Sleep Tips Part 3

How to sleep better tip 3: Create a relaxing bedtime routine

If you make a consistent effort to relax and unwind before bed, you will sleep easier and more deeply. A peaceful bedtime routine sends a powerful signal to your brain that it’s time to wind down and let go of the day’s stresses.

Make your bedroom more sleep friendly

§  Keep noise down. If you can’t avoid or eliminate noise from barking dogs, loud neighbors, city traffic, or other people in your household, try masking it with a fan, recordings of soothing sounds, or white noise. You can buy a special sound machine or generate your own white noise by setting your radio between stations. Earplugs may also help.

§  Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.

§  Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. If you often wake up with a sore back or an aching neck, you may need to invest in a new mattress or a try a different pillow. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support.

Reserve your bed for sleeping and sex

If you associate your bed with events like work or errands, it will be harder to wind down at night. Use your bed only for sleep and sex. That way, when you go to bed, your body gets a powerful cue: it’s time to nod off.

Relaxing bedtime rituals to try

§  Read a book or magazine by a soft light

§  Take a warm bath

§  Listen to soft music

§  Do some easy stretches

§  Wind down with a favorite hobby

§  Listen to books on tape

§  Make simple preparations for the next day

Sleep Tips Part 2

How to sleep better tip 2: Naturally regulate your sleep-wake cycle

Melatonin is a naturally occurring hormone that helps regulate your sleep-wake cycle. Melatonin production is controlled by light exposure. Your brain should secrete more in the evening, when it’s dark, to make you sleepy, and less during the day when it’s light and you want to stay awake and alert. However, many aspects of modern life can disrupt your body’s natural production of melatonin and with it your sleep-wake cycle.

Spending long days in an office away from natural light, for example, can impact your daytime wakefulness and make your brain sleepy. Then bright lights at night—especially from hours spent in front of the TV or computer screen—can suppress your body’s production of melatonin and make it harder to sleep. However, there are ways for you to naturally regulate your sleep-wake cycle, boost your body’s production of melatonin, and keep your brain on a healthy schedule.

Increase light exposure during the day

§  Remove your sunglasses in the morning and let light onto your face.

§  Spend more time outside during daylight. Try to take your work breaks outside in sunlight, exercise outside, or walk your dog during the day instead of at night.

§  Let as much light into your home/work space as possible. Keep curtains and blinds open during the day; move your desk closer to the window.

§  If necessary, use a light therapy box. A light therapy box can simulate sunshine and can be especially useful during short winter days when there’s limited daylight.

Boost melatonin production at night

§  Turn off your television and computer. Many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it. Try listening to music or audio books instead, or practicing relaxation exercises. If your favorite TV show is on late at night, record it for viewing earlier in the day.

§  Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.

§  Change your light bulbs. Avoid bright lights before bed, use low-wattage bulbs instead.

§  When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to cover your eyes.

§  Use a flashlight to go to the bathroom at night. As long as it’s safe to do so, keep the light to a minimum so it will be easier to go back to sleep.

Sleep Tips Part 1

Sleep tips

How to sleep better tip 1: Keep a regular sleep schedule

Getting back in sync with your body’s natural sleep–wake cycle—your circadian rhythm—is one of the most important strategies for achieving good sleep. If you keep a regular sleep schedule, going to bed and getting up at the same time each day, you will feel much more refreshed and energized than if you sleep the same number of hours at different times. This holds true even if you alter your sleep schedule by only an hour or two. Consistency is important.

§  Set a regular bedtime. Go to bed at the same time every night. Choose a time when you normally feel tired, so that you don’t toss and turn. Try not to break this routine on weekends when it may be tempting to stay up late. If you want to change your bedtime, help your body adjust by making the change in small daily increments, such as 15 minutes earlier or later each day.

§  Wake up at the same time every day. If you’re getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock to wake up on time, you may need to set an earlier bedtime. As with your bedtime, try to maintain your regular wake–time even on weekends.

§  Nap to make up for lost sleep. If you need to make up for a few lost hours, opt for a daytime nap rather than sleeping late. This strategy allows you to pay off your sleep debt without disturbing your natural sleep–wake rhythm, which often backfires in insomnia and throws you off for days.

§  Be smart about napping. While taking a nap can be a great way to recharge, especially for older adults, it can make insomnia worse. If insomnia is a problem for you, consider eliminating napping. If you must nap, do it in the early afternoon, and limit it to thirty minutes.

