Parkinson’s Disease and Speech

In a high majority of people with Parkinson’s, the disease also takes a toll on speech. The repercussions can be devastating as patients, unable to communicate clearly, withdraw from social interaction. A form of speech rehabilitation called LSVT compensates by training Parkinson’s patients to talk more loudly.

How to recognize voice and speech problems

Parkinson’s disease can impair muscles of the voice box, throat, mouth, tongue, and lips. Subtle changes may happen early, with the person’s voice becoming softer and flat in tone, making it hard to hear. In advanced stages of Parkinson’s, speech may become unintelligible.

Let the neurologist know if you notice these symptoms:

  • Talking in a monotone, with little inflection in pitch
  • Reduced speech volume
  • Breathy or hoarse voice
  • Mumbled speech, imprecise articulation
  • Difficulties initiating speech
  • Hesitant, sometimes stuttering speech
  • Short, fast rushes of speech

How voice and speech troubles can harm a person’s well-being

Parkinson’s patients experience a sensory processing glitch in the brain that leaves them unable to detect that they’re speaking quietly. Unaware of the problem, they are likely to feel frustrated at being asked to constantly re peat themselves. They may even complain that their spouse needs a hearing aid.

Parkinson’s disease also often causes a loss of facial expressiveness. That change, combined with a soft, monotone voice, can lead family and friends to think the patient is “just depressed, apathetic, bored, disinterested — whereas the person inside feels quite alive,” says Cynthia Fox, a speech-language pathologist and researcher at the National Center for Voice and Speech in Denver.

The upshot is that others stop engaging patients in conversation. They may come to feel ignored, and such patients often give up, says Fox. They drop job responsibilities that require a lot of phone talk, and they avoid dining out because restaurant noise further drowns out their voices. “It’s a real blow to self-confidence,” says Fox.

What are the treatment options?

The standard Parkinson’s drugs don’t always work well for speech impairment. Although some people find that levodopa improves their communication, others don’t. Deep brain-stimulation surgery has also produced inconsistent results for relieving speech difficulties.

The best strategy is drug therapy paired with speech therapy. Traditionally, speech-language experts trained patients to concentrate on multiple, separate aspects of voice and speech, such as breathing properly, articulating well, increasing volume, and slowing down the rate of speech. But even though patients sounded better inside the treatment room, the benefit typically vanished once they walked out the door and reverted to usual habits.

In 1987, however, University of Colorado speech-language researcher Lorraine Olson Ramig devised the Lee Silverman Voice Treatment, the first speech treatment tailored for Parkinson’s disease. (It was named after a Parkinson’s patient whose family funded the research). Small studies have found that LSVT produces lasting improvements.

How LSVT differs from traditional speech treatments:

  • LSVT is much more intensive, requiring four rigorous one-hour sessions a week — and daily voice homework exercises — for one month.
  • It attempts to overcome the sensory processing deficit that affects speech in Parkinson’s. For example, by recording patients’ voices and playing them aloud, the therapist can convince them before treatment that their voices are weak.
  • A patient focuses on a single goal — boosting loudness with maximal ef fort — rather than thinking about several aspects of voice and speech production at once.

How LSVT retrains vocal loudness

When prompted with just one cue of “Speak loudly!” or “Think loud!”, Parkinson’s patients automatically take in a deeper breath, open their mouth more for better resonance and articulation, and increase volume. All aspects of speech production strengthen together, says Fox, who, together with Ramig, cofounded a company called LSVT Global.

LSVT doesn’t train patients to actually yell or scream, although to them it may feeldisconcertingly as though that’s what they’re doing. “A huge piece of the treatment is to teach them that what feels very funny to them, and maybe too loud, is act ually within normal limits,” says Fox.

Each workout session starts with many repetitions of sustained “aaaahhhs” at normal, high, and low pitch, followed by repetitions of 10 everyday phrases or sentences. Over weeks, the therapist trains patients to build a healthy, louder voice to use first with individual words, phrases, and sentences, and then building up to continuous reading and conversational speech.

How long the benefits last:

Studies of LSVT show that in conversation, patients’ voices grow louder by about 5 to 6 decibels, which makes a big difference to a listener’s ability to hear them. A study published in 2001 found that some of the gains from LSVT persist for two years. Ideally, patients keep up voice exercises to maintain benefits. Occasional tune-up therapy visits may be needed.

Where someone with Parkinson’s can go for speech therapy

A neurologist or hospital should be able to refer patients to a speech therapist, where treat ments are usually covered by health insurers. The American Speech-Language-Hearing Association maintains a searchable directory of practitioners at www.asha.org/findpro/ .

To find a certified LSVT therapist in your area, check the directory at the nonprofit LSVT Foundation or its spin-off company LSVT Global . LSVT Global’s eLOUD service offers Internet delivery of the speech treatment via standard webcam technology. The firm is developing a computer program that lets patients do some speech sessions at home.

What you can do to help someone with Parkinson’s communicate better

Encourage them to seek speech therapy early on so that they can remain active at working, socializing, and enjoying life. Fox recommends treatment as soon as problems develop, because once speech impairment starts discouraging someone from conversing, the inactivity may accelerate the speech deterioration.

You can give important positive feedback to Parkinson’s patients the about how much clearer their voice sounds after receiving treatment. These tips can also help when chatting with them:

  • Cut background noise. Turn off the TV, close the windows, and choose quiet restaurants when eating out.
  • Talk face-to-face. Reading their lips will help.
  • Try to be patient. Let them answer questions and finish sentences themselves. Cognitive changes in Parkinson’s disease can slow thinking processes and hinder recall of the words they want to say.
  • Keep encouraging them to speak. Repeat the parts of a sentence that you understood, then ask them to say the full sentence again more slowly. Have them spell words you didn’t catch.

