We are so excited to announce our new Reston location that will start seeing patients at the end of this month. All services will be available at our new location so call to make your next appointment!
12007 Sunrise Valley Dr #120
Reston, VA 20191
We are so excited to announce our new Reston location that will start seeing patients at the end of this month. All services will be available at our new location so call to make your next appointment!
12007 Sunrise Valley Dr #120
Reston, VA 20191
Sleep apnea, spelled ‘apnoea’ by our friends across the pond, is one of the most common sleep disorders in the United States. People affected by the disorder experience involuntary interruptions in their breathing, lasting at least 10 seconds, as they sleep. The word ‘apnea’ is of Greek origins and literally means ‘without breath’. Some patients stop breathing hundreds of times in the night sometimes for longer than a minute. This can seriously diminish the oxygen levels in a person’s blood and create poor sleep as the interruptions cause the body to awaken enough to breathe. Sources differ in the estimation but it is thought that over 22 million Americans are afflicted with this sleeping disorder. Unfortunately, many experts believe that a large number of people with the sleep disorder remain undiagnosed.
There are three types of sleep apnea.
Obstructive sleep apnea (OSA). This type is the most common form of sleep apnea and is caused by a block in the airway that is physically stopping the ability to breathe. It is often due to soft tissues and muscles relaxing at the back of the throat as a person’s body relaxes. A person with this type of sleep apnea may sound like they’re choking or gasping for breath. For the purposes of this article, we will focus mainly on this type of sleep apnea.
Central sleep apnea (CSA). Patients with this type of sleep apnea do not have a blocked airway but the brain fails to send signals to the body to breathe. This insinuates an instability in a person’s respiratory control center.
Mixed sleep apnea. As the name suggests, this is a combination of both obstructive sleep apnea and central sleep apnea.
Untreated sleep apnea can lead to a plethora of consequences for the sufferer. These include:
Anyone can have sleep apnea, even children, but certain risk factors increase your likelihood:
Sleep Apnea can present in a variety of different ways but below are some of the most common.
This is a short self-evaluation of a person’s daytime sleepiness. This is not a diagnosis but an assessment. You can take one by clicking this link.
Another self-assessment questionnaire for sleep apnea. This is just an assessment and not a diagnosis.
If you think you might have sleep apnea speak to your doctor or a sleep specialist. The only way to definitively confirm sleep apnea and the severity of it is through a sleep test called a polysomnogram (PSG).
At Integrated Neurology Services, our patients start with a clinical consultation. It is a critical first step in evaluating the patient. Based on the consultation the doctor may recommend a sleep test. We offer several types of diagnostic testing depending on the type of study needed.
There are several options for treatment of obstructive sleep apnea depending on the severity and a patient’s situation.
Lifestyle Changes – Patients may benefit from some simple lifestyle changes but results may vary depending on the severity of their OSA. This can include things such as:
Continuous Positive Airway Pressure (CPAP) – This is the most form of treatment is considered the gold standard. The patient wears a mask that allows for a continuous airflow to keep the passageway from being blocked while sleeping. Machines have gotten quieter and a wide variety of masks are available including full face masks and ones that just cover the nostril openings. Another type of similar machine is called a bi-level, or BPAP, where the airflow changes with a person’s breathing. These machines are most effective when consistently used and Integrated Neurology Services has a comprehensive compliance program to ensure our patients’ comfort and application of their treatment.
Dental Device – Patients with mild to moderate sleep apnea may consider having a specially trained dentist fit them for an oral appliance. This pushes the lower jaw forward opening the airway while one sleeps at night.
Surgery – Several types of surgery are available to help with obstructive sleep apnea. Nasal surgery corrects the problem of a deviated septum which may contribute to OSA. Uvulopalatopharyngoplasty (UPPP) cuts out the extra soft tissue to help free space in the airway. Mandibular maxillomandibular advancement surgery fixes some facial and jaw problems or throat blockage. Surgery can, however, be expensive and may not always lead to a permanent solution.
Inspire – A new device on the market that creates a mild stimulation to nerves that keep the airway open. It is inserted near the upper chest with wires that lead to the lungs and neck and it learns your breathing patterns. A trained doctor is able to program it externally and the patient has a remote to turn it on before bed.
It’s important to get a full night’s rest every night. If you feel that you may be suffering from any sleep disorder it’s best to discuss your concerns with your doctor and seek treatment, if diagnosed.