§  Fight after–dinner drowsiness. If you find yourself getting sleepy way before your bedtime, get off the couch and do something mildly stimulating to avoid falling asleep, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may wake up later in the night and have trouble getting back to sleep.

Discovering your optimal sleep schedule

Find a period of time (a week or two should do) when you are free to experiment with different sleep and wake times. Go to bed at the same time every night and allow yourself to sleep until you wake up naturally. No alarm clocks! If you’re sleep deprived, it may take a few weeks to fully recover. But as you go to bed and get up at the same time, you’ll eventually land on the natural sleep schedule that works best for you.

Meningitis death toll now 12

Florida officials confirmed Wednesday an elderly man is the 12th U.S. fatality from non-contagious fungal meningitis linked to injections of a tainted steroid.

The U.S. Centers for Disease Control and Prevention in Atlanta said 137 people have become ill in 19 states after receiving injections of a steroid believed to be contaminated with a fungus. About 13,000 patients might have been exposed to the contaminated steroid methylprednisolone acetate, but CDC officials said it didn't expect that many to become ill.

Tennessee has the most cases, 44, with six deaths, followed by: 27 cases and one death in Virginia; 28 cases and three deaths in Michigan; 15 cases in Indiana; nine cases and one death in Maryland; six cases and one death in Florida; three cases in Minnesota; two cases in North Carolina; two cases in New Jersey and one case Ohio.

"We continue to be vigilant in our efforts to protect the health and safety of Floridians," Dr. John Armstrong, state surgeon general and secretary of health in Florida, said in a statement. "We are working in collaboration with the Centers for Disease Control and Prevention, our health partners and the Department of Business and Professional Regulation to ensure that no New England Compounding Center medications are present in any healthcare setting in Florida."

The New England Compounding Center in Framingham, Mass., notified its clients' the medication in question -- the steroid methylprednisolone acetate, which is injected into the body to treat back pain -- and all other products produced in their facility were voluntarily recalled.

The CDC expanded the timeline and scope of injection risk to include any patients known or suspected to have received back or joint injections with the suspect lots of methylprednisolone acetate since May 21.

"If symptomatic, these patients should be evaluated immediately by their healthcare professional and monitored or treated as necessary," Florida health officials said. "Patients without symptoms should be evaluated by their healthcare professionals as soon as possible."

No cases of septic arthritis related to contaminated steroid joint injections had been reported as of Wednesday, Florida officials said.

Meningitis outbreak shows where risks are

This year, a company in Framingham, Mass., the New England Compounding Center, shipped 17,676 steroid injections for back pain to clinics in 23 states. Some of the injections were contaminated with a fungus that has led to a meningitis outbreak in 10 states, in which 119 people have been sickened and 11 have died. The Centers for Disease Control and Prevention estimates that some 13,000 people got the injections, starting May 21. The outbreak has revealed breakdowns in the oversight of businesses known as compounding pharmacies.

Compounding is a traditional part of pharmacy practice. It means that a pharmacist combines, mixes or alters ingredients to create a medication for an individual patient. Usually, it is done to prepare a medicine that is not commercially available, such as for a patient with an allergy to a specific ingredient. However, in the past two decades, businesses with pharmacy licenses have sprung up to use compounding for the production of medicines in quantities rivaling that of drug manufacturers.

The New England Compounding Center seems to be one of these large-scale producers, hardly a corner pharmacy.

The Food and Drug Administration, which imposes strict standards on drugmakers, has long worried about compounding pharmacies. The businesses do not have to register with the FDA. In 2006, an FDA survey found problems with one-third of the drugs it sampled nationwide from compounding pharmacies. An FDA consumer flier in 2007 warned that “poor practices on the part of drug compounders can result in contamination or in products that don’t possess the strength, quality and purity required.” However, several court decisions over the past decade have limited the agency’s enforcement powers over compounding pharmacies, which fall largely under state law, where regulation and enforcement are uneven.

Precisely what went wrong at the New England Compounding Center— causing some kind of fungal contamination — is not yet known. There are voluntary industry standards for testing; were these medicines properly scrutinized for potency, sterility and toxic substances? The Massachusetts Department of Public Health says that state rules allow pharmacies to dispense compounded drugs only for the prescription of an individual patient. A good question is whether the New England Compounding Center followed this rule in shipping tens of thousands of doses.