When speech exercises alone aren’t enough

The speech therapist may also recommend a variety of assistive devices, such as a small personal microphone system to amplify a soft voice. For patients who are able to use a computer, communicating via e-mail can be a satisfying way to stay connected with friends and family. For the advanced Parkinson’s patient who can’t speak at all, one option is a computerized device that speaks aloud the phrases the person types in.

Stress and Diabetes

Throughout our lives, we all face certain stress from time to time. Stress is a physiological response to a perceived attack, event or activity that produces tension or strain. Stress can be physical, caused by an illness or injury, or it can be emotional in the way that we react to certain situations with our families, finances or health. No matter how the stress develops, each form takes a toll on the body. You may experience headaches, muscle pain, trouble sleeping, feeling irritable and depressed, and may end up withdrawing from social activities when you’re stressed.

When you are stressed, your body will react with a “fight or flight” response. Stress hormones like cortisol and epinephrine kick in, creating stored energy in the form of glucose and fat for the cells to help the body cope with the challenge ahead. Your body directs blood to your limbs and muscles, which allows you to fight whatever the stressful situation might be.

How are Stress and Diabetes Related?

When someone has diabetes and is stressed, this elevated amount of blood glucose can affect insulin levels. This is because people with diabetes have a difficult time utilizing that fight-or-flight response effectively, since the right level of insulin isn’t always available to convert energy. This causes an increase of glucose in the bloodstream.

Plus, simply just having diabetes can be a stressful situation for some people. A lot goes into managing the condition, and long term problems with blood glucose can simply wear you down both mentally and physically.

How to Lower Your Stress Levels

First of all, it’s important for people with diabetes to recognize when they are stressed out. Because stress has simply become something we cope with on a daily basis throughout our hectic lives, it can be difficult to note when we are feeling especially stressed or anxious. However, when you have diabetes and are stressed, your insulin levels may need to be adjusted to compensate for the higher levels of glucose in your blood.

Take note of the times your stress levels are elevated. For instance, if you know heading to the doctor makes you anxious, rate how stressed you feel on a level of 1 to 10. Then, check your glucose levels and watch for patterns during these stressful situations. Often insulin will need to be adjusted during these periods.

After you’ve discovered what triggers the most stress in your life, there are ways to combat it. For instance, you can:

Meditate or try yoga. Calm your mind by meditating or practicing yoga and breathing exercises.

Practice relaxation therapy. Learn to tense and relax major muscle groups in a sequence. This type of therapy has been shown to significantly reduce blood sugar levels.

Step back from the situation. If possible, remove yourself from the stressful situation. Take a few minutes to be alone, and find a quiet spot to focus on relaxing and breathing.

Incorporate physical activity into your routine. Cardiovascular exercise raises the levels of endorphins and serotonin in the brain, which can help improve your mood. Aim for 30 minutes of physical activity every day.

Pick up a relaxing hobby. If you find knitting or painting helps calm you down, join a class or workshop to hone in on your talents. Or, if you prefer to cozy up with a good book, make time each day to read for a while.

Join a support group. Talking to others who share similar experiences can provide invaluable help for those dealing with chronic conditions like diabetes. Ask your doctor if there are support groups in your area, or search online.

Find quality senior care at American Senior Communities. Contact us for more information, or find a location near you today.

Benefits of a Good Nights Sleep

Think about how good you feel after a great night of sleep. You’re ready to face the day, conquer that to-do list, and you have that little extra “pep” in your step. Unfortunately, many people find it difficult to get the recommended amount of sleep (7-8 hours) every night, choosing to be as productive as possible into the wee hours of the night. However, recent studies have shown that getting a good night’s sleep is vital to our overall health and wellbeing, especially when it comes to our mental health.

Sleep and Mental Health

When we aren’t sleeping well, we’re more susceptible to mental health issues like depression and anxiety. Sleep allows our brain the recovery time it needs to properly process all the information swirling around up there and getting it stored in our memory banks. Without sleep, our judgement can become impaired, and we can have less control of our emotions.

The importance of sleep for better mental health is apparent in several ways, including:

Improving memory. While we sleep, the brain establishes and strengthens neural pathways that impact our short term and long term memory. Plus, throughout each phase of sleep our brain works on transforming the new information we’ve learned into memories. This means when we aren’t getting enough sleep, it’s much easier to be forgetful or misplace things.

Boosting ability to learn. When we are tired, we have difficulty focusing, which makes it much harder to decipher and retain information. Getting a good night’s sleep provides for a clearer, sharper mind.

Increasing reaction time. Sleepiness slow us down, physically and mentally. One of the more specific ways it slow us down is by decreasing our reaction time, which makes doing certain tasks that require fast thinking difficult. Driving while tired, in particular, is extremely dangerous.

Speeding up thought processes. Getting a good night’s sleep makes you more alert throughout the day, allowing you to concentrate and pay attention more effectively. Sleep deprivation can cloud our minds, making even simple tasks seem confusing.

Improving mood. Better sleep also keeps us emotionally well; a lack of sleep can cause depression, anxiety and we feel generally more unstable. Feeling angry and irritable tends to go together with tiredness!

Improving Sleeping Habits for Better Mental Health

If you aren’t sure if you are getting the right amount of sleep, it’s important to consider how you feel when you wake up and how you function throughout the day. Do you wake up still tired? Do you feel “foggy” and find yourself practically nodding off at certain times? Are you irritable or emotional and have trouble concentrating or remembering things? If so, these are all signs that improving your sleeping habits is necessary for better mental health.

First, make sure you establish a nightly routine. Give yourself time to wind down from the day, aiming for the same time each evening. Avoid drinking caffeinated beverages in the late afternoon and evening; choose herbal tea instead. Keep the bedroom as a space that is solely for sleeping; removing electronic devices like televisions, computers, tablets and cell phones has recently been recommended by specialists. The reason for this is because electronics give off blue light which has been shown to cue the brain that it’s not time to sleep yet. Keep the room dark at night but allow for natural light in the morning, as this helps regulate your circadian rhythms.

