Are You at Risk for Pneumonia with this Medication?

One of the foundations of health is a good night's sleep.  Lack of sleep can lead to consequences including obesity, aggravation of pain conditions like fibromyalgia, poor memory, and even increased risk of cardiovascular disease.  With all the benefits of getting a good night's sleep, it might be tempting to do whatever it takes to correct sleep problems -- including taking pharmaceutical sleep aids.  But let's step back and consider the consequences first.

A common class of medications prescribed for sleep (and anxiety) is the benzodiazepines ("benzos") -- with trade names like Xanax and Valium, or generic names alprazolam, diazepam, and others.  The main problem with these drugs is well known:  they're addictive, and can lead to physiological dependence.

A new study published this month (1) found an unexpected danger with benzos:  a 54% increased risk of pneumonia.  Pneumonia is one of the more serious complications of seasonal influenza, which I wrote about last week.  If you're currently taking benzos for sleep, or considering them, think about all the natural ways you can improve sleep instead.  Of course, discuss changing your medication with the prescribing physician, since it's best to wean down carefully on this type of drug.  Now if you're thinking, "I've tried all that natural stuff before!  It didn't work," my response is... really?  Everything?  Review the list below, and give these suggestions an honest try for a period of several weeks.


IMPROVING THE QUALITY OF YOUR SLEEP

1. Maintain consistent sleep and wake times. Do not push yourself to stay up past the initial signs of sleepiness. This can create epinephrine production, causing more difficulty getting to sleep later. It is good to have a “getting ready for bed” routine to relax and prepare your body for sleep. Avoid taking naps if you have trouble sleeping at night.

2. Reserve the bed for sleep and sex only. Do not read, watch TV, eat, or worry in bed. Solve daily dilemmas outside of the bedroom. If you find that you’ve been lying awake in bed for 15-20 minutes, get out of bed.  Do something mundane until you feel sleepy, and then go back to bed. Repeat this as often as needed.

3. Your sleeping environment should be quiet, cool (70 degrees or less), and comfortable. The room should be clutter-free. Reduce the amount of ambient light as much as possible. Electronic devices such as clocks, stereos, TVs and computers generate electromagnetic fields that can disturb sleep for some people. Experiment with moving these into another room or using EMF shields. Feng Shui, the Chinese art of placement, can be valuable in creating an optimal sleeping environment.

4. Exercise regularly. Exercising during the day or early evening decreases the time it takes to get to sleep and increases the amount of deep sleep obtained. Most people do better avoiding exercise late in the evening.

5. Exposure to sunlight early in the morning and late in the afternoon or evening encourages a strong circadian rhythm. The hormone melatonin, which helps create a sleep state in the body, is suppressed in light and secreted in darkness.

6. As much as possible, ensure complete darkness at night.  Darkness encourages your body’s natural production of melatonin.  Do not fall asleep with the TV or lights on.  Turn off all screens (TV, computer, video games, etc.) 30-60 minutes before bedtime.  If you wake at night to go to the bathroom, do not turn the light on.  Even this brief exposure to light at night may suppress your melatonin significantly, drastically reducing the quality of your sleep.

7. If you have problems with waking during the early hours of the morning, have a small protein snack just before bed to ensure consistent blood sugar levels throughout the night. Consistently get exposure to sunlight as late in the day as possible.

8. Improving overall health will improve the quality of your sleep. Work towards improving or eliminating health problems. Treatment modalities such as Neurostructural Integration Technique will help to relax the body. Effective stress management is essential.


THINGS THAT RELAX THE BODY AND PREPARE IT FOR SLEEP

• Warm baths, possibly adding Epsom salts or lavender oil
• Meditating for 5-30 minutes
• Breathing exercises, progressive muscle relaxation (various recordings are available) or any other means of inducing the “relaxation response”.  Daily practice brings greater results.
• Special acoustic recordings that increase specific brain wave patterns for relaxation and sleep
• Botanical treatments and aromatherapy using herbs and their essential oils (examples include chamomile, valerian, vervain (verbena), hops, lavender, passionflower, avena (oat straw), lemon balm and scutellaria (skull cap).  Consult Dr. Peters for dosages and recommendations.
• Calcium and magnesium supplementation.  Consult Dr. Peters for dosages and recommendations.
• 5-hydroxytryptophan (5-HTP) or melatonin supplementation may be necessary in individual cases.  Consult Dr. Peters for dosages and recommendations.

THINGS THAT INTERFERE WITH SLEEP

• Although alcohol may make you fall asleep, the sleep obtained after drinking is fragmented and light.
• The stimulating effects of caffeine may last up to 10 hours in some people. Avoid it in the afternoon if getting to sleep is a problem. Caffeine is present in coffee, green tea, black tea, chocolate and some medications (pain relievers, decongestants, thermogenic weight loss products, energy supplements, etc.)
• The stimulating effects of nicotine (first- or second-hand smoke) can last several hours.
• Sleeping pills, aside from being highly addictive and full of side effects, decrease the amount of time spent in deep sleep and only increase light sleep.
• B-vitamin supplements can increase energy that keeps some people awake, if taken before bed. Take B-vitamins earlier in the day.
• Do not go to bed with a very full stomach. Large quantities of protein are stimulating to the body as digestion occurs. It’s best to finish eating at least three hours before going to bed.

