The state health department said 10 mosquito samples tested positive for West Nile virus in Suffolk County at the end of August, with three samples being found in Rocky Point.
In a release Aug. 30, Suffolk County Department of Health said that the mosquito samples, collected Aug. 20 and 21, had examples of West Nile virus in Lindenhurst, North Babylon, Farmingville, West Babylon, North Patchogue, Huntington Station, Commack and Rocky Point. All but Rocky Point had only one such sample collected.
Suffolk County has reported 53 mosquito samples to date that have tested positive for West Nile and six for Easter equine encephalitis, a virus that can cause brain infections, though no new samples have been collected at this point.
Dr. James Tomarken, the county commissioner of health, said there is a presence, but there is no reason to panic.
“The confirmation of West Nile virus in mosquito samples or birds indicates the presence of West Nile virus in the area,” said Tomarken. “While there is no cause for alarm, we advise residents to cooperate with us in our efforts to reduce their exposure to the virus, which can be debilitating to humans.”
West Nile virus may cause a range of symptoms, from mild to severe, including fever, headache, vomiting, muscle aches, joint pain and fatigue. There is no specific treatment for West Nile virus. Patients are treated with supportive therapy as needed.
The best way to handle local mosquito populations is for residents to eliminate standing or stagnant water pools in their areas. Tomarken said it’s important for residents to stay vigilant especially if they enter the Manorville area.
People are also encouraged to use long sleeves and socks and use mosquito repellent.
Dead birds may indicate the presence of West Nile virus in the area. To report dead birds, call the Public Health Information Line in Suffolk County at 631-787-2200 from 9 a.m. to 4:30 p.m., Monday through Friday. Residents are encouraged to take a photograph of any bird in question.
To report mosquito problems or stagnant pools of water, call the Department of Public Works’ Vector Control Division at 631-852-4270.
Aerobic exercise and weight lifting may prevent cognitive decline, according to studies. Stock photo
Reducing carbohydrate and sugar intake may reduce risk
By David Dunaief, M.D.
Dr. David Dunaief
Mild cognitive impairment (MCI) is one of the more common disorders that occurs as we age. But age is not the only determinant. There are a number of modifiable risk factors. MCI is feared, not only for its own challenges but also because it may lead to dementia, with Alzheimer’s disease and vascular dementia being the more common forms. Prevalence of MCI may be as high as one in five in those over age 70 (1). It is thought that those with MCI may have a 10 percent chance of developing Alzheimer’s disease (2).
Since there are very few medications presently that help prevent cognitive decline, the most compelling questions are: What increases risk and what can we do to minimize the risk of developing cognitive impairment?
Many chronic diseases and disorders contribute to MCI risk. These include diabetes, heart disease, Parkinson’s disease and strokes. If we can control these maladies, we may reduce the risk of cognitive decline. We know that we can’t stop aging, but we can age gracefully.
Heart disease’s impact
In an observational study, results demonstrated that those suffering from years of heart disease are at a substantial risk of developing MCI (3). The study involved 1,450 participants who were between the ages of 70 and 89 and were not afflicted by cognitive decline at the beginning of the study. Patients with a history of cardiac disease had an almost two times greater risk of developing nonamnestic MCI, compared to those individuals without cardiac disease. Women with cardiac disease were affected even more, with a three times increased risk of cognitive impairment.
Nonamnestic MCI affects executive functioning — decision-making abilities, spatial relations, problem-solving capabilities, judgments and language. It is a more subtle form of impairment that may be more frustrating because of its subtlety. It may lead to vascular dementia and may be a result of clots.
Stroke location vs. frequency
Not surprisingly, stroke may have a role in cognitive impairment. Stroke is also referred to as a type of vascular brain injury. But what is surprising is that in a study, results showed that the location of the stroke was more relevant than the frequency or the multitude of strokes (4). If strokes occurred in the cortical and subcortical gray matter regions of the brain, executive functioning and memory were affected, respectively. Thus, the locations of strokes may be better predictors of subsequent cognitive decline than the number of strokes. Clinically silent strokes that were found incidentally by MRI scans had no direct effect on cognition, according to the authors.
