Health and Wellness

Many patients fall into the habit of having bad posture as teenagers. Good posture distributes body weight appropriately and allows for the most efficient body mechanics, which helps prevent injury. The best way to maintain good posture is to strengthen the core muscles, maintain a regular stretching and range of motion exercise program, and make a habit of sitting or standing properly.

Good standing posture means keeping the shoulders, hips, and ankles are aligned. Good seated posture means keeping the shoulders and hips aligned, knees level with or just below the hips, and feet flat on the floor. Good ergonomics make good posture easier to maintain.

This is essential to avoiding injury. It includes using proper body mechanics while doing physical work but good ergonomics is also important for people with sedentary occupations. Human beings were not meant to spend most of their waking hours sitting at a desk staring at a computer, using a smartphone or tablet, or driving around. Because so many people work in office settings, below is a description of good ergonomics for the office.

Chair

• Choose a chair that supports your spine.
• Adjust the height of the chair so your feet rest flat on the floor.
• If you can’t reach the floor by adjusting the height of the chair, use a footrest so your thighs are parallel to the floor.
• If the chair has armrests, position them so your arms sit gently on the armrests with your elbows close to your body and your shoulders relaxed.

Desk

• Under the desk make sure there’s enough room for your legs and feet.
• Don’t store items under your desk as that can shrink the amount of available space and make it hard to sit correctly.
• If the desk is too low and the desk height can’t be changed put sturdy boards or blocks under the desk legs to raise it.
• If the desk is too high and can’t be changed, raise your chair. Use a footrest to support your feet if necessary.
• If you don’t have a footrest try using a small stool or a stack of sturdy books.
• If your desk has a hard edge that’s not rounded pad the edge or use a wrist rest. This protects your wrists from a problem called contact stress that can happen as a result of extended contact with a hard edge.

Keyboard and Mouse

• Put your computer keyboard in front of you so your wrists and forearms are in line and your shoulders are relaxed.
• If you use a mouse or another type of pointer connected to a computer place it within easy reach on the same surface as your keyboard.
• While you are typing using a computer touchpad or using a mouse or pointer keep your wrists straight your upper arms close to your body and your hands at or slightly below the level of your elbows.
• If possible set the sensitivity of the mouse or pointer so you can use a light touch on it.

Monitor or Laptop

• Place the computer monitor straight in front of you directly behind your keyboard, about an arm’s length away from your face.
• The monitor should be no closer to you than 20 inches (about 50 centimeters) and no further away than 40 inches (about 100 centimeters).
• The top of the screen should be at or slightly below eye level. If you wear bifocals lower the monitor an additional 1 to 2 inches (about 2 to 5 centimeters) for more comfortable viewing.
• Using a laptop computer may lead to discomfort because of the low screen height and cramped keyboard and touchpad.
• If you use a laptop at your desk consider getting an external keyboard and mouse along with a laptop stand to more closely mimic a desktop computer setup.

Frequently Used Objects

• Keep objects you use often, such as the telephone, stapler, or printed materials, close to your body to minimize reaching.
• Stand up to get anything that you can’t comfortably reach while sitting.
• If you spend a lot of time on the phone, or if you often type or write while you’re using the phone, put the phone on speaker or use a headset.
• Don’t cradle the phone between your head and neck.

Remember, no matter how well your workspace is set up for proper ergonomics, sitting in the same position for hours at a time isn’t good for your body. Get up and walk around as often as you can throughout the workday. If possible, do some work standing up. While you’re seated stretch your hands fingers and arms from time to time. Shifting your position, standing up, and moving will ease strain on your body and help you stay healthier.

Exercise can make you look and feel better by:

• Improving cardiovascular fitness.
• Strengthening muscles, tendons, ligaments, and even bones.
• Preserving range of motion of the joints in the body.
• Preventing atrophy or calcification of fascia, muscles, tendons, and ligaments.
• Maintaining a healthy weight.
• Reducing pain by avoiding immobility.
• Helping to alleviate depression, stress, and anxiety.

There are many types of exercise programs (just doing one exercise is not a good idea) and no one program is ideal for everyone. A useful way to approach an exercise program is to understand what your body (and mind) need to stay healthy and what exercises you prefer. For example, swimming is a great exercise, but if you hate swimming (or don’t know how to swim) it’s not a good choice for you. The best exercise program is the one you’re willing and able to do consistently.

