Reducing your stroke risk…because I care

stroke-1-in-6-graphics_170x304With all the upcoming excitement about Halloween, you may have overlooked the fact that yesterday was World Stroke Day.

This year, the global campaign to tackle stroke was highlighted with the slogan “Because I care…”.

The phrase showcases the role of caregivers in supporting people who have suffered a stroke and aims to correct misinformation about the disease, such as the misconception that stroke only happens later in life.

Every other second, stroke attacks a person, regardless of age or gender. Of the 15 million people who experience a stroke each year, six million do not survive. Worldwide about 30 million people have had a stroke and most have residual disabilities.

Overall approximately 55 000 more women have strokes than men each year, mainly because stroke occurs more frequently at older ages and women generally live longer than men. Of note, women are twice as likely to die from a stroke than breast cancer each year.

And recent data published in the Lancet, shows a striking 25% worldwide increase in the number of stroke cases in people aged between 20 and 64. This younger age group now accounts for a shocking 31% of strokes.

But, with greater awareness, these figures don’t have to continue their alarming trend.  Stroke can be prevented, treated and managed in the long term. The campaign theme “Because I care” emphasizes these areas.

The slogan was chosen as it can easily be adapted to all cultures and in any setting. It attempts to address prevailing misinformation about the disease, e.g., stroke only happens later in life. The campaign also celebrates the important contributions of caregivers and the role they play as conduits between the stroke community and the general public in correcting misinformation.

Because I care…

    • Stroke 02.11.13I want you to know the facts about stroke
    • I will work to break down the myths surrounding stroke
    • I want you to learn how to minimize your risk of stroke
    • I want you to have access to the best possible treatment
    • I will ensure that you receive quality treatment, care and support
    • I will be with you every step of the way towards your full recovery

Research presented at the recent European Society of Cardiology [ESC] Congress  showed that there are plenty of steps young obese women can take to reduce their risk of stroke. In young women without metabolic disorders such as high blood pressure, high cholesterol and high blood sugar  or abnormal glucose metabolism being overweight did not increase the chance of having a stroke compared to normal weight women without metabolic disorders. However, the risk of stroke increased by 3.5 times in women who were overweight and had metabolic disorders.

Study author, Dr Michelle Schmiegelow said: “Obesity puts young women at a major risk of developing high blood pressure, diabetes or high cholesterol, which dramatically increases their likelihood of having a stroke. Young women who are overweight or obese probably have a window of opportunity to lose weight and keep a healthy lifestyle so that they reduce their risk of getting high blood pressure, diabetes and high cholesterol. In this way they can protect themselves from having a stroke or heart attack.”

Awareness of important risk factors, such as atrial fibrillation  and hypertension, is crucial.

OBESE-BLACK-WOMENProfessor Joep Perk, MD, a Swedish Cardiologist and spokesperson for the ESC says: “Women are at the same risk of stroke as men, and the level of risk is completely steered by the underlying risk factor pattern they have. The majority of people who have a stroke are disabled for the rest of their lives and may be paralyzed or lose their ability to speak. The devastating consequences of this disease for patients and their loved ones make prevention even more important.”

He adds: “Prevention for all cardiovascular disease follows the same pattern, be it stroke, heart attack, or peripheral arterial disease. Step one for women is absolutely to stop smoking – that beats everything. The second most important thing is to know your blood pressure to see if you are at risk. And finally, adopt healthy behaviors like eating heart healthy food and keeping the amount of salt you eat under control.”

stroke FASTThe global campaign against stroke asks people to commit to six stroke challenges:
•    Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol
•    Be physically active and exercise regularly
•    Maintain a healthy diet high in fruit and vegetable and low in salt and keep blood pressure low
•    Limit alcohol consumption
•    Avoid cigarette smoke. If you smoke, seek help to stop now
•    Learn to recognize the warning signs of a stroke and how to take action.

Check, check, check, check, check and check!  I’m feeling up to the stroke challenge.  Are you?

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10 Brain Damaging Habits

brain damageAccording to the World Health Organization here’s 10 habits that can severely damage your brain:

No Breakfast1.  No BreakfastSkipping breakfast in order to lose weight or save time is totally wrong and directly affects our brain. Those who don’t take breakfast or take unhealthy breakfast having lower blood sugar level and sometime it may cause overweight.

