Archive for the ‘Anti Depressants-Sleeping Aid’ Category

THE ELDERLY

Sunday, February 20th, 2011

On his show many years ago, Art Linkletter was interviewing children, and they came up with the following answers to a question he posed: “You can’t play with toys anymore…the government pays for everything…you don’t go to work…you wrinkle and shrink.” The question was “What does it mean to grow old?” The responses of the children contain many of the stereotypes our society attributes to the elderly. They also show that this negative picture develops from a very early age. There is a stigma to growing old. The notion is that for the elderly there is no play or fun, no money, no usefulness, and no attractiveness.
It is important to recognize that in considering the elderly, we all really are talking about ourselves. It is inevitable: we will all age; we will all become the elderly. A participant at a recent geriatric conference reported being asked by a friend, “Give me the inside scoop… what can I do to keep from getting older?” The response the person received was simple: “Die now!” There is no other way to avoid aging. So, for those not themselves among the elderly, in thinking about the older person, imagine yourself years in the future, because many of the circumstances will probably be the same.
Of the approximately 240 million people in the United States, 29 million are over age 65. This is the group arbitrarily defined as the elderly, or aged. Each day, 3000 die and 4000 reach their 65th birthday, so there is a net gain of 1000. By the year 1990, it is estimated that over 35 million persons will be over age 65; this will represent a larger percentage of the population than ever before. Consequently, the problems of the elderly, including alcoholism, that will be discussed are going to become a growing concern for our society.
Coping styles. Despite the inevitability of aging and despite the inevitability of physical problems arising as the years pass, there is an important thing to keep in mind. It has been said many times and in many different ways that you are as young as you want to be. This is only possible, however, if the person has some strengths going for him. The best predictor of the future, specifically how someone will handle growing old, is how the individual has handled the previous years. Individuals who have demonstrated flexibility as they have gone through life will adapt best to the inevitable stresses that come with getting older. These are the people who will be able to feel young, regardless of the number of birthdays they have celebrated.
Interestingly, as people get older, they become less similar and more individual. The only thing that remains alike for this group is the problems they face. There is a reason for this. Everyone going through life relies most heavily on the coping styles that seem to have served them well previously. With years and years of living, gradually individuals narrow down their responses. What looks, at first glance, like an egocentricity or eccentricity of old age is more likely a life-long behavior that has become one of the person’s exclusive methods for dealing with stress. An example illustrating this point arose in the case of an elderly surgical patient for whom psychiatric consultation was requested. This man had a constant smile. In response to any question or statement by the nurse or doctors, he smiled, which was often felt to be wholly inappropriate. The treatment staff requested help in comprehending the patient’s behavior. In the process of the psychiatric consultation, it became quite understandable. Friends, neighbors, and family of the man consistently described him as “good ole Joe, who always had a friendly word and a smile for everyone, the nicest man you’d ever want to meet.” Now under the most fearful of situations, with many cognitive processes depleted, he was instinctively using his faithful, basic coping style. Very similarly, the person who goes through life with a pessimistic streak may become angry and sad in old age. People who have been fearful under stress may be timid and withdrawn in old age. On the other hand, people who have been very organized and always reliant on a definite schedule may try to handle everything by making lists in old age. What is true in each case is that the person has settled into a style that was present and successful in earlier life.
Main stresses. In working with the elderly, in order to understand what is evolving in an individual case, it is imperative for helping professionals to consider every possible piece of information. Integration of data from the social, medical, and emotional realm is essential for understanding what makes the elderly person tick in order to make an intelligent treatment plan. Four areas of stress should be considered in dealing with the elderly: stresses that arise from social factors; psychological factors; biological or physical problems; and, unfortunately, iatrogenic stresses due to the helping professions as they serve (or inadequately serve) the elderly.
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SLEEP DISORDERS: SLEEP APNOEA

Friday, May 8th, 2009

‘Apnoea’ means not breathing. Sleep apnoea is the inability to breathe whilst asleep. The frequent attacks of sleep apnoea disturb sleep profoundly. Because sufferers do not have enough sleep at night, they feel tired all day and have no energy to do anything. They are unable to concentrate at work, and lose interest in sex and other things they enjoyed before. This is another common cause of excessive daytime sleepiness, and is now studied extensively in sleep laboratories. As a result, this condition is now believed to be more common than was previously believed. It is estimated that over 1 per cent of the adult population is suffering from sleep apnoea.

Sleep apnoea becomes more frequent as we grow older. The typical sufferer is a man over forty years of age who is grossly overweight and has high blood pressure. His sleeping partner invariably complains that he is snoring every night. A keen observer may be able to report that the sufferer snores very heavily, then wakes himself up, takes a few deep breaths, and falls back into snoring again. This may happen many times throughout the night In fact people suffering from sleep apnoea do not have any real sleep. They keep waking up throughout the night. However, in the morning, they may not remember that they have been waking up frequently, but somehow have the feeling that they have not slept. They also fall asleep very easily in the daytime, at the most inappropriate times. Many road accidents involve people who have sleep apnoea.