In general, most pain patients should:

• Avoid overhead presses (also known as military presses). Chest presses and bench presses are a better choice.
• Avoid jogging or running for aerobic exercise.
• Avoid high impact exercises.
• Avoid sit ups. Try using isometric core strengthening exercises such as planks and holds instead.
• Include aerobic exercise (any type of cardiovascular exercise such as using an exercise bicycle swimming etc. and not just Aerobics specifically), core strengthening exercises, and stretching and range of motion exercises in their exercise programs.
• Exercise 3-5 times per week. Less than 3 times per week is not as effective. More than 5 times per week increases the risk of injury without much additional benefit.
• Always use good form and the appropriate equipment to avoid injury when exercising.

Modern diets are filled with junk food, but even “healthier” choices may contain multiple additives that can be harmful. The goal is not to live a life of austerity but rather to enjoy food properly. This is frequently complicated by sophisticated marketing programs that might misdirect people into thinking something is healthy when it is not.

Good nutrition does not consist of taking supplements. At best, they can only supplement the micronutrients (vitamins, minerals, etc.) you get in your diet. Instead, eating a varied, well-balanced diet that provides adequate macronutrients (protein, fats, and complex carbohydrates), micronutrients, and fiber is the goal. The amounts of macronutrients and fiber, as well as the types of micronutrients required, vary based on an individual’s specific needs. There is no single diet that is ideal for everyone.

Water is just as important as food for good nutrition. Many people do not drink enough water, often because they do not realize how harmful that can be. There’s no need to drink a fixed amount of water daily. The goal is to drink enough water to remain well-hydrated.

For those interested in diet and weight loss, please see the next section below on this page.

This is essential for both physical and mental health. Stress, lack of time, anxiety, and poor habits all lead to inadequate rest. In many cases, this is worsened by things like untreated or undertreated sleep apnea and insomnia. For more information on insomnia, see below on this page.

Poor habits that can lead to inadequate rest include:

• Irregular Sleep Schedule: Going to bed and waking up at inconsistent times disrupts your body’s natural sleep-wake cycle.
• Excessive Screen Time: Using phones, tablets, or computers before bed exposes you to blue light, which can interfere with melatonin production and make it harder to fall asleep.
• Not Taking Time to Relax Before Bedtime: Overworking or engaging in mentally stimulating activities before bed can make it difficult to relax and fall asleep.
• Poor Sleep Environment: A noisy, bright, or uncomfortable sleeping space can prevent restful sleep.
• Caffeine or Alcohol Consumption: Drinking caffeinated beverages or alcohol close to bedtime can disrupt sleep quality.
• Eating Heavy Meals Late: Consuming large or spicy meals close to bedtime can cause discomfort and disrupt sleep.
• Lack of Physical Activity: Not getting enough exercise during the day can lead to restlessness at night.

While on a road trip in France with a good friend who is a retired French chef, we noticed that people who came from countries that protected their food supply tended to have a healthier weight than those who came from countries that did not.

During this trip, I ate and drank freely with my many French hosts. I never went hungry and always had as much as I wanted, yet I still lost weight. It was not because we did a lot of walking or exercise; I exercise more at home.

Upon returning, I continued eating the way I had in France and continued to lose weight and have kept it off. I did not change my exercise regimen and did not take any medications. I never went on a specific diet with meal plans or restrictions. I continued eating out at restaurants and did not give up wine, desserts, or anything else I liked. The results were so remarkable that several people have asked me to explain what I did.

Below is a summary of what I did. The following sections provide more detail about the philosophy behind this and there are some examples at the end to illustrate various points. What I have done corresponds closely with the findings in multiple studies, but I left the exact references for your own research. I hope this helps and will update it over time as needed.

