Counteract the winter blues naturally

The natural brain-healthy properties of a high-nutrient diet, regular exercise, adequate vitamin D and omega-3 stores, and light exposure combine to promote a positive mood, even in the cold, gray days of winter.

The connection between a healthy lifestyle and a healthy mood state is often overlooked; however it is well known that exercise and other natural methods are effective at alleviating depression symptoms.  My natural protocol for depression has helped many sufferers of depression and seasonal affective disorder (SAD) improve their symptoms without the risks and side effects associated with antidepressant medications. Even for those of us who do not suffer a mood disorder, it is common to experience some decline in mood during the winter. Fortunately, there are natural methods that help to alleviate the winter blues.
Exercise
Exercise is known to be as effective as antidepressant drugs or cognitive behavioral therapy for improving the symptoms of depression.  Exercise works by increasing the production of serotonin, a mood-elevating neurotransmitter, which is often low in those with depression. The combination of aerobic exercise plus strength training is better than aerobic exercise alone, and yoga has also been shown to improve symptoms.^1-4

Light exposure
In the winter, we tend to spend most the day’s sunlit hours indoors, at work or just staying warm at home. Exposure of the retina to morning light helps the brain to properly regulate its production of melatonin and therefore our sleep-wake cycle; inadequate light exposure during the winter can disrupt this cycle. During the winter, if getting natural sunlight isn’t possible, a therapeutic light is an effective substitute; it corrects the body’s clock, restores normal melatonin production, and stimulates production of serotonin.⁵  SAD has been successfully treated with light therapy for nearly thirty years, and light therapy is also highly effective for depression, comparable to the effects of anti-depressant drugs, so it is effective even for non-seasonal depression.⁶ Light therapy is an excellent tool for anyone who experiences sadness, fatigue, or disrupted sleep patterns, and especially if you note this associated with winter. 
Omega-3 fatty acids
Omega-3 fatty acids play an important role in brain health; DHA is primarily associated with cognitive function, and EPA with mood.⁷ A recent meta-analysis of 28 trials determined that EPA supplementation is effective for improving depression symptoms.^7,8  EPA and DHA are considered long-chain omega-3 fatty acids, in contrast to the shorter ALA found in plant foods, such as flax, hemp, and chia seeds, walnuts and leafy greens. The primary source of EPA is fish, although a small amount ALA from plant foods can be converted to DHA and EPA in the body. Since conversion efficiency is low for many people, in addition to eating ALA-rich foods daily, I recommend a DHA + EPA supplement for everyone, and additional EPA for those with depression.^9-11
High-nutrient diet
Two recent studies compared mood scores in subjects eating vegetarian or omnivorous diets.  In an observational study, vegetarian Seventh Day Adventists reported more positive mood and lower levels of depression and anxiety compared to omnivore Adventists.¹²  In a second study by the same research team, subjects were assigned to different diets for two weeks. The subjects in the vegetarian group increased their mood scores after the two weeks, but those on the omnivorous diet did not.¹³  These results suggest that plant foods contain substances that positively affect mood. One possibility is the high antioxidant content of plant foods; the brain is highly susceptible to oxidative stress, and markers of oxidative stress are indeed associated with a higher incidence of depression.¹⁴
In October 2012, another study found a connection between fruit and vegetable consumption and healthy mood.  The authors collected data on the diets of 80,000 people, and analyzed scores on a life satisfaction questionnaire relative to the amount of fruit and vegetables consumed daily. Even after adjusting for many other parameters such as employment status, marital status, income, illness, education, and other dietary variables, greater fruit and vegetable consumption was strongly correlated with greater life satisfaction scores.¹⁵
In addition to antioxidants, vitamins and minerals may factor into the positive effects of fruits and vegetables on mood. Several B vitamins contribute to the production of mood-enhancing neurotransmitters, folate for example.^16,17 Folate deficiency is known to increase the risk of depression; about one-third of people with depression are folate-deficient.^17-20 Also, a low-sodium, high-potassium diet has been shown to have a positive effect on mood.²¹ Green vegetables and legumes are rich in folate, and all whole plant foods are naturally rich in potassium and low in sodium.
Vitamin D
Reduced exposure to sunlight during the winter means less natural vitamin D production by the skin. Scientists don’t know exactly how vitamin D works in the brain, but it is thought to affect the production of neurotransmitters, including serotonin.²²  Low blood vitamin D levels are associated with SAD and depression, and there is evidence that supplementing with vitamin D helps to maintain a healthy mood state.^{23, 24} For example, a 4000 IU/day dose of vitamin D for six months starting in the summer improved wellbeing scores in February compared to a lower (600 IU) dose.²⁵ Vitamin D is active in essentially every cell and tissue in the human body, and contributes to many facets of health.  It is crucial for everyone to maintain adequate blood vitamin D levels (a 25(OH)D of 35-50 ng/ml) with supplements.

What are good exercises for folks who spend much of their day sitting at a computer?

The answer is simple. Get up and move around frequently during the day. While you could do calisthenics in your cubicle or standing desk pushups, your co-workers may not appreciate your workout.

Office Exercise

If you have trouble staying fit at work, these office exercises are a great way to keep your body moving right at your desk. The moves here involving stretching and strengthening your body, all within the comfort of your office chair. This workout doesn't take the place of traditional strength training, but offers you a way to keep your blood moving if you can't get away from your desk.
Precautions
See your doctor before trying this workout if you have any injuries, illnesses or other conditions. Make sure the chair you use is stable.  If you have wheels, push it against a wall to make sure it won't roll away.
Equipment Needed
A chair and a water bottle or light-medium dumbbell.

Click on the pictures for closer look
Stretches for Your Wrists and ArmsWrist Stretch: Extend arm in front, palm up and grab the fingers with other hand. Gently pull the fingers towards you to stretch the forearm, holding for 20-30 seconds. Repeat on the other side. Wrist & Forearm: Press hands together in front of chest, elbows bent and parallel to the floor. Gently bend wrists to the right and left for 10 reps. Lower Back Stretch: Sit tall and place the left arm behind left hip. Gently twist to the left, using the right hand to deepen the stretch, holding for 20-30 seconds.  Repeat on the other side.
Lower Body Exercises Hip Flexion: Sit tall with the abs in and lift the left foot off the floor a few inches, knee bent. Hold for 2 seconds, lower and repeat for 16 reps.  Repeat on the other side. Leg Extension: Sit tall with the abs in and extend the left leg until it's level with hip, squeezing the quadriceps. Hold for 2 seconds, lower and repeat for 16 reps.  Repeat on the other side. Inner Thigh: Place towel, firm water bottle or an empty coffee cup between the knees as you sit up tall with the abs in.  Squeeze the bottle or cup, release halfway and squeeze again, completing 16 reps of slow pulses.
Chair Exercises Chair Squat: While sitting, lift up until your hips are just hovering over the chair, arms out for balance.  Hold for 2-3 seconds, stand all the way up and repeat for 16 reps. Dips: Make sure chair is stable and place hands next to hips. Move hips in front of chair and bend the elbows, lowering the body until the elbows are at 90 degrees. Push back up and repeat for 16 reps. One-Leg Squat:  Make sure the chair is stable and take one foot slightly in front of the other.  Use the hands for leverage as you push up into a one-legged squat, hovering just over the chair and keeping the other leg on the floor for balance.  Lower and repeat, only coming a few inches off the chair for 12 reps.  Repeat on the other side.
Upper Body Exercises Front Raise to Triceps Press: Sit tall with the abs in and hold a full water bottle in the left hand.  Lift the bottle up to shoulder level, pause, and then continue lifting all the way up over the head.  When the arm is next to the ear, bend the elbow, taking the water bottle behind you and contracting the triceps.  Straighten the arm and lower down, repeating for 12 reps on each arm. Bicep Curl: Hold water bottle in right hand and, with abs in and spine straight, curl bottle towards shoulder for 16 reps. Repeat other side.
Ab Exercises Side Bends: Hold a water bottle with both hands and stretch it up over the head, arms straight. Gentley bend towards the left as far as you can, contracting the abs. Come back to center and repeat to the right. Complete 10 reps (bending to the right and left is one rep). Ab Twists: Hold the water bottle at chest level and, keeping the knees and hips forward, gently twist to the left as far as you comfortably can, feeling the abs contract. Twist back to center and move to the left for a total of 10 reps. Don't force it or you may end up with a back injury.