Exercise’s effects
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Exercise may play a significant role in preventing cognitive decline and possibly even improving MCI in patients who have the disorder. Interestingly, different types of exercise have different effects on the brain. Aerobic exercise may stimulate one type of neuronal development, while resistance training or weight lifting another.
In an animal study involving rats, researchers compared aerobic exercise to weight lifting (5). Weight lifting was simulated by attaching weights to the tails of rats while they climbed ladders. Both groups showed improvements in memory tests, however, there was an interesting divergence.
With aerobic exercise, the level of the protein BDNF (brain-derived neurotrophic factor) increased significantly. This is important because BDNF is involved in neurons and the connections among them, called synapses, related mostly to the hippocampus, or memory center. The rats that “lifted weights” had an increase in another protein, IGF (insulin growth factor), that promotes the development of neurons in a different area of the brain. The authors stressed the most important thing is to exercise, regardless of the type.
In another study that complements the previous study, women were found to have improved spatial memory when they exercised — either aerobic or weight lifting (6). Interestingly, verbal memory was improved more by aerobic exercise than by weight lifting. Spatial memory is the ability to recall where items were arranged, and verbal memory is the ability to recall words. The authors suggest that aerobic exercise and weight lifting affect different parts of the brain.
This was a randomized controlled trial that was six months in duration and involved women, ages 70 to 80, who had MCI at the trial’s start. There were three groups in the study: aerobic, weight lifting and stretching and toning. Those who did stretches or toning alone experienced deterioration in memory skills over the same period.
A Centers for Disease Control and Prevention report claims the majority of the adult population is woefully deficient in exercise: Only about one in five Americans exercise regularly, both using weights and doing aerobic exercise (7).
Diet’s effects
Several studies show that the Mediterranean diet helps prevent MCI and possibly prevents conversion from MCI to Alzheimer’s (8, 9). In addition, a study showed that high levels of carbohydrates and sugars, when compared to lower levels, increased the risk of cognitive decline by more than three times (5). The authors surmise that carbohydrates have a negative impact on insulin and glucose utilization in the brain.
Cognitive decline is a disorder that should be taken very seriously, and everything that can be done to prevent it should be utilized. Exercise has potentially positive effects on neuron growth and development, and controlling carbohydrate and sugar intake may reduce risk. Let’s not squander the opportunity to reduce the risk of MCI, a potentially life-altering disorder.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
Huntington Hospital has received a two-year designation as an Antimicrobial Stewardship Center of Excellence (AS CoE) by the Infectious Diseases Society of America (IDSA). The hospital is one of only 35 hospitals nationwide to receive this recognition.
More than 700,000 people die worldwide each year due to antimicrobial-resistant infections. The AS CoE program recognizes institutions that have created stewardship programs led by infectious disease (ID) physicians and ID-trained pharmacists who have achieved standards established by the Centers for Disease Control and Prevention (CDC). The CDC core elements for antibiotic stewardship include seven major areas: leadership commitment, accountability, drug expertise, action, tracking, reporting and education.
Dr. Cynthia Ann Hoey and Dr. Adrian Popp, infectious disease specialists, worked closely with pharmacists Agnieszka Pasternakand Nina Yousefzadeh to ensure Huntington Hospital met the rigorous criteria to be recognized by the IDSA.
“We are honored to have received this prestigious IDSA recognition,” said Dr. Nick Fitterman, the hospital’s executive director. “We are committed to fighting antimicrobial resistance through our comprehensive training and educational outreach program with all of our infectious disease specialists and pharmacists. The antimicrobial stewardship program will improve patient care and preserve the integrity of current treatments for future generations.”
Pictured from left, Nina Yousefzadeh,Dr. Cynthia Ann Hoey, Agnieszka Pasternak and Dr. Nick Fitterman.
Increasing the quality of food that you eat has a tremendous impact. Stock photo
Micronutrient-dense foods are most satisfying
By David Dunaief, M.D.
