If you have trouble getting off to sleep, or toss and turn and your sleep is generally disturbed, or you feel more weary than wide awake each morning, then you’re not alone. Around 30% of Australians suffer with sleep problems.

Sometimes there is a particular and easily identifiable problem – perhaps pain – that causes your sleep to be less than ideal and if this is the case, the underlying cause needs to be addressed. Snoring, restless legs syndrome, night-time cramps and sleep apnoea are also conditions which prevent restful, rejuvenating sleep and cause us to be drowsy when we should be wide awake and alert.

Often, however, your body clock just gets out of “sync” – maybe because of shift work or jet lag. It becomes a vicious cycle. It seems the less you sleep, the harder it is to get to sleep.

Sleep hygiene is the term given to that regular routine which is most likely to ensure regular, restful sleep leading to plenty of energy and enthusiasm when we wake up refreshed. Exercise is an important component of this routine, but strenuous exercise close to bed time is counter productive. Mental exercise close to bed time can also be problematic, so reading in bed is not recommended; unless it’s an unexciting book that’s bound to send you to sleep. If you are determined to watch late night TV, don’t watch a thriller or a horror story. Dreams are important, but nightmares don’t make for a good sleep. Healthy sleep does include a stage where dreaming occurs. It’s the so called REM (rapid eye movement) sleep which is characterized by intense brain activity similar to that which occurs during the waking state. Breathing is rapid, regular and shallow, blood pressure rises and pulse rate increases.

There are also four stages of non-REM sleep which account for about 80% sleep time in adults. All stages are essential for sleep to be restful and refreshing; and the aim of medicines to induce and maintain sleep is not to disturb these normal sleep patterns, or to do so to the least possible degree.

If you have chronic, (that is long term), sleep problems, there may be some simple ways you can get into a regular sleep pattern more easily. The newly revised Fact Card entitled Sleeping Problems gives some valuable tips. This card is available from pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information.

It’s most important to establish a routine. Try to get up out of bed at the same time every day; and once you’re up, stay up. It helps your body maintain that natural waking and sleeping rhythm that makes sleep easier.

Avoid caffeine-containing drinks (tea, coffee, cola, chocolate) in the evening. As well as being a mild stimulant, caffeine also causes us to pass water more often; so our sleep can be disturbed by the need to visit the bathroom during the night. If you can’t go without your tea or coffee at night, try the ‘decaf’ varieties.

Exercise is important too, but late evening sport and strenuous work-outs can stimulate the system and make sleep difficult. Afternoon exercise, probably after work and before dinner, seems to be best.

We should be aware that night caps are for keeping the head warm. The alcoholic variety really don’t do anything for normalising our sleep pattern. Alcohol can actually disturb the balance between the various stages of sleep and we tend to wake up still a little hung over. And just like coffee, alcohol can also encourage those extra trips to the bathroom.

As well, some prescription and over-the-counter medicines can disturb your sleep. Ask your pharmacist for advice about the possibility of this occurring. If you need a cold and flu remedy the so-called day-time/night-time formulas are worth considering.

Remember that persistent sleep disorders, especially those involving pain or breathing difficulties need to be investigated by your doctor; and you can get more information from your Self Care pharmacy. Phone the Pharmaceutical Society on 1300 369 772 for the nearest location.

©2008 Pharmaceutical Society of Australia

A few weeks ago a horse recently arrived from overseas and resident at the Eastern Creek Quarantine Station in NSW had shown signs of the potentially deadly virus. Fortunately, this year, the infection was contained and spread prevented.

Up until 2007 Australia had been completely free of this infection which makes healthy horses a little hoarse, and puts somewhat less healthy horses at risk of serious complications. Horse flu cannot be acquired by humans, although humans may have unintentionally spread the infection among the horses – race horses, riding school horses, show horses and club ponies.

Given their environment, it might be thought that horses might be more susceptible to hay fever. However, while horses may well suffer allergies, and despite their rather prominent noses, it seems allergic rhinitis is not such a common ailment in the stables – except perhaps among the stable hand.

So while the horses are safe from flu this spring, it’s a sure bet, that with spring well and truly in the air, hay fever will be a significant problem in the human population.

If you suffer from hay fever and are forced to endure the sniffles and sneezes, the running nose and watery eyes, the frequently blocked nose and occasional sinus headache, you’ll know that it’s anything but a trivial complaint.

