QASEM A. AL-SALEH QUALIFICATIONS M.B.B.Ch, Cairo University, with honors M.Sc. in Dermatology and Venereology, Cairo University M.D. in Dermatology, Cairo University PROFESSIONAL EXPERIENCE As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital Consultant Dermatologist 1996 – Present 1991 – Present Head of Dermatology Unit 1991
Ayot place practiceAYOT PLACE PRACTICE
MARY BARTON B.Sc. MNIMH Dip.Phyt
Up to one in three people has some type of sleep problem; most often this is insomnia, although it can include an excessive desire to sleep called somnolence. The information here relates to insomnia as this is by far the most common sleep difficulty. Insomnia includes a difficulty in getting to sleep, waking during the night and being unable to get back to sleep or early waking. Insomnia often gets worse as we get older and is more common in women. There are many things that can be done to help.
Causes of insomnia:
1. Sleep problems sometimes appear to run in families- how much of this is learned is not 3. Snoring or restless partner 4. Anxiety and depression 5. Short term worry 6. Alcohol (causes early waking & poor quality sleep) 7. Coffee, tea, cigarettes in the evening 8. Sensory stimulation before bed- TV, video games, loud music 9. Noisy environment 10. Obesity 11. Physical illness, such as sleep apnea, overactive thyroid 15. Prostate problems 16. Use of diuretics and other prescribed drugs
Dealing with insomnia.
It may be necessary to learn completely new ways of approaching sleep. Worrying about sleep is one of the best ways of preventing sleep. A new attitude is often very helpful. Develop a regular pattern in the evening and do not go to bed except at bedtime- i.e. do not spend the evening lying on the bed and do not go to bed during the day. Stop watching TV and using the computer at least an hour before bedtime and read a book, such as a light novel, or listen to relaxing music instead. Have a warm (not hot) bath before bed with a few drops of relaxing essential oil such as Ayot Place, Ayot St Peter, Welwyn, Herts AL6 9BH
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Lavender or Chamomile. Put a couple of drops of Lavender oil on your pillow. It is important to set a good sleep rhythm so try to go to bed and set your alarm at the same time each day.
Food & Drink
Do not eat your evening meal after around seven p.m. if possible, and have a light snack, ideally oat based, with a cup of chamomile or lemon balm tea before you retire, especially if you think hunger might be a factor. Oats help to maintain the nervous system, and balance the blood sugar level and are reputed to be rich in melatonin, a hormone which regulates sleep. Other foods which might help sleep are banana, milk, avocado, rice, sweet corn, peanuts, ginger, dates, tuna and barley and could all be included in the diet, not necessarily before bed. See how your sleep improves if you do not drink alcohol for a few nights and avoid drinks containing caffeine after 6pm. Try not to smoke just before bed and definitely not if you wake during the night.
Take regular exercise, but nothing too vigorous immediately before bed- one exception to this is
Make sure that your bedroom environment is helpful to good sleep. If you are too hot or
too cold this will interfere with sleep. You could try changing from duvet to blankets to control the temperature in bed and remember that the temperature in the bedroom should be lower than that in the rest of the house. Get heavy curtains or blinds, or put up a blanket in front to the window to keep out light, especially in summer. However, do let some fresh air into the room, via a slightly open window or vent- but don’t do this if it makes you feel unsafe. If noise is a problem, from outside or
Relaxation techniques A number of these can be helpful as they stop the mind wandering on to
anxious or unhappy thoughts which can interfere with sleep. 1. Concentrate on your breath. Breathe in for three seconds, hold for three seconds, breathe out for three seconds then pause for three seconds. As you breathe out feel all the tension flowing from your body into the bed and away into the ground below you. Practice this regularly in bed. 2. Breathe in one nostril and out of the other, then breathe in though the other nostril and out through the opposite one. You might need to close your nostril with your finger to start with. 3. Start at 1000 and gradually count backwards. 4. Concentrate on a white space in your head behind your eyes; if you feel thoughts and images pushing in, just gently return to the white space. If you find the white space difficult to visualise, then think of a simple image e.g. a pink circle or a blue square and rebuild it as it 5. Concentrate on each part of your body in turn, starting with the feet, tensing them and then relaxing them then moving up to your calves etc, finishing with your face and scalp. Many people find this very helpful. 6. Visualise yourself going to bed, sleeping well and waking refreshed. As you go to sleep make an affirmation if this helps along the lines of “I am now entering a deep and restful sleep and will Ayot Place, Ayot St Peter, Welwyn, Herts AL6 9BH
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wake refreshed”. Repeat this slowly and silently. Repeat this affirmation if you wake during the night. 7. Imagine massaging your own head- concentrate on the imaginary sensations.
8. If you have a faith, then silently pray, say psalms, or mantras.
If all else fails
Herbs. There are a number of herbs that have been scientifically proven to help sleep- the most useful
are valerian, hops, skullcap, wild lettuce, passionflower. Strong chamomile tea before bed is a good way to relax. A herbalist may prescribe some stronger herbs such as Jamaica Dogwood or Pasque
Over the counter remedies. There are a number of over the counter remedies such as Nytol
available based on anti-histamines (i.e. diphenhydramine hydrochloride). These can help in the short term, but it is important not to become dependent upon them and to find more natural ways of sleeping- all drugs have an impact on the wider body and anti-histamines will affect the body’s immune system. Other remedies such as Nytol Herbal or Kalms are based on herbs and are a good option.
Prescribed drugs. Many drugs in the benzodiazepine family are used to help sleep especially where
the cause is anxiety. The problem is that benzodiazepines are very addictive and should not be taken for more that a few weeks at a time, and even then, they are best taken every second night. Where dependency arises, it can become almost impossible to sleep without these drugs. It is far better to deal with the cause of anxiety, through counselling, grieving, dealing with work or relationship problems rather than simply covering up the symptoms, such as sleeplessness, with drugs that will not help in the long term. Many of these drugs will help you to fall to sleep quickly, but you may well find that the quality of sleep is not as good and you can wake up feeling lethargic.
Menopause. If you are going through the menopause, hot flushes might keep you awake, so ask for
help in dealing with these. HRT helps some women but many women opt for more natural approaches
Desperate measures! If you cannot sleep, get up and occupy yourself while having a warm relaxing
herb tea. Try something repetitive like knitting, jigsaw, tapestry, model making, but nothing too stimulating – and definitely not work! Ayot Place, Ayot St Peter, Welwyn, Herts AL6 9BH
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Endophytes in turf-type perennial ryegrass Endophytes are naturally-occurring fungi that live inside various plant hosts, ranging from trees to grasses. In many cases the relationship has existed between the fungus and the plant for millions of years, and is mutually beneficial (i.e. symbiotic). The fungus derives its nutrition from the grass, and in return the fungus produces a range of a