Insomnia - What could I do ?

Insomnia , in other word, sleep deprivation , is a common phenomenon which happen often among the people in this modern era.  Back in the childhood time, your mum used to ask you to count the sheep, in ascending order, until you fall asleep. However, when you get older, this trick did not work anymore. The longer you count, the longer the sleepless night it is.  

Sleep is vital in our life. Enough sleep rejuvenates you physically and mentally and get you ready to face challenges in your life. It is such a torture if you could not sleep enough and properly. 

Insomnia is a big umbrella which encompasses your inability to fall asleep , or feel hard to remain your sleep throughout the night , or early morning wakening or unrefreshing sleep ( in turn, make you feel more drowsy and tired in the morning).

Image sourced from Google search 

What are the causes of insomnia ? 

a) Emotional component: When you are under stress - the exam is just a few more days around the corner; when you are too excited as the exam is ending tomorrow; when you are sad due to boyfriend-girlfriend crisis; when you are emotional owing to family problems, office politics etc.

b) Physical component: Exercise too close to sleeping time, traveling across the globe (jet-lag), drinking or eating too late (especially caffeine and alcohol intake), jump on to you bed too early (than usual)

c) Medical conditions: Pain - neuropathic or physical pain - sufferings that disturbs your sleep, depression , mental disorder, heart failure, sleep apnoea etc

d) Medications - certain medicines you are taking may make you stay alert at night and can't fall asleep. Eg pseudoephedrine in your Cold and Flu medicine, fluoxetine, prednisolone 

Therefore, talk to your doctor or pharmacist when you encounter sleeping problems and discuss with them openly to find out the reasons you are experiencing insomnia currently.

Bear in mind that insomnia is often a symptom rather than a disease. Figure out the underlying problem could be helpful in making you having sweet dreams again.

What are the treatments available ? 

First, try not to use medicine ( well, even though I am a pharmacist-to-be, I would not recommend you to take medicine to help you sleep).

Behavioural change could be helpful if you just have a mild insomnia. Sleep hygiene is important. Try to have regular day-night cycle. I understand that  most of us are overwhelmed with so many tasks in out working or studying life. Ergo, while we had a break, we would not miss any single minute we have during four off-day - ends up with late night sleep. And, this disturb your sleeping cycle and may eventually lead to insomnia.

Advice 1 - Even though it is your off day , try to go to the bed same time. DO not exploit your body.

Exercise and eat healthy food is the advice for almost all diseases or disorders.

Advice 2 - Do regular exercise,

Frankly it is hard to exercise everyday. But, just a question here for yourself - if someone pay you one million to exercise , would you not able to do it everyday ?  Just take it as your future-self is paying for your current-self to exercise so that when you get old , you won't have to pay huge amounts of medical cost. Trust me, this is the best investment you will have in your entire life.

I could understand that there will be time ,when you are under extreme stress or some medical conditions or medicines which make you hard to fall asleep. There are a few OTC medicines you can get to help yourself in short term : -

a) Unisom (diphenhydramine 50mg)

Diphenhydramine
Image sourced from Google search 

- Take ONE capsule before bed when required to help you sleep

b) Dozile ( doxylamine 25 mg)

Doxylamine
Image sourced from Google search 

- Take ONE capsule 20-30 minutes before bedtime when required to help sleep.

OTC medicines available are usuallyy sedating antihistamines which help you to fall asleep more easily.


However, if any of the following situations happen , you might need to  see a doctor :

1. the sleepiness drains you out and you cannot focus on your daily activities
2. you are nxious or depressed about your conditions
3. you have recurrent episodes of insomnia  frequently
4. you have sleeping problems more than 3 weeks
5. you have tried OTC medicines and still see no obvious improvement in your sleep

Your general GP may examine you and discuss solutions together with you,

Advice 3 - Do NOT take the '"shortcut" to help you sleep via medicine. Most of the medicines will lose its effect to help you to sleep if you ar eon them regularly (dependence and tolerance issue)

Of course, there are also natural herbs or traditional method, alternative medicines  to help you sleep.

1. Massaging can relax your body and make you sleep better

2. Melatonin could be used to help with your circadian rhythm ( especially for those who have low endogenous melatonin)

3. Other ingredients include L-tryptophan , valerian , lemon balm etc



We all enjoy a good sleep ( well, sometimes I would tell others that sleeping is my hobby). That's a joke. Try not to have too long afternoon nap as it may make you hard to fall asleep at night too.


Good night.



Sweet dream

Image sourced from Google search 

zzzz......

References

1. Pharmacy Today Handbook 2015

2. New Zealand Formulary

3. Hughes RJ, Badia P. Sleep-promoting and hypothermic effects of daytime melatonin administration in humans. 1997, 20(2):124-131.

4. https://sleepfoundation.org/insomnia/content/what-causes-insomnia

Seabather's eruption (Sea lice)

Encountered with a patient who seek help in the pharmacy. She said she went to swim in the sea and develop rashes over some parts of the body. And, she felt itchy and hard to resist to scratch.

