Poor sleep can affect your ability to focus, concentrate, and remember things. It also puts you at risk of depression, high blood pressure, and stroke. The daytime drowsiness that often results from poor sleep increases your risk of automobile accidents and falls. Clearly it’s important to get enough sleep, but should you catch up by napping? You may have seen some alarming headlines about recent studies pointing to a possible association between napping and cardiovascular disease risk in older adults. We’re looking at the data in this month’s issue, but it’s important to keep in mind that previous studies have suggested that napping may lower cardiovascular risk. As we note in our article, it’s likely that naps are harmless and that the links seen in these studies are related to poor sleep at night. I’m generally in favor of naps—as long as they are fairly short and scheduled early in the day, they can help you sleep better at night because they help prevent you becoming so tired that it’s hard to relax into sleep at night.

As far as better overnight sleep, there are strategies that may help you sleep better. These include avoiding caffeinated beverages, such as coffee, in the run-up to bedtime. Limit alcohol intake too—although it may help you fall asleep, it can cause you to awaken during the night. Don’t take strenuous exercise too close to bedtime, since it may energize you instead of tire you out. Ensure that your room is cool (around 65°F is ideal) and dark, and if you “think too much” when the lights are out, keep a notepad nearby so you can jot down any concerns that are keeping you awake. Getting them out of your system may help your mind relax, but if you’re still wide awake a half-hour after lights-off, get up and read until you feel tired.

Another strategy relates to our second sleep-themed article this month. If you have OSA and your doctor has recommended you use a continuous positive airway pressure (CPAP) machine at night, it really does pay to follow your doctor’s advice. Our article has useful tips for choosing a machine and mask. I have OSA myself, and my CPAP machine has made a huge difference in how well I sleep at night. From needing to nap for several hours at the weekend due to intense fatigue, I went to waking up in the morning feeling completely refreshed. It can take a while to get used to CPAP therapy, but stick with it—it may be your first step on the road back to restful nights.

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OSA can cause daytime drowsiness (see our page 4 article on napping) and increases the risk of high blood pressure, heart attack, and stroke. Research also has pointed to links between OSA and diabetes, weight gain, cancer, memory impairment, and depression. Clearly, controlling OSA is important, and a CPAP machine can help you do that. Considered the gold standard for relieving moderate to severe OSA, CPAP works by delivering a steady flow of pressurized air that prevents the tissues of the throat from collapsing. This keeps your airway open and ensures that you get sufficient oxygen while you sleep.

Selecting the Right Machine

A CPAP machine is considered to be medical equipment and requires a prescription. Ideally, your prescribing doctor should guide you when it comes to selecting the machine and mask that best suits you, although David M. Rapoport, MD, professor of medicine/pulmonary, critical care and sleep medicine at Mount Sinai, says a respiratory therapist from the practice or a “CPAP coach” may assist you. “The focus is on getting the right mask fitted, adjusting the tightness of the straps, balancing the humidity of the airflow from the machine, and answering any questions you may have about how to use and maintain the machine,” Dr. Rapoport says.

CPAP machines have undergone numerous design changes since they were first introduced as a therapy for OSA in the 1980s. “For example, all current machines have built-in humidifiers,” Dr. Rapoport says. “About onethird or more of my patients need this.” A humidifier is useful because it can help you avoid waking with a dry, sore throat after using the machine overnight. Dr. Rapoport notes that some machines also have auto-adjusting pressure (APAP), meaning that they monitor your individual breathing pattern and vary the pressure of the flow of air from the machine to match it. Dr. Rapoport is one of the initial inventors of this mode, but says it should be used only if prescribed by your doctor. “It can be used either in the initial period of CPAP use, to determine the fixed pressure that best suits you, or used as ongoing adapting therapy,” he explains. “The problem with the latter is that while it does work in more than 80 percent of cases, it has never been shown to be ‘better’ overall. There also is a risk it may not work properly, especially if there is some other disruption to sleep.”

Choosing a CPAP Mask

As with CPAP machines, you need a prescription to obtain a mask. There are three types: full face, nasal-only, and nasal pillows. Full-face masks tend to be bulkier and have more straps to deal with, but because they cover the nose and mouth, they may be the most practical option if you breathe through your mouth while asleep. Nasal-only masks are smaller and, as their name suggests, cover the nose only. Nasal pillows sit just under the nose and have the smallest profile of all three mask styles.

Some people report that your favored sleep position is an important factor to consider when narrowing down your choice—for example, a full-face mask may be too large for side-sleepers. Overall, Dr. Rapoport says that comfort is the main issue. “The major companies make very good fits available, but there is no single ‘best mask’ any more than one type of shoe fits everyone best,” he observes. “In general, nasal-only masks work better than the full-face ones, but many clinicians start with either.”

CPAP Success

Dr. Rapoport says that some of his patients immediately adapt to CPAP and wake up from their first night of use feeling energized and refreshed. “Most people with OSA are somewhat or very tired when they first try CPAP, and this can help them in the first few nights of use,” he notes. “Others are more neutral, but recognize the benefits after a few nights. A sizable number have difficulty with the treatment, although most establish a set pattern of use within the first two weeks of CPAP therapy.” He adds that if you don’t see the expected improvement in your symptoms after about two weeks of using the machine, a follow-up visit to the prescribing doctor is warranted. “It’s possible changing the settings on the machine may help,” he says.

The benefits of sticking with CPAP treatment are significant. For example, there is evidence that high blood pressure decreases after two weeks of CPAP use. The devices also reduce daytime sleepiness, and are associated with fewer hospital readmissions and emergency department visits, and reduced mortality in people with OSA.

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“What we are seeing is that OSA is a condition that affects the function of the entire body. It exposes the body to higher levels of stress hormones and low levels of oxygen,” says Ana Krieger, MD, medical director of the Center for Sleep Medicine at Weill Cornell Medicine. “If you have OSA, you have a higher risk of several cardiovascular conditions, including heart failure, stroke, abnormal heart rhythms such as atrial fibrillation, and hypertension.”

OSA also increases your chances of developing type 2 diabetes and having complications following general anesthesia. And OSA is linked with poorer performance on tests of cognitive function, including attention, memory, processing speeds, and reaction times.

OSA Symptoms

If you have OSA, while you’re asleep, your throat muscles relax and partially or totally block air from traveling into your chest and lungs. Every time your airway is blocked, your breathing is interrupted, and your brain and body are deprived of oxygen.

“The most common sign of OSA is snoring,” explains Dr. Krieger. “However, everyone who snores does not have OSA.”

Many people with OSA stop breathing for a few seconds, and they may make a gasping or choking sound when they resume breathing. Sleep may be disrupted hundreds of times in one night, but people who have OSA usually aren’t aware of these disruptions. OSA symptoms are often detected by a bed partner or another member of the household. Other symptoms include daytime sleepiness and waking with a dry mouth.

According to Dr. Krieger, older age, obesity, and underlying hypertension are key risk factors for OSA. For women, the chances of developing OSA increase after menopause.

Diagnosing OSA

If you think you may have OSA, discuss your symptoms (or symptoms that someone else has observed) with your doctor; he or she can determine if a referral to a sleep medicine specialist (a boardcertified expert in the management of all types of sleep disorders) is appropriate. Testing for OSA traditionally consists of undergoing a sleep study, during which you are connected to equipment that monitors your breathing patterns, heart and brain activity, blood oxygen level, and other physiological functions while you sleep. You may be able to have a sleep test at your home.

CPAP: Gold Standard for Treatment

If you have moderate-to-severe OSA, your doctor is likely to prescribe a continuous positive airway pressure (CPAP) machine. The machine pushes air through a mask you wear over your nose (or nose and mouth) while you sleep. The air pressure of your CPAP machine is calibrated depending on the results of your sleep study.

It can take some time to get used to a CPAP machine, and many patients don’t use one once they have it. However, giving up on treatment means that you’re not getting good-quality, restful sleep, and your risks of many chronic diseases remain higher.

“Always discuss any problems you have with your doctor. There are a variety of masks available, and the pressure settings on the CPAP can be adjusted,” says Dr. Krieger. “Sometimes, an adaptation session with CPAP is helpful—this could be performed at a sleep center.”

If you’ve previously tried to use a CPAP but you couldn’t get comfortable with it, there might be more suitable options for you now.

“The newer masks are much smaller, lighter, and easier to use than the older masks. CPAP machines are also better designed and easier to tolerate,” says Dr. Krieger. “However, if CPAP is not the best option for you, discuss alternatives with your doctor.”

Other Treatment Methods

For milder cases of OSA, your doctor may advise using oral appliances that help keep your airway open while you sleep. Sometimes, weight reduction or avoiding sleeping on your back may be sufficient to overcome snoring and OSA.

If other treatment options fail, surgery may be considered. Depending on the cause of your OSA, tissue may be removed from your throat, your jaw may be repositioned, or the implantation of a nerve stimulator on your tongue may be considered.

Dr. Krieger notes that there are many other types of sleep disorders. If you don’t have OSA, your doctor can do further testing to identify what other condition you may have and recommend treatment that will improve the quality of your sleep—and your life.

