Insomnia

Sleep is an essential part of good health. A good night's sleep can help you feel good, look healthy, work effectively and think clearly. But sleep is not always so easy to come by. If you sometimes have trouble falling asleep or staying asleep, you're not alone. A 1991 Gallup study found that more than one-third of all Americans suffer occasional or chronic insomnia. People often are surprised to learn that daytime drowsiness is not an inevitable, harmless byproduct of modern life, but rather a key sign of a sleep problem that could be disastrous if not treated. Recent figures show that nearly a quarter of the population regularly cannot go to, or remain asleep, and every year doctors write out more than 14 million prescriptions for sleeping tablets. The causes of sleeplessness are many and varied. 'It can be due to a medical condition, such as chronic pain from rheumatism or arthritis,' says Professor Jim Horne, who runs the Sleep Research Laboratory at Loughborough University. 'Or it can be chemical, as a result of drinking tea, coffee or alcohol. Chronic or long-term insomnia is often associated with depression or anxiety, and environmental factors certainly contribute.' And sleepless nights, staring wild-eyed into the darkness, are worse than bad dreams, For too many people--an estimated 9percent of the American population--a good night's sleep is an elusive goal. The consequences of fatigue from chronic sleeplessness include accidents in the car and at work, a dramatically increased risk of major depression, and worsening physical illness. Immediate relief is available, in the form of hypnotic agents, for persons who have difficulty in falling or remaining asleep or who cannot obtain restful, restorative slumber. However, long-term improvement usually involves behavioral therapy. These therapeutic approaches must be integrated if the patient's short- and long-term needs are to be addressed.

Infertility

Infertility is defined as the inability to conceive after one year of trying, or the inability to carry pregnancies to a live birth. It affects one out of six couples of childbearing age in the United States today - at least ten million people. And in a career-oriented area like Washington, where many couples postpone decisions about childbearing until professional goals have been met, the ration of one in six is probably on the conservative side. Yet it is rarely discussed, and understood even less. For almost all couples the condition comes as a surprise. And no wonder. It seems as if the whole is on its guard against producing unwanted children. Every day 19.9 million women in this country wake up and remind themselves to take the Pill. In China, a woman with more than three children is considered an enemy of the state. In India, population experts fear the country may end up at century's close with four times as many people as it started with - up from 250 million in 1900 to one billion. The huge nation has resorted to quickie vasectomies and cash rewards at commuter train stations. Two will do posters are everywhere. Although infertility may affect people of all social classes, the childless poor usually have neither the time nor the money to undergo a lengthy series of tests - commonly called an infertility work-up - to determine the cause of the problem. There may also be class differences in a person's willingness to endure many sacrifices so that a long-range goal can be realized. For these reasons, the inability to conceive and bear children seems to be a middle and upper middle-class problem. The anguish of infertility will strike increasing numbers of couples in the next few years, however, as the children of the baby boom reach their late twenties and early thirties. Many who till now have postponed marriage and childbearing for their careers will turn to both to round out their lives - and find child-bearing not possible. The men, after years of enjoying what they consider a healthy sex drive, will be shocked to learn that their sperm are too few in number or perhaps not active enough to effect a conception. The women may be given a finding of endometriosis, a condition in which parts of the uterine lining seed themselves in various places along the reproductive tract. Unknown in cultures where women marry young, it is a common finding in American women past 30. Or the women may be part of the 10.9 million who took the Pill every day whether or not previous gynecological abnormalities should have warned the physician against a prescription. A generation ago, before the current explosion in medical technology, many couples who could not produce children were told there was nothing wrong with them: either it was all in their heads or God's will. There was also smirking ignorance on the public, the insinuation they weren't performing correctly in bed. In fact, male impotence is the source of less than five per cent of the cases of male infertility, and the sources of impotence are extremely varied, from diabetes to perineal nerve injury to psychogenic causes.

How to Start

You can get audio or video tapes that give breathing instruction and teach relaxation techniques at health food stores, bookstores, and by mail order. It's probably fine to learn breath and relaxation from a tape or booklet, but don't try the yoga exercises without a skilled teacher. He or she can make corrections, caution you when necessary, and help you to adapt poses, if you need to. It will be worth it to you to spend a little time finding an instructor who is right for you. Your diabetes nurse educator or other health care professional may be able to recommend a yoga instructor. Get referrals for a yoga instructor as you would for any professional you might wish to consult. Yoga instructors aren't required to be certified, but many are, through many different programs. Ask prospective teachers if they are certified. A certified teacher isn't necessarily better than someone who isn't certified, but it's something to consider. Yoga is fun, healthy, and calming. It's a wise way handed down over several thousands of years. There is little danger in yoga, and even a little progress brings with it freedom and peace of mind. Although most people with diabetes can exercise safely, exercise involves some risks. To shift the benefit-to-risk ratio in your favor, take these precautions: Have a medical exam before you begin your exercise program, including an exercise test with EKG monitoring, especially if you have cardiovascular disease, you are over 35, you have high blood pressure or elevated cholesterol levels, you smoke, or you have a family history of heart disease. Discuss with your doctor any unusual symptoms that you experience during or after exercise such as discomfort in your chest, neck, jaw, or arms; nausea, dizziness, fainting, or excessive shortness of breath; or short-term changes in vision. If you have diabetes-related complications, check with your healthcare team about special precautions. Consider exercising in a medically supervised program, at least initially, if you have peripheral vascular disease, retinopathy, autonomic neuropathy, or kidney problems. Learn how to prevent and treat low blood glucose levels (hypoglycemia). If you take oral agents or insulin, monitor your blood glucose levels before, during, and after exercise. If you have type I, and your blood glucose is above 250 milligrams per deciliter, check your urine for ketones. Don't exercise if ketones are present, because exercise will increase your risk of ketoacidosis and coma. Always warm up and cool down. Don't exercise outdoors when the weather is too hot and humid, or too cold.