2. Overreacting – causes hardening of the brain arteries, leading to a decrease in mental power.

3. High Sugar consumption – Too much sugar will interrupt the absorption of proteins and nutrients causing malnutrition and may interfere with brain development by reducing the production of Brain Derived Neutrotrophic Factor, without which the brain cannot learn.

Smoking4. Smokingcauses brain shrinkage, damages memory, judgment, learning and thinking powers and may even lead to dementia and Alzheimer’s disease.

5. Air PollutionThe brain is the largest oxygen consumer in our body. Inhaling polluted air decreases the supply of oxygen to the brain, bringing about a decrease in brain efficiency.

6. Sleep Deprivation Sleep allows our brain to rest. Long term deprivation from sleep will accelerate the death of brain cells.

7. Head covered while sleeping – Sleeping with the head covered decreases available air space and forces you to start breathing carbon dioxide instead of oxygen. This leads to a rise in intracranial pressure and results in brain hypoxia which may lead to brain damaging effects.

8. Working your brain during illness – Working hard or studying with sickness may lead to a decrease in effectiveness of the brain. When we are sick the brain is at its weakest and becomes more easily stressed. This stress can also affect memory.

9. Drinking too little water – Water is the main source of energy and is essential for brain function and activity of neurotransmitters. Dehydration can lead to anger, stress, exhaustion, depression and lack of mental clarity.

Talking Rarely10. Rarely Talking – Intellectual conversations help to train and promote efficiency of the brain. Conversely, lack of stimulating thoughts may cause brain shrinkage. Reading SRxA’s Word on Health and discussing the content with friends is an excellent way to avoid this!  So grab a glass of water and subscribe today. Consider it free brain fuel!

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Sleep Better, Look Better

wake up beautifulGetting treatment for a common sleep problem may do more than help you sleep better – it may help you look better too. So says new research study from the University of Michigan Health System and Michigan Technological University.

And it’s more than just being being bright-eyed after a good night’s rest.  For the first time, researchers have shown specific improvement in facial appearance after at-home continuous positive airway pressure [CPAP] treatment for sleep apnea.

Sleep apnea affects millions of adults, many of them undiagnosed.  It is a condition marked by snoring and breathing interruptions and can put sufferers at higher risk for heart-related problems and daytime accidents.

Using a sensitive “face mapping” technique usually used by surgeons, and a panel of independent appearance raters, the researchers detected changes in 20 middle-aged apnea patients just a few months after they began using CPAP to help them breathe better during sleep and overcome chronic sleepiness. CPAP also helps to stop snoring, improve daytime alertness and reduce blood pressure.

patient_cpap_frustratedWhile the research needs to be confirmed by larger studies, the findings may help sleep apnea patients comply with their treatment.  Compliance is a challenge for some because of the cumbersome breathing mask they have to wear to bed.

Sleep neurologist Ronald Chervin, M.D., M.S., director of the U-M Sleep Disorders Center, led the study, which has just been published in the Journal of Clinical Sleep Medicine.

Chervin says the study grew out of the anecdotal evidence that sleep center staff often saw in sleep apnea patients when they came for follow-up visits after using CPAP.

The common lore, that people ‘look sleepy’ because they are sleepy, and that they have puffy eyes with dark circles under them, drives people to spend untold dollars on home remedies,” notes Chervin. “We perceived that our CPAP patients often looked better, or reported that they’d been told they looked better, after treatment. But no one has ever actually studied this.”

They teamed with U-M plastic and reconstructive surgeon Steven Buchman, M.D., to use a precise face-measuring system called photogrammetry to take an array of images of the patients under identical conditions before CPAP and again a few months after.

The technology used in this study demonstrates the real relationship between how you look and how you really are doing, from a health perspective” says Buchman.

sleepyfacehires1The researchers also used a subjective test of appearance. 22 independent raters were asked to look at the photos, without knowing which were the “before” pictures and which the “after” pictures of each patient. The raters were asked to rank attractiveness, alertness and youthfulness – and to pick which picture they thought showed the patient after sleep apnea treatment.

About two-thirds of the time, the raters stated that the patients in the post-treatment photos looked more alert, more youthful and more attractive. The raters also correctly identified the post-treatment photo two-thirds of the time.

