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Monday, 31 August 2020
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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370: Creating a Profitable Business (& Why Now Is the Best Time!) With Ryan Moran
Today we’re talking all about finances, side hustles, and entrepreneurship — what you need to know and why this is best time (maybe ever) to start a new venture. I’m here with Ryan Moran, founder of Capitalism.com, a site that teaches entrepreneurs to build businesses and invest. Ryan shares how he turned a $600 investment into …
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Sunday, 30 August 2020
Saturday, 29 August 2020
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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Friday, 28 August 2020
Blown up in smoke: Young adults who vape at greater risk of COVID symptoms
COVID-19 has swept across the globe, infecting millions and resulting in hundreds of thousands of deaths. Substantial resources have been invested into understanding individual vulnerability in order to protect those at greatest risk. Age is the most often cited risk factor; 75% of US deaths have been in people over the age of 65, while younger people generally have milder symptoms. In addition to age, the Centers for Disease Control has delineated a list of health factors that increase vulnerability, most of which are chronic disorders that generally alter health status. The single most modifiable risk factor for severe COVID-19 infection is inhaled substance use through smoking or vaping.
Vaping and smoking increase young adults’ risk of COVID symptoms
A new study published in the Journal of Adolescent Health used national data to estimate the toll of smoking and vaping on COVID-19 risk for young adults. The team found that overall, nearly one in three young adults ages 18 to 25 in the US are at heightened risk, though that number falls to one in six among those who do not smoke or vape. In other words, smoking and vaping double the number of young adults in the at-risk category.
The at-risk categorization is more than a theoretical concern. Smoking and vaping both cause lung injury that threatens pulmonary reserve. Substance use can also weaken the immune system, resulting in reduced capacity to fight off infection. A recent study found that adolescents and young adults who smoke and vape were five times more likely to report COVID-19 symptoms and seven times more likely to have a diagnosis, compared to their peers. A combined analysis using data from multiple studies found that among people infected with COVID-19, those with history of smoking were twice as likely to have disease progression.
Risk-taking during adolescence could mean greater risk for COVID
During adolescence and young adulthood, developing brains are wired to seek large neurological rewards, resulting in the risk-taking that is associated with this stage of life. Most young adults enjoy good health and hearty physiologic reserve, allowing them to tolerate the insults of substance use without noticeable impact, until the cumulative effects accrue in middle adulthood — or at least that was generally assumed to be the case prior to the COVID-19 pandemic.
Unlike other risk factors for severe COVID-19 disease, smoking and vaping also inherently increase the risk of respiratory virus transmission. Smoking and vaping are often social activities for young adults. Both involve exhaling forcibly, which may propel droplets that carry viral particles further than at-rest breathing. The Canadian government recommends that people remain six feet apart and avoid sharing products, though people who get together to smoke or vape may not adhere to government guidelines. It goes without saying that both smoking and vaping are incompatible with wearing a mask. These factors combine to pose a real threat in places where young people gather — including colleges and universities. Schools would be smart to institute strict no-smoking and no-vaping rules and enforce them vigorously as part of a COVID-19 containment plan.
Younger people may be overconfident about health risks
Young people tend to overestimate their own ability to control a situation, and think of themselves as invincible; many are inclined to think that they will be able to quit smoking whenever they want to. A little extra confidence may be useful during the transition to adulthood, even if based on a faulty assessment of one’s own capabilities. But the same tendency can cause real problems in this pandemic. The idea that younger people are safe from COVID-19 is inaccurate; according to an early report from the CDC, one in five people ages 20 to 44 who become infected are hospitalized, and 2% to 4% require treatment in an intensive care unit. The best thing we can do for young people is to promote accurate information about their true risks. More than any other group, young adults who are able to quit smoking and vaping have the power to flatten their own personal risk curves.
Supporting young people who want to quit vaping and smoking
Parents and healthcare professionals have a role to play here, too. Many youth who use vaping products have seriously considered quitting, but quit attempts don’t always stick. Vaping is so new that specific treatments have not yet been rigorously tested, but there are effective treatments for nicotine use disorders. Healthcare professionals can prescribe medications that help relieve withdrawal symptoms and prevent cravings, and counselors can provide support during the process. Parents can help by encouraging their children to get help. For people who are trying to quit using nicotine, a little help can go a long way.
The post Blown up in smoke: Young adults who vape at greater risk of COVID symptoms appeared first on Harvard Health Blog.
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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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Thursday, 27 August 2020
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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Wednesday, 26 August 2020
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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Tuesday, 25 August 2020
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