Five Ways to Sleep Well and Protect Your Heart

Protecting your mental health during the coronavirus pandemic – COVID-19 – Johns Hopkins Bloomberg School of Public Health

Five Ways to Sleep Well and Protect Your Heart | Johns Hopkins Medicine

The daily counts of COVID-19 cases and deaths tell the public story of the coronavirus outbreak. Privately, the effects of the pandemic aren’t as clear.

The new reality of social distancing and other safety measures is testing everyone, and those living with mental illness may find this time even more challenging if the support system they rely on is not in place.

Experts from the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health put together these tips and resources on how to protect your mental health during these trying times.

As the coronavirus pandemic has unfolded across the U.S., ordinary life has been put on pause. Lockdowns, travel restrictions, school closings, work closings, and social distancing have created a level of social isolation previously unseen across the globe.

Fears about finances and food shortages have placed additional stressors on an already anxious and sensitized population. The practices recommended by the Centers for Disease Control and Prevention and World Health Organization are necessary and designed to protect the community, particularly the most vulnerable individuals.

However, this pandemic and the associated changes, including serious financial implications for many households, can have profound consequences for our mental health.

Traumatic or stressful experiences put individuals at greater risk for not only poor physical health but poor mental health outcomes, such as depression, anxiety, and PTSD.

You may notice that yourself or others around you are more edgy, irritable, or angry; helpless; nervous or anxious; hopeless, sad, or depressed. Sleep may be disrupted and less refreshing.

Practicing social distancing may leave you feeling lonely or isolated. If you are at home with children, you may have less patience than before.

Those who are especially vulnerable to COVID-19—older individuals and people with medical comorbidities or immune-comprised systems—who need to be especially stringent in following guidelines from the health authorities, may be the very people whose mental health may suffer the most. Individuals with a pre-existing mental health condition, such as an anxiety disorder, are also at heightened risk for poor mental health outcomes as a result of coronavirus.

It is important that as a population, we learn how to protect our mental health during this stressful and ever-changing situation, while also following the guidelines set by health authorities to protect our physical health. Here are some strategies that can be used during these challenging times to protect your and others’ mental health.

Create structure

  • Create a daily schedule for you and your family. Feelings of uncertainty can lead to increased mental health symptoms.
  • Try to limit the amount of time you spend watching, reading, or listening to the news. Get your information on the coronavirus outbreak from a trusted source, such as the CDC or WHO, once or twice a day.
  • Make space for activities and conversations that have nothing to do with the outbreak.

Maintain your physical health

  • Protect your sleep. Good quality, sufficient sleep not only helps to support your immune system but also helps you to better manage stress and regulate emotions. Adults should aim for 7–9 hours, while children and teenagers need even more. [See recommendations by the National Sleep Foundation].
  • Try to eat at regular times and opt for nutritious foods whenever possible. Some people may crave junk food or sugary snacks and be tempted to snack mindlessly when stressed or bored, and others may skip meals altogether.
  • Maintain an exercise routine, even if you can’t go to your local gym. Exercise at home using an online workout video, or go for a walk, run, or bike ride in a sparsely populated area.

Support–and create–your community

  • Create a virtual support group and check in with those around you. There are many options for connecting, including video conferencing software, such as Google Hangouts and Facetime. During this time of isolation, connecting face-to-face (online) is more important than ever. If you can’t stream, then calling and texting is important. Check out some ideas at Wirecutter and Prokit for how to be social during the quarantine.
  • Crises offer a time for community cohesion and social solidarity, and volunteering is one way to not only help others, but yourself as well. Science has repeatedly shown that volunteering can improve mental health. Check out this article for a list of organizations to donate to and this article for other ways to help your neighbors and community.
  • If you have children, talk to them honestly about what is going on in an age-appropriate manner. Help kids express their feelings in a positive way, whether playing in the backyard, drawing, or journaling. Check out these guides by the Substance Abuse and Mental Health Services Administration, Child Mind Institute, or National Association of School Psychologists for tips on how to talk to your kids about coronavirus.

