Questions

• Why is sleep so important, and how do I know if I’m getting enough sleep?
• What is an endocrinologist?
• My doctor just diagnosed me with osteoporosis and referred me to physical therapy. Exactly what is osteoporosis, and how can therapy help?

Why is sleep so important, and how do I know if I’m getting enough sleep?

Clyde Southwell, M.D.
Pulmonology
Pinehurst Medical Clinic
(910) 295-935 98

Sleep is just as necessary to us as air, food and water. When we sleep well, we wake refreshed and ready to face the day. When we don’t, our lives suffer. Our health and safety, our relationships and our productivity depend on our getting enough sleep.

According to the 2002 National Sleep Foundation “Sleep in America” poll, 74 percent of American adults experience a sleeping problem at least a few nights a week. More than one in three (37 percent) are so sleepy during the day that it interferes with daily activities. That said, it’s hard to say exactly how much sleep is enough sleep since quality of sleep is not defined as just how long one sleeps but also how well one sleeps (in terms of continuous and uninterrupted slumber).

As a person sleeps, he or she passes through different states and stages of sleep. This “sleep architecture” follows a pattern of REM (rapideye movement) and NREM (non-rapid eye movement) sleep, each alternating every 90 minutes throughout a typical eight-hour period.

• Stage 1: Light sleep; between being awake and entering sleep.
• Stage 2: Onset of sleep; becoming disengaged with the environment. Breathing and heart rate are regular, and the body temperature goes down.
• Stages 3 and 4: Deepest and most restorative sleep. The blood pressure drops, breathing becomes slower, energy is regained, and hormones are released for growth and development.
• Stage REM: Characterized by changes that include irregular breathing, shallow respiration and relocation of the muscles in the upper airway that may cause snoring in some people and dreaming. The exact purpose of this stage is unclear, but some think that it plays a role in memory consolidation and procedural learning. It also seems to stimulate the brain at a time when the person is most vulnerable.

Time spent in these states and stages of sleep varies by age. The very young need lots of sleep, so infants sometimes sleep as much as 18.5 hours in a 24-hour day. By the time a person reaches adulthood, the average is about seven to nine hours.

The circadian biological clock in the brain, which is influenced by light, regulates the timing of sleep and wakefulness during the day-night cycle. Because of that, we tend to get sleepy when it is dark and we are active when it is light.

The circadian clock also regulates the day-night cycles of most body functions, ensuring that the appropriate levels occur at night when a person is sleeping.

Because sleep is so necessary, it is important that you establish regular times for going to bed and for waking up. Here are a few tips:

• Avoid caffeine (coffee, tea, soft drinks, chocolate) and tobacco products close to bedtime.
• Avoid alcohol, which can lead to disrupted sleep.
• Exercise regularly, but complete your workout at least three hours before bedtime.
• Establish a regular relaxing bedtime routine (take a bath or relax in a hot tub).
• Create an environment that encourages sleep, preferably in a room that is dark, quiet, cool and comfortable.

Clyde Southwell, M.D., is medical director of the FirstHealth Sleep Disorders Centers. For more information on the services they provide, call (800) 213-3284 toll-free.

What is an endocrinologist?

An endocrinologist is a doctor who is specially trained to diagnose diseases that affect the glands or the endocrine system.

Glands are organs that make hormones, the substances that help control activities in our bodies. Hormones control metabolism (food burning and waste elimination), reproduction, and growth and development. They also control the way we respond to our surroundings, and help provide the proper amount of energy and nutrition that the body needs to function. Endocrine glands include the thyroid, parathyroid, pancreas, ovaries, testes, adrenal, pituitary and hypothalamus.

Endocrinologists know how to treat conditions that are often complex and involve many systems within your body. They are trained to diagnose and treat hormone problems by helping to restore the normal balance of hormones in your system. The most common diseases and disorders they treat are diabetes, thyroid diseases, metabolic disorders of the bone (such as osteoporosis), over- and under-production of hormones, cholesterol disorders, infertility and cancers of the endocrine glands.

While some endocrinologists focus on one or two areas, such as diabetes or thyroid disorders, others work in all areas. Endocrinologists finish four years of medical school and then spend three or four years in an internship and residency program. They spend two or three more years learning how to diagnose and treat hormone conditions.

If you have a problem that involves your endocrine system, your primary care doctor will refer you to an endocrinologist.

Osteoporosis means porous bones and refers to a disease that can affect anyone—young or old, male or female. Bones grow weaker and more fragile, becoming easier to break. This process occurs gradually and painlessly, and a person may not even be aware that it is happening until it is too late. Altogether, the symptoms of osteoporosis may affect the person’s independence as well as his or her ability to perform daily activities and participate in recreational activities.

Consider the following suggestions to help slow this process and decrease your risk of suffering one of the common consequences of osteoporosis (fractures of the hip, spine and wrist):

• Maintain a proper diet with sufficient calcium and vitamin D
• Engage in weight-bearing exercises and strength training
• Work on improving your balance and posture to avoid falls and osteoporosis-related injuries
• Use good body mechanics during lifting and bending tasks

Physical therapy can help a person regain strength and range of motion to facilitate a return to normal activities at the most independent level. Your FirstHealth physical therapist will perform a comprehensive evaluation to help identify the risk factors present and determine the most appropriate treatment.