Dr. Harvey Simon: Daytime sleepiness can result from insufficient nighttime sleep. Causes range from simply not devoting enough time to sleep to medical conditions that impair the quality of sleep, including restless-leg syndrome and obstructive sleep apnea. And in some cases, daytime sleepiness can result from medical problems such as depression or an underactive thyroid.
Fortunately, your situation sounds completely different. People who are sleep-deprived feel groggy during the day and may fall asleep when they least want to, at their desks or behind the wheel. Voluntary napping, on the other hand, is not a sign of sleep deprivation, illness or aging. In fact, a "power nap" can be helpful as well as enjoyable.
Federal researchers studied 200 airline flight crews that each conducted eight 9-hour transpacific flights during a span of 12 days. Half the crews stayed awake as usual, while the others took 40-minute naps in rotation. Napping was shown to improve subsequent alertness and performance. Many studies of shift workers and other volunteers have found that a nap as brief as 20 minutes can improve alertness, psychomotor performance and mood. Naps, however, can produce problems of their own. One problem is grogginess and disorientation that may accompany awakening from deep sleep. The second potential problem is nighttime wakefulness.
To get the benefit of a quick snooze, plan your nap at a good time in your daily sleep-wake cycle; for many people, sometime between noon and 4 p.m. is best. Don't sleep too long; a 20- to 40-minute nap may refresh you without keeping you up at night. And give yourself 10 to 15 minutes to wake fully before you resume a demanding task.
Your first question should not be which type of operation to have, but if you should have a weight-loss (bariatric) procedure at all. According to guidelines issued by the NIH, the best candidates are people with a BMI above 40, or those with a BMI of 35 or higher who also have obesity-related illnesses such as diabetes or high blood pressure. Patients should have failed with other methods of weight loss and should be healthy enough to undergo surgery without undue risk of complications. They should also be committed to a lifelong program of a healthful lifestyle, vitamin supplements and regular medical care.
Over the years, surgeons have developed two types of weight-loss operations. Restrictive procedures create a small stomach pouch that limits the amount of food a person can eat at one time. Malabsorptive procedures bypass part of the small intestine so fewer calories are absorbed after a meal. At present, most bariatric operations are performed through laparoscopes, and two procedures are most common:
Gastric banding is a restrictive operation. In the popular lap-band procedure, doctors place a silicone band around the upper part of the stomach. The band is connected to a port under the skin, so doctors can adjust the band by injecting saline (salt water) through the port.
The Roux-en-Y gastric bypass creates a small, nonadjustable stomach pouch and also bypasses part of the intestines. Because it combines features of restriction and malabsorption, it produces faster and more dramatic weight loss than the lap-band. But the lap-band has fewer complications because it is a simpler operation.
How can you decide what's best for you? First, get a comprehensive medical evaluation to find out if you are a good candidate for surgery. Then ask your surgeons for details about the risks and benefits of each approach. Finally, consider the experience of your surgical team and hospital. When it comes to your weight, less is better--but when it comes to surgical experience, more is better.
Without knowing a great deal more about your girlfriend, it's not possible to diagnose her hair loss. But I can try to answer your questions about menopause and stress.
The first is easier: menopause does not ordinarily cause hair loss. The second question requires a bit more explanation. Stress can cause hair loss, but only a particular type of hair loss. The condition is called telogen effluvium . In the normal scalp, about 90 percent of hair follicles are growing, while most of the others are in a resting phase called the telogen stage. Each day, about 75 telogen hairs are shed from the scalp. But severe stress can drive many more follicles into the telogen phase, so many more hairs are shed from the scalp. Hair loss peaks about three months after the stress. The hair loss will become noticeable when about 20 percent of the scalp hair has been shed.
Many types of stress can trigger the hair loss of telogen effluvium. In addition to psychological stress, culprits can include severe weight loss, major medical illnesses, surgery and pregnancy. Fortunately, the condition is temporary and the hair will return to normal over three or four months. In the meantime, shampoos such as Progaine and Vivagen can help the hair look fuller without causing damage.
If your girlfriend's hair continues to fall out, she should consider other causes such as thyroid disease, medication side effects, iron deficiency, inflammatory conditions involving the scalp or, most common of all, ordinary androgenic alopecia , better known as male pattern baldness (and the leading cause of thinning hair in women, too). Treatment can help correct many of these problems, so if your girlfriend is worried about her hair, she should consult a physician; a dermatologist may be best.
At one time not so long ago, continuous exercise was in vogue. Serious runners would jog in place while waiting for a traffic light to change, and some trainers pushed for extended continuous workouts. But in the past few years, at least three studies have demonstrated that three brief workouts a day produce the same improvements as one long workout. At present, most experts agree that the benefits of exercise depend on how much you do, not when you do it.
In your case, splitting your workouts may be easier on your legs, but it also means changing clothes, warming up, cooling down and showering twice a day instead of once. And if your treadmill is at a gym or health club, it also means an extra trip each day. The choice is yours, but you might want to hit the treadmill once a day so you can use the time you save for complementary activities such as stretching, yoga or weight training. Building variety into your workouts will help keep your muscles fresh and your enthusiasm high; balanced fitness will be another reward.
Almost any diet will work at first--and almost all fail to live up to their hype and your hopes. Diets "jump-start" weight loss because the dieter is enthusiastic and committed. Whether the diet calls for subsisting on grapefruit or pork rinds, it works at first because dieters reduce their caloric intake. But the plans fail to produce long-term weight loss because they don't offer a balanced, enjoyable, healthful program.
Liquid-protein diet supplements are no exception to the rule. Yes, they can help you lose weight at first, but no, they won't help you stay slim. And if they provide too little nutrition and you lose weight too fast, you'll run the risk of serious metabolic disturbances and gallstones.