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Insomina -- the inability to fall asleep naturally -- affects most people at some time in their roller coaster lives. And insomina cures are possible with self-managed changes in behavior in many cases.

Sleepless nights. Missed work days. As anyone with insomnia will attest, a sleep-deprived condition can lead to intense personal suffering.

But combine insomnia with anxiety, depression and chronic pain, and sleeplessness can become even more troubling.

Cognitive behavioural therapy (CBT), however, may be a remedy for this multi-faceted problem, says a Ryerson University professor.

"When you have another disorder, you face unique barriers that other people do not," says Dr. Colleen Carney, assistant professor of psychology, and director of Ryerson's Sleep and Mood Disorder Program. "For example, a conventional insomnia strategy involves getting out of bed at the same time every day. But someone with depression may wonder, "what if I have nothing to get out of bed for?"

Cognitive behavioural therapy (CBT)

Carney's latest book is Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those With Depression, Anxiety or Chronic Pain is the only self-help book that focuses on people with insomnia combined with other health conditions. Quiet Your Mind and Get to Sleep was co-authored by Dr. Rachel Manber of Stanford University in Palo Alto, California.

Insominia is Common...and Disruptive

According to insomina research - one in every seven of us - experiences problems going to sleep and/or staying asleep. Furthermore, insomnia is a characteristic of almost all psychological diagnoses. Sleep clinics also report that insomnia patients with psychological disorders outnumber those without other conditions at a rate of nearly two to one.

Quiet Your Mind and Get to Sleep suggests many cognitive behavioural solutions to insomnia. Some of the tips in this practical book about insomnia cures include:

• Never get into bed earlier than your usual bedtime.
• When you catch yourself "trying" to sleep, remind yourself that this is counterproductive.
• Learn about sleep myths, such as "I absolutely require eight hours of sleep to function during the day."
• Actively challenge unhelpful beliefs that may worsen your sleeplessness, such as "Something terrible will happen to you as a result of insomnia."
• Leave your bed and bedroom if you can't sleep.

Previous insomnia research studies have also demonstrated that CBT offers many advantages over sleep-aid medications. Among them,

• CBT is a non-pharmacological treatment that is just as useful as medication (and has longer-lasting effects).
• CBT doesn't carry the risks of dependency or tolerance (requiring increasing the dosage for the drug to remain effective) that are associated with medication.
• CBT techniques also build confidence in one's ability to sleep.

CBT has also become a popular choice for the treatment of sleeplessness says Dr. Carney. Through worksheets and a structured program, Quiet Your Mind and Get to Sleep helps readers discover and then address the cause of their insomnia.

CBT Can be a Self-Help Solution for Insomnia

"For this reason, CBT makes intuitive sense to people," says Carney. "It's a brief treatment and, as our book proves, it can be done on a self-help basis."

In addition to teaching at Ryerson Universtiy Carney is also president of the Association for Behavioral and Cognitive Therapies, an interest group on insomnia and other sleep disorders.

Ryerson University is Canada's leader in innovative career-focused education, offering close to 100 PhD, master's, and undergraduate programs

Antioxidants increasingly have been praised for their benefits against disease and aging, but recent studies at Kansas State University show that they also can cause harm.

Researchers in K-State's Cardiorespiratory Exercise Laboratory have been studying how to improve oxygen delivery to the skeletal muscle during physical activity by using antioxidants, which are nutrients in foods that can prevent or slow the oxidative damage to the body. Their findings show that sometimes antioxidants can impair muscle function.

Antioxidant

"Antioxidant is one of those buzz words right now," said Steven Copp, a doctoral student in anatomy and physiology from Manhattan and a researcher in the lab. "Walking around grocery stores you see things advertised that are loaded with antioxidants.

I think what a lot of people don't realize is that the antioxidant and pro-oxidant balance is really delicate.