Jack Dennerlein, a professor at Northeastern’s Bouvé College of Health Sciences in Boston who specializes in ergonomics and safety, suggests a variation on the 20-20-20 rule used to reduce eyestrain. In the case of the eyes, the rule is to take 20 seconds to look at something 20 feet away (instead of your computer), and repeat this every 20 minutes. But Dr. Dennerlein notes that this eye rule can be applied to movement as well. Every 20 minutes, walk 20 feet away for 20 seconds or more. Stop by a co-worker’s desk. Get a cup of coffee. Pace. Just don’t sit.

An interesting solution for both sore backs and a sedentary workday is the sit-stand workstation. (For more information about these stations, you can read the article “Taking a Stand for Office Ergonomics.”) Dr. Dennerlein said he now has one both at the office and at home and likes the effect it’s had on his work habits.

“It gets me moving around,” he said. “It keeps me varying my postures. When I stand at my desk, if I’ve got a thought I’ll walk around. Instead of just sitting and turning and looking at the window, if I’m already standing then I’ll walk over to the window and come back.”

Dr. Dennerlein notes that standing for long periods of time is not good for you either. The key is to vary your work posture throughout the day. “Just keep moving and changing things around,” he said. “I think people should be empowered to make adjustments to see what feels right for them. And one thing that might feel comfortable in the morning might not feel comfortable in the afternoon.”

Strawberries, blueberries ward off heart disease in women: study

Eating at least three servings of strawberries and blueberries reduces heart attack risk in younger women, says a new study. Anthocyanins, which gives these be rries their beautiful colors, may be to thank.

Younger women who ate at least three servings per week of strawberries or blueberries reduced their likelihood of suffering a heart attack by one-third compared with their sisters who incorporated fewer of the colorful berries into their diet, a new study says.
The berry benefit was sufficiently strong that it held even after researchers adjusted for age, high blood pressure, family history of heart attack, body-mass index, exercise, smoking, and caffeine or alcohol intake. Researchers suggested that a group of dietary flavenoids called anthocyanins, which give blueberries and strawberries their jewel-like colors, may be responsible for the health benefits seen in the study's large sample of subjects.
Anthocyanins are known to dilate arteries and counter the buildup of plaque that causes atherosclerosis.
The latest finding, published in the American Heart Assn.'s journal, Circulation, comes from the Nurses' Health Study II. In that study, about 93,600 women ages 25 to 42 answered detailed surveys about their diets every four years for 18 years.
During the study period, 405 heart attacks occurred — a rate that is predictably low because the women in the study had not yet reached the age at which heart disease is most likely to show up in women. But the study subjects who ate the most strawberries and blueberries, three or more servings weekly, were 32% less likely to be among the group who suffered early heart attack than were women who ate fewer berries — even women whose diets were otherwise rich in fruits and vegetables.
"This simple dietary change could have a significant impact on prevention efforts," said Dr. Eric Rimm, professor of nutrition and epidemiology at Harvard School of Public Health and senior author of the paper. Rimm and his coauthors surmised that if berry consumption showed such measurable health effects early in life, its benefits were likely to show up later as well, when women's heart attack rate more closely approximates that of men.
The authors said they looked specifically at strawberries and blueberries because they are the most commonly consumed berries in the United States. But other berries, including rapsberries, may have similar effects, they said.

Preparing for a older family member in home

 A few key pieces of equipment that can make life easier and safer for the patient may be required in the bathroom.

After a post in November, “Turning a Home into a Hospital,” some readers of this blog left comments asking what equipment they needed on hand and what other steps they needed to take to make that last wish a reality.
To even begin to answer that, you have to consider two things – not simply the patient’s situation, but the caregiver’s, too, said Dr. R. Sean Morrison, director of the National Palliative Care Research Center at the Mount Sinai School of Medicine in New York.
“What I see that prevents people from being able to stay at home [to die] is not their medical needs but the needs of their caregiver — can the caregiver really help, are there resources to help, or is that person going to be overwhelmed?” Dr. Morrison said.
There is professional help available. But before we get to that, here are what specialists say are the most common kinds of equipment and preparations you may need – though, of course, every person’s medical and emotional condition is different, as is every person’s home.
1. Make room for the bed.
One of the trickiest parts of bringing the patient home is realizing that the bedroom may not be the best place to put the bed, especially if it’s located up even a few stairs. “A lot of people put the patient in a family room where there is more space, or the dining room if it’s closer to a bathroom,” said Dr. Stacie K. Levine, a geriatrician and palliative care physician at the University of Chicago. Or you might consider a room closer to the kitchen – the center of life and activity for most families.
2. Don’t forget curtains for privacy.
You can still provide privacy for whichever room you decide to turn into the bedroom by putting up a temporary curtain using a spring pressure curtain rod in the doorway. Especially in the patient’s already vulnerable state, a little privacy can go a long way toward preserving dignity.

