be treatable: Thinking difficulties. You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson’s disease. Such cognitive problems aren’t very responsive to medications. Depression and emotional changes. You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson’s disease.You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms. Swallowing problems. You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling. Chewing and eating problems. Late-stage Parkinson’s disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition. Sleep problems and sleep disorders. People with Parkinson’s disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems. You may also experience: Blood pressure changes. You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure (orthostatic hypotension). Smell dysfunction. You may experience problems with your sense of smell. You may have difficulty identifying certain odors or the difference between odors. Fatigue. Many people with Parkinson’s disease lose energy and experience fatigue, especially later in the day. The cause isn’t always known. Pain. Some people with Parkinson’s disease experience pain, either in specific areas of their bodies or throughout their bodies. Treatment: Numerous medications are available that can relief symptoms. Role of physical occupational speech therapy is very important. Surgery can be done in a few cases when decided by the specialist. When to see a doctor See your doctor if you have any of the symptoms associated with Parkinson’s disease — not only to diagnose your condition but also to rule out other causes for your symptoms. Reference-Mayo Clinic To seek help or know more about sleep and anxiety, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270
Responsibilities & Skills for a Receptionist at Pvt. Clinic
Who is the receptionist? The receptionist is a very important staff of the center, in the face of the center/point of first contact. She/he takes care of the whole reception and helps to provide all relevant information to patients or callers. What characteristics should have in receptionists? There are some general & few specific ones. Following characteristics should have: Should be pleasant, calm, and polite. Should be punctual & organisational abilities. Should be familiar with use of the computer, internet and additional software for prescription / billing. Should have adequate knowledge of all the procedures conducted at the clinic. Should have good communication skills. Should have be able to make quick decisions. What are the role and responsibilities? Greetings to patients and make them comfortable. Attend all calls and queries, messages and emails of the patients and callers. Help them to book an appointment, fill up. After consultation or test provide the prescription / reports / bills etc. Payment collection. Help them to understand about next visit for follow up consultation and other services. To inform them how they can contact if they want to reach us, (phone, messages, email etc.) Maintain patients records. Manage stock / supplies required in clinic (water, glasses, tea, coffee, brochures, stationery stock etc.) Summary: A receptionist’s role is very important to enable the smooth, efficient working of the clinic. It requires a high degree of multi-tasking ability. There should be continuous training / upskilling of the staff to ensure well organized functioning. To seek help or know more about sleep and neurological related problems you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270
Measures One Can do to Maintain “Good Brain Health” By Dr.Manvir Bhatia & Ananya
The brain is a vital part of the human body. It is the center that controls and coordinates all the thoughts, memory, emotions, and functions of the body. Keeping it functioning well and protecting it from neurological disorders is important. Health was defined by WHO in the year 1948 as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. To attain this, brain health should be the main priority of people. A healthy brain is defined as the state in which an individual is capable of realizing his own abilities to cope with situations in life and is able to optimize their cognitive, emotional, psychological, and behavioral functioning accordingly. Nowadays, this term is expanding further and includes concepts of neural development, plasticity, functioning, and recovery throughout life. Research published in BMC Public Health in 2018(Velten et al.), suggested that healthy lifestyle choices such as regular physical exercise, good diet, social interactions, etc. contributed to the improvement of mental health. The following measures should be taken to take care of brain health: Regular physical activity: Multiple research suggests the importance of exercise for our brain. Physical activity in any form such as walking to work, taking the stairs, engaging in sports, brisk walking, strength training, aerobic training, etc. is helpful in keeping our brain in shape. A study performed by Coelho et al, published in 2012 concluded that moderate-intensity physical exercises effectively increase the levels of brain-derived neurotrophic factor(BDNF), which is a protein involved in the maintenance and growth of neurons in the brain of the elderly. A 4 months-long study by Colcombe et al. compared the effect of aerobic and non-aerobic exercises on the brain. It suggested a significant increase in the amount of gray and white matter in the brain regions which suffer from age-related damage with respect to structure and cognition in elders who underwent aerobic exercise training. Sufficient sleep: A good quality sleep of 7 to 8 hours is essential for maintaining good brain health for adults and it maintains the attention-based and executive functions of the brain. According to the AARP Sleep and Brain Health Survey conducted in 2016, 44% of adults 50 years of age or older rated their quality of sleep as extremely good or very good; 84% said they were mostly well-rested in the morning, but only 33% reported being very satisfied with the amount of sleep they got daily. Factors affecting normal sleep : The shift in normal sleep pattern Insufficient exposure to sunlight Medication for the treatment of chronic diseases Diet A diet containing the following food items is recommended to enhance brain health: Vegetables – especially green, yellow and orange vegetables decrease risk of disease occurrence. Fruits Plant proteins Whole grains Fish Poultry Legumes Low sodium intake Low-fat and non-fat dairy products Polyunsaturated fatty acids(like omega 3 fatty acids) – Docosahexaenoic acid (DHA) is the most prevalent in the brain. This omega 3 fatty acid plays a role in maintaining plasticity of the neuronal membrane. Fish, walnuts, olives, canola, flaxseed, soybeans and sunflower seeds are a good source of PUFA. Caffeine and cocoa flavonoids – these contain antioxidants, which