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Sleep Apnea Symptoms: Not all Are Easy to Identify

Sleep apnea is best known for its hallmark symptom of cessation of breathing during episodes in the night. But there is a long list of sleep apnea symptoms, some of which may surprise you:

• Snoring
• Occasional waking with gasping for air
• Insomnia
• Daytime sleepiness
• Fatigue
• Dry mouth
• Loud breathing or shallow breathing
• Headache
• Irritability
• Mood swings
• Bone loss and osteoporosis
• Depression

Sleep Apnea Screening?

In many cases, people experience symptoms of sleep apnea without knowing that they have it. After all, the most noticeable and obvious symptoms like snoring occur while you are asleep.

But if you’re experiencing any of these symptoms, especially inexplicable mood swings or a depressed mood, getting screened for sleep apnea may help you to identify the root cause of your symptoms.

Can Sleep Apnea Really Cause Depression?

Several studies have shown that people with obstructive sleep apnea are significantly more likely to also have depression than the general population.[1] The results of clinical studies show that the prevalence of depression in sleep apnea patients is between 21% and 39%.[2]

So what can explain such a high overlap between depression and sleep apnea? Researchers can’t know for sure whether this is just a correlation, or whether sleep apnea can cause depression directly. One theory is that the lack of oxygen (hypoxia) that occurs with sleep apnea may cause problems in the body and brain that lead to depression.[1,2] Sleep apnea may also cause inflammation in the body and affect neurotransmitter activity, both of which could contribute to depressive symptoms.[1]

Another possible explanation is that depression develops in response to some of the other sleep apnea symptoms like poor sleep quality. Sleep apnea may cause poor sleep and thus fatigue, sleepiness, and other symptoms making daily life difficult; these could in turn trigger depression.[2]

Several studies support this explanation, showing that sleep apnea accompanied with high levels of daytime sleepiness is even more highly associated with depression than sleep apnea alone.[2,3] In one study, men who had previously undiagnosed sleep apnea and excessive daytime sleepiness were four to five times more likely to have depression than men without either condition.[3]

Treating Sleep Apnea Could Improve Your Depression

Many people have found relief from depression when they address and treat their sleep apnea. In one study, participants with sleep apnea who scored higher than a 10 on a health questionnaire measuring depressive symptoms were considered clinically depressed. After the 228 people in the study started to use CPAP therapy to treat their sleep apnea, the percentage of people who scored higher than a 10 on the depressive symptoms questionnaire decreased from 74.6% to only 3.9%.[4]

Other studies have found conflicting results, suggesting that depression may not be so easily relieved in all cases. But if you are suffering from depression, identifying and treating a possible sleep disorder is certainly worth a try.

Diagnosis and Treatment of Sleep Apnea

If you have depression (or one of the many other sleep apnea symptoms like dry mouth or headache) and can’t quite figure out why, get screened for sleep apnea.

A sleep specialist can run tests to measure your oxygen intake during the night to determine if you have this sleep disorder. If so, there are a variety of options to treat the condition. Many people use a CPAP machine, which is a device that helps you to get plenty of oxygen while you sleep. Read How to Stop Sleep Apnea – 4 Non CPAP Remedies for alternative options.

Share Your Experience

Have you ever had sleep apnea? What symptoms did you experience? What treatment options worked for you? Share your experience in the comments section below.

Originally published in December 2015, this post has been updated.

[1] Sleep Breath. 2015 Jul 9. [Epub ahead of print]
[2] Lung. 2015 Apr;193(2):261-7.
[3] Science Daily News Release. 2015 May 18.
[4] J Clin Sleep Med. 2015 Mar 17. pii: jc-00354-14. [Epub ahead of print]

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The main symptom of my sleep apnea was intense fatigue: I often had to nap for several hours on weekend afternoons, and had to pull over to nap when driving for longer than an hour. My brother and a cousin also have sleep apnea, making me more aware that this could be what was happening to me.

The main treatment for OSA is a CPAP (continuous positive airway pressure) machine. This sends a stream of air through your airway as you sleep—the pressure of the air prevents the airway from collapsing. I noticed a difference the very first time I used CPAP—I woke refreshed, and felt much better during the day. After using it regularly, I felt like I gained 10 to 20 productive hours a week. I was able to drive for long distances without feeling as if I might fall asleep at the wheel. Another benefit was weight loss, since I had been snacking to help me stave off sleep.

Medicare covers a three-month trial of CPAP therapy if you’re diagnosed with OSA, and will cover it for longer if your doctor confirms that you are benefiting from the treatment. Unfortunately, many people find CPAP difficult to tolerate, and give up rather easily. A different mask may help—there are now several designs to choose from. I started out using a large mask that covered my nose and mouth, but I found it bulky and uncomfortable to sleep in. I switched to using a smaller option with nasal pillows, but eventually found a more unobtrusive design which provides air through a slit tube that sits just under my nose.

Another issue for some people is the force of the air from a CPAP machine. If you are finding that it prevents you from drifting off to sleep, you might want to try one of the newer APAP (automatic positive airway pressure) machines. I use one of these myself now: rather than deliver a steady stream of air, it senses how much air I need, and changes the air pressure as necessary (for example, if I roll onto my back while sleeping, the pressure increases slightly). Other APAPs don’t incorporate a sensor—instead they start out with a lower flow of air and gradually increase the pressure over time, once you’ve fallen asleep. If you wake with a sore throat after using your CPAP machine, switch to one that incorporates a humidifier—I found that mine made a real difference.

Some people are also embarrassed to have tubing and/or a mask on when they go to sleep. If you are the partner of a person with OSA, make sure you help them realize that it’s not a big deal, especially compared to the health benefits!

The post Don’t Give Up on CPAP if You Have Sleep Apnea appeared first on University Health News.

What Is Sleep Apnea? In sleep apnea, excess soft tissue at the back of the throat essentially “collapses” while you sleep, blocking your airway. This interrupts breathing, resulting in low blood oxygen levels (hypoxia) that alert the brain to wake you. At this point, you start breathing again, often making a loud gasp or choking sound in the process. “These episodes can happen 30 times or more per hour during the night,” says David M. Rapoport, MD, professor of medicine in Mount Sinai’s division of pulmonary, critical care and sleep medicine, and director of the Sleep Medicine Research Program at Mount Sinai.

Harmful to Your Health OSA prevents you from getting the deep, restorative sleep you need—but that isn’t all it does. “We now know it can do a lot more than make you sleepy in the daytime,” Dr. Rapoport confirms. “OSA can cause high blood pressure, or make it worse and harder to treat. It affects your risk of having a stroke or heart attack, and research is pointing to links with diabetes, weight gain, and cancer.” OSA also impacts your neurocognitive performance as you age, impairing your memory, focus, and attention; and it may cause depression. 

Lack of Awareness The symptoms of OSA include snoring, a dry mouth, sore throat and/or headache in the morning when you wake, and unexplained daytime sleepiness that may cause you to fall asleep when you’re not actively engaged in something. However, Dr. Rapoport notes that you may not realize what’s causing your symptoms. “Many people with sleep apnea are completely unaware of the problem or even of waking up, as the arousal after an apnea can last as little as 10 to 30 seconds,” he explains. “But bed partners often are disturbed by gasping and severe snoring, of which the patient is entirely unaware.”

Diagnosing Sleep Apnea The American Academy of Sleep Medicine recommends that doctors ask about possible OSA symptoms during routine physicals, but if your doctor doesn’t, mention any suspicions you have. In order to be sure about your diagnosis, your doctor will likely refer you for a sleep study. This is performed using a test called polysomnography, and can take place either in a lab or at home.

In the Lab You’ll attend the lab in the evening, and should bring your usual nighttime attire and anything else you use during your bedtime routine. The room where you’ll sleep is similar to a hotel room, but will have a camera so you can be observed as you sleep, and an audio link so the technician can hear any sounds that may signal OSA-related arousals.

Lab-based polysomnography incorporates an electroencephalogram (EEG) to measure your brain waves as you sleep, an electrooculogram (EOG) to track your eye movements, and an electromyogram (EMG) to track chin movement. These tests involve having sensors attached to your scalp, temples, and chin. Other sensors will be attached to your chest and legs, to track your heart rate and leg movements. You’ll also wear a clip on your finger to monitor your blood oxygen levels.

While you may find it difficult to drift off to sleep in the lab, you won’t need to sleep for a full night to get accurate study results. “You may get an OSA diagnosis even from what seems to be a short or mediocre night of sleep,” Dr. Rapoport confirms. “This is because most of us underestimate how much sleep occurs during a sleep study, and even short periods of sleep will show the problem.”

At Home Polysomnography also can be performed at home using a portable monitor. These monitors are more limited, incorporating a nasal cannula to measure your airflow, a chest belt to monitor your breathing, and a finger clip to keep track of your blood oxygen levels.

