As a matter of fact, a patient of mine mentioned to me earlier this week about how she has had terrible sleep due to her husband’s infamous talent of producing a deep soprano type snore every single night. She tried every method available to help her sleep. Every night she had to go to bed at least half an hour earlier than him so that she can fall asleep before he revved his v12 engine. Unfortunately, a lot of the time, especially when she is not in a deep sleep stage, she would be woken up by his snore and never able to get back to sleep. Sequentially she resorted to having her GP to prescribe her with some sleeping pills. I told her that dependency on sleeping tablets to help her get to sleep is not a habit she should get into.  Yes, sleeping tablets can initiate sleep and get you to a shallow sleep state. However, it’s never intended to get you to the deep sleep stage where your mind and body could recover fully from a hard day of concentration. Getting into a good sleep hygiene practice would be ideal in her case and I also suggested her to give white noise a go.

What is white noise?

How will it help with your sleeping?

What does the evidence show?

The post Could Noise Be The Remedy To A Good Night Sleep?! appeared first on Eastmed Pharmacy.

Feeling like a walking zombie is somehow expected and socially acceptable when you have a newborn. Besides joking about how tired new parents can be and how much our body can adjust to less sleep, many parents might not be aware, or more correctly, chose to ignore the impact sleep deprivation can have on both our physical and mental well-being and it should not be a health issue taken lightly.

Take me as an example, one morning a few days ago; I was meant to get some more nappies from the supermarket as we were close to running out. Instead of listening to my wife’s suggestion of getting them delivered, I insisted on driving to get them. Partly because despite being beyond tired, I was still functioning well, so I thought I’d go for a drive, and get some much needed fresh after some gruelling nights of fragmented sleep. However, the part I didn’t consider in this was the fact that I hadn’t slept for more than a 2 hour stretch for the last few days. On my way to the supermarket, there were several traffic lights that I had to go through. I stopped at one of the red lights and then what seemed like a split-second later I dozed off, and it must have been a good 5 seconds after the traffic light flashed green and a few horns from cars behind me, I got my thoughts together and started moving again. I was fortunate because it could have been worse if it happened when I was driving where I could drift across to the oncoming traffic and cause a big accident. I didn’t realise how much my cognitive and motor function was impaired by sleep deprivation. What’s worse is that there are many more parents out there on the same page as me, and they don’t understand the negative impact of sleep deprivation has on their cognitive, phycological, and emotional functioning and are an accident in the waiting.

Before the birth of our little guy, both my wife and I were considered ourselves good sleepers. We both enjoyed a good sleep in on the weekends and rarely had problems getting to sleep at night – usually a solid 8 hours for my wife and at least 6 hours for me on weeknights. We were aware of the sleep situation when looking after a newborn. However, we did not anticipate it to this extent. We were a little naïve to think that quantity will make up for the lack of quality from fragmented sleep. However, it this true? Can new parents get the same amount and quality of sleep as usual? Both my wife and I attempted to answer this from our experience of 2 weeks into looking after our newborn. I would generally consider our little guy a good sleeper, considering that it is typical for a newborn to sleep between 2 and 3 hours before they are due for their feed. I remember it so vividly that the first week, he was able to sleep soundly for a good 3 hours before a nappy change or a feed. However, as we approached the second week, cluster feeding kicked in, where he would be feed somewhere between 1 to 2 hourly. This was when things started to get interesting. We noticed that when we had to wake up every 3 hours at night to feed our son, even though it was hard, we were still able to function throughout the day besides a few yawns. However, for the past week of cluster feeding, waking up every 1 to 2 hours does start to take its toll.  Even though we still ended up sleeping for a good 7 hours a day in total, this kind of sleep we are getting is not the kind of sleep that made us feel well-rested the next day because highly fragmented sleep has stolen much of our needed deep sleep. In other words, we are not spending enough hours in restorative sleep to make us feel refreshed and ready to take on the world.