Take care of your spirit

  • Find a place of worship that is streaming or recording services. If prayer is an important part of your life, make time for it. Stay connected to your church community through phone calls, emails, and video chats.
  • Try meditation, deep breathing, progressive muscle relaxation, or another mindfulness or relaxation technique. Check out or phone apps such as Calm or Headspace for guided meditation exercises. Consider enlisting friends and family and practicing meditation together at least once a day. Mindfulness can help lower blood pressure, reduce stress, support your immune system, and protect brain health.

Continue or seek out mental health treatment

  • If you are currently in mental health treatment, continue with your current plan if possible, being mindful of approaches to minimize contact with others. Consider reaching out to a mental health professional even if you haven’t before. Make sure you have ongoing access to any medications you need.
  • Ask about video therapy or phone call appointments. Most states have already made emergency exemptions to insurance coverage for telehealth. Regulations have been temporarily relaxed to allow even non-medical software Skype, Facetime, and Zoom to be used for telehealth. Even if this option wasn't available with your provider previously, it may be now! Contact them to ask about remote services.
  • Avoid drugs and alcohol, particularly if you have a pre-existing mental health or substance use disorder. Check out online support groups and meetings, such as Alcoholics Anonymous, Smart Recovery, and In The Rooms.
  • The need for social distancing may make it difficult to see symptoms of depression in others. In “hunker-down” mode, the in-person opportunities that we usually have to notice that friends, family, and colleagues may be struggling with a problem are no longer there. One way to think about it is that child abuse or intimate partner violence is missed more often in winter because long clothes cover bruises. Conduct regular “check ins” with your network and stay attuned to symptoms of depression, such as persistent feelings of sadness, hopelessness, loss of interest or pleasure in activities, or changes in sleep and weight.

Conclusion

Remember that the emotions you may be experiencing are normal reactions to difficult circumstances. Accept that things are different right now and everyone is adjusting. Prioritize what’s most important and know that it’s okay to let some things go right now.

Be kind to yourself and others. Try to stay positive and use this time to spend more time with your children or spouse, try things you’ve been putting off, such as taking an online class, learning a new skill, or getting in touch with your creative side.

It can be hard to think past what is going on today, let alone in a week or in six months, but give yourself permission to daydream about the future and what is on the horizon. Remember that this is temporary, and things will return to normal.

Resources

Calliope Holingue, postdoctoral fellow in the Department of Mental Health and the Department of Neuropsychology at Kennedy Krieger Institute; M. Daniele Fallin, Mental Health chair; and Mental Health faculty Luke Kalb, Paul Nestadt, and Elizabeth Stuart co-authored this piece.

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Source: https://www.jhsph.edu/covid-19/articles/protecting-your-mental-health-during-the-coronavirus-pandemic.html

Improving Your Atrial Fibrillation Prognosis

Five Ways to Sleep Well and Protect Your Heart | Johns Hopkins Medicine

Atrial fibrillation (AFib) is a heart condition that causes the upper chambers of the heart (known as the atria) to quiver.

This quivering prevents the heart from pumping effectively. Normally, blood travels from an atrium to the ventricle (lower chamber of the heart), where it’s pumped either to the lungs or to the rest of the body.

When the atrium quivers instead of pumping, a person can feel their heart has flip-flopped or skipped a beat. The heart may beat very rapidly. They may feel nauseous, short of breath, and weak.

In addition to the heart sensations and palpitations that can come with AFib, people are at greater risk for blood clots. When the blood doesn’t pump as well, the blood that stalls in the heart is more prone to clot.

Clots are dangerous because they can cause stroke. According to the American Heart Association, an estimated 15 to 20 percent of people who have a stroke also have AFib.

Medications and other treatments are available for those with AFib. Most will control, not cure, the condition. Having AFib can also increase a person’s risk for heart failure. Your doctor may recommend a cardiologist if he or she thinks you may have AFib.

