Sleep Disorders

Sleep Disorders

The normal sleep cycle consists 4 stages of non-REM sleep cycles and 1 cycle of REM (Rapid Eye Movement) sleep throughout the night. When your sleep cycles are disturbed, you wake up feeling tired and difficulty concentrating during the day.

  • NREM sleep. These four stages start from very light sleep during Stage 1 down to very deep sleep in Stage 4. Throughout NREM sleep, there is little muscle activity and it is very difficult to wake someone in stage 4 sleep. Deep sleep helps to restore your body and muscles from stresses of the day
  • REM sleep: This is the stage of sleep in which most dreaming occurs and our eyes are thought to move in relation to the visual images of our dreams

Each cycle lasts around 90 minutes consisting of the 5 stages of sleep.

During the night, the amount of time spent in each stage varies; we spend more time in stages 3 & 4 in the beginning of the night and more time in REM stage towards the morning. Increasing age also changes our sleep patterns as we require less time sleeping while babies spend 50% sleep time in REM stage.

Our internal clock situated at the hypothalamus dictates our normal circadian rhythm which helps us stay awake during the day and gets us ready to sleep at night. However, this rhythm can be disturbed by travelling through different time zones (jet lag) or doing shift work. Psychological issues such as stress or depression can also disturb your sleep pattern.

How can sleep deprivation affect health or quality of life?

  1. Good sleep is important for healthy brain function such as thinking, memory, learning, decision making and creativity
  2. Important for physical health such as:
  • Healing and repair of the body
  • Growing in children
  • Maintaining balance hormones (growth hormone)
  • Sleep deprivation results in poor blood sugar control
  • Obesity risk in sleep deficiency
  • Ensuring good immune system

Common Sleep Disorders
Common sleep disorders include insomnia and Obstructive Sleep Apnoea (OSA)

  1. Insomnia

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Insomnia is the inability to fall asleep or maintain sleep or wake up too early in the morning and feeling tired. The usual time to fall asleep is 10-20 minutes.

The causes can be:

  • Primary (not related to any medical issues)
  • Secondary (related to medical issues such as depression, stress, anxiety, chronic pain from arthritis, asthma, cancer or side-effects of medication)

Treatment involves practising good sleeping habits such as:

  • Going to bed (and waking) at the same time every night
  • Follow the same routine to help you relax before sleep
  • Avoid playing with light emitting devices just before sleep as they stimulate the brain and makes it harder to fall asleep
  • Try to avoid a heavy meal prior to bedtime
  • Avoid caffeine 3-4 hours before sleep
  • Avoid vigorous exercise close to bedtime as the adrenaline release stimulates the brain and body making it difficult to fall asleep
  1. Obstructive sleep apnoea (OSA)

OSA is the most common type of sleep apnoea. Around 15-20% of adults experience OSA and it is associated with being overweight, older age groups, smokers, rhinitis, pharyngeal reflux and in males. During sleep, our muscle tone relaxes and the airway lumen diminishes which requires more respiratory effort. This increase in respiratory effort results in negative airway pressure causing the airway soft tissue to flop back and obstruct the airway.

Image Source: Science based medicine.org

Symptoms of OSA

Most common symptoms include snoring and restless sleep with periods of silence (apnoea) followed by sudden gasping and even arousal from sleep. This causes poor quality sleep which results in early morning headache, unexplained daytime sleepiness, trouble concentrating, mood changes such as irritability and poor work performance.

There are also heath implications as they are more likely to get hypertension, heart disease, stroke, diabetes and involved in accidents.

Investigations

Image Stock: iStock

Important to have a complete examination by an ENT doctor to check BMI, neck circumference, nose and oral cavity to look for any anatomical obstruction by any polyp, septum deviation, tongue or lymphoid tissue.

Sleep study (PolySomnoGram or PSG) is the ‘gold standard’ to diagnose OSA and can be done at home by technicians who will do a home visit. Some other parameters which can be measured include heart rate, oxygen saturation, airflow and sleeping position. The Apnoea: Hyponoea Index (AHI) is used to grade the severity of the sleep apnoea depending on the number of ‘events’ detected per hour of sleep.