The outbreak raises broader policy questions. In 1997, Congress passed legislation establishing state and federal regulation of compounding pharmacies. But the federal role was challenged by some pharmacies in the courts, and it has been caught up in legal wrangling for years. The FDA has attempted to keep watch with“policy guidance” instead of law, and the agency initiated enforcement actions when abuses became apparent. But this lack of clarity has led to serious gaps in oversight. Congress should give the FDA power to oversee any company engaging in large-scale production of drugs and to make sure they meet federal standards for safety and good manufacturing practices.

Tainted steriod medication not in Kentucky

Although the number of reported cases of fungal meningitis continues to increase, Kentucky is not listed as a state to have received the tainted drug causing the infection.

That information comes from Dr. Magdalena Kerschner, with Advanced Pain and Spine Institute in Maysville.  Kerschner's pain clinic administers epidural steroid injections for the management of pain, but Kerschner said Wednesday her patients are at no risk because her clinic purchases only Food and Drug Administration approved pharmaceuticals.

"There are no risks for my patients, my clinic is safe," Kerschner said, in an effort to reassure both her patients and the public.

Kerschner said her office has been receiving numerous calls from frightened patients asking if they are at risk of the fungal meningitis. As of mid-afternoon Wednesday, the Centers for Disease Control and Prevention in Atlanta had confirmed 137 cases and 12 deaths in 10 states: Tennessee, Michigan, Virginia, Indiana, Florida, Maryland, Minnesota, New Jersey, North Carolina and Ohio.

She explained the tainted steroid medication related to the meningitis outbreak was produced at what is called a "compounding" pharmacy in Massachusetts.  She said the CDC has not listed Kentucky as one of the 23 states the tainted drug was shipped to between July and September.

A compounding pharmacy is one that purchases FDA approved drugs from other pharmaceutical manufactures and makes them into specific dosages and strengths for use by physicians or hospitals for a cheaper cost.

Kerschner said The New England Compounding Pharmacy products are not FDA approved and the fungus may have resulted from unsterilized conditions when remaking the drug and returning it to the vials.  As of Wednesday, the company has recalled all of its products.

She said she and other local medical professionals are working with the Buffalo Trace District Health Department on the situation and "all are alert for patients coming from other pain clinics."

Patients who receive epidural steroid injections need to be alert to the symptoms of fungal meningitis which are: headaches that will not go away, fever, stiff neck, sensitivity to light, weakness or numbness in any part of the body, slurred speech and increased redness or pain at the injection site.

Kerschner said it can take up to one month for the symptoms to appear after injection and an IV of anti-fungal antibiotics is the cure to the infection, which requires a hospital stay and can take as long as three months to be fully effective.

Fungal meningitis is an inflammation and/or infection of protective membranes around the brain and spinal cord. Meningitis, whether viral, bacterial or fungal, is very serious and can cause brain damage, strokes or death.  Fungal meningitis is not contagious and is extremely rare.

U.S. meningitis outbreak widens

ATLANTA, Oct. 6 (UPI) -- An outbreak of a deadly and rare form of fungal meningitis has widened to nine U.S. states and killed seven people, health officials said Saturday.

The Centers for Disease Control in Atlanta said the number of cases had risen to 64, up from 47 cases and five deaths in seven states a day earlier. Tennessee had the most cases -- 29 -- followed by Virginia (11), Michigan (8), Indiana (5), Florida (4), Maryland (3), North Carolina (2), Minnesota (1) and Ohio (1).

The source of the outbreak of the non-contagious inflammation of the brain's lining had yet to be confirmed, officials at the CDC said, though interim data indicated all infected patients received injections of preservative-free methylprednisolone acetate prepared by New England Compounding Center in Framingham, Mass.

The CDC said several of the afflicted patients had received steroid injections into the spine, and several suffered strokes related to the meningitis.

"The source of the fungus has not yet been identified, and the cause of infections in the other patients is still being assessed," the CDC said on its website.

"At this point, there is not enough evidence to determine the original source of the outbreak; however, there is a link to an injectable steroid medication. The lots of medication that were given to patients have been recalled by the manufacturer."

The states that received the implicated product are: California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia and West Virginia.

"Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis is an extremely rare cause of meningitis overall, including after epidural injections," the CDC said. "The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth."

Fungal meningitis occurs when the protective membranes that cover the brain and spinal cord are infected with a fungus. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or by direct extension from an infected body site next to the central nervous system, the CDC said.