What Is Good “Brain Food”?

Posted on Posted in Continuing Education, Nutrition, Seminars, Webinars

By Annell St. Charles, Ph.D., R.D.

salmon-518032_640It is clear that eating the right foods may enhance brain function and possibly slow some of the age-related declines in memory and cognition that may occur. It may also be possible to prevent or reduce the progression of diseases of the brain, including Alzheimer’s disease. The following is a list of foods that can be considered “good for the brain,” or more precisely, brain food.  These foods make up the basic structure of both the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, and represent the key phytochemical-containing foods for which researchers have demonstrated cognitive benefits. Note that where “dark-colored” foods are mentioned, the color must persist throughout the entire food, not just on the surface.

  • oily fish (salmon, sardines, mackerel, tuna, etc)
  • walnut oil
  • high omega-3 eggs
  • walnuts and other nuts
  • olive oil
  • blueberries and other berries
  • dark, leafy greens and other dark-colored vegetables
  • avocado
  • wheat germ/whole wheat
  • red, purple, or black grape skins and other dark-colored fruits
  • flaxmeal
  • curcumin (turmeric)
  • canola oil

In simple terms, an optimal diet for brain health relies on whole plant foods that have not been stripped of their fiber, essential nutrients, or critical non-nutrient components through processing. It also consists of healthy fats derived primarily from oils and fish, and a colorful array of fruits and vegetables that are as locally sourced and seasonally fresh as possible. The terms “local” and “seasonal” have been commonly adopted in an effort to draw a distinction between foods that have not spent too much time sitting in containers, transport vehicles, or refrigerators but were recently growing in a nearby field.

Switching to a brain food-rich diet means breaking free of the habit of excessive convenience. Eating foods out of season assures that their nutrient content is lessened due to the effects of heat, cold, or exposure to light. Creating meals out of primarily packaged food items means that they have been subjected to manufacturing processes that reduce their nutrient density. An exception would be frozen plant foods, which are typically subjected to flash-freezing shortly after harvesting, thus increasing the conservation of nutrients. Convenience food products are also, in general, low in phytochemicals and would not be expected to provide the antioxidant or anti-inflammatory benefits inherent in whole foods. Food products, like food supplements, also lack the synergistic potential of whole foods since their available food components have been selectively designed. In addition, most convenience food products make use of inexpensive ingredients designed to appeal to consumer taste. This means that a diet high in convenience foods will likely include high intake of hydrogenated omega-6 fats, sodium, and simple sugars.

In essence, emphasizing a brain food diet means embracing what humans have known for centuries: that eating moderately and simply from a plant-based diet, with the inclusion of ample amounts of fresh herbs and spices to enhance taste, is most likely to deliver the gift of good health.

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The Mystery of Pain: Acute vs Chronic Pain

Posted on Posted in Brain Science, Continuing Education, Pain, Psychology, Seminars, Webinars

By Michael Howard, Ph.D.

Early humans explained the mystery of pain by associating it with evil, magic, or demons. Relief was the responsibility of sorcerers, shamans, priests, and priestesses, who treated their clients with herbs and rituals.

Ancient civilizations recorded on stone tablets accounts of pain and the treatments used, including pressure, heat, water, and sun. The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system were involved in the perception of pain.pain

During the Middle Ages and into the Renaissance, evidence began to accumulate supporting these theories. Leonardo da Vinci and his contemporaries came to see the brain as the central organ responsible for sensation, with the spinal cord transmitting sensations to the brain.

In the 19th century, pain came to dwell under a new domain—science—which paved the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. In the late 1800s, research led to the development of aspirin, to this day the most commonly-used pain reliever. Before long, anesthesia—both general and regional—was refined and applied during surgery.

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are two basic categories of pain, acute and chronic, and they differ greatly.

Acute pain usually results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly—for example, after trauma or surgery—and may be accompanied by anxiety or emotional distress. The cause of acute pain can generally be diagnosed and treated, and the pain is self-limiting—confined to a given period of time and severity. In some instances, it can become chronic.