An ‘apnoea event’ is defined as complete cessation of airflow for at least 10 seconds while ‘hyponoea event’ is defined as 50% decrease in airflow for at least 10 seconds or 30% decrease in airflow with associated decrease in oxygen saturation or an arousal from sleep.

Treatment options

  • Lifestyle modification such as losing weight, gentle regular exercise (read ‘How much should we exercise daily?’) and avoid stimulants such as caffeine, alcohol or light emitting devices before sleep.
  • Treat any nasal symptoms such as allergic rhinitis
  • Continuous Positive Airway Pressure (CPAP) device
  • Surgery such as Cautery Assisted Palatal Stiffening Operation (CAPSO) or mandibular advancement procedure may be helpful

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Healthy Ageing: Have a Purpose, Dream and Goal in Life

Healthy Ageing: Have a Purpose, Dream and Goal in Life

Read 10 points to healthy ageing here.

When we discuss ageing issues the first thing that comes to our mind are the physical issues. However we humans actually should look at ageing from the perspective of Mind, Body and Spirit. We actually are a combination of this three ‘things’. The Spirit I talk of here is really our Purpose. I will define Purpose as simply the reason we were born. All of us are unique and each one of us has our own unique purpose.

However a lot of people go through life without ever finding out their purpose. Sometimes I agree it can be difficult. Most of us go through life like been on a treadmill and been stuck in our daily rut. Our purpose can be something unique to us. How do you know what is your purpose? It will be something that excites you when you think about it. You feel happy when you are doing it and will do it even if you do not get paid for it.

Image Source: Pixabay

Why is purpose important for healthy ageing? I have seen that purpose driven people seem to age better. In addition, it drives you to get up in the morning to complete your tasks. There are enough studies to show that people who retire too early and have nothing to do and do nothing have shorter life spans. Be it a hobby or any activity, do something even if you have retired. Always have new dreams and new goals to achieve.

Image Source: Pexels

So, if we still do not know what is our purpose, then just start with dreams and goals. Your dreams can be materialistic in the beginning and goals can be put in place to achieve them. Again your dreams and goals must be specific. There are enough books written on these subjects and you can read them but never under estimate the power of the mind in healthy ageing.

Keeping the mind active is also a key element in healthy ageing. Mental stimulation keeps the deadly disease Alzheimer’s away. Always keep your mind active by reading and engaging in mental activities. That’s why having Dreams, Goals and a Purpose will keep you active both mentally and physically. This helps to release the right chemicals and hormones in your body that will energize you and keep you feeling younger. People with dreams, goals and a purpose also are more happy and less at risk from loneliness and depression.

Image Source: Pixabay

So in your quest for longevity and ageing well, remember that that your Mind and Spirit are the most important and you need to get them right before you even look at the physical elements.

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Dato' Dr. Rajbans Singh

Dato' Dr. Rajbans Singh

Wellness & Anti-Ageing Consultant

Surviving Childhood Traumatic Experiences

Surviving Childhood Traumatic Experiences

Growing up, we experience many new, unexpected encounters – and many of those encourage new behaviours to form which we then can classify them into separate clusters in our memories. One may be happy events which are unthreatening in nature and we classify them fondly in our memory banks as loving and cherished events which fosters our well-being as individuals. Another one may be unexpected, tumultuous events which we can classify as possibly threatening and classifying them under life-skills might be helpful when we run into a similar scenario again – for instance, how did we cope when a friend we were having coffee with unexpectedly fainted?

However, there exists a third category of events which is unsettling, and is not in the normal scale of events – the crisis. As we all currently are gripped with the ongoing crisis of the Thailand boys’ soccer team caught in a cave during the monsoon storm, we need to also understand the mental and emotional changes they might be facing, not just the physical and physiological demands their bodies will be making on them.

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During the initial phase of the crisis, one’s body and mind is thrown into a ‘flight-or-fight’ response whereby the priority is to keep one alive – so when we are faced with a crisis our internal system cries ‘Danger! Danger!’ and we utilise tunnel vision to get to safety. Once that is done, our bodies then send out signals that indicate we are safe and it’s time to let down our emotional and mental guard, and usually that’s when we become aware of being physically tired and drained, as our system does a ‘internal maintenance check’ and demands fuel in terms of rest and food and water.