One of the things we've seen in our research is that you can't just give a larger dose of antioxidants and presume that there will be some sort of beneficial effect. In fact, you can actually make a problem worse."

David C. Poole and Timothy I. Musch, K-State professors from both the departments of kinesiology and anatomy and physiology, direct the Cardiorespiratory Exercise Laboratory, located in the College of Veterinary Medicine complex. Researchers in the lab study the physiology of physical activity in health and disease through animal models. Copp and Daniel Hirai, an anatomy and physiology doctoral student from Manhattan working in the lab, have conducted various studies associated with how muscles control blood flow and the effects of different doses and types of antioxidants.

Abnormalities in the circulatory system

Abnormalities in the circulatory system, such as those that result from aging or a disease like chronic heart failure, can impair oxygen delivery to the skeletal muscle and increase fatigability during physical activity, Copp said. The researchers are studying the effects antioxidants could have in the process.

"If you have a person trying to recover from a heart attack and you put them in cardiac rehab, when they walk on a treadmill they might say it's difficult," Poole said. "Their muscles get sore and stiff. We try to understand why the blood cells aren't flowing properly and why they can't get oxygen to the muscles, as happens in healthy individuals."

Some of the oxidants in our body, such as hydrogen peroxide, are helpful to increase blood flow.

Copp said there is a potential for antioxidants to reverse or partially reverse some of those changes that result from aging or disease. However, K-State's studies have shown that some of the oxidants in our body, such as hydrogen peroxide, are helpful to increase blood flow.

"We're now learning that if antioxidant therapy takes away hydrogen peroxide - or other naturally occurring vasodilators, which are compounds that help open blood vessels - you impair the body's ability to deliver oxygen to the muscle so that it doesn't work properly," Poole said.

Antioxidants can actually suppress key signaling mechanisms that are necessary for muscle to function effectively.

Poole said antioxidants are largely thought to produce better health, but their studies have shown that antioxidants can actually suppress key signaling mechanisms that are necessary for muscle to function effectively.

"It's really a cautionary note that before we start recommending people get more antioxidants, we need to understand more about how they function in physiological systems and circumstances like exercise," Poole said.

Mobility for advancing age and diseases like heart failure

Hirai said the researchers will continue to explore antioxidants and the effects of exercise training. Their studies are looking at how these can help individuals combat the decreased mobility and muscle function that comes with advancing age and diseases like heart failure.

"The research we do here is very mechanistic in nature, and down the road our aim is to take our findings and make recommendations for diseased and aging populations," Copp said.

The researchers have published their recent findings in several journals, including the Journal of Applied Physiology, Respiratory Physiology and Neurobiology, Microvascular Research, The American Journal of Physiology and Experimental Physiology.

The Cardiorespiratory Exercise Laboratory has been funded by grants from the National Institutes of Health, American Heart Association and intramural awards from the College of Veterinary Medicine.

Lead-based Paint Dangerous for Children

Young children are particularly susceptible to lead poisoning since they are more likely to ingest lead paint chips, flakes, or dust and are more sensitive to the adverse health effects of lead. Elevated lead levels in young children can trigger

• learning disabilities
• decreased growth
• hyperactivity
• impaired hearing
• brain damage

Lead can be found in a number of places inside and outside the home. For example, lead can be found in household dust from deteriorating lead-based paint or from soil tracked into the house. It can also be found in drinking water coming from old lead pipes, fixtures and solder.

"Childhood lead poisoning is easily preventable with the right information and awareness. This grant will help Arizona tribal communities raise awareness about preventing lead's adverse health effects," said Administrator Jackson. "This project is an important example of the efforts happening across the country to protect our children from a major health threat."

Lead-based Paint Outreach to Native American Tribes

The Inter-Tribal Council of Arizona is developing culturally specific outreach materials to educate tribal families, especially parents of young children, and tribal staff on the health risks to children from exposure to lead-based paint.