Chronic pain is widely believed to represent a disease in and of itself. It persists over a longer period of time than acute pain and is resistant to most medical treatments. Chronic pain often persists longer than three months, or longer than expected for normal healing. It can be made much worse by environmental and psychological factors. It can—and often does—cause severe problems for patients, as pain signals keep firing in the nervous system for weeks, months, or years. There may have been an initial mishap such as a sprained back or serious infection, or there may be an ongoing cause of pain such as arthritis, cancer, or infection. However, some people suffer chronic pain in the absence of any past injury or evidence of illness.

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What is Fibromyalgia?

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

alone-62253_640By Nikita Katz, M.D., Ph.D.

The word “fibromyalgia” is derived from the Latin roots “fibro” (connective tissue), “my” (muscles), “al” (pain), and “gia” (condition of).  As a syndrome, fibromyalgia is composed of a specific, often complex, set of signs and symptoms that complicate diagnosis and treatment. Before official recognition as a disorder by the American Medical Association (AMA) in 1987, fibromyalgia was considered a “wastebasket” diagnosis, but lately there has been a “paradigm shift,” and fibromyalgia is being recognized as a true illness and a major cause of disability.

Fibromyalgia is a disorder characterized by chronic widespread musculoskeletal pain with associated fatigue, insomnia, and multiple somatic complaints such as stiffness, headache, and chest pain, with no evidence of disease.  It occurs mostly in women but does occur in men.  Most of the pain involves several tender points in the body, which are targeted areas where people with fibromyalgia feel an exaggerated sense of physical pain upon the slightest application of pressure. Fibromyalgia is neither degenerative nor progressive, and there is no inflammation.  In fact, it used to be called fibrositis, but the name was changed to fibromyalgia when evidence showed no inflammation in the disease process.  It is non-articular, meaning it does not involve the joints, and there is no swelling in the joints or tissues.  Descriptions of conditions consistent with what we now call fibromyalgia have been found in the medical literature as far back as the early 17th century.

Although there is no cure for fibromyalgia, several treatments can alleviate the multiple symptoms of this complex disorder, thus making it easier for patients to live a near-normal life.  Treatments include pharmacological interventions, dietary counseling, alternative medicine, relaxation techniques, and moderate exercise.  Many authors recommend combined management of fibromyalgia rather than just one treatment alone.

Fibromyalgia is not a life-threatening, deforming, or progressive disease.  Although lack of proper treatment may lead to the illusion of disease progression, this illusion is not supported by scientific evidence.  Compensation of sleep deprivation and physical reconditioning should, at least in some patients, lead to reversal of the disease or improvement of function and reduction of pain.

Numerous modalities available can reduce pain and other debilitating symptoms; these include electrotherapy, cryotherapy, and therapeutic heat. The clinician should teach patients how and when to use therapeutic modalities as part of their maintenance program. A multidimensional clinical approach including behavioral therapy, exercise, and pharmacological intervention is essential.

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What Exactly is High-Fructose Corn Syrup?

Posted on Posted in Continuing Education, Homestudy, Nutrition

sugar-485045_640High-fructose corn syrup (HFCS) was first developed in the mid-1960s.  It starts out as cornstarch, which is chemically or enzymatically degraded to glucose and some short polymers of glucose.   Another enzyme is then used to convert varying fractions of glucose into fructose.  Because of its unique physical and functional properties (e.g., stability in acidic foods and beverages, such as soft drinks), it was widely embraced by food formulators.  Its growth has increased dramatically over the past 30 years, principally as an attractive replacement for table sugar.  Today, HFCS serves as a visible marker for foods that are highly processed and refined.

Fructose comes from three main sources:

  • natural sources such as fruits, some sweet vegetables, and honey;
  • sucrose, or common table sugar (which is 50 percent fructose); and
  • high-fructose corn syrup or HFCS (which is up to 55 percent fructose).

While some argue that the addition of fructose to foods and beverages is “natural” because fructose is found naturally in fruit and other foods, the clear difference is that the quantity of fructose that we get from fruit pales in comparison to the amount we get from processed foods.   Another difference is that fructose in fruit serves as a “signal” for sweetness, energy, and nutrition.  This sweet taste encouraged our ancestors to seek out fruit for both pleasure and good health. In contrast, when we consume processed and refined foods sweetened with HFCS, we get the sweetness and calories, but little else.  We are essentially being short-changed on nutrients.