According to Johns Hopkins Medicine, an estimated 2.7 million Americans have AFib. As many as one-fifth of all people who have a stroke also have AFib.

Most people ages 65 and older who have AFib also take blood-thinning medications to reduce the lihood of complications stroke. This improves overall prognosis for people with AFib.

Seeking treatment and maintaining regular visits with your doctor can typically improve your prognosis when you have AFib. According to the American Heart Association (AHA), 35 percent of people who don’t receive treatment for AFib go on to have a stroke.

The AHA notes that an episode of AFib rarely causes death. However, these episodes can contribute to you experiencing other complications, such as stroke and heart failure, that can lead to death.

In short, it’s possible for AFib to affect your lifespan. It represents a dysfunction in the heart that must be addressed. However, many treatments are available that can help you control your symptoms and reduce your risk for major events, such as stroke and heart failure.

The two primary complications associated with AFib are stroke and heart failure. The increased risk for blood clotting could result in a clot breaking off from your heart and traveling to your brain. The risk for stroke is higher if you have the following risk factors:

  • diabetes
  • heart failure
  • high blood pressure
  • history of stroke

If you have AFib, talk to your doctor about your individual risk for stroke and any steps you could take to prevent one from occurring.

Heart failure is another more common complication associated with AFib. Your quivering heartbeat and your heart not beating in its normal timed rhythm can cause your heart to have to work harder to pump blood more effectively.

Over time, this can result in heart failure. This means your heart has difficulty circulating enough blood to meet your body’s needs.

Many treatments are available for AFib, ranging from oral medications to surgery.

First, it’s important to determine what’s causing your AFib. For example, conditions sleep apnea or thyroid disorders can cause AFib. If your doctor can prescribe treatments to correct the underlying disorder, your AFib may go away as a result.

Medications

Your doctor may prescribe medications that help the heart maintain a normal heart rate and rhythm. Examples include:

Your doctor may also prescribe blood-thinning medications to reduce your risk of developing a clot that could cause a stroke. Examples of these medications include:

The first four medications listed above are also known as non-vitamin K oral anticoagulants (NOACs). NOACs are now recommended over warfarin unless you have moderate to severe mitral stenosis or an artificial heart valve.

You doctor may prescribe medications to ideally cardiovert your heart (restore your heart to normal rhythm). Some of these medications are administered intravenously, while others are taken by mouth.

If your heart starts beating very rapidly, your doctor may admit you to the hospital until the medications are able to stabilize your heart rate.

Cardioversion

The cause of your AFib may be unknown or related to conditions that directly weaken the heart. If you’re healthy enough, your doctor may recommend a procedure called electrical cardioversion. This involves delivering an electric shock to your heart to reset its rhythm.

During this procedure, you’re given sedative medications, so you most ly won’t be aware of the shock.

In certain instances, your doctor will prescribe blood-thinning medications or perform a procedure called a transesophageal echocardiogram (TEE) before cardioversion to ensure there aren’t any blood clots in your heart that could lead to stroke.

Surgical procedures

If cardioversion or taking medications doesn’t control your AFib, your doctor may recommend other procedures. They may include a catheter ablation, where a catheter is threaded through an artery in the wrist or groin.

The catheter can be directed toward areas of your heart that are disturbing electrical activity. Your doctor can ablate, or destroy, the small area of tissue that’s causing the irregular signals.

Another procedure called the maze procedure can be performed in conjunction with open-heart surgery, such as a heart bypass or valve replacement. This procedure involves creating scar tissue in the heart so irregular electrical impulses can’t transmit.

You may also require a pacemaker to help your heart stay in rhythm. Your doctors may implant a pacemaker after an AV node ablation.

The AV node is the heart’s main pacemaker, but it can transmit irregular signals when you have AFib.

You doctor will create scar tissue where the AV node is located to prevent irregular signals from being transmitted. He will then implant the pacemaker to transmit the correct heart-rhythm signals.