However, in cases whereby these resources are scarce, or very little, it is useful to utilise a ‘mind over matter’ approach to help the body utilise its own resources – and done in a mindfulness manner can help calmness spread over not just our internal self, but can affect those in our environment in a positive, way too. In a way, this was encouraged by the Thai coach who taught the boys mindfulness techniques to keep calm. This approach also gives the panicked brain something useful and congruent to focus on.

Image Source: Pexels

Once rescued from the crisis scenario and environment, we need to be aware that our brain processes events differently and we might be impacted via nightmares, not being focused at work or school, having difficulty sleeping or eating, and at various points during the day we might become reminded of the stressful event seemingly without a trigger and the memory which washes over us can be an extremely anxiety-provoking event. It’s important that once we leave the scenario of a crisis we take the time to not just do a physical examination of our body, but also complete an on-going ‘internal maintenance check’ of our mind.

 One of the ways as mentioned above is to be able to calm our minds with mindfulness on a regular basis. By practising this, when we are caught unaware during a trigger memory, we can utilise the mindfulness method to help us calm down.

Another one is to keep a daily journal of thoughts that arise from the trigger memory – the most debilitating feelings we tend to associate with crisis and trauma is fear and helplessness – and those two feelings tend to hold us in paralysis. Once we are able to become aware of the strength of these feelings which hold us in a grip, we can then consciously decide to process them – either with a trusted friend, or in cases whereby the re-experience is intense or we are concerned that it will become debilitating, to process them with a trusted professional such as a mental health counsellor.

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Ms. Usha Ponnudurai

Ms. Usha Ponnudurai

Psychologist

 

What is Post-Traumatic Stress Disorder (PTSD)?

What is Post-Traumatic Stress Disorder (PTSD)?

PTSD is a condition that develops in some people after experiencing an event which is dangerous or life-threatening. Feeling scared is a natural response during a traumatic event because it triggers a ‘fight-or-flight’ response to protect us from harm. Everyone will experience a range of reactions after traumatic event but most people will recover from these initial symptoms. However, those who continue to experience problems may be suffering with PTSD and may feel stressed or frightened even when they are not in danger.

Signs and Symptoms

Not every person who goes through a traumatic event develop PTSD. Symptoms usually begin within 3 months of the traumatic incident although they may begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

Image Source: Reader’s Digest

PTSD can be diagnosed and treated by psychiatrist, psychologists & counsellors. The symptoms in adults are as below. Although it is normal to experience these symptoms after a traumatic event, these symptoms should NOT remain after 1 month such that it affects their ability to work or drive them to depression or substance abuse.

  • At least one re-experiencing symptom (such as flashbacks, bad dreams or thoughts)
  • At least one avoidance symptom (such as staying away from things, places or events related to the traumatic event)
  • At least two arousal and reactivity symptoms (feeling tense, frequent angry outbursts, easily startled or difficulty sleeping)
  • At least two cognition and mood symptoms (negative self-thoughts, guilt feelings, loss of interest in previous favourite activities or feeling detached from friends & family)

Children react differently compared to adults and their symptoms may include the following:

  • Bed wetting
  • Keeping silent or even regressing to not being unable to talk
  • Acting out the scary event
  • Unusually clingy to the parents

Risk Factors which increases the chance of getting PTSD

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  • Living through dangerous events such as war or natural disasters
  • Getting hurt or seeing another person hurt in the event (such as car accident)
  • Childhood trauma which has not been forgotten
  • Having minimal or no social support after the event
  • Having extra stress after the event (such as loss of a loved one or job, chronic pain from an injury sustained at the event)
  • Having a history substance abuse

Treatments and Therapies

The main treatment for PTSD is a combination of psychotherapy, counselling or medication.

Medications

In severe cases, anti-depressants or medication to help with sleep may be prescribed by a psychiatrist.

Psychotherapy

Psychotherapy involves being connected with a mental health professional such as a counsellor or psychologist who can provide professional support.  The sessions can be one-to-one online or clinic consultation and can also be in a group session.  It is important to have support from family and friends during the treatment period and also deal with any outside issues such as job-related problems, substance abuse or relationship issues.

