Body & Mind

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SLEEP TIGHT

Mike Hewitson MPharm FFRPS FRSPH IP MRPharmS, Pharmacist, The Abbey Pharmacy

Virtually every day in the pharmacy I have someone come in who is having trouble sleeping. It is something that we take for granted when it is working well, but when it goes wrong, it can have an enormous impact on our physical health, as well as mental health and wellbeing. Sleep isn’t just about quantity, it is also about the quality of the sleep that you have. The health benefits of enough, good quality sleep are overwhelming: better mood, less risk of heart attacks and strokes, better immune system, and better control of blood sugar and weight, to name but a few. So what can you do to help yourself?

Firstly sleep is about habits, once you get into good ones they can be quite long-standing, but once you get into bad habits they can be equally difficult to shift. The very first step for anyone experiencing sleep problems is to begin to look at their routines before going to bed. These measures are called ‘sleep hygiene’, and are designed to help reduce the activity in the brain in the run-up to going to sleep. Keeping

regular sleep hours is really important. That might not be that helpful for shift-workers, but if you are feeling tired, the advice generally is to go to bed – if you can do this regularly each day at the same time your body will begin to adapt to this pattern. The environment is really important, your bedroom should be dark, quiet, not too warm and not too cold, and everything there should be designed to help reduce sensory input in order to lull the brain into winding down its activity. This is one of the reasons that looking at an electronic device immediately before bed is not a good idea. This will stimulate the brain and encourage more activity which will help to keep you awake.

Moving more is also really important to help get you off to sleep. Gentle exercise can help to produce chemicals called endorphins which will help to improve the quality of your sleep. Stimulants such as tea and coffee which contain caffeine are also a bad idea just before you go to bed because they will keep you awake. A simple swap would be to a warm milky drink such as hot chocolate which will not have the same impact on your sleep. Something else that I found quite surprising was the suggestion that if you find yourself wide awake in the middle of the night, one of the worst things you can do is to fight it – get up and do something until you feel sleepy. This sounds completely counterintuitive, but it might help you to stop wrestling the 3am demons. This could also be achieved by writing down things that are worrying you as this has equally been shown to help put the mind at rest.

It probably won’t surprise you to learn that sleep is integrally linked with mental health and that conditions such as depression and anxiety can have a direct impact on sleep. Sometimes problems sleeping can be the first sign of mental health problems – depression is, for example, linked to people waking up early. I would encourage anyone that is having problems sleeping that are long-term or persistent, if they have any history of mental health problems, or if they have experienced a life event such as a bereavement, to get in touch with their GP. Sleeping tablets are probably not the answer in the short-term, and they are definitely not the answer in the long-term. Addressing the underlying causes is likely to lead to a much more sustainable improvement in sleep.

Our brain has different levels of sleep, and it is only during the deepest level of sleep which is called REM (rapid eye movement) that our bodies are able to recharge and make sense of the day. Often medicines can produce a type of drowsiness which leads to low quality sleep which never quite gets us to REM sleep. So in the long-term, we can feel more tired and less refreshed even after a long sleep. Again, adopting the sleep hygiene measures I’ve set out above is likely to help improve what is called your ‘sleep architecture’ i.e. the pattern of sleep and how deeply your brain is relaxed.

One of the other problems with long-term use of hypnotics (‘sleeping tablets’) is that apart from not giving us good quality sleep they can lead to a psychological reliance. The patient isn’t sleeping so they take a sleeping tablet, they then begin to worry that they can’t sleep without taking their sleeping tablet, and thus the anxiety produces the insomnia, and so it goes on. They also carry an increased risk of falls which for older people can be really serious as this can lead to broken bones and hospitalisations. Patients who have been using sleeping tablets in the long-term shouldn’t just stop them cold as this could lead to other problems. Speak to your GP, although to be honest they’ve probably already been trying to contact you to reduce your use of these medicines because it isn’t good to go on prescribing them in the long-term.

Over-the-counter sleep treatments are essentially just antihistamines which cause a lot of sedation. They can be useful short-term for some patients to help them get back into a good habit, but I generally don’t recommend them. The use of these products generally peaks in the 7th decade of life, with people in their 60s. I would only ever recommend using them for a few days at a time. Sleep is an utterly fascinating area and can have a transformative effect on patients and their families once bad habits are broken, mood can improve, as can physical symptoms such as pain. I can’t stress enough that this is best achieved with behaviour change, and not medicines, and would encourage you to seek help if you are struggling.

"Sleep can have a transformative effect on patients and their families once bad habits are broken"

MINDFULNESS

A TOOL FOR WELLBEING Lucy Lewis, Dorset Mind Ambassador

What is mindfulness? Mindfulness has gained more attention in recent years due to the many benefits it can have on wellbeing. Mindfulness is the practice of being truly present and in the moment. Many of us constantly think about what’s next – what will I make for dinner tonight? What shall I buy for my sister’s birthday? Will my meeting at work go well? Other people may habitually ruminate over events from their past, such as previous emotive events and actions they regret.