Practicing a heart-healthy lifestyle is vital when you have AFib. Conditions high blood pressure and heart disease can increase your risk for AFib. By protecting your heart, you may be able to prevent the condition from occurring.

Examples of steps you can take to prevent AFib include:

  • Stopping smoking.
  • Eating a heart-healthy diet that’s low in saturated fat, salt, cholesterol, and trans fats.
  • Eating foods that are high in nutrients, including whole grains, vegetables, fruits, and low-fat dairy and protein sources.
  • Engaging in regular physical activity that helps you maintain a healthy weight for your size and frame.
  • Losing weight is recommended if you are currently overweight.
  • Getting your blood pressure checked regularly and seeing a doctor if it’s higher than 140/90.
  • Avoiding foods and activities that are known to trigger your AFib. Examples include drinking alcohol and caffeine, eating foods that have monosodium glutamate (MSG), and engaging in intense exercise.

It’s possible to follow all these steps and not prevent AFib. However, a healthy lifestyle will enhance your overall health and prognosis if you have AFib.

Source: https://www.healthline.com/health/atrial-fibrillation-prognosis

Services | Johns Hopkins Student Assistance Program

Five Ways to Sleep Well and Protect Your Heart | Johns Hopkins Medicine

The Johns Hopkins Student Assistance Program (JHSAP) is a life management resource that can help you identify and manage challenging issues in healthy ways. JHSAP services are free and confidential, and there is no limit to the number of times you may access services during your academic career. Your spouse, partner, or child may also access JHSAP services.

A message for students from the Johns Hopkins Student Assistance Program (JHSAP):

We know that the COVID-19 situation is causing significant change and potential anxiety and distress for our community. This is an unprecedented event, and JHSAP is committed to supporting students wherever they may be. We will be updating this page with additional information and resources as the process unfolds and want to share the following at this time:

  •  24/7 mental health support is available for students by calling the JHSAP number: (443) 287-7000 or toll free (866) 764-2317.
  • The JHSAP office on the East Baltimore campus is open 8:30am-5:00pm, Monday through Friday. While our other sites are closed, we are encouraging holding appointments with our team via phone or video.
  • Video, telehealth services (via Zoom or Doxy.me) are available for students who are in Maryland ad DC and whose mental health needs can be served via this platform.
  • Phone consultations support to students, staff and faculty will continue as usual.
  • JHSAP is glad to assist students in finding care resources within their communities.
  • Students who are already connected to a JHSAP clinician, can call as noted above or send their clinician a secure message to mailto:jhsap@jhu.ed for any non-urgent issues.

JHSAP urges you to attend to your emotional and mental well-being, and to reach out to us for support during these challenging times.

Managing Concerns and Emotions about COVID-19

Here are some additional tips to help you put information and concerns in perspective, manage your worry, and maintain a positive outlook.

o For JH specific COVID-19 information, consult https://www.hopkinsmedicine.org/coronavirus and/or https://hub.jhu.edu/novel-coronavirus-information/.

o Johns Hopkins Coronavirus Resource Center

  • Keep things in perspective. Take a deep breath and stay focused on the present situation. Most people who contract COVID-19 will experience only mild symptoms. It can be helpful to shift your focus to things within your control and engage in heathy coping strategies.
  • Acknowledge reactions. Allow yourself time to reflect on what you are feeling and how you may be reacting to any fears and uncertainties.
  • Maintain your normal day-to-day activities and keep connected. Maintaining social networks can foster a sense of normality and provide valuable outlets for sharing feelings and relieving stress. Feel free to share useful information you find on governmental websites with your friends and family. Our day to day activities have been significantly disrupted. Work to create structure in your day by having a regular sleep routing, scheduling time with hobbies, homework, reading, etc.; and scheduling regular phone/video contact with friends and family.
  • Follow the prevention and protection tips given by medical professionals such as national medical authorities and your own medical doctor.
  • Seek supports & use campus resources. Reach out to friends and family and learn about on-campus and off-campus resources that are available including’

JHSAP can assist with navigating these resources and provides 24/7 support to address concerns by phoning (443) 287-7000 or toll free (866) 764-2317.

