HOW MUCH SLEEP?

How much sleep is enough? This question is not easy to answer, and is very subjective. Some mink they need at least seven hours, some say ten. In fact this varies from person to person and also with age. It has been shown that babies sleep nearly all day. As they get older, they need less and less sleep. It is well known that the older we are, the less sleep we need. One of the common complaints of the elderly is that they cannot sleep. They hate to be awake and alone at night. They take sleeping pills, as they feel distressed when they cannot sleep.

Sleep is something we have no control over. We cannot close our eyes and give the magic word sleep, as sleep may not follow. In studies of how people fall asleep, it is observed that we are not folly awake one second and asleep the next. We all go through a very brief hypnotic state, which is called the Transitional Hypnotic State or THS.

How much sleep is required to restore, to repair, to recuperate, so that the next day we feel refreshed and satisfied? We will explore this question in two parts:

* Sleep deprivation and how much sleep is enough

* Psychological influence of how much sleep is enough

GENERAL ANSWERS TO QUESTIONS ABOUT BREAST DISEASES

After a recent needle biopsy of a cyst in my breast, I have extensive bruising and tenderness in the area. Is this a sign of something wrong?

Bruising is caused by blood leaking from tiny blood vessels under the surface of the skin and is likely to occur to some degree following a biopsy whatever the precautions taken to prevent it. There is unlikely to be any cause for concern, and the bruising should gradually disappear over the next few days or weeks. If it does persist, is painful or spreads, ask your doctor’s advice.

I have been referred to a general surgeon at my local hospital to investigate a lump in my breast. My GP said there is no specialist breast surgeon in our immediate area, but, having thought about it again, I would rather see such a specialist even if it means travelling to do so. However, I am nervous about asking my GP to change the arrangement. What should I do?

You are entitled to see a specialist breast surgeon and, in fact, it is a good idea to do so. A consultant who specializes in breast diseases will inevitably have more experience in this field than a general surgeon who does not have a specific interest in breast diseases. If there is no breast specialist in your area, you can ask to see one elsewhere, although you may have to insist. You may prefer to write to your GP requesting a referral to a breast specialist if you are anxious about talking to him or her again. Alternatively, you could contact your local hospital and ask if there is a breast care nurse you could talk to; she may be able to advise you and to support your request for another referral.

Following the recent discovery of a small lump in my breast, an appointment has been made for me to see a specialist. I am 48 years old. What are the chances that the lump is cancer?

Although most types of breast cancer are more common in women around the time of their menopause, approximately only 1 in 10 of those who are referred to a specialist with breast problems are found to have cancer. There are, of course, different types of breast cancer with different prognoses, and treatment of a small lump detected at an early stage of development may have a better outcome than that of one which is detected later.

I frequently have pain in my breasts which does not seem to be related to my periods. I cannot feel a lump. What should I do, and what might be the cause of this pain?

Non-cyclical breast pain can have several causes, most of which are benign. It is not common for breast cancer to be associated with pain in the breast, although it can be. You should make an appointment to see your doctor, having first made sure that you are wearing a well-fitting bra. If you have not been measured for a bra for some time, and particularly if you have lost or gained a significant amount of weight recently, it may be that the bras you wear are too big or too small and are not supporting your breasts properly.

Breast pain that is not related to the menstrual periods can be referred pain from a back or shoulder problem, and your doctor will probably want to investigate this possibility. Sometimes, the cause of breast pain is never discovered, but it does often resolve itself in time.

I am 48, and have recently been able to feel hardness around the edges of both my breasts. What is this likely to be?

The breast tissue changes in women around the time of their menopause, and what you are feeling is likely to be a benign condition called dysplasia or fibrocystic disease. However, it is worth checking with your doctor to rule out any other possible cause.

I am about to have a mastectomy. WM I need to wear special bras after my operation, and will I be able to wear swimsuits and sundresses?

There is no reason why you should need special bras; the bras you usually wear will probably be able to be adapted to hold and conceal a prosthesis. This is also likely to be true for most of your clothes. If there is a breast care nurse at your local hospital, she will be able to arrange this for you. Do discuss it with her or with your consultant. Swimsuits, bras and sundresses can usually have a pocket sewn into them to hold the prosthesis, and this will allow you to take part in all sports and your usual activities without worrying about your prosthesis becoming dislodged. Mastectomy swimsuits are available, but they are expensive, and should be unnecessary if your own can be adapted.