Summary

• Understand what is in your food – read the ingredients.
• Change your shopping list to replace those items containing additives that should be avoided. This may mean relearning how to shop.
• Try to eat fresh foods (leftovers are OK), but processed foods should be minimized.
• Do not skip meals so you will not be ravenous when the next mealtime comes around. 
• Do not snack between meals.
• Pay attention to what you are eating. Do not eat mindlessly.
• Avoid seed oils, including vegetable, corn, soybean, canola, sunflower, safflower, and palm oils.
• Avoid artificial substitutes for natural foods. This includes avoiding things such as margarine, artificial sweeteners, high-fructose corn syrup, and similar products.
• Avoid food that contains or is produced with genetically modified organisms.
• Avoid meats (including beef, chicken, pork, lamb, etc.) and seafood that are not antibiotic-free and hormone-free. Just because a particular meat is labeled organic does not mean organic hormone precursors were not used.
• Avoid foods that contain anything other than the natural ingredients that should be there. If your great-grandparents wouldn’t recognize an ingredient as food, don’t eat it.

This isn’t a strict diet—it’s a flexible approach to eating that emphasizes quality. While this does not require adherence to a specific meal plan or constant exertion of willpower, it does require commitment and time. The benefit is that it can provide lasting results without needing to take medications.

Living organisms are not machines and each individual has a unique genetic makeup. The conceit that everyone is the same has led many to erroneous assumptions about health. One of these erroneous assumptions is that everyone responds the same way when exposed to additives and contaminants.

This is why two people can eat the same things and maintain the same activity level but one will gain weight whereas the other remains the same or even loses weight. It is why some people can tolerate the additives and contaminants without becoming obese or sick, but many others cannot.

What it means in practice is that those with the genetic susceptibility to weight gain or other health problems from exposure to additives and contaminants can benefit from following a pure and natural diet as discussed here. There is no medication, supplement, or treatment that can change this. Even those who do not have this genetic susceptibility, however, find their mood and energy improve with this type of diet.

It’s important to note that exposure to additives and contaminants comes from sources other than just food. One source is personal care products such as soaps, shampoos, deodorants, cosmetics, etc., which are a common source of exposure. It’s just as important to understand what you are putting on your body as it is to understand what you are eating.

It is not enough to rely on testing to judge whether something is safe. Testing of personal care products is, by necessity, of short duration. Yet there’s a big difference between exposure to a high dose of something for a short period of time and using a low dose over a long period of time. There are conditions that appear only after prolonged use.

Another source of exposure is via the water supply. Even the best municipal water supplies now contain measurable quantities of estrogen and other hormones, antidepressants, and other pharmaceuticals. Water treatment plants cannot remove these small molecules, so the general public is constantly exposed to these substances.

There are a couple of ways to get rid of these from one’s personal water supply. One is via a reverse osmosis system. These are typically more expensive, but these systems can serve an entire house. If that’s not available, a carbon filter (either a whole house filter or a smaller filter in a refrigerator’s water supply line or a pitcher, which is much more affordable) can be helpful.

The relentless exposure to small quantities of a variety of substances, even if they are not directly toxic, eventually begins to affect hormonal regulation and metabolism. The explosion in obesity, diabetes, vascular disease, autoimmune conditions, developmental disorders, infertility (both male and female), early onset hair loss (often coupled with low testosterone, which is highly unusual) in males, and precocious puberty has occurred concurrently with the widespread exposure to these substances in our food, water, and personal care products.

The problem with additives is more than just an issue of food safety. Part of the problem with obesity that afflicts so many people today is that satiety signals are subverted. Look at pictures from the 1950’s and 60’s. Notice how few obese people there were compared to today. The foods they were eating were fundamentally different from today. That changed starting in the 1970’s, when additives in food became increasingly prevalent.

When you have an appetite or craving for something, your brain has a mental idea of what that is. Once you eat it, that craving is satisfied and your brain is satiated, regardless of whether your stomach is full. This makes it easier to avoid overeating.

When foods contain additives (even if they are completely benign), that craving is harder to satisfy. You will tend to eat until your stomach is full, which is an alternate pathway to satiety. As more foods contain more additives, food consumption increases because people are looking to be satisfied but wind up having to accept simply eating until they are full. Over time, this leads to widespread obesity.

You can confirm this yourself via a simple experiment. Get two different versions of the same food. It can be anything but make sure one has only natural ingredients and the other has all the additives and preservatives commonly found today. Notice that the one without any extras is more satisfying without having to eat a huge amount whereas the other is “addictive” and you want to keep eating more.