SilverCloud is an online, self-guided, interactive mental health resource that provides students with engaging activities, tools, videos, and exercise 24-hours a day. Sign in at: jhu.silvercloudhealth.com/signup/.

  • Avoid stigmatizing or generalizing. Remember to keep in mind the kindness and empathy with which we strive to treat one another at all times as we address this challenge together. Be aware if your behavior or attitudes change towards others from another country, and avoid stigmatizing anyone who is sick as potentially having the Coronavirus.

RECOGNIZING DISTRESS – A SELF-CHECK LIST

  • Increased worry, fear, and feelings of being overwhelmed
  • Depressive symptoms that persist and/or intensify
  • Inability to focus or concentrate accompanied by decreased academic or work performance or performance of other daily activities
  • Sleep difficulties
  • Excessive crying
  • Isolating or withdrawing from others
  • Unhealthy coping (e.g., increased alcohol or drug use, engaging in risky/impulsive behaviors)
  • A feeling of hopelessness and/or a paralyzing fear about the future
  • Sudden anger or irritability, or noticeable changes in personality

SEEKING SUPPORT

It is common to experience signs of distress during times of uncertainty.

If you notice these signs in yourself, reach out to family and friends for support, and engage in your usual heathy coping strategies (e.g.

moderate exercise; eating well; getting adequate sleep; practicing yoga, meditation, or some other mindfulness activity; take time for yourself; engage in a hobby or other fun activity, etc.).

If your distress continues or increases to make it difficult to manage your day-to-day activities, then seek professional help. JHSAP is available 24/7 by calling (443) 287-7000 or toll free (866) 764-2317.

Adapted from: Amherst University – “Managing Concerns and Emotions about COVID-19 (https://www.amherst.edu/campuslife/health-safety-wellness/counseling/covid-19-news-and-service-changes) and American Psychological Association- “Five Ways to View Coverage of the Coronavirus” (https://www.apa.org/helpcenter/pandemics).

Which students are eligible for JHSAP services?

The Johns Hopkins University Counseling Center provides services to all undergraduate and graduate students who are currently enrolled in full-time programs in the Krieger School of Arts and Sciences and the Whiting School of Engineering and all Peabody Conservatory undergraduate and graduate students. All of these students are encouraged to utilize the services offered by the Counseling Center by calling 410-516-8278.

Source: http://jhsap.org/services/

Promoting Sleep to Improve Delirium in the ICU

Five Ways to Sleep Well and Protect Your Heart | Johns Hopkins Medicine

A night in the ICU is often characterized by a chaotic whirlwind of beeping machines, staff conversations, bright lights, medical interventions, and visits from care providers.

Mix in mind-altering drugs, uncomfortable medical devices, an unfamiliar environment and pain, and sleep becomes markedly fragmented and devoid of the restorative stages considered vital for repair and recovery (1).

A recent study demonstrated that critically ill patients obtained only 5 hours of sleep per 24-hour period, which was broken into 38 discrete episodes, each lasting a median of 3 minutes (2). Understandably, sleep loss contributes significantly to stress during the ICU stay (1).

Recently, sleep within the ICU setting has gained attention.

There is an intriguing, yet poorly understood, relationship between sleep and delirium, a common ICU syndrome affecting up to 80% of mechanically ventilated patients and associated with negative outcomes, such as prolonged length of stay and long-lasting neurocognitive impairments (3).

In a recent global survey, 97% of 1,223 ICU physicians and nurses agreed that poor sleep in the ICU is a risk factor for delirium (4).