Dr. David Dunaief
Why do we eat? Hunger is only one reason. There are many psychological and physiological factors that influence our eating behavior, including addictions, lack of sleep, stress, environment, hormones and others. This can make weight management or weight loss for the majority who are overweight or obese — approximately 72 percent of the U.S. adult population — very difficult to achieve (1).
Since calorie counts have been required on some municipalities’ menus, we would expect that consumers would be making better choices. Unfortunately, studies of the results have been mostly abysmal. Nutrition labeling either doesn’t alter behavior or encourages higher calorie purchases, according to most studies (2, 3).
Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about willpower. Changing diet composition is more important.
What can be done to improve the situation? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in their cravings. But don’t take my word for it. Let’s look at the evidence.
Effect of refined carbohydrates
By this point, many of us know that refined carbohydrates are not beneficial. Well, there is a randomized controlled trial (RCT), the gold standard of studies, with results that show refined carbohydrates may cause food addiction (4). There are certain sections of the brain involved in cravings and reward that are affected by high-glycemic (sugar) foods, as shown by MRI scans of trial subjects.
The participants consumed a 500-calorie shake with either a high-glycemic index or with a low-glycemic index. They were blinded (unaware) as to which type they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. In fact, the region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.
According to the authors, this effect may occur regardless of the number or quantity of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. The composition of calories matters.
Comparing macronutrients
We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the most impact on weight loss? In an RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (5, 6). In fact, only 15 percent of patients achieved a 10 percent reduction in weight after two years.
The four different macronutrient diet combinations involved an overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another relatively well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is defined as obese (at least 30 kg/m²).
Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.
Impact of obesity
In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (7). The authors surmise that it may have to do with the change in metabolic activity associated with more fat tissue. These micronutrients include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.
However, supplements don’t compensate for missing micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation. Please ask your doctor.
Steroid levels
The good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose weight, the levels of cortisol metabolite excretion decreases significantly (8).
Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.
Therefore, controlling or losing weight is not solely about willpower. Don’t use the calories on a menu as your sole criteria to determine what to eat; even if you choose lower calories, it may not get you to your goal. While calories may have an impact, the nutrient density of the food may be more important. Thus, those foods high in micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.
References:
(1) www.cdc.gov. (2) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (3) Am J Prev Med.2011 Oct;41(4):434–438. (4) Am J Clin Nutr Online 2013;Jun 26. (5) N Engl J Med 2009 Feb 26;360:859. (6) N Engl J Med 2009 Feb 26;360:923. (7) Medscape General Medicine. 2006;8(4):59. (8) Clin Endocrinol.2013;78(5):700-705.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.
A ribbon-cutting ceremony was held at Stony Brook Eastern Long Island Hospital on July 23. Photo from SBU
By Carol A. Gomes
With the latest addition of Stony Brook Eastern Long Island Hospital, Stony Brook Medicine further expands its role as a leading integrated health care system delivering increased care options to benefit our patients across Long Island.
The Stony Brook Medicine health care system now consists of Stony Brook University Hospital (SBUH), Stony Brook Children’s Hospital (SBCH), Stony Brook Southampton Hospital (SBSH) and Stony Brook Eastern Long Island Hospital (SBELIH). The system includes more than 1,200 physicians on the full-time faculty in the Renaissance School of Medicine and nearly 200 additional employed physicians in the community. Our ambulatory footprint is comprised of more than 100 outpatient care sites, strategically located to enhance convenient access to care.
The hospitals in the Stony Brook Medicine health care system will work together to provide access to the full range of health care services to East End residents, locally in the community and at SBUH, a world-class tertiary medical center. By combining our resources, we will match patients with the right type of care in the right facility.
Our objective is to improve coordination of complex episodes of care for our patients while at the same time improving efficiency and lowering the cost of care. To deliver this seamless care, we are making considerable incremental investments to facilitate caregiver communication, including integration of electronic medical records.
We look forward to further realizing the benefits of combining a large academic medical center with community-based hospitals. The latter offers unique academic and training opportunities for our residents and fellows. As clinical campuses and training sites, SBELIH and SBSH will help increase the number of physicians, specialists, allied health professionals and nurses on Eastern Long Island choosing to explore opportunities to practice medicine in community settings.
