Insomnia and its management

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

This is a quick summary of insomnia and how to prevent and ease it; for a more detailed article on insomnia and how to tackle it, ask a Whelehans Pharmacy staff member for a free copy or check www.whelehans.ie.  One in three people suffer from insomnia at some stage in their life while one in ten suffers from chronic insomnia. Half the elderly population complains of suffering from insomnia.

How much sleep do we need?
This varies greatly from person to person. The amount of sleep needed varies from four hours to over ten hours. It also depends on level of activity. A person who is retired may undertake less activity than when they were working and less sleep is needed. On the other hand, a person with a young family and constantly on the go will require more sleep to recuperate. The amount of sleep needed reduces as we get older. A baby needs 16 to 17 hours sleep; by the age of five, sleep requirement reduces to 8 to 9 hours and teenagers generally need less than 8 hours sleep. Even less sleep is needed as we enter adulthood.

Reasons for insomnia

The main reasons for sleep problems include ageing as we need less sleep as we get older (so for example an older people may wake up at something like 5am as the body has enough sleep but it is considered too early to actually get up). Medical conditions can be a reason. Pain is often a problem.  Needing to get up to go to the toilet can disturb sleep. It is estimated that over 60% of men and women over 60 need to get up at least once during the night to go to the toilet. However urinary frequency can easily be treated by your doctor. It could be a medical problem such as unstable bladder which can be rectified with medication. Not drinking tea or coffee late and not taking certain blood pressure tablets late at night can alleviate this. Emotional upset from bereavement can be a cause. Some prescription and over the counter medication including decongestants can disturb sleep. Anxiety, worry and stress can be a factor. Sleep disturbance is a common symptom of depression and low mood.  Change in sleep routine such a shift work can affect sleep. Surroundings can be a reason for poor sleep, for example, a room is too hot or cold, too bright or too noisy.

Recent research

In 2008, research by the German Institute for Quality and Efficiency in Health Care showed that good bedtime habits are more effective than sleeping pills to help insomnia.  The institute found that going to bed when tired, avoiding caffeinated drinks like tea and coffee at night, and not reading or watching television in bed can help people who suffer from sleeping problems. They showed that learning relaxation techniques can help people switch off and make it easier to get to sleep. Getting up at the same time each morning can help your sleep pattern.

Self Help

Avoiding cat naps during the day can help ensure a good night’s sleep. Nicotine can have a negative impact on sleep so stopping smoking can improve your sleep pattern. A warm bath before going to bed can relax you and help you sleep. Many people consider alcohol as an aid to sleep, however alcohol actually disturbs sleep so it should be avoided if you have difficulty sleeping. Regular exercise helps sleep but do not exercise in the late evening. You should avoid watching TV, eating and talking on the phone in bed. If you feel restless in bed you may try getting up and try reading or listening to relaxing music for a while until you get tired again. If you still feel you don’t get a sufficient night’s sleep, it is possible that you don’t need as much sleep as you think you need. We don’t need as much sleep when we were older. Many people in their seventies only need less than 6 hours sleep.

Treatment

Quite often sleep disturbance is due to a medical condition. Examples include depression, asthma, ADHD or pain. Treating the medical is often the key to solving the sleep problem. There are many natural products available on the market with varying degrees of success. Their effectiveness is questionable but they may help if suffering from mild insomnia. Sleeping tablets are only available on prescription and should be used for short term use only. It is easy to become dependent on them and they become less effective if used long term (more than 5 days). The newer non benzodiazepine sleeping tablets such as zopiclone are less addictive than older varieties but it is still easy to become dependant on them. They are best avoided in the elderly as they cause confusion and increase the likelihood of falls. Your GP will generally try to rule out other medical problems such as depression before prescribing sleeping tablets.

I’ll discuss sleeping tablets in this blog in the coming days.