Additionally, in the 2013 Clinical Practice Guidelines for Pain, Agitation, and Delirium (PAD), the Society of Critical Care Medicine recommended “promoting sleep in adult ICU patients by optimizing patients’ environments, using strategies to control light and noise, clustering patient care activities, and decreasing stimuli at night to protect patient’s sleep cycles” (3). This ICU sleep-delirium relationship has even been highlighted in major news outlets (5, 6) and a bestselling book (7), and motivated a highly viewed video (8).

In this issue of Critical Care Medicine, Flannery et al (9) perform a synthesis of sleep-delirium research within the ICU setting. They conducted a systematic review of ICU studies involving sleep-promoting interventions to improve delirium.

Using a comprehensive search strategy, they identify 10 relevant articles (excluding a large randomized controlled trial [RCT] [10], published after the January 2016 search date, demonstrating no effect of bright light therapy on delirium in the ICU).

Overall, the studies occurred in six countries, including both medical and postoperative ICU patients, with four studies enrolling less than or equal to 40 patients, and two enrolling only men. Interventions varied markedly, including earplugs, bright light therapy, medications, and sleep/delirium intervention “bundles.

” Due to substantial heterogeneity, the authors do not perform a meta-analysis, and conclude too many confounders were present to derive a “firm conclusion” regarding the best ICU-based methods to improve sleep.

Notably, eight of 10 studies demonstrated significant improvements in delirium or confusion—albeit using unadjusted analyses in six studies. Furthermore, all four studies evaluating sleep “bundles” demonstrated improvements in delirium.

Given the PAD guideline recommendation for use of bundled sleep-promoting interventions (3), and the feasibility of bundled intervention implementation as part of clinical care (11), future studies could evaluate the dissemination, sustainability, and benefit of these interventions across broad ICU settings and populations.

Additionally, RCTs evaluating melatonin supplementation prior to cardiac surgery and daily ramelteon (a melatonin receptor agonist) in elderly ICU patients demonstrated substantial reductions in delirium in the intervention arms (9).

Given melatonin’s role in circadian entrainment and the absence of “circadian cues” in the ICU environment (1), these medications might be viable pharmacologic options for improving sleep and delirium; additional trials are completed or planned (clinicaltrials.

gov identifiers: {“type”:”clinical-trial”,”attrs”:{“text”:”NCT00470821″,”term_id”:”NCT00470821″}}NCT00470821, {“type”:”clinical-trial”,”attrs”:{“text”:”NCT02691013″,”term_id”:”NCT02691013″}}NCT02691013, {“type”:”clinical-trial”,”attrs”:{“text”:”NCT02588742″,”term_id”:”NCT02588742″}}NCT02588742, and {“type”:”clinical-trial”,”attrs”:{“text”:”NCT02615340″,”term_id”:”NCT02615340″}}NCT02615340). Notably, improvements in delirium were also observed in pre-post studies involving minimization of sleep-disrupting and deliriogenic medications, suggesting that withholding harmful medications may be a key starting point for any ICU-based pharmacologic sleep guideline.

As an important limitation, only four of 10 studies measured sleep itself, all using subjective tools. In the ICU, sleep measurement is a challenging barrier to research, with no clear solution.

Polysomnography, the gold standard for sleep measurement, is challenging to use and interpret in critically ill patients (1).

Alternatively, self-report instruments, such as the Richards-Campbell Sleep Questionnaire, are easy and feasible to implement on a large-scale but are impossible to collect from delirious patients; additionally, proxy raters may overestimate patients’ sleep duration and quality (12).

Finally, actigraphy and bispectral index may be promising tools, but need rigorous validation in the ICU. Hence, future research on sleep promotion for improving delirium may advance the field by simultaneously embedding substudies evaluating sleep measurement techniques (12, 13).

Finally, the authors highlight the importance of using rigorous research methods in future studies, including consideration of both frequency and duration of delirium as outcome measures.

In terms of measuring delirium, three different instruments were used within this systematic review, of which only one is recommended in PAD guidelines (3).

Notably, 46 intervention studies were excluded from the systematic review since they did not assess for delirium as an outcome, perhaps a missed opportunity for advancing knowledge in ICU sleep research.