When you look at the sleep pattern of an adult versus, a newborn, an adult has a definite sleep pattern cycle, each one lasting about 90 minutes to 2 hours. On the contrary, a newborn usually has a much shorter sleep cycle of approximately 50 minutes, and they generally spend 50% to 80% of sleep time in the deep sleep phase (REM), compared with our 20%. In other words, if your newborn wakes up every 1 to 1 and a half hours, technically, the fragmented sleep that you managed to fit in during the night may not even allow your body to complete the full cycle of sleep. This type of sleep, which is typical for most new parents – where you are up 2 to 3 times for at least 1 hour over 8 hours could be worse than someone only managed to get 4 to 5 hours of straight sleep at night. Because at least they are getting somewhere between 2 to 3 sleep cycles compared to nothing at all if your sleep is fragmented. This is alarming because every time you get up and go back to sleep, you are practically starting the sleep cycle all over again – meaning that you have to go through shallow sleep stages before you return to deep sleep. The problem is the majority of parents felt like a walking zombie because, with a newborn, you will never reach the deep sleep stage.

So, what can parents do about their deprived sleep state? Most of the parents I came across on my walks tried to convince me that we eventually just get used to the feeling of being so fatigued, however, we tend to underestimate the significant effect on our health and performance as a direct result of prolonged sleep deprivation. Sometimes what we need to do is to make sleep a priority and admit that we do need a decent amount of sleep to function properly. Rather than just accept our fate, we need to proactively try to do something about it and find some personalised ways to help us fit in a few naps where possible. Because at the end of the day, listening to expert advice or finding methods that work entirely for you and your partner can often be the fine line between what will or will not remedy the situation.

Of course, this often is easier said than done, especially when parents need to deal with small children on top of a newborn. However, after almost three weeks of fragmented sleeping patterns, there were several things we’ve noticed and are actively doing that helped us to make us perform a little better than just being walking zombies and could be beneficial advice for some of the new parents or parents to be that you know.

1. Sleep in on the weekends – what we’ve found beneficial was to sleep an extra 2 to 3 hours on the weekends if possible. Even if it means that you need to get your in-laws or parents in to look after your little ones so that you can catch up on some well-needed rest. However, the trick is not to let yourself over-indulge because oversleeping can often lead to a new cycle of sleep deprivation where you don’t feel tired at times where you need to sleep.
2. Take regular naps – take frequent naps is crucial, but getting a full cycle of nap is much more critical. We have often been told to take 20 minutes power nap. However, it only helps if you are getting a decent amount of sleep at night. Given that we now know that a full cycle of sleep last approximately 90 minutes, it would be much better off if you could get an entire cycle of sleep into a nap where it will allow your brain to get into a deep sleep stage and sequentially giving you a feeling of being well-rested.
3. Ask your partner so you can skip a feeding – I’ll be doing this more when I’m back to work in a week so that my wife and I could get a good stretch of 6 hours sleep. This can be done by getting your partner to get a bottle of breast milk pumped ready to go so that you can feed the little one while your partner is getting some well-deserved sleep.

Despite a difficult time for us and many other new parents out there who are feeling sleep deprived, knowing that the gruelling nights will eventually come to an end and that we can start enjoying a good night’s sleep that we always taken for granted is reassuring.

Sweet dreams,

Chris
Pharmacist

The post Sweet Dreams Are Not Made Of This appeared first on Eastmed Pharmacy.

Continuing on the theme of sleep I’ve been covering the last few weeks, I want to share with you an interesting question from a patient of mine:

“I’ve been reading about tart cherry – I saw it in a health advertisement recently as a natural sleep remedy which is also suitable for children – what do you think Chris? Should I buy some for my family?”

Some of you may be familiar with tart cherry, but for those of you that are not, I’ll give you a brief overview:

Cherries can be divided into sweet or tart varieties. There are two main types of tart cherries – morello and amarelle.

Montmorency tart cherries date back to ancient Rome where the fruit was used for food and the wood to build equipment. It’s a variety of amarelle and is the most common constituent of “medicinal” cherry products.

Tart cherries are claimed to reduce symptoms of gout, arthritis and fight cancer. They are also said to help us sleep which is what I’ll focus on. Tart montmorency cherries are rich in phytonutrients, including anthocyanins, that give cherries, grapes, black currants and other berry fruits their red colour. They also contain melatonin, which if absorbed, may have sleep regulation properties.

Our sleep and wake cycles are strongly influenced by melatonin produced by the brain. More of the hormone is produced in the dark than in the light. This natural source of melatonin influences our core body temperature and helps to promote sleep.