Meanwhile, the objective measures of facial appearance showed that patients’ foreheads were less puffy, and their faces were less red, after CPAP treatment. The redness reduction was especially visible in 16 Caucasian patients.

However, they didn’t see a big change in facial characteristics often associated with sleepiness. “We were surprised that our approach could not document any improvement, after treatment, in tendency to have dark blue circles or puffiness under the eyes,” says Chervin. “Further research is needed, to assess facial changes in more patients, and over a longer period of CPAP treatment.”

I don’t have sleep apnea but if CPAP makes you look younger, more attractive and alert, tell me where do I sign up?!?

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Tee-Total but Drinking Yourself to Death?

Bloomberg Moves To Ban Sugary Drinks In NYC Restaurants And Movie TheatersAccording to research presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism meeting last week, sugar-sweetened sodas, sports drinks and fruit drinks may be associated with a staggering 180,000 deaths around the world each year,

Researchers calculated the quantities of sugar-sweetened beverage intake around the world by age and sex.  They also looked at the effects of this on obesity and diabetes. Using data from the 2010 Global Burden of Diseases Study, they linked intake of sweetened beverages to 133,000 diabetes deaths, 44,000 cardiovascular disease deaths and 6,000 cancer deaths.

78% of these deaths were in low and middle-income countries.  But that doesn’t mean America is off the hook.

In the U.S., our research shows that about 25,000 deaths in 2010 were linked to drinking sugar-sweetened beverages,” said Gitanjali M. Singh, PhD, co-author of the study.

Of nine world regions in 2010:

  • Latin America/Caribbean had the most diabetes deaths (38,000) related to sugar-sweetened beverages
  • East/Central Eurasia had the largest numbers of cardiovascular deaths (11,000) related to sugary beverage consumption

Cola can and measuring tapeAmong the world’s 15 most populous countries, Mexico had the highest death rate due to these beverages, with 318 deaths per million adults.

Japan, one of the countries with lowest per-capita consumption of sugary beverages in the world, had the lowest death rate associated with the consumption of sugary beverages, at about 10 deaths per million adults.

Because we were focused on deaths due to chronic diseases, our study focused on adults. Future research should assess the amount of sugary beverage consumption in children across the world and how this affects their current and future health,” Singh said.

In the meantime, the American Heart Association recommends adults consume no more than 450 calories per week, from sugar-sweetened beverages.

diet soda 2And don’t assume you’re OK just because you drink diet, rather than regular soda. According to research presented at the American Stroke Association’s International Stroke Conference in  2011, drinking diet soda daily is linked to a higher risk of stroke, heart attack and vascular-related deaths, compared to those who don’t drink soda.  Even though you are avoiding the sugar calories, the high salt content may double the risk of ischemic stroke, independent of sodium’s role in hypertension.

Here at SRxA’s Word on Health we’re canning the cans and from now on it will be water all the way!

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The Skinny on Childhood MS

Childhood Obesity imageAs we’ve previously reported, childhood obesity is on the increase. Cases have more than doubled in children and tripled in adolescents in the past 30 years. The percentage of children and adolescents aged 6–18 years in the United States who are obese is now estimated to be >18%.

Childhood obesity can cause a number of health complications including diabeteshypertension, high cholesterolasthma  and emotional problems.  This is deeply troubling in and of itself, but now there’s a new cause for concern.

A new study has found that obese children and teenage girls may be more at risk for developing the chronic, debilitating central nervous system disorder – multiple sclerosis (MS).

Kaiser Permanente researchers studied 75 children aged 2 to 18 with pediatric MS, and compared them to more than 900,000 kids without the disease. Fifty percent of the kids with MS were overweight or obese, compared to 36% of the children who didn’t have the disease.

The study also found that the risk of developing multiple sclerosis was one-and-a-half times higher for overweight girls, almost two times higher for moderately obese girls and four times higher for extremely obese girls.

Mary Rensel, MD, who treats pediatric MS patients at Cleveland Clinic offers an explanation for the increased risk. “Fat increases the inflammation in the body. Multiple sclerosis is an auto-immune condition where the immune system is set too high. If there’s too much inflammation, it can increase the risk of having a disorder associated with inflammation – like MS.”