Importantly, future ICU-based sleep promotion research should be conducted using delirium instruments that have been validated for use in the ICU setting.

Furthermore, in the ICU, there are statistical challenges with evaluating delirium as an outcome, including its time-varying nature and the competing risks of mortality and ICU discharge. Notably, recent publications have recommended against using delirium-free days as an outcome measure (14, 15) and instead, recommend employing modern statistical methods, such as a joint modelling approach combining two survival models for a repeated daily delirium outcome and for the competing risk of ICU discharge or death (15, 16).

In summary, this systematic review is a timely synthesis of the expanding research evaluating sleep and delirium in the ICU. This review reminds us of the limitations of prior research and provides valuable guidance for investigations moving forward.

Although it may be difficult to ascertain whether poor sleep is casually related to delirium, or to determine unequivocally whether interventions actually improve objective sleep quality, it is well known that patients experience poor quality sleep in the ICU and that sleep promotion represents a low-risk intervention with potential to improve patient outcomes.

We look forward to more rigorous studies in this area, and anticipate that improving sleep may become a cornerstone in preventing ICU delirium and improving patient outcomes.

Biren B. Kamdar, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Jennifer L. Martin, Department of Medicine, David Geffen School of Medicine at UCLA, University of California; and Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA.

Dale M. Needham, Outcomes After Critical Illness and Surgery (OACIS) Group, Division of Pulmonary & Critical Care Medicine, Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD.

Michael K. Ong, Division of General Internal Medicine and Health, Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, University of California; and VA Greater Los Angeles Healthcare System, Los Angeles, CA.

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4. Kamdar BB, Knauert MP, Jones SF, et al. Perceptions and practices regarding sleep in the ICU: A survey of 1,223 critical care providers. Ann Am Thorac Soc. 2016 Apr 22; [Epub ahead of print] [PMC free article] [PubMed] [Google Scholar]

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6. Brody JE. Vigilance About the Dangers of Delirium-NYTimes.com. [Accessed May 30, 2016]; Available at: http://well.blogs.nytimes.com/2012/10/01/vigilance-about-the-dangers-of-delirium/

7. Huffington AS. The Sleep Revolution: Transforming Your Life, One Night at a Time. New York: Harmony Books; 2016. [Google Scholar]

8. Baystate Health: THINK Delirium. Don’t Get Delirious, Take Sleep Serious in the ICU. [Accessed May 30, 2016]; Available at: http://youtu.be/vv3W20POzNw.

9. Flannery AH, Oyler DR, Weinhouse GL. The Impact of Interventions to Improve Sleep on Delirium in the ICU: A Systematic Review and Research Framework. Crit Care Med. 2016;44:2231–2240. [PubMed] [Google Scholar]

10. Simons KS, Laheij RJ, van den Boogaard M, et al. Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: A randomised controlled trial. Lancet Respir Med. 2016;4:194–202. [PubMed] [Google Scholar]

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16. Needham DM, Colantuoni E, Dinglas VD, et al. Rosuvastatin versus placebo for delirium in intensive care and subsequent cognitive impairment in patients with sepsis-associated acute respiratory distress syndrome: An ancillary study to a randomised controlled trial. Lancet Respir Med. 2016;4:203–212. [PMC free article] [PubMed] [Google Scholar]

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599108/

Heart Health Tips for Living with Aortic Stenosis

Five Ways to Sleep Well and Protect Your Heart | Johns Hopkins Medicine

With aortic stenosis, you’ll want to take special care of your heart. The condition, which affects your aortic valve, can make it hard for your heart to pump blood to the rest of your body. And over time, it also injures your heart muscle.

There are steps you can take, in addition to the treatment plan your doctor recommends, to keep your heart as healthy as you can. The goal is to manage the condition well — and that includes these simple habits.

Keep all your doctor visits. How often you check in with your doctor will depend on the symptoms you have and how far along your condition is. If it’s moderate or severe, you may need to see your cardiologist twice a year. If it’s mild, you may only need a yearly exam and an echocardiogram every 1-2 years.