1.  The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort.  Thorax doi:10.1136/thoraxjnl-2012-202374.  

Flu Season: Here with a Vengeance

Influenza has arrived early this year, and it looks like it's gearing up to be a nasty one:  both the H1N1 and H3N2 strains of influeza A virus have been identified, as well as influenza B.  According to the Centers for Disease Control and Prevention (CDC), the rate of infection is still low this week in Illinois, but is high in southern states like Alabama and Mississippi.


Remember, this is the respiratory flu we're talking about (sore throat, fever, fatigue, muscle aches), not the "stomach flu" (more properly called gastroenteritis).  The CDC recommends flu vaccines for everyone, though there is no scientific evidence for this approach.  Furthermore, the flu vaccine might prevent flu virus infection, but does absolutely nothing to protect against related viruses that cause flu-like illnesses.  Are there good natural alternatives for preventing and treating the flu?

My first recommendation to everyone at this time of year is to get a blood test for vitamin D levels.  The proper test is called 25-hydroxyvitamin D, and the optimal level should be between 40 and 100 ng/ml.  Research has shown a clear connection between low blood levels of vitamin D and risk of catching the flu.  Flu season can span anytime from October to May – the same time period that we don’t get enough sun exposure to produce vitamin D naturally through the skin.  Coincidence?  If you have low vitamin D levels now, it’s critical to supplement at high doses under a doctor’s supervision.  Without a blood test, a supplement of 1,000-2,000 International Units per day is advisable through the winter.

Remember good hygiene – wash hands frequently, and avoid touching your eyes, nose, and mouth.  There is no need to use antibacterial soap, since this does no better than standard soap in protecting against infection.  Get a good night’s sleep to support your immune system.  For supplemental support, look into herbs such as astragalus, larch, and elderberry, as well as extra vitamin C and zinc.  If you’re exposed to people with flu or other respiratory illnesses, use a neti pot or squeeze bottle with plain salt water to rinse the nasal passages, twice a day.

Flu vaccination is important for those with asthma and other lung problems; for nursing home residents and health care workers; and for those with suppressed immune systems.  For the rest of us, take care of yourself naturally.  At the first sign of illness, use supplemental support often:  elderberry and andrographis every two hours for 24-48 hours can help to shorten the duration and severity of your misery.

Natural Medicine Myth #5: One-A-Day

This is a continuation of my series (in no particular order) on misperceptions in the field of natural medicine.  My previous articles focused on policosanol, cinnamon, systemic candida, and acai berry.

Those of you who know my articles and recommendations will find it no surprise that therapeutic lifestyle changes are the foundation of naturopathic medicine:

• diet
• exercise
• sleep
• stress management

In many cases, though, specific nutritional and herbal supplements can be critical for supporting a patient's vis medicatrix naturae:  the healing power of nature.  Particularly in the case of complex or chronic disease, such supplements are often necessary for a certain period of time.

One thing that often surprises patients is the dosages I recommend for many nutritional and herbal supplements.  I think that many of us have been conditioned by "One-A-Day" multivitamins to think that all supplements work that way.  In fact, this under-dosing is a key reason why many folks find that self-treatment with herbs and supplements is ineffective.

As an example, take one of my favorite supplements:  fish oil.  The beneficial components of fish oil are the long-chain omega-3 fatty acids, EPA and DHA (that's eicosapentaenoic acid and docosahexaenoic acid for you nutritional biochem geeks out there).  Some folks take one softgel a day of fish oil -- 1000 milligrams!  Sounds like a lot, doesn't it?  Well, research shows that for general cardiovascular health, you should take around 1000 mg of omega-3 fatty acids per day.  "Well, great, then," you think, "I guess I'm covered."  Hold it right there:  fish oil supplements are not 100% omega-3 fats; each softgel might have only 300-400 mg of omega-3s.  So now you're faced with 3-4 softgels per day to get the recommended amount.  Do you see why I recommend liquid cod liver oil so often now?  Much easier to blend a teaspoon into a breakfast smoothie, yielding 1200 mg of omega-3s.

If you already have conditions such as high triglycerides that can benefit from omega-3 supplementation, now you need to up that dose to 2000-3000 mg per day:  7-10 softgels, or 2 - 2.5 teaspoons of liquid.  Omega-3 fats can benefit so many different conditions, such as autoimmune diseases, skin problems, menstrual cramps, depression, and anxiety -- as long as you're taking the proper dose.

Feel a cold coming on?  Yes, zinc lozenges can help -- as long you get a total dose of at least 75 mg of zinc per day (be sure to take with food, to avoid stomach upset).  Herbs such as echinacea, and my favorite combo of lomatium (Lomtium dissectum) and osha (Ligusticum porteri), are wonderful immune boosters -- just be sure take a dose every 2 hours during those first couple of days of a cold.  Less than that, you might as well skip it.

Nutritional and herbal supplements require these larger doses since they work synergistically to support the body's natural functions, rather than to suppress symptoms like pharmaceuticals.  So shift your mindset, and reap the benefits that nature has to offer.