There have been limited clinical research studies investigating cherry extracts on sleep, most of the evidence for tart cherries come from small studies. They have shown that tart cherries were associated with a reduction of insomnia severity and an increase in total sleep time. However, there have been no studies involving children, therefore the efficacy and safety of cherry extracts are not known.

The studies found that the amount of melatonin in the cherry extracts was very small – smaller than the level found to have an impact on our sleep! There may be a different way than tart cherries helps our sleep that we don’t know about yet.

Do tart cherries interact with my medicines?

It can interfere with some medicines including blood thinners – if you’re thinking of starting a product talk to myself or one of the team members to make sure it’s ok.

Could I just eat cherries instead?

Tart cherries have a short season and can be difficult to source in New Zealand. They are more readily available as juice, capsules, lozenges and sachets.

So, is it worth trialling a tart cherry product?

I think that if you are having difficulty sleeping and have tried sleep hygiene techniques (see my last email for details) then trialling a product for one or two weeks could be helpful. I recommend keeping a sleep diary to track if there had been any improvement in your sleep during this time. If there has been no improvement or you begin to experience adverse effects then stop the tart cherry product.

As always you can speak to myself or a team member for recommendations or alternatives if it’s not right for you.

Sweet dreams,

Chris

Pharmacist

The post The FRUIT that could help you sleep?! appeared first on Eastmed Pharmacy.

“So Chris, what do you think about taking magnesium? My friend told me that it helps her with sleep.”

I’m glad you asked, I often talk with my patients about the importance of magnesium and the under-recognised role it plays in sleep and overall health.

I’ve seen many of my patients’ sleep benefit greatly from increasing the intake of magnesium either through diet or supplements.

Magnesium deficiency is common among adults. In particular, the elderly are more vulnerable to magnesium deficiency. Women are also at higher risk for low magnesium. Some medicines, for example, heart and indigestion (Proton Pump inhibitors – omeprazole) medicines can affect the way we absorb magnesium from our diet. It’s not uncommon for those people to have less than optimal magnesium levels.

One of the roles magnesium plays in our body is to assist us in having a restful sleep. Low magnesium levels can throw our quality sleep off course, hence affecting our energy levels. The problem with magnesium is that our body does not produce it naturally nor store it. This means that the magnesium your body needs must come from outside sources (e.g. eating the right food or supplements).

“What kind of food shall I eat to receive magnesium?”

You can increase your magnesium levels by eating dark leafy greens, seeds & nuts (e.g. sunflower and sesame seeds, cashews and almonds), broccoli, legumes, dairy products, meat and unprocessed whole grains. They are all rich in magnesium.

“How does magnesium improves my sleep?”

Magnesium has a widespread role in the body’s functioning. So it’s no surprise that sleep can also be affected by the level of magnesium in our body.

Insomnia is a common symptom of magnesium deficiency. People with a low level of magnesium often experience restless sleep and frequent waking during the night.

A deeper and restful sleep can be achieved by maintaining adequate levels of magnesium. Magnesium increases the level of GABA – a neurotransmitter that encourages relaxation and promotes sleep. People with low GABA levels usually find it hard to relax.

Research indicates that supplementing with magnesium in people with poor sleep or restless-leg syndrome can improve sleep quality.

“There are many magnesium supplements out there. How do I know which one to choose?”

The number of magnesium products available in the market makes it relatively difficult to find the one that’s right for you. Besides different brands of magnesium supplements, magnesium is also available in numerous forms – including:

· Magnesium carbonate

· Magnesium chloride

· Magnesium citrate

· Magnesium oxide

· Magnesium phosphate

· Magnesium sulphate

· Magnesium diglycinate

I usually suggest my patients avoid salt forms of magnesium for 2 reasons:

1. The absorption rate between different salt forms of magnesium varies greatly. Most magnesium salts are only absorbed to the extent of about 5 to 10%.
2. People poorly tolerate salt forms of magnesium because it has a laxative effect. This explains why many people can experience loose bowel motions when they take magnesium supplements.

The form of magnesium I believe is better absorbed and tends not to cause diarrhoea is an amino acid chelate form (e.g. magnesium aspartate). By attaching an amino acid structure to a magnesium molecule, it makes the mineral less foreign to our body (as our body is made up of building blocks of amino acids). Hence, allowing magnesium to be recognised by the body as such, so they’re absorbed much faster and more efficiently into the bloodstream compared to the salt forms.

