Insomnia as a chief complaint, the main reason for a patient visit, is responsible for approximately 10% of medical visits. When one considers that it's a common add-on to visits for many other diagnoses, its importance is further underscored.

A careful history can help to glean underlying causes and hopefully help in putting together a treatment plan. It's important, for instance, to ask whether a patient has difficulty falling asleep or whether he or she awakens frequently after falling asleep easily. Difficulty falling asleep can be easier to treat as patients with this complaint often respond to more natural treatments that re-set the body's natural clock. Some of these might include melatonin, passionflower extract, valerian, or kava.

Laboratory tests that include a CBC, thyroid function tests, chemistry panel and hormone levels (if appropriate) are part of a standard work-up for insomnia. They will reveal electrolyte abnormalities, thyroid dysfunction, hidden infections, anemia, and peri-menopausal hormone fluctuations.

Difficulty sustaining sleep can have different implications. It's important in this case, to rule out subclinical depression. Sleep disorders of this kind are often typical of depression. It's important to assess whether or not this may be of a transitory nature, e.g. temporary external events that may heighten anxiety and stress levels. Additionally, if depression has been diagnosed, certain antidepressants are classic offenders in regard to altering sleep patterns. Wellbutrin, for example, can impede sleep, whereas tricyclics, such as Amitriptyline can have a marked sleep-inducing effect.

Steroids, such as Prednisone, can interrupt sleep as well as make it difficult to fall asleep. Thyroid medications such as Synthroid or Armour Thyroid can impede sleep. Oral contraceptives and hormone replacement therapy for menopause can alter sleep patterns as well as energy levels during the day.

Stimulants such as caffeine can have a profound effect on sleep patterns. Patients often wrongly assume that tolerance to a certain daily caffeine intake precludes the possibility that the caffeine may be impeding sleep. However, a profound change in sleep patterns can often be effected with a decrease or cessation of daily caffeine consumption. Caffeine is actually a bona fide mood-altering substance according to the food and drug administration.

Similarly, it is often assumed that tolerance to, and indeed craving for, nicotine suggests that a patient may be immune to its known stimulant effects. Once again, this may be an erroneous assumption. Tolerance to daily stimulant effects can be quite independent of nighttime over-stimulatory effects.

In addition to good nutrition and the judicious use of certain supplements such as passionflower, valerian, kava and mclatonin, basic sleep hygiene is mandatory. Caffeine intake should be limited to at least six hours before bedtime. The patient should get into bed at the same time each night, set an alarm, and awaken at the same time each morning. This sleep schedule should be adhered to seven days a week. "Catching up" on sleep on weekends can wreak havoc on the body's internal clock. There should not be any television or music in the bedroom. If it's necessary to watch TV or read in order to fall back asleep, the patient should get out of bed and read, listen to music or watch TV in another room. Proper diaphragmatic breathing can do wonders to assist falling asleep. I suggest a simple course of 50 diaphragmatic breaths before falling asleep. I often teach patients in the office - where I can watch them breathe - how to properly empty the lungs, how long to exhale and how long to hold an inhalation while moving the diaphragm appropriately. After these basics have been addressed, it's often rewarding to look at occult food allergies as they can actually alter sleep patterns.

ARTHRITIS (back to nutrition facts A to Z menu)

Characteristics of Arthritis There are two main types of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis rarely develops before the age of forty, but it affects most people after the age of sixty. The severity of symptoms range from so mild that you don't know you've got it, to so severe that the smallest movement is agony. The most common reason is wear and tear of the cartilage that covers the end of the bones.

Rheumatoid arthritis is an inflammatory condition, where cartilage and tissues in and around the joints are damaged or destroyed. Rheumatoid arthritis creates stiffness, swelling, fatigue, anaemia, weight loss, fever and, often, crippling pain. It frequently occurs in people under forty years of age, including young children.

Diet Advice and Nutrition Facts - Arthritis

Eat plenty of sulphur containing foods, such as garlic and onion, and eggs. Sulphur is needed for the repair and rebuilding of bone, cartilage and connective tissue, and aids in the absorption of calcium.

Eat plenty of green leafy vegetables, and vegetables of every colour, non-acidic fresh fruit.

Eat whole grains (except wheat) such as spelt, kamut, millet and brown rice.

Eat oily fish, such as mackerel, herring, sardine, pilchard (avoid the tomato sauce in the tins of fish).

Eat fresh (not dried or tinned) pineapple when available as the enzyme Bromelain found in pineapple will help reduce inflammation.

Take a tablespoon of linseeds with a couple of glasses of room temperature water every day.

Apple cider vinegar is very good for people with arthritis.

Reduce saturated fat from animals in your diet and avoid fried foods.

Avoid all milk and other dairy produce. You may be alright with goats or sheeps yoghurt.

Avoid red meat, unless you have Blood Type O, in which case you may find that small portions of lean and organic red meat (no more than 4oz/ 125g) will suit you quite well.

Avoid the nightshade family of vegetables (peppers, aubergine or eggplant, tomatoes and white potatoes - also tobacco). The solanine found in these foods can cause pain in the muscles to susceptible people.

Avoid table salt (sodium chloride) but include the natural sodium found in foods such as celery - this is needed to keep calcium in solution and not sit on top of your joints.

Get your iron from food, but ensure your multimineral supplements does not contain extra iron (unless your Doctor tells you you're anaemic) - there is some evidence iron may be involved in pain, swelling and joint destruction. You do need some iron though, so eat broccoli, blackstrap molasses, beetroot, peas.

Check for food aller,,Ties and intolerances with a nutritional consultant or allergy specialist, and, especially if you suffer from rheumatoid arthritis, have a test done via a nutritionist to check whether you have a ` leaky eut' - you almost certainly have!

NSAIDs, among other things, cause `leaky gut'. This can be healed with the help of a nutrition consultant. Meanwhile, take L-Glutamine (Higher Nature) and Butyric Acid (BioCare).

Also have a hair mineral analysis via a nutrition consultant.

Get tested for chlamydia organism which has been linked to some cases of arthritis. Check silicone breast implants.

If you are overweight, lose the excess.

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