19/04/2019

Mindfulness meditation helps fight insomnia, improves sleep

How long do hot flashes last? It used to be said that menopause-related hot flashes fade away after six to 24 months. But for many women, hot flashes and night sweats often last seven years and may go on for 11 years or more.

The hormonal roller coaster that comes with the end of a woman’s childbearing years can trigger a range of hot flash symptoms. Up to 80% of women going through menopause experience hot flashes. Hot flashes, also known as vasomotor symptoms, are often described as a sudden sensation of heat in the chest, face, and head followed by flushing, perspiration, and sometimes chills. When a hot flash occurs during sleep, it can be accompanied by a drenching sweat. Such night sweats make it difficult to get a good night’s rest.The estimates of the duration of these symptoms come from the Study of Women’s Health Across the Nation (SWAN), a long-term study of women of different races and ethnicities who are in the menopausal transition. They were published in JAMA Internal Medicine.

“The data from this study confirm what many women already know firsthand. Hot flashes can go on for years and take a toll on a woman’s health and well-being,” says Dr. JoAnn Manson, professor of women’s health at Harvard Medical School and professor of epidemiology at Harvard School of Public Health.
The SWAN researchers found that some women are more likely to deal with long-term hot flashes than others. Women who had their first hot flashes before their menstrual periods ended had hot flashes for an average of nine to 10 years. When hot flashes didn’t start until after the last menstrual period, the average duration was only about three and a half years. But even on the short end of the spectrum, that’s a long time to deal with hot flashes and night sweats.
Women in the SWAN study who experienced hot flashes for a longer time tended to be current or former smokers, overweight, stressed, depressed, or anxious. Ethnicity also played a role. African American women reported the longest duration of hot flashes (averaging more than 11 years), while Japanese and Chinese women had hot flashes for about half that time.
The “reality check” the SWAN study provides on hot flashes should encourage women to seek solutions. If hot flashes and night sweats are really bothering you, don’t put up with them. Talk with your doctor about treatment options.

The most effective hot flashes treatment is estrogen-based hormone therapy, though it comes with several downsides. “While hormone therapy is very effective at relieving hot flashes, longer-term treatment carries an increased risk for breast cancer, and women at older ages have higher risks of stroke, blood clots, and other health problems. So it’s important that women explore a full range of treatment options — especially women likely to have persistent hot flashes,” advises Dr. Manson.

Several non-hormonal medications can also provide r hot flashes treatment and relief from night sweats. These include some types of antidepressants, some drugs commonly prescribed for nerve pain, and some high blood pressure medications. As with any medication, it’s best to opt for the lowest dose that effectively relieves your symptoms, and to take it for the shortest amount of time possible.

For some women, self-help measures can help ease hot flashes. These include deep-breathing exercises when a hot flash starts; dressing in layers; lowering the thermostat; staying away from caffeine, alcohol, hot beverages, and spicy foods; stress reduction techniques like meditation and mindfulness; and doing your best to stay cool in general.

A free mobile app called MenoPro, developed by Dr. Manson and her colleagues at the North American Menopause Society, helps women understand their treatment options and work with their healthcare providers to find the best approach for them. The app is currently available for iPhones and iPads. More information is available at the North American Menopause Society website. If you knew that a vaccine could prevent your daughter or son from developing a relatively common and potentially deadly cancer later in life, would you have her or him get it? Such a vaccine is available, and it’s about to get even better than it is now — but fewer than half of all teens have gotten it.

I am talking about a vaccine against the human papilloma virus (HPV). It is responsible for cervical cancer, which strikes 12,000 women each year in the United States and kills 4,000. Only 15% of women diagnosed with advanced cervical cancer survive for five years or more — a grim statistic. HPV also causes cancer of the vulva, vagina, penis, anus, mouth, and throat.

A key barrier against more widespread use of this vaccine is an issue that stops many conversations about teen health: sex.
A new HPV vaccine

Human papilloma virus isn’t a single virus. It’s a family of 150 or so related viruses. The first HPV vaccine, approved for girls in 2006 and for boys in 2009, attack four types of HPV that cause the majority of cervical cancers. The new vaccine covers nine HPV types, making it even more effective.

A report in today’s New England Journal of Medicine shows that the new vaccine was effective against 97% of cancerous or precancerous changes in the cervix, vulva, and vagina related to five HPV types not covered by the first vaccine. That means it is expected to be able to prevent most cases of cervical cancer — a very important advance in cancer prevention.
Low coverage

About half (57%) of American girls between the ages of 13 and 17 get the first dose of the HPV vaccine, while only one-third (32%) get all three necessary doses. Coverage for boys is even lower.