have a positive impact on brain health. Tea and coffee immediately increase mind alertness and dark chocolate is well known for cognitive enhancement. Such a healthy diet reduces the risk of neurodegeneration, increases cognitive functioning, decreases hypertension and the risk of cardiovascular diseases. Food items that one should avoid: Red meat Refined grains Sweets Trans-unsaturated fatty acids – It is mainly found in processed, fried and baked foods. Trans fats increase the levels of low density lipoprotein(LDL) and decrease levels of high density lipoproteins(HDL), thereby increasing the risk of heart disease, stroke, and type two diabetes. All these conditions affect brain health adversely. Tobacco Alcohol Mental activity: Our brain is a muscle. Hence, regular exercise is important for it to be healthy. Cognitively stimulating activities such as mind-teaser games(sudoku, puzzles), educational activities(learning a new language, a new instrument), intellectual inquiries, and mental challenges are very helpful. They mentally engage an individual and prompt them to think and process information. This helps in preserving the cognitive reserves and tends to decrease the incidence of age-related disorders of the brain. Social involvement: Human beings are social beings. Positive interaction with people and surroundings is good nutrition for our brain. In a study published in Cerebrum(2011) by Michelle C Carlson, known as The Experienced Corps Trial, the elderly population was engaged in local schools to promote purpose-driven involvement. The participants exhibited immediate short-term gains in the brain regions that are vulnerable to aging. Strong social bonds are great for boosting mental health. Loneliness is the gap between the level of social engagement a person actually has and the level that he wants. It may lead to mental and social disorders. There are various ways to tackle it, for example, meeting more people, investing in human-animal relationships (keeping pets, volunteering for animals, etc.), taking up a hobby that demands interaction with many people, etc. Emotional stability: Stress, especially for a prolonged period, leads to an increase in the levels of cortisol. This hormone has a long-term negative effect on the brain and might cause inflammation which gives rise to reactive oxygen species(ROS), thereby damaging neurons. Regular meditation(even for 5-10 minutes) helps us to deal with anxiety, depression, fatigue, stress, and inflammation, making us emotionally strong and stable. Digital detox: Keeping all electronic devices away 30-60 minutes before going to sleep is a good way to maintain a good quality of sleep and brain health. Take care of your overall health: Our brain and body are dependent on each other. Maintaining good physical health is important for a healthy brain. The following need to be taken care of: Cardiovascular system – Conditions like high blood pressure, cholesterol, increased heart rate, etc. are extremely stressful for our brain and tend to increase the risk of dementia, Alzheimer’s etc. Blood sugar – Diabetes and high blood sugar(without diabetes) make an individual susceptible to dementia. Therefore, it
Fatigue affects our Physical, Cognitive, and Emotional Conditions
All of us have a good idea of how those days feel when we want to do nothing. The laziness that seeps in makes us feel unenergetic and we often say, “I don’t know why I am feeling so tired today”. Experiencing this once in a while is normal, but if this becomes a regular thing, it might require more attention. In layman’s terms, fatigue is a well-known feeling of overall tiredness and lack of energy. It is used to describe a decrease in physical activity and the real or perceived difficulty in performing a task. There isn’t a single mechanism or factor that can induce or increase stress. It is a complex mechanism and involves abnormalities of the CNS, PNS dysfunction, or any skeletal muscle disease. Fatigue affects our physical, cognitive, and emotional condition. It also negatively impacts our work, relationships, and social behavior. There is a close relationship between physical and mental stress but, there are different pathophysiological mechanisms causing the same. Mental fatigue is a state of reduced mental alertness. It impairs one’s performance at work. It mostly occurs as a result of working on a cognitively demanding task for a long period of time. Physical fatigue is the decrease in the efficiency of the skeletal muscles. It occurs due to a variety of underlying conditions such as metabolic disorders, neuroendocrine dysfunction, etc. Classification of fatigue: Secondary fatigue – it may be caused by an underlying medication that may last for about a month or longer. It generally lasts for less than six months. Physiologic fatigue – it is due to the imbalance in the daily routines of exercise, sleep, diet, etc., and not due to some underlying medical condition. Chronic fatigue – it is a very severe form of fatigue and lasts for more than six months. It is not relieved by stress. It severely deteriorates the quality of life and the rate of recovery is only around 5%. Causes of fatigue: Stress: stress and fatigue are deeply correlated. A very high relation has been observed between fatigue, tension and lack of joy. Low socioeconomic status and poor self-perceived overall health are the two major causes of stress, causing fatigue. Depression – Mental fatigue is mostly the outcome of partially treated depression. Medications used in the treatment of depression also induce fatigue. Sleep: Sleep is an extremely important part of life. Incomplete or poor-quality sleep makes the brain tired, negatively affecting our health and concentration. Getting a good quality sleep of 7 to 8 hours regularly is necessary. A person suffering from sleep apnea gets disturbed sleep and might always feel tired. Neurological disorders: There are neurological disorders like Parkinson’s, multiple sclerosis, myasthenia gravis, traumatic brain injury, etc., that are associated with fatigue. Around 83% of patients with multiple sclerosis experience fatigue as one of the most common symptoms. Damage of brain structures and lesions in the CNS in the case of MS causes fatigue. Diet: A healthy balanced diet helps us maintain overall good health. Eating too little or too much deep-fried junk food makes us sluggish and irritable. Fatigue can also be caused by dehydration and excessive caffeine intake. Sometimes an individual might be unaware of mild allergies we have from a certain food. Having those food items can make us feel very tired. Medications: Medication classes that are commonly associated with fatigue, although sometimes only in the first week or two of use, include sedative-hypnotics, antidepressants, muscle relaxants, opioids, antihypertensives, antihistamines, and many types of antibiotics. Anemia: