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David Fisher, MD, MPH: October 2009

House Calls Radio

House Calls Radio
Sundays at 10pm AM 560 WIND in Chicago

Sunday, October 25, 2009

Natural sleep aids in pregnancy

Tuesday morning on WMBI a caller asked if there was something safe that her daughter could take in her 7th month of pregnancy to help her sleep.  In the midst of a busy morning of calls, I gave her a kneejerk response by recommending the antihistamine diphenhydramine, the active ingredient in Benadryl.  This approach is safe, as diphenhydramine is a pregnancy category B medication (meaning that studies in humans have proven it to be generally safe for the unborn child).  However, I did not take the opportunity to discuss other natural remedies, as well as behavioral strategies for sleep in the later stages of pregnancy.  My response brought to light one of the problems in our health care system, namely, that the increasing demands of insurance companies and health care systems force doctors to rush through an office visit, and we often fall back to the old playbook of the most commonly recommended pharmaceutical solution, rather than exploring other 'natural' and behavioral remedies. I felt like I did the radio equivalent of a rushed office visit on Tuesday. Thankfully, I have the opportunity to follow up and explore those alternatives here.

Sleep patterns are clearly altered for pregnant women as they approach the birth of their baby.  The expanding uterus presses on the surrounding organs, making it difficult to last the night without having to get up to empty the crowded and shrunken bladder.  The sheer discomfort of the expanding abdomen, and the often corresponding back pain, make it difficult to sleep comortably, especially if the woman is used to sleeping on her stomach.  I believe that the disturbed sleep can help prepare an expecting mom for motherhood.  Once the baby is born, new moms are called upon to spend odd hours nursing and caring for their baby.  Every new parent knows that while their newborn may sleep 18 out of 24 hours, the sleep usually comes in 90-120 minute spurts followed by 1-2 hours of wakefulness.  Furthermore, newborns tend to have an opposite sleep cycle after birth, spending more time sleeping during daytime hours and more time awake at night.  In a way, the woman who has to adapt to irregular sleep patterns is being trained for the physical demands of early motherhood.

That being said, there are some simple ways to improve sleep during pregnancy.  The basic behavioral recommendations to improve sleep still apply.  Try to wake up and go to bed around the same time every day.  Avoid caffeine in general, but especially in the afternoon and evening.  It is important to continue to drink plenty of water during pregnancy, but try to limit your intake for 2-3 hours prior to sleep, and be sure to empty your bladder fully before bed.  Many women state that sleeping on the side and placing a pillow between the legs provides additional comfort.  Continuing to exercise during pregnancy is safe, and regular exercise has a positive impact on sleep.

Regarding "natural" sleep aids, some are safe in pregnancy and some are not.  It is important to remember that herbal and 'natural' remedies are not regulated by the FDA, so they can claim anything they want on their packaging without having to prove their claims with scientific studies.  Also, the FDA does not test the products to ensure that the ingredients listed on the label are actually contained in the supplement.  Some of the more popular sleep aids are below.

Melatonin is a chemical that resets the body's 24-hour clock, called the Circadian rhythm.  Pregnant women have naturally lower melatonin levels, and these lower levels may be important to the baby's development.  Therefore, I would not recommend melatonin durnig pregnancy.

Chamomile is commonly used to make tea that is used by many as a sleep aid.  Most would consider chamomile tea to be safe, but probably not the more concentrated chamomile oil.  I can safely recommend chamomile tea during pregnancy.

Valerian is an herb that has a mild effect on the body and is one of the safer herbal sleep aids, however, there is conflicing evidence about whether it is safe during pregnancy.  Therefore, I would play it safe and not use valerian during pregnancy.

5-HTP is a supplement used for depression that can also aid in sleep.  It affects serotonin levels, and while many doctors consider serotonin-altering medications to be generally safe in pregnancy, we do not have convincing evidence that it is completely safe.  Therefore, I would not recommend 5-HTP.

Kava was once a popular herbal supplement used for anxiety symptoms and insomnia.  Many problems with kava have been uncovered, including its harmful effects on the liver.  I do not recommend taking kava for any reason.

Tryptophan is not available as a supplement but is present in turkey, cheese, nuts, beans, eggs, and milk.  High levels have induced fetal tumors in laboratory animals, so seeking out tryptophan in high doses is not advised.  The amount of tryptophan in a glass of warm milk would be safe, and it may be enough to assist with falling asleep.

In summary, about the only "natural" sleep aids that I recommend are warm milk or chamomile tea.  Making some behavioral changes may also help with sleep during pregnancy, but in the later stages, it is probably unrealistic to maintain normal sleep patterns.  If you find yourself wide awake and frustrated as your due date nears, take a moment and pray for your baby.  It's a great way to prepare yourself spiritually and emotionally for the arrival of your child, while your body trains itself physically for more sleepless nights ahead.
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Saturday, October 24, 2009

Feature on Albert Schweitzer Fellowship website

The fine people at the Albert Schweitzer Fellowship recently invited me to participate in their "Five Questions for a Fellow" feature on their blog Beyond Boulders.

Read the article here.
Read more about Albert Schweitzer here.
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Saturday, October 3, 2009

The 411 on H1N1

Here it is: the breakdown you've been looking for on the flu vaccines.
Who should receive them?

First- the regular seasonal flu vaccine, available now.
You should get the flu vaccine this year.
The only people who should not are infants less than 6 months, people with an egg allergy, and people with a previous reaction to the flu vaccine.

Next- the H1N1 vaccine, available in the next few weeks.
The following groups of people should get this vaccine:
Pregnant women
Children age 6 months to 18 years
Caregivers for children this age
Young adults 18-24
Health care workers
People age 25-64 with a chronic medical condition
(Examples include diabetes, asthma, COPD, and autoimmune conditions)

People age 65 and older are at lower risk for H1N1, so they are not recommended for the vaccine until the higher priority groups are inoculated.  Sometime in December or January, people age 65 and older may be recommended to receive the H1N1 vaccine.

The H1N1 vaccine will be available as a nasal spray and as a shot.  Pregnant women cannot receive the nasal spray because it contains a live virus.  It is safe for everyone else except those with a compromised immune system (as in HIV).  Children under 10 will require 2 doses about 4 weeks apart.  Everyone else will need only one dose.
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This Week's Health Headlines

Scientists extend lifespan by blocking protein
Most babies born this century will live to 100
Yoga may decrease age-related "dowager's hump"
Yet another benefit of vitamin D- it prevents falls
Combination of generic drugs cuts heart risk by 60%
Federal WIC program finally allows use for fruits and veggies
Skinny friends could wreck your diet
Treating your kids to too much candy could land them in... jail?
Read more....