Although HFCS is chemically similar to sucrose (though HFCS has a slightly higher percentage of fructose), concerns have been raised that our bodies react differently to HFCS from the way our bodies react to other types of sweeteners.

All of these nutritive sweeteners are composed of approximately 50 percent glucose and 50 percent fructose (though the amount of fructose may be slightly higher in HFCS).  All are absorbed similarly, have similar sweetness, and have the same number of calories per gram

Clearly, more research is needed to  understand fully the metabolic effect of dietary fructose in humans.  And more research is needed to determine whether there are any unique attributes of fructose or HFCS that make these substances a problem.  Until we know more, it may be best simply to focus on reducing ALL added sugars from our diet because too much of any caloric sweetener can pose a problem (whether the sugars are derived from corn, sugar cane, beets, or fruit-juice concentrate). Excessive consumption of any sugar can promote weight gain and a range of metabolic abnormalities.  Excessive consumption can also bring about adverse health conditions  as well as inadequate intake of essential nutrients.

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Review of INR Seminar, “Understanding Depression and Bipolar Disorder”

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

understanding-depressionRecently, I attended a continuing-education online seminar (Webinar) and was asked to write a blog post about my experience. The seminar’s title was “Understanding Depression and Bipolar Disorder.” The seminar’s sponsor was INR (Institute for Natural Resources). The presenter was Dr. David Longo (Ph.D.). The Webinar was six hours long. There were two breaks and time for lunch.

If you are a health-care professions (registered nurse, licensed practical nurse, pharmacist, registered dietitian, psychologist, social worker occupational therapist, physical therapist, case manager, nursing home administrator, counselor, or care-giver), this course is for you.

My first impression of the Webinar is that it was very well organized. My Webinar code worked correctly the first time. It appeared that no one else taking the Webinar had any technical issues. The Webinar platform was very simple and easy to understand. Dr. Longo, the presenter, had a pleasant voice and spoke at the right pace — not too fast and not too slowly. Dr. Longo kept my interest. He relied on case studies and his extensive knowledge.
The first hour examined the Three Brains of humans: The Brain Stem (Archaic Brain); Limbic System (Old Brain); and the Cerebral Cortex (New Brain). Dr. Longo discussed, in-depth, how changes in brain chemistry and structure occur in depression and bipolar disorder. Then, he covered how stress becomes a pathway for the development of major depressive disorders.

Dr. Longo discussed the new DSM-V (Diagnostic Statistics Manual, Version Five) criteria for the diagnosis of major depressive disorders and bipolar disorder.

I work in the marine industry, and I learned a fascinating fact: marine engineers have, by occupation, the highest suicide rates. Next in line are physicians and dentists.

Dr. Longo mentioned that there are many significant changes in the new Diagnostics and Statistical Manual of Mental Disorders. I was pleased to have an instructor who showed a working knowledge of such mental disorders.

The afternoon session focused on drugs used in the treatment of bipolar disorder, cyclothymia, and other disorders. Dr. Longo had experience with these medications and covered them thoroughly. He also focused on various forms of psychotherapy used to treat depression.

Overall, the Webinar provided superb information. Dr, Longo and INR did a superb job. I look forward to being part of future INR programs.

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What Is Gluten?

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars

wheat-allergiesBy Annell St. Charles, Ph.D., R.D.

Gluten is the general name given to the proteins found in certain grain products, including wheat and its derivatives (wheat berries, durum, emmer, semolina, spelt, farina, faro, graham, einkorn wheat), rye, barley, triticale (a hybrid of wheat and rye), malt, brewer’s yeast, and wheat starch.  Apparently, the hybridization that led to the production of modern bread wheat enabled the creation of a product with high amounts of the gluten complex, making modern bread wheat the “worst” gluten offender.

Gluten plays a significant role in nourishing plant embryos during germination. In addition, as the name implies, GLU-ten acts as a type of glue that holds food together, affects the elasticity of dough made from these grains, and gives shape and a chewy texture to products (such as bread), which are made from the dough. Gluten is also used as an additive in foods that have low-protein levels or no protein at all. When it is used in vegetarian recipes (lacking any animal products), it helps to increase the firmness of the texture of the finished product in order to replicate the texture found in meats and other animal foods.