“Most people sleep better in their own bed, so a home study works well to diagnose uncomplicated OSA,” Dr. Rapoport observes. “However, the absence of EEG, EOG, and EMG means we won’t be able to confirm that you actually slept, so if the study shows no apnea, it’s possible—even if highly unlikely—that you didn’t sleep at all. If your doctor thinks it’s highly likely that you have OSA, a negative home test will usually prompt a follow-up lab study.” Dr. Rapoport adds that a home sleep study won’t diagnose other sleep disorders (such as restless legs syndrome) because of its limited tracking of movement. A home sleep study also may not be suitable for people with other health conditions that may affect the accuracy of polysomnography (for example, heart failure).

Treating OSA You’re at greater risk for sleep apnea if you are overweight or obese, smoke, and/or consume excessive amounts of alcohol, so take steps to address these risk factors if necessary. You also should follow your doctor’s advice for treating any conditions that may be connected to your OSA, such as high blood pressure.

If lifestyle changes don’t ease your OSA, mild cases may respond to oral devices that keep the throat open by repositioning the tongue and jaw. “There are also several other gadgets, including an implantable ‘pacemaker’ for the tongue,” Dr. Rapoport adds, “but none of them works consistently for everyone.” One option that has proven quite successful for Dr. Rapoport and his team at Mount Sinai is a device called Night Shift, which vibrates to alert you if you roll over onto your back during sleep (sleeping on your back makes it easier for the tissue of the upper airway to collapse and block your airflow). The intensity of the vibration gradually increases until you change position.

However, none of these options is as effective as a CPAP machine, which delivers a steady flow of air via nasal cannula or a mask. “CPAP essentially always cures the blockage that is causing OSA,” Dr. Rapoport observes. “Unfortunately not all people are able or willing to use CPAP, or they do so for only part of the night.”

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“What we are seeing in study findings is that sleep apnea affects the function of the entire body. It exposes the body to higher levels of stress hormones and lower levels of oxygen,” says Ana Krieger, MD, medical director of the Center for Sleep Medicine at Weill Cornell Medicine.

Fortunately, the risks associated with OSA can be reduced if the condition is treated. However, many people who have OSA have not been diagnosed, and, among those who have been diagnosed, many do not use a continuous positive airway pressure (CPAP) machine, which is one of the most effective treatments for OSA.

OSA Testing

If you have any symptoms of OSA, which include snoring, making a gasping or choking sound while sleeping, and daytime fatigue or sleepiness, report it to your doctor. If your primary care physician thinks you may have a sleep disorder, ask for a referral to a doctor who specializes in sleep disorders.

A couple of tests may be used to determine if you have OSA. One is an at-home sleep study. For this test, you will receive equipment that you will use at home. Before you go to sleep, you will attach sensors to your torso, wear a probe on one finger, and wear a mask that positions two small tubes at the openings of your nostrils. Then, you go to sleep and return the equipment to the doctor the next day. The results will show the doctor whether your breathing pauses or stops.

Pros and Cons

There are pros and cons to an at-home sleep study. Since you are doing the test in your own home, it may be easier for you to fall and stay asleep. It costs less than having a study in a sleep center, and insurance often will cover the cost. However, at-home tests are sometimes inconclusive, and they provide less information than a sleep center study. If your doctor recommends an overnight study at a sleep center after you’ve done an at-home study, your insurance may deny coverage for it. Before you have a sleep study, discuss these issues with your doctor to determine which test is best for you, and contact your insurance company to get information about what will be covered.

If you have a sleep study at a sleep center, you will have sensors on your legs as well as your torso, and you will have multiple sensors attached to your head. A sleep center study provides information about your breathing, brain waves, leg movements, the oxygen level in your blood, your heart rhythm, and how long it takes you to fall asleep. In addition, while you sleep, a technologist monitors the equipment and is available to assist you should you need to go to the bathroom or have any problems.

A sleep study at a sleep center costs more than an at-home study, but it gives your doctor a comprehensive view of what is happening in your body and brain while you’re asleep. Sleep center staff strive to make your experience as comfortable as possible, but you still may feel some apprehension before the test; see What You Can Do for tips to ease your concerns.

Using a CPAP

If you have OSA, your doctor will probably recommend treatment with a CPAP machine. The CPAP machine pushes air through a mask or apparatus you wear in or over your nose (or nose and mouth) while you sleep, which keeps your airway open and allows uninterrupted breathing.

It can take some time to get used to a CPAP machine, but many patients stop using it after only a few nights. One of the most common complaints is that the mask is irritating or bothersome. This is a classic case of, “If at first you don’t succeed, try, try again.” If your CPAP is uncomfortable, ask your doctor about trying other types and sizes of masks. For example, you may be able to use nasal pillows, which fit in your nostrils and are held in place with thin straps—no mask required. There are also many adjustments that can be made to improve the fit. And if you gave up on using a CPAP in years past, consider giving it a second chance.

“The technology for CPAP has significantly improved in terms of comfort. The equipment now provides air pressure in a similar way to how we breathe, which allows patients to tolerate it much more easily than in the past. Masks are also a lot more comfortable and lighter. Those are the key changes in terms of comfort and technology. The machines also allow for remote monitoring and adjustment of settings, which helps with compliance; this means you don’t have to take your machine to your doctor’s office for an adjustment,” says Dr. Krieger.

Finally, if you still don’t want to use a CPAP machine, consider how much it could improve your health and your life: “Many patients say that using a CPAP has made them feel younger and given them more energy. They perform better at work and have a better quality of life,” says Dr. Krieger.

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Additionally, research continues to identify new strategies for minimizing the risk of specific diseases that go beyond these four basic healthy lifestyle principles—whether it’s a certain balance of food groups to improve energy or a physical activity regimen aimed at preserving bone health. These strategies offer an opportunity to make some small changes that may add up to big results in the long run.

Hypertension

Odds are that every time you go to your health-care provider’s office, you have your blood pressure checked. That is because having high blood pressure, or hypertension, can have serious health consequences, including an increased risk of heart attack, stroke, heart failure, kidney disease, vision loss, sexual dysfunction, and peripheral artery disease. A blood pressure reading in-cludes two numbers: the systolic (the higher number on top) and diastolic (lower number on bottom). The systolic number is the pressure in your arteries when the heart beats and the diastolic pressure is the number when the heart rests between beats. The threshold for what is considered “high” blood pressure was just recently lowered by the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines to 130/80 mmHg (millimeters of mercury) from the previ-ous limit of 140/90 mmHg in 2017. This change means that 46 percent of American adults now have hypertension compared with 32 percent when the old criteria were used. The good news is that while there can be a genetic component to your risk of de-veloping hypertension, lifestyle plays a major role and there are a number of steps you can take to minimize your risk.