 

Upcoming talk on depression and mental health

Whelehans Pharmacy Mullingar has organised an expert panel to discuss depression and mental health. The information evening is being held in The Greville Arms Hotel on Tuesday February 10^th at 7pm. Speakers will include Consultant Psychiatrist from St Lomans Mental Health Service, Dr Ciaran Corcoran; Specialist Psychiatric Nurse Colette Moriarty and Pharmacist Eamonn Brady.  This talk is open to all and is free of charge. You can turn up on the night or incase it is booked out you can put your name down in advance by calling Whelehans at 04493 34591.

Disclaimer: Consult a healthcare professional before making any changes recommended

 

 

 

 

Constipation in Children

Constipation is a common complaint in infants and children. There are many reasons but it is rarely caused by an actual medical condition. In many children, constipation is triggered by experience of painful bowel movements or caused by factors such as toilet training, change in routine or diet, stressful events, illness like viruses or delaying defaecation (delaying going to the toilet).

Constipation can present at three common stages of childhood:

·         in infancy at weaning

·         in toddlers learning toilet skills

·         at school age.

Signs of straining in infants less than one year do not usually suggest constipation because children only develop muscles to assist bowel movements gradually. Provided that they pass soft stools and are otherwise healthy there should be no major problem.

What is constipation?

Constipation describes infrequent bowel movement, often with hard, dry stool that is difficult to pass. It may be associated with bloating, straining and pain. It is caused by inadequate muscle contraction or under absorption of water. Constipation is thought to affect approximately 20 per cent of the population. It can be a symptom of a serious illness but this is rare. Once a serious illness is ruled out its management can involve dietary interventions and then only if this does not work, laxatives may be considered but only under medical supervision (ie) must be prescribed by a doctor

Diagnosing in children

The general diagnosis criteria for constipation in adults and children must include 2 or more of the following:

·         less than 3 bowel movements per week

·         a history of painful or hard bowel movements

·         at least 1 episode of faecal incontinence (diarrhoea) per week (this is due to an excess build-up of faeces which when suddenly released can cause diarrhoea

·         presence of large faecal mass in rectum

·         a history of stool so large that may obstruct the toilet

These symptoms must be present for 4 weeks in infants and children under 4 years and for 8 weeks in children over 4 years in order to enable diagnosis

What is ‘Normal’ bowel function in children?

The ‘normal’ frequency of bowel movements varies from child to child and varies widely

Examples of average bowel movements include:

Age	Average	Per Week
0-3 months	2.9/ day	5-40
3 years and over	1.0/day	3-14

 Bowel motions in breast fed babies can be very variable. It is not common, but some babies can have infrequent motions sometimes once in 7 or even 10 days

Risk factors for constipation in infants and children
 

·         Some drugs - Antihistamines/anticonvulsants/iron supplements and many more

·         Intolerance to cow’s milk

·         Inadequate fluid intake

·         Poor diet including excess milk

·         Low fibre diet

·         Lack of exercise

·         Obesity

Treatment

Constipation can be challenging to treat and often requires prolonged support, explanation, encouragement and medical treatment. Aim is restoration of bowel habit so stools are soft and passed without discomfort. Treatment starts with education of parents/carers and children (as appropriate for age).

Constipation may be Acute (short term) or Chronic (long term):

Treatment of acute constipation

Acute constipation refers to short term constipation that lasts only one to three weeks (generally brought on by short term illness eg. viral illness). In this case, ensure the child has adequate fluid intake and a good diet. You should see your GP if no improvement or it is causing distress to the child. If not improving, the GP may consider prescribing lactulose or Movicol^® for a short period of one week. Movicol^® is brand name for macrogol; the other brand is Molaxole^®, for the purpose of this article I will refer to as Movicol. Lactulose and Movicol are called osmotic laxatives, they work by drawing water into the stool and are considered to be the safest type of laxative as they do not stimulate the bowel muscle like laxatives such as senna. Laxatives if required are generally only required short term. If a child is prescribed laxatives, it is important a GP reviews progress even if it is only a short term use of laxatives.

