Healthy Living

Drug-free Sleep Solutions

When doctors talk about sleep hygiene, they don’t mean clean pajamas, fresh sheets, brushing your teeth and flossing but rather healthy bedtime rituals. These include dedicating the bedroom to sleep rather than video games, television and computer work. Reading is fine if it helps your mind to wind down. Avoid big meals, caffeine, alcohol and exercise close to bedtime.

Though many think a nightcap helps their sleep, alcohol is a dirty, two-faced drug. It first sedates the brain (making you feel you can fall asleep right away) and later stimulates (waking you up in the middle of the night).  It can contribute to both depressive and anxious feelings.

We now recognize that many sleep problems are related to circadian rhythm disorders. Our brain’s daily rhythm can be out of sync with our environment.

Normally, bright light stimulates our brains to be more alert during the daytime and the darkness of night is a signal for sleep. Shift workers often have difficulty working nights and getting enough sleep during the day. They need to establish their own winding down rituals soon after the end of their workdays, putting up think curtains in their bedrooms to block the daylight and reducing noise during their day. Exposure to plenty of light for at least 30 minutes after rising can wake up the brain. Consider melatonin to reset your internal clock after discussion with your doctor. It seems to work best if taken three to five hours before bedtime.

Sufficient refreshing sleep is an important aspect of your wellbeing, essential for functioning well in all the important areas of your life, and a marker of good health.

Dr. Davidicus Wong is a physician and writer. His Healthwise column appears regularly in the Burnaby Now, Vancouver Courier and Royal City Record. You can find his posts at

Healthy Living stress management

Insomnia as a symptom: treat the underlying cause

Insomnia and other sleep disorders are common problems that patients present to their doctors.

Sleeping pills are usually not the best solution.

They sedate the brain and by doing so may increase our risk for accidents including falls. This is particularly risky in the elderly who happen to be the group that is prescribed the most sleeping pills. Sedation may persist into the morning, impairing our judgment and alertness at home, at work and on the road.

The regular use of sleeping pills may result in dependence – when your brain requires a pill every night to fall asleep and tolerance – when the same dose no longer works and you have to switch to a stronger medication.

Instead, you and your doctor could think of sleeping difficulties as a symptom – a marker for a more significant problem. Together you can treat the underlying cause.

Early insomnia – or difficulty falling asleep – can be due to anxiety, stress or stimulants. Avoid exciting activities (i.e. vigorous exercise and arguments) just before bedtime along with caffeinated drinks. Reduce unnecessary stress, and adopt strategies to manage anxiety during the day. These might include meditation, self-reflection, debriefing with your friends or professional counseling. Moderate exercise earlier in the day is often helpful.

Middle and late insomnia, such as early morning awakening can sometimes be a symptom of depression. If you are having persistent symptoms, don’t hesitate to talk to your doctor.

Some medical conditions can interrupt your sleep. These include bladder problems (such as enlargement of the prostate), congestive heart failure (when individuals feel more short of breath when lying flat) and asthma (wheezing or bronchospasm that is often worse at night or in the early morning). Nocturnal symptoms suggest that something more is needed to adequately control the underlying condition.

Nonrestorative sleep can be a sign of a respiratory problem, including obstructive sleep apnea. If you have significant daytime sleepiness, talk to your doctor. The diagnosis can be confirmed with noninvasive tests.

Next: non-drug sleeping solutions.

Dr. Davidicus Wong is a physician and writer. His Healthwise column appears regularly in the Burnaby Now, Vancouver Courier and Royal City Record. You can find his posts at


Not every moment has to be magical

I took this photo on the Sunshine Coast the last time I went camping with my family. A little girl was flying a Tinkerbell kite and it looked so magical in the air . . . and hilarious whenever it landed.

It’s a lighthearted reminder that life can be fun and worthwhile even if it’s not always perfect.

It’s okay not to be graceful all of the time.

Balance Healthy Living

Getting Enough Sleep: Three Questions to Ask Yourself

How can you tell if you are getting enough sleep? Ask yourself three questions.

Do you feel well rested when you awaken in the morning? If it’s easy for you to make the transition into your morning’s activities, you’re probably getting enough rest. It’s not just about logging enough hours in bed; the quality of your sleep matters just as much.

Patients with obstructive sleep apnea stop breathing so many times during the night that the oxygen level in their blood (and getting to their brain cells) is abnormally low. They commonly feel less rested in the morning than they did going to bed. They experience daytime sleepiness and can fall asleep easily during the quiet times of the day.