• Diet, diet, diet: One of the most important modifiable risk factors for hypertension is diet. To reduce your risk of hypertension or to help manage existing hypertension, the American Heart Association recommends limiting sodium intake to 2300 mg/day and consuming a diet rich in fruits, vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and non-tropical oils, and low in saturated and trans fats, sodium, red meat, sweets, and sugar-sweetened beverages. The DASH diet discussed in Chapter 1 models this dietary pattern and has been shown to be effective in lowering blood pressure. The CDC al-so recommends limiting foods high in sodium (salt) and eating foods high in potassium as part of a hypertension prevention strategy, because potassium helps balance out the negative effects of sodium (see “The Salty Six”). Many of the fruits and vege-tables included in the DASH diet, such as cantaloupe, grapefruit, tomatoes, broccoli, and sweet potatoes, are excellent sources of potassium.A key to healthful eating when you are trying to avoid developing hypertension is reading Nutrition Fact labels. Many pack-aged and processed foods, from deli meats to canned soups and even fresh poultry (sometimes injected with saline solutions), can be hidden sources of sodium and account for roughly 80 percent of our sodium intake. Generally speaking, the higher your sodium intake, the higher your blood pressure, so keeping an eye on your salt intake is one of the most important steps you can take to avoiding hypertension. It is also important to watch your fat intake, particularly your saturated and trans-fat intake. Die-tary saturated fat can directly raise your cholesterol levels which, in turn, can lead to narrowing of your arteries. The narrower your arteries become, the less space there is for blood flow, so the arteries must work harder to push that blood through—leading to higher blood pressure. Some packaged foods carry the American Heart Association (AHA) Heart-Check mark, which means they meet the AHA’s criteria for acceptable saturated and trans-fat and sodium content in a single serving, helping to guide your food purchases.
• Be active: If you haven’t already figured out that being physically active is a key component to establishing a healthy lifestyle, then here is another plug for it. Physical activity can help lower your blood pressure and strengthen your heart. It also can help with other hypertension prevention strategies such as maintaining a healthy weight and reducing stress. Aim for the Physical Activity Guidelines of at least 150 minutes of aerobic exercise a week coupled with two days of strength training. Remember that it is the total time spent that counts, not just the longer bouts of exercise. So, walking or jogging up the office stairs or doing a few pushups against your desk can make a difference. Your best chances of making exercise a regular habit will come from finding a routine that you enjoy, so try out a few different activities to see which you prefer and consider getting a friend to join you. The AHA suggests setting physical activity goals and then rewarding yourself when you meet them, whether that means setting aside a small amount of money with each workout that you then use to splurge on new exercise clothes or signing up for a massage.
• Maintain a healthy weight: There are many health benefits that come from keeping your weight at a healthy level and a normal blood pressure is one of them. When you are overweight, your heart must work harder to pump blood to all of your tissues and this puts you at risk of developing high blood pressure and damaging your blood vessels. Thankfully, research has shown that even small weight loss for someone who is overweight (a body mass index of 25 or more) can help lower your blood pressure. If you know your weight and height, you can calculate your body mass index (BMI) and see the different BMI ranges (e.g. under-weight, normal, overweight, obese) at the CDC’s Assessing Your Weight website: https://tinyurl.com/jkkjv95.The two factors that will most influence your ability to maintain a healthy weight are a healthy diet and a regular exercise regimen.
• Moderate your alcohol consumption: There is a strong link between alcohol and blood pressure. A 2013 study of roughly 4,000 indi-viduals by researchers from the CDC showed that alcohol increased participants’ blood pressure by 1 mmHg for every 10 grams consumed per day. A standard drink (e.g. 12 ounces of beer, 5 ounces of wine, 1.5 ounces of 80-proof liquor) has 14 grams of pure alcohol, more than enough to raise your blood pressure by 1 mmHg. The researchers concluded that any amount of al-cohol above 10 grams raises your systolic blood pressure. This information contradicts the previously held belief that small amounts of alcohol (less than 2 drinks a day for men and less than 1 drink a day for women) actually helped improve blood pressure. The CDC, 2015 DGA and the AHA recommend that men limit themselves to no more than two drinks and women no more than one drink per day. It is also important to note that even though the health benefits of certain alcoholic beverag-es—think red wine—are often touted, when it comes to blood pressure, it is the total amount that counts, not the type. The good news is that the effects of alcohol and high blood pressure are considered rapidly reversible, so if your blood pressure is on the high side because of your alcohol consumption, cutting back can help you normalize it. If not, it is fine to enjoy amounts within the current recommendations.
• No smoking: The AHA states that “smoking is the most preventable cause of premature death in the United States” so if you smoke, quitting could be the single-most important step to improving your health that you can take. It is also an important hypertension prevention measure. Smoking leads to the build-up of plaques in your arteries (atherosclerosis), which also can impact blood pressure. While the full relationship between smoking and chronic hypertension isn’t fully understood, it is known that a single episode of smoking raises your blood pressure, likely through nicotine’s stimulation of epinephrine (adrenaline).
• Try to de-stress: There appears to be an association between chronic stress and higher blood pressure. Certainly, acute or “situa-tional” stress such as occurs when the car in front of you abruptly slams on their brakes, can cause a release of hormones (adrenaline and cortisol) that contribute to the fight-or-flight response of faster heart rate, constricted blood vessels, and high-er blood pressure. This is a short-lived response, though, and once the situation has stabilized, your blood pressure returns to baseline. Whether a state of constant or chronic stress contributes to long-term high blood pressure is not totally clear, but experts nonetheless recommend trying to work on reducing the stress in your life as part of a hypertension prevention strate-gy. Engaging in regular physical activity can definitely help you manage your stress, but you might need to take other steps. Know what triggers your stress and try to avoid those things when possible. If you are stretched too thin identify areas in your life where you can cut back on some commitments. Be mindful by appreciating the here and now instead of all that awaits you in the future.
• Keep track of your numbers: Make sure you get your blood pressure checked on a regular basis so that you know what your typical blood pressure is. If you are noticing an upward trend—even if the numbers fall below the threshold—make an effort to check between your annual physical appointments, either at your local pharmacy or using a home device. This can help you deter-mine whether or not you need to step up your prevention strategy game with, for example, exercise or monitoring your diet.

Coronary Artery/Heart Disease

Coronary artery or heart disease occurs when cholesterol deposits build up in the blood vessels of the heart to form plaque—a process called atherosclerosis. When a blood vessel becomes narrowed or blocked by these plaques, adequate amounts of oxy-gen and nutrients can’t reach the heart muscle and a heart attack can occur. Recommendations for reducing your risk of devel-oping heart disease read very much like those for preventing hypertension: eat healthfully, be physically active, maintain a healthy weight, avoid smoking and excess alcohol, and manage your stress. The most critical aspects of diet are to replace sources of saturated fat (meat and dairy fat) with liquid vegetable oils, and maintaining a healthy body weight. Studies have repeatedly shown that a life-style which follows those patterns is associated with better heart health. Additionally, there are other steps you can take to opti-mize your heart health:

• Get regular physical exams: Results from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey indicate that roughly one in three American adults receive an annual physical exam in any given year. And yet the American Heart Association cites getting a regular exam as an important step in preventing heart disease because it offers a regular opportunity for your health-care provider to assess heart disease risk factors such as weight, blood pressure, and plas-ma cholesterol and blood glucose levels, and to guide you in lifestyle modifications or medication options that might improve those parameters. It is also a chance for your health-care provider to ask about symptoms which might seem unrelated to you but could potentially be suggestive of heart disease. An example could be regular cramping leg pain with exercise which can be a sign of peripheral vascular disease in which plaques build up in the body’s peripheral arteries. People with peripheral artery disease have a higher risk of coronary artery disease. There are certain physical signs that can indicate a higher risk of heart disease. For example, soft yellow deposits on or around the eyelids called xanthelasma can be a sign of hyperlipidem-ia—elevated cholesterol, triglycerides, or other lipids in the blood—that can lead to plaque build-up in the coronary arteries. Some people might mistake these lesions for “age spots” but upon recognizing these, your health-care provider can order the appropriate lab tests and help start you on a cholesterol-lowering regimen if necessary.
• Be familiar with your family history: A family history of heart disease, particularly premature heart disease in a parent or sibling de-fined as an event under the age of 65 years in women and 55 years in men, is an important risk factor for heart disease. If you do have this increased risk, focusing on lifestyle strategies like regular exercise, healthy eating, and weight management are all the more critical. Sharing this history with your health-care provider is also important as it may influence his or her decision to treat you medically for high cholesterol levels.
• Monitor your blood sugar: Diabetes and metabolic syndrome are both risk factors for heart disease, so monitoring your blood glu-cose or sugar levels should be a part of monitoring your heart health. The American Heart Association recommends that every adult should have a fasting blood glucose test by the age of 45 and then at least every three years thereafter. And speaking of sugar, watch your sugar-sweetened beverage consumption. A large number of studies have shown an association between heart disease and sugar-sweetened beverage intake. A study published in the journal Circulation showed that, after adjusting for multiple lifestyle-related factors such as BMI, overall diet quality, smoking, and physical activity, among others, consuming one sugar-sweetened beverage per day was associated with a 19 percent increased risk of coronary heart disease.
• Follow your lipid profile: One of the factors that influences your risk of developing plaques in your blood vessels is the profile of fats or lipids in your blood. Current American Heart Association recommendations for adults are that beginning at the age of 20, every adult should have a fasting lipid profile performed. Depending on your results and risk factors, this should be repeated every four to six years. Included in a fasting lipid profile are measurements of HDL cholesterol, LDL cholesterol, and triglycer-ides. Abnormalities in these levels can raise your risk of heart disease, so it is important to know what your levels are and which way they are trending. Lifestyle changes such as replacing saturated and trans fat with unsaturated fat, particularly polyunsatu-rated fat, and replacing carbohydrate-rich foods in your diet with fiber-rich fruits and vegetables and expanding your fitness regimen can help improve your lipid profile. In some cases, medication such as statins, nicotinic acid, or fibrates may be needed as well.
• Don’t ignore snoring: Roughly 50 percent of people who snore have some degree of obstructive sleep apnea (OSA), a condition characterized by loud, frequent snoring and pauses in breathing followed by gasping for air during sleep. In OSA, the upper airway becomes blocked, reducing or completely obstructing airflow. OSA is a known risk factor for heart disease, so if you have been told that you are a snorer, you should mention this to your health-care provider. They will ask you questions about common signs and symptoms of sleep apnea and assess other factors that increase your risk of OSA such as being overweight. In some cases, lifestyle changes such as limiting alcohol and losing weight can mitigate OSA, but in others, after undergoing a sleep study, you may be prescribed a breathing device such as a continuous positive airway pressure or CPAP machine that keeps the airway from collapsing and allows for continuous airflow. The bottom line is that snoring can be a sign of OSA and there is strong evidence that OSA increases your risk of both high blood pressure and heart disease. So, don’t ignore snor-ing—addressing it early on could be helpful for your heart. For more details, see “Signs and Symptoms of Sleep Apnea”.
• Know the warning signs: Getting treatment for a heart attack as quickly as possible improves your chances of survival and minimizing permanent damage. In a survey reported by the CDC, however, only 27 percent of respondents were aware of all the major symptoms of a heart attack: chest pain or discomfort, pain or discomfort in the arms, back, neck, jaw, or upper stomach, short-ness of breath, nausea, lightheadedness, or cold sweats. Additionally, the symptoms frequently manifest themselves differently in women and men. If you suspect you or someone you know might be experiencing symptoms of a heart attack, don’t wait to see if they get worse or go away—call 911 immediately.

