Sleep like a baby

Having trouble getting restful sleep at night? Dr. N. Ramakrishnan writes about overcoming this problem.

SHAJU JOHN

Most people take sleep for granted and fail to observe some simple and healthy habits that help get a restful sleep. Our health and ability to succeed depend on how we meet our body’s need for rest and quality sleep.

There can be a wide variation in the amount of sleep required for individuals. Most of us require an average of 6-8 hours. The following are some common sleep hygiene measures.

Regular bedtime

Although this may not always be practical, remember that your body likes regular routines. This may not be very exciting but it is comfortable. So pick a reasonable and regular time to go to bed each night and stick to it.

Even if you don’t think you are tired when the time comes, your body will appreciate it. After a while, when it feels it can rely on the routine, it will repay the favour by letting you go to sleep when you want. On the same lines, get up at the same time every day, even on weekends and holidays.

Once you’re awake, get up. Don’t lie in bed thinking about getting up.Keep your sleep environment comfortable

Keep the bedroom quiet and as dark as possible when you’re sleeping. Make sure you sleep in a well-ventilated room. Fresh air and optimal room temperature are the best sleeping conditions. Sleep on a good firm bed that will give the body the support it needs.

Identify bed with sleep

Do not work, read, watch television or work out crossword puzzles while lying in bed. If you can’t sleep, get out of bed. Don’t lie awake trying to get sleep any longer than 30 minutes. If you can’t sleep in 30 minutes, get out of bed. Do something quiet and non-stimulating. When you feel tired, go back to bed.

Avoid stimulants

Preferably avoid coffee, alcohol and tobacco completely. If not at least four to five hours before bedtime. If you are used to them for a long time, it is not wise to stop them abruptly as withdrawal symptoms can disrupt your sleep pattern. Discuss it with your doctor and withdraw them slowly.

Sleeping full stomach

It’s a healthy habit to have dinner at least two to three hours before bedtime. This will ensure that you don’t have a full stomach when you sleep and also prevent acid reflux (heartburn).

Be active during the day.

Get some physical exercise on a regular basis, preferably in the morning. Regular exercise improves restful sleep. This includes walking, stretching and aerobic exercise.

People who work more with their minds have far more trouble with insomnia than people who do physical work. It’s best to avoid daytime naps. If you’re really having trouble sleeping at night - and you’re not a senior citizen who sleeps for small periods of time - skip naps.

You’ll be more tired at bedtime and be able to fall asleep. Do not exercise just before going to bed, as it can be detrimental to your sleep.

Relaxation techniques

Only you will know what is relaxing to your body and mind. Some common relaxation techniques that have proven to be beneficial are warm baths, massage, yoga, listening to music and meditation.

Decide what works best for you. Take a warm bath a few hours before bedtime.It’s a great way to relax the body. But don’t overdo it. You want to relax not exhaust your body. Play some soft soothing music that will lull you to sleep.

If after trying these measures, you still have problems like insomnia, non-refreshing sleep, daytime fatigue or significant snoring, consult a doctor and get appropriate treatment.

The most common cause of insomnia is a change in your daily routine. For example, travelling, change in work hours, disruption of other behaviours (eating, exercise, leisure).

Sleep pattern disruption may also be a result of tension, stress and anxiety or be a symptom of other physical disorders.Of course, the more anxious we get about our insomnia, the worse it gets.

Problem for boys

What is Hypospadias? What are the problems it causes? Dr. Ramesh Babu Srinivasan explains.

Baby boys pass urine like a fountain. Small boys can pass urine straight.

The urine comes out from the tip of the penis. In boys with hypospadias, the opening is on the under surface of penis and so the urine is directed down towards their feet.

Hypospadias occurs in one in 300 baby boys. The following features point to it:

* Urine coming from the under side of the penis

* Penis being slightly bent downwards

* Excess foreskin on the top of the penis

When hypospadias is left uncorrected, it can cause problems. Unlike the normal boys who can stand and pass urine, these children have to sit. If they stand, it goes down the leg.

As adults, their chances of having children are much lower, as they can’t deposit the sperm normally. Sometimes the urinary opening is small, leading to blockage in urine stream leaving them at a risk of urinary infection.

In general, hypospadiac children do not have other kidney abnormalities.

However, in 10 per cent of these kids, the testis may not be descended normally. When both testes have not come down normally, they can have associated hormone defects.

When the first child or the father has hypospadias, there is a slightly higher chance (7-10 per cent) for the siblings to have the same birth defect.

>From six months onwards, hypospadias can be corrected by an operation. By operating before two years, these children can be toilet trained like any other child.