3. Get tools that keep them moving.
Walkers, four-point canes and slim wheelchairs all help the patient to get out of bed and take part in daily life (and are covered by Medicare). To get the house ready for this new equipment, Dr. Levine cautioned, you will have to remove slippery throw rugs, as well as chairs and other furniture that can get in the way. (See this earlier post and this post for more details on reducing fall hazards at home.)
Changing door handles from knobs to levers can make moving from room to room easier on the patient feeling weak or suffering from painful arthritis.
4. Fix their favorite chairs.
Many patients find that they are just too weak to get up from what used to be their favorite chair. You can buy risers or foam cushions to put on the seats — or replace a side chair with an armchair — to give them extra leverage and allow them to stay in their old spots comfortably.
5. Experiment with earphones.
You may need several models to fit into the TV, radio and iPods or tape players so those who are losing their hearing can still enjoy their entertainment, whenever they choose, without disturbing the rest of the household.
6. Make the existing bathroom safer.
“You’ll need to install grab bars or benches inside the tub,” Dr. Levine said. (Note: Tub benches, costing about $30 to $40, are one of the few things Medicare does not cover, according to Janet Wulf, a home care registered nurse with Gilchrist Hospice Care in Baltimore, the largest hospice organization in Maryland. Convertible commodes with arms that fit over the existing toilet – and solid foam risers that fit on the toilet seat — make sitting and getting up easier.
“Sometimes we suggest changing the shower head to install a hand-held shower head so that they can still participate in bathing themselves,” Dr. Levine advised. Putting down nonskid bathmats with a rubber underside also helps prevent slipping. (Find other bathroom and household safety tips in an earlier post on fall prevention.)
7. Good lighting is critical.
Nighttime trips to the bathroom or even moving down poorly lit corridors on an overcast day can pose serious falling hazards for those whose eyes and minds may be declining. Night lights with light sensors in every room and hallway of the house are an energy-and-cost-efficient way to keep pathways lit and safe.
8. Bedside commodes are a delicate matter.
People resist bedside commodes, said Dr. Morrison. It’s not only the lack of privacy, but it makes them feel like invalids. Dr. Morrison said he stresses with patients that it’s safer than slipping and falling on the way to the bathroom. And it can be done discreetly. “I say, ‘We can put it there at night and move it in the morning.’”
What if they still balk, as many do? Dr. Morrison had this useful reminder: “Our parents are adults and they are allowed to make bad decisions.”
9. Make breathing easier.
If the patient experiences breathlessness, common for those with heart and lung disease, Dr. Morrison said, oxygen equipment can ease the discomfort and the anxiety that gasping for breath can trigger. The caregiver needs to practice not only operating the machines, but getting the long, plastic oxygen tubing out of the way as the patient moves around the house.
10. Are pain pumps or intravenous drips for pain helpful?
In most cases, they are not necessary. “We can control pain orally with medication that comes in highly concentrated form, so even if patients can’t swallow, they can have pain control,” Dr. Levine said. Or the patient can get a steady baseline of pain medication by wearing a skin patch, or a nurse can administer a shot (through the skin, not the muscle, which would itself be painful).
Occasionally, for those with long-standing pain issues who require unusually high doses of medication, an intravenous drip can deliver a steady supply, which can be controlled by the patient with a button (within limits) or by a nurse or caregiver.
In even more rare cases, for patients with the highest pain-control needs, an intrathecal pain pump can be inserted into the intrathecal space around the spine area, “much like an epidural used in childbirth,” Dr. Levine said, and added that “It is an invasive procedure and requires a lot of monitoring.” So it is most commonly used as a solution for chronic pain over many years – and rarely recommended for those with less than a few months to live.
11. Should you order a hospital bed?
The idea of bringing this piece of equipment home sparks some of the most emotional disputes, among patients and caregivers alike.
“It’s a big deal to give up sleeping with a lifetime partner and the warmth and comfort of sleeping together,” Ms. Wulf said.
It is also the one piece of equipment that clearly turns the home into a hospital. Small wonder so many resist, as the blogger who wrote the “Turning Home into a Hospital” post admitted.
“And there is the issue of where are you going to put it?” said Ms. Wulf, as the hospital bed is not only an extra bed in the home, but it is slightly longer than a regular twin bed.
But if your loved one is having trouble getting in and out of a regular bed, and your back is being strained as you help, the hospital bed, which lowers, can make that process safer and easier for both of you. (It is covered by Medicare.) Similarly, being able to raise the hospital bed can make assisting with dressing, changing adult diapers and making up the bed a lot easier.
Also, because the head and foot of the hospital bed can be adjusted separately, it can make patients (especially those with heart and lung disease who need propping up to prevent fluid from accumulating in the lungs and legs) more comfortable than they would be lying flat or propped up with an assortment of pillows.
For those with dementia, who forget to change position, or with cancer and other ailments that leave them too weak to move around, the hospital bed — with an air compression mattress — will do the job for them. It can prevent bedsores, which, according to Dr. Levine, “can start very soon in somebody who isn’t turned and repositioned every three hours” all day and night.
12. Consider hospice.
Equipment aside, one of the biggest resources that a caregiver can call upon in these last stages, in addition to backup care from family, friends and home health aides, is hospice — as we’ve talked about in this blog many times. I can tell you from my family’s recent experience that hospice is like sending in a team of loving aunts – only they’re far more patient (no family baggage) and way more competent.
A good hospice team not only helps the caregiver figure out a plan for care but arranges for Medicare approval and payment. What many don’t know is that hospice even covers “respite care” for the caregiver – paying for up to five days of room and board for the patient in a nearby medical facility (or nursing home) so the caregiver can take a break – even to go on vacation, according to Lori Mulligan, senior director of development marketing and community services at Gilchrist Hospice Care, the largest hospice care organization in Maryland.
But as this blog has written many times before, too many people wait until the very end to call hospice. The median time in hospice is about 19 days, and more than a third of patients wait until the last week, according to the 2012 report tracking hospices nationwide from the National Hospice and Palliative Care Organization.
Why don’t they take advantage of the six months of extra help at home that they are eligible for under Medicare once a prognosis is made?
First, “clinicians are not great at prognosis” until the very end, said Dr. Levine. And the patient and family aren’t always ready to hear it.
“When people think of hospice, they think, ‘Oh, my mom will be lying in bed all the time,’” Dr. Levine said. Or they worry that calling in hospice may actually hasten death. Instead, Dr. Levine has found just the opposite.
“I have been doing this for over a decade and I find my patients who choose hospice sooner at home may live a little longer,” said Dr. Levine. When you shift the focus from a full-court press on cure (hospitals’ goals) to providing comfort (hospice credo), patients can stop using all their energy to fight the pain, so they are more likely to have the energy to “eat and walk and do all the things they like to do that keep us alive,” Dr. Levine added.
How do you know when it’s time?
Dr. Levine advises: Ask yourself if you would be surprised if the person you’re caring for would die within six months. And ask the patient about his or her goals. If he or she feels that all the treatment options have been exhausted but the disease is still progressing, and the patient is tired, doesn’t want to go back into the hospital, and just wants the comfort of their own bed — then it may be time to go home.
One more thing to bear in mind if you decide to call hospice: size matters.
“The larger the hospice, usually the more services for the patient and caregiver,” said Dr. Morrison, referring to a 2011 study in Medical Care journal supporting the bigger-is-better rule of thumb. “Ask for their daily patient census – several hundred patients per day is a good size,” Dr. Morrison added.
Remember, the point of all this is to make both the patient and the caregiver as comfortable as possible in those final days.
For most of us that can mean, “There’s no place like home.”

Tossing and turning all night to find that perfect sleeping position?

Experts say there is no one right way to sleep. But for people with certain types of pain and medical conditions, there are positions that can help keep problems from getting worse and may even alleviate them. In some cases, sleeping in the same position night after night can itself create pain, such as neck or shoulder problems.
"It's important that people take time to think about how they position themselves when they sleep," said Peggy Brill, a Manhattan orthopedic physical therapist. "Rest is important for the muscular skeletal system to recover" from the day's stresses, she said. "The proteins get back into the muscles, there's rejuvenation of the body, so you want to be in a healthy anatomical position when you sleep."
The most common sleeping position is on the side—57% of us at least start the night in that position, according to a nationwide survey of more than 2,000 people performed for mattress maker Tempur-Pedic TPX -0.91% North America. That's followed by the back—17% of people opt for this position—and the stomach, 11%. Most of the remaining respondents said their position when they first go to bed varies each night.