Type 2 Diabetes

Approximately 26 percent of Americans over the age of 65 have been diagnosed with type 2 diabetes, a disease in which the body cannot properly respond to the hormone insulin to keep blood glucose levels normal. Even more staggering is the number of adults who have prediabetes, an often-asymptomatic precursor stage to type 2 diabetes characterized by blood glucose levels above normal but below the threshold for diabetes. The American Diabetes Association reports that half of all Americans over 65 have prediabetes. Importantly, having a diagnosis of prediabetes does not mean you are guaranteed to develop diabetes. In fact a seminal study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), called the Diabetes Prevention Program (DPP), demonstrated that lifestyle modifications could reduce your risk of type 2 diabetes by 58 percent. That reduction jumped to 71 percent for study participants over the age of 60. The study followed over 3,000 individuals at high risk for diabetes for roughly three years. It found that those individuals who engaged in a lifestyle modification program that in-cluded better nutrition, 150 minutes of exercise a week, and a weight loss of 5 to 7 percent dramatically reduced their risk of developing type 2 diabetes compared to those who took a placebo without lifestyle changes. The take-home message is that even if you have prediabetes (see “What Is Prediabetes?”), there are steps you can take not only to avoid developing diabetes, but even to reverse your prediabetes. And, if you don’t have prediabetes, maintaining a healthy, active lifestyle can keep abnormal blood glucoses at bay.

• Control your weight: Avoiding excess weight might be the most important step you take to avoiding diabetes. Research has shown that your risk of type 2 diabetes is seven times greater when you are overweight and being classified as obese makes it as much as 20 to 40 times more likely that you will develop diabetes. If you are overweight, a weight loss of even 5 percent can make a big difference in reducing your risk. So, for example, if you weigh 175 pounds, aim for a loss of 9 to 12 pounds; if your current weight is 225 pounds, aim for losing 11 to 16 pounds. Make healthy eating one of the ways you accomplish this goal: cut down on portion size—particularly for foods that are a concentrated source of quickly digested energy such as refined carbohy-drates, a concentrated source of calories such as cheese and fatty meats, and a quickly consumable source of calories, such as sugar-sweetened beverages and fruit juice. Consume a diet rich in fruits, vegetables, low and nonfat dairy, lean proteins, and whole grains. You can use a resource such as the USDA’s www.ChooseMyPlate.gov to help guide you on portions or the NIDDK’s Diabetes Prevention Program Lifestyle Manual of Operations to determine daily calorie intake goals. Be strategic about your meal planning to avoid bad eating habits—keep healthy snacks on hand like fresh fruit, precut vegetables; when cooking a healthy meal, make extra that you can freeze for another day when you might not have the time for healthy meal prep; slow down your eating rate to allow your stomach the 20 minutes or so it takes to signal to your brain that you are full; and aim for eating at roughly the same time each day to avoid hunger pangs.
• Move, move, move: Exercise not only can help you lose weight, it can directly affect your blood glucose level. When you exer-cise, your muscles contract and burn glucose; hence, your cells need to take up glucose from your blood. Exercise also makes your cells more sensitive to insulin, further facilitating the uptake of glucose. This enhanced sensitivity to insulin can last as long as 24 hours after physical activity. Studies have shown that you don’t have to run a marathon to achieve this benefit. Brisk walking for 30 minutes 5 days a week can make a difference. But don’t consider yourself “finished” after that 30-minute walk. Try to incorporate movement throughout your day by adding a short stroll around the block after dinner or taking the stairs in-stead of the escalator. Equally important is to avoid too much sitting or sedentary time. The link between prolonged sitting and diabetes, along with heart disease, is strong, so try to make a point of getting up and moving for at least a few minutes on a reg-ular basis when you have to sit for a while.
• Keep track: Research has shown that people who log their physical activity and weight are more successful in reaching their goals than people who don’t track their progress. This may be particularly helpful as you get started. Consider keeping a record of the time you spend exercising, your daily food and drink intake, and your daily weight. This can help you see whether or not you are truly sticking to your plan and find areas for improvement. There are many helpful apps that make the process con-venient.
• Ditch the cigarettes: You can add type 2 diabetes to the list of diseases for which smoking increases your risk. Smokers have an increased risk of developing type 2 diabetes compared to non-smokers and that risk increases with the number of cigarettes a person smokes per day. Chemicals released from cigarette smoke cause inflammation and oxidative stress in human cells, both of which have been shown to increase the risk of type 2 diabetes. Additionally, smokers often have higher levels of cortisol, a hormone that raises blood glucose levels.

Stroke

The same basic tenets of eating healthfully, exercising, maintaining a healthy weight, avoiding smoking and excess alcohol con-sumption that are part of hypertension, heart disease, and diabetes prevention strategies apply to stroke—and not surprisingly, since all of these factors can improve the health of your blood vessels and heart. The National Stroke Association reports that as many as 80 percent of strokes can be avoided if lifestyle risk factors and medical risk factors are addressed. They specifically highlight several risk factors that can be controlled with proper treatment or lifestyle changes and subsequently can have a big impact on reducing stroke risk:

• Hypertension: High blood pressure is the number one risk factor for stroke and is associated with a one-and-a-half times greater risk of stroke than having a normal blood pressure. Taking measures such as minimizing your sodium intake and eating a diet rich in vegetables, fruits, and low-fat and nonfat dairy products, maintaining a healthy body weight, and exercising regularly are important in not only avoiding high blood pressure but managing it if you already have been diagnosed with hypertension. If lifestyle changes alone can’t keep your blood pressure under control, treating it with medication may be a critical stroke pre-vention measure.
• Atrial fibrillation: Atrial fibrillation, or A-fib, is the most common type of heart arrhythmia or irregular heartbeat and carries a four to five-fold increased risk of stroke. In A-fib, the upper chambers of the heart—the atria—do not beat regularly and the irregu-lar flow of blood that ensues when they pump it into the lower chambers—the ventricles—can cause blood to pool and form clots. If these clots become dislodged, they can travel to the brain and cause a stroke. High blood pressure, obesity, diabetes, coronary artery disease, and excessive alcohol use are among the leading risk factors for A-fib and lifestyle changes aimed at managing these risk factors are an important A-fib treatment strategy.
• Keep LDL cholesterol in check: Atherosclerosis—or the build-up of cholesterol-laden plaques in the arteries—can block blood flow in the brain’s blood vessels leading to stroke. Regularly checking your LDL cholesterol levels and working to keep your levels within a normal range through diet, exercise, and, if necessary, medication is important to stroke prevention.
• Manage your diabetes: Type 2 diabetes confers a four-time greater risk of stroke. This is in part because diabetes is associated with other stroke risk factors such as high blood pressure. But diabetes also causes damage to blood vessels, making them more susceptible to blood clot formation. So, if you have elevated glucose levels, working with your health-care provider to keep your blood glucose under control can help mitigate your risk of stroke.
• Know the signs and symptoms: The sooner you can get treatment, the better your odds for survival and recovery. Research has shown that patients who arrive in the emergency room within three hours of their first stroke symptoms have less disability three months following their stroke than those with delayed care. The sooner you get to the hospital, the more likely there will be a better outcome. The American Stroke Association developed the FAST acronym to help people remember the common signs and symptoms of stroke and to act fast.

Face: Does one side of your face droop when you smile?
Arms: When you raise your arms, does one arm drift downward?
Speech: Does your speech sound strange or slurred?
Time: Don’t delay. If you notice any of these signs, call 9-1-1 immediately.

Digestive Ailments

Maintaining a healthy digestive system not only helps you get the most out of the fuel you provide your body but also makes a big difference in the way you feel on a daily basis. Digestive problems such as heartburn or constipation can impact your quality of life and can frequently become more common with age. One reason for this is inadequate fluid intake due to age-related declines in thirst. Reduced activity levels also can lead to constipation. Gut motility—the process by which our digestive tract moves food through our body—can slow with age leading to constipation which, over time, can cause other problems such as hemorrhoids. The number of medications we take usually increases with age and many medications can have gastrointestinal side effects rang-ing from stomach irritation to diarrhea. You can be proactive about some of these problems though by making a few lifestyle ad-justments and working with your health-care provider:

• Fill up on fiber: Foods such as fruits and vegetables, beans, nuts, seeds, and whole grains are excellent sources of fiber and fiber is key to keeping you regular and avoiding constipation. Fiber is also important if you have been diagnosed with diverticulosis—a condition in which small protrusions or pockets form in your colon. On their own, these diverticula can cause gas and bloating, but when they become infected they can become a serious health threat, so keeping things moving through your gut and avoiding having material get trapped is important in managing diverticulosis.
• Hydrate: Your digestive system needs water to keep stools soft and to facilitate elimination. Be sure you are drinking adequate flu-ids throughout the day and talk with your health-care provider if you are on medications such as diuretics that increase your fluid losses.
• Be mindful of your meds: Among the most notorious medications for causing GI ailments are non-steroidal anti-inflammatory drugs or NSAIDs such as ibuprofen or naproxen. You may find yourself taking more of these for some age-related aches and pains, but it is imperative that you take them with food and discuss your dose and frequency with your healthcare provider. NSAIDs can cause ulcers and gastrointestinal bleeding so should be used with caution. NSAIDs, along with other medications ranging from antibiotics to heart medications like nitrates to anticholinergics, used for irritable bowel syndrome or overactive bladder, can cause acid reflux and heartburn. If you take medication and are experiencing GI disturbances, talk with your healthcare pro-vider to see if there might be less irritating alternatives or changes you can make to ease your GI discomfort.
• Get moving: Exercise not only helps with constipation and reduces the risk of colon cancer but can optimize your gut microbiota. Research has shown that exercise increases the diversity of bacterial populations in your gut and increases the number of beneficial microbial species that reside within your GI tract.
• The role of probiotics: The more we learn about the important role bacteria play in our GI system, the more interest there has been around probiotics, microorganisms ingested for potential health benefits. There have been some promising results from pre-liminary studies on the impact probiotics might have on certain GI ailments including diarrhea and constipation, but there have not been enough large-scale, well-designed trials from which to draw a definitive conclusion about which specific probiotics and what doses might be most beneficial. At this point, the FDA has yet to approve any probiotic for prevention or treatment of a health problem. That doesn’t mean you shouldn’t give them a try if you are curious. Most experts agree that they are gener-ally safe, but they are not tested or regulated by the FDA so there is no guarantee about what you are getting when you buy a supplement. If you plan on trying them for a digestive ailment such as constipation, you should let your health-care provider know.