Lead Awareness for Facility Maintenance Personnel

The program specifically reaches out to facility maintenance personnel to stress the importance of using lead-safe work practices when renovating buildings.

The use of lead-based paint in U.S. residential housing was banned in 1978.

Approximately 75% of the U.S. housing stock built before 1978, or 64 million homes, contain some lead-based paint.

For information on EPA's lead paint program, go to: http://www.epa.gov/region09/toxic/lead

For information on lead in paint, dust and soil, visit: http://www.epa.gov/lead

For information on protecting your family from lead hazards, visit: http://www.epa.gov/lead/pubs/leadinfo.htm#where

Having just tried to find more cost effective health insurance and long term care insurance, I can tell you how frustrating it is to get good data.  We live in Los Angeles and one would surmise that a large city is more expensive than smaller communities -- but the long term insurance rep said it was less expensive.  

So where is the real data?  I found it!  The Dartmouth Atlas of Health Care!  And believe me,  location matters!

For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians.

Look up your region on this handy interactive map: 

This interactive US Atlas of Health Care shows you various information by local areas... the best, the growth, by hospital referral region.

As you can see, the Los Angeles region has a bit of a difference in prices and cost increases than counties north and south of it.  Hmmmm....

The cost of providing health care to seniors is rising more than twice as fast in Dallas as in San Diego, and Medicare now spends nearly three times more to care for its enrollees in Miami than it does in Honolulu.

This illustrates how huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care, according to a new analysis of Medicare spending by researchers of the Dartmouth Atlas Project published in February 2009 in the New England Journal of Medicine.

Nationally, Medicare spent an average of $8,304 per enrollee in 2006, and national spending grew at a rate of 3.5 percent annually from 1992 to 2006. Among states, New York was tops in spending per enrollee, at $9,564. Hawaii was lowest, at $5,311.

Where Medicare spending per enrollee grew at an annual rate of 5 percent in Miami, the rate was less than half, at 2.4 percent, in San Francisco. Medicare spent $16,351 per enrollee in Miami in 2006, almost twice the spending of $8,331 in San Francisco.

The researchers project that, at current spending rates, Medicare will be $660 billion in the red by 2023. But by reducing the annual growth in per capita spending from 3.5 percent, the national average, to 2.4 percent, the rate in San Francisco, Medicare could save $1.42 trillion and turn the deficit into a healthy surplus.

Small Differences Make a Huge Savings

"The good news is that small differences, because of compounding, can make an enormous difference for the long-term solvency of Medicare and our ability to expand coverage for the uninsured," said co-author Jonathan Skinner, Ph. D., the John Sloan Dickey Third Century Chair of Economics at Dartmouth College.

The authors call on physicians to lead an effort to reform how the U.S. delivers and pays for health care to bring spending under control.

Systems of Quality Care

They write: "Payment systems could then shift from purely volume-based payments to systems ... that foster accountability for the overall costs and quality of care, allowing physicians to align their work more closely with the values that brought them to health care. "

"This work demonstrates why health reformers should work to realign private and public payment schemes to benefit quality performance over the volume of services," said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "Clinicians who successfully provide high quality care and slow spending growth should be rewarded, not penalized."

About the Dartmouth Atlas Project
For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians. These reports, used by policymakers, the media, health care analysts and others, have radically changed our understanding of the efficiency and effectiveness of our health care system.

About The Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful, and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves.

Depression often coexists with other long-term health problems, presenting additional complexities. About 60 percent of depressed outpatients have at least one other chronic medical condition as well, such as a heart problem, high blood pressure, or diabetes.

The US Department of Health & Human Services, through the Agency for Healthcare Research and Quality  has funded research to track effective care of depression. 

Heart Attacks and Depression

Research results have shown that patients with a history of heart attacks have 1.8 times more depressive spells in a year and more persistent symptoms than depressed patients without a history of heart attacks.

