Safe Effective Sleep Aids For Seniors
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Safe Efective Sleep Aids For Seniors
Choosing a safe, effective sleep aid can be difficult, especially as we get older. Take for example this research review, which practically says, when it comes to drugs, “Nope nope nope nope nope, definitely not, we don’t know, wow no, useful in one (1) circumstance only, definitely not, fine if you must”:
Review of Safety and Efficacy of Sleep Medicines in Older Adults
Let’s break it down…
What’s not so great
Tranquilizers aren’t very healthy ways to get to sleep, and are generally only well-used as a last resort. The most common of these are benzodiazepines, which is the general family of drugs with names usually ending in –azepam and –azolam.
Their downsides are many, but perhaps their biggest is their tendency to induce tolerance, dependence, and addiction.
Non-benzo hypnotics aren’t fabulous either. Z-drugs such as zolpidem tartrate (popularly known by the brand name Ambien, amongst others), comes with warnings that it shouldn’t be prescribed if you have sleep apnea (i.e., one of the most common causes of insomnia), and should be used only with caution in patients who have depression or are elderly, as it may cause protracted daytime sedation and/or ataxia.
See also: Benzodiazepine and z-drug withdrawal
(and here’s a user-friendly US-based resource for benzodiazepine addiction specifically)
Antihistamines are commonly sold as over-the-counter sleep aids, because they can cause drowsiness, but a) they often don’t b) they may reduce your immune response that you may actually need for something. They’re still a lot safer than tranquilizers, though.
What about cannabis products?
We wrote about some of the myths and realities of cannabis use yesterday, but it does have some medical uses beyond pain relief, and use as a sleep aid is one of them—but there’s another caveat.
How it works: CBD, and especially THC, reduces REM sleep, causing you to spend longer in deep sleep. Deep sleep is more restorative and restful. And, if part of your sleep problem was nightmares, they can only occur during REM sleep, so you’ll be skipping those, too. However, REM sleep is also necessary for good brain health, and missing too much of it will result in cognitive impairment.
Opting for a CBD product that doesn’t contain THC may improve sleep with less (in fact, no known) risk of long-term impairment.
See: Cannabis, Cannabinoids, and Sleep: a Review of the Literature
Melatonin: a powerful helper with a good safety profile
We did a main feature on this recently, so we won’t take up too much space here, but suffice it to say: melatonin is our body’s own natural sleep hormone, and our body is good at scrubbing it when we see white/blue light (so, look at such if you feel groggy upon awakening, and it should clear up quickly), so that and its very short elimination half-life again make it quite safe.
Unlike tranquilizers, we don’t develop a tolerance to it, let alone dependence or addiction, and unlike cannabis, it doesn’t produce long-term adverse effects (after all, our brains are supposed to have melatonin in them every night). You can read our previous main feature (including a link to get melatonin, if you want) here:
Melatonin: A Safe Natural Sleep Supplement
Herbal options: which really work?
Valerian? Probably not, but it seems safe to try. Data on this is very inconsistent, and many studies supporting it had poor methodology. Shinjyo et al. also hypothesized that the inconsistency may be due to the highly variable quality of the supplements, and lack of regulation, as they are provided “based on traditional use only”.
Chamomile? Given the fame of chamomile tea as a soothing, relaxing bedtime drink, there’s surprisingly little research out there for this specifically (as opposed to other medicinal features of chamomile, of which there are plenty).
But here’s one study that found it helped significantly:
The effects of chamomile extract on sleep quality among elderly people: A clinical trial
Unlike valerian, which is often sold as tablets, chamomile is most often sold as a herbal preparation for making chamomile tea, so the quality is probably quite consistent. You can also easily grow your own in most places!
Technological interventions
We may not have sci-fi style regeneration alcoves just yet, but white noise machines, or better yet, pink noise machines, help:
White Noise Is Good; Pink Noise Is Better
Note: the noise machine can be a literal physical device purchased to do that (most often sold as for babies, but babies aren’t the only ones who need to sleep!), but it can also just be your phone playing an appropriate audio file (there are apps available) or YouTube video.
We reviewed some sleep apps; you might like those too:
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Enjoy, and rest well!
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The Problem With Active Listening
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The problem with active listening
Listening is an important skill to keep well-trained at any age. It’s important in romantic relationships, parent-child relationships, friendships, and more.
First, for any unfamiliar or hazy-of-memory: active listening is the practice of listening, actively. The “active” side of this comes in several parts:
- Asking helpful questions
- Giving feedback to indicate that the answer has been understood
- Prompting further information-giving
This can look like:
- A: How did you feel when that happened?