This is one of the main causes of fatigue in women. Red blood cells are important because they carry oxygen to tissues and cells, thereby providing us with energy via complex cellular mechanisms. Loss of RBCs during the menstrual blood flow often leads to iron deficiency, putting women at a higher risk. Anemia due to GI tract bleeding is also a cause. Thyroid: People suffering from hypothyroidism tend to be very sluggish and inactive due to a decrease in basal metabolism. In the case of hyperthyroidism, the basal metabolism speeds up. This overactivity causes fatigue. Diabetes: Diabetes is the abnormal levels of sugar in the blood. This high level remains in the blood as it does not enter the cells to be further converted into energy. It may persist even after the normal glycemic levels have been achieved. Hidden UTI: Burning pain and a sensation of urgency are the common symptoms of UTI. But, the symptoms might not always be the same. In some cases, fatigue might be the only symptom. Cardiovascular diseases: Sometimes people experience a sudden flash of fatigue while performing regular activities. This may be an indication of the fact that our heart is not functioning efficiently. Fatigue often is the first clinical manifestation of any sort of cardiovascular disease. Diagnosis of fatigue: As mentioned earlier, there isn’t a single cause of fatigue. It is a multidimensional and nonspecific condition. Therefore, an individual with complaints of tiredness needs to be diagnosed with fatigue with the help of a questionnaire. This actually helps a physician to differentiate between sleepiness and fatigue. Once fatigue is confirmed, it becomes important to screen for unhealthy lifestyle choices, underlying health conditions, and the mental state of the person. In case of unexplained fatigue, laboratory tests such as complete blood count, thyroid, pregnancy, HIV, etc. should be conducted. Management: Medications that might be the cause of fatigue must be replaced or discontinued if possible. In case of any diseases associated with anaemia, the haemoglobin level of the patient must be maintained at least at 10g/L. Regular moderate aerobic exercise(e.g. 30 minutes of brisk walking, yoga etc.) is very helpful for improvement. Psychostimulants are helpful for short term management of fatigue. Adequate sleep, good sleep hygiene, increase in engagement in various activities in the daytime, increasing exposure to sunlight, taking a bath within two hours of sleep etc. are some steps that should be taken to reduce physiological stress. Conclusion: Fatigue is a very common symptom in our lives.
Brain Fog Symptoms
Those foggy mornings, when we really cannot see anything clearly while walking or driving, are a real nuisance. We lack clarity of vision and it becomes really difficult to keep going ahead. A similar condition occurs in the case of brain fog. A person feels cloudy-headed. It may happen due to overworking, stress, excessive exposure to blue light, or some other underlying medical condition. It becomes extremely frustrating after a point and It is characterized by confusion, forgetfulness, lack of mental clarity, and lack of focus. High levels of inflammation and hormonal disturbance are responsible at the cellular level. It can also lead to other comorbidities such as diabetes, obesity, abnormal menstruation, etc. Symptoms of brain fog include: It becomes extremely difficult for an individual to focus on a particular thought or idea. An individual is unable to recall things. Falling asleep becomes a challenge. A person tends to suffer from insomnia. Headaches and mood swings become extremely common. A lack of motivation makes one feel less energetic. Causes of brain fog: Stress: It has the capability of increasing blood pressure, weakening our immune system, increasing anxiety, and triggering depression. It makes the brain exhausted, making it difficult for us to focus. Medication: Intake of some medications might make us foggy. These include anticholinergics, antihistamine treatment for the management of allergies, etc. Chemotherapy and drugs used during cancer treatment are extremely strong and affect a person’s ability to think, focus and multitask. This effect is generally short-lived, but sometimes it continues for a very long time. Depression: Depression causes a loss of energy and motivation. People tend to become less enthusiastic. This affects our brain such that it causes fog. Lack of sleep: Some people experience this(brain fog) occasionally if they haven’t slept well. A regular, good quality sleep of 7-9 hours is optimal for us. Long-term sleep deprivation also negatively impacts our thinking capability. Chronic inflammatory diseases – Includes conditions like rheumatoid arthritis, multiple sclerosis(MS), and Sjogren’s syndrome. Inflammation in any part of the body, in general, tends to affect the brain. It decreases the volume of grey matter in the inferior parietal lobe. Such patients tend to suffer from chronic pain, fatigue, and anxiety, which distracts them and affects their ability to think and focus well. The medications used in the treatment of these conditions are also responsible for the same. Multiple sclerosis adversely damages the central nervous system. Therefore, it raises the condition of brain fog as there are issues with memory, planning, language, and attention. Hormonal changes: A balanced level of hormones is important for us to think clearly and be efficient. A few conditions that result in hormonal changes are listed below: Pregnancy – During pregnancy, the levels of estrogen and progesterone increase. This is the time when women are overwhelmed, and sensitive and find it difficult to focus and control their emotions. Menopause – A decrease in the levels of estrogen adversely affects concentration levels. At this stage of life, women find it very hard to learn new things and remember them. Thyroid – hypothyroidism adversely affects many organs of the body, including the brain. It affects our ability to concentrate, think and perform. COVID-19 infection – It can cause inflammation in the brain, which adversely affects the ability of the neurons to communicate with each other, thereby causing brain fog. Indirectly, the anxiety and pandemic caused by the pandemic has also contributed to this condition. Chronic fatigue syndrome – We suffer from this when both our body and brain are tired for a very long period of time. One is unable to think properly and focus. It is also common in the case of a variety of health conditions such as neuroimmune diseases, fibromyalgia, autism spectrum disorders, Alzheimer’s disease, etc. Disorders of mast cell activation are majorly responsible. Ways to reduce brain fog: Enough sleep: Sleep serves as a drainage system for our body to remove toxins that may be involved in the feeling of brain fog. Following a fixed sleep routine, practicing