When discussing food and weight loss, the question of which diet to follow always comes up. In nature, human beings are omnivores – they eat both meat and plants. This means the ideal human diet naturally consists of a variety of plants and animal proteins (including seafood).

None of the multiple diets (including keto, low-carb, paleo, gluten-free, low fat, vegan, raw food, macrobiotic, etc.) that have become popular over time have ever been shown to be superior to a well-balanced diet composed of pure and natural foods. Many of these other diets can actually damage your health and should only be tried under medical supervision.

Another question that comes up repeatedly is whether a vegetarian diet is better. While I respect those who choose to become vegetarian for moral or ethical reasons, the fact remains that a vegetarian diet is simply not as healthy or varied as a well-balanced natural diet. A pescatarian diet in which the seafood is the only meat in an otherwise vegetarian diet is also not ideal.

Organic Food
Eating a natural diet does not necessarily mean eating organic foods exclusively. There are plenty of organic additives that can be quite detrimental. For example, many companies sell organic dried fruit made with organic sunflower oil. Regardless of whether it’s organic or not, seed oils like sunflower oil should be avoided.

When trying to lose weight with a pure and natural diet, the goal is to eat to satiety rather than keep eating until your stomach is full. If you have an appetite for something, eat it. Do not deny yourself, but make sure what you’re eating is the pure and natural version, not one loaded with additives.

Eating to satiety allows you to reach and maintain a healthy weight without dieting in the usual sense of needing willpower to avoid overeating. It’s difficult, and not much fun, to live a life of austerity constantly denying yourself what you crave. For many people, enjoying food is one of the few pleasures they have in life.

This is why so many people either fail at dieting or simply regain the weight after going through a rigorous diet. Long deprivation from the simple pleasure of eating what they want leads to a strong desire to return to previous eating habits once they reach their goal weight. Diets are like a punishment.

It’s better to rely instead on understanding how appetite and satiety work in the brain. This helps avoid those things which subvert the satiety mechanism and don’t satisfy the appetite. While it does not require a tremendous amount of willpower, it does require a lot more time and effort in thinking about food, researching ingredients, and finding the right products. Natural foods also tend to be more expensive and tend to go bad more quickly. This means going to the store much more often. For example, we go to 7 different grocery stores to find the right products at the right time.

Here is a comparison of the ingredients in several common foods from before 1970 and today. In all cases, foods with ingredients similar to the pre-1970 ingredients are readily available today, you just have to read the labels.

White Bread
Before 1970 – enriched wheat flour, water, sugar, yeast, salt, milk, butter.
Today – unbleached enriched flour (wheat flour, malted barley flour, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), water, sugar, yeast, calcium carbonate, wheat gluten, soybean oil, salt, dough conditioners (sodium stearoyl lactylate, calcium stearoyl lactylate, monoglycerides, mono- and diglycerides, distilled monoglycerides, calcium peroxide, calcium iodate, DATEM, ethoxylated mono- and diglycerides, enzymes, ascorbic acid), vinegar, monocalcium phosphate, citric acid, cholecalciferol, soy lecithin, calcium propionate.

Cuban Bread/Pan Cubano (in Miami)
Before 1970 – bread flour, water, salt, sugar, yeast, lard.
Today – enriched flour (wheat flour, malted barley flour, niacin, reduced Iron, thiamine mononitrate, riboflavin, folic acid), water, soybean oil, salt, yeast with sorbitan monostearate and ascorbic acid, wheat flour, ascorbic acid, enzymes, yellow cornmeal.

French Fries
Before 1970 – fresh, hand-cut potatoes, beef tallow, salt.
Today – partially cooked, frozen potatoes, soybean oil, natural beef flavor [from wheat and milk derivatives], dextrose, sodium acid pyrophosphate, salt.

Sports Drinks
Before 1970 – water, sugar, salt, potassium citrate, lemon juice.
Today – water, sugar, dextrose, citric acid, salt, sodium citrate, monopotassium phosphate, modified food starch, natural flavor, artificial food coloring (such as Yellow 5, Red 40, or caramel color), glycerol ester of rosin.

Peanut Butter
Before 1970 – peanuts, sugar, salt.
Today – roasted peanuts, sugar, hydrogenated vegetable oils (cottonseed, soybean, and rapeseed oils).