It’s also important to stay active throughout the day. Regular exercise allows you to fall asleep quicker and sleep more soundly. If you find you have a hard time winding down, try deep breathing and relaxation exercises to induce sleep.

Exercise for Lower Back Pain

As we age, our bodies start to go through some physical changes. We lose muscle mass and flexibility, and some of us start to deal with pain from certain chronic conditions, such as osteoporosis or arthritis. One of the most common ailments older adults suffer from is lower back pain, and this is due to the fact that over time, the bones and disks in our spines can start to degenerate, making us sore, stiff and uncomfortable.

Basically, the individual bones in our spine, called vertebrae, are stacked on top of each other with small joints in between them that allow the spine to move, along with disks with a jelly-like center that acts as a shock absorber. These disks begin to wear away as we age, allowing the bones to rub on top of each other, causing the soreness and pain we feel. This degeneration of the joints in the spine occurs in many individuals over the age of 60. In fact, aging is called the number one cause of back pain in seniors.

However, there are many other reasons lower back pain occurs in seniors. Having poor posture throughout your life, being overweight, lack of physical activity and unhealthy eating habits, conditions like spinal stenosis and osteoarthritis can cause chronic back pain.

The Best Exercises for Lower Back Pain

By properly adjusting your lifestyle, back pain doesn’t have to be an inevitable part of aging. Adding some gentle lower back exercises into your daily workout routine can help strengthen your back muscles, increase your range of motion and improve your flexibility. Plus, these exercises have other positive effects, like improving your balance and mobility.

Some of the best exercises for lower back pain include:

Pelvic Tilt: Strengthen muscles in the pelvic and abdominal regions for the support needed to avoid back strain leading to pain. Lie on your back on the floor with your legs straight out in front of you. Tilt your pelvis in toward your chest, keeping your mid-back on the floor. Hold for 3 seconds, then release. Repeat up to 10 times.

The Bridge: Strengthen muscles of the lower back and buttocks while stretching the hip flexors, which help keep the lower back muscles healthy and strong. Like the pelvic tilt, start lying flat on the floor on your back, bending your knees and keeping your arms at your sides. Raise your pelvis into the air as high as you comfortably can and hold for 3 seconds, then lower back down.

Stability Exercises: These exercises often require the use of an exercise ball to strengthen the lower back. A good one to try is sitting on the ball with your feet flat on the floor, slowly raising one arm overhead, repeating on both sides.

Core Exercises: Having a strong core is an essential part of your overall health, as every movement you make is generated from the muscles located in your abdomen, back, hips and pelvis. Core exercises can be done anywhere, at any time, and no fancy equipment is needed.

Leg Strengthening: Strong legs help prevent tension in the lower back, because these muscles pull on your spine. Leg strengthening exercises such as simply standing with your hands on a piece of sturdy furniture for balance, slowly bending the knee and pulling it up to hip level, then lowering it and repeating on the other side will not only reduce lower back pain, but also make daily tasks like getting out of bed or into the shower easier.

American Senior Communities’ New Energy Wellness program is a unique fitness program for seniors designed to promote an active lifestyle. Contact us today to request more information.

Alzheimers and Yoga

Yoga has long been considered one of the best exercises for older adults. Yoga allows seniors to improve their flexibility and balance, enhance overall strength and boost their mood. In fact, yoga can even help ward off conditions like osteoporosis, keeping bones strong and healthy, as well as alleviate many of the aches and pains associated with aging.

Recently, studies have been conducted that reveal yoga may offer additional benefits to seniors: slowing cognitive decline and improving memory.

Yoga and the Brain

Yoga is a Sanskrit word that means “to join” or “to unite.” Practicing yoga helps form a union between your body, mind and spirit, allowing for a balance between all three. Adding yoga to a senior workout routine is a safe and effective way to gain strength and stay mentally engaged.

The mental benefits of yoga are currently being studied more aggressively, and results so far have been very promising. Those who practice yoga generally have calmer, more relaxed minds. When yoga and meditation are combined, the results can help improve both your attention span and your memory. How? Well, meditation basically “exercises” parts of the brain that regulate our emotions and mind-body awareness, leading to changes in brain activity that can improve our memory. Studies have shown that the regions of the brain associated with attention and sensory processing can diminish over the years, but practicing yoga and meditation can keep those regions more youthful.

The Benefits of Yoga for Brain Health

Currently, there is no cure for Alzheimer’s disease, the most common form of dementia and the sixth leading cause of death in the United States. However, yoga and meditation can play a role in slowing the progression of the disease, as way as helping prevent the onset of symptoms. Some of the main benefits of yoga for brain health and memory include:

Improves brain function and memory.

Yoga can improve how quickly your brain processes information. In fact, studies show that yoga is as beneficial to overall brain function as playing brain games. Yoga may increase the production of a protein called brain-derived neuropathic growth factor, which can stimulate the growth of connections among neurons.

Boosts mental health.

Some studies suggest that yoga can have a similar effect on mental health as using medications like antidepressants or psychotherapy. Those who practice yoga regularly report less depression and anxiety in their lives.

Provides an opportunity for socialization.

Staying socially active is key to overall health and wellness, and joining a yoga class provides that much-needed time with others. So, not only will you experience all the benefits of yoga, you’ll also reap the benefits of getting more involved in social activities.

Reduces stress.

The hippocampus, the area of the brain responsible for memory and learning, can be particularly vulnerable to high cortisol levels. Cortisol is a stress hormone. Yoga helps manage stress levels, which in turn lowers those cortisol levels that can compromise our ability to learn and store memories.

If you’re new to yoga, it’s recommended to seek a class specifically designed for seniors. Try a beginner’s class and if you notice any new pain or discomfort, talk to the instructor and about modifying the movements to suit your needs.