- B: My heart was racing and I felt panicked, it really shocked me
- A: It really shocked you?
- B: Yes, because it was so unexpected; I’d never imagined something like this happening
- A: You’d never expect something like that
- B: No, I mean, I had no reason to
And… As a superficial listening technique, it’s not terrible, and it has its place
But unfortunately, if it’s one’s only listening technique, one will very quickly start sounding like a Furby—that children’s toy from the 90s that allegedly randomly parroted fragments of things that had been said to it. In fact this was a trick of programming, but that’s beyond the scope of this article.
The point is: the above technique, if used indiscriminately and/or too often, starts to feel like talking to a very basic simulacrum.
Which is the opposite of feeling like being listened to!
A better way to listen
Start off similarly, but better.
Ask open questions, or otherwise invite sharing of information.
People can be resistant to stock phrases like “How did that make you feel?”, but this can be got around by simply changing it up, e.g.:
- “What was your reaction?” ← oblique but often elicits the same information
- “I’m not sure how I’d feel about that, in your shoes” ← not even a question, but shows active attention much better than the “mmhmm” noises of traditional active listening, and again prompts the same information
Express understanding… But better
People have been told “I understand” a lot, and often it’s code for “Stop talking”. So, avoid “I understand”. Instead, try:
- “I can understand that”
- “Understandable”
- “That makes sense”
Ask clarifying questions… Better
Sometimes, a clarifying question doesn’t have to have its own point, beyond prompting more sharing, and sometimes, an “open question” can be truly wide open, meaning that vaguer is better, such as:
- “Oh?”
- “How so?” ← this is the heavy artillery that can open up a lot
Know when to STFU
Something that good therapists (and also military interrogators) know: when to STFU
If someone is talking, don’t interrupt them. If you do, they might not start again, or might skip what they were going to say.
Interruption says “I think you’ve said all that needs to be said there”, or else, if the interruption was to ask one of the above questions, it says “you’re not doing a good enough job of talking”, and neither of those sentiments encourage people to share, nor do they make someone feel listened-to!
Instead, just listen. Passive listening has its place too! When there’s a break, then you can go to one of the above questions/prompts/expressions of understanding, as appropriate.
Judge not, lest they feel judged
Reserve judgement until the conversation is over, at the earliest. If asked for your judgement of some aspect, be as reassuring as you can. People feel listened-to when they don’t feel judged.
If they feel judged, conversely, they can often feel you didn’t listen properly, or else you’d be in agreement with them. So instead, just sit on it for as long as you can.
Note: that goes for positive judgements too! Sit on it. Expressing a positive judgement too soon can seem that you were simply eager to please, and can suggest insincerity.
If this seems simple, that’s because it is. But, try it, and see the difference.
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When Doctors Make House Calls, Modern-Style!
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In Tuesday’s newsletter, we asked you foryour opinion of telehealth for primary care consultations*, and got the above-depicted, below-described, set of responses:
- About 46% said “It is no substitute for an in-person meeting with a doctor; let’s keep the human touch”
- About 29% said “It means less waiting and more accessibility, while avoiding transmission of diseases”
- And 25 % said “I find that the pros and cons of telehealth vs in-person balance out, so: no preference”
*We specified that by “primary care” we mean the initial consultation with a non-specialist doctor, before receiving treatment or being referred to a specialist. By “telehealth” we mean by videocall or phonecall.
So, what does the science say?
A quick note first
Because telehealth was barely a thing (statistically speaking) before the first stages of the COVID pandemic, compared to how it is now, most of the science for this is young, and a lot of the science simply hasn’t been done yet, and/or has not been published yet, because the process can take years.
Because of this, some studies we do have aren’t specifically about primary care, and are sometimes about specialists. We think this should not affect the results much, but it bears highlighting.
Nevertheless, we’ll do what we can with the science we have!
Telehealth is more accessible than in-person consultations: True or False?
True, for most people. For example…
❝Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare.
Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%.
Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information.❞
whereas…
❝Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people❞
~ Ibid.
Source: Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review
Now, perception of those things does necessarily equate to an actual increased barrier, but it is reasonable that someone who thinks something is inaccessible will be less inclined to try to access it.
The quality of care provided via telehealth is as good as in-person: True or False?
True, ostensibly, with caveats. The caveats are:
- We’re going offreported patient satisfaction, not objective patient health outcomes (we found little* science as yet for the relative incidence of misdiagnosis, for example—which kind of thing will take time to be revealed).
- We’re also therefore speaking (as statistics do) for the significant majority of people. However, if we happen to be (statistically speaking) an insignificant minority, well, that just sucks for us personally.
