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How to help your child get the sleep they need

How to help your child get the sleep they need

This year, back-to-school plans are still a work in progress, and some (perhaps many) children will be learning from home because of the pandemic. As tempting as it might be to let the summer sleep schedules stay in place, it’s important that children have a regular routine — and that they are sleeping during the dark hours and awake during the light ones, as our bodies do best that way. So while a child whose trip to school is just a walk to the kitchen table might be able to sleep a bit later than one who has to catch an early bus, no child should be spending all morning in bed.

Sleep is crucial for all of us, and this is particularly true for children. Without enough quality sleep, children are more likely to have health and behavioral problems — and difficulty learning.

Here are a few simple things you can do to help your child get the sleep they need.

Have a regular schedule

Our bodies do best when we go to bed and wake up at roughly the same time every day.

  • Children and teens need eight to 10 hours of sleep. Count back 10 hours from when your child needs to get up in the morning. That’s roughly the time they need to be getting ready for bed (for younger children, count back 11 hours).
  • For example, if your teen needs to be up at 7, then they should be getting ready for bed by 9, and in bed by 10 (since most of us don’t fall asleep the moment our head hits the pillow). A younger child should start getting ready (bathing, etc.) by around 8.
  • Understand that teens are biologically wired to fall asleep later and wake up later and will naturally have later bedtimes. Unfortunately, most school districts don’t accommodate to this, so you are often working against biology.
  • While it’s okay to stay up a bit later on weekends, don’t let the bedtime vary by more than an hour or so.

Turn off the screens before bed

The blue light emitted by screens can keep us awake.

  • It’s best if the screens can be off two hours before you want your child asleep. Use that time when they start getting ready for bed as the time that the screens go off.
  • The only real way to achieve this is to get all devices out of the bedroom. (So true!)
  • Teens will fight you on this. If you can, hold firm (and buy them an alarm clock if they say they need their phone for this). At the very least, be sure that the phone is on Do Not Disturb mode overnight.

Have an environment that encourages sleep

  • Quiet things down. If you are watching TV, turn the volume down, and in general try to not make much noise after children go to bed.
  • Consider a white noise machine, or a fan (or air conditioner if you live somewhere warm). There are also white noise apps for those teens who won’t give up their phones.
  • Room-darkening curtains can make a difference for children who tend to wake up at the first light of dawn — or who can’t fall asleep if it’s not fully dark outside.

Know how other factors influence sleep

  • Busy teens often have difficulty getting everything done in time to get enough sleep. Talk with your teen about their daily schedule and look for ways to help them get more shut-eye, such as getting homework done during the school day, or limiting video games or other activities that eat into homework time. Sleep needs to be the priority.
  • Limit caffeine. It’s best not to have any, but certainly nothing from mid-afternoon on.
  • Limit naps! For a tired older child naps may seem like a good idea, but they can interfere with nighttime sleep. Naptime is okay through preschool.
  • Make sure your child gets exercise. It’s not only important for their health, it helps their sleep.
  • Have calming routines before bed (not exercise!).

If your child is having trouble falling asleep, or is waking up at night, talk to your doctor. It’s also important to talk to your doctor if your child is snoring or having other breathing problems at night. Don’t ever ignore a sleep problem; always ask for help.

The post How to help your child get the sleep they need appeared first on Harvard Health Blog.

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Is Organic Food Worth The Price? What the Label Really Means

Is Organic Food Worth The Price? What the Label Really Means

Just as I prefer to use non-toxic kitchen equipment, I also try to stick with organic foods when possible. But many people wonder if organic food is really worth the extra cost. Here’s what I found about when it is (and when it isn’t) worth it. What Is Organic Food? We’ve all been to a …

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Coconut Oil for Hair: Good or Bad?

Coconut Oil for Hair: Good or Bad?