Are you alert throughout the day?

Making stupid mistakes doesn’t mean we’re stupid. We all make them when we are rushed, inattentive or just sleep-deprived. What kind of mistakes do you make each day? How attentive are you in your conversations with others?

When you finally roll into bed, how quickly do you fall asleep? If you’re sound asleep the moment your head hits the pillow, you’ve likely accrued a sleep debt.

Next: The Special Challenges of Shift Work, and Practical Strategies for a Good Night’s Sleep

Balance Healthy Living

Are You Getting Enough Sleep?

We celebrated at my son’s high school graduation dinner last Friday. I was reminded of the novelty of staying up all night when I was seventeen, and at 4 a.m. when I picked him up from his dry aftergrad, how countless sleepless nights have taken away the luster of sleep deprivation. Not quite caught up with my sleep, I spent the early hours of Victoria Day with a patient in labour.

Special events, the stages of our family lives, the demands of school and the nature of our work push aside the priority of a full night’s sleep.

But we can just get accustomed to insufficient sleep (to the detriment of physical, emotional and mental health). We can fall into habits of staying up late at different stages of our lives. Many young people stay up to study; others stay out partying. New parents, especially breastfeeding moms, sacrifice their sleep for their children.

If you need an average of 7.5 hours of sleep each night and only allow yourself 6, you’ll create a sleep debt of 7.5 hours after just 5 days. That’s why teens can sleep well into the afternoon on weekends.

We’re not at 100% without a good night’s sleep. A generation ago, it was customary for doctors in their residencies to work 24 to 48 hours without a break. This was found to be harmful not only to young doctors but the patients they cared for.

When we are sleep-deprived, we are not at our best. We are less alert and more forgetful. We are slower to react and our judgment is impaired. Imperfect as we are, we are more imperfect. We make more mistakes.

Those mistakes can be very serious if you are a doctor or nurse making life and death decisions, an airline pilot, a NASA engineer, the captain of a ship, or the driver of an automobile. Consider the many moments throughout your day where a sleep-deprived error can have serious repercussions.

Next: How can you tell if you’re getting enough sleep. Three questions.

Awareness Balance Healthy Living stress management

Setting the Right Pace

Most of us are working for our weekends.

We can run a treadmill for five or more days of the week and long for our brief weekends and distant holidays. I think weekends and holidays are great for spending extended time with the people you love.

Yet we shouldn’t wait that long to find balance and rest in our lives. To prevent the cumulative effects of unremitting stress, we need to balance each day. We can’t wait for the weekends.

We need our morning recess, lunch and mid-afternoon breaks. It doesn’t have to be a game of tetherball or a full-scale walkout. A change of tasks, a healthy snack, your favourite music or a stretching break may suffice.

Our bodies are machines that need fuel throughout the day. We don’t have big tanks that we can fill with one big meal. To keep our bodies and minds running smoothly, we need daily exercise (at least a good walk) and regular healthy meals.

Attend to the pace of your thoughts – with the goal of being fully present in every waking moment. I encourage medical students to be mindful with each patient encounter so that we may be totally focused on the needs of the patient before us. I teach them to view hand washing as a mindful ritual; in this transition between patients, we ensure that we have been complete and thorough with the patient we have just seen and fully awake for the next.

This makes us more empathic listeners, better diagnosticians and safer health care providers.

How is the pace of your day? How present are you in the moments that make up your life?

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Are You Living at the Right Pace?

The pace by which you live the moments of each day is an oft neglected source of stress. A dizzying pace can push us to act and react mindlessly. We make more mistakes, we may bypass the beauty of the day, and by nightfall, we know not where the time has gone.

How can you tell if the pace of the day is right for you?

If you’re bored, you could use more challenge, and you need to pick up the pace. If you’re mentally and physically exhausted at the end of the day, your pace and workload are overwhelming.

If you lose your focus or feel restless at different points in the day, you may need a break. We can get so accustomed to a fast pace that we may never think about slowing down in order to do things right.

We can run a treadmill for five or more days of the week and long for our brief weekends and distant holidays. I think weekends and holidays are great for spending extended time with the people you love.

Next: Setting the right pace.

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A Source of Stress: The Pace of the Day

There are infinite sources of stress in our days: the competing demands of home, work or school; conflicts with others; illness, injury and addiction; financial stress and debt; suffering from the past, worries about the future; mean bosses, bullies and angry customers.

But we often neglect one source over which we have some control – the pace of the day.