*we did find some, but it wasn’t very helpful yet. For example:
An electronic trigger to detect telemedicine-related diagnostic errors
this one does look at the incidence of diagnostic errors, but provides no control group (i.e. otherwise-comparable in-person consultations) for comparison.
While most oft-considered demographic groups reported comparable patient satisfaction (per race, gender, and socioeconomic status, for example), there was one outlier variable, which was age (as we quoted from that first study above).
However!
Looking under the hood of these stats, it seems that age is not the real culprit, so much as technological illiteracy, which is heavily correlated with age:
❝Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions. ❞
Source: Meta-analysis: eHealth literacy and attitudes towards internet/computer technology
There are things that can be done at an in-person consultation that can’t be done by telehealth: True or False?
True, of course. It is incredibly rare that we will cite “common sense”, (as sometimes “common sense” is actually “common mistakes” and is simply and verifiably wrong), but in this case, as one 10almonds subscriber put it:
❝The doctor uses his five senses to assess. This cannot be attained over the phone❞
~ 10almonds subscriber
A quick note first: if your doctor is using their sense of taste to diagnose you, please get a different doctor, because they should definitely not be doing that!
Not in this century, anyway… Once upon a time, diabetes was diagnosed by urine-tasting (and yes, that was a fairly reliable method).
However, nowadays indeed a doctor will use sight, sound, touch, and sometimes even smell.
In a videocall we’re down to two of those senses (sight and sound), and in a phonecall, down to one (sound) and even that is hampered. Your doctor cannot, for example, use a stethoscope over the phone.
With this in mind, it really comes down to what you need from your doctor in that consultation.
- If you’re 99% sure that what you need is to be prescribed an antidepressant, that probably doesn’t need a full physical.
- If you’re 99% sure that what you need is a referral, chances are that’ll be fine by telehealth too.
- If your doctor is 99% sure that what you need is a verbal check-up (e.g. “How’s it been going for you, with the medication that I prescribed for you a month ago?”, then again, a call is probably fine.
If you have a worrying lump, or an unhappy bodily discharge, or an unexplained mysterious pain? These things, more likely an in-person check-up is in order.
Take care!
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Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
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Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
First things first… How much fiber should we be eating?
- The World Health Organization recommends we each get at least 25g of fiber per day:
- A more recent meta-review of studies, involving thousands of people and decades of time, suggests 25–29g is ideal:
- The British Nutritional Foundation gives 30g as the figure:
- The US National Academy of Sciences’ Institute of Medicine recommends 21g–38g per day, depending on age and sex:
- A large study last year gave 30–40g as the figure:
*This one is also a great read to understand more about the “why” of fiber
Meanwhile, the average American gets 16g of fiber per day.
So, how to get more fiber, without piling on too many carbs?
Foods that contain fiber generally contain carbs (there’s a limit to how much celery most people want to eat), so there are two key ideas here:
- Getting a good carb:fiber ratio
- Making substitutions that boost fiber without overdoing (or in some case, even changing) carbs
Meat → Lentils
Well-seasoned lentils can be used to replaced ground beef or similar. A cup of boiled lentils contains 18g of fiber, so you’re already outdoing the average American’s daily total.
Meat → Beans
Black beans are a top-tier option here (15g per cup, cooked weight), but many kinds of beans are great.
Chicken/Fish → Chickpeas
Yes, chicken/fish is already meat, but we’re making a case for chickpeas here. Cooked and seasoned appropriately, they do the job, and pack in 12g of fiber per cup. Also… Hummus!
Bonus: Hummus, eaten with celery sticks.
White pasta/bread → Wholewheat pasta/bread
This is one where “moderation is key”, but if you’re going to eat pasta/bread, then wholewheat is the way to go. Fiber amounts vary, so read labels, but it will always have far more than white.
Processed salty snacks → Almonds and other nuts
Nuts in general are great, but almonds are top-tier for fiber, amongst other things. A 40g handful of almonds contains about 10g of fiber.
Starchy vegetables → Non-starchy vegetables
Potatoes, parsnips, and their friends have their place. But they cannot compete with broccoli, peas, cabbage, and other non-starchy vegetables for fiber content.
Bonus: if you’re going to have starchy vegetables though, leave the skins on!
Fruit juice → Fruit
Fruit juice has had most, if not all, of its fiber removed. Eat an actual juicy fruit, instead. Apples and bananas are great options; berries such as blackberries and raspberries are even better (at around 8g per cup, compared to the 5g or so depending on the size of an apple/banana)
Processed cereals → Oats
5g fiber per cup. Enough said.