American Senior Communities offers a variety of senior fitness classes and options through our New Energy Wellness program, available at several of our locations. Contact us today to request more information.

Helping Seniors Organize and Prepare for Winter

Here are some things you can do to help elderly loved ones stay safe in their home during the colder months.

•    Schedule a furnace check: HVAC System Maintenance is important, especially for at-risk populations like seniors.  The last thing we want to happen is for the furnace to go out in the middle of the night when it’s below freezing outside!

•    Make sure all seasonal clothes and coats are accessible: If your loved one changes out their clothes with the seasons, you’ll want to be sure that all of their fall and winter items are unpacked and accessible. Make sure their coats, hats, gloves, etc. are easy to find and in good condition.

•    Stock the Pantry: An extra reserve of canned goods and other non-perishable or frozen foods is good to have on hand when inclement weather is in the forecast. This is also a good time to check existing items in the pantry and fridge for freshness If food is running low during an episode of bad weather, we don’t want our loved ones to get sick from eating expired food stores.

•    Stock the Medicine Cabinet: This time of year marks the beginning of Cold & Flu season. Make sure your loved ones have current basic medications in their cabinet in case they need them, but of course be sure to check all over-the-counter medications with their doctor/pharmacist to be certain they are safe to take.  If you help your loved one manage their medication, you may want to be aware of the weather forecast and portion out their medication in advance in case you are not able to travel to see them.

•    Check their emergency kit: Now is a good time to make sure they have plenty of blankets, flashlights, bottled water, batteries and other emergency items that are in good and working order in case of a power outage.

•    Arrange for leaf & snow removal: Falling leaves and icy sidewalks both create major slipping hazards for seniors. This can be a difficult conversation to have, especially with seniors like George & Martha who are striving to maintain their independence, but paying for leaf & snow removal will ensure that driveways and sidewalks are cleared. If your loved one can’t afford to pay for the service, you might investigate volunteer services in your area. Check with your local resource on aging (State Departments of Aging, Area Agencies on Aging, etc.) for more information.

•    Purchase sand or salt to have on hand: As snow melts and refreezes, it’s always a good idea to have these items at home to treat icy spots.

•    Prepare the car: If your loved one is still driving, make sure to have their car checked for winter and stock it with all the winter necessities (ice scraper, blankets, etc.).

•    Winterize the home: Gathering the family for a weekend or hiring a handyman to put in storm windows, clean the gutters, and check for roof leaks will help make sure your loved ones are safe and warm all season.

By staying organized in advance of the changing weather, you’ll have peace of mind that your loved ones are safe in their home – even if you can’t get over to help due to road conditions.

7 Winter Safety Tips for Seniors

Prepare older people for the unique challenges of wintertime weather.

During the winter months, ice, snow and cold temperatures can make life challenging for everyone. Slippery sidewalks and cold weather can cause a wide range of injuries and illnesses especially for seniors.

Here is some helpful advice for preventing common winter dangers that the elderly population faces.

  1. Avoid Slipping on Ice
    Icy, snowy roads and sidewalks make it easy to slip and fall. Unfortunately, falls are a common occurrence for senior citizens, especially during the winter months, says Dr. Stanley Wang, a physician at Stanford Hospital in Palo Alto, Calif. Often these falls cause major injuries such as hip and wrist fractures, head trauma and major lacerations.

    While younger people often recover relatively quickly from such injuries, older adults face complications, which Dr. Wang says are a leading cause of death from injury in men and women over the age of 65.

    Make sure to wear shoes with good traction and non-skid soles, and stay inside until the roads are clear. Replace a worn cane tip to making walking easier. Take off shoes as soon as you return indoors because often snow and ice attach to the soles and, once melted, can lead to slippery conditions inside.

    To find out more, read our article on Preventing Senior Falls

  2. Dress for Warmth
    Cold temperatures can lead to frostbite and hypothermia a condition where the body temperature dips too low. According to the CDC, more than half of hypothermia-related deaths were of people over the age of 65.

    So dont let indoor temperatures go too low and dress in layers. Going outside? Wear warm socks, a heavy coat, a warm hat, gloves and a scarf. In very cold temperatures, cover all exposed skin. Use a scarf to cover your mouth and protect your lungs.

    Your body temperature should never dip below 95 degrees if it does get medical assistance immediately.

  3. Fight Wintertime Depression
    Because it can be difficult and dangerous to get around, many seniors have less contact with others during cold months. This can breed feelings of loneliness and isolation.

    To help avoid these issues, family members can check in on seniors as often as possible; even a short, daily phone call can make a big difference. Seniors can also arrange a check-in system with neighbors and friends, where each person looks in on one or two others daily.

    For more information on this topic, read our article on Getting Help with the Holiday Blues

  4. Check the Car
    Driving during the winter can be hazardous for anyone. But it is especially dangerous for older people, who may not drive as often anymore or whose reflexes may not be as quick as they once were. Get your car serviced before wintertime hits or ask a family member to bring it to a garage for you. Checking things like the oil, tires, battery and wipers can make a big difference on winter roads. Also make sure your AAA membership is up-to-date in case of emergencies.

    Learn the Warning Signs a Senior Shouldnt Be Driving

  5. Prepare for Power Outages
    Winter storms can lead to power outages. Make sure you have easy access to flashlights and a battery-powered radio in case the power goes out. Stockpile warm blankets. Longer power outages can spoil the food in your refrigerator and freezer so keep a supply of non-perishable foods that can be eaten cold on hand. If the power goes out, wear several layers of clothing, including a hat. Move around a lot to raise your body temperature. Check out this winter weather checklist from the CDC to make sure you have everything you may need.
  6. Eat a Varied Diet
    Because people spend more time indoors and may eat a smaller variety of foods, nutritional deficits especially Vitamin D deficiency can be a problem. Nicole Morrissey, a registered dietician in southwest Michigan, recommends consuming foods that are fortified with Vitamin D, such as milk, grains and seafood options like tuna and salmon.
  7. Prevent Carbon Monoxide Poisoning
    Using a fireplace, gas heater or lanterns can lead to carbon monoxide poisoning. Ensure your safety by checking the batteries on your carbon monoxide detector and buying an updated one if you need to.