Childhood-Obesity-Linked-to-Multiple-SclerosisLead author, Annette Langer-Gould, MD, PhD, with the Kaiser Permanente Southern California Department of Research & Evaluation in Pasadena  “Even though pediatric MS remains rare, our study suggests that parents or caregivers of obese teenagers should pay attention to symptoms such as tingling and numbness or limb weakness, and bring them to a doctor’s attention,”

The researchers also stress that parents of overweight or obese children should play an active role in controlling their kids’ weight by getting them into the habits of eating healthy and getting enough exercise.

Dr. Rensel agrees, saying, “The good news is now we know. We can educate parents and patients of the importance of maintaining a healthy weight to decrease the chance of having consequences of being overweight.”

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When’s Your Time to Die?

risk of dyingWhat are your chances of dying in the next 10 years?

Obviously there are some activities that may increase your risk  such as driving drunk and active military duty in a war zone, but how about getting winded after walking several blocks or having trouble pushing a chair across the room

Turns out the latter might be just as dangerous as the former.

Researchers at the University of San Francisco VA Medical Center have recently come up with a “mortality index” to predict when a person may die.  Marisa Cruz and her colleagues have developed a list of 12 questions that can help predict chances of dying within 10 years for patients aged 50 and older.  The researchers created the index by analyzing data on almost 20,000 Americans over 50 who took part in a national health survey in 1998. They tracked the participants for 10 years. Nearly 6,000 participants died during that time.

risk of dying 2While the test scores may satisfy people’s morbid curiosity, the researchers say their index wasn’t meant as guidance about how to alter your lifestyle.  Instead, it is mostly for use by doctors, to help them discuss the pros and cons of costly health screenings or medical procedures in patients who are unlikely to live 10 more years.

That said, we know that many of our readers are “simply dying” to take the test themselves – right now.

So without further ado…here’s how it works.

The 12 items on the mortality index are assigned points.  The fewer your total points the better odds of living.

  • Men automatically get 2 points. In addition, men and women ages 60 to 64 get 1 point; ages 70 to 74 get 3 points; and 85 or over get 7 points.
  • Two points each for: a current or previous cancer diagnosis, excluding minor skin cancers; lung disease limiting activity or requiring oxygen; congestive cardiac failure; smoking within the past 2 weeks; difficulty bathing; difficulty managing money because of health or memory problem; difficulty walking several blocks.
  • One point each for: diabetes or high blood sugar; difficulty pushing large objects, such as a heavy chair; being thin or normal weight.


The highest, or worst, score is  26, which equates to  a 95% chance of dying within 10 years. To get that, you’d have to be a man at least 85 years old with all the above conditions.
healthy young womanFor a score of zero, which correlates to a 3% chance of dying within 10 years, you’d have to be a woman of “normal weight” younger than 60 without any of those infirmities.

While it’s hardly surprising that a sick, older person would have a much higher chance of dying than someone younger why would being overweight be less risky than being of normal weight or slim?  One possible reason is that thinness in older age could be a sign of illness.

Dr. Stephan Fihn, a health quality measurement specialist with Veterans Affairs health services in Seattle, said the index seems valid and “methodologically sound.”
However, he adds that it is probably most accurate for the oldest patients, who don’t need a scientific crystal ball to figure out their days are numbered.

For fans of SRxA’s Word on Health, I’m pleased to report that my 10-year mortality index is zero. Let the blogging continue!

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Don’t Ignore the Snore

snoringThink for a moment about the factors that influence health.  Chances are you thought about: smoking, obesity, high blood pressure, high cholesterol and insufficient exercise. Maybe you added in family history of disease, and stress. How about snoring?

What!?!  Well, according to researchers at Henry Ford Hospital in Detroit, snoring may put your health at a greater risk than any of the above.

Their study revealed that isolated snoring may not be as benign as first suspected.  The trauma and subsequent inflammation caused by the vibrations of snoring can lead to changes in the carotid arteries – the pair of blood vessels that deliver blood to your brain and head. Snoring can cause a build-up of plaque which can eventually block the blood supply to the brain and increases the risk of stroke.

Snoring is more than a bedtime annoyance and it shouldn’t be ignored. Patients need to seek treatment in the same way they would if they had sleep apnea, high blood pressure or other risk factors for cardiovascular disease,” says lead author Robert Deeb, M.D., with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford.

Obstructive sleep apnea– a sleep disorder that occurs due to the collapse of the airway in the throat during sleep and causes loud snoring and periodic pauses in breathing – has long been linked to cardiovascular disease, along with a host of other serious health issues.