Summary
Far from being a Herculean task, getting >30g of fiber per day can be easily accomplished by a lentil ragù with wholewheat pasta.
If your breakfast is overnight oats with fruit and some chopped almonds, you can make it to >20g already by the time you’ve finished your first meal of the day.
Enjoy!
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‘Naked carbs’ and ‘net carbs’ – what are they and should you count them?
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According to social media, carbs come in various guises: naked carbs, net carbs, complex carbs and more.
You might be wondering what these terms mean or if all carbs are really the same. If you are into “carb counting” or “cutting carbs”, it’s important to make informed decisions about what you eat.
What are carbs?
Carbohydrates, or “carbs” for short, are one of the main sources of energy we need for brain function, muscle movement, digestion and pretty much everything our bodies do.
There are two classifications of carbs, simple and complex. Simple carbs have one or two sugar molecules, while complex carbs are three or more sugar molecules joined together. For example, table sugar is a simple carb, but starch in potatoes is a complex carb.
All carbs need to be broken down into individual molecules by our digestive enzymes to be absorbed. Digestion of complex carbs is a much slower process than simple carbs, leading to a more gradual blood sugar increase.
Fibre is also considered a complex carb, but it has a structure our body is not capable of digesting. This means we don’t absorb it, but it helps with the movement of our stool and prevents constipation. Our good gut bacteria also love fibre as they can digest it and use it for energy – important for a healthy gut.
What about ‘naked carbs’?
“Naked carbs” is a popular term usually used to refer to foods that are mostly simple carbs, without fibre or accompanying protein or fat. White bread, sugary drinks, jams, sweets, white rice, white flour, crackers and fruit juice are examples of these foods. Ultra-processed foods, where the grains are stripped of their outer layers (including fibre and most nutrients) leaving “refined carbs”, also fall into this category.
One of the problems with naked carbs or refined carbs is they digest and absorb quickly, causing an immediate rise in blood sugar. This is followed by a rapid spike in insulin (a hormone that signals cells to remove sugar from blood) and then a drop in blood sugar. This can lead to hunger and cravings – a vicious cycle that only gets worse with eating more of the same foods.
Naked carbs can make blood sugars spike then crash.
Pexels/Alexander GreyWhat about ‘net carbs’?
This is another popular term tossed around in dieting discussions. Net carbs refer to the part of the carb food that we actually absorb.
Again, fibre is not easily digestible. And some carb-rich foods contain sugar alcohols, such as sweeteners (like xylitol and sorbitol) that have limited absorption and little to no effect on blood sugar. Deducting the value of fibre and sugar alcohols from the total carbohydrate content of a food gives what’s considered its net carb value.
For example, canned pear in juice has around 12.3g of “total carbohydrates” per 100g, including 1.7g carb + 1.7g fibre + 1.9g sugar alcohol. So its net carb is 12.3g – 1.7g – 1.9g = 8.7g. This means 8.7g of the 12.3g total carbs impacts blood sugar.
The nutrition labels on packaged foods in Australia and New Zealand usually list fibre separately to carbohydrates, so the net carbs have already been calculated. This is not the case in other countries, where “total carbohydrates” are listed.
Does it matter though?
Whether or not you should care about net or naked carbs depends on your dietary preferences, health goals, food accessibility and overall nutritional needs. Generally speaking, we should try to limit our consumption of simple and refined carbs.
The latest World Health Organization guidelines recommend our carbohydrate intake should ideally come primarily from whole grains, vegetables, fruits and pulses, which are rich in complex carbs and fibre. This can have significant health benefits (to regulate hunger, improve cholesterol or help with weight management) and reduce the risk of conditions such as heart disease, obesity and colon cancer.
In moderation, naked carbs aren’t necessarily bad. But pairing them with fats, protein or fibre can slow down the digestion and absorption of sugar. This can help to stabilise blood sugar levels, prevent spikes and crashes and support personal weight management goals. If you’re managing diabetes or insulin resistance, paying attention to the composition of your meals, and the quality of your carbohydrate sources is essential.
A ketogenic (high fat, low carb) diet typically restricts carb intake to between 20 and 50g each day. But this carb amount refers to net carbs – so it is possible to eat more carbs from high-fibre sources.
Choose complex carbohydrates with lots of fibre.
ShutterstockSome tips to try
Some simple strategies can help you get the most out of your carb intake:
reduce your intake of naked carbs and foods high in sugar and white flour, such as white bread, table sugar, honey, lollies, maple syrup, jam, and fruit juice
opt for protein- and fibre-rich carbs. These include oats, sweet potatoes, nuts, avocados, beans, whole grains and broccoli
if you are eating naked carbs, dress them up with some protein, fat and fibre. For example, top white bread with a nut butter rather than jam
if you are trying to reduce the carb content in your diet, be wary of any symptoms of low blood glucose, including headaches, nausea, and dizziness
- working with a health-care professional such as an accredited practising dietitian or your GP can help develop an individualised diet plan that meets your specific needs and goals.