It's about summer time. Swimming in the sea seems like a good choice during weekend to getaways. 

You may encounter with this also - a hypersensitivity reaction to  marine life 'bites' which result in itchy rashes. Do not worry too much. 

Seabather's eruption, more commonly known as sea lice , or pika-pika, ocean itch, is indeed a skin hypersensitivity reaction owing to marine creature's sting. The common 'culprits' for this allergic reaction are thimble jellyfish and sea anemone. They usually sing on our body when they get trapper under our swimsuit. 

Signs and symptoms 

The bites usually looks like flea-bite - small, angry-red dots, that could be in clusters. 

Usually, they are very itchy. (caused by the larvae trapped underneath your swimsuit and in turn sting your skin and release the toxin that causes hypersensitivity reactions. ) It may manifest as soon as few hours after swimming. 

Sometimes, you may experience systemic effect such as low grade fever, nausea, general unwell, headache. 

Example of sea bather's eruption.
Image sourced from dermnet.org.nz 

Treatment and advice 

Do not rub your skin especially you are still on your swimsuit. This may cause more larva to sting you and make the condition worse. 

Remove your swimsuit as soon as possible. Do not wear it again until you remove the larvae that might remain on the suit. You can rinse your swimsuit with vinegar or rub with alcohol

Take antihistamine such as loratadine or ceterizine to ease the itchiness. try not to scratch. 

If the itch is intense or become painful, can apply topical corticosteroid e.g. hydrocortisone 1% on those red-angry, inflamed affected area. 

Talk to a pharmacist to seek his/her advice. 

If the rashes spread to extended area of the body or pus coming out from the affected are or unexplained high fever - see a doctor immediately. 

Stingose API : aluminium sulphate
 (suitable for sea lice stings)  

Antihistamine- loratadine
Image sourced from Google search 

Hydrocortisone 1%
Image sourced from Google search 

Antihistamine - ceterizine
Image sourced from Google search 

References 

1. http://www.stuff.co.nz/auckland/local-news/waiheke-marketplace/4484891/Sea-lice-an-itchy-problem 

2. http://www.webmd.com/skin-problems-and-treatments/tc/seabathers-eruption-topic-overview#2

3. dermnet.org.nz - http://www.dermnetnz.org/topics/sea-bathers-eruption/

4. http://www.beautyhealthplus.org/2016/07/sea-lice-rash-symptoms-pictures-get-rid-prevention.html

5. http://emedicine.medscape.com/article/1088160-overview

6. http://www.stingose.co.nz

Smoking cessation awareness

Went to the shopping mall at saw a few teenagers were smoking cigarettes. They are still so young and they thought they are trendy. Seriously, Smoking cessation awareness needs to be increased in the public.

There are helps all around. You just need to take the first step , an the rest will come easily.

Every year, we head that the government has increased the taxation on cigarettes and enact law to increase the sole-free zone. Yet, almost ONE in SIXTH of Malaysian is lighting up their cigarettes every day. This number is appalling. These are definitely good moves but they are not enough. Most time, there may be peer pressure among teenagers that lead to smoking. They think, smoking is a cool stuff.  Smoking makes you look "rich". And, they spent money on smoking so that their friends accept them.

Education is crucial in this case. Smoking is definitely NOT a cool thing to do!

Image sourced from Google search

There is no such age thing where it is too late for you to stop smoking. The earlier you start, the better it is. However, there is no such thing is it is too late.

As in Malaysia, there is a mQuit, which offers quit-smoking program which is personalised for you.

One thing to understand that it is not a one-off effort. Most of the smokers who successfully quit smoking have attempted many times. Determination is the key. Think about yourself, think about your family , think about the better life you can live up to.

The craving is hard to stop. If you are on stop-smoking attempt - make sure that you discuss with health professionals. Most of them are ready to help, if not, they know whom to recommend for you. If you are trying hard to quit smoking with some help of medicines such as nicotine patches, gums, lozenges or Champix, yet you have the urge to smoke some time during the day - try these :

1. Delay acting on the urge to smoke -  just tell yourself you gonna light the cigarette up later and wait till the urge is weakened to the point that you can resist.
2. Deep breath - take a deep breath when the urge is sudden - just breathe in and out slowly  this could calm your mind
3. Drink water - drink a mouthful of water and drink it down slowly.
4. Do something else - do something that you love that can take your  mind off smoking - listen to music, go for a walk, talk to someone else.

Do not give up. It is ok to fail, but seek advice from the health professionals and discuss about the reasons that you fail. Figuring out the causes together and work on it, usually you will be a smoke-free person. 

Image sourced from Google search

References 

1. TheStar
2. mQuit 
3. https://ajp.com.au/education/clinical-pharmacy/clinical-tips-quit-smoking/
4. https://www.quit.org.nz/47/staying-quit/cravings-and-stress