Treatment of chronic constipation

Chronic constipation refers to constipation that lasts longer term, usually a period of weeks or months. In this section I discuss laxative use; however bear in mind laxatives are generally last resort and should be only used under medical supervision. However they are very beneficial if it is an ongoing problem

Age 1 to 6 months

 

If it is a problem from birth or meconium (sticky tar like faeces a baby passes for the first few days after birth) has not passed in first 24 hours then discuss with hospital staff as Hirschsprungs Disease or another complication is a possibility.

 Other things to look at are:

·         type of milk (If formula fed, maintain on first formula for his/her particular age and do not    overfed)

·         Ensure adequate fluid intake (150mls/kg)

Maintenance regime

If it is an ongoing problems and diet, fluid intake etc have be assessed and are adequate, laxatives may need to be prescribed and these should only be maintained under regular medical supervision

Options include:

·         Macrogol (Movicol): ½ to 1 sachet daily

Or

·         Lactulose: 2.5mls twice daily (adjust depending response)

Or

·         Lactulose and Senna*: 2.5mls once daily  

Senna should be last resort as stimulant laxatives tend to case more side effects like lazy bowel than osmotic laxatives like lactulose and Movicol.

Dis-impaction regime: if faecal impaction (ie. Blockage) has occurred

Movicol ½ - 1 sachet daily; if this is not tolerated then Lactulose and Senna are alternative options

Age 6 months to one year

·         Ensure adequate fluid intake

·         Ensure overfeeding is not a problem and there is not excess milk (check with dietician)

·         May benefit from dietician assessment if diet is thought to be poor

·         Refer to specialist if abdominal pain, stomach bloating or vomiting occurs

·         An anal fissure (tear in anal skin that is painful when passing stools) is a possibility; easily rectified by medical intervention if it occurs

Maintenance regime and dis-impaction regime

Please note, the regime for this age is the same as the regime described above for one to six months (see above)

Children over 1 year

 

·         Ensure adequate fluid intake

·         May benefit from dietician assessment if diet is thought to be poor

·         Adequate exercise? Ensure an active lifestyle as this can help bowel movement

·         Ensure regular toileting

·         Behaviour modification :- toilet training/rewarding/toilet diaries etc (this can done by specialists

Maintenance regime

Movicol:

·         1-6 years: 1 sachet daily (adjust to response to max of 4 sachets/day)

·         6-12 years: 2 sachets daily (to a max of 4 sachets/day)

·         Over 12 years: same as adult regime

Lactulose:

·         1-5 years: 2.5 to 10mls twice daily (adjust to response)

·         >5 years: 5 to 20mls twice daily (adjust to response)

Senna*:

·         1-4 years: 2.5 to 10mls once daily

·         Over 4 years: 2.5 to 20mls once daily

*only if lactulose or movicol do not work

Dis-impaction regime: if faecal impaction (ie. Blockage) has occurred

Movicol:

·         1-5 years: 2 sachets on day 1, then 4 sachets for 2 days, then 6 sachets for 2 days and 8 sachets daily thereafter

·         5-12 years: 4 sachets on day 1, then increase by 2 sachets daily until max of 12 sachets daily

·        Over 12 years: same as adult regime

If dis-impaction not achieved by 2 weeks, add a stimulant laxative like Senna. If Movicol is not tolerated, use Lactulose and Senna for dis-impaction

Enemas can be considered in cases undergoing dis-impaction that do not have the required result from the medicine regime, if they are on maximum medication, and have been compliant with treatment. Enemas should only be used under specialist supervision

References

References for this article are available on request. The article was written and researched by pharmacist Eamonn Brady and Eamonn will forward references upon request.

Disclaimer: Information given is general; please ensure you consult with your healthcare professional before making any changes recommended

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. Email queries to info@whelehans.ie. Find us on Facebook.