good sleep hygiene, and avoiding electronic devices at least two hours before sleep is helpful in getting quality sleep. Regular exercise: Exercise makes us tired. This helps us sleep well and then be fresh and active. Good quality diet: Food rich in vitamins, especially B12 can be very helpful to fight brain fog. Also, intake of food that we are mildly allergic to shall be avoided. Prolonged hunger and dehydration should be avoided at all costs. Avoiding multitasking: Our brain gets extremely tired when we try to multitask. It drains our energy and lowers our efficiency. Mental breaks – Our mind is a machine that needs some rest after strenuous work. These breaks should be such that one thinks about nothing. Keeping our eyes closed for some time, going out for a walk, and indulging in relaxing hobbies are a few ideal ways. Meditation is also a great way to relax our minds. Efforts to focus attention – Nowadays, people are constantly distracted all the time by various things. This makes them quite restless, as anything concrete does not seem to get done. We should consciously try to focus our attention on a single task no matter how small it is and try to complete it. Try new things – Our brain needs new interests on a regular basis to stay stimulated. Reading a new genre of a book every month, taking a different route to work, trying to cook something new, etc., are a few activities where our brain stimulates itself to think. Brain fog has the general symptom of confusion and tiredness. It can be extremely frustrating If this continues for a long time, immediate measures should be taken to deal with it. Seeking out therapy and making appropriate lifestyle changes can be extremely effective to alleviate this condition. References: Callan, C., Ladds, E., Husain, L., Pattinson, K., & Greenhalgh, T. (2022). ‘I can’t cope with multiple inputs’: a qualitative study of the lived experience of ‘brain fog’ after COVID-19. BMJ Open, 12(2), e056366.
World Sleep Day
We feel fresh and energetic after a good sleep. To celebrate such good sleep, World Sleep Day is celebrated annually. Addressing the problems related to sleep is also a purpose of this day. It has been organized by the World Sleep Day Committee of the World Sleep Society since 2008. It is celebrated on Friday each year before Spring Vernal Equinox. This year, it falls on the 18th of March and the theme for it is Quality Sleep, Sound Mind, and Happy World. History: This initiative was first taken by dedicated healthcare professionals – Liborio Parrino, MD, Associate Professor of Neurology at Parma University, Italy, and Antonio Culebras, MD, Professor of Neurology, Upstate Medical University, and Consultant, The Sleep Center, Community General Hospital, Syracuse, New York, USA. The main goal of the first World Sleep Day was to discuss and promote the importance of sleep across the globe. We, at Sleep Medicine Institute, a division of Neurology and Sleep Centre, New Delhi, have been organizing programs regarding awareness about the importance of good sleep, sleep hygiene, etc. for the past 15 years. Benefits of good sleep: Just like breathing, eating, and drinking, sleep is a compulsory and essential part of our life. It is the time when our body shreds away all its exhaustion and re-energizes itself. Sleep helps in repairing our heart and blood vessels. Sleep deficiency for a long period of time makes an individual vulnerable to heart, kidney, and liver diseases. It also reduces the risk of obesity in all age groups. It keeps a balanced level of hormones in our body: Food hormones: Ghrelin makes us feel hungry and leptin makes us feel full. In the case of sleep deprivation, the levels of ghrelin go up and that of leptin goes down. This makes us feel hungry more than usual, increasing the risk of obesity. Insulin: This hormone regulates the blood sugar levels in our body. Less sleep might interfere with its action and high blood sugar levels have been reported. This increases the risk of diabetes. Sleep supports normal growth and development. This is the reason why infants require around 12 to 16 hours of sleep on a regular basis. It boosts our immune system, helping us to fight against infections. It is vital for learning and remembering information. It enhances our learning, decision-making, and problem-solving ability. Sleep is necessary for keeping our emotions under control and staying mentally healthy. Sleep deficiency is linked to depression, suicidal tendency, etc. Sleep deficient kids and teenagers often have problems getting along with others. They might become aggressive, depressed, lack motivation, and are not very attentive. Good quality of sleep helps us to be efficient(at work and school) and safe. Driver sleepiness significantly contributes to road accidents. Ways to get good quality and quantity of sleep: Physical exercise – Regular physical exercise such as brisk walking, cardio workouts, yoga, etc. not only helps us stay fit but also sleep well at night. Exercising, especially in the morning, helps maintain our circadian rhythm. Sticking to a single sleep time – going to sleep every day at the same time adjusts our body clock such that we automatically start feeling sleepy at that time. Fixing the sleep hours becomes very important and sleeping for the same duration every day makes us feel less tired. This helps us avoid daytime sleep. Diet – Eating a limited quantity of food at least two hours before bedtime is a good measure towards good sleep. A hungry or an overfull stomach makes us feel uneasy, and it becomes very difficult to fall asleep. Avoiding acidic food at night is also helpful. Avoid stimulants – Caffeine and nicotine are stimulants and their effect takes hours to wear off. Hence, coffee, chocolates, and tea are to be avoided before going to bed. Surprisingly, alcohol also has the same effect. It makes one feel drowsy for some time but disrupts late night sleep. Celebration of World Sleep Day at Neurology and Sleep Centre, New Delhi. Addressing worries and stress – Taking efforts to address our worries before bedtime helps us to relax and sleep well. Planning our day and getting most of our work done on or before time saves us from stress. A piling up to do list makes us anxious, which kicks in the fight or flight hormone. This hormone works against sleep. Restful environment – A cool, dark and quiet place works well. Too many lights make it difficult to fall asleep. Keeping an ambience of our bedroom such that it induces sleep is a good step. One should avoid looking at television or phone before going to bed. If a person is unable to fall asleep, relaxing activities like reading a book, listening to soothing music, meditation etc. are helpful. Sleep ritual – As kids, most of us had the habit of falling asleep while listening to a story or lullaby. Similarly, creating a ritual, which stimulates sleep for example, taking a shower before bed, drinking a glass of warm milk, etc. can improve our quality of sleep. Professional help – If the above measures do not bring good results, seeking professional medical help is a good choice. Underlying conditions like sleep apnea, restless leg syndrome etc. should be addressed and the medications should be taken carefully and regularly. Self participation: Educate people around you about the benefits of good sleep. Organize a small event where people can interact and talk about their sleep habits and exchange ideas about sleep hygiene and promote this idea. Coordinate with healthcare professionals to promote the idea of good sleep. References: https://worldsleepday.org/ https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379