Image Source: iStock 

Effective psychotherapy involve education about recognising the symptoms and teaching skills to help identify the trigger factors.

  1. Cognitive behavioural therapy (CBT) can involve:

(a) Exposure therapy to help people face and control their fear by gradually exposing them to the trauma they experienced in a safe way.

(b) Cognitive restructuring to help people make realistic sense of the bad memories and gradually remove any bad feelings of guilt or shame.

  1. Relaxation and anger-control skills
  1. Guidance to better sleep, diet and exercise habits

Treatment goals

It may be very hard to take that first step to help yourself.  Set realistic targets and break up large tasks into smaller achievable ones.  Take one step at a time and aim for gradual improvements.  Do not be shy to reach out for help and support from your family, friends and mental health practitioners.

 

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Five Positive Ways to Manage Stress

Five Positive Ways to Manage Stress

Watch ‘How to train your brain to stop worrying’

You can’t avoid stress in your daily life but you can manage it. Don’t ignore stress as stress can lead to major health problems and it affects your health mentally and physically. It can lead to mental health problems such as depression or anxiety and physical health problems such as acne, hair loss, fluctuations in weight and life-threatening heart attacks.

Create a list of positive ways to manage stress to keep your stress levels in check and low. Here we have listed 5 things that you can do.

1) Take Charge of Your Health

check-up

Image source: Stock Unlimited

Taking care of your health helps you both mentally and physically. Focus on healthy habits such as healthy diet, exercise 3-4 times a week and go for body check-up annually. The best way to reclaim control of your life is by taking charge of your health.

 

2) Make a Change

clean-desk

Image source: Iris

Start with a small positive change. It can be as simple as cleaning up your work desk or your bedroom, step away from your work desk for 5 minutes and take a walk or take 5 minutes to do simple exercises at your work desk or simply go for a short vacation. A small positive change can make a difference to the stressors in your life.

 

3) Laughter is the Best Medicine

laugh

Image source: Shutterstock

Watch funny videos, movies or talk to a funny friend who keeps you happy. Do whatever it takes to give yourself time for laughter each and every day.

 

4) Join Meditation or Yoga Classes

meditate

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Meditation or yoga may be used to reduce stress, anxiety, depression and tension as both practices promote relaxation and calmness. It requires you to focus to achieve a mentally clear and emotionally calm state.

 

 

5) Help Others

help-others

Image source: Goodnet

Volunteer to help others take your mind off the stress in your life and you’ll cultivate an attitude of gratitude as you help others who are not able to get help for themselves. You’ll also feel happy and relieved to be able to help people or animals in need and you’re actually making a positive difference to their lives.

 

Reference: Beliefnet

 

If stress level is too overwhelming and you can’t cope with it, please reach out to one of our Psychologist below for advice.

 

Study on User Experience with E-Counseling

Study on User Experience with E-Counseling

Below is a summary of how e-counseling is comparable to traditional face-to-face counseling sourced from an extensive study done by Berkeley Well-Being Institute and its references. Read more on the full study here.

Study 2 was conducted to examine user satisfaction with e-counseling. Read on the summary of Study 1 on changes in depression symptom severity amongst BetterHelp members from pre-treatment to 3-months post-treatment here.

Study 2

Given the potential accessibility, affordability, and effectiveness of e-counseling, Berkeley conducted a second study to gain insight on user experience with BetterHelp e-counseling. The present investigation reports findings from a survey that asked current members of BetterHelp to report their experiences with both e-counseling and face-to-face counseling. More specifically, it assessed whether BetterHelp e-counseling differs from face-to-face counselling with regard to:

1) Affordability

2) Convenience

3) Effectiveness

4) Fit

5) Accessibility

6) Progress

7) Satisfaction

8) Quality

9) Meeting needs

10) Therapeutic alliance

 

Method

Participants:

  • 48 participants (88% female)
  • Age: 22 – 65 years old
  • These participants responded to an account notification from BetterHelp inviting them to complete a survey post participation
  • Used BetterHelp for 3 months or more
  • To answer a series of questions with regard to their experiences on BetterHelp and also if they have been in face-to-face counseling
  • A subset of 38 participants (79%) had also been in face-to-face counseling and was asked the same series of questions regarding their experiences with face-to-face counselling

 

Measures:

1) Therapeutic Alliance

The quality of the therapeutic relationship was assessed using the Working Alliance Inventory (WAI) –short form (Munder, 2010). Questions were phrased to assess alliance with BetterHelp counsellors or alliance with face-to-face counselors. The WAI has been shown to have good reliability and validity (α BetterHelp = .94; α face-to-face = .97 in the present sample).