It is also essential for boys to appear like others when they go to school, to grow without emotional problems. Most cases are mild and require a single stage operation. When the opening is too far down from the tip, it might require a two-stage operation.

The operation is usually done under general anaesthesia and a catheter/dressing is left for 5-7 days. Three things are corrected:

* The opening is brought to the tip

* The penis is straightened

* Excess foreskin is removed (circumcision)

Optical magnification (microscope) and fine suture materials are used to provide a successful result. When extra care is taken there is a very good success rate.In five per cent the following complications can occur: The new opening gets small gradually (meatal stenosis), Urine leaks at the original site (Fistula). Both can be corrected by another minor operation; so the parents need not be unduly concerned.When the problem is corrected by 1-3 years of age with a good outcome, there should be no problem in future.

How to avoid dying from a heart attack

Dr. R. A. R. Perera, Consultant Clinical Psychologist

Should you ever collapse, suddenly and critically ill, somebody other than a doctor will most probably decide not only whether or not you are dead, but also whether or not you live. When one person finds another in a state of collapse, a decision must be made as to whether the collapsed person.

* Requires no help because he or she merely seems to be ‘ill’ (drunk, hypochondriac, malingering etc.)

* Needs help urgently

* Is dead

Placing a victim in the first category allow the passer-by to move on without taking action. Use of this category account for the low level of helpfulness.

The decision that medical attention is needed urgently usually means that resuscitation attempts begin immediately. If the victim is assumed to be dead resuscitation attempts are virtually non existent.

The category in which the collapsed person is placed depends importantly on social factors. For example, age may have a major influence over the categorization process. The older the patient, the more likely that his or her lack of vital signs of life will be taken at face value - the person is assumed to be dead.

However, the same lack of vital signs may be viewed as ‘cardiac arrest’ if the person is younger, and resuscitation attempts may commence immediately.

In an experiment conducted from the patients who were brought in a collapsed state to the Royal Free Hospital Medical School of London University, only thirty percent of old people (age 75-80 years) were resuscitated. But energetic attempts were made to save the lives of all hundred percent of the young (age group between the ages of 35-43 years).

Another factor that may determined the category into which people are placed is presumed moral character. Alcohol use, especially by someone dressed shabbily or unwashed, leads to an assumption that the person is merely drunk and little help is furnished.

Alcoholics, drug addicts, prostitutes, vagrants, persons injured in fights, homosexuals, and attempted suicides are less often judged as needing urgent attention. Hospital medical personnel seem to feel that such persons are less deserving of help than those of higher moral character are.

In many instances of suicides who requires stomach pumping the hospital staff will make commends like ‘this will teach her a lesson’ or ‘may be now.

In contrast a person who is successful in society’s standards usually receives rapid and continuous help.So to avoid dying from a heart attack, look as young as you can, and dress well, disguise your deviancies, and keep your breath fresh.

Chewing gum aids bowel recovery

Chewing gum aids recovery from bowel surgery, mounting evidence suggests.

The latest work published in Archives of Surgery reviews data from five recent trials involving 158 patients.

Chewing gum appears to speed up the return of normal bowel function by stimulating nerves in the digestive system, say the UK report’s authors.

Trials are now needed to see if this, in turn, can reduce the recovery time needed in hospital, the London-based team from St. Mary’s Hospital say.

In each study, a group of patients chewed sugarless gum three times per day following surgery for a period of five to 45 minutes and were compared with patients who did not chew gum.

Chewing is a bit like eating and it starts peristalsis, which is the movement of the bowel * An advisory nurse for Bowel Cancer UK Patients who chewed gum passed gas and had a bowel movement sooner than those who did not chew gum - signs that their bowel function returned sooner.

Any type of abdominal surgery can slow down or halt bowel function - a condition known as ileus, which can cause serious complications.

In four of the trials, the length of hospital stay after an operation was also a day shorter for the patients who chewed gum. But the researchers say more work is needed to see if this is a direct link rather than a chance finding.

If chewing gum did reduce hospital stay, this could save the NHS millions of pounds, say the researchers, given that more than 31,000 bowel operations are carried out in England each year and an overnight stay in hospital costs the NHS around £200.

An advisory nurse for Bowel Cancer UK said: “Chewing is a bit like eating and it starts peristalsis, which is the movement of the bowel.“ Ileus - when the bowel is slow to start working again - can occur after an operation, but it has become less common as surgery has become more refined.

“There is some evidence that chewing gum might help, but not enough that bowel surgery patients are routinely being advised to chew gum.”

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