Virginity pledges can be effective: study

Last Updated: 2008-09-11 12:33:29 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Teens who take a pledge to remain a virgin until marriage may in fact be more likely than their peers to delay sex, according to a U.S. study.

Investigators at the RAND research institute found that even among U.S. teenagers with similar backgrounds and values, those who'd taken a virginity pledge were less likely to start having sex over the three-year study period.

"Our data suggest that it is a good idea for teens who are inclined to delay sex to make a pledge, because they're more likely to delay sex if they do so," lead researcher Dr. Steven C. Martino said in a statement. "A public statement or commitment to do -- or not do -- something makes it more likely that you will follow through on your stated intention."

On the other hand, virginity pledges alone are not enough to prevent teen pregnancies and sexually transmitted diseases, noted Martin of RAND in Pittsburgh, Pennsylvania.

"You also need a comprehensive program of sexual education for young people who are not inclined to delay sex and for virginity pledgers who eventually break their pledge," Martino said.

The findings, published in the Journal of Adolescent Health, are based on telephone surveys of 1,461 U.S. teenagers who were interviewed at the beginning of the study and again one and three years later.

The adolescences were selected to reflect a nationwide sample; 68 percent were white, 47 percent were female, 14 percent were African American, 12 percent were Hispanic and 6 percent were "other." One third had a parent with a college degree and nearly two thirds had parent with some education after high school.

During the first interview, they were questioned about their sexual history and about characteristics that would make them more or less likely to take a virginity pledge -- factors such as how many of their friends were sexually active, how involved they were at school and church, and their parents' attitudes toward premarital sex.

Martino's team found that even among teens who had values that made them more likely to take a virginity pledge, those who actually took one were more likely to delay having sex.

Of the former group, 42 percent started having sex during the study period. In contrast, one third of "pledgers" did.

Among those pledgers who did have sex, the rate of condom use was similar to that of other sexually active teens -- suggesting that taking such a pledge does not diminish teenagers' knowledge about safer sex.

"Making a virginity pledge appears to be an effective means of delaying sexual intercourse initiation among those inclined to pledge without influencing other sexual behavior," Martino and his colleagues conclude.

An estimated 23 percent of teenage girls and 16 percent of teenage boys in the U.S. have taken a virginity pledge, according to the researchers. Hundreds of churches, schools and colleges across the country now advocate them.

SOURCE: Journal of Adolescent Health, October 2008.

Weight doesn't hamper women's sexual activity

Last Updated: 2008-09-11 15:52:00 -0400 (Reuters Health)

By Joene Hendry

NEW YORK (Reuters Health) - A high body mass index (BMI), indicating overweight or obesity, may not play a significant role in women's sexual activity, researchers report.

"Obese and overweight women are just as sexually active as normal-weight women and need to be counseled similarly about their risks of unintended pregnancy and infection," Dr. Bliss E. Kaneshiro told Reuters Health.

Kaneshiro, of the University of Hawaii in Honolulu, and colleagues base these findings on surveys from 6,690 women, 15 to 44 years old, who participated in the 2002 National Survey of Family Growth.

The group is representative of the women living in the U.S. at the time. Just over half were 30 to 45 years old and about 16 percent were 15 to 19 years of age, the researchers report in the journal Obstetrics and Gynecology.

Overall, 54 percent of the women were of normal weight (BMI of less than 25). Another 25 percent were overweight (BMI between 25 and 30), and 21 percent were considered obese (body mass index than 30). Body mass index -- the ratio of weight to height - is often used to classify subjects as under- or overweight.

Women in different weight groups were similar in age, cohabitation status, race, ethnicity, education, and total household income. A higher proportion of normal-weight women reported never having borne a child and a higher proportion of overweight and obese women reported having three or more children.

The investigators found no significant differences among the weight groups in sexual orientation, frequency of sexual intercourse, the number of current partners, age at first intercourse, the number of lifetime male partners, or the number of male partners in the previous year.

However, Kaneshiro's group unexpectedly found that obese and overweight women, compared with normal-weight women, were more likely to report a history of intercourse with a male, even though they did not report an early initiation of intercourse.

The investigators suggest continuing research into the association between BMI and women's sexual behavior as this association can affect the risk of unintended pregnancy and sexually transmitted diseases.

SOURCE: Obstetrics and Gynecology, September 2008.

HIV racial disparities greatest for women, gay men

Last Updated: 2008-09-11 16:21:30 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Blacks and Hispanics continue to be disproportionately affected by increasing rates of HIV infection, the U.S. Centers for Disease Control and Prevention reported today, with minority women and men who have sex with men at particularly high risk.

Last month, the CDC reported that at 56,300 new cases in 2006, the rate of new HIV infections was roughly 40-percent higher than earlier estimates had indicated. At that time, they found that 75 percent of new infections that year were among men.

In the Morbidity and Mortality Weekly Report, the CDC reports more detailed analysis of data from the HIV Incidence Surveillance System. Dr. Kevin Fenton and Dr. Richard Wolitski, at the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, discussed the findings in a telebriefing.

"For the first time we're able to provide new HIV incidence estimates for specific subpopulations, with further breakdowns of new infections among various races, transmission categories, age groups, and gender," Fenton said. "These data will allow us to target HIV prevention efforts and evaluate their impact with much more precision than ever before."

According to Fenton, the data show a "strikingly high incidence of new HIV infections among young (ages 13 to 29) black males who are gay or bisexual; the heavy impact among white men who have sex with men in their 30s and 40s; and that, compared with other women, black women bear the heaviest burden of HIV."

Dr. Wolitski pointed out that "individual differences in rates of risk behavior and substance use do not account for the disparity in infection rates in young black men who have sex with men, which means that factors outside the individual are increasing the risk associated with any risky sexual encounter."

Such factors include higher background prevalence of HIV among African Americans, he said, the risk is increased because the infection rate among African Americans is already higher than in other groups.

Another factor is the "different patterns of age mixing, in which younger black men who have sex with men may be more likely to have slightly older partners compared with other races or ethnicities."

Other factors likely include stigma, lack of access to effective prevention services, and underestimation of personal risk.

Responding to a question from Reuters Health, Fenton said that the HIV prevalence (overall number of individuals already infected) is driving the disproportionate disease incidence (the rate of new infections) among black women, as well as "patterns of sexual mixing in which they are having intercourse with men who are themselves at high risk, such as bisexual men or men who inject drugs or who were exposed while in prison."

Also at issue among black women, he added, are "power imbalances with men in sexual relationships that limit their ability to protect themselves."

Summing up, Fenton said, "Today's analysis serves as a powerful reminder that the U.S. epidemic of HIV is far from over, and we all need to do more."

He concluded: "The U.S. epidemic will end only when all of us -- federal, state, and local governments; politicians, communities, and businesses; social and civic organizations; schools, families, and individuals across the nation -- realize that ending AIDS is possible, and then collectively committing to make that happen."

"Together we can realize the goal of ending this epidemic in our lifetime."

SOURCE: Morbidity and Mortality Weekly Report, September 12, 2008.

Many colon cancer patients skip follow-up care

Last Updated: 2008-09-11 10:57:58 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The results of new research indicate that many older patients who survive colorectal cancer do not attend the guideline-recommended follow-up office visits or undergo carcinoembryonic antigen (CEA) testing and colonoscopy.

"The current study is the first known national, population-based study in the U.S. to examine actual adherence to published comprehensive guidelines. The study included patients cared for in diverse practice settings and by different specialists," lead author Dr. Gregory S. Cooper told Reuters Health.