Since gluten is found in the grains wheat, rye, barley, and triticale (as stated above, a hybrid of wheat and rye), and foods made from these grains, people who are sensitive to gluten should avoid any foods that contain these substances. Avoiding wheat is considered especially difficult because of the number of wheat-based flours and ingredients commonly used.

Common Foods that Typically Contain Gluten

  • Pastas (ravioli, gnocchi, couscous, dumplings)
  • Noodles (ramen, udon, soba, chow mein, egg noodles)
  • Breads and pastries (croissants, pita, naan, bagels, flatbreads, cornbread, potato bread, muffins , donuts, rolls)
  • Crackers (pretzels, goldfish, graham crackers)
  • Baked goods (cakes, cookies, pie crusts, brownies)
  • Cereal and granola (corn flakes and rice puffs often contain malt extract/flavoring; granola is often made with regular oats, which do not contain gluten, however oats may be cross-contaminated during growing, harvesting, or processing
  • Breakfast foods (pancakes, waffles, French toast, crepes, biscuits)
  • Breading and coating mixes (panko, breadcrumbs)
  • Croutons (stuffings, dressings)
  • Sauces and gravies (many use wheat flour as a thickener; soy sauce, cream sauces made with a roux)
  • Flour tortillas
  • Beer (unless listed gluten-free; malt beverages)
  • Brewer’s yeast

By all accounts, gluten sensitivity is increasing in the U.S. The rise in gluten-related sensitivity disorders can be traced back to changes in the way that wheat is processed and wheat-based products are manufactured.  The changes led to alternation in the type and availability of grain products in the marketplace. In essence, the amount of gluten in grain-based products increased as manufacturers attempted to create products with more consumer appeal.  In addition, the number of complaints that seemed to stem from an increased consumption of these products kept pace with their availability. Somewhere along the line, our genes also changed in response to these modifications in our diet. Our bodies reacted in alarm to the presence of gluten, targeting it as a foreign invader.

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Migraines In Women

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars

woman-565132_640Migraine headaches are usually characterized by throbbing, severe pain (usually on one side of the head), an upset stomach, and — sometimes — disturbed vision.

Migraines were recognized as early as the 7th century BC—when the usual treatment involved trephining, or creating a hole in the skull to relieve the headache pressure, and release the “evil spirits or demons” thought to be causing the pain.

Women are three times more likely than men to suffer from migraine headache. Hormonal changes and the patient’s stage of life may play a role in women’s higher susceptibility to migraine. Even in ancient history, women with migraines probably greatly outnumbered men with the disorder.

Throughout history, a number of myths about migraine in women have flourished. Migraines in women were often attributed solely to PMS (pre-menstrual syndrome) or hormonal changes, such as those that occur during menopause. Another myth was that headaches in general — and headaches in women, in particular — were due to psychological problems, rather than being a biological condition. Consider some facts about migraines and women:

  • In the United States, almost nine million women suffer from migraines each year, and over three million have more than one migraine attack per month.
  • Sixteen out of every 100 women suffer from migraine headaches.
  • The highest prevalence for migraine in women occurs between the ages of 35 and 45, a time when many women are at the height of their professional careers and have the most family responsibilities and social obligations.
  • Half of all women with migraines report having 24 or more migraine attacks each year, and over 25 percent report having such headaches every week.
  • In women who have migraines, 60 percent experience headaches during menses as well as at other times of the month. Just 14 percent of women have migraine pain only during their menstrual period.

Headache is one of the most common conditions seen by clinicians today. Migraine headaches can be especially troublesome for patients and can cause symptoms that include significant pain as well as neurologic symptoms. Fortunately, there are now many effective treatments for migraine and other headaches, including medications and lifestyle changes.

In women with migraines, hormonal changes can play a significant role in the severity of symptoms. Thus, successful treatment of female migraineurs requires knowledge of neuro-endocrine changes from menarche to menopause. With such knowledge, clinicians can help female patients find relief from this challenging condition.

A thorough medical history and careful physical examination are essential to rule out less common but serious causes of headache. The best treatment always starts with the right diagnosis.

INR offers continuing education courses such as Women’s Health: Migraines and Headaches.  Click below for this and more from our library.