The recommended age for getting the vaccine is 11 to 12. One reason is that the body mounts a more powerful antibody response at that age than it does a few years later. Furthermore, children ages 11 and 12 are already scheduled to get vaccines for tetanus, diphtheria, pertussis, and meningitis, so adding the HPV vaccine would be convenient. Finally, HPV is spread mostly by sexual contact. Getting the vaccine by age 12 ensures that children will be protected before they enter their early teens, an age when a growing number of American youths begin sexual activity.

Some parents refuse HPV vaccination because they think it will encourage their children to become sexually active or sexually promiscuous. Several solid studies have refuted this.

As does a new one published last week in JAMA Internal Medicine. It took a novel approach to this issue. Dr. Anupam Jena, assistant professor of health policy at Harvard Medical School, and colleagues looked at rates of sexually transmitted infections among more than 200,000 young women before and after HPV vaccination. There were no differences in these rates, suggesting that being vaccinated does not promote risky sexual behavior.
Improving coverage

HPV isn’t a problem for women only. Boys develop HPV-related cancer, too, as highlighted by actor Michael Douglas’s revelation that his throat cancer was likely caused by HPV transmitted during oral sex. Vaccinating boys as well as girls would also help stem the spread of HPV.

In an editorial in JAMA Internal Medicine that accompanied the report by Dr. Jena’s team, Dr. Robert A. Bednarczyk of Emory University wrote, “just as we do not wait until we have been in the sun for 2 hours to apply sunscreen, we should not wait until after an individual is sexually active to attempt to prevent HPV infection.”

I believe that HPV vaccination makes good sense for both girls and boys. The benefits of cancer prevention clearly outweigh any small risks, and the benefits will be further extended by the broader spectrum of the new vaccine. I urge parents to protect their children with this important preventive measure. If you’ve ever crawled under the covers worrying about a problem or a long to-do list, you know those racing thoughts may rob you of a good night’s sleep. Sleep disturbances, like having a hard time falling asleep or staying asleep, affect millions of Americans.

The daytime sleepiness that follows can leave you feeling lousy and sap your productivity, and it may even harm your health. Now, a small study suggests that mindfulness meditation — a mind-calming practice that focuses on breathing and awareness of the present moment — can help.

A study published a few years ago in JAMA Internal Medicine  included 49 middle-aged and older adults who had trouble sleeping. Half completed a mindfulness awareness program that taught them meditation and other exercises designed to help them focus on “moment-by-moment experiences, thoughts, and emotions.” The other half completed a sleep education class that taught them ways to improve their sleep habits.

Both groups met six times, once a week for two hours. Compared with the people in the sleep education group, those in the mindfulness group had less insomnia, fatigue, and depression at the end of the six sessions.

The findings come as no surprise to Dr. Herbert Benson, director emeritus of the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. “Mindfulness meditation is just one of a smorgasbord of techniques that evoke the relaxation response,” says Dr. Benson.

The relaxation response, a term he coined in the 1970s, is a deep physiological shift in the body that’s the opposite of the stress response. The relaxation response can help ease many stress-related ailments, including depression, pain, and high blood pressure. For many people, sleep disorders are closely tied to stress, says Dr. Benson.

Mindfulness meditation involves focusing on your breathing and then bringing your mind’s attention to the present without drifting into concerns about the past or future. It helps you break the train of your everyday thoughts to evoke the relaxation response, using whatever technique feels right to you.

Dr. Benson recommends practicing mindfulness during the day, ideally for 20 minutes, the same amount suggested in the new study. “The idea is to create a reflex to more easily bring forth a sense of relaxation,” he says. That way, it’s easier to evoke the relaxation response at night when you can’t sleep. In fact, the relaxation response is so, well, relaxing that your daytime practice should be done sitting up or moving (as in yoga or tai chi) so as to avoid nodding off.

Step 1: Choose a calming focus. Good examples are your breath, a sound (“Om”), a short prayer, a positive word (such as “relax” or “peace”), or a phrase (“breathing in calm, breathing out tension”; “I am relaxed”). If you choose a sound, repeat it aloud or silently as you inhale or exhale.

Step 2: Let go and relax. Don’t worry about how you’re doing. When you notice your mind has wandered, simply take a deep breath or say to yourself “thinking, thinking” and gently return your attention to your chosen focus.

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