You know what they say, ‘what’s good for the heart is good for the brain’. Ok, it might not actually be a saying but maybe it should be. There is increasing information that steps to prevent heart disease may also prevent or slow dementia.
A rising public epidemic is railing brain health. In a person’s 20s, the brain naturally starts showing signs of cognitive decline and an estimated 3 out of 5 Americans will, in their lifetime, have some type of brain disease. However, the rate of Alzheimer’s, dementia, and stroke cases seems to be increasing and by 2030, these conditions are expected to exceed 1 trillion dollars.
There have been a number of studies that show that factors that affect heart and vessel health also affect the brain. Considering the brain uses 20% of the body’s oxygen and is surrounded by hundreds of vessels, it makes sense that poor cardiovascular health would, in turn, affect the brain’s health.
There are overlapping risk factors for both cardiovascular disease (CVD) and dementia. A few include type 2 diabetes, high cholesterol, obesity, and especially high blood pressure. These can have some effect on the vessels in the brain, cause the brain to shrink at a faster rate, cause changes to white matter, or lead to a stroke. In fact, according to Ralph Sacco, M.D., chief of neurology at the Miller School of Medicine at the University of Miami and past president of the American Heart Association (also the first neurologist to be president of the AHA), high blood pressure is the “strongest predictor of brain health.” Some research indicates that the presence of these risk factors in middle age may have a greater effect on brain health than if they were in old age, however, specifics as to why are yet to be determined.
Some studies have followed participants following this guideline for many years (30 years in some cases) to see how their health progressed. They awarded how well a person abided by each guideline with points between 0-2 and researchers found that every point missed seemed to correspond with about a year’s worth of age-related brain shrinkage. Similarly, other researchers found that with each increase of a point, the participant’s risk for heart failure was lowered by 23%. The research, however, does have some limitations and requires more data.
The earlier a person takes their health seriously the better, but starting now is better than never starting at all. Take steps and actions to take control of your health. Assess your health and speak with a physician if you have any questions or concerns. Simple actions can go a long way such as taking daily walks, incorporating more vegetables, or cutting out something high in sugar. A healthy heart can lead to a healthy brain, which could lead to a multitude of other positive life and body changes. Take charge of your health today!
Think about the last time you were wrapped in a blanket drinking a cup of hot cocoa as a snowstorm rages on outside. Or cuddling on the sofa with a loved one as you watched the latest blockbuster. Or the joy of having a summer-time barbecue with your friends. What do these have in common? How do these things make you feel? The Danish would call these things hygge.
Hygge is a concept deeply rooted deep in Danish culture. It’s hard to give it a direct translation but a popular one is ‘cozy’. It’s more about a feeling or atmosphere than anything in particular. To be hygge or hyggelig (hygge-like), it’s about creating comfort and safety. There’s often a togetherness aspect of spending time with family and close friends. Enjoying coffee together, eating a meal and having conversations, playing games, all these things are considered hygge. Hygge is often thought of as candles, cozy sweaters, and fuzzy socks – and it is (per person Denmark uses the most candles compared to any other nation) – but it is so much more and it is what each person makes it to be. Popular hyggelig activities include cooking together and enjoying the meal, making homemade sweets or treats to share with friends, or even watching a movie at someone’s house. Anything that creates togetherness or homeyness. While hygge often centers around creating intimacy with others but it can also be enjoyed alone. Enjoy a book with coffee, sit outside with the sun warming your face, or whip up your favorite comfort food. Whatever lets you feel grounded, connected, comforted, and safe – that is hygge.
The Danes have been developing hygge since the 18th century when the word first appeared. It is thought that it may have come from the Norwegian word hugga which means, “to comfort” and where the English word “hug” is derived from. This concept of coziness and self-kindness envelopes their way of life. Perhaps it’s no coincidence that they consistently rank as one of the happiest countries in the world.
What’s important is that hygge isn’t a new set of rules to add to your life. It’s really about giving yourself a break. So to start, put the phone down and slow down for a second. A huge part of hygge is not just being present but appreciating and living in the moment. Enjoy a cup of coffee with friends or a co-worker. Have a slice of cake or that piece of chocolate. Drink tea while reading a book in a comforting corner. A hygge life is about little indulgences that let you escape from the busy day or stress, not bingeing or being gluttonous. Balance.
