Behavioral Health, Senior Care
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Older Adults Should Treat Insomnia Without Drugs
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Nearly one third of older people in the U.S. take sleeping pills. These drugs are called “sedative hypnotics” or “tranquilizers.” They affect the brain and spinal cord.
“Doctors prescribe the drugs for sleep problems,” says Ira Weinstein, MD, a pulmonologist who specializes in sleep disorders. “The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.”
Usually older adults should try non-drug treatments first. According to the American Geriatrics Society, there are safer and better ways to improve sleep or reduce anxiety. Here’s why:
Sleeping pills may not help much.
Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, people who take one of these drugs sleep only a little longer and better than those who don’t take a drug.
Sleeping pills can have serious or even deadly side effects.
All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs’ effects than younger adults. And these drugs may stay in their bodies longer.
“The drugs can cause confusion and memory problems that more than double the risk of falls and hip fractures,” says Dr. Weinstein. These are common causes of hospitalization and death in older people. They also can increase the risk of car accidents.
The new “Z” drugs also have risks.
Most ads are for these new drugs. At first, they were thought to be safer. But recent studies suggest they have as much or more risk than the older sleep drugs.
Try nondrug treatments first.
Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions. Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs.
Over-the-counter drugs may not be a good choice.
Side effects of some drugs can be especially bothersome for seniors: next-day drowsiness, confusion, constipation, dry mouth, and difficulty urinating. Avoid these over-the-counter sleep drugs:
Diphenhydramine (Benadryl Allergy, Nytol, Sominex, and generic)
Doxylamine (Unisom and generic)
Advil PM
Tylenol PM
When to try sedative hypnotic drugs
“Consider these drugs if the sleep problems are affecting your quality of life and nothing else has helped,” says Dr. Weinstein. “But your healthcare provider should watch you carefully to make sure that the drug is helping and not causing bad side effects.”
Kinds of sleeping pills (sedative-hypnotics)
All of these pills have risks, especially for older adults:
Barbiturates
Secobarbital (Seconal and generic)
Phenobarbital (Luminal and generic)
Benzodiazepines for anxiety
Alprazolam (Xanax and generic)
Diazepam (Valium and generic)
Lorazepam (Ativan and generic)
Benzodiazepines for insomnia
Estazolam (generic only)
Flurazepam (Dalmane and generic)
Quazepam (Doral)
Temazepam (Restoril and generic)
Triazolam (Halcion and generic)
“Z” drugs
Zolpidem (Ambien and generic)
Eszopiclone (Lunesta)
Zaleplon (Sonata and generic)
Tips for better sleep
Exercise. Physical activity helps people sleep better. But avoid vigorous activity for several hours before bedtime.
Keep a routine. Try to go to bed and wake up at about the same time every day, even on weekends.
Try not to eat right before bedtime. Eat three hours or more before going to bed.
Avoid caffeine after 3 p.m. Some people need to avoid caffeine even earlier.
Limit alcohol. Alcohol causes sleepiness at first, followed by wakefulness.
Create the right environment. Keep the bedroom peaceful. And avoid mental excitement before bedtime.
Avoid bright lights. Watching a bright screen can make you stay awake.
Control pets. Pets disrupt sleep if they are on and off the bed, taking up space, or wanting to be let out.
If you don’t fall asleep soon, get out of bed and do something that will make you sleepy, such as reading. Return to bed after you start to feel drowsy.
Source: ChoosingWisely.org.
Behavioral Health, Men's Health, Patient Stories
General Page Tier 3
Walking the walk: Quitting Smoking Once and For All
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As director of engineering, Tony Kuzawinski is responsible for plant operations, maintenance and facilities. On a typical day you’ll find him running all over Anne Arundel Medical Center’s medical park campus to meetings and inspections that help ensure a safe environment of care for patients, families and employees.
One day, he noticed he was having trouble keeping up with his boss, who always takes the stairs.
“We’d go up a couple flights of stairs and it felt like my heart was coming out of my chest,” says the 36-year-old who had been a pack-a-day smoker since age 14. “It would take me several minutes to catch my breath and be able to talk. When alone, I’d take the elevator.”
Tony had tried to quit several times, including three years ago when his daughter was born. Then, in early 2014, AAMC announced that starting July 2015 it would not hire people who use tobacco. Although the new policy would not affect him, it hit a nerve.
“I found myself defending the policy with family and friends about how it’s about helping people live healthier,” says Tony, who lives in Catonsville. Finally, a friend challenged him to practice what he preached: quit smoking once and for all.
So he did. Tony chose June 20—his birthday—as the day he would stop smoking. And he hasn’t looked back.
“I wanted do it—for my wife, for my kids and for my health,” he says.
Since quitting, his blood pressure has returned to normal. He can run up five flights of stairs and no longer gets winded carrying his kids up to bed at night. And, he’s inspired some of his colleagues to quit.
“Little things make a difference,” he says. “Make up your mind and do it. It’s not easy at first, but it gets easier. You can do it, but you have to want to do it.”
Ready to quit? Learn more about smoking cessation programs at Anne Arundel Medical Center. Courses and individual counseling are free if you live, work or attend school in Anne Arundel County. If you live elsewhere in the region, our staff may be able to navigate you to free resources in your area so please call 443-481-5366. If you’re an employee, we have specific resources for you, too.
Men's Health, Women's Health, Wellness, Patient Stories
General Page Tier 3
One Woman’s Journey with Weight Loss
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Margie Chase usually had success with weight loss when she put her mind to it. But then, something stressful would happen in her life, and the pounds would add up again. It wasn’t until the 53-year-old Davidsonville resident learned to understand nutrition and the underlying reasons for weight gain that she was able to make the lasting changes required for permanent weight loss.