This condition is caused by obesity; in particular, the accumulation of fat around the throat. During sleep, air is sucked into the lungs, creating negative pressure around the surroundings of the throat and the tongue, which leads to a reduction in the diameter of the throat. This reduces air flow into the lungs. In normal people this reduction in the diameter of the throat is minimal, and may create only a snoring sound. Snoring results from the vibration of the palate, which is the roof of the mouth, as air is blowing across it. The flute and other woodwind instruments work on the same principle. In some obese people the air passage is narrowed far more than in normal people because of the accumulation of fat around the throat. This causes an even greater reduction in the flow of air to the lungs and results in obstructive sleep apnoea.

The condition is made even more severe during REM sleep. In REM sleep the muscles of the body are almost paralysed. Hence the muscles in the throat become flaccid and the diameter of the opening is further reduced. Because there is a reduced air flow into the lungs the person is virtually suffocating; this subsequently reduces the amount of oxygen circulating in the brain.

For normal people, the blood oxygen level during sleep stays above 90 per cent, but for sufferers of sleep apnoea this may go down to 40 per cent at times. Whenever the brain is deprived of oxygen, the body is signalled that all is not well, and the person wakes up immediately. After taking a few deep breaths, the brain regains its oxygen supply and the body feels that all is well. The person falls back into sleep, and snores again. Further cycles of waking and snoring then follow. This snoring/waking cycle repeats itself many times throughout the night. Normal people may also have occasional attacks of apnoea, but less than four times in one hour. People with sleep apnoea have as many as 30 attacks in one hour, and each attack of apnoea may last as long as three minutes. Because there is not enough air going into the lungs, and consequently less oxygen is circulating in the blood, these people may suffer from high blood pressure and irregular heart beats. It is thought that many heart attacks and strokes are triggered during these attacks of sleep apnoea.

Professor Colin Sullivan at the University of Sydney devised a nasal mask which can be worn during sleep. Air is pumped through the mask to ventilate the lungs by an electric pump. This device is now available commercially and is called continuous positive airway pressure, commonly known as ‘CPAP’, which is pronounced as ‘see-pap’. Besides this, there are other ways of helping sufferers of sleep apnoea. Weight reduction in the obese is very important, as this is sometimes the main cause of sleep apnoea. Tablets can also be given to reduce the time spent in REM sleep, as sleep apnoea is worse during REM sleep. Some sufferers may consume an excessive amount of alcohol or may be heavy smokers. Giving up drinking and smoking will definitely help. Plastic surgery of the soft palate and the oral cavity is sometimes very successful.

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THE SELF-MANAGEMENT OF ANXIETY: HOW TO DO THE

Wednesday, April 29th, 2009

EXERCISES-DIFFICULTIES IN ATTAINING PHYSICAL RELAXATION

The difficulties in attaining relaxation of the body are not great. But I think it wise to mention various difficulties that different people have experienced. Then if you find that you have similar problems you will at least know that others have also experienced them, and have overcome them without too much trouble.

The most common difficulty in learning to relax is undoubtedly the simple reluctance of many people to try it. I have had so many people say to me, “I really did not think that this would be any good for me, but you talked me into trying it, and now I am already feeling much easier in myself.”

Another difficulty, as I have pointed out, is the simplicity of the procedure. Some people find it hard to believe that anything so simple and so natural could help them when they have already tried dozens of tablets and injections without effect. Do not forget that you too, by the very

culture that surrounds you, have been at least partially conditioned into this pattern of thinking.

Restlessness may be a difficulty. We sit down ready to start, and we immediately find we want to move about. We fidget. We move a leg and then an “arm. Then we are aware that our clothes are uncomfortable, and we move again. Restlessness like this is only an initial difficulty. If you have this trouble, make yourself as comfortable as you can. Use cushions; lie on a soft bed—anything that appeals to you as making you comfortable. Then do your relaxation; but do it only for a very short period—two or three minutes. After that have a rest and a stretch, and then do it again. Soon the phase of restlessness will pass, and then you can move into doing the exercises in more uncomfortable positions.

The feeling of physical discomfort in some part of our body may cause difficulty in relaxation. We become aware of our leg. It is uncomfortable. It is beginning to hurt, and we feel we want to move it. At this stage, instead of moving it, concentrate on relaxing more completely. In spite of the discomfort we bring ourselves to let go more completely. We do this. We let ourselves go through the discomfort, as it were. The discomfort passes, and we relax more easily.

Sometimes a trembling of the muscles makes relaxation difficult. This is only a worry at the very start, and it soon passes. It is most common in the eyelids and the muscles around the eyes. In fact, some trembling of the eyelids would seem to be the general rule in the initial phases, and is of no consequence at all.

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