Sleep Apnea Course
By Dr. Manvir Bhatia and Garima Sharma Ignorance isn’t always bliss. 22 March 2022, 4 min 16sec read As we have been breaking down many myths and beliefs by the valuable advancement in science, we should learn better about the basic necessity of our body – SLEEP- the first thing people compromise on for the daytime work. Worst case scenario, they take it as a waste of time and want to sleep the least to function for extra hours. The importance of good quality and quantity of sleep needs to be understood better. There are many myths about sleep but what we are discussing here is the one that can impact health severely. Myth: Snoring is a sign of deep and sound sleep. Fact: Snoring isn’t good for anyone as it is caused by an obstruction in the airway during sleep as the muscles relax that keeps vibrating the soft tissues in your mouth, nose, and throat causing loud noises and even disruption of sleep. Definition: Snoring can be often associated with a sleep-related disorder that is SLEEP APNEA which is defined as repeated cessation of breathing for 10 or more seconds with or without significant de-saturation during sleep. Sleep apnea can be obstructive or central or mixed, obstructive sleep apnea (OSA) being the most common one About 80 percent to 90 percent of adults with OSA remain undiagnosed. What is OSA? Repeated blockage of the upper airway by the collapse of the soft tissue of throat and tongue, causing complete or partial cessation of breathing for 10 or more seconds (even for a minute or more at a time) with or without de-saturation is called obstructive sleep apnea.[i] If this occurs more than 15 to 30 times per hour it is severe and needs to be paid attention to. HOW DO WE RECOGNISE OBSTRUCTIVE SLEEP APNEA? Often OSA is recognized by those at home who observe you sleeping. OSA can have night and day time symptoms: Nighttime symptoms: Loud snoring, choking/gasping during sleep, sudden breath pauses related arousals, dry mouth, and headache. Daytime symptoms: waking up with headaches, excessive daytime sleepiness, irritability, mood swings, memory loss, short temper, anxiety, and eventually depression. WHY DO WE NEED TO TREAT IT? In addition to short term effects of OSA like excessive daytime sleepiness, headaches, mood swings, anxiety, irritation, etc. other long term consequences of OSA are: High blood pressure Heart disease Stroke Pre-diabetes and diabetes Depression ARE YOU AT RISK OF HAVING OSA? [ii] Risk factors that contribute to high chances of OSA: Overweight (Body Mass Index of 25 to 29.9) and obese (Body Mass Index of 30 and above) Neck circumference 17 inches (40cm) or more for men, 16 inches (35cm) or more for women. Habits like alcohol and smoking. Middle-aged and older men and post-menopausal women People with abnormalities of the bony and soft tissue structure of the head and neck Adults and children with Down Syndrome Children with large tonsils and adenoids Anyone who has a family member with OSA People with endocrine disorders such as Acromegaly and Hypothyroidism A person suffering from nocturnal nasal congestion due to abnormal morphology, rhinitis, or both. DIAGNOSTIC TESTS OF OSA? People who snore and have excessive daytime somnolence should undergo the diagnostic tests of OSA. Level 1 In-laboratory, technologists attended polysomnography. (Gold-standard). It records brain waves (EEG), the oxygen level in your blood, heart rate, and breathing, as well as eye and leg movements during the study. It can also be used to diagnose periodic limb movement disorder, narcolepsy, chronic insomnia, and REM sleep behavior disorder. Level 2 Full polysomnography is done at the comfort of your home. Level 3 Portable monitoring with three or more channels, including pulse oximetry, heart rate, asses airflow, and thoracoabdominal movements. Used for screening in patients at high risk of OSA. The AHI is the number of times you have apnea or hypopnea during one night, divided by the hours of sleep. Normal sleep: An AHI of fewer than 5 events, on average, per hour Mild sleep apnea: An AHI of 5 to 14 events per hour Moderate sleep apnea: An AHI of 15 to 29 events per hour Severe sleep apnea: An AHI of 30 or more events per hour HOW DO WE MANAGE OSA? Mild OSA can be managed with weight management, diet control, avoiding supine position, avoiding personal habits like smoking and alcohol, and some oropharyngeal exercises. Moderate and severe OSA can be managed with PAP THERAPY which is the positive airway pressure that is given by a device and delivered to the patient using a nasal or oro-nasal mask. This air pressure keeps the airway open during sleep thus improving sleep quality, and normalizing the apnea-hypopnea index (AHI) and oxyhemoglobin saturation levels. Along with PAP therapy, diet control, weight management, and lifestyle changes are also recommended. CONCLUSION To conclude we can say that sleep is as essential as food and exercise to our body. If we get the proper quantity and quality of sleep, we can work efficiently even during the day and enhance productivity. The most prevalent, and majorly unrecognized, the underdiagnosed sleep-related disorder is Obstructive sleep apnea which often occurs with repetitive snoring, choking, or gasping during the night followed by morning headaches, excessive daytime sleepiness, and severe mood swings like irritation, memory problems, and anxiety. Obesity and male gender are at high risk of having OSA. If left untreated, OSA can lead to heart diseases, high blood pressure, diabetes, stroke, and depression. To diagnose it level 1 to level 3 of overnight sleep study can be done at our center. PAP therapy is the gold standard therapy that is recommended along with behavioral and lifestyle changes to manage the signs and symptoms of OSA. To seek help or know more about your sleep apnea, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA) Or give a call on +91-11-46070321, +91-9643500270 Book your sleep study today.[iii] [i] Slowik and Collen, “Obstructive Sleep Apnea.” [ii] “Osa Aasm – Google Search.” [iii] “Best Neurologist in Delhi
How to Increase Deep Sleep?