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Probiotics: The Good Bacteria

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

girl-791563_640By Barbara Sternberg, Ph.D. and Clare Fleishman, M.S., R.D.

Probiotics are live, nonpathogenic microorganisms that are typically bacteria or yeasts. The term “probiotics,” also called “good bacteria,” has its root in the Greek pro, meaning “promoting” and biotic, meaning “life.” The term includes some types of beneficial microbes that can be found in probiotic supplements as well as certain microbes added to food. The term also refers to the trillions of friendly microbes that typically live in our digestive tracts and other organs.  Probiotics are naturally found in fermented foods such as yogurt, aged cheese, and kimchi. Thus far, the FDA (Food and Drug Administration) has not approved any health claims for probiotics.

People usually associate bacteria with infection and illness. However, most bacteria are not pathogenic for humans, and many play a very important role in supporting good health. Trillions of bacteria live on or in the human body, collectively known as microbiota, microbiome, or microflora.

Probiotics are found on the skin, in the respiratory system, and in the urinary tract, but most of them are in the gastrointestinal tract—some 100 trillion of them. These so-called gut bacteria greatly outnumber our body cells. Gut microflora get their nutrients from our bodies and create a healthy environment that protects us from illness and helps in disease control and the digestion of food.  Probiotics and humans have a symbiotic relationship.

Considerable research has been done and continues to be done on the relationship between these bacteria and various aspects of overall human physical and mental health, including obesity, celiac disease, inflammatory bowel disease, fatty liver disease, atherosclerosis, autoimmune disorders, and depression.

The gastrointestinal tract is an amazing metabolic machine. The surface area of the human gut is huge—about the size of a tennis court. Along this surface are nearly 1,000 different species of bacteria doing their important work — work that supports normal digestion. The numbers and balance of these bacteria vary. The numbers and balance are affected by diet, aging, geographical location, and environmental factors such as infections and the use of antibiotics.

How do gut bacteria facilitate health? They produce several B vitamins, vitamin K, and certain key fatty acids. The byproducts of bacterial interactions supply up to 10 percent of the body’s daily energy needs. In addition, gut bacteria play an important role in normal immune-system development. Their efficacy generally depends on a balance between the numbers and species of bacteria present. Disruptions of this balance can lead to significant problems with illness and disease.

Probiotics are vital for the immune system. They send signals to the immune system that reduce destructive overreactions, including inflammation. Insufficiency of probiotics affects immune responses and, hence, affect every aspect of our health.

Probiotics is a continuing education course available from the INR bookstore.  Check it out… and more.

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Obsessive-Compulsive Disorder (OCD)

Posted on Posted in Continuing Education, Homestudy, Psychology

sink-400276_640Obsessions are thoughts, images, or ideas that are disturbing or disruptive. Obsessions occur repeatedly, and are sources of great anxiety. Obsessions can range from religious concepts to thoughts of losing control. They can involve unreasonable distress about becoming contaminated. Some obsessions involve such pedestrian concerns as whether a door has been locked. Other obsessions include bizarre and frightening fantasies.

Fear of being contaminated by dirt is the most common obsession. Other common obsessions are:

  • Fear of harming oneself or someone else.
  • Fear of disease.
  • Preoccupation with losing or discarding something of minimal value.

People who have OCD (Obsessive-Compulsive Disorder) feel compelled to repeat ritualistic behaviors and follow rigid routines that they have devised. These compulsions are designed to alleviate the anxiety that these obsessions induce. Nine out of 10 people who have OCD have both obsessions and compulsions. Many recognize the irrationality of their thoughts and actions but cannot overcome them. Some spend hours adhering to behaviors that they hope will repel unwanted thoughts and images. Others live in dread of inadvertently doing the wrong thing or saying something other than what they mean.

Cleaning oneself or household items, often for hours at a time, is the most common compulsion. Checking — from several to hundreds of times a day — for symptoms of illness or to make sure a task has been performed, for example, is another. Other common compulsions are:

  • Counting objects.
  • Using verbal repetition.
  • Hoarding items like rubber bands.
  • Rearranging items to maintain precise alignment.
  • Making lists.
  • Using an extremely painstaking approach to performing routine tasks.
  • Blinking.
  • Apologizing over and over.
  • Performing tasks again and again.