"The biggest finding was the low rate of guideline adherence, with approximately 60 percent receiving less than the recommended care and, in contrast, 20 percent received care in excess of guidelines," according to Cooper, a gastroenterologist with University Hospitals Case Medical Center in Cleveland, Ohio. "All patients were insured under Medicare, so lack of insurance cannot be a factor."

Using a linked tumor registry-claims database, the researchers identified 9,426 patients, 66 years of age or older, who were observed for 3 years following diagnosis and treatment of colorectal cancer in 2000 to 2001. The subjects were classified as receiving recommended follow-up if they had at least two office visits per year; at least two CEA tests per year in the first 2 years; and at least one colonoscopy performed within 3 years.

Overall, 60.2 percent of the patients received follow-up below recommended levels and 22.7 percent received excessive follow-up, according to the report in the journal Cancer. Thus, just 17.1 percent of patients received follow-up at the recommended frequency.

Guideline adherence ranged from 92.3 percent for office visits to 46.7 percent for CEA testing, while 73.6 percent of patients underwent recommended colonoscopy.

Although not recommended, abdominal/pelvic CT was performed in 47.7 percent of patients and PET scan was performed in 6.8 percent.

Adherence to follow-up guidelines was more likely in patients who were younger, white and had regional-stage malignancies and poorly differentiated tumors, the report indicates. The findings also indicate there was significant variation in guideline adherence by geographic location. This suggests that local practice patterns play a role in receipt of recommended follow-up, Dr. Cooper noted.

"Routine surveillance has been shown to improve survival after potentially curative treatment of colorectal cancer," Cooper said. "Assuming that the patient would benefit from early detection of recurrence, the use of these procedures should be encouraged. As some of these patients may be receiving their care from primary care physicians alone, primary providers should also be aware of guidelines."

SOURCE: Cancer, October 15, 2008.

Women respond better than men to antidepressant

Last Updated: 2008-09-11 16:04:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Women with major depression are more likely than men to achieve remission during treatment with citalopram, an antidepressant that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRI), according to findings from the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study.

Previous research on this topic has yielded contradictory results, Dr. Elizabeth A. Young and co-authors note in their report, published online by the Journal of Psychiatric Research. The STAR*D study, they say, is "the largest to address sex differences in depression treatment using a representative sample of treatment-seeking patients."

The current analysis included 2,876 outpatients between 18 and 75 years old, 64 percent of whom were female. Citalopram was initiated at 20 milligrams per day and adjusted up to a maximum dose of 60 milligrams per day. The patients were treated for major depression for up to 14 weeks.

At the beginning of the study, the women had more severe depressive symptoms and more additional illnesses than men did. Women were also more likely than men to have a personal history of a suicide attempt and a family history of depression or substance abuse.

According to Young, of the University of Michigan in Ann Arbor, and her associates, the female patients were significantly more likely to achieve remission, at 29.4 percent vs 24.1 percent, respectively. Remission was defined as a score of 7 or less on the 17-item Hamilton Rating Scale for Depression.

Treatment response -- defined as a reduction of at least 50 percent from the beginning of trial on a self-reported 16-item inventory of depression symptoms -- also occurred more frequently among women than the men (48.5 percent vs 44.0 percent).

Side effects, maximum dose, and length of time on the drug, did not differ between the men and women, the authors report. "The elimination of these potential explanations for the sex differences found in this study increases the likelihood that the explanation is a differential biological response to citalopram in women."

The researchers suggest that the better treatment response among women is related to "the role of estrogen on serotonergic systems," as well as cognitive and psychological factors that differ between men and women.

SOURCE: Journal of Psychiatric Research, August 29, 2008.

Detailed Study on Spread of H.I.V. in U.S.

By GARDINER HARRIS

Published: September 11, 2008

An unusually detailed study of people newly infected with H.I.V. in the United States has confirmed that the majority of new cases occur among gay and bisexual men and that blacks are most at risk. But the data show that whites and blacks tend to be infected at different times in their lives with the virus that causes AIDS.

Most new infections of white gay and bisexual men occur when the men are in their 30s and 40s, the study found, while black gay and bisexual men are more likely to be infected in their teens and 20s. The results were reported on Thursday by the Centers for Disease Control and Prevention.

The C.D.C. reported last month that the study found that the virus was spreading faster in the United States than had been thought. In 2006, the study found, 56,300 people were newly infected with H.I.V. — 40 percent more than the agency’s previous estimate of roughly 40,000 new cases a year. The study was performed using new technology that allowed researchers to distinguish between new and older infections.

Dr. Kevin Fenton of the C.D.C. said the study’s findings served “as a powerful reminder that the U.S. epidemic of H.I.V. disease is far from over.”

The details of the agency’s demographic analysis were released on Thursday in the hope that knowledge of the age, race and other characteristics of the newly infected would better direct prevention efforts.

“The data really confirm what we had suspected and known before,” said Dr. Fenton, who emphasized the disease’s “disproportionate impact on gay and bisexual men and on blacks and Latinos.”

Black people, who make up about 12 percent of the population, accounted for more than 45 percent of the new infections, the study found, and the disparity was particularly acute among women.

Black women are nearly 15 times as likely to be infected with H.I.V. as white women. Hispanic women are four times as likely to be infected as white women. Black men have six times the H.I.V. incidence rate of white men and nearly three times that of Hispanic men.

Among those newly infected with the virus, black men were no more likely to be drug users or to engage in risky sex than were white men, according to the study. More research is needed to explain why young black men are at such greater risk for contracting the disease, but there are several hints from other studies, researchers said.

The fact that proportionally more blacks than whites are already infected would tend to produce higher transmission rates among blacks, said Dr. Richard Wolitski, acting director of the center’s division for H.I.V. and AIDS prevention. Young black men are much more likely to have been incarcerated. Infection rates among former convicts are high, largely because of behaviors outside of prison, studies show.

Dr. Wolitski said young black gay and bisexual men also tended to have partners who were older than their white counterparts and thus were more likely to have already been infected.

Girls and women make up 27 percent of those newly infected with the virus, and 80 percent of them contracted H.I.V. because of high-risk heterosexual contact. Among newly infected males, 81 percent of white men and 63 percent of black men were gay or bisexual.

In one of the most dismal statistics provided by the centers, researchers said that 80 percent of gay and bisexual men in 15 cities had not been reached by intensive H.I.V. prevention efforts that have proven effective. Agency officials said that more must be done, including expanded H.I.V. screening programs and better directing of prevention efforts at those most at risk.

http://www.nytimes.com

Unsafe sex 'biggest threat' for gay men

Unsafe sex 'biggest threat' for gay men

By Xie Chuanjiao (China Daily)
Updated: 2008-09-09 07:46

The incidence of HIV/AIDS among Beijing's drug users is in decline but the city's gay community remains the most at-risk group, a local health official said on Friday.

He Xiong, deputy director of the Beijing center for disease control and prevention (CDC), said that based on figures for the first seven months, 1.5 percent of the city's drug users are HIV positive, compared with 5 percent in 2001.

In comparison, 5 percent of gay men in the capital are HIV positive, while 0.5 percent of unlicensed prostitutes are infected with the virus, He said, without giving figures for 2001.

"More than 43 percent of all newly reported cases are attributed to people having unprotected sex, and gay men are the most at risk," he said.

Related readings: AIDS rampant among Beijing gays Capital strengthens AIDS prevention and control More prevention, better access to medicine against AIDS

Research carried out over the past three years has shown that less than 50 percent of gay men use condoms, so promoting better health awareness among them is a major task, he said.

During the first seven months of the year, 563 new HIV cases were reported in Beijing, 118 of which involved local people and the rest migrant workers, He said.

New cases were reported in each of Beijing's 18 districts and counties, he said.

In the whole of last year 1,190 new cases were reported, up slightly on 2006, he said.