This example illustrates how even benign additives can subvert your satiety mechanism.

Many soft cheeses, like cream cheese, are sold in bars. In order to make the cheese shelf-stable in a bar shape, various types of gum are added to the cheese. The gums used are not harmful, and even organic versions are readily available.

These gums stabilize the shape of the cheese and makes it last longer on the shelf. The trade-off is that it is not as satisfying as traditional cream cheese made without gum. Traditional cream cheese is made with milk, cream, and salt. Because it won’t keep a bar shape, it’s sold in tubs and it has to be mixed before eating. That cheese, however, is much more satisfying so you tend to eat less of it.

This example illustrates why simply relying on organic foods is not always enough.

Propylene glycol is a type of alcohol used in antifreeze, deicers, paints, and plastics. According to the US government (but not the Europeans) it is safe for human consumption, although frequent exposure is known to cause skin irritation. It’s in multiple foods and personal care products.

I wanted to stop using aluminum-based antiperspirants. I did not need this medication (just because it’s sold over the counter, doesn’t mean it’s not a medication) and aluminum compounds can be neurotoxic. I tried three different brands that did not contain aluminum. Each time, I got a rash. After the first two, I assumed I was allergic to fragrances and switched to an unscented brand. I still got a rash.

When I checked the ingredients, the common ingredient was propylene glycol. After switching to a brand that did not contain propylene glycol (but was still scented), I had no rash.

I have discovered it’s in various foods, including the flaked coconut used as an ingredient for various baked goods. I also found that propylene glycol can be made from natural vegetable sources so it can even be included in organic foods.

Packaging can have a major influence on how you eat.

Go to any store or warehouse club and you will find huge packages of food. This might be helpful if you have a large family, are having a party, or run a restaurant. The problem is individuals buy these huge packages to save money but then eat more because, subconsciously, they don’t feel like they are eating a lot if the package still has so much food left in it.

For example, in a typical grocery store, you can buy a 9-ounce box of dried figs, but warehouse clubs sell 36- or 40-ounce bags. The impulse to eat extra figs is always present each time you have figs because there are so many in the big bags. It’s easy to have multiple figs, even though a serving size is only two figs and you were satisfied with just the normal serving size. This principle applies to almost every food that comes in large packages.

Why does most of the cheese available today have a texture like rubber and taste like plastic?

Because, like so many other ingredients in our foods, the rennet used to make it is not the same as it was in the past. Rennet is a key ingredient used in making hard cheeses such as cheddar. It consists of several enzymes, including chymosin (the enzyme that initially separates milk into curds (solids) and whey (liquid)) and other enzymes that, over time, help aged cheese develop its flavor. Traditionally, most hard cheeses were made with rennet from animal sources, although some were made from vegetable rennet, which imparts a particular flavor that is suitable for only certain cheeses.

Because animal rennet is expensive and hard to produce in large quantities, and because vegetable rennet is not suitable for most hard cheeses, cheesemakers began looking for alternatives. They wanted something that was less expensive, readily available, and could be used to make cheese that vegetarians would eat.

The alternative they chose is rennet produced from naturally occurring molds. This type of rennet is known as microbial (because molds are a type of microbe) or fermentation produced rennet (because these molds are produced using a fermentation process). Microbial rennet is used to try to mimic traditional rennet by producing some of the same enzymes.

There is even a genetically modified organism (GMO) that can produce large quantities of rennet even more cheaply and easily. GMO rennet exclusively produces only one enzyme (chymosin) and is used extensively in cheesemaking today.

The problem with microbial or GMO rennet is that it does not produce cheese that tastes the same as cheese made with traditional rennet. For cheeses that are aged for less than 3 months, this is not much of a problem because they do not need all the enzymes in traditional rennet. Cheeses that require longer aging, however, simply can’t develop the complex, refined flavors that one expects without the enzymes in traditional rennet.

As usual, the result of substituting traditional rennet with these alternatives is that people tend to eat more cheese because the satiety that comes from tasting the complex flavors in cheese are missing. They just eat cheese until they’re full, well past the point where they were satisfied and no longer hungry.