The most important tip to keep in mind during the colder months is to ask for help. If you need to clear your property of snow and ice, dont hesitate to ask a family member or neighbor, or hire a professional. Arrange rides to the grocery store and doctors appointments. Many communities have shuttle services specifically for seniors. Dont be afraid to reach out for help.

Wintertime certainly poses challenges for seniors, but with a bit of planning and awareness, you will stay healthy and experience the joys of springtime soon enough.

Andrea Lee lives in Silicon Valley, Calif., and is a part-time college instructor and a full-time mom of two boys one in college, the other in preschool.

Inflammation in the Body

Get ready for the health buzzword of the decade: inflammation. A key biochemical process inside every one of us, inflammation is the cornerstone of health and healing and yet unless you learn the secrets to managing it it will also probably eventually kill you.

The good news: As scientists slowly but surely uncover how the inflammatory response works, theyre learning how we can influence it to our benefit.

Here are five surprising and life-changing facts.

Inflammation surprise #1: Inflammation is both your bodys best friend and its worst enemy.

Inflammation is what happens when a bee stings, a paper cut slices your skin, or pollen or a virus land up your nose. Your body reacts. More specifically, your white blood cells issue a short-term response to defend your body against the assault and help it heal. So far, so good.

Unfortunately, sometimes this process goes haywire. In a classic too much of a good thing, certain triggers create chronic inflammation the bodys defense team doesnt quit. Immune cells never wind down, causing damage to various body systems and, ironically, leaving them more vulnerable to attack.

Why its important

Inflammation is the basic mechanism that maintains the well-being of our cells, says Janko Nikolich-Zugich, chair of the department of immunobiology at the University of Arizona College of Medicine and codirector of its Arizona Center on Aging. But pretty much every disease is also connected to it.

Luck (good or bad) is a factor; some people are genetically prone to inflammation overload, Nikolich-Zugich says. But within the span of your genes, you have a lot of individual control, he adds. The key is to have well-controlled inflammation, to keep it regulated so that it switches on when you need it and switches off when you dont need it anymore.

Action step: Consume healthier fats.

Fats we eat are the building blocks of both proinflammatory hormones (needed to fight the invader) and anti-inflammatory hormones (needed to calm down the healing process after the wound or other threat is gone), says Beth Reardon, director of integrative nutrition at Duke University. We need both kinds.

The trouble: We live in such an inflammatory environment (from pollution, germs, diet, and other sources) that its tough to keep the inflammation process in balance. The best way to do this is with diet: Decrease the inflammatory fats you eat (called omega 6s, found mostly animal fats from meat and dairy) while increasing anti-inflammatory fats (called omega 3s, found mostly in cold-water fish such as salmon and herring or in fish-oil supplements).

A tricky point: You need two kinds of omega 3s. There are long-chain omega 3s (from fish) and short-chain omega 3s (from flax, seeds, and fortified products, like omega-3 eggs or juice). The two types work in different ways in the body. People think if they eat foods fortified with omega 3s, theyre doing enough. But most people dont get enough long-chain omega 3 fats, Reardon says. Eating cold-water fish twice a week does the trick.

Beware Inflammatory Foods and Extra Weight

Inflammation Surprise #2: Chronic Inflammation Contributes to Almost Every Major Disease

Most people have heard of so-called autoimmune diseases, when the body turns on itself with a hyperactive defense mechanism. Common examples include hay fever, rheumatoid arthritis, gout, pelvic inflammatory disease, colitis, and bursitis.

You can add to this list cancer, Alzheimers disease, type 2 diabetes, hypertension, heart disease, Parkinsons, osteoporosis, and even depression. Many researchers also now believe that inflammation isnt just a result of osteoarthritis; it may be a contributing cause. The one thing that unifies most major diseases is inflammation, says the Arizona Center on Agings Nikolich-Zugich. Whether inflammation is the root cause or whether these diseases are made worse by the inflammatory process isnt entirely clear yet but inflammation is almost always a factor.

Why its important

Scientists believe that the key to extending lifespan and late-life well-being lies in figuring out how to manipulate and cut off chronic inflammation. While all the diseases listed above manifest themselves in the body in very different ways, they seem to share many commonalities down at the cellular level.

Action step: Eat a more anti-inflammatory diet.

Because our bodies are exposed to more damage at the cell level than they can handle a process called oxidative stress shoring up defenses is key. And theres no easier way to do that than by carefully choosing what we eat and drink.

What foods contain the most antioxidants? You neednt be a chemist. Just think three words: color, taste, aroma. In whole (not processed) foods, these traits signal high-antioxidant chemical content, Duke Universitys Beth Reardon says. This means:

Bright or deep-hued fruits and vegetables (berries, eggplant, purple grapes, sweet potato, dark green leafy veggies)

Foods with strong flavors (bell pepper, watermelon, tomatoes, cruciferous vegetables)

Foods with powerful odors (garlic, onion, chives)

Other beneficial foods: the spices turmeric, ginger, cinnamon; curry; tart cherries; green tea; red wine; dark chocolate. These help inhibit the formation of inflammatory prostaglandins and COX inhibitors (the same enzyme-inhibiting substances in medications such as Vioxx or Celebrex).

At the same time, avoid highly processed foods full of sugar and saturated fats. These so-called high-glycemic index foods (chips, cookies, crackers, cakes) pour sugar into the bloodstream, upping inflammation.

Inflammation Surprise #3: Its Not the Look of Your Body Fat but Whats Inside it That Really Hurts You

Little wonder obesity is linked with so many damaging diseases, from diabetes to Alzheimers. In just the past five years or so, researchers have discovered that being overweight is a huge cause of inflammation.

