June 2007: Health Briefs from Baylor Health Care System

In Search of Sweet Dreams: Getting Treatment for Sleep Disorders

Do your eyelids droop as soon as you crack open the latest best-seller? Are you literally snoring or kicking your partner out of bed?

If so, here’s a wake-up call: you may have a sleep disorder.

Jeffrey Kopita, M.D., pulmonologist and sleep medicine specialist on the medical staff at Baylor Medical Center at Garland, talks about sleep disorder diagnosis and treatment.

Q: What is the difference between simply not getting enough sleep and having a sleep disorder?
A: For many reasons, people often don’t get the recommended eight hours of sleep. A hectic daily schedule, erratic sleep-wake habits and poor sleep hygiene are big culprits. But when someone reports continued difficulty falling asleep or staying asleep—or is getting adequate sleep, but is still excessively fatigued—then sleep is not restorative, and that reflects a sleep disorder.

Q: What’s the first step in finding the cause of a sleep problem?
A: A good medical history and lifestyle evaluation are very important to determine what could be affecting someone’s sleep quality. Not all people with sleep problems require a sleep study. Often, making a few behavioral changes such as removing the TV from the bedroom or eating dinner earlier is sufficient to improve the situation.

Q: What is involved in a sleep study?
A: For a sleep study, or polysomnography, patients check into our Sleep Center for a six- to eight-hour period. A technologist connects the patient to various monitors, which document what is going on during sleep by recording brain activity, heart rate, breathing and blood oxygen levels, eye and leg movements, and more. The brain activity, measured by electroencephalography (EEG), is the core of any sleep study because it indicates the occurrence, type and quality of sleep.

Q: What are the most common sleep disorders you find?
A: Obstructive sleep apnea is most common, followed by various insomnias. Less frequently we see periodic limb movement disorders, such as restless legs syndrome (RLS). Sometimes a patient will have a combination of several disorders.

Q: What are some treatment options?
A: For sleep apnea: A continuous positive airway pressure (CPAP) mask, nasal surgery and/or weight loss. Leg movement disorders usually respond well to medication, or by treating an underlying condition that may be causing them. Also, stress management and cultivating proper sleep habits will help improve sleep quality.

The Joys of Summer: How to Have Fun in the Sun Safely

Ah, summer! Baseball, hot dogs, apple pie—bugs, heat, accidents. Follow these tips to keep your family healthy this summer.

Play it safe. Whether it’s hiking, bicycling, inline skating or soccer, everyone loves to get out and play, but that often means an increase in injuries.

“We see more trauma cases during the warm months, like someone playing basketball who sprains an ankle,” says Nick Zenarosa, M.D., medical director of the emergency department and a physician on the medical staff at Baylor Medical Center at Garland. Wear the proper clothing and gear for your activity.

Beat the heat. Excessive warm-weather activity can lead to heat exhaustion or heat stroke, particularly when humidity is high. “The importance of hydration cannot be overstressed,” says Dr. Zenarosa. Drink plenty of water, and switch to sports drinks if you’ll be working or exercising in the heat for a long stretch. Limit outdoor activities when heat alerts are forecast. If you begin to feel dizzy or nauseated, get out of the heat and drink some Gatorade or water. Try to speed the cooling process by wiping down your skin with moist cloths and sitting in front of a fan.

Young children and the homebound elderly are especially at risk for heat illness. Check on relatives, and never leave kids or pets in the car.

Don’t get burned. Use SPF 15 or higher sunscreen, wear a hat and sunglasses, and limit sun exposure. The same goes for kids. “Children’s skin is more sensitive to the sun,” says Dr. Zenarosa.

Bug off. Use insect repellent containing DEET, particularly at dawn or dusk. Few people develop West Nile virus, but keep an eye out for fever, headache and body aches after a recent outing where you may have been bitten.

Put it on ice. When picnicking, bring ice packs to keep cold food cold. “Don’t leave food out very long. Anything made with eggs or mayonnaise can go bad very quickly,” says Dr. Zenarosa. Toss leftovers unless you’re certain they’ve been kept properly chilled. Make sure grilled meat is cooked thoroughly.

Just say no. Alcohol increases dehydration and mental impairment and is a big factor in many car and watercraft accidents.