A note about labeling
Cheesemakers do not always label their cheeses fully. One can find rennet, fermentation produced rennet, or microbial rennet on labels but it is not clear if that rennet was made with a GMO product. In Europe, some cheesemakers label cheeses made with a GMO product fermentation produced chymosin (FPC) to differentiate it from natural rennet, but this is not the case in the US. For cheeses with unclear labeling, you will have to search the cheesemaker’s website or even contact the cheesemaker directly to clarify what type of rennet they are using.

Stress, anxiety, depression, and other psychological conditions can make pain worse even if there is no underlying physical change causing problems. It’s important to treat those conditions, as many patients can benefit by going to a psychiatrist or therapist experienced in treating pain patients.

Pain medications and psychiatric considerations
Psychiatric medications can also affect pain and certain pain medications can make psychiatric problems worse. For example, some (but not all) antidepressants may help relieve certain types of neuropathic pain. This is not because they make you feel better emotionally, but rather because they block pain signals in the nervous system. Usually, the dose of antidepressant used for pain management is much lower than the dose used for psychiatric conditions.

On the other hand, some pain medications such as opioids can have psychiatric side effects such as addiction and dysphoria (a feeling of unease or dissatisfaction). Psychiatric medications can also cause neurological problems such as rigidity and other extrapyramidal symptoms (similar to Parkinson’s Disease), insomnia, and seizures among other things. These can worsen pain control.

Psychiatric medications can be very helpful but they are serious medications that should not be used lightly.

Many people confuse addiction with substance abuse. While addiction can include substance abuse with drugs or alcohol, there are major problems with addiction to things like gambling, pornography, eating, social media, and shopping which do not involve substance abuse. As this list illustrates, addiction is not always related to something illegal, but it is invariably harmful.

Addiction is rampant throughout Western society. Many organizations actively seek to create something addictive in order to have a captive audience that can be exploited. There are entire industries that thrives on people who have addictions. Despite all this there are good options for handling addiction – if the person is truly ready to get help. Ultimately, without a sincere commitment to change, there will not be much chance of success.

Smoking is a great example of how addiction is about more than just being dependent on a particular substance. People assume the main reason smokers don’t quit is nicotine addiction, but this is not the case. Over the years, various forms of nicotine patches and gums were developed to help people quit smoking. None of these proved very effective, although they are very good at preventing the withdrawal symptoms from nicotine dependence that occur when someone stops smoking.

Eventually, electronic cigarettes were introduced based on the assumption that smokers needed something to simulate the physical act of smoking a cigarette in addition to nicotine itself. The original e-cigarettes just had water vapor with nicotine, but they were not very popular.

It was only when various flavors were introduced that e-cigarettes became popular. The combination of flavors and nicotine proved highly addictive and now there are people who are addicted to e-cigarettes. As a result, the original idea of using of e-cigarettes as a smoking substitute to help people quit did not work out as planned.

Modern life is very stressful for a variety of reasons. Most people live in a state of chronic dissatisfaction, alienation, and anxiety which is often mislabeled as depression but is not the same as major depressive disorder (a serious condition that requires ongoing psychiatric care). Nevertheless, they are prescribed the same antidepressants as those used to treat major depressive disorders.

Over time, they become dependent on these antidepressants. When they try to stop the antidepressants, they go through a withdrawal syndrome similar to that faced by people dependent on substances such as opioids, marijuana, or alcohol. They are then told this is happening because they are still depressed or anxious and need to go back on antidepressants. Eventually, they stop trying to come off antidepressants and just resign themselves to taking these medications for life.

Something similar happens with opioids. Only a minority of people get the euphoria (the “high”) everyone assumes happens with opioids. Instead, one of the most highly addictive properties of opioids is the feeling of calmness and tranquility they produce. It is quite seductive to those who struggle with anxiety, alienation, and dissatisfaction. This is why it is important to use opioids solely to control pain and not to simply feel better.

This highlights a few important considerations:

• Getting the right diagnosis is very important. Just going to someone for a prescription medication to treat feelings of anxiety, alienation, and dissatisfaction without having major depressive disorder can lead to chronic dependence on antidepressants and other psychiatric medications. Therapy is usually a better choice in these cases.
• The stress associated with modern life leads many people to adopt unhealthy coping mechanisms that can lead to addictions, even if those addictions are to legal things such as sugar, smoking, alcohol, social media, gambling, etc. Just because something is legal does not mean it will not hurt you.
• Withdrawal syndromes can occur with almost anything, including legal medications such as antidepressants and even activities such as gambling, shopping, or pornography. There are ways to minimize withdrawal syndromes that can help when trying to stop an addictive substance or behavior.