While indulging in that extra sweet or taking comfort in curling up makes hygge seem like an indoor activity it works outside as well. The Scandinavian countries experience a lot of darkness during the winter months and the weather isn’t always pleasant but that doesn’t stop them from getting outside or exercising. They don’t believe in bad weather, just unsuitable clothes. Partaking in outdoor activities that you enjoy is also hygge, especially if you do it with friends or family. Walk the dog, play games while waiting for the barbecue, enjoy a picnic. At this point I’m sure you’ve noticed the trend, almost anything can be hyggelig and it isn’t confined to a particular definition. You can enjoy it indoors or outdoors and it is all year round.
Meik Wiking, author of The Little Book of Hygge and the CEO at The Happiness Research Institute, sums it all up really well in this VICE Interview:
The art of coziness that is hygge has been gaining popularity in the last few years around the world. In 2016 it was the U.K.’s second most popular word (after Brexit) and that was just the beginning of its momentum. There are Pinterest boards beyond Pinterest boards about hygge and dozens of articles like this one talking about its spectacular ability to help you find happiness. But it’s important to remember that hygge is about how things make you feel not the actual things. It isn’t about spending lots of money to buy a concept of coziness. In fact, spending lots of money isn’t hygge at all. The saying, “home is where the heart is” is related to a similar essence; “coziness is when you feel comforted” could be something to keep in mind as you create your hygge journey.
What makes you happy? How can you incorporate self-kindness into your life? What is cozy to you?
Discover your hygge.
It’s a new year and we thought we’d start it off with a new site. We are proud to announce the launch of our new website. It has all the same great information as our old one; click around to learn more about our services.
Cheers to an amazing 2018 from all of us to you!
~The Integrated Neurology Services Team
It’s no mystery that sleep (rather, lack of) and stress can go hand in hand. Being overstressed keeps you awake at night and leads to unrestful sleep, while being sleep deprived causes things to stress you out easier and less able to handle the tasks of the day, inevitably becoming a cranky person. It’s a vicious cycle to be in. The holidays, full of cheer and merriment, are no stranger to stress either. Between holiday parties, pageants, gift buying, family visits, and who knows what else is on that to-do list how is anyone supposed to actually find time to rest? Here are a few tips to help guide your way to a fun and well-rested holiday.
Even if you don’t usually keep a calendar, agenda, or task list, do it for this time of year. Print out a calendar, draw your own, or fire up that calendar app and write down every event, task, and person you want to see, or thing you want to do. Staying on top of your daily and holiday to-dos will keep you from getting blindsided by anything and help you to not procrastinate on tasks. Get your shopping done, clean the house, wrap the gifts, and when you get to have some fun you won’t have to be worried about ‘the next thing’. The last thing anyone wants is for everything to snowball into an overwhelming mess preventing you from enjoying your time with friends and family.
Saying ‘no’ can be really hard but it can also be empowering. Think about yourself and what you can give, or want to give, in terms of your time or commitment to something or someone. Maybe you can’t get out of volunteering for the school pageant, but you can minimize the time you spend this holiday with people that stress you out or you find unpleasant. Your time is limited so don’t feel too bad about prioritizing people, sometimes you can’t see everyone or do everything. You could try getting everyone together for one event rather than go to 4 different ones to see everyone on your list. This one might take some reflection and thought, but staying organized can help you put your time in perspective.
Without getting too much into how to manage your diet (there are tons of articles that do that already), just be sure not to eat too close to your bedtime as it can cause sleep disruptions. Watch out for sugars since they’ll make you crash and pay attention to your coffee intake since too much or too late can mess with your sleep schedule. While we’re on the subject of sleep schedules, mind your alcohol too. While alcohol may seemingly help you fall asleep, as your body processes it, it will interfere with your proper sleep cycle leaving you feeling groggy the next morning—and possibly hungover.
With an increase of other things to do it’s easy to knock exercise to the bottom of the list but that shouldn’t be the case. If you can get into your usual routine, fantastic! Exercise helps you manage stress, feel better (thank you endorphins), and sleep easier—all things that are pretty important right now. If not, try modifying your work out. Maybe find a HIIT routine so that you spend less time but still get a good work out, find time to stretch between activities or tasks, take the stairs if you can, or even park further away from the store to get some extra steps in (it might even save you time getting in and out of the lot). And, bonus points for getting sun exposure while doing any of this. You’ll soak up some vitamin D and help keep your circadian rhythm regulated.