Chronic Conditions and Depression in Older Persons

The challenge of treating depression as one of multiple chronic conditions is especially an issue in older persons. AHRQ research comparing elderly patients with and without depression in a primary care clinic found that the depressed patients had:

• Nearly $200 more in annual diagnostic test costs.
• Almost 1.5 more ambulatory care visits per year.
• Over 12 percent more annual visits to the emergency department.
• Five percent more hospitalizations each year.

To reduce the cost of care and improve outcomes for older persons with depression, coexisting psychiatric and medical illnesses must be targeted for treatment.

Best Care:  Mental Health Specialists or Medical Care Providers?

The organization of care can affect care delivery for depression. One AHRQ-sponsored study showed that shifting patients away from mental health specialists to general medical providers (as is the practice in some managed care arrangements) may lead to fewer improvements in patient functioning but costs two to three times less.

Other AHRQ-funded research on the effects of changes in health care payment and delivery found that after switching to a prepaid plan, the health status of outpatients with depression did not appear to suffer although they were 12 percent less likely to use antidepressants and made 35 to 40 percent fewer visits to their mental health care providers.

Even where there is substantial agreement about how treatment for depression can be improved, changes to everyday practice have been slow. Past efforts by managed care organizations to improve compliance with guidelines for improving diagnosis and treatment of depression have met with only modest success.

Two AHRQ studies investigating academic detailing and continuous quality improvement interventions in managed care organizations concluded that these approaches were only mildly effective in improving clinicians' adherence to the recommended guidelines for care. However, promising early results from a current study evaluating ways to increase use of antidepressants and psychotherapy in managed primary care practice suggest that depressed patients in the intervention groups were more likely to receive these interventions and exhibit better outcomes.

The National Guideline Clearinghouse™ (NGC) sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, allows physicians and other Internet users to assess and compare guidelines online at http://www.guideline.gov. The NGC is being used by Georgetown University Medical Center's Mood Disorder Program in the development of clinical practice guidelines on depression for primary care physicians in managed care settings.

Last year pharmaceutical companies spent more than $4 billion urging patients to "ask your doctor" about their drugs. But if you want an effective prescription that is affordable, ask your doctor about drugs you don't see on TV. And ask for generic drug and behavioral options for your health care -- both prevention and cures.

AARP reports that prices for the most popular drugs rose an average of 8.7% last year, more than twice the rate of inflation.

Fortunately there are cheaper alternatives to many popular and well-advertised medications.

For example, AstraZeneca's acid reflux drug Nexium -- the "purple pill" -- was the second best-selling drug in the U.S. last year, with a hefty price tag of about $215 per month. But a drug from the same family, that works the same way, is available over-the-counter for about $20 a month as Prilosec.

Generic drugs already make up nearly 70% of prescriptions in the U.S., and that percentage is expected to rise. Over the next five years products worth $137 billion are expected to go generic.

These generic drugs are older.  But not necessarily less effective.

The FDA does not judge drugs based on how they stack up against older medications. Rather, the FDA weighs each drug's benefits against its risks. If the drug appears more beneficial than harmful, the agency is obligated to approve it.  

Pharmaceutical Advertising to Physicians

Only a licensed health care professional can prescribe a drug, and you'll want to defer to their judgment, but that doesn't mean you can't ask questions and ask for your options. It's important to understand that physicians may not be completely objective when choosing a prescription.

The pharmaceutical industry spends about 90% of its $20 billion annual marketing budget pitching new, proprietary pharmaceuticals to doctors, according to the Journal of the American Medical Association.

The Best Drugs for Less

On the consumer information side of the equation, Consumer Reports is now publishing "Best Drugs for Less". The Consumers Union team analyzes dozens of academic and government studies to make recommendations on the most affordable and effective medications.

More information is coming.  The US federal government has set aside $1.1 billion to study various medical treatments and see which ones work best, in an effort to cut out costly, ineffective treatments. This is part of the Obama administration's effort to reform health care and reduce costs.