Lack of sleep is often associated with stress, but many people have insomnia even without a lot of stress.

There are two types of insomnia – sleep onset and sleep maintenance. Sleep onset insomnia means having trouble falling asleep. With sleep maintenance insomnia, the person falls asleep easily but then has trouble staying asleep. For example, someone is able to fall asleep easily but cannot get back to sleep after waking up to go to the bathroom or drink water. Most people have both types of insomnia.

Rumination is an important part of both types of insomnia. This develops insidiously and consists of lying in bed thinking about things – work, personal relationships, pending projects, worries about loved ones, etc. These are things that cannot be addressed at night when the person is trying to sleep. The first step in refraining from rumination is avoiding the bad sleep habits outlined in the Adequate Rest section above. Cognitive behavioral training (CBT) and biofeedback can also be very effective for insomnia that remains problematic despite avoiding bad sleep habits. These tend to have better outcomes in the long term than simply using medications or supplements such as melatonin.

Other causes of insomnia include untreated or undertreated sleep apnea, medication side effects, seizures, cardiac arrhythmias, periodic limb movement disorder/restless leg syndrome, and pain from peripheral neuropathy or vascular disease. While everyone has insomnia at some point, the causes of chronic insomnia should be addressed.

Why Acting Early Matters for Patients and Families

Dementia affects families before patients realize what’s happening

One of the most difficult parts of dementia is that the person affected often doesn’t see how much they’re struggling. Families are usually the first to notice — repeating questions, forgetting important details, withdrawing from social life. But when it comes time to get help, many patients resist.

If this sounds familiar, you’re not alone. Dementia is complex, but the earlier it’s diagnosed and treated, the better the outcome for both patients and caregivers.

Why a full evaluation matters

Dementia isn’t just one disease. It can be caused by Alzheimer’s, Parkinson’s, medication side effects, silent seizures, or even depression. That’s why it’s important to start with a **thorough workup** rather than assuming it’s “just memory loss.”

Our patients start with a detailed consultation and evaluation by one of our nurse practitioners, who specialize in neurological care. I review and guide all care plans as medical director to ensure patients get an accurate diagnosis and safe treatment.

What a dementia workup includes

• Medication review – Many older adults take multiple prescriptions, and drug interactions can cause confusion or memory problems. Adjusting these can sometimes make a big difference.
• Lab testing – There’s now an FDA-approved blood test for Alzheimer’s, but other lab tests are often needed to rule out additional causes.
• Brain imaging – Usually an MRI, which helps identify strokes, tumors, or other brain changes.
• EEG (brain wave test) – Subtle seizures, sometimes during sleep, can affect memory. An EEG can pick this up.
• Neuropsychological testing – A detailed cognitive exam to pinpoint the type and severity of memory changes, and to see if conditions like depression are playing a role.

Treatment options: medications and beyond

If Alzheimer’s or another dementia is diagnosed, treatment usually includes a combination of:

• Medications – While older drugs like cholinesterase inhibitors can help a little, the newer anti-amyloid therapies can slow progression, although no medication can reverse the disease. Starting sooner makes them more effective.
• Therapies and programs – Cognitive therapy, memory training, and structured day programs can help preserve function longer. These are often underused but make a real difference.
• Supportive care – In advanced cases, memory care units provide structured environments that are far more than “nursing homes.” They are designed to support dignity, safety, and cognitive activity.

Why early action matters

The biggest mistake families make is waiting. Every month lost is time when treatment could have helped maintain memory and independence. Even though there’s no cure, acting early helps patients and families cope better with the road ahead.

How our practice helps

Our goal is to make care accessible quickly. Patients are seen directly by our experienced nurse practitioners, who take the time to listen and guide families through the process. I oversee each treatment plan as medical director, ensuring that every patient benefits from specialist input without long delays.

If you’re noticing memory changes in a loved one, don’t wait.