Do your best to stick to your normal sleep schedule. Going to bed and waking at the same time will help you get the rest you need to tackle your busy days. As mentioned before, sleep is important for managing stress but it also keeps you alert, balances your hormones (like the stress one, cortisol, and the one that makes you hungry, ghrelin) and mood, and helps your memory. You don’t want to have fun things planned but then be too tired to enjoy them or snap at anyone during a holiday party. If you need to, schedule a nap in your day to help with your alertness but remember: keep it to 20-30 minutes and try not to have it after 3 pm.
If you don’t have one yet this is a great time to start. At least an hour before bed, it’s time to put all your blue-light emitting devices away and get ready for sleep. Your routine can include a variety of things but the point is to do it consistently so your brain recognizes that now is the time to mellow out. Reading, a hot bath, listening to relaxing music, drawing, or journaling are some options you can try out. Anything that helps calm you down and doesn’t require bright lights. Whatever your takeaways from this are, the important thing to remember is to have fun and enjoy your holiday season. Get some sleep, take care of yourself, and don’t be a grinch!
We wish you the happiest of holidays!
The Integrated Neurology Services Team
Lidwina of Schiedam is the patron saint of ice skating and disease. According to her biography, she may be the first case of MS as the risk factors and symptoms seem to line up. Regardless who was the first possible case, multiple sclerosis was not named or described as it’s own disease until 1868 by Jean-Martin Charcot, a man considered to be the father of neurology who called it sclerose en plaques.
We don’t have a full understanding of what causes MS but for every 10 degrees away from the equator symptoms seem to occur an average of 10 months earlier. It’s been suggested that vitamin D and exposure to sunlight may play a role but it’s not completely clear what that is yet. There are studies that suggest though that they may help with reducing risk and symptoms of MS. Researchers have measured the levels of UVB radiation, which is related to latitude, finding that Mexico has almost 18 times more UVB levels during the winter than Denmark. Patients from the lowest UVB countries seem to develop symptoms two years before those in the highest UVB countries. While light exposure might be a link to MS, there are other environmental and genetic factors that play a role as well.
And the numbers might even be as high as four times now. It’s pretty well known that the brains are women and men are hardwired differently but researchers are finding that this goes beyond emotions, logic, and reasoning. Scientists have found that the S1PR2, a protein that controls the permeability of the blood-brain barrier, is more common in those diagnosed with MS and women seem to produce a lot more of it than men. Work is being done to create a ‘tracer’ chemical that will attach to S1PR2 proteins that will show during PET scans.
Multiple sclerosis is a complex disease that can be hard to identify at first glance. Symptoms will present differently in each patient depending on what nerves are being affected even if it’s the same region in the central nervous system (CNS). Fatigue is the most common symptom of MS but others include:
Like with other conditions, scientific advancements have improved quality of life for many. There are more options compared to even just 10 years ago. Scientists are finding new ways to screen with PET scans as mentioned above and are coming with more ways to help patients. Many of the treatment options are available in pill or infusion form and their ultimate goals are to either slow the damage from MS, minimize flare-up symptoms, or help physical or mental functions. Treatment is a lifelong course and starting as soon as possible helps slow the progression of MS so it’s important to find a medicine that is a good fit. Clinical trials are imperative in learning more about how to help treat the disease. Keeping an active lifestyle and eating properly can also help with reducing symptoms.
2.3 million people around the world are affected by multiple sclerosis and there are communities that are actively seeking ways to better their lives. Living with MS is an increasingly manageable condition with some lifestyle adjustments and a proper course of treatment.
We remember being told as children to drink milk to have strong bones. The ‘Got Milk?’ campaign centered around milk being essential to healthy bones. As we get older we may replace milk with soft drinks and forget to be mindful of our bones, that is until we notice our joints aching and the looming possibility of osteoporosis.
Around the age of 25, our bones and joints are at the height of their strength. Bone mass decreases and cartilage wears down as time goes on becoming fragile. Joints protect the bones from rubbing against each other but when cartilage is worn away too much it can lead to arthritis. At some point after the age of 50, half of all women and a fourth of men will fracture a bone due to osteoporosis. This condition, that affects women more aggressively than men especially after menopause, continually weakens the bones causing the break very easily.