Cancer

The process in which a normal cell becomes a cancerous cell, multiplying and frequently invading or spreading to other parts of the body, can be influenced by different factors: our genetic predisposition, environment factors, and lifestyle behaviors. While there is much we still don’t know about exactly how and why this process gets triggered, research has revealed modifiable risk factors or steps you can take to reduce your risk of cancer.

• Don’t smoke: The National Cancer Institute states that cigarette smoking is responsible for approximately 30 percent of all cancer deaths in the U.S. Smoking has been linked to not only to lung cancer, but also kidney, pancreatic, stomach, and esophageal cancer. Avoiding smoking or quitting if you do smoke, and avoiding exposure to second-hand smoke, can dramatically lower your risk of cancer and cancer-related death.
• Avoid infections associated with cancer: Certain infections are known to contribute to cancer. For example, human papillomavirus (HPV) has been linked to cervical cancer, Hepatitis B can cause liver cancer, and Helicobacter pylori infection increases the risk for stomach cancer. To reduce your risk of these infections, use protection to avoid sexually transmitted diseases, ensure you are current on vaccinations, and make sure you complete your full course of treatment if you are diagnosed with Helicobacter pylori.
• Avoid unnecessary radiation exposure: Ionizing radiation from medical imaging tests and radon gas, and ultraviolet radiation in sunlight can both cause cancer. To reduce this risk, limit your exposure to sunlight, which increases the risk of melanoma and nonmel-anoma skin cancers. Have your home tested for radon gas which has been linked to lung cancer. Make sure you aren’t unnec-essarily undergoing medical imaging tests. X-rays, CT scans, fluoroscopy, and nuclear medicine scans can expose you to ionizing radiation, a cause of a number of different types of cancer. If you have had an imaging test in the recent past, be sure to let your health-care provider know as you might be able to avoid a duplicate test and the unnecessary radiation associated with it.
• Watch what you eat: Some research has shown that a diet high in red meat and processed meat made with nitrates may increase the risk of colon and prostate cancers. Conversely, a diet rich in fruits and non-starchy vegetables may lower your risk of cancers of the stomach, esophagus, and mouth. Fruits also may reduce your risk of lung cancer. Animal studies also have shown that cer-tain chemicals—heterocyclic amines and polycyclic aromatic hydrocarbons formed when meat is cooked at high tempera-tures—can be carcinogenic. While human studies are less conclusive, the National Cancer Institute says you can reduce your risk of exposure to these chemicals by cooking your meat at lower temperatures or removing the charred portions of meat before eating.
• Keep alcohol intake moderate: Alcohol has been linked to oral, esophageal, breast, colorectal, and liver cancers. If you choose to drink, experts advise limiting your intake to no more than one drink per day for women and two for men.
• Exercise: In addition to being a pillar of an overall healthy lifestyle, exercise has been shown to be associated with reduced risk of colon, postmenopausal breast, and endometrial cancers.
• Avoid excess weight: Obesity is linked to a range of cancers including colon, esophageal, pancreatic, kidney, endometrial, postmen-opausal breast, gallbladder, and liver cancers. Cutting total calories and increasing your physical activity can help you maintain a healthy body weight and avoid the many health risks that come with excess weight.
• Watch for environmental toxins: Air pollution, including secondhand tobacco smoke, has been linked to increased risk of lung cancer. Chemicals found in some common products ranging from gasoline to paints can potentially be carcinogenic at high concentra-tions, so health experts recommend limiting your exposure to fumes in unventilated spaces and avoiding skin contact.
• The vitamins question: While they play an important role in overall health as part of a balanced diet, there is little evidence that vit-amins can prevent cancer. Some well-designed trials have shown supplements of vitamins B6, B12, E, C, D, beta carotene, folic acid, and selenium do not lower the risk of cancer. In fact, a large study—the Selenium and Vitamin E Cancer Prevention Tri-al—found that vitamin E alone could increase the risk of prostate cancer.
• The aspirin dilemma: There is some evidence that taking aspirin may lower the risk of colon cancer, but this reduced risk isn’t seen until 10 to 20 years after an individual begins taking aspirin. Aspirin at low doses has the added benefit of also reducing the risk of heart attack and ischemic stroke—stroke that results from blood clots, but this benefit must be weighed against the risk of GI bleeding that is associated with aspirin use. For this reason, aspirin should not be used on a regular basis without consulting your health-care provider.

Osteoporosis

Human bone is living, growing tissue that is in a constant state of flux. The bone you have reflects a balance between new bone formation and bone loss. Bone formation occurs faster than bone loss during your first few decades and is dependent on ade-quate supplies of calcium and vitamin D, which is why you were likely encouraged to “finish all your milk” as a child. This balance begins to shift around the age of 25—the point at which your bone density reaches its peak—and bone loss can begin to outpace new bone formation, putting you at risk of low bone density or mass. When this density becomes critically low as in osteoporosis, your risk of fractures becomes significant. But just because your bone density peaks in your 20s doesn’t mean there is nothing you can do to prevent osteoporosis. The National Osteoporosis Foundation (NOF) states, “It’s never too late at any age to take steps to protect your bones.” This applies to women and men. Women are usually the target audience for bone health and oste-oporosis prevention campaigns because hormonal changes that occur after menopause accelerate bone loss and thus they tend to lose a greater percentage than men. Nonetheless, many men develop osteoporosis. In fact, the NOF reports that one in every four men age 50 and older will break a bone due to osteoporosis.

So, what can you do to preserve your bone health?

• Get your calcium and vitamin D: Calcium and vitamin D are essential to bone health. Calcium is a building block of bones and comes exclusively from what you ingest. Food is the best source of calcium because the calcium in food is more easily absorbed than that in supplements (see “Calcium Content of Selected Foods”). Calcium absorption becomes less efficient with age which is why daily calcium intake recommendations increase as you move from your 30s and 40s into your 50s and beyond:
  31 to 50 years old: 1,000 mg
  51 to 70-year-old males: 1,000 mg
  51 to 70-year-old females: 1,200 mg
  70 years and older: 1,200 mg
  Nonfat and low-fat dairy products such as milk and yogurt, dark green, leafy vegetables like collard greens or broccoli, canned fish such as sardines and salmon, and fortified foods like cereals and orange juice can be good sources of dietary calcium. If your diet is low in calcium-rich foods (e.g., lactose-intolerant or vegan) or you at are at increased risk for osteoporosis because of age or having a small, thin-boned frame, you may need to consider taking a calcium supplement. Remember, more is not better when it comes to supplements. Taking more than the dose recommended by your health-care provider can cause adverse health ef-fects. Discuss the calcium sources with your health-care provider who can guide you to the specific form of calcium best suited for you and the appropriate supplement dose, if needed.Vitamin D facilitates absorption of calcium and is important to the health of your muscles, which support bones. Food sources of vitamin D include nonfat and low-fat milk, saltwater fish, egg yolks, and fortified foods like orange juice and cereals. Sunlight is your key source of vitamin D—or rather sunlight allows your skin to make vitamin D. As you age, your ability to produce vitamin D from sunlight declines, so you may need to increase your food intake or consider a supplement. Recommended daily vitamin D intakes are 600 IU up to age 70 and 800 IU for 70 and older.
• Exercise for your bones: The two types of exercise that are most critical for bone health are weight-bearing exercises—which go against gravity—and muscle-strengthening exercises. Weight-bearing exercises such as walking, jogging, tennis or treadmill ex-ercises actually help maintain and even increase bone density by stimulating bone formation. Muscle-strengthening exercises help make the muscles that support your bones stronger and can improve your balance—an important factor in preventing falls, particularly those that work on improving balance.
• Don’t smoke: There is some evidence that smokers absorb less calcium from their diet than non-smokers. Additionally, female smokers have lower estrogen levels and tend to go through menopause earlier than non-smokers, both of which put them at increased risk for osteoporosis.
• If you drink, do so in moderation: Excessive alcohol intake not only can disrupt the balance of calcium in the body but also interfere with your ability to produce vitamin D. Chronic alcohol exposure also can reduce male and female hormone levels, which re-duces bone formation, and increase cortisol levels, which accelerates bone breakdown.
• Watch your caffeine intake: Caffeine can interfere with calcium absorption so experts recommend limiting your intake. For example, the NOF recommends no more than three cups of coffee per day.
• Add some bone-boosting foods to your diet: The NOF recommends adding some olive oil, blueberries, soy beans, and foods rich in omega-3 fatty acids like flaxseed oil and fish oil to your diet. There is some evidence these foods may be advantageous to bone health, and while the research is not conclusive, their other health benefits make them a worthwhile addition until more is known.