While the development of a comprehensive HIV/AIDS monitoring network - comprising 69 clinics and 128 laboratories - has helped keep the spread of the virus in check, high-risk groups must become more aware of the dangers, the head of a local volunteer group told China Daily Monday.

Xiao Dong, chief of the Chaoyang Chinese AIDS Volunteer Group, said: "Gay people must voluntarily practice safe sex and take regular tests."

The efforts of groups like Xiao's are vital to reducing the health risks faced by Beijing's gay community, He said.

"They work closely with gay people and provide free condoms and confidential consultancy and test services."

Between January and July, more than 1 million people in Beijing had received an HIV test, He said.

Also, prevention and treatment clinics throughout the city now have intervention teams to work with high-risk groups. These people help not only with essential medical treatments, but also everyday matters such as problems at work, he said.

http://www.chinadaily.com.cn

Hypnosis: Another way to manage pain, kick bad habits

During hypnosis, you might receive suggestions designed to decrease your perception of pain and increase your ability to cope with it. Alternatively, you might receive suggestions designed to decrease cravings.

Have you ever been totally absorbed while reading a book, cooking or watching a movie? Did you zone out to the point you didn't notice what else was going on around you? If so, you've experienced a trance-like state that's similar to what happens to you during hypnosis.

Although its medical uses aren't entirely understood, hypnosis appears to help with a variety of health conditions, when provided by a certified hypnotherapist or other qualified clinician. These range from helping to manage pain from chronic conditions to easing the symptoms of asthma to kicking bad habits like smoking.

What is hypnosis?

Hypnosis, also referred to as hypnotherapy or hypnotic suggestion, is a trance-like state of mind. It is usually achieved with the help of a hypnotherapist and is different from your everyday awareness. When you're under hypnosis:

• Your attention is more focused
• You're deeply relaxed and calm
• You're more open to suggestions, and less critical or disbelieving

The purpose of hypnosis is to help you gain more control over your behavior, emotions or physical well-being.

It's not clear how hypnosis works. Hypnotherapists say that hypnosis creates a state of deep relaxation and quiets the mind. When you're hypnotized, you can concentrate intensely on a specific thought, memory, feeling or sensation while blocking out distractions. You're more open than usual to suggestions, and this can be used to change your behavior and thereby improve your health and well-being.

Who is hypnosis for?

Hypnotherapy has the potential to help relieve the symptoms of a wide variety of diseases and conditions. It can be used independently or along with other treatments. For example, it's one of several relaxation methods for treating chronic pain that has been approved by an independent panel convened by the National Institutes of Health.

According to preliminary studies, hypnotherapy may be used to:

• Change negative behaviors, such as smoking, bed-wetting and overeating
• Reduce or eliminate fears, stress and anxiety
• Treat pain during childbirth and reduce labor time
• Control pain during dental and surgical procedures
• Relieve symptoms associated with irritable bowel syndrome (IBS)
• Lower blood pressure
• Control nausea and vomiting caused by chemotherapy
• Reduce the intensity or frequency of headaches, including migraines
• Treat and ease the symptoms of asthma
• Hasten the healing of some skin diseases, including warts, psoriasis and atopic dermatitis

Although hypnosis may have the potential to help with a wide variety of conditions, it's typically used as one part of a broader treatment plan rather than as a stand-alone therapy. Like any other therapy, hypnosis can be helpful to some people but not to others. It seems to work best when you're highly motivated and your therapist is well trained.

Types of hypnosis

There are a variety of hypnotic techniques. The approach you choose depends on what you want to accomplish as well as your personal preferences. Your hypnotherapist may make a recommendation regarding the best technique for your condition.

For example, in one method a hypnotherapist leads you into hypnosis by talking in a gentle, soothing tone and describing images that create a sense of relaxation, security and well-being. While you're under hypnosis, the hypnotherapist suggests ways for you to achieve specific goals, such as reducing pain or stress or helping to eliminate the cravings associated with smoking cessation.

In another technique, once you're under hypnosis, the hypnotherapist helps stimulate your imagination by suggesting specific mental images for you to visualize. This conscious creation of vivid, meaningful pictures in your mind is called mental imagery, and it's a way to help bring about what you want to achieve. For instance, hypnotherapists can help athletes visualize what they want to accomplish before they perform it physically, such as shooting baskets or hitting a golf ball.

Self-hypnosis is a third technique. A certified hypnotherapist teaches you how to induce a state of hypnosis in yourself. You then use this skill on your own to help yourself.

Although hypnotherapists, like other health care practitioners, each have their own style, expect some common elements:

• A typical session lasts from 30 to 60 minutes.
• The number of sessions can range from one to several.
• You generally bring yourself out of hypnosis at the end of a session.
• You can usually resume your daily activities immediately after a session.

Myths about hypnosis

If you've ever seen hypnotism used as entertainment in a stage act, you've probably witnessed several of the myths about hypnosis in action. Legitimate clinical hypnotherapy practiced by a qualified professional is not the same process as that performed on stage.

Myth: When you're under hypnosis, you surrender your free will.
Reality: Hypnosis is a heightened state of concentration and focused attention. When you're under hypnosis, you don't lose your personality, your free will or your personal strength.

Myth: When you're under hypnosis, the hypnotherapist controls you.
Reality: You do hypnosis voluntarily for yourself. A hypnotherapist only serves as a knowledgeable guide or facilitator.

Myth: Under hypnosis, you lose consciousness and have amnesia.
Reality: A small number of people who go into a very deep hypnotic state experience amnesia. However, most people remember everything that occurred under hypnosis.

Myth: You can be put under hypnosis without your consent.
Reality: Successful hypnosis depends on your willingness to experience it. Even with voluntary participation, not everyone can be led into a hypnotic state.

How to choose a qualified professional

Hypnosis as a practice is not regulated in most states, so it pays to be very careful when selecting a therapist. Certified lay hypnotherapists are individuals who have completed 200 or more hours of training in hypnosis but don't have additional professional health care training. Licensed health care professionals who practice hypnotherapy, such as psychologists, doctors and social workers, are trained in hypnosis in addition to their university training.

Apply the same care in choosing a hypnotherapist as you would a doctor. Ask someone you trust for recommendations. When you find a potential hypnotherapist, ask questions such as:

• Do you have training in a field such as psychology, medicine, social work or dentistry?
• Are you licensed in your specialty in this state?
• Where did you go to school, and where did you do your internship, residency or both?
• If you're a lay hypnotist, how much training have you had and from what school?
• What professional organizations do you belong to?
• How long have you been in practice?
• What are your fees? Does insurance cover your services?

Risks of hypnosis

Hypnosis conducted under the care of a trained therapist is considered a safe complementary and alternative medicine treatment. Adverse reactions, such as headache, dizziness and nausea, can happen but are uncommon.

Use special caution before allowing a hypnotherapist to help you restore lost memories. In this type of hypnosis, some people actually create "memories" from their imagination. These "implanted memories" can be very troubling to you and your loved ones. You should avoid this type of hypnosis.

http://www.mayoclinic.com

Complementary and alternative medicine: What is it?

Ranging from herbs to acupuncture, alternative medicine is becoming increasingly popular. Learn the basics.

When you were a child and sprained an ankle or came down with the flu, you probably visited a family doctor or a pediatrician to treat your problem. As an adult, you most likely visit your primary care physician for what ails you. But now your friends are suggesting alternative medicine treatments that you've never heard of — things like homeopathy, ayurveda, acupuncture and herbs.

What are these alternative medicine treatments? Are they safe? Will they work? Get the basics yourself before starting any alternative medicine therapy, and always tell your doctor which ones you're trying.

What is alternative medicine? What is complementary medicine?