But the risk for cardiovascular disease may actually begin with snoring, long before it develops into obstructive sleep apnea.

carotid arteryInvestigators reviewed data for 913 patients aged 18-50, who had participated in a diagnostic sleep study, none of whom had sleep apnea.  54 patients completed a survey regarding their snoring habits, and underwent a carotid artery ultrasound to measure the thickness of the innermost two layers of the carotid arteries. This test is able to pick up the first signs of carotid artery disease.

What they found was that snorers were had significantly greater thickening of the carotid arteries, compared to non-snorers.  Interestingly, no statistically significant differences in carotid artery thickening could be found for patients with or without some of the traditional risk factors for cardiovascular disease – smoking, diabetes, hypertension or hypercholesterolemia.

Snoring is generally regarded as a cosmetic issue by health insurance, requiring significant out-of-pocket expenses by patients. We’re hoping to change that thinking so patients can get the early treatment they need, before more serious health issues arise.”

The Henry Ford research team plans to conduct another long-term study on this topic, particularly to determine if there’s an increased incidence of cardiovascular events snoring2in patients who snore.

In the meantime, instead of kicking your snoring bed partner out of bed, seek out medical treatment for him…or her.

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Vital Signs of Health

blood pressure heartRoll up your sleeve for the blood pressure cuff. Stick out your wrist for the pulse-taking. Lift your tongue for the thermometer.Report how many minutes you are active or getting exercise.

Wait, what?

If the last item isn’t part of the usual drill at your doctor’s office, a movement is afoot to change that. One recent national survey indicated only a third of Americans said their doctors asked about or prescribed physical activity.

Kaiser Permanente, one of the nation’s largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit. And the trend is spreading among other medical systems.

30-Minutes-ExerciseHere’s how it works: During any routine check of vital signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it’s among the first things the doctor sees.

All we ask our physicians to do is to make a comment on it, like, ‘Hey, good job,’ or ‘I noticed today that your blood pressure is too high and you’re not doing any exercise. There’s a connection there. We really need to start you walking 30 minutes a day,'” says Dr. Robert Sallis, the Kaiser family doctor who initially hatched the vital sign idea.

A study looking at the first year of Kaiser’s effort showed more than a third of patients said they never exercise.  Many patients were not aware that physical inactivity is riskier than high blood pressure, obesity and other health risks people know they should avoid. Few know that those who routinely exercise live longer than others, even if they’re overweight.

Take Zendi Solano, 34, who works for Kaiser as a research assistant in Pasadena, CA. She always knew exercise was a good thing, but until about a year ago, when her Kaiser doctor started routinely measuring it, she “really didn’t take it seriously.”  She was obese, and had elevated blood sugar. She sometimes did push-ups and other strength training but not anything very sustained or strenuous.

joggers-in-track-suits-running1So she decided to take up running and after a couple of months she was doing three miles. Then she began training for a half marathon, formed a running club with co-workers and started eating smaller portions and buying more fruits and vegetables.  She is still overweight but has lost 30 pounds and her blood sugar is normal. Her doctor praised the improvement at her last physical in June and Solano says the routine exercise checks are “a great reminder.”

Kaiser began the program after 2008 government guidelines recommended at least 2 1/2 hours of moderately vigorous exercise each week. That includes brisk walking, cycling, lawn-mowing — anything that gets you breathing a little harder than normal for at least 10 minutes at a time.

Now other health systems are following suite. Dr. Elizabeth Joy of Salt Lake City has created a nearly identical program and she expects 300 physicians in her Intermountain Healthcare network to be involved early this year.  NorthShore University HealthSystem in plans to start an exercise vital sign program this month, eventually involving about 200 primary care doctors.

All of which is good news. Figuring out how to get people to be more active could have a big effect in reducing medical costs and improving health. Here at SRxA’s Word on Health we’ll be working on our Exercise Minutes.  Will You?

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Ho Ho Ho: health hazards for Santa

santa_claus obesityAfter weeks of harried holiday shopping, when the stores finally close on the evening of December 24, it will be a welcome reprieve from the madness. Families and friends gather together and enjoy a relaxing day or two of rest.

But for one man, the real work is just beginning. That’s right – Santa Claus is coming to town!