Vision

Just as the rest of your body undergoes age-related changes so do your eyes. Many adults will notice some visual changes as they age, including a need for additional light, a decline in sensitivity, and a loss of focus. But the NIH’s National Eye Institute points out that change in vision is not a normal part of aging. When vision impairment occurs, it is from some form of eye pathology, most often age-related macular degeneration (AMD), cataracts, diabetic retinopathy, or glaucoma. Your risk of developing these dis-orders goes up the older you get. And while you may not be able to avoid them, there are some steps experts recommend taking to optimize your eye health and reduce your chances of eye disease:

• Protect your eyes from the sun: Ultraviolet light from the sun doesn’t just pose a health risk to your skin. Your eyes are vulnerable to UV damage as well and, according to the American Academy of Ophthalmology, this is even more true for people with light-colored eyes (blue, green, or hazel). This may also be true for people taking photosensitizing drugs such as certain antibi-otics, psoriasis medications, and some estrogen supplements. The National Eye Institute recommends wearing a wide-brimmed hat and sunglasses when you are outside to keep your eyes protected.
• Get dilated: Recommendations vary. The National Eye Institute recommends all adults age 60 and older have an annual dilated eye exam. The American Academy of Ophthalmology recommends a comprehensive exam beginning at age 40 and then every two to four years until 54, every one to three years between age 55 and 64, and then every one to two years at age 65 and older. A dilated eye exam is different from an optometry exam where your vision is checked and you are fitted for glasses or contact lenses. A dilated exam allows an ophthalmologist to have a larger view of areas in the back of the eye including the retina, mac-ula, and optic nerve. This exam is particularly important because most age-related diseases of the eye have no warning signs or early symptoms, but early detection can allow for early intervention and treatment that slows the progression of the disease.
• Quit smoking: Smoking raises your risk of several eye diseases including cataracts, AMD, diabetic retinopathy, uveitis, and dry eye. The good news, according to the American Academy of Ophthalmology, is that for many people, quitting smoking can lower your risk for many of these diseases to the same level as someone who never smoked.
• Eat leafy greens and foods rich in omega-3s: The American Academy of Ophthalmology recommends eating a heart-healthy diet for eye health too: one that is rich in fruits, vegetables, oily fish (e.g., salmon, mackerel), and whole grains. They also recommend some specific foods to lower your risk of certain eye diseases. Studies have shown that the nutrients lutein and zeaxanthin found in dark, leafy grains like kale and spinach can help reduce your risk for AMD and cataracts. Other research has demonstrated that omega-3 fatty acids in cold-water fish like salmon can lower your chances of developing AMD.
• Be active: Your eyes are filled with tiny arteries, and just like the rest of your blood vessels, regular exercise keeps them healthy by optimizing circulation and oxygenation.
• Stay on top of your health: Many other health conditions such as high blood pressure or diabetes can impact your eye health. Keep-ing those conditions under control through healthy lifestyle habits and, if necessary, medications will help your eyes as well.
• Get your sleep: Sleep is an important time for your eyes to clear out irritants accumulated during the day and experience continu-ous lubrication. This lubrication is particularly important as you age because many adults experience a decline in natural tear production with age leaving them prone to dry eye.

Key Health Screening Tests

Screening tests are a critical part of preventive healthcare. They facilitate early detection of disease and allow you and your healthcare provider to implement lifestyle changes or treatment that can slow the progression and, in some cases, even reverse the course of disease. Recommendations for health screening are issued by a variety of organizations ranging from government committees like the U.S. Preventive Services Task Force (USPSTF) to professional medical groups like the American Academy of Orthopedic Surgeons. These recommendations can differ, though, and your specific age and medical history may impact what tests you need and when you need them, so you should work with your health-care provider to determine what tests are right for you. In general, there are several tests every adult needs to have:

• Blood pressure: The USPSTF recommends every adult age 40 and older should have an annual blood pressure screening. If your blood pressure is elevated, your health-care provider may want to obtain additional measurements more frequently including some taken outside their office.
• Cholesterol testing: Cholesterol testing, including total cholesterol, high density lipoprotein (HDL) or “good” cholesterol, low density lipoprotein (LDL) or “bad” cholesterol, and triglyceride levels should be checked at least once every 5 years. If you have risk factors for cardiovascular disease, you may need your cholesterol checked more often.
• Colorectal cancer screening: Every adult needs a screening for colorectal cancer beginning at age 45 and continuing through age 75. After age 75, current recommendations are for an individualized plan based on your overall health and medical history. There are different ways of screening for cancer ranging from stool tests to colonoscopy. Colonoscopies are considered the gold standard and should be performed every 10 years.
• Diabetes Testing: The American Diabetes Association recommends all adults should be screened for diabetes with a fasting blood glucose test beginning at age 45 and then every three years. If you have risk factors for diabetes such as high blood pressure, a sedentary lifestyle, a family history of type 2 diabetes, or are overweight, you may need to be screened earlier and at more frequent intervals.
• Cervical cancer screening: Unless you have had a hysterectomy, women should have a cervical cancer screening with a Pap smear every three years until the age of 65: The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had three normal screenings and are not otherwise at high-risk for cervical cancer.
• Breast cancer screening: The American Cancer Society recommends women with an average risk for breast cancer begin having an-nual mammograms at age 45 followed by mammograms every other year starting at age 55. By contrast, the USPSTF recom-mends biennial screening from age 50 to 74. They do not have a recommendation for women aged 75 and older. You should discuss the risks and benefits of a specific screening schedule with your healthcare provider.
• Lung cancer screening: If you are between the ages of 55 and 80 and are currently a heavy smoker or were a heavy smoker and quit within the past 15 years, the USPSTF recommends an annual low-dose computed tomography (CT) screening for lung cancer.
• Osteoporosis: Current USPSTF recommendations are for all women age 65 and older to undergo a baseline bone density scan. The USPSTF does not currently have a recommendation for screening men, but they are in the process of updating their osteoporosis screening recommendations.
• Vision: Vision is a critical but often overlooked aspect of health. It has a tremendous impact on quality of life, affecting factors ranging from your ability to read, to your risk of falls, and even to your ability to live independently. The American Academy of Ophthalmology recommends a comprehensive dilated eye exam every two to four years beginning at age 40 through 54, fol-lowed by an exam every one to three years between ages 55 and 64 and then every one to two years from 65 on. Remember that this is not the same as a simple vision test in which your visual acuity is measured, but rather an ophthalmolo-gist-administered dilated eye exam.
• Dental: See your dentist at least once a year for routine checkups. Typically, the dentist will check your gums for any sign of dis-ease, and clean and polish your teeth. The tongue should be examined along with your entire mouth. The neck and jaw should also be assessed. You may or may not need x-rays. Keep your mouth healthy by brushing twice daily for at least two minutes. Floss once a day to rid your mouth of particles stuck between teeth and gums.

Tests You May Not Need

The adage “more is not always better” can certainly apply to medical tests. It is important to weigh the pros and cons of testing with your health-care provider, taking into consideration your personal medical and family history. Some tests offer little ad-vantage in low risk people and may lead to false alarms that result in further unneccessary testing.

• Electrocardiograms (ECG or EKG): It is probably a good idea to have a baseline EKG at some point in your 40s or 50s, but if you do not have heart disease or risk factors such as high blood pressure, you probably don’t need a regular EKG.
• Whole-Body Scan: Whole body CT scans used to screen for early signs of disease such as cancer are often part of executive physi-cals, but there is little evidence to suggest this kind of testing makes sense or impacts health outcomes overall. In addition to exposing patients to potentially unnecessary radiation, they often are not covered by insurance.
• Prostate Specific Antigen (PSA): Whether or not to get a PSA test has been a controversial subject in recent years. The USPSTF re-cently updated their recommendation to advise that the decision to perform PSA screening in men between 55 and 69 should be an individual one made with your health-care provider. They do not recommend PSA screening in men age 70 and older. If you have had prostate cancer, your healthcare provider may perform regular PSA testing for monitoring.