The symptoms of hay fever develop as the result of a super active immune system. That is: substances which in most people would cause no reaction, actually cause a severe allergic reaction in the really sensitive ones among us. These substances, generally called allergens or trigger factors, include wind borne pollen from grasses, weeds and trees – more likely to be troublesome around this time of year, spring and summertime.

But hay fever can occur all year round. When it does, the most common trigger factor is exposure to dust mite – these microscopic animals live with us in their millions in our pillows, blankets, bedspreads, doonas, cushions, curtains and carpets. Rather hard to avoid!

Exposure to cigarette smoke – your own or someone else’s – may increase sensitivity to allergens; and occupational exposure may lead to a greater likelihood of developing hay fever. For instance, if you work with wood dust, seed dust, textile dust, rubber latex, some chemicals and certain foods and spices, you may also have to work with hay fever.

Among all this doom and gloom there is some good news. Hay fever symptoms can often be prevented and almost always well controlled.

Of course, avoiding trigger factors altogether is the best option. But, when that is not possible, appropriate use of medication can work very well.

Which medication we choose will depend largely on the severity and frequency of symptoms. Mild symptoms occurring less than four days a week or less than four weeks at a time respond well to oral antihistamines. The new non-sedating antihistamines, such as Claratyne, Telfast or Xergic, will be the best choice.

If your symptoms adversely affect your sleep or your work, school or leisure activities; or the symptoms persist for more than four days a week or more than four weeks at a time, then the so-called intranasal corticosteroid sprays (Rhinocort or Beconase) will be the most appropriate treatment. When symptoms are severe a combination of antihistamine and nasal spray might be required.

There are other options too; depending on which symptoms are causing the most trouble. For watery, itchy eyes Zaditen eye drops, now available without prescription, will give fast relief.

You can get some really good advice on how to manage even the toughest forms of allergic rhinitis on the Hay Fever fact card. It’s available from pharmacies around Australia providing the Self Care health information. Phone the Pharmaceutical Society on 1300 369 772 for the nearest location.

©2008 Pharmaceutical Society of Australia

Locally, the A League Soccer has just begun again, but for the other football codes, it’s finals time; and for every winner there’ll be thousands of disappointed fans.

Even if you supported the top team, there will often be an emotional let down after the event. Nothing unusual about that; these feelings are quite normal. We all have these emotional highs and lows – times of elation and times of disappointment.

It’s also normal to feel anxious now and again. We’ve all had that experience of butterflies in our stomach maybe before an exam or a job interview. Anxiety is actually a normal and reasonable response to danger or stress; it’s an emotion that triggers our body’s nervous system to be able to make quick, and hopefully, correct decisions.

We certainly don’t need to be reminded about stress, but perhaps we do need to be reminded about how best to manage it. And this is one of the messages to come from World Mental Health Day (October 10). Each year, World Mental Health Day aims to promote good mental health and aims to raise public awareness of mental health issues.

The Mental Health Council of Australia (MHCA) uses the flannel flower as a symbol for mental health awareness. The flannel flower, an Australian native, is commonly found growing wild in the Australian bush. To survive the extremes of climate the flannel flower has to be adaptable. And so, according to the MHCA, regardless of our life’s circumstances, we also need to develop resilience and the ability to adapt to change in order to maintain and strengthen our mental health.

Just as the flannel flowers, with their open petals and their soft silky texture encourage contact, so too we need to be open and empathetic with the person experiencing mental health problems. It will not only help with the person’s recovery but also help change the negative attitudes our society has towards mental illness.

Some studies suggest that we inherit the tendency to feel more stress. Other studies describe stress as a response that is learned over a lifetime. In any event, people who experience high levels of stress, tend to hold beliefs which make them feel threatened, ultra vigilant and out of control.

There is no doubt too much stress can be a health hazard; so the first important step in stress management involves being aware of when our stress levels become unhealthy. Once stress overload is recognised there is a range of stress management skills available to address the problem.

If you feel tense or “stressed out” almost all the time, and anxiety is affecting your everyday activities, then it’s time to have a chat with your GP. You might also benefit from the top ten Stress Less Tips from your state Mental Health Association. Check out their website at: www.mentalhealth.asn.au

For instance: go for a regular walk, or maybe a bike ride; delegate some of your work; schedule in some quiet time for yourself; relax with a good book or a movie; take regular tea breaks; catch up with friends or family; accept a compliment and give one back; cook yourself a healthy meal; book your next holiday; and don’t take life too seriously – “reduce tears, increase cheers.”