For example, Stony Brook Medicine already hosts a psychiatric residency program at SBELIH, and a new Mastery in General Surgery Fellowship program provides surgical fellows with four months of community hospital experience.
Stony Brook has also improved access to prehospital emergency care on the North Fork, with two EMS “fly cars,” staffed by paramedics who serve as first responders on the scene of emergencies. In the future, telehealth connections will be established between the emergency departments of SBUH and SBELIH, and on Shelter Island, to further improve direct access to Stony Brook Medicine specialists.
Fortunately, Stony Brook Medicine has a long history of working collaboratively with both of our community-based hospital partners to meet the needs of patients on the East End. Formalizing the relationship with SBSH two years ago and now adding SBELIH to the system will allow us to work even more closely together to improve access to medical and surgical services, as well as specialty care, and to offer new community-based health programs.
We look forward to creating even closer ties in the future as we further develop our integrated healthcare system, with the patient at the center of everything we do.
Carol A. Gomes, MS, FACHE, CPHQ is the Interim Chief Executive Officer of Stony Brook University Hospital.
Pictured above, at the Stony Brook Eastern Long Island Hospital ribbon-cutting ceremony, held on July 23, from left: New York State Assemblyman Fred W. Thiele Jr.; Paul J. Connor III, Chief Administrative Officer, Stony Brook Eastern Long Island Hospital; Greenport Mayor George Hubbard; Thomas E. Murray Jr., ELIH Board Chairman; Scott Russell, Supervisor, Town of Southold; Michael A. Bernstein, PhD, Interim President, Stony Brook University; Kenneth Kaushansky, MD, MACP, Senior Vice President, Health Sciences, and Dean, Renaissance School of Medicine at Stony Brook University; Al Krupski, Suffolk County Legislator; Margaret M. McGovern, MD, PhD, Vice President for Health System Clinical Programs and Strategy, Stony Brook Medicine; and New York State Senator Kenneth P. LaValle.
Selden Pharmacy, 1224B Middle Country Road, Selden closed its doors on July 30 after 40 years in business. In a letter sent out to his customers, owner George Akruwala said, “As much as I would love to continue this business, I have made the very difficult decision to retire, and spend more time with my children and grandchildren. It has been our great pleasure to serve this wonderful community. We wish you continued health and happiness.” All prescriptions have been transferred to Rite Aid, 229 Independence Plaza, Selden.
Argen Medical recently joined Stony Brook Community Medical, Stony Brook Medicine’s expanding network of community practices and physicians. The medical group practices obstetrics and gynecology in Port Jefferson Station.
“We are extremely pleased that Dr. Gustavo San Roman is joining the Stony Brook family,” said Dr. Todd Griffin, chair, Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine. “He has been an outstanding Ob-Gyn in the community and a wonderful proponent of women’s health.”
Stony Brook Medicine welcomes private practices that are committed not only to the community but to providing the highest level of quality care. Argen Medical has been providing expert, comprehensive care to women of all ages in the community for more than 30 years.
“I am very excited to be back at Stony Brook University Hospital. I have built a practice based on the concept of providing excellent and personalized Ob-Gyn care,” said San Roman. “With this in mind, I have helped to build many strong families in our community. In fact, I am now taking care of the next generation of women whose births I attended many years ago.”
“As a member of Stony Brook Medicine, I have the honor to continue to provide complete personalized Ob-Gyn services in my Port Jefferson Station office and three local hospitals,” he added.
The Argen Medical team, comprised of San Roman and two nurse practitioners, Laura Doti and Jaclyn Cuccinello, welcomes new patients. And as a bilingual practice, they are able to offer comprehensive services to Spanish-speaking patients as well.
For more information, call 631-331-8777.
Pictured in photo, from left, Jaclyn Cuccinello, Gustavo San Roman and Laura Doti.
Balance and strengthening exercises help to prevent falls. Stock photo
Our best line of defense is prevention
By David Dunaief, M.D.