Overcoming Obstacles

• Lifestyle and beyond: While the body of evidence linking certain lifestyle habits with increased risk of disease is strong and growing, lifestyle is by no means the only factor that dictates whether or not someone develops a disease. Genetics and envi-ronmental influences also play a role, so being diagnosed with a chronic disease is not necessarily an indictment on your life-style. At the same time, poor choices in the past don’t mean that it is too late to make a difference by adopting healthy habits. We’ve all likely made some lifestyle choices at one point or another that may not have been the healthiest, but it is never too late to change some bad habits. A number of studies have shown that changing an unhealthy habit—such as quitting smoking or trading a sedentary lifestyle for a more active one—can reduce your risk of disease and make a significant difference in your overall health.
• Chronic conditions can change: Being diagnosed with a chronic disease does not mean your fate is sealed. For example, a diagno-sis of prediabetes does not mean that type 2 diabetes is inevitable. Improving your diet, increasing your physical activity, and losing some weight can help normalize your blood glucose levels and avoid the progression to diabetes. If you already have di-abetes, those same measures can help keep it in check and help you avoid some of the complications that can be associated with it.

While there is no guarantee for avoiding every disease, adopting a healthy lifestyle not only can reduce your risk but also provide a host of other benefits, from improving your energy level to enhancing your quality of sleep.

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As a long, hot summer starts to wind down, it’s still important to focus on staying hydrated. Your cognition depends on it. According to an analysis published recently in Medicine & Science in Sports & Exercise, researchers found that fluid loss equaling 2 percent of your body mass can affect your ability to think clearly. In their research the scientists examined the results of 33 studies involving more than 400 adults. The researchers looked at the records of people who lost fluids amounting to 1 to 6 percent of their body mass either through exercise or through exposure to heat or through fluid restriction. It turns out that losing just 2 percent of your body mass in fluids amounts to a reduction in decision-making skills and other cognitive abilities. It’s just another reminder to stay hydrated, particularly if you live in a very hot region or are very active. Check the color of your urine to get an idea about your hydration level. Urine should be mostly clear. If it’s very yellow or even turning a shade of yellowish-brown, you should start hydrating. If your urine is very clear, you may be consuming more fluids than you need. Also keep in mind that you could already be getting dehydrated before you start feeling thirsty. If you’re unsure how much water you need throughout the day, consult with your doctor. The average person needs the equivalent of about eight 8-ounce glasses of water daily, but medical conditions such as heart failure may affect your doctor’s recommendation.

Sleep Apnea May Contribute to Structural Changes in the Brain That Affect Cognition

Here is another reason to have your obstructive sleep apnea (OSA) symptoms evaluated by a sleep specialist: This common sleep-disordered-breathing problem may cause the same kinds of changes in the brain that are seen in the early stages of dementia. That’s according to a study published in the European Respiratory Journal. OSA is a condition in which the tissue in the back of the throat relaxes and causes you to pause in your breathing throughout the night. As a result, your brain doesn’t get a steady and sufficient supply of oxygen while you sleep. This drop in oxygen may be linked to a shrinking of the brain’s temporal lobes and a corresponding decline in memory. If you snore or you experience daytime sleepiness, talk with your doctor or see a sleep specialist for an evaluation. Treatment, such as a continuous positive airway pressure (CPAP) machine, may be helpful in keeping your airway open throughout the night. OSA is also associated with other serious health complications, including high blood pressure, obesity, and an abnormal heart rate. Often a bed partner is the one who is first aware of a partner’s sleep-related breathing issues. Gasping while sleeping is usually a sign of OSA. Another important symptom is the tendency to fall asleep during the day at inopportune times, such as behind the wheel at a stoplight or lying down for a moment.

Time Spent Outdoors May Help Reduce Stress and Provide Multiple Health Benefits

British researchers suggest that time spent outside and living close to nature is associated with lower risks of stress, cardiovascular disease, high blood pressure, type 2 diabetes, and even premature death. The researchers arrived at this conclusion after reviewing the data from about 140 studies including 290 million people in 20 countries. In their report, published in Environmental Research, the researchers compared the health of people living near green spaces with people who had little access to parks, forests and other natural settings. In addition to the previously mentioned health benefits, people who spend more time in green spaces also enjoy greater sleep duration. One of the more interesting findings was that greater exposure to green space decreased people’s levels of salivary cortisol, a physiological marker of stress. The reasons for the health benefits associated with lakes, trees and outdoor settings weren’t entirely clear. The researchers suggested that people who live near outdoor recreation areas may be more likely to be physically active outside and have a generally healthier lifestyle; they may eat healthier foods and avoid unhealthy behaviors, such as smoking. Exposure to a wide variety of bacteria outdoors may benefit the immune system and help reduce inflammation.

The post News Briefs: Dehydration’s Effect on Brain Function; Sleep Apnea & Cognition appeared first on University Health News.

“What we are seeing in study findings is a validation of our clinical suspicions that sleep apnea is a condition that affects the function of the entire body. It exposes the body to higher levels of stress hor-mones and low levels of oxygen,” says Ana Krieger, MD, medical director of the Center for Sleep Medicine at Weill Cornell Medicine. “If you have sleep apnea, you have a higher risk of several car-diovascular conditions, including hypertension, stroke, atrial fibrillation, and heart failure.”

What Is Sleep Apnea?

The most common type of apnea, obstructive sleep apnea (OSA), is defined as the narrowing or collapse of the posterior aspect of the airway (typically behind the tongue) during sleep; in layperson’s terms, your throat muscles relax and partially or totally block (obstruct) the air from traveling into your chest and lungs.

“The most common sign of OSA is snoring, although not all snorers have OSA,” explains Dr. Krieger. Many people with OSA stop breathing for a few seconds, and they may make a gasping or choking sound when they resume breathing. Other symptoms include daytime fatigue or sleepiness and waking with a dry mouth.

WHAT YOU CAN DO

Other measures that you can take to reduce OSA include:

• Avoiding alcohol or medications, such as sedatives, that relax the muscles in your throat at night.
• Getting regular exercise.
• Treating allergies that may be causing blockages in your nasal passages.

According to Dr. Krieger, older age, obesity, and high blood pressure are key risk factors for OSA. For women, the chances of developing OSA increase after menopause.

Another type of apnea, central sleep apnea (CSA), is a result of underlying cardiovascular or neurological dysfunction; basically, the brain doesn’t send the proper signals to the muscles that control breathing. CSA may be caused by stroke, a brain tumor, or opioid medications, and patients who have heart failure or atrial fibrillation are at higher risk.

Severity Guides Treatment

“To decide on the best treatment options, we first need to analyze what level of OSA the patient has,” says Dr. Krieger.

The severity of OSA is determined by a sleep study, which monitors breathing interruptions as well as heart and brain activity, blood oxygen level, and other physiological functions while you sleep. If patients have changes in breathing more than five times per hour, that is considered abnormal. In severe cases, people with OSA have interrupted breathing more than 30 times per hour.

“For patients who have breathing changes five to 15 times an hour, we tend to recommend oral appliances that are similar to a mouth guard. These devices enhance the space in the back of the throat by moving the tongue forward,” explains Dr. Krieger.

Oral devices are available in some retail stores, but Dr. Krieger recommends seeing a dental sleep apnea specialist, who can evaluate the airway and decide if and what type of oral device is appropriate.

All About CPAP

Treatment with a continuous positive airway pressure (CPAP) machine is most often recommended for patients with severe OSA. The CPAP machine pushes air through a mask you wear over your nose (or nose and mouth) while you sleep, which keeps your airway open and allows uninterrupted breathing.

It can take some time to get used to a CPAP machine, and many patients can’t get comfortable with it.

“Look at equipment and mask options. Current machines are less problematic due to improve-ments that have been made, and the newer masks are much lighter and easier to use. There are also new ways to adjust the pressure settings on CPAPs; with some machines, it is possible to set up a Web interface that allows sleep specialists to adjust CPAP settings remotely, so patients no longer have to bring their CPAPs to their doctors,” explains Dr. Krieger.

If you’re reluctant to try a CPAP machine, or you’ve tried one before but given up, con-sider this: “Many patients say that using a CPAP has transformed their lives. Before treatment, many patients feel depressed and lethargic. After treatment, patients say they feel younger and they have more en-ergy and a better quality of family life. They also see health benefits, such as improvements in blood pressure and blood glucose levels,” says Dr. Krieger.

Other Treatment Options

Some patients have OSA only when they sleep on their backs. For these patients, there are belts that can be worn that force you to sleep on your side, and sleep shirts that have inflatable air balloons attached to the back that keep you from rolling onto your back. Dr. Krieger also notes that some patients are able to lessen or eliminate their OSA simply by losing weight.

“For patients that fail CPAP and other treatment methods, we have a device similar to a pace-maker that connects to a muscle close to the tongue; when the muscle is stimulated, the tongue moves, and the space opens in the back of the throat,” explains Dr. Krieger. The pacemaker is surgically implant-ed under the skin on the chest.

Don’t Ignore Sleep Problems

“During a doctor’s appointment, it can be difficult to find time to discuss sleep prob-lems,” says Dr. Krieger. “If you think you may have sleep apnea, or you have been diagnosed with sleep apnea but aren’t receiving treatment for it, set an appointment with your doctor to discuss your specific concerns about sleep. He or she may refer you to a sleep medicine specialist, who can focus on your sleep problems and guide your treatment decisions,” advises Dr. Krieger.

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