I struggle with emotional eating. When I have a lot of stress in my life; I don’t smoke, I don’t drink, I eat. The death of my mom in 2005 put me into a downward spiral and I just never seemed to get out of it. Then a friend suggested I go to the Mayo Clinic Workshop.
I followed the workbook and I read the chapters in the book and I realized I can do this. I can do all of this. The difference is that I learned a lot about nutrition that I didn’t know the other times. Things like reading the labels and how products are labeled to make you think they’re healthier than they are. Now I really understand the nutritional value of the food I eat. However a few weeks into the program my sister passed away. It was a tragic event and I didn’t know if I could keep going with the program. I was afraid I would start eating junk again. The biggest thing that kept me in it was talking it over with Ann and Carole, (the nutritionists who run the program.) They were so supportive, and even though I was eating, I was making healthy choices.
And I still make healthier choices. For instance, today, I’m going out to Garrett County and I made sure I had plenty of water, fruits, and nutritional bars in the car to help me on this long drive. It’s all healthy. I never would have done that before. I would have just gone for the fast food junk.
When I started in February I was at 223, and I’m now down to 180. I’ve hit a plateau, but that’s OK. I’ve learned with the program that you’ll hit these places where you get stuck. I’ve hit a couple before and I just keep going. Then all of a sudden it breaks loose and the scale starts to move again. Your body needs to adjust. Staying steady is better than focusing on the scale.
I’ve never been much of an exerciser, but I always knew I felt better when I had the weight off. So now, I make sure I do the exercise. I even joined a boot camp after the Mayo Clinic workshop was over. With the things I’ve learned I’m still able to treat myself. Someone recently made me a blackberry pie, and that’s my favorite. So I didn’t deprive myself. I made a different choice. I took a small slice instead of what before would have been a quarter of a pie, and I told myself that I would exercise for an additional 20 minutes or so to make up for it. I don’t feel like I’m missing out on anything. I eat everything I want but in small portions and keep doing my exercises.
None of this has been easy. It’s been a long, challenging journey, but it’s gotten me 43 pounds closer to my goal weight. It’s not over for me because I still have my goal in sight, but I’m hoping the changes I’m making will allow me to live longer and have more energy to enjoy my two small nephews.This is a life style change and it feels so good.
Men's Health, Wellness, Patient Stories
General Page Tier 3
Twin Brothers Share Strength and Encouragement for Weight Loss Surgery
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Twins Andrew and Anthony Henderson grew up on a farm in Upper Marlboro where being active and fit was just a part of daily life. But over time, age, busy lives, and injuries slowed them down. That’s when the weight gain began to creep up on them. They both struggled to keep the weight down, but nothing worked, and it eventually took a toll on their health. Last year, at 47 years old, Andrew decided it was time for a major change. He signed up for a free weight loss seminar at AAMC to learn about his options. Together with Dr. Alex Gandsas who leads AAMC’s Weight Loss and Metabolic Surgery Program, Andrew determined that gastric sleeve surgery was right for him.
Inspired by his brother’s success, Anthony has joined the weight loss program and is preparing for gastric surgery. “Since he had the surgery I was amazed, how he’s doing so good,” Anthony says, gesturing toward his brother. “I got jealous. Now, I want what he got.”
Andrew laughs. “It’s true. When I walk in the door my family says ‘where’s the rest of you?” Before attending the weight loss seminar, Andrew weighed 407 pounds. He suffered from sleep apnea, diabetes, high cholesterol and gout. “It seemed like every time I went to the doctor, I was not responding to the medication and they gave me something else. I was on 13 medications total.”
All that changed after his surgery. Within four months, Andrew had lost 73 pounds. The sleep apnea was gone, and he needed only two medications instead of 13.
Anthony is looking forward to similar changes after his surgery. At 396 pounds, he suffers from high blood pressure and sleep apnea, and he’s taking five medications a day. Even so, the thought of surgery intimidated him and he considered not going through with it. That’s when Andrew encouraged him to go to the weight loss seminar. It gave him the information and resolve he needed. “This is a life changer,” Anthony said to his brother, “I’m glad you told me, go to that seminar. It eased me from being scared.”
“The seminars are so important,” Andrew says, admitting to his own fears about surgery. “I was scared, I won’t lie. But I said, it doesn’t cost me anything to go to the seminar, so I went. It was very valuable, because things you don’t know about your own body you can learn there. You have three types of surgery that you could qualify for. You have the sleeve, then you have the lap band, and then you have the gastric bypass. He goes through each one and explains to you the purpose of it, the outcomes of it and who can qualify for it.”
“You need the mindset to make the change and you need the support,” Andrew says. “And the program is lifechanging. I’m 73 pounds lighter and I got something to look forward to.”
“We want to retire,” says Anthony. “We’ve got things we want to do.
Weight Loss
General Page Tier 3
Weight Loss Surgery Options
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AAMC offers two weight loss surgery procedures — sleeve gastrectomy and gastric bypass. Both have been shown to be highly effective in combination with a long-term program of exercise, proper nutrition and medical support.
Each procedure is minimally invasive and creates a small stomach pouch, helping patients feel fuller sooner and stay full longer. As less food is eaten, the body stops storing excess calories and starts using its fat supply for energy. Patients are able to digest food in a normal manner after recovery.
“Bariatric surgery gives you an advantage in addition to diet and exercise, and is the only proven long-term weight loss solution,” says AAMC bariatric surgeon Courtney Doyle, MD. “By changing the anatomy, we help patients curb appetite and limit portions. These changes may also alter the body’s hormones, which can help to suppress appetite.”
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Contributor
Courtney Doyle, MD, is a bariatric surgeon with AAMC.