I’ve been a fan of coconut oil for a really long time. It is a highly nourishing oil with hundreds of uses, and lately I’ve run across many sources touting the benefits of coconut oil for hair. It can certainly be beneficial for certain hair types when used correctly, but many sources recommend using it in …

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369: Lessons From Gaining & Losing 75 Pounds of Fat With Fit2Fat2Fit Drew Manning

369: Lessons From Gaining & Losing 75 Pounds of Fat With Fit2Fat2Fit Drew Manning

This episode is so much fun! Today I’m talking to someone who has gained and lost 70 pounds and who is about to do it again. Drew Manning is the New York Times bestselling author of the book Fit2Fat2Fit. He writes about his experiment that went viral online where he gained and then lost a …

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Is it safe to reduce blood pressure medications for older adults?

Is it safe to reduce blood pressure medications for older adults?

“Doctor, can you take away any of my medications? I am taking too many pills.”

As physicians, we hear this request frequently. The population most affected by the issue of being prescribed multiple medications, known as polypharmacy, is the elderly. Trying to organize long lists of medications, and remembering to take them exactly as prescribed, can become a full-time job. In addition to the physical and emotional burden of organizing medications, older adults are at increased risk for certain types of side effects and potential worse outcomes due to polypharmacy.

A common source of prescriptions is high blood pressure, with older adults often finding themselves on multiple medications to lower their blood pressure. Data from the Framingham Heart Study show that over 90% of middle-aged people will eventually develop high blood pressure, and at least 60% will go on to take medications to lower blood pressure.

The OPTIMISE trial, recently published in JAMA, studied the effect of reducing the number of blood pressure medications, also known as deprescribing, in the elderly.

How low should blood pressure be in older adults?

Previous large studies, including the HYVET trial and the more recent SPRINT trial, have shown that treatment of high blood pressure in older adults remains important, and may reduce the risk of heart attack, heart failure, stroke, and cardiovascular death. Black adults made up 31% of the SPRINT trial study population; therefore, study results could be used to make recommendations for this population, which is at increased risk for high blood pressure. However, many groups of older people were excluded, including nursing home residents, those with dementia, diabetes, and other conditions common in more frail older adults.

The most recent guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA), published in 2017, define optimal blood pressure as less than 120/80 for most people, including older adults age 65 or above. They recommend a target of 130/80 for blood pressure that is treated with medication. The 2018 guidelines from the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) recommend a more relaxed goal of less than 140/90.

The US and European populations differ in their risk for cardiovascular disease, with the US population generally considered at higher risk for strokes, heart failure, and heart attacks, so it might be appropriate to have different blood pressure goals for these two groups. Regardless, both groups acknowledge that factors such as frailty, limited life expectancy, dementia, and other medical issues should be considered when developing individualized goals for patients.

What happened to older patients whose blood pressure medications were reduced?

 The OPTIMISE trial provided preliminary evidence that some older adults may be able to reduce the number of blood pressure medications they take, without causing a large increase in blood pressure. For the trial, researchers randomized 569 patients age 80 or older, with systolic blood pressure lower than 150 mm Hg, to either remain on their current blood pressure medications, or to remove at least one blood pressure medication according to a prespecified protocol. The study subjects were followed for 12 weeks to assess blood pressure response.

Researchers found that both the people who remained on their previous blood pressure medications and those who reduced the number of medications had similar control of blood pressure at the end of the study. While the mean increase in systolic blood pressure for the group that reduced medications was 3.4 mm Hg higher than the control group, the number of patients who had systolic blood pressure below the goal of 150 mm Hg at the end of the study was not significantly different between groups. Approximately two-thirds of patients were able to remain off the medication at the end of the study.

It is important to note that OPTIMISE is relatively a small study, and the investigators did not examine long-term outcomes such as heart attack, heart failure, or stroke for this study (as the HYVET and SPRINT trials did), so we don’t know what the long-term effect of deprescribing would be.

More research needed to examine long-term effects of deprescribing

While the OPTIMISE trial was promising, larger and longer-duration trials looking at outcomes beyond blood pressures alone are necessary to really know whether deprescribing is safe in the long term. Additionally, these researchers used a target systolic blood pressure of less than 150 mm Hg, which is higher than the most recent ACC/AHA and ESC/ESH recommendations.