Feeling low? It’s OK to be not OK

Depression is a medical condition which is considered to be as common both asthma and diabetes combined. Can you imagine however a diabetic or asthmatic feeling ashamed to ask for help? The answer is no…with these conditions, sufferers are aware of their situation and what action and help they need to take should difficulties arise. Sadly, this is not the case for many who suffer from depression. Historically, depression is viewed as something that affects other people, or is “nothing worth fussing about” These archaic views combined with feelings of shame or indeed denial mean that a significant number of cases go undiagnosed. The stigma of depression stops many from seeking help. If you are feeling low or down, do not be ashamed to ask for help, there is absolutely no shame in asking for help. It may be depression or maybe not, however if you don’t ask, you’ll never know.

Recognising, acknowledging and then seeking help is a sign of strength. So, think of it this way….  It’s OK to be not OK and it’s absolutely OK to ask for help”

Depression is not choosy about who it affects and like many other conditions; it can strike anyone at any-time. Education can really help; learning simple facts about depression can help us prevent it’s onset as well as recover quicker if it does strike. Ignoring facts about depression makes us more prone and less likely to seek help. With this in mind, here are some of the facts to help you discover what many choose to ignore (in no particular order)

What NOT to ignore about depression?

·         AWARE (a charity that supports people with depression) estimates that 300,000 Irish people suffer from depression (7.7% of the population). Some experts consider this a low estimate as it is reckoned two thirds of sufferers do not even seek treatment

·         Major Depression is 1.5 to 3 times more common among first-degree biological relatives of those with the disorder than among the general population

·         Statistically, women experience depression about twice as often as men and may be at a higher risk for depression. This may be due in part to oestrogen, which can alter the activity of those neurotransmitters that contribute to depression

·         Women between the ages of 25 and 44 are most often affected by depression with the inability to express or handle anger a major cause.

·         Once men hit midlife, they may face an increased risk of depression due to the decrease of testosterone

·         Men typically experience depression differently from women and use different means to cope. For example, while women may feel hopeless, men may feel irritable. Women may crave a listening ear, while men may became socially withdrawn or become violent or abusive

·         As the brains of older people are more vulnerable to chemical abnormalities, they are more likely to suffer depression than younger people

·         By the year 2020, the World Health Organization (WHO) estimates that depression will be the number two cause of "lost years of healthy life" worldwide

·         Perhaps this is the most important fact…..80% of people with clinical depression who have received treatment have found it significantly improved their lives.

Want to learn more?

Now you can, Whelehans Pharmacy have organised an information evening hosted by an expert panel of local healthcare professionals to discuss depression and mental health. Our talk will be in the Greville Arms Hotel on Tuesday February 10^th at 7pm, is free to attend and all are welcome.

 

Speakers will include:-

• Consultant Psychiatrist from St Lomans Mental Health Service, Dr Ciaran Corcoran;
• Specialist Psychiatric Nurse from Mullingar General Hospital, Colette Moriarty
• Pharmacist Eamonn Brady from Whelehans Pharmacy, Mullingar

You can turn up on the night or book your place in advance by calling Whelehans Pharmacy at 04493 34591.

Are you feeling low? Your GP should be your first port of call and can offer you support and advice on treatment options. For more support and advice on depression contact AWARE at 01 661 7211 or check www.aware.ie

Stress Management

A little bit of pressure is good as it gives you the motivation to perform better. However, too much pressure on a prolonged period can lead to stress which is unhealthy for the mind and body.

Complications

Too much stress for a prolonged period can lead health problems including anxiety, depression, insomnia, high blood pressure, stomach and duodenal ulcers, asthma, rheumatoid arthritis, and over-active thyroid.

Tips to relieve stress

Just say no
It is important to say no at times and know your limits. It is a trait of many of us to try do everything. If tasks or commitments are becoming too much of a burden, it is important to learn when to ask for help. Stress is deemed a health and safety hazard by the Health and Safety Authority. Therefore if you feel stressed due to your work responsibilities it is important to discuss this with your employer at the earliest opportunity.