And while he spends most of the year enjoying a flexible work schedule, monitoring naughty-and-nice behaviors around the world and occasionally checking in on his elves and reindeer, things are about to get frantic for Old Nick.

And to be honest, this year we’re a little concerned about his health.  That belly fat!  The all-nighter he’s about to pull!  All those cookies!

He may know when you are sleeping, but the only way for Santa to get the job done is to stay up all night on December – and that can lead to some serious health concerns.
Studies have suggested that drowsy driving is as dangerous as drunk driving.  Even if he manages to get Rudolf and his friends safely parked on the rooftops, sleep deprivation could cause his judgment to become fuzzier, leading to the wrong presents traveling down the wrong chimneys.
What’s worse is that sleep loss has a cumulative effect. So while people in the Southern hemisphere might do OK, those of us in Northern climes, and especially those on the West Coast aren’t so lucky. Chronic sleep deprivation could mean he could fly over some houses altogether.

santa + sackBut even if we manage to keep him awake with coffee and Red Bull rather than the usual glass of milk, we’ve got to change Santa’s sack. By carrying something that weighs more than 10% of his body weight, one shoulder is going to end up taking on most of the burden, which could lead to back strains, sprains and spasms.
If you’re thinking of getting Santa a gift this season maybe you could consider a backpack, or better still, a rolling suitcase.

That’s not to say Santa doesn’t need the exercise of his Christmas Eve jaunt. Like 70% of adult men in the US, he is severely overweight. The health risks linked to obesity include Type 2 diabetes, coronary heart disease, stroke, hypertension, certain types of cancer and osteoarthritis.

With his giant waist comes the risk of belly fat associated problems such as insulin resistance, high triglycerides, heart disease and metabolic syndrome.

Santa beardThen there’s that beard to worry about. After a month or so of letting thousands upon thousands of kids sit on your lap at the mall, we wouldn’t be surprised if he’s harboring some germs in his whiskers.  So if Santa touches his beard followed by his eyes, ears or mouth, he’s pretty much bound to catch something, especially in the midst of this cold and flu season.

We suggest leaving some hand sanitizer next to the milk and cookies this year to give him a fighting chance.

And finally we’re worried about that thin Red Suit. While we’ll give Santa props for covering his head with a hat, traveling outside all night in December in a red velvet suit and a touch of faux fur seems ill advised. In addition to the hat, he should probably throw on a scarf or knit mask, mittens, thermals and a water-resistant coat to ward off hypothermia.

So whether you’ve been naughty or nice, there’s still time to give some thought to Santa’s Health, as well as your own this Christmas season.

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Sleeping Your Way to Success

As the fall semester winds down at colleges and universities, countless students will doubtless be pulling all-night study sessions to prepare for upcoming exams. Fueled by Red Bull, Monster energy drinks, or sheer fear of failure, last minute cramming will be going on in dorm rooms, libraries around the world.

Ironically, as it turns out, the loss of sleep during these all-nighters could actually work against students performing well.

Dr. Philip Alapat, medical director of the Harris Health Sleep Disorders Center, and assistant professor at Baylor College of Medicine, recommends that students study throughout the semester instead, and get at least 8 hours of sleep the night before exams.

Memory recall and ability to maintain concentration are much improved when an individual is rested,” he says. “By preparing early and being able to better recall what you have studied, your ability to perform well on exams is increased.”

College-aged students ideally should get 8-9 hours of sleep a night. Truth is, most students get much less.

Any prolonged sleep deprivation will affect your mood, energy level and ability to focus, concentrate and learn, which directly affects your academic performance,” Alapat adds.

All-nighters, especially when coupled with caffeinated beverages lead to a risk for developing insomnia and sleep disorders, including apnea, restless legs syndrome, narcolepsy and chronic fatigue syndrome.

Alapat’s recommendations:

  • Get 8-9 hours of sleep nightly (especially before final exams)
  • Try to study during periods of optimal brain function (usually around 6-8 p.m.)
  • Avoid studying in early afternoons, usually the time of least alertness
  •  Don’t overuse caffeinated drinks
  • Recognize that chronic sleep deprivation may contribute to development of long-term diseases like diabetes, high blood pressure and heart disease

Good advice!  Excuse me while I go to bed – I have an Advanced Cardiac Life Support (ACLS) exam in the morning!