Thursday, February 07, 2008
Why do we have trouble sleeping sometimes?

By Anthony Policastro, M.D

Sleep problems can occur at any age. There are a variety of sleep problems that we see. Some involve falling asleep. Some of them involve waking in the night and going back to sleep. One of the more common problems has to do with what we call sleep associations. When someone falls asleep, there is a certain routine to it. People tend to go to sleep at the same time of night. If they go to bed earlier, they cannot fall asleep. If they go to bed later, they have trouble staying awake until that time. They tend to do the same activity before they go to sleep. This could be reading. It could be watching television. It could be listening to the radio. It could be having a glass of milk. It could be taking a warm bath. Everyone has a different routine. Then when they lay down there are certain things that they are used to. They might need to be in a certain position in the bed. They might need to think about a certain thing. They might need a night light on. They might need a window open. They might need to be under the covers. They might need to have certain clothing on. Again this is different for everyone. All of these are called sleep associations. When there is an interruption to the normal sleep associations that a people have, they will have trouble falling asleep. With all of the things that are involved, it is not surprising that it is easy to have problems falling asleep at night. This is the main reason that people have trouble sleeping away from home. The bed is different. The room is different. The sounds are different. The aromas in the room are different. They may think it is just due to the bed. However, it is usually due to a combination of things. Some people will get into bed and start thinking of the day's events. They then keep themselves awake by thinking about things that are not related to falling asleep. The old wives' tale about counting sheep is related to this. If you use your thoughts to do something boring like counting sheep, you will not be thinking about the things that are keeping you awake. It could make it easier to fall asleep. Another problem related to sleep associations is waking up in the middle of the night and then having a problem falling back to sleep. One of the main issues here is that your body is used to going to sleep with certain things in place. If those are not in place, you may have trouble falling asleep. For example, if you are used to falling asleep with the radio playing, you may need the radio on to fall asleep again. This could be a problem if your spouse is asleep and would not appreciate you turning the radio on in the middle of the night. This is a common problem with young children who wake up in the middle of the night. They have certain associations when they go to sleep. They may brush their teeth. Then they put on their pajamas. Then they have a story read to them. Then a light is left on until they fall asleep. If they wake up in the middle of the night, they are not going to fall asleep easily without all those sleep associations. Sometimes we train children to learn new associations. They wake up in the middle of the night and we change the bedtime situation. We may hold them. We may talk to them. We may let them get in bed with us. The result is that we have created a whole new set of sleep associations. We have taught them that the only way to fall asleep when they wake up in the middle of the night is to have those things happen. When children wake up in the middle of the night, the back to sleep situation should be as close to the original bedtime situation as possible. That way they do not learn new associations and have new expectations for going back to sleep. Most people tend to think of sleep as something that happens automatically when you go to bed. It is a lot more complicated than that. I suspect that each of us would be surprised at how many sleep associations we have developed over the years.

No new cases of equine virus
The results of additional background testing at the index farm in the Felton/Frederica area have been reported. Five horses on the index farm were screened for EHV-1 on blood and nasal swab samples. All five came back negative on the blood samples, two came back positive on the nasal swabs. Of the nasal swabs, one was typed out to be the neuropathogenic form of EHV-1. However, merely finding the neuropathogenic form of EHV-1 on a nasal swab does not constitute a "case." A case is defined as clinically infected (neurologic disease) with positive EHV-1 PCR test results. Therefore, the original quarantine order will hold until Feb. 7, pending any additional cases. The original 21-day quarantine was a result of the index case showing signs of disease and a positive nasal swab test result. Since the original index case, there have been no new cases, hence the original 21 day quarantine will stand. If another horse becomes a clinical case during this quarantine, then the quarantine will be extended. However, there is no reason at this time to extend the state imposed quarantine. The owner of the index farm has decided to extend a self-imposed quarantine in order to be extra cautious. Delaware Department of Agriculture Animal Health Inspectors will continue to visit all of the farms under quarantine to check temperature logs. Horse owners should be advised that the neuropathogenic form of EHV-1 is in Delaware and a spike in a horse's temperature is often the first sign of a problem

Beebe holds Heart Fair
Beebe Medical Center will host the 4th annual Community Heart Fair on Thursday, Feb.21, from 10 a.m. to 2 p.m. at the Rehoboth Beach Convention Center. The event drew more than 1,000 people last year and features exhibitors, free screenings, health education, food and entertainment. Due to the high demand for the free cholesterol screenings, each attendee wishing to have a screening will receive a designated screening appointment time so that he or she is free to enjoy the event without having to wait in line. Other free screenings include blood pressure checks, glucose screenings, body mass index calculations and stroke risk assessments. "We have grown our offerings to better serve our community. And we are happy to say that we have been joined by representatives from other health organizations who wanted to take part," says Peggy Diehl, R.N., MSN, CEN, Beebe Medical Center community health nurse coordinator and event organizer.