Deep breathing
If you feel yourself getting stressed, try to halt those feelings in their tracks by relaxing your muscles and taking deep breaths. Start by inhaling for three seconds, then exhale for a little longer. This will help to remove the older oxygen from your lungs and replace it with fresh oxygen that will improve your circulation and alertness.

Healthy eating

It is important to eat a healthy, balanced diet when you are stressed because food and drink can have a big influence on the way that you feel and act. Some people find that stress causes them to snack on sugary, unhealthy foods such as crisps and biscuits. This gives your body a sugar rush followed by a sharp drop in your sugar and energy levels. This can make you feel tired or irritable, as well as making it harder for you to concentrate. You should also try to reduce the amount of caffeine and alcohol that you drink because they can have similar effects on your body as stress and anxiety.

Exercise

The benefit of exercise to relieve stress is often underestimated. Exercise releases a chemical called serotonin, which makes you feel happier and less stressed. Exercise also allows you to take out your frustration and anger in a constructive way.

Sleep

It is common for your sleep pattern to be disturbed when you are feeling stressed and this invariably leads to more stress. If you are having difficulty sleeping, you should ask your pharmacist or GP to discuss your sleep pattern and any potential causes of stress.

Quit smoking

Contrary to popular belief, smoking does not help to combat stress. In fact, it can make stress worse and it causes damage to your body. For more help in giving up smoking, visit your local pharmacy or ring the Smokers Quitline, 1850 201 203.

Relaxation

When you are stressed, your muscles often tense, which can cause muscular aches to develop later on. When you feel yourself getting stressed, shrug your shoulders a few times and shake out your arms and legs. This will help to loosen your muscles. A massage or reflexology can also be very beneficial. Check out Whelehans Holistic Therapy and Beauty for great massage and reflexology deals.

Laugh

Laughter is a great way to relieve stress. Watch funny movies. Read funny stories. Meet up with friends who you can have a good laugh with. Laughter causes the release of neurotransmitters called endorphins in the brain which reduce stress by giving a feeling of well being.

Be Realistic in Expectations

Don’t expect everyone to be like you or behave as you want them to. Don’t expect to be right all the time. You can’t expect harmony all the time. In reality, life will have conflicts in it. Be willing to confront conflict, state your needs then work at coming to a mutual compromise.

Treatment

Counseling
Counseling involves talking to someone about a range of issues, such as the triggers for your stress. A counselor will encourage you to discuss your feelings and they can help you to find solutions to your problems. They can also help you to discover ways to deal with stress and its effects.

Medication

If stress is affecting your mood, your doctor may prescribe antidepressants. There is sometimes a taboo about taking antidepressants but they can be very beneficial in most cases.  If you are suffering from anxiety, there are several options which can be used temporarily to get you through this period.

Anti-anxiety drugs such as benzodiazepines may be prescribed and can sometimes be beneficial for the short term relief of anxiety and stress. They are not a long term solution and treatment should be limited to the shortest possible dose for the shortest possible time. Benzodiazepines are safe for the short periods of use of five days or less. Unfortunately, in too many cases in Ireland over the years, patients have been prescribed benzodiazapines such as Valium^® and Xanax^® long term and this has lead to dependence problems. Their effect is reduced if used for too long. Betablockers which are mainly used for high blood pressure are sometimes prescribed for anxiety caused by stress as they reduce heart palpitations and tremor. Natural medicines are available which may help mild anxiety and stress. These contain natural ingredients such as hops and valerian. Examples available in Whelehans include Kalms^® and Rescue Remedy^®. Their efficacy is questionable.

Upcoming talk on depression and mental health

Whelehans Pharmacy have organised an expert panel to discuss depression and mental health early in the New Year in Mullingar; some of the leading local experts on this subject will be talking. This talk will be open to all and will be free of charge. The date will be confirmed; keep an eye on this column in the coming weeks for more details. In order to avoid disappointment, you can put your name down on the waiting list for this event by calling Whelehans at 04493 34591.

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.