Moving around during the night is common. Videotaped sleep studies have found that adults might change their position between three and 36 times a night, with the average person switching about a dozen times. The tendency to shift in one's sleep decreases with age.
Each sleep position has benefits and disadvantages, although sleeping on the stomach generally isn't recommended because it can constrain the neck. Lying flat on your back, for instance, may be good for the lower back but can exacerbate digestive and breathing problems—and snoring.
"You want to make sure that your joints are not being excessively compressed or muscles put in abnormally shortened or stretched positions," said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services.
Dr. Wilmarth said that always sleeping in the same position can cause problems. Consistently compressing the body on one side or stretching another side over time can create an imbalance and result in soreness or pain in that area or exacerbate an existing condition.
In general, for most painful conditions, experts say choosing a mattress that isn't too firm or soft is ideal. Something that conforms to your body without creating pressure points works best. And surrounding yourself with multiple pillows usually helps. Getting comfortable when you sleep is important because a lack of sleep can cause joint inflammation and lowers your pain threshold, experts say.
Sometimes the right sleep position changes. Maurine Netchin, 65 years old, used to sleep on her stomach when she was younger. In recent years, the Manhattan resident started sleeping on her left side to avoid light streaming through a window. With the help of Ms. Brill, the orthopedic physical therapist, Ms. Netchin discovered that sleeping on her left side was aggravating an old injury to the rotator cuff in her left shoulder. She now sleeps on her right side hugging a full-length body pillow between her knees. The position allows her to keep her left shoulder and arm in a neutral position, akin to sitting in a chair with arm rests.
Here are some common conditions that may be helped by specific sleep positions.

People change their body position an average of 11 to 13 times a night, videotaped sleep studies have shown.

Obstructive sleep apnea/snoring. Stay off your back, sleep specialists say. This potentially dangerous sleep disorder results in breathing interruptions caused by a blockage or narrowing of the airway, often resulting from the tongue or tissue in the throat collapsing. It's often accompanied by snoring. Roughly 10% of sleep apnea patients can be cured by changing their sleep position, said Eric Olson, co-director of the Mayo Clinic's Center for Sleep Medicine in Rochester, Minn. While there are many sleep products designed to keep people off their backs, Dr. Olson and other experts recommend sewing a tennis ball onto the back of your night shirt to avoid rolling on to your back. And for people who want to stay on their back, he suggests elevating the head by at least 30 degrees or using a wedge pillow.
Acid Reflux. Sleeping on your side can help this condition, commonly known as heartburn. Back sleeping can pose problems because the head isn't elevated relative to the stomach so gastric contents can bubble up to the esophagus or back of the throat. Another solution is to prop up your head with pillows or to raise the head of the bed by two to four inches by placing bricks or large books under the front legs, sleep experts say. Some studies suggest that sleeping on your left side is better than the right in terms of alleviating reflux, but experts say the evidence isn't conclusive.
Back pain. The rule of thumb for many back problems is that sleeping on the back is the most comfortable. Keep a neutral position, with your spine aligned as if standing straight. Avoid flexing forward, for instance, by sinking into a mattress that is too soft, or bending backward, said Nick Shamie, associate professor of orthopedic surgery at University of California, Los Angeles and spokesman for the American Academy of Orthopaedic Surgeons.
For people suffering from lumbar spinal stenosis, in which nerves are pinched in the lower back, lying in any position can create significant pain except, perhaps, when the knees are bent.
"When these people are sleeping, whether on the back or side, they like to bend their knees because that brings their legs up and opens up the back of their spine," said Dr. Shamie. Spinal stenosis patients often place a pillow under their knees when sleeping on their back or between their legs if sleeping on their side. Adopting a fetal position while sleeping also helps ease pain for many patients, he said.
Shoulder pain. Avoid sleeping on the side with the painful shoulder. Sleep on your back with a small pillow to support the bad shoulder. Or, if you sleep on the other side, hug a pillow.
Also, if the neck isn't adequately supported, you could get compression of the nerves that go from the neck to the arm, said Harvard's Dr. Wilmarth. "That's when you can get numbness or tingling, usually with the compression of a nerve from the sleeping position," she said.
Neck pain. Avoid sleeping on your stomach, experts advise people with this condition. Turning the neck to the side compresses the joints. "Sleep on your side or back," Ms. Brill said.
Also, use a pillow that is as thick as the space between your neck and shoulder, and position it above the shoulders so they don't become hunched, she said. "You want a soft down pillow or something similar that you can kind of bulk and put into the hollow of your neck and support your head," Ms. Brill said.
Joseph Feinberg, director of the physiatry, or rehabilitative medicine, at the Hospital for Special Surgery in Manhattan, suggests supporting the neck.
This helped Loli Wu, 45, an investment banker in Manhattan, who said he used to wake up with horrible neck cramps. Dr. Feinberg diagnosed a herniated cervical disc, the result of years of imperfect posture.
In addition to physical therapy, Dr. Feinberg suggested Mr. Wu use a rolled towel in his pillowcase. "Since doing that I have not had a reoccurrence of the neck cramps," Mr. Wu said. "I stick to it religiously now."

Sitting For 9 Hours A Day Is Nearly A Lethal Activity

 As we work, we sit more than we do anything else. We're averaging 9.3 hours a day, compared to 7.7 hours of sleeping. Sitting is so prevalent and so pervasive that we don't even question how much we're doing it. And, everyone else is doing it also, so it doesn't even occur to us that it's not okay. In that way, I've come to see that sitting is the smoking of our generation.
Of course, health studies conclude that people should sit less, and get up and move around. After 1 hour of sitting, the production of enzymes that burn fat declines by as much as 90%. Extended sitting slows the body's metabolism affecting things like (good cholesterol) HDL levels in our bodies. Research shows that this lack of physical activity is directly tied to 6% of the impact for heart diseases, 7% for type 2 diabetes, and 10% for breast cancer, or color cancer.
You might already know that the death rate associated with obesity in the US is now 35 million. But do you know what it is in relationship to Tobacco? Just 3.5 million. The New York Times reported on another study, published last year in the journal Circulation that looked at nearly 9,000 Australians and found that for each additional hour of television a person sat and watched per day, the risk of dying rose by 11%. In that article, a doctor is quoted as saying that excessive sitting, which he defines as nine hours a day, is a lethal activity.
And so, over the last couple of years, we saw the mainstreaming of the standing desk. Which, certainly, is a step forward. But even that, while it gets you off your duff, won't help you get real exercise.
So four years ago, I made a simple change when I switched one meeting from a coffee meeting to a walking-meeting. I liked it so much it became a regular addition to my calendar; I now average four such meetings, and 20 to 30 miles each week. Today it's life-changing, but it happened almost by accident.
My fundamental problem with exercise has always been this: it took time away from other more "productive things." Going to the gym to take care of me (vs. companies, colleagues, family) seemed selfish. My American-bred Puritan work ethic nearly always won out. Only when I realized I could do both at the same time, by making exercise part of the meeting, did I finally start to get more exercise. This is one of those 2-for-1 deals. I'm not sacrificing my health for work, nor work for fitness. And maybe that's why making fitness a priority finally doesn't feel like a conflict. It's as easy as stepping out the door and might require as much as a change of shoes.
And, yet, it's true that some people will turn you down. Probably 30% of the people I ask to do these kinds of meetings say that they are not fit enough to do a walking meeting. I had one person tell me afterwards that they got more active for an entire month before our meeting, so as to not embarrass themselves on their hike with me. I don't judge the people who won't do a hiking meeting, and in most cases will choose to do another type of meeting with them (lunch or whatever) but I am also reminded of James Fowler and Nicholas Christakis's research from their related book, Connected.
They observed that obesity spreads according to network effects; if your friend's friend's friend who lives a thousand miles away gains weight, you're likely to gain weight, too. And if that extended friend also loses weight, even if you're not in the same city, you're likely to lose weight, too. My goal is to be someone who socializes the idea that physical activity matters, and that we each matter enough to take care of our health.
And after a few hundred of these meetings, I've started noticing some unanticipated side benefits. First, I can actually listen better when I am walking next to someone than when I'm across from them in some coffee shop. There's something about being side-by-side that puts the problem or ideas before us, and us working on it together.
Second, the simple act of moving also means the mobile device mostly stays put away. Undivided attention is perhaps today's scarcest resource, and hiking meetings allow me to invest that resource very differently.
And, finally we almost always end the hike joyful. The number one thing I've heard people say (especially if they've resisted this kind of meeting in the past) is "That was the most creative time I've had in a long time" And that could be because we're outside, or a result of walking. Research certainly says that walking is good for the brain.
I've learned that if you want to get out of the box thinking, you need to literally get out of the box. When you step outside, you give yourself over to nature, respecting its cycles and unpredictability. It keeps me more awake to what is happening around me by experiencing the extreme heats of summer, or the frigid power of winter. It makes me present to the world around me instead of being insulated from it.
To keep this commitment — to myself and to others — I've marked off certain times on my calendar for these meetings. I block off two morning appointments (when I can take a shower afterwards) and two end-of-day appointments for hiking meetings. I try and schedule these slots before scheduling "regular" sitting meetings because it means I have no excuse to not move that day and it helps me be more awake during the day or less zombie-like (and still-thinking-about-my-inbox) going into the evening. On the rare days when someone bails on a hike last minute, I typically still head out for the time, and I find myself hearing even my own voice more clearly.