An interesting aspect of this study design is that the primary care physician had to feel that the patient would be a good candidate for deprescribing. This left room for physicians, who may know patients well, to individualize their decisions regarding deprescribing.

The bottom line

This trial gives doctors and other prescribers some support when considering a trial of deprescribing a blood pressure medication for select older patients, with a goal to improve quality of life. These patients must be closely followed to monitor their responses.

The post Is it safe to reduce blood pressure medications for older adults? appeared first on Harvard Health Blog.

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Spinach Artichoke Chicken Salad Recipe

Spinach Artichoke Chicken Salad Recipe

I love spinach artichoke dip at restaurants. However, like many other restaurant favorites, I’m not too crazy about some of the ingredients used (like corn chips made with vegetable oils). Luckily, one of my favorite hobbies is to figure out how to make these recipes at home using ingredients that are more wholesome. I love my …

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368: Finding Joy, Developing Intuition, and Asking Empowering Questions With Joy Martina

368: Finding Joy, Developing Intuition, and Asking Empowering Questions With Joy Martina

Dr. Joy Martina is my guest today and I credit her as a key part of my own personal growth in the last few years. She is a psychic psychologist with an incredible ability to help people see into themselves and find their own key for transformation. Dr. Joy teaches super practical, easy-to-use ways to …

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5 ways to ease pain using the mind-body connection

5 ways to ease pain using the mind-body connection

I smashed my elbow a few weeks ago. There was no bone break — just a bad bruise after slipping in the kitchen and landing on my arm — but at times the pain has been excruciating. So I’ve been following doctor’s orders: babying my elbow, icing it, and taking an occasional over-the-counter painkiller. (PS: I wear sneakers in the kitchen now.)

Something else has helped, too: mind-body therapies. These approaches aim to change our awareness of pain and retrain the way we respond to it. The therapies can help us control pain — such as long-lasting back pain — or live with it better. While these techniques won’t erase pain, they can help change perception of pain intensity through distraction, relaxation, and reframing our thoughts.

Five mind-body therapies to consider for pain relief

Cognitive behavioral therapy (CBT). This talk therapy teaches people to redirect their thoughts, feelings, and behaviors in response to chronic pain. For example, when a pain flare-up strikes, instead of bracing yourself and thinking, “Oh no, here it comes again,” tell yourself you’ve handled this before, and focus instead on your favorite place in the world: picture it in your mind, and feel how happy or relaxed you are when you’re there. A therapist trained in CBT can train you to hone your skills.

Deep breathing. We typically take short little breaths without noticing our breathing, especially when we’re in pain. Focusing on breathing and taking deep breaths quiets the mind and induces the relaxation response, a well-studied physiologic response that counteracts the stress response, and may lessen chronic pain severity. To practice deep breathing:

  • Breathe in slowly through your nose, allowing your chest and lower belly to rise as you fill your lungs completely.
  • Now exhale slowly through your mouth or nose.
  • Practice deep breathing for several minutes.

Meditation. Like deep breathing, meditating triggers the relaxation response and may reduce the perception of pain. You can use many methods to meditate, such as transcendental meditation (repeating a word, phrase, or sound to quiet your thoughts); yoga (a series of strengthening and stretching postures combined with breathing techniques); or mindfulness meditation (focusing objectively on negative thoughts as they move through your mind, so you can achieve a state of calm).

One simple way to meditate:

  • Sit quietly, close your eyes, and focus on your breathing.
  • Say a word such as “peace” or “one” each time you exhale.
  • Don’t worry about thoughts that come to mind; you can come back to them later. Continue to repeat your word and focus on breathing.

Mindfulness-based stress reduction (MBSR). This approach combines mindfulness meditation and yoga to build awareness and acceptance of moment-to-moment experiences, including pain. A 2019 study published in the journal Evidence-Based Mental Health found MBSR was just as effective as CBT at reducing pain and depression, and improving physical functioning, compared with usual care or no care. You’ll find MBSR programs at hospitals, universities, and meditation centers, and online videos.

