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Sunday, 5 May 2013





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Sleep disturbance?:

The young are vulnerable

Are you struggling with a sleep problem? Do you wake up constantly? Is your sleep disturbed often? Then you probably have a sleep disorder.

Depending on a number of factors including illness, pain, certain medications, your hormones, gender and age, stress, sleep disturbances are now a common problem especially among young persons.

While opinions are divided concerning the causes contributing to this phenomenon, medical experts believe that a combination of several factors is to blame.

They include the strides in technological development which have spawned television, internet, computer games and other hi tech gadgets, the constant pressure put by parents on their children to perform well at school, stress due to too much homework, lack of exercise, as well as watching the television and playing computer games for long hours, lie at the heart of the problem.

All these have led to a lack of sufficient hours of sleep and mental over stimulation resulting in sleep disturbances.

Consultant Paediatrician, Lady Ridgeway Hospital and Kandy Teaching Hospital Dr Anuruddha Padeniya explains in this interview with The Sunday Observer, what factors have led to sleep disturbances in young persons, their health impacts, and how they could be prevented.

He emphasises the fact that it is the parent’s responsibility to resolve these problems by ensuring their children get a sufficient quota of sleep, by sending them to bed early and limiting their time spent before the television and computer games.


Question: Sleep disturbance is said to be a common disorder especially among young people. What is sleep disturbance?

Answer: Sleep disturbance includes disorders of initiating and maintaining sleep, disorders of excessive somnolence, disorders of sleep - wake schedule, and dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias).

Q. Is sleep disturbance a chronic condition? Or a temporary one caused by certain factors such as stress, overwork and fatigue? What are the main causes?

A. It could be either a chronic or a temporary condition.

Factors that can disturb your child’s sleep are arising early in the morning to go to school, staying awake late for school work and tuition classes, extreme academic stress on child, disturbances from cell phones, TV, Computers and urbanisation. Children with disabilities have more sleep problems than others.

Q. Is it genetic?

A. Some sleep disorders may have a genetic predisposition. Boys have a higher tendency to develop obstructive Sleep apnea.

Q. You were recently quoted as saying that over 30 percent of Lankan School children suffer from this. Why? Is it a recent development or an illness that has not been diagnosed until now?

A. In Sri Lanka usually complaints regarding sleep problems are not presented to medical officers due to lack of awareness of sleep disorders among parents. So most probably it has not been diagnosed until now. Problems to do with a child’s sleep might not be noticed for some time and parents often find it harder to detect that something is wrong.

Q. What age groups of school children are most at risk?
A. More than one-third of school going children may have sleep problems.

Q. What are the symptoms? Are they easily detected in a routine visit to the doctor?
A. Irritability and sleepy during the day.

Having it difficult to stay awake while playing, watching TV or reading, showing difficulty in concentrating, looking tired always, reacting slowly and falling grades recently.

Q. Can a blood test or X-ray reveal this condition?

A. Some of the causative factors of obstructive sleep apnea can be seen in X- ray (e.g. lymphoid hyperplasia and some other anatomical defects)

Q. In some countries, it is said there are sleep apnea machines and even pillows that are given to patients to help them breathe normally? Are they available here as well?

A. CPAP (Continuous Positive Airway Pressure) machines are available in the private sector.

Q. Can surgery reverse this condition?
A. Yes. Some causative factors of obstructive sleep apnea can be corrected.

Q. Is it a serious disorder? What are the health implications on (a) young children (b) adults? Can it lead to heart trouble in later life?

A. Sleep practice has an impact on growth and development of the child. Sleep deprivation can lead to Hypertension and certain other diseases in later life.

Q. Is it linked to depression? And other psychological problems such as overeating or under eating? Sleepwalking (somnambulism)?

A. Yes. Childhood depression and sleep disturbance are linked with each other.

Q. Does it affect work output? Concentration powers? School performance?

A. Disturbed sleep at night makes harder for children to function during the day. It raises the risk of problems with how he behaves and learns. Disturbed sleep has a great impact on education and his/ her learning, creativity and personality.

Q. Can someone suffering from it take part in sports and other extra- curricular activities?

A. Those activities are impaired due to poor attention span and aggressiveness.

Q. Is a chronic sufferer constantly drowsy?
A. Yes. They are irritable and sleepy during the day.

Q. Are there different types of sleep disorders? What are they?

A. Yes. They are insomnia, nightmares, obstructive sleep apnea, and narcolepsy, sleep walking, sleep terrors, confusional arousals, nocturnal bed wetting, periodic limb movement disease, nocturnal seizures.

Q. How can it be prevented?

A. Early identification of the sleep disorder and probable causes, improve sleep hygiene.

Q. Will eating well balanced meals, avoiding friend food help? Or is having enough sleep the only answer?

A. Those practices which are collectively known as sleep hygiene will definitely help your child to have a normal good night sleep and good day time alertness.

Q. You have said that parents have an important role to play in preventing this disorder? How?

A. The information you provide to the doctor will help him to reach a diagnosis. You can evaluate your child's sleeping problems as Bedtime problems, excessive day time sleepiness, awakening during the night, regularity and duration of sleep, snoring (BEARS Sleeping Screening Algorithm)

You can also state the behavioural changes you observe in your child such as reduced attention at school, sleepiness during day time, irritability, hyperactivity, and bed wetting. Mention if there is any family history of sleep disorder.

Alternative therapies may help lower blood pressure

Alternative therapies such as aerobic exercise, resistance or strength training, and isometric hand grip exercises may help reduce your blood pressure.