Alternative medicine generally refers to practices not typically used in conventional medicine. What's considered alternative medicine changes constantly as more and more treatments undergo rigorous study and are proved to be effective or not.

• Complementary medicine is thought of as treatments used in addition to the conventional therapies your doctor may prescribe, such as using tai chi or massage in addition to prescription medicine for anxiety.
• Alternative medicine is generally thought of as being used instead of conventional methods. For example, this might mean seeing a homeopath or naturopath instead of your regular doctor.

Integrative medicine: Combining complementary treatments with conventional care

Conventional doctors are learning more about complementary and alternative medicine (CAM) because they recognize that more than half of people try some kind of alternative treatment. Many health care institutions have begun integrating therapies that aren't part of mainstream medicine into their treatment programs. A number of medical schools now include education on nontraditional techniques in their curriculum. As complementary and alternative therapies prove effective, they're being combined more often with conventional care. This is known as integrative medicine. You're practicing integrative medicine when you choose to add a complementary treatment to an existing conventional treatment. For instance, you may decide to take an omega-3 fatty acid supplement to help keep your heart healthy in addition to statins your doctor prescribed to reduce your cholesterol. Remember, talk to your doctor before combining complementary and alternative treatments with conventional treatments to avoid possible problems.

What are the principles of complementary and alternative medicine?

Many alternative medicine practitioners base their work around a few common principles. Some of these are similar to what your conventional doctor might do, while others are quite different. Basic philosophies of complementary and alternative medicine include:

• Prevention is key to good health. Taking steps to better your health before you get sick is the best way to keep yourself healthy.
• Your body has the ability to heal itself. Alternative medicine practitioners see themselves as facilitators. To them, your body does the healing work, and treatment encourages your natural healing processes.
• Learning and healing go hand in hand. Alternative medicine practitioners see themselves as teachers and mentors who offer guidance. To the practitioner, you're the one who does the healing.
• Holistic care. The focus is on treating you as a whole person — recognizing that physical health, mental well-being, relationships and spiritual needs are interconnected and play a part in your overall health.

What are some examples of complementary and alternative medicine?

To make sense of the many therapies available, it might help to look at them in the broad categories that the National Institutes of Health uses for classification. Keep in mind that while these categories may be useful for understanding types of complementary and alternative medicine, the distinctions between therapies aren't clear-cut. Some treatment systems may use techniques from more than one category. For example, traditional Chinese medicine uses several types of complementary and alternative medicine. Some techniques may fit in more than one category. For example, acupressure could fit either in the category of manipulation and touch or in the category of energy therapies. Here are the broad categories of complementary and alternative medicine.

Healing systems
Healing systems are complete sets of theories and practices. A system isn't just a single practice or remedy — such as massage — but many different practices that all center on a philosophy or lifestyle, such as the power of nature or the presence of energy in your body. Many healing systems developed long before the conventional Western medicine that's commonly used in the United States.

Examples of complementary and alternative medicine healing systems include:

• Ayurveda. This form of medicine, which originated in India more than 5,000 years ago, emphasizes a unique cure per individual circumstances. It incorporates treatments including yoga, meditation, massage, diet and herbs.
• Homeopathy. This treatment uses minute doses of a substance that causes symptoms to stimulate the body's self-healing response.
• Naturopathy. This type of treatment focuses on noninvasive treatments to help your body do its own healing. Naturopaths draw on many forms of complementary and alternative medicine, including massage, acupuncture, herbal remedies, exercise and lifestyle counseling.
• Ancient medicines. These complementary and alternative medicine treatments include Chinese, Asian, Pacific Islander, American Indian and Tibetan practices.

Mind-body connections
Mind-body techniques strengthen the communication between your mind and your body. Complementary and alternative medicine practitioners say these two systems must be in harmony for you to stay healthy. Examples of mind-body connection techniques include:

• Meditation
• Yoga
• Biofeedback
• Prayer
• Hypnosis
• Relaxation and art therapies, such as poetry, music and dance

Dietary supplements and herbal remedies
These treatments use ingredients found in nature. Examples of herbs include ginseng, ginkgo and echinacea, while examples of other dietary supplements include selenium, glucosamine sulfate and SAM-e. Herbs and supplements can be taken as teas, oils, syrups, powders, tablets or capsules. Some say that they trust herbal medicine because it's been used for thousands of years. Others say that they like it because it's "natural."

Remember, though, that natural doesn't mean that herbs and supplements are always safe — and added ingredients aren't always natural. Dietary supplements and herbal remedies can cause side effects and interact with medications, so be sure to investigate possible dangers or drug interactions with your doctor. As with other complementary and alternative treatments, always talk to your doctor before taking an herb or supplement to make sure it's safe for you.

Manipulation and touch
These methods use human touch to move or manipulate a specific part of your body. They include:

• Chiropractic and spinal manipulation
• Massage
• Other types of manipulation and touch therapies, such as osteopathy, craniosacral therapy and acupressure

Energy therapies
Some complementary and alternative medicine practitioners believe an invisible energy force flows through your body, and when this energy flow is blocked or unbalanced you can become sick. Different traditions call this energy by different names, such as chi, prana and life force. Unblocking or re-balancing your energy force is the goal of these therapies, and each claims to accomplish that goal differently. Proponents of acupuncture, for instance, say that the insertion of needles into points along energy pathways in your body restores your natural energy.

Other energy therapies include:

• Therapeutic touch
• Reiki
• Magnet therapy
• Polarity therapy
• Light therapy

Are conventional doctors opposed to complementary and alternative medicine?

Many doctors aren't opposed to complementary and alternative medicine. But many doctors practicing today did not receive training in CAM therapies, so they may not feel comfortable addressing questions in this area. However, as the evidence for certain therapies increases, doctors in the United States are increasingly referring people to complementary and alternative practitioners. Your doctor may be willing to discuss these options with you.

At the same time, conventional doctors also have good reason to be skeptical when it comes to complementary and alternative medicine. Some complementary and alternative medicine practitioners make exaggerated claims about curing diseases, and some ask you to forgo treatment from your conventional doctor to use their unproven therapies. Some forms of complementary and alternative medicine can even hurt you.

Conventional medicine relies on methods proved to be safe and effective with carefully designed trials and research. But many complementary and alternative treatments lack solid research on which to base sound decisions. The dangers and possible benefits of many complementary and alternative treatments remain unproved.

Why is there a lack of evidence about complementary and alternative treatments?

One reason for the lack of research in complementary and alternative treatments is that large, carefully controlled medical studies are costly. Trials for conventional medications or procedures are often directly or indirectly funded by the government or drug companies, giving conventional treatments more resources to do studies. Most complementary and alternative treatment trials are more difficult to fund, so there are fewer trials. Nonetheless, a number of studies are currently under way on complementary and alternative treatments ranging from herbs to yoga that may help identify what works and what doesn't, and what's safe and what isn't. In fact, the U.S. government has established a National Center for Complementary and Alternative Medicine to help guide the public in making wise choices when it comes to complementary and alternative treatments.

Talk to your doctor about possible benefits and dangers

Work with your conventional medical doctor to help you make informed decisions regarding complementary and alternative treatments. Even if your doctor can't recommend a specific complementary and alternative treatment, he or she can help you understand possible risks and benefits before you try a treatment. Though some of these treatments can be helpful, many have side effects and can cause problems with certain medications or health conditions. Keep in mind that CAM treatments aren't a substitute or replacement for conventional medical care — but used wisely and in conjunction with conventional medical treatment, they may help you alleviate stress, pain and anxiety, manage your symptoms, maintain strength and flexibility, and promote a sense of well-being.

http://www.mayoclinic.com

Family therapy: Healing family conflicts

Families can be torn apart by illness, divorce or other problems that create conflict and stress. Family therapy can help families identify and resolve problems.