Correction: this article has been updated to indicate how carbohydrates are listed on food nutrition labels in Australia and New Zealand.
Saman Khalesi, Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, CQUniversity Australia; Anna Balzer, Lecturer, Medical Science School of Health, Medical and Applied Sciences, CQUniversity Australia; Charlotte Gupta, Postdoctoral research fellow, CQUniversity Australia; Chris Irwin, Senior Lecturer in Nutrition and Dietetics, School of Health Sciences & Social Work, Griffith University, and Grace Vincent, Senior Lecturer, Appleton Institute, CQUniversity Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Polyphenol Paprika Pepper Penne
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This one’s easier to promptly prepare than it is to pronounce unprepared! Ok, enough alliteration: this dish is as full of flavor as it is full of antioxidants, and it’s great for digestive health and heart health too.
You will need
- 4 large red bell peppers, diced
- 2 red onions, roughly chopped
- 1 bulb garlic, finely chopped
- 2 cups cherry tomatoes, halved
- 10oz wholemeal penne pasta
- 1 tbsp nutritional yeast
- 1 tbsp smoked paprika
- 1 tbsp black pepper
- Extra virgin olive oil for drizzling
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 200℃ / 400℉ / Gas mark 6
2) Put the vegetables in a roasting tin; drizzle with oil, sprinkle with the seasonings (nooch, paprika, black pepper), stir well to mix and distribute the seasonings evenly, and roast for 20–25 minutes, stirring/turning occasionally. When the edges begin to caramelize, turn off the heat, but leave to keep warm.
3) Cook the penne al dente (this should take 7–8 minutes in boiling salted water). Rinse in cold water, then pass a kettle of hot water over them to reheat. This process removed starch and lowered the glycemic index, before reheating the pasta so that it’s hot to serve.
4) Place the roasted vegetables in a food processor and blitz for just a few seconds. You want to produce a very chunky sauce—but not just chunks or just sauce.
5) Combine the sauce and pasta to serve immediately.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Which Bell Peppers To Pick? A Spectrum Of Specialties ← note how red bell peppers are perfect for this, as their lycopene quadruples in bioavailability when cooked
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- The Many Health Benefits Of Garlic
- What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
Take care!
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Get The Right Help For Your Pain
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How Much Does It Hurt?
Sometimes, a medical professional will ask us to “rate your pain on a scale of 1–10”.
It can be tempting to avoid rating one’s pain too highly, because if we say “10” then where can we go from there? There is always a way to make pain worse, after all.
But that kind of thinking, however logical, is folly—from a practical point of view. Instead of risking having to give an 11 later, you have now understated your level-10 pain as a “7” and the doctor thinks “ok, I’ll give Tylenol instead of morphine”.
A more useful scale
First, know this:
Zero is not “this is the lowest level of pain I get to”.
Zero is “no pain”.
As for the rest…
- My pain is hardly noticeable.
- I have a low level of pain; I am aware of my pain only when I pay attention to it.
- My pain bothers me, but I can ignore it most of the time.
- I am constantly aware of my pain, but can continue most activities.
- I think about my pain most of the time; I cannot do some of the activities I need to do each day because of the pain.
- I think about my pain all of the time; I give up many activities because of my pain.
- I am in pain all of the time; It keeps me from doing most activities.
- My pain is so severe that it is difficult to think of anything else. Talking and listening are difficult.
- My pain is all that I can think about; I can barely move or talk because of my pain.
- I am in bed and I can’t move due to my pain; I need someone to take me to the emergency room because of my pain.
10almonds tip: are you reading this on your phone? Screenshot the above, and keep it for when you need it!
One extra thing to bear in mind…
Medical staff will be more likely to believe a pain is being overstated, on a like-for-like basis, if you are a woman, or not white, or both.
There are some efforts to compensate for this:
A new government inquiry will examine women’s pain and treatment. How and why is it different?
Some other resources of ours:
- The 7 Approaches To Pain Management ← a pain specialist discusses the options available
- Managing Chronic Pain (Realistically!) ← when there’s no quick fix, but these things can buy you some hours’ relief at least / stop the pain from getting worse in the moment
- Science-Based Alternative Pain Relief ← for when you’re maxxed out on painkillers, and need something more/different, these are the things the science says will work
Take care!
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