The following is what I usually tell my patients to look for when deciding on a magnesium supplement:

1. Magnesium amino acid chelate for enhanced absorption and reduced stomach intolerance.
2. Added L-glutamine for muscle repair and recovery.
3. Added B vitamins to support energy production and mental focus (do not choose a magnesium supplement containing B vitamins if you intend to use it for sleep – as mentioned in my last email).
4. Added sour cherry to improve sleep duration, efficiency and quality.
5. Added vitamin B6 for the relief of PMS including muscular pains and cramps.

As always, talk to one of our pharmacists or your doctor if you are intending to start magnesium supplements. This is because magnesium supplements may not be ideal for certain people with specific health conditions or certain medicines.

Sweet Dreams,

Chris

Pharmacist

The post If you are thinking of trying magnesium supplements – you NEED to read this!!! appeared first on Eastmed Pharmacy.

My article last week about vitamin B12 sparked great interest. I’ve been seeing many of you in the pharmacy asking about what you should be taking to boost your vitamin B12 levels.

One thing I should stress is that low iron and vitamin B12 levels are only the tips of the iceberg when it comes to lack of energy and tiredness. Many other factors could potentially contribute to it including the type of medication you are taking. So do not jump into conclusions straight away without exploring other contributing factors. Although supplementing with iron and vitamin B12 doesn’t usually cause any harm if you are taking them according to the recommended dose, it doesn’t do any good either if your body doesn’t need it. So always talk to one of us before picking any iron and vitamin B12 supplements off the shelves.

Speaking of lack of energy, I think you might find this case interesting which I came across last week.

A long-standing patient of mine came in last week after reading my email asking me if she should start taking some Vitamin B12.

I asked her: What makes you think you need vitamin B12?

She replied: I have been feeling very tired for the past couple of weeks. After reading your email, I decided to give it a go to see if it might help because the vitamin B complex I’m taking at the moment contains only a very small amount of vitamin B12.

I asked her further: So, do you mind telling me why are you taking vitamin B complex?

She said: I’ve been very stressed at work lately and I thought the vitamin B complex “stress relief” formulation might help. It did help to relax me.

I asked her more: So how often do you use it?

She replied: I have been taking it for the past 2 weeks, usually with my dinner.

I then asked: So how has your sleep been lately?

She said: I find it a little harder to get to sleep lately and some nights I woke up in the middle of the night and couldn’t fall back to sleep. I guess it’s because of my stress?

I replied: I think stress plays a role here but I also noticed a few things that I picked up from our conversation that might also be contributing to your tiredness lately.

First of all, I think it is fine to supplement with vitamin B complex during this stressful time of yours. However, I believe the time of your dose might be one of the reasons why your sleep pattern was disrupted.

Vitamin B complex tends to boost energy and increase attention, so taking them at night can lead to restlessness and insomnia. I would suggest you take it in the morning instead.

I asked: Before you go to sleep, do you usually allow your body to wind down first?

She replied: I usually take a bath most night but lately I haven’t been. I have been working in front of my computer up until bedtime.

I replied: I think that could also be another reason why your sleep quality has been greatly affected.

I usually suggest not to use your phone or the computer at least an hour before bedtime because the blue light emitted from those devices could affect our sleep.

Light affects our biological clock by turning off the melatonin production line. So, when we look at the light exposure that we have from those devices in the evening, that’s something to be very aware of because by looking at our phones or working in front of the computer in the evening, we are telling our brain its morning not evening. Subsequently, we won’t be producing enough melatonin to help us fall asleep.

She said: Oh…I see.

I replied: I think if you change the dosing time of your vitamin B complex and allow your body to wind down with no exposure to blue lights emitting from your phone or computer devices and with minimum exposure to household lights at least an hour before bedtime. Then I think you’ll sleep better and won’t feel as tired.

Try it first and let me know whether it helps before we find a supplement for you

When it comes to sleep, many patients of mine have asked what’s the best way of managing insomnia without using any drugs.

I like to think sleep is a sensory experience. I usually look at the 5 senses in the bedroom that could be contributing to promoting sleep or detracting from sleep.

1) Sight (which I’ve mentioned in the above conversation with my patient)

2) Sound – listening to soothing music (with no lyrics) for 10 minutes before you turn in for the night can help reduce stress and anxiety, help you fall asleep more easily. The key is to choose tunes you like that have a slow beat (classical or soft jazz).