In a new scientific statement published in the journal Hypertension, alternative approaches is reported to be able to help people with blood pressure levels higher than 120/80 mm Hg and those who can't tolerate or don't respond well to standard medications.

However, alternative therapies shouldn't replace proven methods to lower blood pressure - including physical activity, managing weight, not smoking or drinking excess alcohol, eating a low sodium balanced diet and taking medications when prescribed, the association said.

High blood pressure - a major risk factor for heart attack and stroke - affects more than 26 percent of the population worldwide and contributes to more than 13 percent of premature deaths.

An expert panel assessed three alternative remedy categories: exercise regimens; behavioral therapies such as meditation; and non-invasive procedures or devices including acupuncture and device-guided slow breathing. The panel did not review dietary and herbal treatment.

“There aren't many large well-designed studies lasting longer than a few weeks looking at alternative therapies, yet patients have a lot of questions about their value,” said Robert D. Brook, Chair of the panel and an associate professor of medicine at the University of Michigan in Ann Arbor. “A common request from patients is, ‘I don't like to take medications, what can I do to lower my blood pressure?’ We wanted to provide some direction.”

The alternative therapies rarely caused serious side effects and posed few health risks, but the analysis revealed some approaches were more beneficial than others and could be part of a comprehensive blood pressure-lowering treatment plan.

Brook and colleagues reviewed data published in 2006-11, including 1,000 studies on behavioural therapies, non-invasive procedures and devices, and three types of exercise (aerobic, resistance or weight training and isometric exercises, most commonly hand-grip devices).

The studies also examined the effects of yoga, different styles of meditation, biofeedback methods, acupuncture, device-guided breathing, relaxation and stress techniques.

The panel's find: All three types of exercise reduced blood pressure. Walking programs provided modest benefit while, somewhat surprisingly, four weeks of isometric hand grip exercises resulted in some of the most impressive improvements - a 10 percent drop in systolic and diastolic blood pressure. However, isometric exercise should be avoided among people with severely-uncontrolled high blood pressure (180/110 mm Hg or higher).

- Behavioural therapies such as biofeedback and transcendental meditation may help lower blood pressure by a small amount. However, there's not sufficient data to support using other types of meditation.

- Strong clinical evidence is also lacking to recommend yoga and other relaxation techniques for reducing blood pressure.

- There isn't enough evidence to recommend acupuncture for lowering blood pressure, particularly given the complexities involved in employing this treatment. However, device-guided slow breathing did prove effective in lowering blood pressure when performed for 15-minute sessions three to four times a week.

“Most alternative approaches reduce systolic blood pressure by only 2-10 mm Hg; whereas standard doses of a blood pressure-lowering drug reduce systolic blood pressure by about 10-15 mm Hg,” Brook said.

“So, alternative approaches can be added to a treatment regimen after patients discuss their goals with their doctors.”

Given the global public health burden of high blood pressure more research is needed to look at the long-term cardiovascular health impact of alternative therapies and the effects of combining them together or adding them to other proven lifestyle measures, Brook said.


Coronary heart disease increases with BMI

Coronary heart disease (CHD) increases with BMI, as well as with age, finds an article published in BioMed Central's open access journal BMC Medicine.

The research from the Million Women Study indicates that increased weight increases risk of CHD equivalent to that caused by getting older.

Researchers from the University of Oxford followed the health of 1.2 million women from England and Scotland for (on average) almost a decade.

Analysis of the data showed that the occurrence of CHD increases with BMI so that every five unit increase in BMI, calculated as weight/height2, increases incidence by 23 percent which is equivalent to the risk conferred by getting older by 2.5 years.

The results showed that one in eleven lean middle aged women (with an average BMI of 21) will be admitted to hospital or will have died from CHD between the ages of 55 to 74. This risk progressively increases with BMI, and it reaches one in six, for obese women (with an average BMI of 34). Dr Dexter Canoy, who led this study said, “The risk of developing CHD increases even with small incremental increases in BMI, and this is seen not only in the heaviest but also in women who are not usually considered obese. Small changes in BMI, together with leading a healthy lifestyle by not smoking, avoiding excess alcohol consumption, and being physically active could potentially prevent the occurrence of CHD for a large number of people in the population.


Scientists slow down ageing in mice

Manipulating a molecule in almond-sized structure increased longevity by 20 percent, says study.

An almond-sized structure in the brain may hold the key to slowing down the rate of ageing throughout the entire body, a study suggests.

Scientists believe they have found the “fountain of ageing” in the shape of the hypothalamus, a small region of the brain involved in regulating the secretion of various hormones.

The researchers said they have speeded up and slowed down the rate of ageing in laboratory mice by manipulating chemical messengers that affect the hypothalamus, which is known to play a fundamental role in growth, development, reproduction and metabolism. “Scientists have long wondered whether ageing occurs independently in the body's various tissues or if it could be actively regulated by an organ in the body,” said Dongsheng Cai of Albert Einstein College of Medicine in New York.

“It's clear from our study that many aspects of ageing are controlled by the hypothalamus. What's exciting is that it's possible, at least in mice, to alter signalling within the hypothalamus to slow down the ageing process and increase longevity,” Dr Cai said.

The study, published in the journal Nature, focussed on a molecule known to be central to the many biochemical reactions involved in the process of inflammation, which is important in many age-related conditions, he said.

“As people age, you can detect inflammatory changes in various tissues.

“Inflammation is also involved in various age-related diseases, such as metabolic syndrome, cardiovascular disease, neurological disease and many types of cancer,” Dr Cai said.

By manipulating the levels of the molecule, known as NF-kB, within the hypothalamus, the researchers were able to slow down the rate of ageing and increase longevity of mice by up to 20 percent.

- The Independent


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