What is Sleep? Sleep is a state of physical rest but dynamic activity. This state is controlled by neurotransmitters released by neurons of different groups of nerve cells in the brain. These cells produce neurotransmitters such as serotonin and norepinephrine that keep us active and awake. There are neurons in the brain stem that connect the brain to the spinal cord. It is the activity of these neurons that allow us to fall asleep. They switch off the signaling of the neurotransmitters that keep us awake. There is also a build-up of adenosine while we are awake, causing drowsiness. When we sleep, adenosine breaks down, revitalizing our brain and body. Stages of Sleep: Stage 1: This is a state of extremely light sleep. A person can be awoken very easily and tends to remember the dreams at this stage. Our muscle activity starts to slow down and our eyes move very slowly. Stage 2: This is a state in which the brain waves start slowing down. Eye movements stop and there are occasional bursts of rapid waves called sleep spindles. Stage 3 and 4: Brain waves are extremely slow during stage three and delta waves appear interspersed with smaller and faster waves. Delta waves occur almost exclusively during the fourth wave. It is very difficult to wake someone up during stages 3 and 4 of sleep. There is absolutely no eye movement and muscle activity. If awakened, a person is very confused and groggy. It takes some time to adjust to the surroundings. Some children might experience night terrors, sleepwalking, and bedwetting during deep sleep. REM sleep: Our breathing gets rapid, shallow, and irregular. Our blood pressure and heart rate rise. Eyes have jerky movements and the limbs are temporarily paralyzed for a short period of time. It occurs around 40 to 90 minutes after we fall asleep. On average, it is 90-110 minutes long. Initially, our sleep cycles have short REM and long durations of deep sleep. As morning approaches, we are mostly in the 1st, 2nd, and REM stages of sleep. Deep sleep refers to slow-wave sleep i.e. third and fourth stages of sleep. Our heart rate and breathing are the lowest at this stage. Our brain waves tend to slow down and our muscles and eyes relax. It is during this phase that the body restores itself by repairing our tissues and strengthening our immune system. Deep sleep is essential for us as it is the factor that decides whether we will wake up fresh and energetic. Ways to increase deep sleep: Slow waves play a very important role in deep sleep. Hence, strategies to improve sleep efficacy have been targeted to improve the potential of the slow-wave activity. Clinical investigations have reported tiagabine and gaboxadol to increase slow-wave sleep by enhancing GABAergic transmission. Dependence and tolerance are common issues that one faces in this respect. Non-pharmacological methods have been used to deal with these limitations. Stimulating the brain: This is done with the help of an electric current and magnetic field. According to a study by Marshall et al.,(2006, Nature) application of intermittent transcranial direct-current stimulation (tDCS) at 0.75 Hz for 5-min intervals separated by a 1-min off period after the onset of slow-wave sleep (SWS) increases EEG power. This increase was associated with sleep-associated memory acquisition. A study by Miassimi et al., (2007) demonstrated that perturbing the cortex with the use of transcranial magnetic stimulation (TMS) during NREM sleep can trigger SWS. Sensory stimulation : A study by Cordero et al., 1986(American journal of perinatology) demonstrated that the time spent in sleep increased in infants when subject to vestibular stimulation. A similar study was conducted on healthy adults by Krystal et al.,(Journal of clinical sleep medicine, 2010). It showed that the duration of sleep onset decreased with bilateral electrical stimulation of their vestibular apparatus as compared to sham nights. Acoustic stimulation significantly enhances slow-wave sleep. If there is intermittent stimulation with gaps of 15 seconds, remarkably large and numerous slow waves were observed. Regular exercise: A good amount of exercise that tires us out and makes us sweat is a really useful step towards getting good quality deep sleep. Exercising about 150 minutes a week enhances one’s sleep quality. Inculcating yoga in our life improves sleep quality. Practicing meditation along with yoga and exercise has a positive influence on our life and Healthy diet: A healthy diet is a prerequisite to a good quality duality sleep. Greater intake of fiber results in an increase in the duration of deep sleep. Stimulants such as caffeine should be strictly avoided before going to sleep. There should be a gap of seven hours between intake of caffeine and a good night’s sleep. Alcohol works as a sedative, but consuming it before going to sleep adversely affects the sleep quality. Once the sedative effect wears off, we are wide awake and unable to sleep further. Experiencing this regularly has deleterious effects in the long run. Use of eye masks: Light greatly influences our quality of sleep. If one is exposed to light (due to work timings) at night, she should keep an eye mask ready to grab quality sleep. Hence, we conclude that getting a good night’s sleep refers mainly to enough deep sleep. If we wake up tired and unenergetic regularly, we should consult a professional as soon as possible. Also, living a disciplined life regularly, and following an appropriate timetable irrespective of work and other important commitments shall be helpful in the long run. References: Marshall, L., Helgadóttir, H., Mölle, M., & Born, J. (2006). Boosting slow oscillations during sleep potentiates memory. Nature, 444(7119), 610–613. https://doi.org/10.1038/nature05278 Massimini, M., Ferrarelli, F., Esser, S. K., Riedner, B. A., Huber, R., Murphy, M., Peterson, M. J., & Tononi, G. (2007). Triggering sleep slow waves by transcranial magnetic stimulation. Proceedings of the National Academy of Sciences of the United States of America, 104(20), 8496–8501. https://doi.org/10.1073/pnas.0702495104 Bellesi, M., Riedner, B. A., Garcia-Molina, G. N., Cirelli, C., & Tononi, G. (2014). Enhancement of sleep slow waves: underlying mechanisms and practical consequences. Frontiers in
Sleep, Mental Health, and Happiness