Mindfulness offers a respite from intrusive thoughts of the past and future, and the uncomfortable emotions they induce. Mindfulness offers the opportunity to be truly present in our lives and focus on the ‘now’.

What does mindfulness involve? Mindfulness does not involve blocking our thoughts or emotions. The opposite is true; to be mindful, you need to observe everything that’s happening in the present moment, including your own thoughts, emotions, and senses, as they occur.

This awareness should be non-judgemental and accepting. For example, you can notice that you feel anxious without assigning further judgment to it.

When you first begin to practice mindfulness, you are likely to find yourself getting distracted, but this is normal. You just need to note the distraction and bring yourself back to your practice. Over time, it will become easier to remain in a mindful state, providing a wellbeing tool for you to use when needed.

Benefits of mindfulness Mindfulness is associated with a whole host of benefits. It can be used to reduce symptoms associated with many mental health difficulties, such as anxiety and depression. One way mindfulness achieves this is by increasing our ability to regulate our emotions and prevent distressing rumination.

Additionally, practising mindfulness can lead to cognitive benefits, such as improved focus and memory. Physical benefits can include reduced chronic pain, improved sleep, lowered blood pressure, and alleviated digestive issues.

Ways to practice mindfulness There are many techniques that can be used in mindfulness practice. For example, mindfulness meditation involves sitting in a comfortable position and observing your internal experience. This might look like noting any thoughts that cross your mind non-judgementally, any physical sensations, or external sensory information.

Alternatively, some people prefer to do routine activities in a mindful state, such as eating, walking, or brushing their teeth. To do this, they need to notice and mentally note each sensation. For teeth brushing, this can involve noticing the minty taste and smell of the toothbrush, the sound and physical feel of the brush against their teeth, and the colours of the toothbrush. With all mindfulness practice, it is fine to become distracted – you just need to pull yourself back to the practice.

There are hundreds of ways to practice mindfulness that can be found with a quick online search, so don’t worry if one doesn’t feel right for you. Try different techniques and remember that mindfulness is a skill that can take some practice to develop, but the potential benefits are immeasurable.

For resources, real-life blogs, and further information about the 1-2-1 and group support services offered across Dorset for mental health and wellbeing, head to dorsetmind.uk

If you need further support with your mental health, the first step is to talk to your GP, or if in a crisis, call 999. If you need emotional support, call The Samaritans FREE on 116 123. 24/7.

NAVIGATING THE MENOPAUSE BRAIN HEALTH

Julia Witherspoon, Nutritional Therapist

The huge changes women go through during the perimenopause years can have quite an impact on our brains. So this, my final article of the series, explains what’s going on and what we might do about it.

In 2013 The Alzheimer’s Association reported that two-thirds of clinically diagnosed cases of dementia and Alzheimer’s Disease occur in women (both in the US and Europe). The primary reason proposed for this gender difference is women’s greater longevity, as the risk of dementia increases with age, however, this statistic is worrying. Alzheimer’s Disease is mostly seen as a disease that is non-preventable, non-treatable and non-reversible, but since 2014 it has been shown that

Image: Barbara Leatham

this need not necessarily be the case. A therapeutic programme of diet and lifestyle interventions has been shown to reverse cognitive decline in some people and, if cognitive decline can be reversed, then it is believed it absolutely can be prevented in the first place.

The slow development of Alzheimer’s Disease starts decades before signs of cognitive impairment are apparent, so if we make the appropriate diet and lifestyle changes now and really support our brain health in our 40s, 50s and 60s then we may be able to prevent its onset completely. The physiological changes women go through during menopause transition means this is a key time in our lives to really start being mindful of brain health. Adopting a healthy diet and lifestyle may dictate whether we do or do not succumb to dementia or Alzheimer’s Disease decades down the line.

Most perimenopausal symptoms experienced by women are neurological in nature and this is because of a massive re-wiring and re-calibration of the brain at this time of life. As we begin to permanently lose oestrogen, the brain undergoes what has been described as a temporary ‘energy crisis’ due to the reduced ability of our energy-producing cells (the mitochondria) to turn the sugar from our food into energy. Our mitochondria love oestradiol (our main type of oestrogen) and the high levels we have in our bodies during our reproductive years improves insulin sensitivity and helps the mitochondria burn glucose for energy.

The energy crisis the brain undergoes has been studied and results measured in brain scans. It has been shown that there can be up to a 25% drop in brain energy activity in women going through perimenopause. Fortunately, this is temporary but does go some way towards explaining why we experience such mood swings, anxiety, poor sleep, overwhelm, irritability etc as we go through our forties.

