Posted by & filed under Noah's Notes.

Insomnia is one of the most frequent complaints that a primary provider hears in the office. 50% of adults experience it in their lifetime and up to 10% of adults may suffer from long-term insomnia. It is also one of the most challenging to treat and one of the most misunderstood of the common ailments that people face. In the past this malady was poorly understood and it was felt to be a symptom of some other underlying condition, such as anxiety, depression, medical sleep disorders or medication. It was also thought that it could be improved if you addressed that underlying disorder. While all of these problems can cause sleep disturbances, we now also understand that insomnia can occur in the absence of those underlying problems or may need to be treated in addition to dealing with the underlying issues. In fact, we know that lack of sleep or ineffective sleep makes many chronic diseases more difficult to manage, and successfully treating insomnia can improve those diseases.

First of all, insomnia can present in a variety of ways. It can be difficulty falling asleep, difficulty staying asleep, or waking early and being unable to go back to sleep and in order for it to be diagnosed as insomnia, it must result in difficulty functioning during the day (for example, fatigue, sleepiness, difficulty concentrating, forgetfulness, low energy).

Short term insomnia (less than 3 months duration) is usually associated with life stress or environmental stress. This can be anything from a change in the sleep environment (light, noise, temperature) to the loss of a loved one, illness, pain or withdrawal from certain substances like caffeine or alcohol, a variety of prescription medications and illegal drugs. Jet lag and shift work are also common causes of short term insomnia. Long term insomnia is, as previously noted, often associated with chronic diseases, anxiety and depression, with some medications and illegal drugs and with the use of substances like alcohol and caffeine.

Contrary to popular belief and practice, the best treatments for insomnia do not involve drugs. A variety of behavioral treatments can be effective and are much safer in the short and long run than medications. These include sleep hygiene (get out of bed when you’re not sleeping, keep a regular schedule, don’t try to force sleep, exercise daily, avoid caffeine after lunch, deal with worries prior to bedtime, etc.), relaxation techniques, biofeedback and stimulus control (limiting time spent trying to fall asleep to 20 minutes, get up at the same time every day, don’t nap during the day), sleep restriction, cognitive therapy (developing the skill to break anxious cycles of thought that keep you awake), and even light therapy. It’s important to understand that all of the prescription medicines used for insomnia lose effectiveness over time, have potentially very serious side effects (sleep walking, eating and even driving, increased risks of falls and accidents) and most carry a risk of addiction. Overdose is also a concern, especially when these medications are combined with alcohol.

Finally it’s important to understand that not all people require the same amount of sleep and that sleep duration may decrease as a natural part of the aging process.

For more information you can go to:,, or and search for “insomnia”.

Posted by & filed under Noah's Notes.

Keeping up with the most current information in medicine is always challenging.  It is a rapidly changing landscape and as our knowledge expands, standards of care change and recommendations are adapted.  However, there have also always been pervasive yet unfounded “medical myths” that are often quoted and can even be perpetuated by those of us in the profession.  In recognition of April Fool’s Day here are just a few medical myths and some actual facts.

  • Sugar causes hyperactivity in children – many well accepted studies have shown no impact of diets containing various levels of sugar on children’s behavior.  However, when parents were told that their children had received a high sugar treat they perceived their child as being more active, whether the child had received sugar or not.  This belief is deeply engrained in our society and the many parents and healthcare providers believe this myth.  On the other hand, if it results in a decrease in simple sugars in childrens’ diets perhaps we should leave well enough alone!
  • You should drink 8 glasses of water a day – There is no science to suggest that there is a health benefit from this practice.  You should drink as thirst dictates.
  • Cracking your knuckles causes arthritis – It does not.  If you are relentless it can loosen the joint, but the practice is otherwise harmless.  The cracking sound is actually the sound that results from the formation of a small gas bubble in the joint as the joint space is slightly expanded by the movement torsion applied during the activity.
  • Teething causes fever in babies – It does not cause either fever or diarrhea.  Fever should be evaluated if it is high or persistent.  Teething does cause pain and pain relievers like acetaminophen can help.
  • If you normally run a below average body temperature, a temp of 98.6 is a fever – It is not a fever and does not indicate illness, no matter where you may think your normal temp runs.  In fact, temperatures under 100 F in adults don’t mean much.
  • Back pain should be treated with rest – Most back pain will resolve on its own and it typically gets better sooner if you stay active.  XRays are usually not necessary either.
  • Tryptophan in Turkey causes drowsiness – It doesn’t, but overeating does.
  • Coffee helps you to become sober faster – although caffeine may modestly affect the drowsiness caused by alcohol intoxication, it does not lower alcohol levels in the blood.  The best advice is to avoid drinking to the point of inebriation in the first place.
  • You should wait 30 minutes after eating before going swimming – My mother enforced this with great fervor, much to my (and my siblings’) dismay.  In fact, unless you are swimming vigorously for exercise (when a full stomach can make any exercise more difficult) there is no problem with going swimming right after eating.  The fear is that the exertion diverts blood away from the stomach and slows digestion, which can cause cramping.  In fact that does not happen with recreational swimming.
  • A full moon makes people act crazy – This is a long held belief with no foundation in reality (and reflects the origin of the word “lunatic” as in “lunar” as in moon).  Studies have shown no increase in unusual behavior or psychotic episodes or use of ERs at the time of a full moon.  This myth persists among many medical personnel and is an example of recall bias (giving more weight in your memory to incidents that reinforce your pre-existing beliefs).  I’ve had this good natured debate with other healthcare providers more than once!

Here is a link where you can learn more about medical myths:

Posted by & filed under Noah's Notes.

Over the last few decades a number of vitamin supplements have had their 15 minutes of fame as they were promoted for unproven health benefits. Linus Pauling incorrectly postulated that vitamin C supplements could prevent and treat viral infections, a concept which still persists and is manifested in the extreme by a story I recently heard of a man who decided to forego his usual daily bottle of cola in favor of orange soda because he had a cold! Vitamin E supplements were widely promoted for heart health because vitamin E is an anti-oxidant. But studies failed to show any benefit and there may be adverse effects from taking vitamin E supplements regularly. Read more »