Take your meds. Follow your doctor’s orders and take any drugs exactly as prescribed. These medicines can help keep your heart from working too hard and can prevent blood clots and infections.

Stay active, safely. Working out is good for your heart, even if you have aortic stenosis. First, check with your doctor about what’s OK to do. Ask if there are any physical activity you should avoid. You’ll also want to know how long your heart rate can safely be raised and if you need to track how high it gets during a workout.

Ask questions. Notice new or changing symptoms? Don’t ignore them. Call your doctor with any concerns that you may have.

Care for your teeth and gums. Aortic stenosis makes infective endocarditis, a severe infection of the heart lining and valves, more ly. It’s caused by bacteria getting into your bloodstream — even through your gums. To prevent this, brush your teeth twice each day and get regular cleanings. Let your dentist know that you have aortic stenosis.

Don’t put off surgery. Your doctor may advise surgery to repair or replace your damaged valve. While this may sound daunting, most people find that their symptoms improve. If left untreated, your chance of heart failure — which means your heart doesn’t pump blood as well as it should — will rise.

Get support. If having a heart condition makes you feel anxious or depressed, talking about these concerns may make you feel better. Confide in loved ones or ask your doctor to refer you to a counselor.

Get to a healthy weight. Being overweight or obese puts a strain on your heart. If most of your fat’s around your waist, rather than your hips, your risk for health problems rises even more. Writing down the foods you eat and when you exercise can help you spot unhealthy patterns you need to change.

Work to manage your stress. Everyone feels anger, sadness, and anxiety from time to time. But if they’re control, it can take a toll on your emotional and physical health. You need healthy ways to relax, such as exercise, meditation or prayer, spending time with loved ones, and laughing more. Talking with a counselor can also help.

Watch what you eat. Aim for a diet that’s rich in whole grains, lean protein, fruits and vegetables. Eating more meals at home will help you build better eating habits. When you can, avoid highly processed foods. Many products that come in a bag or box tend to have sodium, sugar, and unhealthy fats that you can do without.

Manage other health conditions. If you also have diabetes and other types of heart disease, make it a priority to take care of those conditions.

Cut down on drinking. Alcohol can raise the amount of some fats in your blood. It can also boost your blood pressure and put more strain on your heart. Limit yourself to no more than one glass of beer or wine a day if you’re a woman, and two glasses if you’re a man.

Quit smoking. The chemicals in tobacco smoke harm your blood vessels and keep your heart from working as well as it should. Talk to your doctor about ways you can break this habit.

Many hospitals and local community groups offer free classes or support groups to help you meet your goal. If you’ve tried to quit before, that’s OK.

Keep trying, and ask your doctor what you might do differently this time to help this change stick.

SOURCES:

Johns Hopkins Medicine: “Valvular Heart Disease.”

Columbia University Department of Surgery: “Aortic Valve Disease.”

Michigan Medicine Cardiac Surgery: “Heart Valve Disease.”

Medscape: “Aortic Stenosis Treatment & Management.”

Alliance for Aging Research: “Patient Information: Heart Valve Disease.”

National Heart, Lung, and Blood Institute: “Aiming for a Healthy Weight,” “Managing Stress,” “Quitting Smoking,” “How Does Smoking Affect the Heart and Blood Vessels?”

American Heart Association: “Alcohol and Heart Health,” “Heart Valve Awareness: Seek Clarity About Your Risks,” “Life’s Simple 7®| Losing Weight,” “Tips and Hacks,” “Can Processed Foods Be Part of a Healthy Diet?”

Merck Manual (Consumer Version): “Infective Endocarditis.”

British Heart Foundation: “Counselling.”

Cleveland Clinic: “What You Need to Know about Heart Valve Disease.”

© 2019 WebMD, LLC. All rights reserved.

Source: https://www.webmd.com/heart-disease/aortic-stenosis-heart-health