In The Battle Between Health And Taste, Why White Bread Still Wins

The tantalizing aroma of freshly baked brioche is hard to resist, while a virtuous loaf of whole wheat often lacks that same allure. Blame it on the ferulic acid.
See, whole-wheat bread contains all parts of the wheat, including the bran, but white bread does not. That bran in the wheat bread contains the aforementioned ferulic acid, which overrides the compounds that give white bread its mouthwatering smell, according to new research.
Much nudging from the health police has convinced more people to eat whole-grain bread, but just 60 percent of Americans eat a whole-grain food at least once in two weeks, according to the Whole Grains Council. Clearly our hearts, and our palates, still belong to white.
"My children, they cut off crusts from wheat bread. Why?" asks Devin Peterson, co-director of the Flavor Research and Education Center at the University of Minnesota. He knows he's not the only parent who's noticed that whole wheat can be a tough sell.
But unlike the rest of us, Peterson has the chops to figure out what makes for whole wheat's lack of appeal. His lab baked up whole wheat and white bread, removed the crust right when it came out of the oven, and froze the crust in liquid nitrogen.
After that Peterson and his colleagues ground the frozen bread crust in a mortar and pestle, added solvent, distilled the liquid, and ran it through a series of gas chromatographs and sniffers. (Crust was chosen because it's the part of bread that browns the most, and browning is a major part of flavor.)
The white bread crust gave off chemicals that smell like corn chips, potatoes, caramel, and flowers, while the whole wheat produced malty, earthy, cucumber, fatty smells. Which would you choose for toast?
To combat some of these issues, manufacturers often add salt and sugar to whole-grain bread. But that takes away from its nutritional value. Indeed, some products labeled "whole grain" have more sugar and calories than products that don't sport that label, a recent study in the journal Public Health Nutrition found.
Products with the Whole Grain stamp, which is a common symbol on food packages these days, were higher in fiber and lower in trans fats than some other foods, but had more sugar and calories compared to products without the stamp. Researchers from the Harvard School of Public Health found that products that met the American Heart Association's standard — requiring a 10:1 ratio of carbohydrates to fiber — were healthiest overall.
The Whole Grains Council, which developed the stamp, took some issues with Harvard's conclusions. "It's designed to address whole grain content and nothing more," says Cynthia Harriman, director of food and nutrition strategies for Oldways and the Council. And, she noted: "Whole-grain consumption went up 20 percent in the first three years after [the stamp] was introduced in 2005."
Still, more of us could stand to gain from the well-documented health benefits of whole grain, so figuring out how to make it yummier while still being healthy would be a big plus for the many people who have yet to make the switch.
In Peterson's quest for better whole-grain taste, he found that ferulic acid in wheat bran blocked production of d-2, a molecule that helps produce a warm, browned smell we associate with white bread. "If I were to give you this compound in pure form, it's very discernible," Peterson told The Salt. "It's a very nice baked note."
Chefs call that nice baked note the Maillard reaction, after a Frenchman who realized a century ago that it's what gives grilled steak and browned bread its rich flavor. (NPR's Joe Palca gives the lowdown on Maillard and how deliciousness can come from heating a mixture of sugars and amino acids.)
Bitter taste is also a problem for whole-wheat bread. Peterson has looked into that, too, and says the problem is not in the flour but in compounds created in fermentation and in the Maillard reaction. In the past, bakeries have tried different forms of flour to reduce bitterness, but Peterson thinks the solution lies in tweaking the proofing and baking process instead.
Removing ferulic acid from whole-wheat bran isn't the answer, Peterson thinks; he speculates that it may have health benefits. "You have to look at the whole picture and keep the good elements together."
He hopes that by figuring out just what makes whole-wheat bread taste and smell the way it does will help food manufacturers how to keep the nutritional goodness of whole grains, without losing the rich brown smell of freshly baked bread. Peterson's research was published in the Journal of Agricultural and Food Chemistry.

Why Sleeping May Be More Important Than Studying

Getting enough sleep is an under-valued but crucial part of learning. Contrary to students’ belief that staying up all night to cram for an exam will lead to higher scores, truth is, the need for a good night’s rest is even more important than finishing homework or studying for a test.

A recent study in the journal Child Development showed that sacrificing sleep in order to study will actually backfire. The study followed 535 Los Angeles high school students for 14 days, tracking how long they slept, as well as how well they understood material being taught in class and how they performed on a test, quiz, or homework.
“Although the researchers expected that extra hours of studying that ate into sleep time might create problems in terms of students’ understanding of what they were taught in class, they were surprised to find that diminishing sleep in order to study was actually associated with doing more poorly on a test, quiz, or homework,” Science Daily wrote.
“Reduced sleep … accounts for the increase in academic problems that occurs after days of increased studying,” said UCLA scientist Andrew Fuligni. “Although these nights of extra studying may seem necessary, they can come at a cost.”
In another study by a research team at the University of York, researchers found that sleep even helps boost language acquisition skills in young children. ”Children’s ability to recall and recognize new words improved approximately 12 hours after training, but only if sleep occurs,” said Dr. Lisa Henderson, a lead researcher on the study. “The key effects were maintained one week later, suggesting that these new words are retained in long-term memory.” The study, published in Developmental Science, shows that when they sleep enough, children show the same learning patterns as adults.
Yet even with the well-documented evidence that sleep is necessary to learning, students continue to face increasing demands on their time. Kids often participate in extracurricular activities as well as hours of homework each night.

What’s really happening during sleep?