Your family can be your greatest source of support, comfort and love. But it can also be your greatest source of pain and grief. A health crisis, mental illness, work problems or teenage rebellion may threaten to tear your family apart.

Family therapy can help your family weather such storms. Family therapy can help patch strained relationships, teach new coping skills and improve how your family works together. Whether it's you, your partner, a child or even a sibling or parent who's in crisis, family therapy can help all of you communicate better and learn to get along.

What is family therapy?

Family therapy is a type of psychotherapy. It helps families or individuals within a family understand and improve the way family members interact with each other and resolve conflicts.

Family therapy is usually provided by therapists known as marriage and family therapists. These therapists provide the same mental health services as other therapists, simply with a specific focus — family relationships.

Family therapy is often short term. You usually attend one session a week, typically for three to five months. In some cases, though, families may need more intensive treatment. The treatment plan will depend on your family's specific situation.

Who can benefit from family therapy?

In general, anyone who wants to improve troubled relationships can benefit from family therapy. Family therapy can help with such issues as:

• Marital problems
• Divorce
• Eating disorders, such as anorexia or bulimia
• Substance abuse
• Depression or bipolar disorder
• Chronic health problems, such as asthma or cancer
• Grief, loss and trauma
• Work stress
• Parenting skills
• Emotional abuse or violence
• Financial problems

Your family may do family therapy along with other types of mental health treatment, especially if one of you has a serious mental illness that also requires intense individual therapy. Family therapy isn't a substitute for other necessary treatments. For instance, family therapy can help family members cope if a relative has schizophrenia. But the person with schizophrenia should continue with his or her individualized treatment plan, such as medication and possibly hospitalization.

In some cases, family therapy may be ordered by the legal system. Adolescents in trouble with the law may be ordered into family therapy rather than serving jail time, for instance. Violent or abusive parents are sometimes spared jail if they enter family therapy. Divorcing couples may also be required to attend family therapy.

How does family therapy work?

Family therapy often brings entire families together in therapy sessions. However, family members may also see a family therapist individually. Family therapy can even include nonfamily members, such as teachers, other health care providers or representatives of social services agencies.

Working with a family therapist, you and your family will examine your family's ability to solve problems and express thoughts and emotions. You may explore family roles, rules and behavior patterns in order to spot issues that contribute to conflict. Family therapy may help you identify your family's strengths, such as caring for one another, and weaknesses, such as an inability to confide in one other.

For example, say that your adult son has depression. Your family may not understand the roots of his depression or how best to offer help. Although you're worried about your son's health, you have such deep-seated family conflicts that conversations ultimately erupt into arguments. You're left with hurt feelings, decisions go unmade, and the rift grows wider.

Family therapy can help you pinpoint your specific concerns and assess how your family is handling them. Guided by your therapist, you'll learn new ways to interact and overcome old problems. You'll set individual and family goals and work on ways to achieve them. In the end, your son may be better equipped to cope with his depression, you'll understand his needs better, and you, your partner and your son may all get along better.

How do you choose a family therapist?

Like other psychotherapists, family therapists are licensed mental health professionals. Although different states have different licensing or credentialing requirements, most states require advanced training, including a master's or doctoral degree, graduate training in marriage and family therapy, and training under the supervision of other experts. Many marriage and family therapists opt to become credentialed by the American Association for Marriage and Family Therapy (AAMFT), which sets specific eligibility criteria.

Most family therapists work in private practice. But they may also work in clinics, mental health centers, hospitals and government agencies.

Ask your primary care doctor for a referral to a marriage or family therapist. Family and friends also may give you recommendations based on their experiences. Your health insurer, employee assistance program, clergy, or state or local agencies also may offer recommendations. You can also look in the phone book.

What questions should you ask when choosing a family therapist?

Before choosing a family therapist, you can ask lots of questions to see if he or she is the right fit for your family. Consider asking questions like these:

• Are you a clinical member of the AAMFT or licensed by the state, or both?
• What is your educational and training background?
• What is your experience with my type of problem?
• How much do you charge?
• Are your services covered by my health insurance?
• Where is your office, and what are your hours?
• How long is each session?
• How often are sessions scheduled?
• How many sessions should I expect to have?
• What is your policy on canceled sessions?
• How can I contact you if I have an emergency?

Starting therapy with a family therapist can be one of the best things you do when your family is torn apart. You can heal emotional wounds, come to understand one another better and restore a sense of harmony you may not have felt for a long time.

http://www.mayoclinic.com

CPAP devices: Tips for avoiding 10 common problems

CPAP is an important treatment for sleep apnea, but it's not without its frustrations. Learn how to avoid uncomfortable masks and other common CPAP problems.

CPAP (continuous positive airway pressure) therapy is a common treatment for sleep apnea. CPAP includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose piece. Common problems with CPAP include a leaky mask, trouble falling asleep, and a dry mouth or nose. If you are experiencing these or other issues, you're not alone — two out of every three people using CPAP devices will experience such problems.

The good news is that if one CPAP mask or device doesn't work for you, you have other options. And most CPAP masks are adjustable, to help make them more comfortable for you. Here are 10 common CPAP problems and what you can do about them.

The wrong size or style CPAP mask

Work closely with your doctor and CPAP supplier to make sure you have a CPAP mask that suits your needs and fits you. Everyone has different needs and face shapes, so the right style and size mask for someone else may not work for you.

• Many mask styles available. A range of CPAP masks are available. For example, some feature full face masks that cover your mouth and nose, with straps that stretch across your forehead and cheeks. These may make some people feel claustrophobic, but they work well at providing a stable fit if you move around a lot in your sleep. Other masks feature nasal pillows that fit under your nose and straps that cover less of your face. These can feel less cumbersome. And they may work well if you wear glasses or read with the mask on, because some nasal pillow masks obstruct vision less than do full face masks. However, they may not work if you move around a lot in your sleep or sleep on your side.
• Size important. Most masks come in different sizes. Just because you're a certain size in one mask doesn't mean you'll be the same size in another. CPAP masks are usually adjustable. Ask your doctor or CPAP supplier to show you how to adjust your mask to get the best fit. Manufacturer product instructions also can help show you how to do this.

Trouble getting used to wearing the CPAP device

It may help to start by practicing wearing just the CPAP mask for short periods of time while you're awake, for example while watching TV. Then try wearing the mask and hose with the air pressure on, still during the daytime while you're awake. Once you become accustomed to how that feels, shift to using the CPAP device every time you sleep — at night and during naps. Inconsistently wearing the CPAP device may delay getting used to it. Stick with it for several weeks or more to see if the mask and pressure settings you have will work for you.

Difficulty tolerating forced air

You may be able to overcome this by using a "ramp" feature on the machine. This feature allows you to start with low air pressure, followed by an automatic, gradual increase in the pressure to your prescribed setting as you fall asleep. For example, the pressure can be increased over 10, 15 or 20 minutes. The rate of this ramp feature can be adjusted by your doctor.

If this doesn't help, talk with your doctor about changing to a different type of device that automatically adjusts the pressure while you're sleeping. For example, units that supply bi-level positive airway pressure (BiPAP) are available. These provide more pressure when you inhale and less when you exhale.

Dry, stuffy nose

A CPAP device that features a heated humidifier, which attaches to the air pressure machine, can help. The level of humidification is adjustable. Using a nasal saline spray at bedtime also can help. Your doctor may prescribe a nasal steroid spray if your dryness doesn't respond to heated humidity. It's also important that your mask fit well. A leaky mask can dry out your nose.