 

2) Satisfaction with Counselling

To measure satisfaction with counseling, items were developed assessing a range of factors that tend to affect satisfaction with counselling (see Table 2 for questions).

 

 

Table 2

Comparing BetterHelp to face-to-face counseling

To directly assess whether participants preferred BetterHelp when they compared BetterHelp to their experiences with face-to-face counseling.

 

Results

1) Therapeutic alliance

Using within group t-tests, ratings of therapeutic alliance were significantly greater for BetterHelp than face-to-face counseling.

 

2) Satisfaction

Descriptive statistics are used to clarify the percentage of people who were satisfied with each dimension of counseling for both BetterHelp and face-to-face counseling (see Figure 3). The results suggest greater satisfaction with BetterHelp e-counseling than face-to-face counseling. All analyses supported BetterHelp as being more satisfying than face-to-face therapy. In particular,

BetterHelp was found to be significantly more convenient, affordable, and accessible than face-to-face therapy.

Figure 3

Results for satisfaction with BetterHelp and satisfaction with face-to-face counseling shows that clients of BetterHelp are more satisfied with e-counseling than face-to-face counseling (see Figure 4).

 

Figure 4

Finally, when asked how likely one would be to recommend BetterHelp to a friend or colleague on a scale from 0 (Not at all likely) to 10 (Extremely likely), participants reported scores ranging from 5 to 10.

Comparing e-counseling to face-to-face counseling

Descriptive statistics were used to directly assess whether people found experiences with BetterHelp to be better or worse than experiences with face-to-face counseling.

First, Berkeley assessed whether people would choose BetterHelp (e-counseling) or face-to-face counseling in the future (see Figure 5). Next, Berkeley assessed how participants compared BetterHelp to face-to-face counseling on each of the dimensions of satisfaction. The strongest effects suggest that BetterHelp members find BetterHelp to be more convenient and accessible than face-to-face therapy, and all analyses supported BetterHelp as being more satisfying than face-to-face counseling (see Figure 6).

 

Figure 5

Figure 6

E-counseling appears to address a number of significant barriers (i.e. convenience, affordability, and accessibility) that sometimes prevent face-to-face counseling from being effective. Notably, the present data further suggest that therapeutic alliance for BetterHelp e-counseling may be even stronger than face-to-face counseling.

While there are many reasons as to why this may be the case, Berkeley postulate that these strong alliances are formed when using BetterHelp as a result of BetterHelp counselors’ flexible availability. Face-to-face counseling is often limited to a pre-determined number of sessions (as defined by insurance companies or by financial capabilities).

Research has shown that the national average number of counseling sessions available to an individual is less than 5, despite knowledge that between 8-13 sessions are needed to see improvement (Hansen et al., 2002). BetterHelp counselors are able to quickly respond to members’ needs, with an average response time of 10.6 hours, and have more frequent interaction with members as compared to a face-to-face therapist, with BetterHelp members receiving an average of 3.7 sessions over the course of a week.

This study, like most survey studies, may have been affected by sampling bias. Only participants who were already using BetterHelp for 3 months were included in analyses. Because individuals who terminated treatment before 3 months were not included in pre/post analyses, results exclude those who may not have found BetterHelp beneficial and sought other forms of therapy in that time. It was essential for Berkeley to focus on this group to ensure that all participants were familiar with, and had the time to benefit from, the service; however, this approach may have led to a bias towards including people in the study who favoured BetterHelp e-counseling.

That being said, we should not discount the positive impacts that BetterHelp had on the members who chose to opt in. No intervention approach will work for everyone. Given the affordability and accessibility of Betterhelp e-counseling, Berkeley’s findings suggest that Betterhelp e-counseling represents an opportunity to have a bigger impact, across a larger number of people, for a reduced cost.

Reference:

Berkeley Well-Being Institute

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