We tend to think of body fat as an inert, annoying consequence of eating too much and not exercising enough, Beth Reardon says. We need to think of it as what it really is: metabolically active tissue thats actually a source of the compounds that trigger inflammation.

Why its important

Having too many extra fat cells basically amps up the inflammatory process. Thats because fat cells are producers of hormones, such as estrogen and leptin, and other molecules that signal the immune system. Excess fat creates excess inflammation.

Belly fat (accumulated around the abdomen) may be especially dangerous, compared with fat in the hips or rear, because midsection fat tends to produce even more estrogens and inflammatory compounds called cytokines, Reardon says.

Theres a silver lining to perimenopausal weight gain, though, she adds. A stubborn muffin top may be natures way of trying to hang onto estrogen when hormone levels shift as the ovaries close up shop, in order to protect heart health and make symptoms like hot flashes less severe. (Postmenopause, though, you still want to maintain a healthy weight.)

Action step: Aim for a healthy weight.

Possibly the single best health move you can make: Keep moving. Why? In addition to burning fat and warding off unhealthy fat cells, vigorous exercise three to four times a week subjects the body to controlled stress. That trains the immune system to deal with high-energy demands followed by lower, maintenance levels of functioning. This allows inflammation to recalibrate, says Janko Nikolich-Zugich.

Exercise also produces hormones like endorphins, which make you feel good and therefore encourage you to continue this important, immune-boosting activity.

How Stress and Allergies Affect Inflammation

Inflammation Surprise #4: You Cant Control Everything That Trips Inflammation but You Might Want to Conquer That Fear of Public Speaking

Inflammatory agents (things that set off our immune system) are all around us in the air we breathe, the UV rays we absorb, the cleaning agents we use, the makeup we wear, the candles we light, the germs we encounter.

Another surprising source of chronic inflammation: chronic (long-term) stress. Know how some faces flush and palms sweat before the person gives a speech? Thats an inflammatory response. So is breaking out in hives during an argument, or getting a headache and racing heart when pulling an all-nighter.

Why its important

In concentrated doses, emotional stress is no big deal. But when the stress is constant as when dealing with a ongoing personal crisis it trips a constant inflammatory response.

You cant control the fact that your aging skin or gut may be a leaky barrier, for example, letting in more invaders that cause the body to mount an inflammatory response, Nikolich-Zugich says. Also, as we age, changes to the immune system itself may make it harder to fight familiar bugs and viruses. But, as with diet and exercise, emotions and stress are areas most people can control. And when it comes to inflammation, the body needs all the help it can get.

Action step: Sweep your life of stressors as much as you can.

In addition to following basic advice about using sun protection, washing your hands, exercising, eating an anti-inflammatory diet, and avoiding known toxins (dont smoke and dont live with someone who does!), it pays to curb your emotional stress as much as you can.

Some areas many overlook:

Dont scrimp on sleep.

Get depression symptoms treated; its a form of chronic stress on the body.

Know that short-term anxiety is unavoidable, but seek confidence-building help if youre constantly in an edgy situation (the frequent flyer who hates to fly, the CEO whos terrified of public speaking).

Inflammation Surprise #5: Many of Us Have Infections and Allergies we Dont Know About, Which Send Us Into a State of Constant High Inflammation

Heres a classic case: Someone has inflammatory bowel disease, migraines or other chronic headaches, chronic fatigue syndrome. The various maladies are treated with medications, but the underlying cause of the problem an undiagnosed food sensitivity, for example goes untreated. Get to the root of the problem (the food sensitivity upsetting the balance of bacteria in the gut, say) and youre closer to a cure.

Our medical system tends to treat specific issues rather than the whole person. When things go wrong, we take something to fix it, instead of trying to control the underlying cause: inflammation, integrative nutritionist Beth Reardon says.

Why its important:

Up to 40 percent of the population has a gluten sensitivity, Reardon says. Thats different from a full intolerance (celiac disease), but enough to notice brain fog, bloating, gastric distress, or fatigue after eating wheat. Dairy sensitivity (lactose intolerance, which is short of true milk allergy) is similar. Both sensitivities tend to grow more common as people get older.

Human bodies evolved to eat dozens of grains, but modern society focuses on one wheat and a high-gluten type at that (all the better for fluffy bread and crispy snacks). The problem: Protein in wheat risks irritating the gut (where the immune system mostly begins), causing inflammation. Substances the body believes shouldnt be there arent absorbed well; instead, these undigested proteins work their way into the bloodstream, where the white blood cells react as if they were a virus or any other foreign substance.

Ditto with milk: We evolved to consume fatty breast milk for the first years of life, not to subsist on milk, cheese, and ice cream. Too much of these foods overwhelm a system thats sensitive to them.

Action step: Pay attention to what your bodys telling you.

You can tell if you have a food sensitivity by how your body reacts. Try eliminating a food type (wheat, dairy, soy, meat) for two weeks. See how you feel. Do symptoms disappear or fade? Now add back the potential allergen and see what happens.

Avoid writing off uncomfortable reactions to fibromyalgia or migraines or some other specific disorder until youve experimented with the possibility of a more global root cause. Even if you dont have a food allergy, replacing problematic foods with the healthier options within a low-fat, plant-based, Mediterranean-style diet will be a win-win for your body, Reardon says.

Cant Get a Good Nights Sleep? 5 Surprising Reasons

Its natural to blame sleep problems on stress or physical changes that come with age. But many cases of either sleeplessness or poor sleep are caused by a handful of specific problems, most of them fixable with lifestyle changes or the help of a doctor. Here, five little-known causes of sleep problems and what to do about them.