Feeling claustrophobic

While you're awake, practice by first just holding the mask up to your face without any of the other parts. Once you're comfortable with that, try wearing the mask with the straps. Next, try holding on the mask and hose, without the straps, with the hose attached to the CPAP machine at a low pressure setting (turn the ramp feature on). And, finally, wear the mask with the straps and with the air pressure machine turned on while awake. After you're comfortable with that, try sleeping with it on.

Relaxation exercises, such as progressive muscle relaxation, also may help reduce your anxiety. If you're still feeling claustrophobic, talk to your doctor or CPAP supplier. It may help to get a different size mask or try a different style, such as one that uses nasal pillows.

Leaky mask, skin irritation or pressure sores

A leaky or ill-fitting mask means you're not getting the full air pressure you need, and you may be irritating your skin. It can also release air into your eyes, causing them to become dry or teary. Try adjusting pads and straps to get a better fit. If the device fits over your nose, make sure it doesn't sit too high on the bridge of your nose, which can direct air into your eyes. Washing the mask daily with warm, soapy water and washing your face at night can help ensure a better, less irritating seal to your skin. If your mask comes with instructions on how to use and clean it, review them before using the mask and again, later, if you have problems.

You may need to ask your supplier to help you find a different size mask, particularly if your weight changes markedly, or try a different style device such as a nasal pillow. If you develop skin deterioration or sores, such as on your nose, tell your doctor promptly.

Difficulty falling asleep

This is a normal, temporary problem. Wearing the mask alone for some time during the day may help you get accustomed to how it feels. Using the ramp feature, which provides an automatic, gradual increase in the air pressure to your prescribed pressure setting as you fall asleep also may help. And practice good general sleep habits — exercise regularly, avoid caffeine and alcohol before bedtime, and try to relax. For example, take a warm bath before you go to bed. Avoid going to bed until you're tired.

Dry mouth

If you breathe through your mouth at night or sleep with your mouth open, some CPAP devices may worsen dry mouth. A chin strap may help keep your mouth closed and reduce the air leak if you wear a nasal mask. A full-face-mask-style device that covers your mouth and nose may also work well for you. A CPAP-heated humidifier that attaches to the air pressure machine also may help.

Unintentionally removing the CPAP device during the night

It's normal to sometimes wake up to find you've removed the mask in your sleep. If you move a lot in your sleep, you may find that a full face mask will stay on your face better. You may be pulling off the mask because your nose is congested. If so, ensuring a good mask fit and adding a CPAP-heated humidifier may help. A chin strap also may help keep the device on your face. If this is a consistent problem, consider setting an alarm for sometime in the night, to check whether the device is still on. You could progressively set the alarm for later in the night if you find you're keeping the device on longer.

Annoyed by the noise

Most new models of CPAP devices are almost silent, but if you find a device's noise is bothersome, first check to make sure the device air filter is clean and unblocked. Something in its way may be contributing to noise. If this doesn't help, have your doctor or CPAP supplier check the device to ensure it's working properly. If the device is working correctly and the noise still bothers you, try wearing earplugs or using a white-noise sound machine to mask the noise.

Time and patience key to success

Using a CPAP device can be frustrating as you try to get used to it, but it's important you stick with it. The treatment is essential to avoiding sleep apnea-related complications such as heart problems and daytime fatigue. Work with your doctor and CPAP supplier to ensure the best fit and device for you, and try making adjustments if you're experiencing some of the common CPAP problems. It may take several months to find the correct settings for you and to adapt to the mask. With time and patience, CPAP can positively affect your quality of life and health.

http://www.mayoclinic.com

Depression and anxiety: Exercise eases symptoms

Exercise can improve symptoms of depression and anxiety. Even a little exercise helps. Use these realistic tips and goals to get started and stick with it.

If you have depression or anxiety, you might find your doctor or mental health provider prescribing a regular dose of exercise in addition to medication or psychotherapy. Exercise isn't a cure for depression or anxiety. But its psychological and physical benefits can improve your symptoms.

"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.

When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. See how exercise can ease depression symptoms and anxiety symptoms. Plus, get realistic tips to get started and stick with exercising.

How exercise helps depression and anxiety

Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes and other diseases. A growing volume of research shows that exercise can also help improve symptoms of certain mental health conditions, including depression and anxiety. Exercise may also help prevent a relapse after treatment for depression or anxiety.

Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve depression symptoms. But smaller amounts of activity — as little as 10 to 15 minutes at a time — can improve mood in the short term. "Small bouts of exercise may be a great way to get started if it's initially too hard to do more," Dr. Vickers-Douglas says.

Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Some evidence suggests that exercise raises the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release muscle tension, help you sleep better, and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety

http://www.mayoclinic.com

Sleep apnea

Definition

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly and you feel tired even after a full night's sleep?

Sleep apnea occurs in two main types: obstructive sleep apnea, the more common form that occurs when throat muscles relax, and central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing. Additionally, some people have complex sleep apnea, which is a combination of both.

If you think you might have sleep apnea, see your doctor. Treatment is necessary to avoid heart problems and other complications.

Symptoms

The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making the type of sleep apnea more difficult to determine. The most common signs and symptoms of obstructive and central sleep apneas include:

• Excessive daytime sleepiness (hypersomnia)
• Loud snoring, which is usually more prominent in obstructive sleep apnea
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea
• Awakening with a dry mouth or sore throat
• Morning headache
• Difficulty staying asleep (insomnia)

When to see a doctor
Consult a medical professional if you experience, or if your partner observes, the following:

• Snoring loud enough to disturb the sleep of others or yourself
• Shortness of breath that awakens you from sleep
• Intermittent pauses in your breathing during sleep
• Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving

Many people don't think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. But be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence.

Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness (hypersomnia) may be due to other disorders, such as narcolepsy.

Causes

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Sleep apnea

Causes of obstructive sleep apnea
Obstructive sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily stops. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.

Causes of central sleep apnea
Central sleep apnea, which is far less common, occurs when your brain fails to transmit signals to your breathing muscles. You may awaken with shortness of breath or have a difficult time getting or staying asleep. Like obstructive sleep apnea, snoring and daytime sleepiness can occur. The most common cause of central sleep apnea is heart disease, and less commonly, stroke. People with central sleep apnea may be more likely to remember awakening than people with obstructive sleep apnea are.

Causes of complex sleep apnea
People with complex sleep apnea have upper airway obstruction just like those with obstructive sleep apnea, but they also have a problem with the rhythm of breathing and occasional lapses of breathing effort.

Treatments and drugs

For milder cases of sleep apnea, your doctor may recommend lifestyle changes such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Treatments for obstructive sleep apnea may include:

Therapies

• Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.

  Although CPAP is a preferred method of treating sleep apnea, some people find it cumbersome or uncomfortable. With some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit. You may need to try more than one type of mask to find one that's comfortable. Some people benefit from also using a humidifier along with their CPAP system.

  Don't just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable. Additionally, contact your doctor if you are still snoring despite treatment or begin snoring again. If your weight changes, the pressure settings may need to be adjusted.

• Adjustable airway pressure devices. If CPAP continues to be a problem for you, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping. For example, units that supply bilevel positive airway pressure (BiPAP) are available. These provide more pressure when you inhale and less when you exhale.

• Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances, but oral appliances may be easier for you to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.

  A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Once you find the right fit, you'll still need to follow up with your dentist at least every six months during the first year and then at least once a year after that to ensure that the fit is still good and to reassess your signs and symptoms.

Surgery
The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:

• Uvulopalatopharyngoplasty (UPPP). During this procedure, your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. However, it may be less successful in treating sleep apnea because tissue farther down your throat may still block your air passage. UPPP usually is performed in a hospital and requires a general anesthetic.
• Maxillomandibular advancement. In this procedure, the upper and lower part of your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.
• Tracheostomy. You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.

Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) are procedures that doctors sometimes use to treat snoring. Although sometimes these procedures are combined with others, they aren't usually recommended as sole treatments for obstructive sleep apnea.

Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

• Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
• Surgery to remove enlarged tonsils or adenoids

Treatments for central and complex sleep apnea may include:

Therapies

• Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help. For example, optimizing therapy for heart failure may eliminate central sleep apnea.
• Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs.
• Continuous positive airway pressure. This method, also used in obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway to keep it from collapsing. CPAP may eliminate snoring and prevent sleep apnea. As with obstructive sleep apnea, it's important that you use the device as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made.
• Bilevel positive airway pressure (BiPAP). Unlike CPAP, which supplies steady, constant pressure to your upper airway as you breathe in and out, BiPAP builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale. The goal of this treatment is to assist the weak breathing pattern of central sleep apnea. Some BiPAP devices can be set to automatically deliver a breath if the device detects you haven't taken one after so many seconds.
• Adaptive servo-ventilation (ASV). This more recently approved airflow device learns your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing. ASV may be more successful than CPAP at treating central sleep apnea. However, more study is needed.

Along with these treatments, you may read or hear about different treatments for sleep apnea, such as implants. Although a number of medical devices and procedures have received Food and Drug Administration clearance, there's limited published research regarding how useful they are, and they aren't generally recommended as sole therapies.

http://www.mayoclinic.com

Traveling for business? Work in a workout

When you're traveling, you can stick to your fitness routine — seriously! Use these simple tips to maintain your fitness program when you're away from home.

If your job keeps you on the road, you know how challenging it can be to maintain your fitness program. Hours of travel and back-to-back meetings may leave little room in your schedule for exercise. But it's not a lost cause. A little dedication and planning can help you stay in shape when you're traveling.

Pack for fitness

Before your trip, call your hotel and ask about on-site or nearby fitness facilities. Then pack accordingly. You may want to bring:

• Athletic shoes
• Exercise clothing
• Swimsuit
• Jump-rope
• Resistance tubing
• Tennis racket
• Music and headphones
• Exercise video or DVD

If you prefer a quicker pace, ask the hotel staff about renting in-line skates or a bicycle.

Start right away

Wear your walking shoes when you travel. If you're traveling by plane, store your carry-on bags in a locker and walk briskly through the terminal while you're waiting for your flight. Pump your arms to increase your heart rate. During your flight, get up once an hour to stretch and walk.

If you're traveling by train, walk through the cars occasionally. Walk outdoors when the train stops to let passengers on and off. If you're driving, take frequent breaks to get out and stretch. Even a short walk around a rest area can boost your mood and energy level.

Check out the facilities

When you arrive at your destination, check out the fitness facilities at your hotel or a nearby health club. Then schedule time for a workout. If the options seem limited, get creative:

• Use the halls. Walk up and down the hotel halls. Better yet, climb the stairs between hallway laps.
• Get wet. Swim laps in the hotel pool.
• Skip rope. Use a jump-rope in the hotel's fitness room or at the edge of the parking area.
• Do jumping jacks. Try a few sets right in your room.
• March in place. Pump your arms to increase your calorie-burning power.
• Try aerobics. Follow an aerobics program on TV, or play an exercise video or DVD from home.
• Use resistance tubing. These stretchy tubes offer weight-like resistance when you pull on them. You can use resistance tubing to build strength in nearly any muscle group.
• Take advantage of your own body weight. Try push-ups, abdominal crunches and leg squats.

http://www.mayoclinic.com

Tai chi: Improved stress reduction, balance, agility for all

The ancient art of tai chi uses gentle flowing movements to reduce the stress of today's busy lifestyles and improve health. Find out how to get started.

The graceful images of people gliding through dance-like poses as they practice tai chi (TIE-chee) are compelling. Simply watching them is relaxing. Tai chi, in fact, is often described as "meditation in motion" because it promotes serenity through gentle movements — connecting the mind and body.

Originally developed in China as a form of self-defense, tai chi is a graceful form of exercise that has existed for some 2,000 years. Practiced regularly, tai chi can help you reduce stress and enjoy other health benefits.

Understanding tai chi

Tai chi, sometimes called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do tai chi, you perform a series of postures or movements in a slow, graceful manner. Each posture flows into the next without pausing.

Anyone, regardless of age or physical ability, can practice tai chi. It doesn't take physical prowess. Rather, tai chi emphasizes technique over strength.

Tai chi is used to:

• Reduce stress
• Increase flexibility
• Improve muscle strength and definition
• Increase energy, stamina and agility
• Increase feelings of well-being

Tai chi has more than 100 possible movements and positions. You can find several that you like and stick with those, or explore the full range. The intensity of tai chi varies somewhat depending on the form or style practiced. Some forms of tai chi are more fast-paced than others, for instance. However, most forms are gentle and suitable for everyone. And they all include rhythmic patterns of movement that are coordinated with breathing.

Although tai chi is generally safe, consider talking with your doctor before starting a new program. This is particularly important if you have any problems with your joints, spine or heart.

Stress reduction and other benefits of tai chi

Like other practices that bring mind and body together, tai chi can reduce stress. During tai chi, you focus on movement and breathing. This combination creates a state of relaxation and calm. Stress, anxiety and tension should melt away as you focus on the present, and the effects may last well after you stop your tai chi session.

Tai chi may also help your overall health, although it's not a substitute for traditional medical care. Tai chi is generally safe for people of all ages and levels of fitness. Older adults may especially find tai chi appealing because the movements are low impact and put minimal stress on muscles and joints. Tai chi may also be helpful if you have arthritis or are recovering from an injury.

Despite its ancient history, tai chi has been studied scientifically only in recent years. And that research is suggesting that tai chi may offer numerous other benefits beyond stress reduction, including:

• Reducing anxiety and depression
• Improving balance and coordination
• Reducing the number of falls
• Improving sleep quality, such as staying asleep longer at night and feeling more alert during the day
• Slowing bone loss in women after menopause
• Lowering blood pressure
• Improving cardiovascular fitness
• Relieving chronic pain
• Improving everyday physical functioning

Learning to do tai chi

Wondering how to get started in tai chi? You don't need any special clothing or equipment to do tai chi. To gain full benefits, however, it may be best to seek guidance from a qualified tai chi instructor.

A tai chi instructor can teach you specific positions and how to regulate your breathing. An instructor also can teach you how to practice tai chi safely, especially if you have injuries, chronic conditions, or balance or coordination problems. Although tai chi is slow and gentle, with virtually no negative side effects, injuries are possible if tai chi isn't done properly. It's possible you could strain yourself or overdo it when first learning. Or if you have balance problems, you could fall during tai chi.

You can find tai chi classes in many communities today. Contact your local senior center, YMCA or YWCA, health club, community education center or wellness facility for help finding qualified instructors.

During tai chi classes, the instructor can give you personal guidance and correct any errors in your style before they become habit. Eventually, you may feel confident enough to do tai chi on your own. But if you like the social element, consider sticking with group classes.

Putting tai chi into practice

To reap the greatest stress reduction benefits from tai chi, consider practicing it regularly. Many people find it helpful to practice tai chi in the same place and at the same time every day to develop a routine. But if your schedule is erratic, do tai chi whenever you have a few minutes.

You can even draw on the soothing concepts of tai chi without performing the actual movements if you get stuck in stressful situations — a traffic jam or a work conflict, for instance.

http://www.mayoclinic.com

Restless leg syndrome

Definition

Restless leg syndrome (RLS) is a condition in which your legs feel extremely uncomfortable while you're sitting or lying down. It makes you feel like getting up and moving around. When you do so, the unpleasant feeling of restless leg syndrome temporarily goes away.