Mental health, happiness, and sleep are closely intertwined and have a complex relationship. Sleep deprivation in general makes us feel irritated and exhausted in the short term, but in the long term, it might lead to severe physical and mental health consequences. It might also cause severe psychiatric disorders such as anxiety, depression, and bipolar disorder. In the same way, living with a mental health condition can negatively impact our sleep. Happiness is a psychological state in which a person feels a sense of gratification and pleasure with regard to both simple and important things in life. This comes from various activities like social interactions, pursuing a hobby, accomplishing decided targets in life, and most importantly, good quality of sleep. An average individual spends one-third of her time sleeping. Keeping this in mind, a lot of effort has been put into the study of the relationship between sleep and happiness. Happiness is reflected by positive behavior such as gratitude, altruism, and appreciation. It helps us fight negative feelings such as fear and anger by positively impacting our physical, mental, and social state. Lack of sleep makes us irritated and cranky. We tend to always have the feeling of wanting to sleep more and avoid interactions. Thus, our behavior in the sleep-deprived state varies significantly from when we are well-rested. The amygdala in the brain is our emotional center. It is responsible for responses of fight and flight, stress, fear, and anger. When an individual is well-rested, her amygdala is controlled and kept in check by the prefrontal cortex. This helps us to process our feelings in a better way and provide a well-balanced, appropriate response in any situation. If a person is not well-rested, this control is lost, affecting our response. The amygdala becomes 60% more reactive and the risk of mood swings increases. A sleepy brain is five times more prone to depression and twenty times more prone to anxiety disorders. According to a study on Japanese adolescents published in Sleep Medicine(May 2020) by Otsuka et al., a linear relationship was observed between sleep problems and their subjective happiness scores. The following psychological conditions can be detrimental to sleep: Stress – When a person is sleep-deprived, it becomes extremely difficult to deal with even minor levels of stress. This makes us extremely sensitive and irritated. Petty things become a major source of frustration. Depression – This is a mood disorder marked by the overwhelming feeling of sadness and helplessness. Lack of sleep can cause depression. It also has the potential to exacerbate the symptoms of depression via a negative feedback loop. Poor sleep worsens depression which further interrupts sleep. If early insomnia is treated well, it reduces the risk of depression. Hence, we conclude that sleep deprivation and depression are mutually reinforcing. Anxiety – Anxiety disorders cause us to worry excessively. It includes social anxiety disorder, phobias, post-traumatic stress disorder(PTSD), obsessive-compulsive disorder(OCD), panic disorder, etc. This affects our everyday life and increases the risk of various physical and mental health problems. Worry and fear take us to the state of hyperarousal which makes our mind alert, leading to insomnia. People suffering from PTSD tend to replay negative events in their minds and suffer from nightmares. Hence, their mind is always alert and unable to rest. Poor sleep and insomnia significantly contribute to anxiety. Bipolar disorder – This is a condition during which a person experiences extreme moods. There are two phases of it – high(mania) and lows(depression). The feelings and symptoms of a person may differ according to the phases they are experiencing. During the manic episodes, they do not feel the need to sleep but in the case of the depressive ones, a person tends to sleep excessively. This major shift in sleep often continues for a person in between episodes. Sleep problems tend to induce and worsen the occurrence of high and low episodes. Schizophrenia – This condition makes it difficult for a person to differentiate between what is real and unreal. They have a higher chance of experiencing sleep-related disorders and disturbed circadian rhythm. Medications used to treat schizophrenia also contribute to sleep problems. ADHD – It is a neurodevelopmental disorder. Its symptoms include reduced attention span and increased impulsiveness. It is usually diagnosed in children. Sleeping problems are relatively common in these patients. They have difficulty in falling asleep, frequent awakenings, and excessive daytime sleepiness. Some also have severe conditions like obstructive sleep apnea, restless leg syndrome, etc. ADHD and sleep have a bidirectional relationship. Good quality sleep is essential for neurodevelopment. It ensures a healthy and well-functioning brain. It also maintains brain plasticity and prevents the loss of brain tissue. When awake, it ensures our safety while performing various activities such as driving. A good quality sleep of at least 8 hours enables us to handle our workload efficiently. We happen to balance our personal and professional life well. It helps us to be very patient and communicate well with our kids and spouse. We tend to be more energetic and tend to exercise more and put in more efforts towards a healthy and active lifestyle. Ways to take care of mental health and sleep: Simple exercises like walking, yoga, regular sports, etc., for at least half an hour per day, are helpful in getting a good night’s sleep. It is also good for relieving stress. A healthy diet is essential for a well-functioning mind. Our gut and brain are closely wound and eating healthy, good quality and quantity of food are helpful in maintaining our mental health. Eating greasy and junk food adversely affects our sleep quality in the long run. Following a fixed sleep routine every day makes us sleepy every day at the same time. This enables us to get a good night’s sleep so that we are fresh and efficient the next day. Practicing gratitude is a habit that helps us restore mental peace. It instills positivity in us such that we are capable of dealing with all situations in life and being happy. Picking up a
How to Manage Back Pain?
