San Antonio Express-News (Sunday)
Don’t lose sleep over getting enough sleep
Q: I read that seniors are strongly advised to get seven to eight hours of sleep a night. While I am in bed for that time, nature calls once or twice a night, and I have some difficulty getting back to sleep. So if I am resting while trying to get back to sleep — say, 20 percent of an eight-hour night — does that meet the sleep advisory?
A: No, resting at night is not the same thing as sleeping. People who sleep seven to eight hours per night have a lower risk of developing disease and even death than people who sleep less. Interestingly, people who sleep much longer, over nine hours per night, are also at a higher risk of disease and death than people who sleep the optimal amount.
It isn’t clear that it’s the long amount of sleep causing the increased risk. It’s possible they have depression or other conditions that cause pain and disability that cause both the increased sleep and the increased risk.
Similarly, seven to eight hours per night isn’t right for everybody. There are some people who feel perfectly well-rested on less sleep and just can’t sleep any more. What’s right for a population might not be right for everybody in the population. Further, agonizing over how much time you sleep might actually worsen your sleep.
What is clear is that if you are forcing yourself to get up after little sleep and then feel tired all day, that’s not good for your overall health. Going to bed earlier or changing your schedule to be able to sleep later is a good idea. I heard a great quote from Asker Jeukendrup: “Never stay up late for something you wouldn’t get up early for.”
Q: What are the best things to eat and do when having Type 2 diabetes? I want to reverse the disease.
A:
Once you have a diagnosis of diabetes, it stays with you, even if your disease is controlled, with or without medication. This reflects the propensity for a person to get high blood sugars again unless they maintain the good behaviors that brought the blood sugars down.
For diabetes, being careful comes down to three things for most people: eating well, exercising regularly and losing weight.
Eating well means emphasizing what’s good: vegetables, legumes and nuts. Other good protein sources are fatty fish and lean poultry (no skin). Whole grains and whole fruits in moderate amounts are also good choices. Limit refined starches, like white rice, pasta and white bread. Avoid concentrated sweets, even if it’s made with some of the other good things
(carrot cake, sadly, isn’t a good option).
Exercising regularly means very different things to different people. If you haven’t exercised much, start with a moderate 10-minute walk a day, and build up to 20 to 30 minutes of moderate exercise.
Losing weight is really hard with diabetes. Most people with Type 2 diabetes are overweight, and for those who are, many struggle with weight loss in part due to the high insulin levels that go along with insulin resistance, which is the hallmark of Type 2 diabetes. Many diabetes medications promote weight gain as well. However, there are several new classes of medicines, as well as one old one, that help promote weight loss, and your diabetes provider can discuss these with you.
Q: I have suffered from asthma and nasal polyps for more than 20 years. The asthma is controlled, and I mention it only because it might have some connection with my polyps. The polyps get so bad that both sides of my nose are blocked, and I have to breathe through my mouth. It is miserable.
I have had three surgeries to remove polyps over the past 20 or so years, which involves a trip to the hospital and anesthesia. They always grow back. My current ENT now removes them in an office procedure. While not fun, it gets the job done, and it is preferable to not being able to breathe through my nose. Unfortunately, they grow back within a year.
My ENT has mentioned the drug Dupixent as a possible solution. I have researched it and see that it has to be injected every two weeks. I am
not sure I want to go that route, but I would like more information before I make a decision.
Can you give me your thoughts on this drug and whether you would recommend it for someone with my condition?
A:
Asthma and nasal polyps frequently occur at the same time, sometimes called “united airway disease.” When combined with aspirin sensitivity, it has the eponym “Samter’s triad,” or “aspirin-exacerbated respiratory disease.” In any given person, either the asthma or the nasal symptoms may be more problematic.
Standard treatment for nasal polyps includes tobacco cessation,
if appropriate. If specific allergens can be identified, they can be avoided as much as possible. However, medications like nasal saline and steroids, along with other medications, sometimes including antibiotics, are usually required for symptom relief. If medicines don’t work, surgery is often tried. But surgery by itself isn’t a cure; the medications need to continue.
People with polyps that grow back have a new option in medications that block a pro-inflammatory protein called interleukin-4. “Interleukin” means “between white (cells),” as this molecule is a means by which inflammatory cells communicate with each other. Dupilumab (the ending “-mab” always
means a monoclonal antibody, which must be injected; this one is generic for and the brandname Dupixent) is among the most effective of these and has been proven to improve allergic asthma as well as reduce nasal congestion and obstruction in people with nasal polyps.
The major side effects were pain at the injection site and conjunctivitis (caused by inflammation, not infection). Conjunctivitis was sometimes so bad that people needed to stop therapy. This was especially true in people with allergic skin disease.
As a generalist, I treat chronic sinus disease routinely, but your symptoms clearly need an expert. Your expert is recommending a drug that is both pretty safe and moderately effective, and I would recommend a trial of the medication to most people in your situation.
Q: Your recent articles on the benefits of coffee recommended skipping the cream and sugar. Is your point to skip the cream and sugar because there is no added benefit, or does the cream and sugar negate some of the benefits of the coffee?
A:
Cream is high in saturated fat, which is probably not good for you, and excess sugar is likewise not a healthy option. If you like a little in your coffee, enjoy it. Just don’t be like the guy I saw recently who asked for 14 sugars for his coffee.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.