Dr. David Dunaief
When we are young, falls usually do not result in significant consequences. However, when we reach middle age and chronic diseases become more prevalent, falls become more substantial. And, unfortunately, falls are a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, falls can lead to loss of independence (2).
Of those over the age of 65, between 30 and 40 percent will fall annually (3). Most of the injuries that involve emergency room visits are due to falls in this older demographic (4).
What can increase the risk of falls?
Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age, being female and using drugs, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia.
Chronic diseases, including arthritis, as an umbrella term; a history of stroke; cognitive impairment; and Parkinson’s disease can also contribute. Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (5).
How do we prevent falls?
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Fortunately, there are ways to modify many risk factors and ultimately reduce the risk of falls. Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance, whether home based or in groups, all play significant roles in fall prevention (6). We will go into more detail below.
Many of us in the Northeast suffer from low vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes, if recent winters are any indication, are of the utmost concern. Inexpensive changes in the home, like securing area rugs, can also make a big difference.
Medications that exacerbate fall risk
There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. Ironically, they also top the list of the best-selling drugs. But what other drugs might have an impact?
High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (7). Surprisingly, those who were on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase. One would have expected those on the highest levels to have the greatest increase in risk, but this was not the case.
While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio, specifically in older patients, before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (8).
Why is exercise critical?
All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (9). If the categories are broken down, exercise had a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.
Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries. The weakness of this study was that there was no consistency in design of the trials included in the meta-analysis. Nonetheless, the results were impressive.
Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (10).
What specific types of exercise are useful?
Many times, exercise is presented as a word that defines itself. In other words: Just do any exercise and you will get results. But some exercises may be more valuable or have more research behind them. Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.
A randomized controlled trial, the gold standard of studies, showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was no change in the control group.
There was also a 44 percent decline in the number of patients who fell. This study’s duration was six months and involved 108 postmenopausal women with an average age of 58. This is a group that is more susceptible to bone and muscle weakness. Both groups were given equal amounts of vitamin D and calcium supplements. The good news is that many patients really like aquatic exercise.
Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have “arthritis” and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your BP medications, review the risk-to-benefit ratio with your physician. The most productive way to prevent falls is through lifestyle modifications.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
Dorothy Crawford with her granddaughter and great-granddaughter
About 110 family and friends gathered at St. Johnland Nursing Center in Kings Park on Aug. 1 to celebrate its Medical Model Adult Day Health Service Annual Breakfast.
Participants who attend the Monday through Saturday program were joined by family and friends for a wonderful morning of food, fun and music. Guests had an opportunity to see the program firsthand and get a glimpse of how their loved one spends a typical day interacting with others and engaging in games and other mindful activities.
Lillian Safina with her son
Providing care for an aging parent, spouse or loved one can be an overwhelming responsibility for family members and friends. Adult Day Care at St. Johnland Nursing Center offers a wide range of services for adults who need a protective environment but choose to remain in the community and continue to be a vital part of family life.
St. Johnland Nursing Center is a nonprofit, nonsectarian facility, offering residents excellence in skilled nursing care and all aspects of rehabilitation, Alzheimer’s/dementia care, head injury rehabilitation, adult day care, home health care and subacute care.
To learn more about St. Johnland programs and services visit www.stjohnland.org.
Though statistics vary widely, about 30 percent of Americans are affected by insomnia, according to one frequently used estimate, and women tend to be affected more than men (1). Insomnia is thought to have several main components: difficulty falling asleep, difficulty staying asleep, waking up before a full night’s sleep and sleep that is not restorative or restful (2).
Unlike sleep deprivation, patients have plenty of time for sleep. Having one or all of these components is considered insomnia. There is debate about whether or not it is actually a disease, though it certainly has a significant impact on patients’ functioning (3).
Insomnia is frustrating because it does not necessarily have one cause. Causes can include aging; stress; psychiatric disorders; disease states, such as obstructive sleep apnea and thyroid dysfunction; asthma; medication; and it may even be idiopathic (of unknown cause). It can occur on an acute (short-term), intermittent or chronic basis. Regardless of the cause, it may have a significant impact on quality of life. Insomnia also may cause comorbidities (diseases), including heart failure.