3) Smell – an unpleasant smell can disturb your sleep. A room that smells musty can prevent you from falling asleep naturally. Surrounding yourself with a scent you like could help you drift off.

4) Taste – The things you eat or drink before sleep can disrupt your sleep. I always suggest stopping caffeine intake at 2 pm because caffeine has a “half-life” of about 8 hours, which means that its level is reduced, but still somewhat effective in your system after this time. Caffeine is a stimulant, and it will prevent you from either falling asleep or have a good quality sleep.

Alcohol is also another contributing factor to bad quality sleep. While alcohol can make you sleepy, it also detracts you from a good sleep by keeping you from reaching the deep stages of sleep, dehydrates you and awakens you in the middle of the night (usually to go to the bathroom)

5) Touch – the temperature of your bedroom can also affect your sleep. It is recommended that the optimum temperature for sleeping is between 18 to 19 degrees Celsius.

By following the 5 senses technique on how to sleep better, you will put yourself on the road to improved rest and greater health.

If you have insomnia or bad quality sleep and are running out of ideas, please try the above suggestions first before considering taking prescription medicines. If you have any concerns about your sleep in general, please do not hesitate to contact one of our team or myself to gain more valuable advice.

To you and your family’s health

Chris

Pharmacist

The post My sleep is terrible…what can I do??? appeared first on Eastmed Pharmacy.

It’s a common complaint for most of us living busy lives trying to juggle work, family and leisure. There are many reasons for us to be tired and I find my patients are always quick to assume that tiredness must mean a lack of iron. This could be true but without blood tests to confirm iron deficiency, it’s difficult to determine if someone is iron deficient – especially if they eat a balanced diet.

Another less well-known deficiency that could be causing tiredness and lack of energy is a deficiency in vitamin B12 – also known as cobalamin. This vitamin is incredibly important because it is involved in the production of red blood cells and plays a crucial role in maintaining the health of nerve cells.

Everyone needs vitamin B12 but older people and vegans or vegetarians are particularly at risk of being vitamin B12 deficient.

Veganism is becoming popular amongst teenagers and young adults – they may not be aware of the additional supplements required following this dietary lifestyle.

You may be asking: why is this?

Vitamin B12 and all of the B vitamins are water-soluble, meaning that the body does not store them, so we must consume them daily. Vitamin B12 is mainly found in meat, eggs and dairy products. Plants don’t contain B12.

Older adults can have poor diets and vegan/ vegetarian diets can exclude animal products. Approximately 10% of those over 75 could be B12 deficient.

Also, those with intestinal problems such as Crohn’s Disease or inflammatory bowel disease could be at risk.

Some medicines can also lead to B12 deficiency such as anti-seizure medicines – come in and see us if you’re concerned.

“Now I can imagine you’re asking this: why does my body need B12?”

This is an important question which links to the symptoms of tiredness. All B vitamins help the body convert food, specifically carbohydrates, into fuel (glucose), which our body used to produce energy. Vitamin B12 works closely with vitamin B9 (also, called folate) to help make red blood cells. Lack of B12 can cause red blood cells to be abnormally large and not function properly – they’re unable to transport oxygen efficiently around the body which can lead to tiredness and exhaustion.

Other symptoms can include mouth ulcers, muscle weakness and confusion.

“What should I do if I think I’m lacking B12?”

The first step is to see your GP who can confirm B12 deficiency with a blood test. If you are deficient then they can replace the B12 with an injection of it into the muscle. If possible, increasing your intake of meat, salmon, milk, cheese and eggs can also help prevent B12 deficiency.

“I’ve seen B12 tablets at some pharmacies – should I buy them if I think I’m B12 deficient?”

The short answer is no – you should get the blood test to confirm deficiency first. If you are eating a balanced diet then it’s unlikely that you would be deficient and buying tablets could be a waste of money. However, if you are vegan, vegetarian or on a restricted diet supplementation could be beneficial but it’s best to talk to a nutritionist or GP first. If they agree then see me or another of the eastMED Pharmacy team who can help advise on the best B12 supplement to take.

To you and your family’s health,

Chris

Pharmacist

The post Could this be the reason you’re tired all the time?! appeared first on Eastmed Pharmacy.