There are more than 84 types of sleep disorders. Treatment depends upon the cause(s). Sleep problems can be caused by factors as benign as a change in living arrangements or as serious as a brain disease or a tumor.

Follow these general guidelines for better sleep hygiene.

• Set a regular time to go to bed — a key component to improving sleep — and adhere to this as closely as possible. If you cannot fall asleep within a reasonable period of time, get out of bed, leave the bedroom and do something nonstimulating. This may be watching a late-night talk show or reading. After 30-60 minutes, try again to fall asleep. The idea is to not spend too much time in bed awake. An association between the bed and an inability to fall asleep can increase the problem.

• Establish a regular wake-up time. No matter how long it took to fall asleep, no matter how little sleep you have had, no matter how flexible the morning schedule is, there should be no “sleeping in.” This will only further confuse and disorganize the internal biological clock.

• Make the sleep environment as comfortable as possible. Make your bedroom dark and quiet, neither too hot nor too cold. Although minor fluctuations in room temperature and firmness of the mattress probably have little impact on sleep, extremes can be disturbing.

• Omit alcohol and caffeine in the late afternoon and evening. For the very sensitive, caffeine intake may need to cease each day by noon. Alcohol is often used as a self-treatment for relaxation and sleep induction, but it is disruptive to the sleep-wake cycle.

• Develop a sleep habit using the bedroom primarily as a place to sleep. Although many people use the bedroom for watching television, preparing work for the following day, eating snacks and paying bills, the person with a sleep problem needs to set the bedroom aside for sleep only.

• Carefully time meals and exercise. In some individuals, a heavy meal late in the evening can severely disrupt sleep. Heavy exercise too late in the evening also can lead to sleep difficulty.

• Some people simply need to relax sufficiently to allow sleep to occur. Relaxation tapes can facilitate this process.

• Since at least 35 percent of those with sleep difficulties have an identifiable psychological cause, some form of treatment should be considered.

Consult your physician if sleeping problems persist. If you or someone you know appears to suffer from a sleep problem, call for help.

Throughout the past six months, more than 80 percent of the responding hospital pharmacy directors indicated they experienced the effects of drug shortages on a daily basis. These drugs include, but are not limited to, those used in surgery and anesthesia, emergency care, intravenous nutrition and cancer care. In all, the U.S. Food and Drug Administration has identified more than 250 pharmaceuticals in limited supply — a record number.

“Drug shortages are hampering hospitals’ ability to provide the best possible care to the communities they serve,” said Herb B. Kuhn, MHA president and CEO. “The inability to obtain certain drugs has led to unavoidable delays in patient treatment and the use of alternative pharmaceuticals.

“Hospital pharmacists and physicians throughout the state have expended significant energy to find or formulate medications for their patients,” Kuhn said. “When specific drugs were unavailable, they identified the best alternatives to help provide safe, effective care.”

Every pharmacy director participating in the survey indicated they had experienced a shortage, with 82 percent reporting daily shortages and 17 percent citing weekly shortages. These shortages generally come without warning or explanation. Among the hospital pharmacy directors, 92 percent reported no warning of the shortage, and 90 percent reported minimal information about the cause of the shortage. In 88 percent of shortages, the duration of the shortage was unknown.

Patient care is affected by pharmaceutical availability. Of those surveyed, 28 percent indicated that shortages had led to delayed care, and 52 percent said that shortages resulted in patients not receiving the recommended drug.

“Stabilizing the system would allow hospitals to identify problems earlier and develop systems to work around shortages,” Kuhn said. “Not seeing these problems coming costs both patients and hospitals. Congress should create an early warning system for shortages and formalize the distribution of information about responses and alternative therapies.”

The shortage is adding to the costs of health care. According to the survey, 86 percent of hospital pharmacy directors had expended substantial resources responding to drug shortages and had difficulty obtaining suitable alternative products. When alternatives could be found, they were often at a much higher cost.

The shortages are not limited to a specific class of drug but extend to a broad spectrum of pharmaceuticals. Nearly 70 percent of pharmacy directors reported that more than 21 drugs were of limited supply or unavailable during a six-month period.

“Last July, the American Hospital Association surveyed its members about the pharmaceutical shortage,” Kuhn said. “Their results mirror our data. This means that the despite efforts by many federal regulatory agencies, the problem has not improved during the past year.

“Next week, MHA members will be in Washington, D.C., addressing the drug shortage and other health care issues with members of Missouri’s congressional delegation. I’m hopeful that we can make progress on this issue. It is critically important to hospitals’ ability to deliver safe, effective patient care.”

While teenagers may feel independent, this is a question that needs to be discussed as a family, according to Michelle Nadler, APRN, BC, pediatric liver transplant nurse practitioner at St. Louis Children’s Hospital.

Even if a teenager signs the back of his or her driver’s license to indicate organ donor status, the family still has to give permission in the event of a tragedy. Signing the driver’s license can open the door to conversation.

“It’s difficult to make a decision if you’ve never talked about organ donation and you’re dealing with the shock of losing a child,” Nadler says. “No one wants to think about the loss of a child, but unfortunately, sudden death happens every day. It’s easier to have a conversation around the dinner table to explore feelings about organ donation rather than during a crisis. This also gives teens some autonomy to make their own decisions. Then, you can prepare and carry out each other’s wishes if you should ever need to.”