Our backbone is a very important part of our body. It maintains our posture. The vertebrate is made up of 24 bones sitting one on top of the other with discs in between each of them except the tail bones. These bones are supported by muscles and ligaments. The spinal cord connects the base of the skull to the rest of the body. The spinal cord passes through the vertebrae. It acts as a protective structure for the spinal cord. There are facet joints placed on either side of the spine. Back Pain is a very common ailment. About 8 out of 10 people suffer from back pain at some point in their life due to various reasons such as any form of strenuous work, getting back to an old sport, or some underlying health condition such as arthritis or spondylitis. Types of back pain: Acute – It develops suddenly and lasts for less than six weeks. Subacute – It lasts for around three to four months. Chronic – It develops over a period of time and lasts for more than three months limiting our normal lifestyle. Causes of back pain: Mechanical causes: Muscle strain and ligament sprain are very common causes of acute back pain. Excessive strain, weight lifting, unsupervised training, etc can cause a strain on the muscles and ligaments resulting in back pain. Strenuous work or exercise: Being fit and exercising regularly strengthens our spinal and stomach muscles. Strenuous exercise or work e.g. lifting heavy objects suddenly, after a prolonged period of inactive lifestyle affects the back causing severe pain. Structural causes: These include ruptured or bulging discs present between each vertebra. Sciatica is a result of a bulged or herniated disc that causes pain to shoot and travel through the buttocks and downwards from the back of the leg. Arthritis, abnormal curvature of the spine(e.g.scoliosis), osteoporosis and kidney problems are also responsible for back pain. Ankylosing spondylitis: This is an inflammatory condition in which the joints of the spine swell up. This causes excessive pain, especially during the morning. There is stiffness which improves with movement. Age: As we age, the bones and discs of the back become very weak. Hence, the incidence of back pain is very common after the age of 45. Medical ailments such as cancer of the spine, Cauda Equina Syndrome, fibromyalgia, infections, sleep disorders, etc. are common causes that can cause or exacerbate back pain. Diagnosis of back pain: The consultation of a doctor becomes extremely important in managing back pain. Depending upon his examination, a tentative cause is identified and investigations suggested accordingly, such as diagnostic tests, which will help in reaching the root cause of the pain. A few of them have been listed below: X-ray: It gives a clear idea of the alignment of bones, broken bones, and arthritis. MRI or CT scans: The generated images reveal herniated discs, and problems with bones, muscles, tissues, etc. Blood tests : This helps in detecting underlying deficiencies, and infections that might be the cause of the back pain. Bone scan: This is used very rarely, but identifies the tumors or bone compressions caused due to osteoporosis. Nerve tests: measure the electrical impulses produced by the nerve cells and the response of the muscles. It can confirm nerve compression in case of herniated discs and spinal stenosis (narrowing of the spinal cord). Treatment of back pain: Medication – Pain killers are used. Non-steroidal anti-inflammatory drugs such as ibuprofen and narcotics such as codeine, hydrocodone, etc. are prescribed for a short period of time. If these medications do not work, cortisone, an anti-inflammatory drug is injected into the epidural space. This provides relief by reducing the inflammation around the nerve endings. Exercise – There are exercises that need to be under the guidance of trained professionals. Making a chart of exercises that may be relevant to a particular body type and the underlying problems in presence of a trained instructor is very effective. Manual therapy – It includes treatments where the trained therapist uses hands to massage and apply pressure to muscles, bones, and joints present along the spine. It is known to work wonders if supplemented with exercise. Nerve treatment – Needles are inserted into the nerves connected to the affected nerves. Radio waves are sent through the needles to these nerves. This heat prevents them from sending pain signals. A local anesthetic is used to numb the back before performing the procedure. The associated risk of bleeding, bruising, and accidental nerve damage should be discussed with the Surgeon beforehand. Transcutaneous electrical nerve stimulation (TENS) – This is popular among patients with chronic back pain. A machine provides electrical signals to the body through electrodes placed on the skin. It is non-invasive and cost-effective. The body releases endorphins that reduce pain signaling. Spinal fusion surgery – This is recommended only if our bones are significantly damaged. It fuses two vertebrates to strengthen the bones. It stops the damaged vertebrates from squeezing the nerves thereby reducing the pain. Self-management of back pain: Staying active: It was earlier believed that rest tends to relieve back pain. Now individual suffering from back pain should remain active in performing their regular activities and also find time to exercise regularly. Stretching and back exercises are of great help. Hot and cold packs: Heat works well to relieve back pain for some people. Therefore, placing a hot water bottle on the affected area is very helpful. Cold packs are also effective for the short term. Alternating between hot and cold packs works very well. Relaxing and staying positive: It is important that one stays positive irrespective of their condition. Believing that proper treatment and care shall be helpful. Relaxing helps relieve pain and muscle tension. Hence, we conclude that our back being such an important part of the body deserves our utmost care. We should exercise regularly to keep our backbone strong and in good condition. Eating good food, getting a good night’s sleep, etc. are measures that we need to inculcate in our life. Also,