Relaxation. Relaxation techniques, such as progressive muscle relaxation, may also help reduce the perception of pain. To try progressive muscle relaxation, start with your facial muscles and work your way down the body. Tighten each muscle or muscle group for 20 seconds before slowly releasing the contraction. As the muscle relaxes, concentrate on the release of tension and the sensation of relaxation.

The post 5 ways to ease pain using the mind-body connection appeared first on Harvard Health Blog.

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How to Create a Homeschool Schedule That Works

How to Create a Homeschool Schedule That Works

Many families are turning to homeschooling either out of necessity or a desire to create a more custom-fit education that works for their kids. This can be exciting or terrifying, depending on your reasons for beginning and how much the other areas of your life line up with this kind of approach. One way you can …

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Worried about sleep apnea? Home-based testing is now the norm

Worried about sleep apnea? Home-based testing is now the norm

If your bed partner complains about your loud snoring, it might be a disruptive nuisance — or something more serious. High-volume snoring punctuated by snorts, gasps, and brief pauses in breathing is the hallmark of obstructive sleep apnea.

Although this condition occurs most often in men over 40 who are overweight or obese, it can affect people of all ages and sizes. The resulting daytime sleepiness — a direct result of not getting enough high-quality sleep — can leave people moody and forgetful. Even more worrisome: car accidents are two to three times more common in people with sleep apnea. Sleep apnea also can boost blood pressure and may increase the risk of clogged heart arteries, heart rhythm disorders, heart failure, and stroke.

What is the STOPBANG test for sleep apnea?

The easy-to-remember acronym STOPBANG can help you decide whether it’s wise to talk to a doctor about having a sleep study to determine whether you have sleep apnea. It helps to have input from someone who sees you sleep.

A “yes” answer to three or more of these questions suggests possible sleep apnea. Ask your doctor if you should have a sleep study.
S Snore: Have you been told that you snore?
T Tired: Do you often feel tired during the day?
O Obstruction: Do you know if you briefly stop breathing while asleep, or has anyone witnessed you do this?
P Pressure: Do you have high blood pressure or take medication for high blood pressure?
B Body mass index (BMI): Is your BMI 30 or above? (For a calculator, see www.health.harvard.edu/bmi.)
A Age: Are you 50 or older?
N Neck: Is your neck circumference more than 16 inches (women) or 17 inches (men)?
G Gender: Are you male?

Sleep monitoring can be done at home

Diagnosing sleep apnea is less complicated that many people realize. In the past, diagnosing this condition always required an overnight stay in a sleep lab. “Today, about 60% to 70% of sleep studies for suspected sleep apnea are done using home-based tests,” says Dr. Sogol Javaheri, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital. If your symptoms suggest moderate to severe sleep apnea and you don’t have any other significant medical problems, home sleep monitoring is almost as accurate for detecting apnea as a night in a sleep lab, she says.

So, if you suspect you have sleep apnea, ask your doctor for an evaluation. Or if your health insurance allows you to see a specialist without a referral, you can start there instead. “Sleep specialists are better versed in insurance-related barriers, and they know how to order testing to avoid problems and delays in care,” says Dr. Javaheri.

For the test, you’ll get a small, lightweight monitor, a belt you slip around your midsection, a small finger clip that monitors your oxygen, and an airflow sensor to place under your nose. These sensors and devices measure your oxygen saturation, heart rate, and airflow, as well as the movements of your chest and abdomen and your position while you sleep.

One main advantage of home-based testing is the cost, which runs between $150 and $500, compared to testing done in a sleep laboratory, which usually tops $1,000. But the best part about home sleep test is the convenience. You sleep in your own bed, not an unfamiliar hospital bed, and you do the test based on your schedule. However, you’ll need to borrow the monitor from a hospital sleep lab, and you may have to wait a few weeks to get it. Later, if you are diagnosed with sleep apnea, home-based tests also provide an easy way for a physician to check how well your treatment is working.

The post Worried about sleep apnea? Home-based testing is now the norm appeared first on Harvard Health Blog.