ACS plans benefit for March 16
The Lighthouse Restaurant, located at Fisherman's Wharf, 7 Anglers Road, Lewes, is donating the restaurant's pavilion area as the site for an American Cancer Society (ACS) benefit on Sunday, March 16 from 10 a.m. to 4 p.m. "Spruce Up for Spring and Summer: Caring for the Mind, Body and Soul," is the theme of the ACS Relay for Life 2008 fundraising event as vendors from across Sussex and Kent counties bring their products, information and expertise in hopes of raising contributions and awareness for cancer patients and caregivers. Paul and Mary Buchness, owners and operators of the Lighthouse Restaurant, are longtime supporters of ACS Relay for Life. The ACS Relay for Life 2008 benefit is open to the public. Along with ACS information booths, vendors offer an array of specialty products from skin care to chocolates, handbags to spring and summer houseware gifts and much more. For more information about the American Cancer Society Relay for Life 2008 benefit, contact the Ribbon Cap Club team at 302- 422-7878 or e-mail

Bill to increase access to CHIP
Lt. Gov. John Carney, Senate Majority Whip Patricia Blevins and Rep. Terry Schooley have announced the introduction of legislation to eliminate premium payments for enrollment in the Delaware Healthy Children (CHIP) program. The program provides comprehensive health insurance, including well-care visits, hospitalization, prescription coverage and dental care to children whose families' income is between 100 percent and 200 percent of poverty. Approximately 45 percent of Delaware's eligible children are enrolled in the program. "Participation in the Delaware Healthy Children Program is declining, and there are 5,000 children in Delaware who are eligible for this program, and yet are not enrolled," said Blevins, Elsmere, the bill's lead sponsor. Currently, the state is returning $3 million per year to the federal government because of low participation in the program, which is paid for jointly by state and federal funds. Deborah Gottschalk, a leader in the child advocacy group Action for Children, said that constant movement in and out of the system hurts children's health. "We find children aren't getting the kind of check-ups and preventative care they need when they aren't in the program," she said. "That can lead to illness and drives up the cost of health care."

Cholesterol screenings planned
Nanticoke Memorial Hospital will be offering cholesterol screenings on February 14, 16 and 21, from 7:30 to 10 a.m. at the Seaford Golf & Country Club, located at 1001 W. Locust St., Seaford. The lipid profile test requires a 12-hour fasting and reads the HDL and LDL blood levels. Cost for the lipid profile is $15. No pre-registration is required. In addition to the cholesterol screening free blood pressure checks will be offered as well as information on Nanticoke's Cardiac Rehabilitation services and Cancer Care services. Results from the cholesterol screening will be mailed approximately two weeks after the test is performed. For more information, call 629-6611 ext. 2404.

CPR classes offered at Del Tech
Cardiopulmonary resuscitation (CPR) basic classes for the general public and refresher courses designed for health care professionals are available at Delaware Techinical & Community College, Owens Campus. Parents, teachers, coaches and babysitters are just a few of the people who can benefit from these classes. Healthcare providers whose jobs require CPR certification can take the refresher course to meet continuing licensure requirements. Two separate sessions of CPR Heartsaver courses are offered: one teaches adult (one-rescuer) and the other infant and child techniques. Participants may sign up for either or both. Instruction includes video, discussion, demonstration, skills practice and scenarios. After passing the course, participants will receive a two-year course completion card. The Health Care Provider Renewal course is designed for those who need recertification after prior CPR training. Part one is an online assessment from the American Heart Association website; part two requires attending a skills evaluation session at Delaware Tech within 60 days of completing part one. For complete information about these and other prevention and wellness courses, contact Corporate and Community Programs at 854-6966.

Daffodil Days through Feb. 20
For 35 years the American Cancer Society has been sharing hope for a world free of cancer with Daffodil Days, its longstanding program to help raise funds and awareness to fight cancer. This year's Daffodil Days are up and running thru Feb. 20. For a donation of $10, local residents will receive a bouquet of fresh-cut daffodils or a pot of miniature daffodils to support the fight against cancer. In addition to cut and potted daffodils, the American Cancer Society will offer Gea R. Hope, the third in a series of special Boyd's Bears designed exclusively for the American Cancer Society's Daffodil Days Bear in a Pot or Bear and a Bunch that can be ordered for a donation of $15. For more information about Daffodil Days, to place an order, or to get involved with the program contact Mary Catherine Hopkins at 875-7308.

Jewelry sale at Milford Memorial
Reflections Gift Shop at Bayhealth Medical Center - Milford Memorial Hospital will hold a special Jewelry Sale in the main entrance lobby on Wednesday, Feb. 13 from 9 a.m. until 4 p.m. Pretty Pickins Jewelry will be here for a one-day sale just before Valentine's Day with a large selection of costume and fine jewelry. All proceeds benefit Milford Memorial Hospital. For more information, call Reflections at 430-5622.