Before talking with your teen about organ and tissue donation, educate yourself about the topic by researching trusted online resources together. One valuable source of information about donation is DonateLife.net. You also can register to donate online at the site by state.

Unfortunately, too many families never have the conversation or are hesitant to donate because they don’t know enough about organ and tissue donation, according to Nadler.

“Some people fear signing their driver’s licenses because they think in the case of an emergency, doctors won’t do everything they can to save them. That’s simply not true,” Nadler says. “Only after a patient is determined to have brain death is the family asked about organ donation.”

The Benefits of Donating

Organ and tissue donation is the gift of life. Up to eight people can benefit through solid organ donations of the lungs, heart, kidneys, liver, pancreas and intestines. Countless others are helped, and their quality of life is improved from tissue donation that includes heart valves, veins, skin, bones and corneas. Donors can designate all or specific organs or tissues they would like to donate.

“I don’t see any downside to being a donor—you only benefit other people,” Nadler says. There are no costs to the family for organ and tissue donation. Through the entire donation process, the body is treated with care, respect and dignity.

Nadler points out that most religions support organ and tissue donation and see it as the final act of love and generosity to others.

Meanwhile, the number of people on the waiting list for organ transplants continues to grow exponentially.

“We know if everyone who could be an organ donor would donate, then the wait times for a new organ would be dramatically shorter and the list would be smaller,” Nadler says. “Because survival rates from transplants are so good, we continue to find more ways in which organ transplant can be used to treat and cure more diseases. I encourage people to step forward to donate and help others.”

So it’s my duty to provide you with a brief service announcement before you read any further.

**WARNING**

Don’t read the following if you don’t want easy, user-friendly strategies to lose weight and look fantastic. Implementing the following tips may lead to reduced body fat, feelings of vitality and increased energy levels, producing feelings of euphoria.

•  The 85 percent rule: If you scored an 85 on a test, you’d earn a B to a B+ and feel pretty good about yourself. If you make good food choices 85 percent of the time, you’ll be consuming foods that are more nutrient-dense — such as high-fiber, low-glycemic carbs and lean proteins — which will make an immediate impact in weight loss. And you can enjoy decadence the other 15 percent of the time guilt-free.

• The water trick: At every meal or snack, take one sip of water for every bite of food. It will prevent over-eating and keep you hydrated.

• The food log: There’s nothing like accountability staring you in the face. Keep a log for a week and let it show you the light.

• Muscle confusion: The body will adjust to your current workout in four weeks. To force it to make changes that will result in more lean muscle and less body fat, confuse it. If you normally walk on the treadmill, take Zumba or try an indoor cycle class. Do anything that will make your muscles think, “What the heck just happened?”

• Work with a pro: Accountants do your taxes, roofers repair your roof and attorneys help you with legal issues. Working with a credible fitness professional will put you ahead of the curve and closer to your objective than going it alone. Why? This is what we do, and we know the safest, most effective strategies to get you past your barriers and on the path to losing weight and looking fantastic.

Congestive heart failure (CHF), is a cardiovascular condition in which your heart loses its pumping power and your body doesn’t receive enough of the oxygen-rick blood it needs to function. If your heart does not pump blood properly, the blood backs up in your lungs and other body parts.

Although it is a serious condition, there are treatment options that allow people with CHF to live fuller, more active lives.

“If you’ve been diagnosed with CHF, it’s a good idea to understand your treatment options, and work with your doctor to manage your condition,” says Marty Megenhardt, R.N., BSN, chronic condition coordinator at Lake Regional Health System in Osage Beach.

There are a few different things patients can do to manage CHF.

Doctor’s Orders
After being diagnosed, your doctor will order medications to help control your symptoms. Never stop taking your medication without talking to your doctor.

Some heart-failure medications include:

• diuretic “water pills” decrease fluid retention and swelling. A potassium supplement may be given to replace lost potassium.
• ACE inhibitors/ARBs lower blood pressure, decrease strain on the heart and help it pump more efficiently
• beta blockers help to lower blood pressure, slow the heart rate and lessen the workload of the heart
• digoxin strengthens the heart and slows the heart rate
• warfarin, a blood thinner, works to prevent blood clots

Keep It Moving
Although medications can help, nothing will strengthen your heart like exercise.

Physical activity will build up your heart muscle while improving blood circulation, cholesterol and blood pressure. Be sure to talk to your physician before starting any kind of exercise regimen.

If your physician recommends walking, start slow and build to 20 or 30 minutes, three to four times a week. If time is a factor, consider home options, such as resistance bands or hand weights. An exercise partner, as well as a regular schedule, can offer accountability.

“If you just say, ‘I’m going to exercise tomorrow,” you won’t. But, if you have it on your schedule at noon, you have a much better chance,” Megenhardt says.

Hold the Salt
Limiting your sodium intake helps to prevent and control fluid buildup. Extra fluid makes your heart work harder, which can increase your blood pressure.