Good bone and joint health start in childhood often with a tall glass of milk and an active lifestyle. Proper nutrition is imperative to strengthening and later maintaining bones and joints. Calcium and vitamin D are essential. Many kinds of cereal and milk come fortified, making a bowl in the morning, not a bad option (just watch the sugar levels). Dark leafy greens such as kale, spinach, bok choy, and collard greens are packed with calcium — so are edamame and yogurts. For the dairy-sensitive, enriched soy and almond milk can make up your calcium needs.
While there are foods fortified with vitamin D, your body will naturally produce when exposed to sunlight making for an excellent opportunity to get up and go on an afternoon walk. Just 15 minutes a few times a week should produce enough vitamin D for your body to properly absorb calcium.
But don’t let those 15-minute walks be your only source of exercise. Maintaining a healthy weight is imperative to the body’s health. Extra weight can put unnecessary strain on your bones and joints. Research shows that for every extra pound, there’s four times more stress on the knees. Bones become stronger through activity and benefit from muscle building exercises (muscles and ligaments protect the bones and joints too — bonus!), dancing and brisk walking. Change up the types of exercises, though, since weight-bearing exercises can wear out joints. Mix in some aerobic workouts like running or for low-impact options try swimming and cycling. Speak with your doctor before starting any new exercise programs and find a trainer if you need help learning proper form to avoid injury.
Somethings aren’t so helpful to keeping bones and joints strong. Soft drinks and caffeine may not be so bone-friendly so try to limit the intake of these. Alcohol can also hinder bone and joint health so women should have no more than one drink a day, up to seven a week, and men two drinks a day but no more than 10 a week. Not only is it bad for your lungs, but smoking is also bad for the bones. Healthy lifestyle choices can help improve quality of life in later years.
It’s important to understand what effects medications may have outside of its main purpose as some may have adverse side effects. Prednisone, a corticosteroid used to help arthritis inflammation, decreases the amount of calcium absorbed causing bones to weaken.
Supplements could be an option for maintaining the nutrition needed for bone and joint health. Talk to your doctor if you are concerned about any deficiencies in your diet and if supplements are a good fit. There are new medicines on the market in recent years to help with osteoporosis and more to come. They’re all a little different but increase bone mass either by encouraging new bone growth or slowing the breakdown of the bones.
In a person’s younger years, it’s vital to build up strong bones and joints to set the foundation for their later years. Nutrition and exercise are the pillars of building and maintaining all aspects of a person’s health. So remember, drink your milk.
This September marks the 6th annual global World Alzheimer’s Month. This year is following the theme “Remember Me” and emphasizes the importance of early detection and diagnosis of dementia. The Nothern Virginia area will be hosting several walks throughout the month to raise awareness of Alzheimer’s and dementia in communities. Integrated Neurology Services will be participating in the following walks:
Join us in raising awareness and say hi at our booths!
We’re accustomed to joint problems increasing as we age into our wisest selves but there is a small population that experiences this at a young age. Juvenile arthritis (JA) is an umbrella term for several autoimmune and inflammatory diseases that can affect children.
Almost 300,000 children in the United States have some form of juvenile arthritis and 50,000 of those suffer from the most common, juvenile idiopathic arthritis. These diseases present themselves in children as young as 6 months old. Some children may have no symptoms at all and symptoms can vary depending on which type of disease they have.
Unfortunately, diagnosing for juvenile arthritis can be difficult. There are no specific tests for JA but doctors can use tests to eliminate other options or even help determine which type of arthritis the child may have. A careful physical exam and a thorough medical history will help with determining a diagnosis. As with most diseases, early identification and treatment are important to deterring future complications.
The cause of juvenile arthritis is still unknown. It is possible that genetics could cause a predisposition for the disease. There is no data to suggest that it could be caused by toxins, foods, or an allergy. There’s no known cure for juvenile arthritis but treatments can help lessen symptoms. Some goals for treatments include reducing swelling and pain, preventing joint damage, and improving joint mobility and strength. There are a variety of options for medication, including IVIg. While it may seem counterintuitive, exercise is actually a vital part of treatment. Diet is another component of maintaining proper nutrition is important to a child’s natural development and to encourage an active lifestyle. Children with juvenile arthritis are still able to lead active lives along with their friends and family. With the care of a trained physician, families can work together to improve a child’s chance of maintaining an improved quality of life, maybe even gaining remission.