Although the underwiring of strapless bras can damage a prosthesis, it is probably all right to wear one for short periods of time if you want to wear a strapless dress. Low-cut dresses may not conceal your prosthesis, but apart from this, you should have no restriction on the clothes you will be able to wear.

PREVENTING ASTHMA: SOME NECESSARY PRECAUTIONS – EXERCISE

Many children get attacks after some form of exercise. This tends to lead to a lifestyle without regular physical activity. However, such children should be encouraged to participate in regular sports starting off at a comfortable level and progressively working towards more difficult sports which require higher levels of strength and endurance.

There is no reason why such children should avoid sports or physical activity so long as they understand their limitations and take proper medication. Several Olympic athletes have had asthma and yet gone on to win world class competitions.
An excellent physical exercise for children with asthma is swimming. As emphasised earlier, children should learn to recognise their own physical limitations through experience. There may be episodes of wheezing or tightness during such activity but these should be taken as a part of the learning experience. Parents and teachers should help these children manage these episodes. This will help these children become more confident about their activities.

Exercise: Some Important Tips

• Physical exercise is a must.
• Consult the physician about:
a. What exercise is best and convenient for the child.
b. Whether a defibrillator pre-medication is required.
• The child should be motivated to take regular exercise.
• The child should know his or her limitations.
• If one kind of exercise induces asthma the child should be encouraged to try another one under the guidance of a physical instructor.
• The child should warm up with a light exercise.
• After exercise the child should cool down with a light exercise.

CREATE A SUPPORTIVE HOME ENVIRONMENT

During Times of Stress, You May Need to Modify Your Expectations

BDD symptoms can increase at times of stress. Virtually any type of change can be stressful—positive events as well as negative ones. Don’t be discouraged if the BDD sufferer has a temporary setback during stressful times. At these times, you may need to lower your expectations a little bit. Keep implementing the suggestions in this chapter (e.g., encouraging progress, praising small gains) while also keeping in mind that progress may be slower, or may even stop, during stressful times. At times like these, your encouragement, support, and understanding may be especially helpful.
Create a Supportive Home Environment

Because BDD can be so hard to cope with, it’s easy to criticize and express anger toward someone who has it. It’s best to avoid this. Instead, do your best to create a supportive home environment. Help them talk about their feelings of anxiety, depression, shame, and isolation. Show your support, and help them fight BDD. Without being judgmental, critical, or hostile, explain that if you participate in their rituals or help them avoid things like social situations, this will only strengthen the BDD. Let them know that you care and that you’ll try to understand and support them through the recovery process.

HETEROSEXUAL OFFENDERS VS. CHILDREN: MASTURBATION

The importance of masturbation to these offenders when the easy availability of coitus afforded by marriage was absent suggests difficulty in heterosexual adjustment, a difficulty also reflected in other aspects of their lives. The extremely large masturbatory proportions of total outlet shown by those whose marriages broke up in their teens or early twenties leads one to think that the marital failure aggravated preexisting difficulties in working out sexual adjustments with women.

As is usual, the masturbation was ordinarily accompanied by sexual fantasies. The fantasies of the heterosexual offenders vs. children seem to have been, with two exceptions, similar in general content to those of other sex offenders. The two exceptions to this are fantasies of sexual contact with animals and fantasies of a bizarre or highly specialized nature. Some 8 per cent of the offenders vs. children fantasied, on occasion, contact with animals; this is a small percentage in absolute terms, but it is the second largest exhibited by any group, and more than double that of the control group. Perhaps those who will disregard age taboo are more inclined than other offenders to disregard species taboo, at least in fantasy. However, not an unduly large percentage of the offenders vs. children had had actual sexual contact with animals. About one fifth had bizarre fantasies, the third highest figure within that classification and far in excess of the prison (2 per cent) and control groups (1 per cent).