1. Light

How it disrupts sleep: You probably already know that when you stay up late under bright lights, you interrupt your bodys natural sleep-wake cycle, because light tricks your brain into remaining in daylight mode. Less well known is that the light from computer screens and iPads shining directly into your eyes at close range is especially troublesome. Why? Part of the problem is that the light from these devices is at the blue end of the spectrum, which scientists believe is particularly disruptive to circadian rhythms. Blue light, although common during the day, doesnt occur naturally during the evening.

Similarly, light shining in your eyes while you sleep even very small amounts coming from, say, a lighted clock makes your brain think its morning and emerge out of deep sleep. Darkness triggers production of the hormone melatonin, the hormone that triggers sleepiness and the onset of sleep. Light prevents this release or shuts it off.

The evidence: Studies have long shown that shift workers and those who work late at night have poorer sleep and higher incidences of certain conditions associated with lack of sleep than those who regularly sleep eight or nine hours at night. A recent study published in Cancer Causes & Control, for example, found that the countries generating the most light at night have the highest incidence of breast cancer. And studies at the Light Research Center at Thomas Jefferson University in Philadelphia have found that the use of computers, lighted readers, and TVs at close range is tied to a higher incidence of sleeplessness.

Whos at risk: Everyone exposed to light shortly before bed or during sleep. Light is also bad for hearts, which need deep sleep to recharge. Surprising fact: Every year theres a spike in the number of heart attacks just after the start of daylight savings time in the spring.

What to do: Dim the lights and turn off all lighted screens at least an hour before bed. If you use a reading light, make sure its not any brighter than necessary and doesnt shine in your eyes. Do a light police room check: Are there streetlights outside your windows? Use blackout curtains or shades and make sure they fit the windows tightly so no light seeps in around the edge. Charge laptops, phones, cameras, and other devices in another room. Use an alarm clock without a lighted dial, or turn it to face the wall. Keep a flashlight next to your bed and use it whenever you have to get up to use the bathroom or let the dog out and be careful to point it away from yourself so you dont look into the beam. Dont turn on an overhead light, and never use nightlights.

If you must use a laptop, turn down the screen brightness as low as you can tolerate and prop the laptop as far away from you as your typing arms will reach. If you love eReaders, try a Kindle or other device with a screen thats not backlit.

Pain and breathing problems

2. Pain

How it disrupts sleep: Just about any kind of pain signals sent by the brain jaw pain, headaches, back pain, or arthritis, for example disrupt sleep, lifting you from the deep, restful REM cycle into lighter sleep or causing you to sleep fitfully and partially wake up over and over, which experts call microarousals.

The evidence: Surveys of chronic pain sufferers reveal that between 60 and 90 percent sleep poorly. But many dont realize that their pain is the cause of their poor sleep. This can become a vicious cycle, says Thomas Roth of the Sleep Disorders and Research Center at the Henry Ford Hospital in Detroit, because even partial sleep disruptions can increase sensitivity to pain. In other words, even mild pain causes poor sleep, which in turn leads to more pain.

Whos at risk: Anyone who suffers chronically painful conditions such as arthritis, back or neck pain, jaw alignment problems, dental pain, fibromyalgia, headaches, or any other type of chronic pain.

Note: The pain doesnt need to be severe; studies show that even mild pain disrupts sleep. According to Roth, frequent microarousals can occur throughout the night without your being aware of them. The result is that you never attain deep REM cycle sleep and wake up feeling tired and grumpy, but you dont know why.

What to do: Take steps to treat your pain proactively. Using over-the-counter pain relief is a start, but its always best to consult with a doctor and develop a comprehensive pain-relief program. For example, you may need physical therapy to combat back and neck pain, or migraine medication if your frequent headaches might be migraines. If bruxism (teeth grinding) or jaw clenching is leading to jaw pain, a mouth guard is often the solution.

3. Disrupted breathing

How it disrupts sleep: When oxygen flow to the brain is interrupted, your brain sends a warning signal that wakes you up either fully or partially, causing fitful sleep or preventing deep, restful sleep. The result: You wake feeling like you didnt sleep well, even if you were out for nine hours straight.

The best known version of this is apnea, which is a complete stoppage of breathing. A much more common and less recognized problem is upper airway resistance syndrome, or UARS. In UARS, structural blockages somewhere in the airway nasal congestion, your tongue falling back and blocking the back of the throat, or just having a smaller airway to begin with begin to interfere with the flow of air. What happens is that you wake up over and over again without knowing it, but the sleep interruptions last only a few seconds, too short to be detected by a standard sleep apnea test.

The evidence: Even subtle levels of restricted breathing can lead to deep brain stimulation and arousals that prevent your ability to stay in deep sleep, says otolaryngologist Steven Park, an otolaryngologist and author of Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired. You dont realize youre waking up, but your brain wakes up, so its now in a light sleep. We see people who are waking up 100 times a night.

Whos at risk: People who breathe through their mouths or have chronic congestion, such as from asthma or allergies. If you sleep more poorly on your back, this can be a sign of UARS, because when you sleep on your back your tongue is more likely to sink back and block the entrance to your throat. If you have a narrow face, a thin neck, or had extensive orthodontic work to correct a crowded jaw, youre likely to be at particular risk for UARS, says Park.

What to do: Start with some self-tests. Try using pillows to keep yourself on your side, or put a tennis ball in the back pocket of pajama bottoms, so you cant sleep on your back. If your nose often feels stuffed up, you might find relief with breathing strips, available at the drugstore. Another option is to try is a device designed to hold the nostrils open; brand names include Nozovent and Breathe with Eez. A saline nasal spray works for many people. If you have congestion due to seasonal allergies, try an antihistamine. (But if you take one that can act as a stimulant, such as Claritin or Sudafed, dont take it too close to bedtime.)

If none of these help, ask your doctor to refer you to an ear, nose, and throat (ENT) specialist, who can evaluate whether youre a candidate for Continuous Positive Airway Pressure (CPAP), a nasal mask that delivers air directly through your airways. An ENT can also determine whether tongue position is causing your UARS, in which case a dental device that pushes the jaw and tongue forward can help.