Lock and latch. Kids wander away quickly, so be sure your swimming pool is secure. If you’re planning a road trip, buckle up.

Whatever your plans this summer, pack a little common sense and you’ll have everything you need to stay safe.

What Women Need to Know: Getting the Facts About Women and Heart Disease

Many women don’t worry about heart disease, or if they do, they are concerned it’s something the men in their lives might develop. But that attitude is a mistake. While it’s true that estrogen gives women some protection against the disease, at least until menopause, heart disease is still the leading killer of American women. Here’s what women should watch for.

Keep heart disease at bay. First, because the disease is so prevalent, prevention is the key. Two major risk factors—obesity and smoking—are in your control. Padma Uppalapati, M.D., a cardiologist on the medical staff at Baylor Medical Center at Irving, says that women sometimes develop a cluster of conditions, including obesity, diabetes, high blood pressure, polycystic ovarian disease and depression that are linked with a high risk of heart disease. And while smoking is a risk factor for both men and women, it seems to affect women differently, she says.

Watch and test. Dr. Uppalapati recommends that all women at high risk for heart disease be tested, even if they don’t have any symptoms. That’s because symptoms in women can be more subtle than in men. “Women may have shortness of breath, feel tired, and maybe just have neck, jaw or upper back pain,” she explains. “It’s so common to hear women say, ‘I’m just not feeling well,’ with no additional symptoms.”

Search for signs. In women, a stress test with an EKG has a higher rate of false positives than in men, Dr. Uppalapati says. She recommends combining a stress test with an ultrasound, which can check for other heart problems such as mitral valve prolapse. She notes that with a good image from an ultrasound you shouldn’t need a nuclear scan, which sometimes returns a false positive in women due to a breast shadow.

Time to treat. Dr. Uppalapati warns that because women’s symptoms can be mild, they often postpone seeking treatment. Women need to get to the hospital early so the blockage can be cleared. “Time is extremely crucial,” she says. “It’s very important to get in early. Once women have angioplasty or bypass surgery they can do fine.”

Here are five ways women can lower their risk of heart disease:
1. Maintain a healthy weight.
2. Eat a balanced diet that helps keep cholesterol levels under control.
3. Exercise.
4. Don’t smoke.
5. Talk to your doctor about the pros and cons of hormone replacement therapy.

Eight Steps to Prepare for Baby: a Pre-Pregnancy Checklist

Planning for pregnancy can help your baby get the best possible start in life. Here are eight valuable tips from Barbara Coulter-Smith, D.O., an obstetrician/gynecologist on the medical staff at Baylor Regional Medical Center at Grapevine.

1. Add folic acid to your diet. If you’re of childbearing age, it’s important to take folic acid supplements—especially if you have stopped using contraception. Folic acid is a B vitamin that reduces the risk of neural tube defects like spina bifida. Few women get enough folic acid in their diet alone, so talk with your physician about supplementation.

2. Get vaccinated. Make sure that all of your vaccinations are up to date, including immunization against rubella (also called German measles) and chickenpox. It’s also important to be up to date on your tetanus shot (every 10 years).

3. Kick bad habits. No one should smoke while trying to get pregnant or during pregnancy. Smoking can lead to higher risk for miscarriage as well as low-birth-weight babies. Drinking alcohol is OK, but in moderation only. If you think you might be pregnant, it’s better to abstain.

4. Maintain a healthy weight. Being overweight can increase your risk of gestational diabetes and other pregnancy-related complications.

5. Keep exercising. Exercise will help you maintain or lose weight and it helps manage stress. If you think you might already be pregnant, check with your doctor about the kinds of exercise that are safe to continue.

6. Ask about chronic health problems. Discuss with your physician the health risks of pregnancy if you have a chronic medical condition and which prescription medications are safe to continue. It’s also important to talk about a family history of any heredity disorder prior to planning a pregnancy.

7. Wait a month after stopping contraception. Dr. Coulter-Smith recommends waiting for one spontaneous menstrual cycle before trying to conceive. A normal menstrual cycle is the signal that the endometrium, the lining of the uterus, is healthy enough to support new life.

8. What about the dad-to-be? Prior to conception, the important consideration is sperm count. Avoid hot tubs and saunas. Smoking and alcohol also can affect sperm count. Advancing age does not affect fertility in men as much as it does in women.