Emergency physicians and family doctors are no strangers to demanding, high intensity workdays. In a typical shift, they may not have time to eat or even go to the washroom. Fortunately for their patients, they do take the time to wash their hands.

The constant pressure to keep up with a never-ending queue can create sufficient mental and physical stress to affect the quality of our work.

Employees in downsized offices, taking on the workload of laid off colleagues can face burnout from the ever-growing mountains on their desktops.

And let’s not forget the mothers and fathers of young children. Their only downtime is when their kids are finally sleeping (hopefully throughout the night).

There is a tempo and rhythm at which we function best. We need just enough challenge to keep growing, moving forward and experiencing the satisfaction of accomplishment. Without such positive stress, we would be stagnant, bored and unproductive.

But too rapid a pace – when the demands of work exceed our capacity to meet them – can lead to physical stress, anxiety, burn out and depression. And if we are acting faster than we can think, we are bound to make mistakes. Quality and productivity suffer. Our sense of wellbeing suffers.

Next: How can you tell if your pace is right for you?

Coping with Loss stress management

What Can Make Us Resilient To Stress?

One of the reasons I love family practice is the uniquely personal story that every patient shares. I have learned a wealth of wisdom from my patients. I am often moved by their courage and strength. They may at first feel overwhelmed with the diagnosis of a serious disease or distraught with the loss of a loved one, but many are able to re-create and reaffirm a firm sense of self and trust in the universe.

Many couples separate after an affair, but I have seen determined partners accept their respective responsibilities, learn from their mistakes and remain together in a strengthened relationship.

Some individuals never find resolution after the loss of their loved ones. Others accept with grace the ways in which their loved ones enriched their lives and learn to live and be happy again.

During my psychiatry rotation in my internship, my preceptor instructed me to read his well-worn copy of George Vaillant’s “Adaptation to Life.” It outlined Dr. Vaillant’s interpretation of the Grant Study or the Harvard Study of Adult Development that was started in 1937 to study healthy Harvard men and has continued for over 70 years.

These men were followed regularly with interviews, questionnaires and physical examinations to study the factors that influence physical and mental health.

Dr. Vaillant focused on adaptations or defense mechanisms – unconscious responses to stressors, including conflict or pain. He classified these defense mechanisms into four categories.

“Psychotic” adaptations include paranoia and hallucinations, and theses were the unhealthiest. Above this, “immature” adaptations include acting out, passive aggression, hypochondriasis, fantasy and projection. One level up, “neurotic” adaptations include intellectualization, dissociation (separating from our feelings) and repression (unconsciously ignoring our feelings). Though it doesn’t mean that we are neurotic, most of us use these adaptations. The “mature” adaptations most associated with long-term health and wellbeing are altruism, humour, anticipation, suppression and sublimation.

Suppression differs from repression because the former is the conscious decision to defer attention on certain feelings until a better time is available to deal with them. Sublimation is the channeling of our emotions (including aggression and anger) through a positive outlet (such as fighting injustice, creativity or sport).

The adaptations or defense mechanisms that we personally use are not easily apparent to us. They operate on an unconscious level. We can gain insights by reflecting on the patterns of our behaviour and our relationships. What mistakes do we keep making?

A friend who knows you well may be helpful; your physician or a professional counselor may be even better.

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How We Respond To Stress Is As Important As The Stress Itself

When it comes to our physical and emotional wellbeing, how we cope with the circumstances of our lives is as important as the circumstances themselves. What we end up with – happiness or unhappiness – depends on what we do with what we get.

In medical school, we learned that the disease caused by an infectious agent – viral or bacterial – depends on both infection and “host” factors. In general, those with compromised immune systems are at greater risk for a more severe infection. Bacteria that may cause a simple boil in one person could cause septic shock in another.

Sometimes our own bodies react in ways that are harmful to us.

This is analogous to the effects of stress and our reactions to it.

When our lives are already out of balance, when we have a host of other worries running in the background and when we’re nearing the tipping point for burnout, one more unexpected stress can blow us away.

That’s why one employee may be able to brush off a negative review at work, another will accept it as useful feedback, and a third may be totally devastated. Our baseline levels of stress – and our ability to cope with it – influence our response to life’s unpredictable challenges.

A strong sense of self and self-worth and flexibility of thought can make you more resilient to adversity. They help us conceptualize our circumstances in more positive and life-affirming ways. Without such resilience, we may succumb to anxiety and depression.

Next: Adaptive and Maladaptive Responses to Stress