Fortunately, there are numerous treatments. These can involve medications, such as benzodiazepines like Ativan and Xanax. The downside of these medications is they may be habit-forming. Nonbenzodiazepine hypnotics (therapies) include sleep medications, such as Lunesta (eszopiclone) and Ambien (zolpidem). All of these medications have side effects. We will investigate Ambien further because of its warnings.
There are also natural treatments, involving supplements, cognitive behavioral therapy and lifestyle changes.
Let’s look at the evidence.
Heart failure
Insomnia may perpetuate heart failure, which can be a difficult disease to treat. In the HUNT analysis (Nord-Trøndelag Health Study), an observational study, results showed insomnia patients had a dose-dependent response for increased risk of developing heart failure (4). In other words, the more components of insomnia involved, the higher the risk of developing heart disease.
There were three components: difficulty falling asleep, difficulty maintaining sleep and nonrestorative sleep. If one component was involved, there was no increased risk. If two components were involved, there was a 35 percent increased risk, although this is not statistically significant.
However, if all three components were involved, there was 350 percent increased risk of developing heart failure, even after adjusting for other factors. This was a large study, involving 54,000 Norwegians, with a long duration of 11 years.
What about potential treatments?
Ambien: While nonbenzodiazepine hypnotics may be beneficial, this may come at a price. In a report by the Drug Abuse Warning Network, part of the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of reported adverse events with Ambien that perpetuated emergency department visits increased by more than twofold over a five-year period from 2005 to 2010 (5). Insomnia patients most susceptible to significant side effects are women and the elderly. The director of SAMHSA recommends focusing on lifestyle changes for treating insomnia by making sure the bedroom is sufficiently dark, getting frequent exercise, and avoiding caffeine.
In reaction to this data, the FDA required the manufacturer of Ambien to reduce the dose recommended for women by 50 percent (6). Ironically, sleep medication like Ambien may cause drowsiness the next day — the FDA has warned that it is not safe to drive after taking extended-release versions (CR) of these medications the night before.
Magnesium: The elderly population tends to suffer the most from insomnia, as well as nutrient deficiencies. In a double-blinded, randomized controlled trial (RCT), the gold standard of studies, results show that magnesium had resoundingly positive effects on elderly patients suffering from insomnia (7).
Compared to a placebo group, participants given 500 mg of magnesium daily for eight weeks had significant improvements in sleep quality, sleep duration and time to fall asleep, as well as improvement in the body’s levels of melatonin, a hormone that helps control the circadian rhythm.
The strength of the study is that it is an RCT; however, it was small, involving 46 patients over a relatively short duration.
Cognitive behavioral therapy
In a study, just one 2½-hour session of cognitive behavioral therapy delivered to a group of 20 patients suffering from chronic insomnia saw subjective, yet dramatic, improvements in sleep duration from 5 to 6½ hours and decreases in sleep latency from 51 to 22 minutes (8). The patients who were taking medication to treat insomnia experienced a 33 percent reduction in their required medication frequency per week. The topics covered in the session included relaxation techniques, sleep hygiene, sleep restriction, sleep positions, and beliefs and obsessions pertaining to sleep. These results are encouraging.
It is important to emphasize the need for sufficient and good-quality sleep to help prevent, as well as not contribute to, chronic diseases, such as cardiovascular disease. While medications may be necessary in some circumstances, they should be used with the lowest possible dose for the shortest amount of time and with caution, reviewing possible drug-drug and drug-supplement interactions.
Supplementation with magnesium may be a valuable step toward improving insomnia. Lifestyle changes including sleep hygiene and exercise should be sought, regardless of whether or not medications are used.
References:
(1) Sleep. 2009;32(8):1027. (2) American Academy of Sleep Medicine, 2nd edition, 2005. (3) Arch Intern Med. 1998;158(10):1099. (4) Eur Heart J. online 2013;Mar 5. (5) SAMSHA.gov. (6) FDA.gov. (7) J Res Med Sci. 2012 Dec;17(12):1161-1169. (8) APSS 27th Annual Meeting 2013; Abstract 0555.
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