To recalibrate, adapt and enable us to get through menopause transition, our mitochondria need to learn to use ketones instead of (and as well as) glucose. Ketones are chemicals that the liver produces when it breaks down fats and these can be used for making energy. The mitochondria need to become what is called ‘metabolically flexible’ and be able to burn both types of fuel for energy. Burning ketones is harder to do, particularly if there is a constant influx of sugar from our diets or in those who are insulin-resistant.

So, it’s really important to support our brains during menopause transition and onwards, to not only help reduce symptoms but also to optimise cognition in later life and minimise, where possible, our risk of developing dementia 20-40 years down the line. It’s not just about feeling better now but protecting our brains long-term.

Also worth noting is that during this time of life, our brains may be having to deal with increased exposure to toxic metals, particularly lead (it’s not that long ago since we had leaded petrol, lead paint and lead pencils) that may have been stored in our bones for decades but is now being liberated as our bone density starts to decrease and there is increased bone turnover. This is another symptom of declining oestrogen levels in the body and another reason to really think about our brain health post 40.

So what can we do about all this? What is quite handy is that many of the diet and lifestyle approaches below mirror those for supporting menopause transition and good health generally, so it doesn’t require a totally separate strategy!

This is a very basic action plan to help the brain re-calibrate during this time which is suitable for all:

•Work to reduce insulin resistance if necessary / cut right back on simple sugars and carbs •Eat protein, healthy fat and lots of fibrous veggies at every meal •Reduce alcohol intake (the menopausal brain does not like alcohol) •Build muscle (shown to benefit our brains at a cellular level) •Soothe the nervous system (perimenopause is

NOT a time to be super busy – self-care is vital) •Supplements to consider are magnesium and taurine (both can act to calm the brain and support energy production)

I lost my dad to Lewy Body Dementia and have a particular gene which puts me at higher risk of developing an age-related neurodegenerative disease. I am determined not to succumb and am passionate about supporting our very precious brains during the second half of our lives.

Please don’t worry about the brain fog you might be experiencing during perimenopause – forgetting names, where the car keys are or taking a while to find the right word etc are quite normal and are not indicative of a disease process.

HYDRATION

Craig Hardaker BSc (Hons), Communifit

Image: Stuart Brill

It’s June and let’s hope we experience a hot, sunny month! If so, it will certainly be a time to remember that it is important to drink lots of water and stay fully hydrated. Did you know we are supposed to drink approximately two litres (6-8 glasses) each day? That may seem a lot and indeed for some can be quite difficult to do. However, different people need different amounts – you could in fact need more. The amount needed also increases with strenuous activity – those who have attended a hot and sweaty bootcamp will know exactly what I mean!

As well as being temperature and activity-driven amongst other things, one constant is the fact that on average approximately 60% of our body is water! The exact amount is primarily age and gender-specific. The brain contains one of the highest percentages – between 70% and 80%.

So it seems obvious we must stay hydrated and drink lots, but what are some of the benefits?

Boosting mental performance Research suggests that losing as little as 1% of your body weight in fluid may reduce mental performance. This mild level of dehydration can easily occur during a busy day of activities. This amount may not even equate to feeling thirsty with some evidence suggesting that thirst may occur when we lose 2-3% of our body water. So in fact, if we feel thirsty we may already be slightly dehydrated.

Boosting physical performance Research suggests that as little as a 2% loss in your body’s water content may impact how well you perform physically. With time for many being so precious, we need to maximise performance every time we exercise.

Boosting mood If we are hydrated, we are happier! Drink more, smile more – stay hydrated!

If like me you find staying hydrated challenging, why not try these four tips to help you succeed. •Keep a bottle with you throughout the day. It will remind you to keep drinking. The bottles sold on our website would be perfect! *wink* •So many people don’t particularly like the taste of water.

So why not add a slice of lemon or lime for added taste? •Drink before, during and after exercise – even if you don’t feel like it! •If you have trouble remembering to drink water, then drink on schedule – breakfast, lunch and dinner. Or drink on the hour, every hour!

If you don’t drink enough water, you will become dehydrated. There are many symptoms but some of the common ones include a dry mouth, headache, and in more severe situations, confusion, dizziness and fatigue. We are all at risk of becoming dehydrated but some are of higher risk. Those who exercise strenuously, are sick, pregnant or those who are in the older generation can be more prone to the issues connected to dehydration.

Putting delicacy aside for a moment, I suspect the number of people who don’t drink enough water because they are worried about being ‘caught short’ is far too high. Particularly us men! If that is an issue then It is best to drink little and often. This will help to train the bladder and give us more confidence, encouraging us to drink more and reducing the chances of dehydration.

Take a reusable water bottle with you each and every day. You’ll hopefully find that many places in Sherborne will be happy to fill it up for you, free of charge. If you happen to walk through Pageant Gardens you’ll notice the water tap next to the water feature. Fill up next time you pass!

We hope everyone has the most wonderful, hydrated June.