Restless leg syndrome affects both sexes, can begin at any age and may worsen as you get older. Restless leg syndrome can disrupt sleep — leading to daytime drowsiness — and make traveling difficult.

A number of simple self-care steps and lifestyle changes may help you. Medications also help many people with restless leg syndrome.

Symptoms

Difficult to describe sensations
People typically describe restless leg syndrome (RLS) symptoms as unpleasant sensations in their calves, thighs, feet or arms, often expressed as:

• Deep-seated
• Creeping
• Crawling
• Jittery
• Tingling
• Burning
• Aching

Sometimes the sensations seem to defy description. People usually don't describe the condition as a muscle cramp or numbness.

Characteristics of signs and symptoms
Common characteristics of RLS signs and symptoms include:

• Starts during inactivity. The sensation typically begins while you're lying down or sitting for an extended period of time, such as in a car, airplane or movie theater.
• Relief by movement. The sensation of RLS lessens if you get up and move. People combat the sensation of restless leg in a number of ways — by stretching, jiggling their legs, pacing the floor, exercising or walking. This compelling desire to move is what gives restless leg syndrome its name.
• Worsening of symptoms in the evening. Symptoms typically are less bothersome during the day and are felt primarily at night.
• Nighttime leg twitching. RLS may be associated with another condition called periodic limb movements of sleep (PLMS). Once called myoclonus, PLMS causes you to involuntarily flex and extend your legs while sleeping — without being aware you're doing it. Hundreds of these twitching or kicking movements may occur throughout the night. If you have severe RLS, these involuntary kicking movements may also occur while you're awake. PLMS is common in older adults, even without RLS, and doesn't always disrupt sleep. More than four out of five people with RLS also experience PLMS.

Most people with RLS find it difficult to get to sleep or stay asleep. Insomnia may lead to excessive daytime drowsiness, but RLS may prevent you from enjoying a daytime nap.

Although RLS doesn't lead to other serious conditions, symptoms can range from bothersome to incapacitating. In fact, it's common for symptoms to fluctuate in severity, and occasionally symptoms disappear for periods of time.

RLS can develop at any age, even during childhood. Many adults who have RLS can recall being told as a child that they had growing pains or can remember parents rubbing their legs to help them fall asleep. The disorder is more common with increasing age.

Causes

In many cases, no known cause for restless leg syndrome exists. Researchers suspect the condition may be due to an imbalance of the brain chemical dopamine. This chemical sends messages to control muscle movement.

Heredity
RLS runs in families in up to half the people with RLS, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Stress and pregnancy
Stress tends to worsen the symptoms of RLS. Pregnancy or hormonal changes also may temporarily worsen RLS signs and symptoms. Some women experience RLS for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.

Related conditions
For the most part, restless leg syndrome isn't related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:

• Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
• Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.
• Kidney failure. If you have kidney failure, you also may have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS

Tests and diagnosis

Some people with restless leg syndrome never seek medical attention because they worry that their symptoms are too difficult to describe or won't be taken seriously. Some doctors wrongly attribute symptoms to nervousness, stress, insomnia or muscle cramps. But RLS has received more media attention and focus from the medical community in recent years, making more people aware of the condition.

Reviewing your signs, symptoms and medical history
If you think you may have RLS, consult your doctor. Doctors diagnose RLS by listening to your description of your symptoms and by reviewing your medical history. Your doctor will ask you questions such as:

• Do you experience unpleasant or creepy, crawly sensations in your legs, associated with a strong urge to move?
• Does movement help relieve the sensations?
• Are you more bothered by these sensations when sitting or at night?
• Do you often have trouble falling asleep or staying asleep?
• Have you been told that your legs or your arms jerk while you sleep?
• Is anyone else in your family bothered by restless legs?

Ruling out other conditions
There's no blood or lab test specifically for the diagnosis of RLS. Your answers help your doctor clarify whether you have RLS or whether testing is needed to rule out other conditions that may explain your symptoms. Blood tests or muscle or nerve studies to exclude other possible causes may be necessary to pinpoint RLS.

Your doctor may refer you to a sleep specialist for additional evaluation. This may require that you stay overnight at a sleep clinic, where doctors can study your sleep habits closely and check for leg twitching (periodic limb movements) during sleep — a possible sign of RLS. However, a diagnosis of RLS usually doesn't require a sleep study.

Treatments and drugs

Sometimes, treating an underlying condition, such as iron deficiency or peripheral neuropathy, greatly relieves symptoms of restless leg syndrome. Correcting the iron deficiency may involve taking iron supplements. However, take iron supplements only with medical supervision and after your doctor has checked your blood iron level.

If you have RLS without any associated condition, treatment focuses on lifestyle changes, and, if those aren't effective, medications.

Lifestyle changes
Making simple lifestyle changes can play an important role in alleviating symptoms of RLS. These steps may help reduce the extra activity in your legs:

• Take pain relievers. For very mild symptoms, taking an over-the-counter pain reliever such as ibuprofen (Advil, Motrin, others) when symptoms begin may relieve the twitching and the sensations.
• Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
• Apply warm or cool packs. You may find that the use of heat or cold, or alternating use of the two, lessens the sensations in your limbs.
• Try relaxation techniques, such as meditation or yoga. Stress can aggravate RLS. Learn to relax, especially before going to bed at night.
• Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it's important that you practice good sleep hygiene. Ideally, sleep hygiene involves having a cool, quiet and comfortable sleeping environment, going to bed at the same time, rising at the same time, and getting enough sleep to feel well rested. Some people with RLS find that going to bed later and rising later in the day helps in getting enough sleep.
• Exercise. Getting moderate, regular exercise may relieve symptoms of RLS, but overdoing it at the gym or working out too late in the day may intensify symptoms.
• Avoid caffeine. Sometimes cutting back on caffeine may help restless leg. It's worth trying to avoid caffeine-containing products, including chocolate and caffeinated beverages such as coffee, tea and soft drinks, for a few weeks to see if this helps.
• Cut back on alcohol and tobacco. These substances also may aggravate or trigger symptoms of RLS. Test to see whether avoiding them helps.
• Stay mentally alert in the evening. Boredom and drowsiness before bedtime may worsen RLS.

Medication therapy
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

• Medications for Parkinson's disease. These medications reduce the amount of motion in your legs by affecting the level of the chemical messenger dopamine in your brain. They include pramipexole (Mirapex), ropinirole (Requip) and a combination of carbidopa and levodopa (Sinemet). However, people with RLS are at no greater risk of developing Parkinson's disease than are those without RLS. Side effects are usually mild and include nausea, lightheadedness and fatigue.
• Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in too high doses. Some examples include codeine, the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Lortab,Vicodin).
• Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night. But these medications don't eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include clonazepam (Klonopin), eszopiclone (Lunesta), ramelteon (Rozerem), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).
• Medications for epilepsy. Certain epilepsy medications, such as gabapentin (Neurontin), may work for some people with RLS.

It may take several trials for you and your doctor to find the right medication and dosage for you. A combination of medications may work best.

One thing to remember with drugs to treat RLS is that sometimes a medication that has worked for you for a while becomes ineffective. Or you notice your symptoms returning earlier in the day. For example, if you have been taking your medication at 8 p.m., your symptoms of RLS may start at 6 p.m. This is called augmentation. Your doctor may substitute another medication to combat the problem.

Most of the drugs prescribed to treat RLS aren't recommended for pregnant women. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of pain relievers.

Some medications may worsen symptoms of RLS. These include most antidepressants and some anti-nausea drugs. Your doctor may recommend that you avoid these medications if possible. However, should you need to take these medications, restless leg can still be controlled by adding drugs that manage the condition.

http://www.mayoclinic.com