Sleep happens in several stages, with each phase serving a particular purpose. The human body takes care of its physical needs first. Quickly passing through stages one and two, which are brief, the body settles into several hours of stage three and four sleep. During these stages, neurons in the brain have synchronized into a regular rhythm and the body begins to repair itself. The immune system is restored, muscles and cardiovascular systems are rejuvenated and the positive effects on metabolism and muscle growth from exercise take effect.

“If you didn’t get a good night’s sleep, it’s really hard to learn new things because you didn’t clear out all the synaptic connections.”

“The reason to get a good night’s sleep is really so you can enjoy the next day and so you can consolidate what you did the day before,” said Dr. Matt Carter, senior fellow at the University of Washington in a recent webinar.
Towards the end of a typical six- to eight-hour night of sleep, the brain gets its chance at rejuvenation, during Rapid Eye Movement (REM) sleep. This is the stage that’s crucial for learners because the brain solidifies all that was taken in the day before and clears out old, unnecessary memories to make room for new information.
“In REM sleep your brain is basically replaying everything that happened during the day and consolidating what you’ve learned,” Carter said. During the learning process, the brain’s synapses fire in particular patterns. At night, those patterns are firing over and over again, strengthening the path. Equally important, there are many small details the brain remembers from the previous day that it won’t need. During REM sleep the brain purges the unnecessary details to make room for new learning the following day.
“If you didn’t get a good night’s sleep it’s really hard to learn new things because you didn’t clear out all the synaptic connections,” said Carter. The brain-rejuvenating functions happen in REM sleep, a later sleep stage, so if a student doesn’t sleep enough he won’t spend much time in REM.
Just as with adults, sleep-deprived kids won’t be able to focus as well, and over time, the effects of sleep deprivation will wear on the body.

What’s the solution?

Educator Madeline Levine and author of Teach Your Children Well says high schools should adjust their schedules to meet the needs of adolescents. School should start at 10 a.m. to help ensure high school students get the nine hours they need. That would go a long way in helping them to focus in class and could even prevent depression, a condition increasingly linked to lack of sleep.
And it’s not just about the number of hours in bed – it’s about the quality of sleep. “Sleep is something you can prepare for and be deliberate about,” Carter said, adding that people assume sleep comes naturally to kids. But for young ones, it’s especially important to establish a routine, not to eat carbohydrates before sleep, and to avoid bright screens before bed — the glow biologically resets circadian rhythms that respond to how much light enters the eye. For kids who have trouble falling asleep, parents should teach them relaxation techniques like taking deep breaths and listening to slow tempo music – that helps the neurons fall into their synchronized pattern quicker.

Collard Green and Kale

Kale and collard greens occupy similar niches in a healthy diet. Both belong to the family of
cruciferous vegetables, which also includes broccoli and cauliflower, and both count towards the 1.5 to
2 cups of green vegetables the USDA recommends you consume each week. Collard greens and kale
make for very nutritious additions to your diet, but differ in their micronutrient content.
Fat-Soluble Vitamins
Kale and collard greens both provide rich sources of two fat-soluble vitamins, A and K, although kale
boasts a higher vitamin content. Eating 1 cup of chopped collards provides you with 2,400
international units of vitamin A, as well as 183.9 micrograms of vitamin K. An equivalent serving of
kale contains significantly more vitamin K, at 547.4 micrograms, as well as 10,302 IU of vitamin A.
However, consuming large amounts of vitamin K without first informing your doctor can prove
dangerous for some individuals. Because vitamin K plays a role in blood clotting, high levels of vitamin
K in your system can affect the efficacy of blood thinners, such as warfarin. Talk to your doctor about the safety of consuming kale on a regular basis if you suffer from clotting disorders or take anti-coagulant medications, and consider consuming collards as a more moderate source of vitamin K.
Water-Soluble Vitamins

Collard greens and kale also boost your intake of water-soluble vitamins. Both types of greens contain a range of B vitamins, including vitamin B-1, riboflavin, niacin, folic acid and vitamins B-5 and B-6. These nutrients support your metabolism and help maintain healthy skin and hair. Kale and collards differ slightly in their vitamin C content. A 1-cup serving of collard greens contains a moderate 12.7 milligrams of vitamin C -- 17 percent of the recommended daily intake for women, or 14 percent of the RDA for men, according to the University of Maryland Medical Center. Kale contains 80.4 milligrams of vitamin C, the entire daily recommended intake for women, or 89 percent of the RDA for men.
Minerals
Eating collard greens or kale boosts your intake of essential minerals, including potassium, phosphorus, copper, manganese, selenium and zinc. Both greens also provide some calcium, although kale proves richer in calcium, boasting 90 milligrams per cup, compared to 52 milligrams in a cup of collard greens. Kale also contains more iron than collard greens, offering 1.14 milligrams of the mineral per 1-cup serving -- much more than the 0.07 milligrams found in an equivalent serving of collard greens. If you rely on dark leafy greens as vegetarian sources of iron and calcium, choose kale over collards.
Preparation Tips
Since both kale and collards contain large amounts of fat-soluble vitamins A and K, you should consume these vegetables with fat. Adding a small amount of oil to your greens allows your body to properly absorb these vitamins so you can reap the full nutritional benefits of your greens. Chop your kale or collard greens into slices, then lightly coat with olive oil and steam until tender. If plain steamed kale or collards sound boring, try

Weight-loss regimen a preferred choice for countering diabetes

More doctors are prescribing the Diabetes Prevention Program, a 12-week regimen, to ward off Type 2 diabetes. It may be a crucial test of the Affordable Care Act's focus on preventive health.

The Diabetes Prevention Program is not rocket science. In 12 weekly sessions, a coach teaches obese subjects at high risk of developing diabetes to set goals for losing 5% to 7% of their body weight, limit the fat and calories they consume, track their food intake, get at least 150 minutes of exercise each week, and devise strategies to avoid gaining back lost pounds.
In trials, subjects who attended the tightly scripted sessions and followed the regimen were far more likely than those who were on their own to reach their weight-loss goals in three months — and to keep that weight off for more than a year. By doing so, they drove down their risk of developing Type 2 diabetes by 58%, according to a landmark report published in the New England Journal of Medicine in 2002.
The program, in short, is powerful medicine.
"If you could take it as a pill, it would definitely be commercialized," said Sean Duffy, a software designer and former Google employee who launched an online version of the program about a month ago.

 

Ayurveda Home remedies for losing weight

 Increase the quantity of fruits and vegetables and low calorie foods.

Avoid intake of too much salt as it may be a factor for increasing body weight.

Milk products like cheese, butter etc. and non-vegetarian foods should be avoided as they are rich in fat

Mint is very beneficial in losing weight. Chutney of green mint with some simple spices can be taken with meals. Mint tea also helps.

Spices like dry ginger, cinnamon, black pepper etc. are good for loosing weight and can be used in a number of ways.

Regular intake of carrot juice.

Avoid rice and potato, which contain a lot of carbohydrates. Among cereals wheat is good.

Vegetables like bittergourd and drumstick are useful in loosing weight.

Honey is an excellent home remedy for obesity. It mobilizes the extra deposited fat in the body allowing it to be utilized as energy for normal functions.

Dosage: One should start with small quantity of about 10 grams or a tablespoon, taken with hot water early in the morning. A teaspoonful of fresh lemon juice may also be added.

