Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Viewer Question: When I'm under stress, I can't seem to get any sleep. How can I learn to sleep even during times of emotional stress?
Doctor's Response: If you experience short-term, stress-related insomnia, there are some measures you can take to help improve the quality of your sleep.
Make your bedroom an inviting place to be. Clear the clutter and invest in some quality sheets or comforter in a soothing color. Create a welcoming environment with flowers, photos, pictures, candles-whatever makes you feel content and relaxed.
Avoid use of the bed for watching TV, eating, or working, so that you are conditioned to associate the bed with sleep. If you do wish to use the bed for a bit of nighttime reading, read only pleasure books in bed.
Establishing a regular sleep-wake cycle is also important. Your body will learn to set its internal clock to your schedule and will eventually respond to internal cues to become sleepy at a given time and to awaken at a given time. A good way to begin this is by getting up at the same time every morning-yes, even on weekends. Even if you're tired, try not to nap....
Insomnia is defined as difficulty initiating or maintaining
sleep, or both,
despite adequate opportunity and time to sleep, leading to impaired daytime
functioning. Insomnia may be due to poor quality or quantity of sleep.
Insomnia is very common and occurs in 30% to 50% of the general population.
Approximately 10% of the population may suffer from chronic (long-standing)
insomnia.
Insomnia affects people of all ages including children, although it is more
common in adults and its frequency increases with age. In general, women are
affected more frequently than men.
Insomnia may be divided into three classes based on the
duration of symptoms.
Insomnia lasting one week or less may be termed transient
insomnia;
short-term insomnia lasts more than one week but resolves in less
than three weeks; and
long-term or chronic insomnia lasts more than three weeks.
Insomnia can also be classified based on the underlying reasons for insomnia
such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on.
It is important to make a distinction between insomnia
and other similar terminology; short duration sleep and sleep deprivation.
Short
duration sleep may be normal in some individuals who may require less time for
sleep without feeling daytime impairment, the central symptom in the definition
of insomnia.
In insomnia, adequate time and opportunity for sleep is available,
whereas in sleep deprivation, lack of sleep is due to lack of opportunity or
time to sleep because of voluntary or intentional avoidance of sleep.
What causes insomnia?
Insomnia may have many causes and, as described earlier, it can be classified
based upon the underlying cause.
Situational and stress factors leading to insomnia may
include:
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Pinworm infection is an intestinal infection caused by a pinworm, seatworm, or threadworm. Female pinworms leave the intestine through the anus and deposit eggs on the skin around the anus while a person is asleep. Pinworm infection is the most common worm infection in the US. Symptoms include anal itching or vaginal itching. Pinworm infection is generally spread by inadequate handwashing from infected persons. Treatment is effective after a diagnosis is made with a pinworm test.
Myofascial pain syndrome is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
Rabies is a potentially fatal viral infection. Rabies symptoms include fever, headache, myalgia, and can progress to more serious symptoms such as seizures, coma and death. The rabies vaccine (rabies treatment) should be administered immediately after the person or pet has been bitten.
Chronic fatigue syndrome is a debilitating and complex disorder characterized by profound fatigue that lasts 6 months or longer, is not improved by bed rest, and may be worsened by physical or mental activity.
Mercury is a naturally occurring element found in water, soil, and the air. Mercury is also contained in some fish, some of the products we use in the home, school, or dentist. Information about sources of mercury exposure, potential health effects, symptoms of exposure, fish that may contain mercury, consumer products that contain mercury, and ways to reduce your exposure to mercury is important for the health of you, and your family.
Grief is the feeling one experiences after a loss (of a friendship, death of loved one, job). Complicated grief refers to grief that lasts for more than a year. Mourning describes the customs and rituals that help a bereaved individual make sense of their loss.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Snoring, like all other sounds, is caused by vibrations that cause particles in the air to form sound waves. While we are asleep, turbulent air flow can cause the tissues of the nose and throat to vibrate and give rise to snoring. Any person can snore. Snoring is believed to occur in anywhere from 30% of women to over 45% of men. People who snore can have any body type. In general, as people get older and as they gain weight, snoring will worsen. Snoring can be caused by a number of things, including the sleep position, alcohol, medication, anatomical structure of the mouth and throat, stage of sleep, and mouth breathing.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Jet lag (desynchonosis) is a temporary disorder that results from travel across time zones. Symptoms include anxiety, constipation, headache, nausea, dehydration, diarrhea, confusion, sweating, irritability, and even memory loss.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
How does depression in the elderly differ from
depression in younger
adults?
Depression in later life frequently coexists with other medical illnesses
and disabilities. In addition, advancing age is often accompanied by loss of
social support systems due to the death of a spouse or siblings, retirement, or
relocation of residence. Because of changes in an elderly person's
circumstances and the fact that elderly people are expected to slow down,
doctors and family may miss the signs of depression. As a result, effective
treatment gets delayed. Many seniors find themselves trying to cope with
symptoms that could have been easily treated.
Depression tends to last longer in elderly adults. It doubles their risk of
cardiac diseases and increases their risk of death from illness. At the same
time, depression reduces an elderly person's ability to rehabilitate.
Studies of nursing home patients with physical illnesses have shown that the
pres...