For many people, losing a few pounds can be the ticket to better sleep, since excess weight is linked to all kinds of breathing problems, including UARS, snoring, and sleep apnea.

Medications and depression

Medications

How they disrupt sleep: Medications sometimes have side effects that trigger sleeplessness or interfere with deep sleep. Most common culprits: asthma medications, corticosteroids, blood pressure medications, and antidepressants.

Also, many ingredients in common medications act as stimulants. They may cause jitteriness during the day and trigger sleeplessness or prevent deep sleep at night. Example: Bronchodilators like albuterol and salmeterol, commonly used to treat asthma, bronchitis, and COPD, can amp you up and interfere with sleep, yet patients are often directed to use them at the end of the day. Other common medications that can interfere with sleep include SSRIs, such as Prozac and Paxil, and beta-blockers taken for high blood pressure and heart disease.

Sometimes medications sabotage your sleep indirectly. Diuretics, for example, can interfere with sleep by causing you to use the bathroom at night. Tagamet (generic name cimetidine), taken to control reflux and ulcers, can cause sleeplessness, especially when combined with caffeine or other medications. Like many side effects, sleeplessness from medications can affect some people but not others; Propecia, used to treat hair loss, and the antihistamine loratadine (brand name Claritin) are both known to cause sleeplessness in a percentage of those who take them. Some people react to opioid pain medications with rebound sleeplessness, feeling sleepy at first but then waking up and being unable to get back to sleep.

The evidence: Although every medication is tested for side effects during the FDA approval process, in many cases evidence of side effects mounts over time as a drug enters more widespread use. Albuterol has been widely reported to cause restlessness, nervousness, and sleeplessness. An article in the European Journal of Clinical Pharmacology also found that beta-blockers interfere with melatonin release.

Recent studies have found that Prozac, Zoloft, Celexa, and other SSRIs affect sleep in a significant number of patients. If youre using an antidepressant, be sure to talk to your psychiatrist about any possible sleep problems and ask about alternative antidepressants if this is an issue.

Whos at risk: Those taking regular medication for a chronic condition such as asthma, depression, high blood pressure, or pain. A medication that you take once is less likely to cause an ongoing sleep issue because you take it for a short period of time and are more likely to notice the side effect. When you have a chronic condition, youre more likely to attribute any sleep problems to the condition rather than the treatment.

What to do: Any time youre prescribed a new medication, ask the doctor to discuss in detail all side effects you should be alert to. Its always a good idea to ask both the doctor and the pharmacist, How will this medication affect my sleep? Because some medications cause sleepiness, some interfere with sleep, and some do both, asking the question in an open-ended way will get you the most information.

5. Depression

How it disrupts sleep: Fatigue is one of the most prevalent symptoms of depression, yet many people dont realize how closely related depression and poor sleep can be. Depression wreaks havoc with your natural biological rhythms; many people with depression have trouble getting out of bed in the morning, and they oversleep or get fatigued and nap during the day. Yet their sleep is fitful and of poor quality, so despite spending more hours ostensibly sleeping or trying to sleep, they dont feel well rested. Then at night, depression sufferers often have trouble maintaining a regular bedtime routine. Having slept late in the morning or napped late in the day, they may not feel sleepy. Anxiety, which often accompanies depression, may cause excessive late-night worry that contributes to sleeplessness.

The evidence: Because the relationship between depression and insomnia is a chicken-and-egg cycle, experts have studied it from both directions. Psychological studies have found that a high proportion of those with depression suffer from either sleeplessness or disrupted sleep, and a recent study by the University of Maryland found that 40 to 60 percent of people with sleeplessness show signs of depression.

Whos at risk: Those with a history of mood disorders such as depression and anxiety, or anyone who has recently undergone a stressful life event likely to trigger depression.

What to do: One of the most effective steps you can take in this situation is to exercise vigorously during the day. According to experts at the University of Maryland, exercise combats depression by increasing serotonin levels in the brain. Its also one of the best ways to get your sleep-wake cycle back on track. Do 45 minutes to an hour of physical activity before dinner, and youll feel tired earlier and sleep more deeply. If your low mood persists, consult a therapist or ask your doctor for a referral to a psychologist or psychiatrist.

How Do You Know if Someone Has Shingles?

The telltale symptoms of shingles (herpes zoster, a viral infection in a nerve) usually include:

First: The skin may tingle or there may be a burning or stinging pain, usually felt on just one side of the body (frequently the trunk, neck, or face), often in a band-like formation. Some people may also experience headache, fever, tiredness, or general achiness.
Within a few days or weeks: A small rash of raised, reddish bumps appears, which can vary in appearance from person to person. The rash may appear in the same area as the pain, usually in a stripe or band (roughly following a nerve path) and on only one side of the body or face.
A few days after the rash begins: Fluid-filled blisters that tend to resemble chicken pox replace the bumps and crust over, lasting up to two weeks.
The pain of shingles can be mild or severe. It can last for days, weeks, months, or occasionally even years. When pain outlasts the blisters, its a sign of postherpetic neuralgia, a common complication of shingles.

Its a good idea to have any suspicious rash, especially one thats accompanied by pain, checked out by a doctor. Always see a doctor promptly if the pain or rash is near the eye, forehead, or nose. A condition called herpes zoster ophthalmicus (shingles of the eye) can lead to eye infections, glaucoma, or even blindness.

Shingles can also become very severe and dangerous in people who are immune-suppressed (for example, on chemotherapy, with a history of transplant, or with a disease such as HIV). For most people, however, shingles is painful and uncomfortable but eventually gets better on its own. If started within a few days of the appearance of rash, treatment with antiviral medications can reduce the risk of post-herpetic neuralgia.

The shingles vaccine does make it less likely that one will develop shingles and is recommended for all adults over age 60.