Fasting on honey and lime- juice is highly beneficial in the treatment of obesity without the loss of energy and appetite. For this, mix one teaspoon of fresh honey with the juice of half a lime in a glass of lukewarm water.

Dosage: Take several times a day at regular intervals.

Raw or cooked cabbage inhibits the conversion of sugar and other carbohydrates into fat. Hence, it is of great value in weight reduction.

Exercise is an important part of any weight reduction plan. It helps to use up calories stored in body as fat.

Walking is the best exercise to begin with and may be followed by running, swimming or rowing.

The gum of Commiphora Mukul called 'guggulu' is the drug of choice for the treatment of obesity.

Blood Purification and Fat Reduction
Take one glass of warm water and mix 1-2 teaspoonful of honey and one teaspoonful of lemon juice. Take this preparation daily before evacuation. It helps to purify the blood. It also helps to reduce fat and to clean the bowels.

Dr. Fuhrman’s Tips for Healthy Eating with a Nutritarian Plant-Based Diet

Dr. Furhman: I summarize my core nutritional philosophy with the equation H = N/C, or Health = Nutrients/Calories. For you to be in excellent health, your diet must be rich in micronutrients (vitamins, minerals, antioxidants, and phytochemicals) and you must not overeat on calories – I call it a nutritarian diet.  An eating style based on foods that are naturally rich in micronutrients and low in calories is the key to longevity and a healthy weight. The foods with the highest nutrient to calorie ratio are leafy green vegetables; a nutritarian diet is based on copious amounts of vegetables, especially green vegetables, and includes plenty of beans and fresh fruit, plus nuts and seeds daily. Because of their high micronutrient and fiber content, these foods help to blunt appetite and suppress food cravings; this eating style allows people to break out of the constant cycle of overeating that is so common because of the addictive foods that make up the standard American diet. When you make the commitment to a nutritarian lifestyle, you’ll never need to make another New Year’s resolution to eat more healthfully because this eating style changes your taste buds; you will prefer the taste of healthful foods and lose the desire for disease-causing foods. It takes months, but once you become a black belt nutritarian you’ll never have to worry about having a heart attack or a stroke and you’ll never need to make another New Year’s resolution to lose weight, because you will get in touch with your body’s true hunger signals, and desire only the amount of food that your body needs, no more.  So instead of counting calories, let’s see how much nutrient-rich produce you can eat each day.  Eating right sets you up with the proper biochemistry to boost your emotions and avoid depression too.

To read the full article, click on 

http://yummyplants.com/vegan-nutrition/dr-fuhrman-eating-nutritarian-plant-based-diet/

Depression, through the lens of inflammation

Did you know that the World Health Organization predicts that by 2030, more people will suffer from depression than any other medical condition?

The incidence of depression has skyrocketed in children and adults since World War II; depression affects about 10 percent of the population in the U.S.
Antidepressant medication use has also increased (to the tune of 400 percent) since the 1980s, when drugs such as Prozac hit the market, even though recent data suggest that these medications offer little if any benefit to people with mild to moderate depression.
In spite of this, the Centers for Disease Control and Prevention reported in 2011 that 11 percent of Americans over the age of 12 take antidepressants.
Why more depression?
Although traumatic life events, stress and social isolation can increase the risk of depression, our Western way of life is probably a bigger contributor. Evidence suggests that nutrient-poor diets high in refined carbohydrates and commercially raised animal foods, combined with lack of exercise, all contribute to obesity, heart disease and diabetes.
These diseases are associated with elevated levels of inflammatory markers in the blood such as C-reactive protein, and they are also all associated with depression. People with other inflammatory disorders such as rheumatoid arthritis are also at increased risk of depression.
Could inflammatory changes in the brain be one of the main drivers behind our epidemic of depression? And could this explain why antidepressant medications often don't work for people with depression?
This is an exciting new area of research.
Inflammation connection
In pursuit of the inflammation-depression connection, researchers from Emory University in Atlanta looked at the use of an anti-inflammatory drug called infliximab for the treatment of major depression in people who had not responded to antidepressants. Infliximab, also known as Remicade, is usually given to people with inflammatory disorders such as rheumatoid arthritis, inflammatory bowel disease and psoriasis.
The researchers in the study found that 62 percent of depressed people with high blood levels of C-reactive protein had a reduction in their depression while taking the infliximab, while only 33 percent of those with normal CRP levels noted improvement. This was the first time that a drug specifically targeting inflammation was used to successfully treat depression, and provides some support for the depression-inflammation theory.
Lessening inflammation other ways
This is intriguing data, but drugs such as infliximab are very costly and also carry the risk of significant side effects, so they would not be first-line medications for depression. Fortunately, there are much easier ways to reduce inflammation, including — you guessed it — improving your nutrition and getting regular exercise. In fact, a diet high in healthy foods such as vegetables, fruit and fish — similar to what we call the Mediterranean diet — has been shown to reduce the risk of depression.
A 5-year study of 3,500 middle-aged adults published in the British Journal of Psychiatry in 2009 showed that people who ate a diet high in processed foods, including refined carbohydrates, sugary desserts, fried foods and processed meats, had a 58 percent higher risk of depression compared with those who followed a Mediterranean-type diet.
And if you just can't give up those steaks and hamburgers, take heart. Another study from the University of Melbourne in Australia showed that a healthy whole-foods diet including grass-fed beef, fish, vegetables, fruit and whole grains reduced the risk of depression. Pastured grass-fed beef, unlike cattle raised in feedlots, is high in healthy omega-3 fatty acids, which play an important role in the health of your brain.
Should you or your loved ones suffer from persistent depression, it's important to see your doctor. But in the meantime, this new research is confirming what some scientists have speculated for years — what we eat and how we take care of ourselves can play a huge role in our mental well-being. And that means less reliance on expensive medications — as well as lower health care costs — for you.
62 percent of depressed people with high blood levels of C-reactive protein had a reduction in their depression while taking the anti-inflammatory drug infliximab

How to Need Less Sleep by Getting Better Sleep Every Night

Many of us struggle to get enough sleep every night, but is the sleep we get any good? While it's important to get enough sleep,better sleep is a greater ally than more hours of sleep. We sat down with a sleep expert and a stack of studies to help you get a better night's sleep and need less in the process. Here's how.

Most of Us Have a Hard Time Getting Enough Sleep in the First Place

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Let's make sure we're on the same page from the start: You need sleep, and odds are, you may not be getting enough as it is. This guide will help you improve the quality of your sleep, so you can survive on less, but it'll be useless if you don't know how much sleep is right for you to begin with. The truth is, each of us needs a different amount of sleep to be productive, and the whole "8 hours" thing is more of a guideline than a rule. In fact,some research suggests that sleeping too much can actually be harmful to your health.  

We've discussed how to get on a good sleep schedule and ditch a dysfunctional relationship with sleeping, so if you're having trouble sleeping, make sure to follow that guide first. Our goal in this post is to walk you through improving the sleep that you get to the point where you can fine tune and dial back the amount that you get to match what you really need. You'll spend less time tossing and turning, and more time getting truly restful sleep.

Why Better Sleep is More Important than More Sleep

We frequently hear about the dangers of too little sleep, but there's also research to suggest too much sleep is a problem too. One study published in the Journal of Psychosomatic Researchconcluded that quality of sleep is more important than quantity of sleep when it comes to feeling rested and rejuvenated.