National guidelines recommend restricting sodium intake to 1,500 mg per day; however, your doctor may allow up to 2,400 mg a day. Staying within the limit designated by your doctor may decrease your chances of needing emergency medical treatment.

“When grocery shopping, always refer to the nutrition facts label to determine sodium content in food items,” Megenhardt says. “Try selecting foods with no more than 140 mg of sodium per serving.” Remember, if you eat more than one serving, you will ingest more sodium than the amount listed.

Tracking Your Weight
Your doctor may ask you to weigh yourself daily. This will show how well your diet and medications are working to keep you from retaining extra fluid.

“It is important to weigh yourself daily and to keep a weight record,” Megenhardt says. “A weight gain of three pounds overnight or five pounds in one week is most likely a sign of fluid retention, and you should notify your physician.”

After heart failure, it is especially important to stick to your daily caloric goal and to maintain your weight to help detect water retention.

Medical Alert: Know the Signs of Heart Failure

Red
Stop and call your doctor immediately if you have:

- no relief from chest pain

- no relief from shortness of breath with activity

- shortness of breath at rest

- wheezing or chest tightness at rest

Yellow
Proceed with caution, and talk to your doctor if you have two or more of these warning signs.

- increased weight

- increased cough when lying down or after activity

- increased swelling of hands, ankles, feet or legs

- increased shortness of breath with activity

- increased use of pillows or need to sit in a chair to sleep

- chest pain or discomfort relieved with rest

- unusual symptoms that bother you

Green
Keep going, as directed by your doctor, if you have:

- no shortness of breath

- no swelling

- no weight gain

- no decrease in your ability to maintain your activity level

One of the biggest issues facing lawmakers is the state fiscal year 2013 budget. With the end of federal stimulus funding last June and a reduction in the federal share of the state’s Medicaid match, lawmakers must craft the state’s budget with more than one-half billion less revenue than fiscal year 2012.

The governor has released an overview of his budget proposals to the General Assembly for the fiscal year that begins July 1. Legislators commonly use the governor’s budget as a starting point for legislative debate. There seems to be consensus developing on Medicaid funding in the budget. Gov. Nixon and lawmakers are suggesting that Medicaid spending reductions can be found through efficiency rather than direct cuts.

Missouri’s constitution dictates that the session will end Friday, May 18, and the state budget must be adopted by Friday, May 11.

“Hospitals generate and report a significant amount of data on the care they provide,” said Herb B. Kuhn, president and CEO of the Missouri Hospital Association. “However, efforts to make these data meaningful for the public have been uneven. The resources now available through Missouri Health Matters will help consumers identify local hospitals’ performance on standardized quality metrics in a user-friendly format.”

The site features process of care measures for heart attack, heart failure, pneumonia and surgical care, in addition to patient satisfaction data. These data are identical to those reported to the Centers for Medicare & Medicaid Services that are published on CMS’ Hospital Compare website. However, the data presentation is much more dynamic.

In addition to increasing the transparency of hospital quality measures, the site contains data on community health indicators and links to assist Missourians in making informed health care decisions. At launch, the site includes county level data on tobacco use. However, additional research and analysis will regularly be added to identify behavioral health risks in Missouri communities.

Visitors interested in finding a hospital in their community or learning more about how hospitals support the economy can find both by using the new mapping functions. By clicking the hospital icon, visitors can find economic impact data, such as the hospital’s capital investments or full time-equivalent employees; hospital location; and contact information. The site also can help users get directions to hospitals.

“We are excited to offer Missourians this new access to information about their hospitals,” Kuhn said. “Knowledge is power. And, we hope that Missourians will check up on the progress their hospitals are making in delivering high quality care and learn more about their health and the health of their communities.”

Whether you are trying to lose a few pounds or simply trying to maintain your weight this season, here are a few things that could work against you.

Skipping Breakfast
Whether you skip breakfast to save time or to “save” calories, you may be doing your diet more harm than good. Skipping breakfast leads to increased hunger later in the day and larger portions of less healthy choices at lunch and dinner. Taking the time to eat breakfast can fight midmorning drowsiness and help control the amount of calories consumed during the rest of the day. A breakfast high in fiber and protein promotes healthy weight loss.

Overdoing Low-Fat Foods
Choosing low-fat foods can be a beneficial part of your diet plan, but low-fat doesn’t mean you should eat more. People often think that eating low-fat foods means portion sizes don’t matter. Low-fat foods still contain calories, and excess calories lead to weight gain whether they come from one serving of a “regular” food or three servings of a low-fat food. So, just because cookies are low-fat doesn’t mean that you should eat three instead of one.

Skimping on Sleep
Diet and exercise aren’t the only things that affect weight loss efforts. Skimping on sleep causes an increase in your body’s hunger hormones, making you more likely to overeat during the day. Research finds that getting more sleep promotes loss of fat mass while inadequate sleep (5.5 hours or less) burns more lean muscle mass.

Water Intake
Your body needs water to burn calories. Inadequate water intake can actually slow your metabolism, thus hindering weight loss. Water can help you metabolize the stored fat you already have more efficiently. Drink plenty of water before meals and throughout the day to help you feel fuller and eat fewer calories.