Several hours a day may be devoted to concentrating on obsessions and performing rituals that make sense to no one but the person with OCD. Concentrating on routine activities becomes difficult. Perfectionists often develop perfection paralysis, which prevents them from completing or turning in work that they fear might not be flawless.

Equally common in men and women, OCD afflicts about one percent of the U.S. population 18 years of age and older. OCD is more prevalent than schizophrenia, bipolar disorder, or panic disorder. About one- [hyphen] third of adults with OCD experienced their first symptoms as children. Unlike adults, children with OCD do not recognize the irrationality of their obsessions or compulsions.

OCD often coexists with depression and other anxiety disorders. This chronic long-term illness is generally characterized by periods when symptoms are severe and is followed by times when symptoms are more moderate. Treatment results in considerable improvement for most patients, but entirely symptom-free periods are rare.

Disorders that may be part of OCD or are strongly associated with it include:

  • Body dysmorphic disorder (BDD), in which patients are obsessed with the idea that they are ugly or a part of their bodies is deformed.
  • Trichotillomania, which causes people to pull out enough of their hair to leave bald patches.
  • Tourette’s syndrome, the symptoms of which include jerking motions, tics, and involuntary vocalization.

Diagnosis of OCD is usually based on the patient’s description of his or her own behavior. Physical examination can rule out physical sources of symptoms, and psychiatric evaluation may be used to eliminate psychiatric causes. The Yale-Brown Obsessive Compulsive Scale and other questionnaires can be useful in diagnosing OCD and monitoring treatment efficacy.

INR offers several courses on various aspects of psychology. This article was taken from Understanding Anxiety by Barbara Sternberg, Ph.D

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Chronic Insomnia

Posted on Posted in Brain Science, Continuing Education, Webinars

sleeping-child-812181_640By Nikita Katz, M.D., Ph.D.

Chronic insomnia is associated with an increased risk of depression, anxiety, excess disability, reduced quality of life, and increased use of health care resources.

Insufficient sleep can result in industrial and motor vehicle accidents, somatic complaints, cognitive dysfunction, depression, and decrements in daytime work performance owing to fatigue or sleepiness. It is also associated with hypertension, heart disease, and greater risk of mortality.

Statistical evidence highlights the scope and gravity of the problem of sleep loss among Americans.

  • More than one-third of all Americans suffer from sleep disorders at some point in their lives.
  • Up to two-thirds of adults report difficulty sleeping at some point each year. Approximately 20 percent of adults consider the problem to be serious.
  • Twenty percent of adults (approximately 40 million) report having a chronic sleep disorder.
  • The prevalence of insomnia is about 1.4 times higher among women than among men.
  • Mature age predisposes one to sleep disorders. The rate increases from 5 percent in persons aged 30 to 50 to approximately 30 percent in those more than 50 years old. In the National Institute on Aging’s Established Populations for Epidemiologic Studies of the Elderly, 42 percent of senior citizens who participated in the survey had difficulty falling and staying asleep.
  • Twenty-three percent of adults report having difficulties concentrating because they do not get enough sleep: For this reason, 18 percent say they have trouble remembering things; 38 percent report unintentionally falling asleep during the day at least once in the preceding month; and 5 percent, while driving, report nodding off or falling asleep at least once in the prior month.
  • Up to one in four adults reports using a “sleep aid” at least a few nights a week.
  • According to the 2011 Sleep In America Poll, conducted by the National Sleep Foundation, the growing use of cell phones and electronic devices (for phone calls, texting, or emailing) — shortly before going to bed and being awakened after going to sleep by one of these forms of communication — is causing individuals to get less sleep at night, negatively affecting millions of Americans’ functioning the next day.

Although insomnia is very common, evidence suggests that only a small proportion of people who suffer from sleep disturbance report it to their physicians. Moreover, physicians may not detect or adequately assess or treat insomnia. Factors that contribute to under-diagnosis and under-treatment of insomnia include reluctance on the part of patients to discuss it; physicians’ limited training in this condition; time constraints in medical practice; misperceptions about the impact poor sleep can have on patients’ daytime functioning, health, and safety (such as putting insomnia sufferers at risk for serious accidents); and misconceptions about the benefits and risks associated with the use of hypnotic medications.

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