So where does that leave us? First, start tracking your sleep, and find your perfect bedtime. There are great apps that can help. Eight hours of sleep is worthless if you spend all of it tossing and turning, or you only sleep for about 3-4 hours of it. Trying to fix poor sleep habits by going to bed earlier is like trying to lose weight by spending more time at the gym without actually changing the duration of your workout. Once you've learned to optimize your time, you'll see better results.

The Keys to Better, Quality Sleep

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Optimizing your sleep depends heavily on three things: preparation (building good sleep habits), environment (tweaking your surroundings for optimal sleep), and timing (getting the sleep you need when you need it). We sat down with Dr. Nitun Verma, MD, a Stanford University trained specialist in sleep medicine and Medical Director of theWashington Township Center for Sleep Disorders in Fremont, to come up with some tips to help you improve the quality of your sleep so you'll need less in the long-term. 

Preparation

The first step is to build the habits that will help you fall asleep faster, stay asleep longer, and be more comfortable while you rest. For example:

• Exercise regularly. The goal here isn't to wear yourself out, but The National Sleep Foundation has said exercise in the afternoon can improve sleep in the evening. Specifically, morning or afternoon exercise helps you fall asleep faster with less trouble. Just be sure not to exercise right before bed, as that had the opposite effect.
• Set a kinder, gentler alarm. Ditch your incredibly loud, annoying alarm clock and try something new that will make waking up easier and more natural. Grab an alarm clock app that will wake you to music or soothing sounds, or try a wake-up light that slowly rises the light level in the room as you approach your wake-up time.
• Ditch the alcohol, cut out the caffeine, and watch the cigarettes. This one study, published in 1994, approached all three topics, and concluded that alcohol can be relaxing and help you get to sleep, but it's damaging to the sleep cycle once you're out. The end result is a choppy, restless night where you wake more frequently than you would. Caffeine has a different effect. It lengthens the 2nd phase of your sleep cycle (where your brain starts reorganizing itself and processing the day)—which is great for naps, but not for a night of deep sleep. Caffeine shortens phases three and four, where REM sleep and dreaming occur. Cigarettes on the other hand, or specifically nicotine, can be relaxing in small doses, but too much keeps you awake and prevents the onset of sleep entirely.
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   Cut back on screen time. We'vementioned it before, but study afterstudy all point to the notion thatelectronic devices harm our sleep cycles. Dr. Verma suggested turning off your gadgets at least 1-2 hours before bedtime, even those e-ink devices. Two hours is best, but admittedly impractical for many people. "The screens on tablets/phones/tv's are so bright, that they can confuse the brain's suprachiasmatic nucleus, or SCN," he explains. "Bright light too late at night can confuse the brain into thinking it is 2pm when it is 2am. Even if sleep occurs, it will not be as deep, and therefore less restorative."  
• Meditate before bed. We've shared one sleep-oriented meditation method designed to help you fall asleep, but there are many others. Try visualizing a dream you'd like to have, or if you've woken up in the middle of the night, relax, focus on sleeping, and try to visualize where your dream left off.
• Improve your evening ritual. Your evening ritual is important, and if you're not working in everything from a snack (you don't want to go to bed hungry, you'll wake up or sleep restlessly) to going to the bathroom (waking frequently to go to the bathroom can lead to shallow sleep all night and throw off your sleep cycle), you may suffer for it. Start a healthy "sleep routine" of winding down that starts long before your head hits the pillow.

Environment

Before you lay down to sleep, you should also make sure your environment is conducive to a good night's rest:

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   Make sure your bed is actually comfortable. We've said this several times before, but put your money where your time goes. Since most of us will spend an average of 24 years of our lives asleep, your bed deserves serious investment. Buy the right mattress, pick some good pillows, and pick up some good sheets. Don't underestimate the power of a more comfortable comforter, a pillowtop over your old mattress, or even a cooling pillow. Your bed is important, and you should make sure itimproves your sleep, not hinder it.  
• Adjust the temperature. Some studies have shown that optimal sleeping temperature for most adults is between 60 and 68 degrees Fahrenheit. Too much warmer than that and you start having difficulty with insomnia. Again, studies say one thing, but find your sweet spot—sometimes a cool room and a hot water bottle in bed, or maybe a fan going over your body is all you need to feel just right.
• Filter out the light. LEDs and standby lights from electronics can cause just as much havoc with your sleep cycle as a glowing phone or tablet screen. We've already banished your electronic devices—or at least turned them off, but make sure to cover up that pulsating light on your laptop while it's charging too. Cover up those lights on your cable box, TV, or any other devices in standby near your bed while you're at it. There are products for this, but even some tape will do. If you live somewhere lit at all hours like I do, invest in a sleeping mask. Whether you shell out for the expensive adjustable kind that mold to your face and have cushions or just grab a dollar-store mask that's essentially cloth with an elastic band, it'll work wonders for your sleep. Plus, if you work off-hours and have to sleep through sunrise or during the day, it'll help you get better rest.
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   Cut out the distractions. Kids waking you up? You may not be able to do much about that, but if your phone is waking you up, buzzing with notifications or new emails, it's time to turn it off, set some quiet hours,improve your notifications so they help you sleep, or just set it to silent when you go to bed. If your neighborhood is noisy and that keeps you from sleeping, try a white noise generator or some soothing music to drown it out and help you rest.  

Timing

You already know that how long you sleep is important, but for the best possible sleep, you really should go to sleep and wake up at the same time every day. The debate rages over the concept of "sleep debt" and whether it can be "paid off" by sleeping in, and different experts saydifferent things about it.

Dr. Verma suggests an alternative: "An often overlooked way for people to optimize their sleep is to wake at the same time every day, or at least within the same hour. So rather than oversleep on off days, waking at the same time and then taking a nap allows the extra sleep without disrupting the normal wake/sleep schedule."

He continues, "Many of my patients have such a different weekday/weekend wake schedule that they are experiencing the same sleepiness that people who are jet-lagged. Even two hours difference hurts, especially if they are already sleep deprived." If that's the case, and you still don't want to adjust your sleep schedule, maybe our tips on beating jet lag can help.

Get Help From the Experts

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Finally, if you're having trouble getting quality sleep, or even if you sleep for long periods and don't feel rested, it may be time to talk to your doctor. There could be any number of medical issues causing your sleep problems, all of them treatable. You may be suffering from chronic insomnia, which is treatable with mild sedatives. You could also be suffering from sleep apnea, or some other undiagnosed condition that, once treated, can turn the hours you get into the most restful you've ever had. Ultimately, the only way to know for sure is to check with your doctor, and possibly submit to a sleep test that'll settle the issue once and for all.  

Once you have your sleep issues sorted out, whether by the professionals or through our tips above, you can start to fine tune the amount of sleep you actually get to make sure you only take away as much as you actually need. If you've been sleeping nine or ten hours because it's the only way to feel rested, but once you start wearing a mask and ditching the gadgets before bed, you find that you feel just as rested after eight, you can start to edge back to see what happens. Bonus: you'll get two extra hours in your day to do the things you want to do, and your mind and body won't be worse for the wear as a result.

Dr. Nitun Verma, MD is a specialist in sleep medicine and the Medical Director of the Washington Township Center for Sleep Disorders in Fremont. He has offered his tips for better sleep here before, and he graciously volunteered his expertise for this piece as well. We thank him, and you can follow him on Twitter at @nitunverma.