The offenders vs. children closely match the control-group individuals in the amount they worry about the possible bad effects of masturbation. During 40 per cent of the years in which masturbation occurred there was concomitant worry ranging from mild concern to real anxiety. In terms of rank-order this percentage is neither high nor low.

Turning to the question of how they first learned of self-masturbation, the offenders vs. children reveal no distinctive trends. As in all other groups, the majority obtained this knowledge through a mixture of talking, reading, and observation.

IBS AND FOOD INTOLERANCE – MARGARET’S STORY

The condition responds well to treatment, but because of the lack of information it can be difficult to find someone who understands the problem. Some clinical nutritionists believe many chronic conditions, such as certain chest and kidney troubles and arthritis, are caused by food intolerance. The dramatic improvement in some degenerative and nervous illnesses in people who have been treated for food intolerance – even if they have only used self-help methods – would seem to confirm this.


 Here is Margaret’s story:It all started when I was pregnant. I had lost a lot of weight and my bowel movement was never normal; I either had diarrhoea or constipation. After my son was born I had a rash on my legs which formed blisters.The doctor said it was post-natal depression and gave me tranquillizers. This went on for years, I was convinced it was something to do with food but I was given more and more tranquillizers, then anti-depressants.

 When I developed migraine -although it seemed like the last straw – it put me on the right road. I found a book in the health shop on headaches. It was the first time I had heard of food intolerance or elimination diets. I cut out all dairy produce, chocolate, tea and coffee and did improve a little but it was not until I had an asthma attack after drinking a glass of orange squash (containing E102, Tartrazine) that the doctor began to think about allergies.

 He referred me to a private doctor who just said I had severe allergies and sent me to a dietician. This was not very helpful and it was not until I found a doctor with an interest in clinical nutrition that I started to make progress. Tests revealed I had trouble with wheat, yeast and several other foods. The treatment suggested was an elimination /anti-Candida diet, vitamins and minerals.I really feel I am getting somewhere; for the first time in years my head is clear, I am not depressed, and my silly bowel is starting to behave.

ANOREXIA NERVOSA: BEHAVIORAL TREATMENT

Having a contract reduces the “arbitrariness” of treatment and makes it easier to accept. The rules are codified, written down, and stored away someplace-somewhat like the Constitution. The patient might argue about how to interpret those rules, or how they should be enforced, but she can’t dispute that they exist.

Of course, it’s important to work with patients to help them overcome their fears and anxieties. I tell them, “Look, I know this whole situation is pretty scary. But we want to help you. Of course we want you to gain weight, but that’s really your responsibility. We’re not going to be spies and monitor every mouthful you eat. But if you find you’re having trouble, we’ll have someone sit with you and help you get through the fear. Yes, we need to give you enough calories so that you begin to gain weight, but we don’t want to go too fast. We’re not here to just fatten you up and send you on your way. We want to help you gain weight in a healthy and calm manner, so that we can begin to find out what’s really troubling you deep down inside.”

The food journal provides clues about strategies that might work. Anorexics might not be ready to fill out such sheets, especially at first. They dwell on food constantly anyway; writing it all down might just make them more anxious (that can be true for bulimics, too). If they feel that way, I don’t push it. Sometimes keeping a journal focusing just on feelings and events (not food) can be useful.

A journal can provide a vivid record of the patient’s thoughts and feelings about her situation. By examining these thoughts, we can often reveal distortions in the way the patient perceives and interprets events in her life. Cognitive therapy, which I will discuss in just a moment, is a good method for correcting such distortions.

In the final phase, we concentrate on helping the patient maintain her weight within the target range. We reinforce normal eating habits and look ahead to her continued recovery as an outpatient.

Before sending her home, we work out a plan to monitor her weight. We agree on who should do the weighing-a doctor, a nurse, her parents. She understands that if her weight drops below a certain limit, she will have to come back to the hospital.

A word about outpatients: It is possible to set up a contract with anorexics treated outside the hospital, even though they are not being monitored twenty-four hours a day. Usually such contracts set lower goals for weight gain-say, between one and two pounds a week. In family therapy sessions we work out the system of rewards and penalties. The parents may agree, for example, that if the patient fails to meet her target, they will suspend her allowance or ground her.