Your pharmacist can help too. There is a series of mental health information cards available from pharmacies around Australia as part of the Pharmaceutical Society’s Self Care Program. Developed with the assistance of the Department of Veterans Affairs, they cover a number of topics such as Anxiety, Depression and Post Traumatic Stress Disorder. Whether you have been on the winning or losing side recently, it’s important to be able to manage those tense times during and after the event.

And throughout life – not just sporting life – there’ll be plenty of stressful situations for us to cope with. Just how we cope will determine how healthy we stay. For a little extra help on how to stress less, ask your Self Care Pharmacist for the fact card titled Anxiety. There are also useful cards on subjects such as Relaxation Techniques and Sleeping Problems. Phone 1300 369 772 for the location of the nearest pharmacy providing the Self Care information.

©2008 Pharmaceutical Society of Australia

But the concept of contraception, and even of oral contraception, is not all that new.

Taking precautions: the story of contraception was recently the subject of an exhibition at Sydney’s Powerhouse Museum of science and technology. It’s a story that begins many, many centuries ago.

Modern oral contraceptives became possible when scientists developed the ability to manufacture artificial hormones from plants. The yam plant from the jungles of Mexico was the basis of the first so-called oral contraceptive pill. It hit Australian pharmacy shelves in the 1960s, and by the mid 70s “the Pill” had become the most widely used method of contraception in Australia, with Australian women the highest users in the world. The safety and predictability of oral contraceptives may have become certain only within the last 40 years or so; but as the Powerhouse Museum exhibition described, historians now believe that effective oral contraceptives could have existed for more than 2,000 years.

Medical scientists of the 20th century considered the very early oral contraceptive recipes as wishful thinking at best, however, experiments on plants related to the once widespread silphium indicate that those ancient contraceptive claims could well be true.

From around 600-400BC, silphium was the main cash crop of the north African city-state of Cyrene. It was exported widely and so important to the economy of the region that its image was stamped on their coins. A Roman physician at the time declared that “Cyrenaic juice” would both “prevent conception and destroy an existing one”.

Right through to the Middle Ages, many other herbs were also claimed to have contraceptive or abortion-like effects, but either safety or reliability, or both, were always in doubt.

With correct use the combined hormonal oral contraceptive (COC) of today is almost 100% effective, but as with all medications, adherence to the required dosage is not always perfect. As a method of contraception COCs need a high level of motivation (the calendar packs are a useful, perhaps necessary, aid to memory).

Some COCs have non-contraceptive benefits, as well – benefits such as improved management of acne and pre-menstrual symptoms in some women. This is especially so with the new formulation which contains 24 active tablets in every 28.

This “24/4” formulation combined with the low dose of hormones is said to improve the severe physical and emotional “ups and downs” some women experience with what is known as premenstrual dysphoric disorder (PMDD), a severe form of PMS.

Mild symptoms of PMS may respond to simple lifestyle changes, and dietary supplements may be helpful in more severe cases. Calcium, vitamin B6 and vitamin E have shown modest benefit; and certain prescription medicines including antidepressants, diuretics, non-steroidal anti-inflammatory drugs and the “monophasic” COCs can help with specific symptoms.

Of course, there are some disadvantages, side effects, interactions and contraindications associated with COCs too. These should be discussed with your doctor or pharmacist to ensure you have a good understanding of how appropriate a particular product is for you.

A late or missed tablet is quite often (and understandably) a reason for concern. Just what action to take will depend on when in the cycle the tablet is missed. According to Dr Christine Read, spokesperson for Sexual Health and Family Planning Australia, the three additional days of low dose hormones in the new product may also mean a lesser chance of contraceptive failure if a dose is missed.

Remember, no hormonal contraceptive protects against sexually transmitted infections; however, correct use of condoms can reduce the risk of transmission.

For more advice about contraceptives generally, more specifically the oral contraceptives, and in particular the new formulation of COC, you can ask at one of the pharmacies providing the Pharmaceutical Society’s Self Care health information. Phone 1300 369 772 for the nearest location. We can’t expect the image of an oral contraceptive to appear on an Australian coin or a bank note any time soon, but the combined hormonal oral contraceptives are certain to maintain their currency for many years to come.

©2008 Pharmaceutical Society of Australia

It’s a reminder also that the ears are much more than a couple of fairly useful appendages either side of our head. The ear is a complex piece of equipment consisting of many parts – not just the visible exterior section. And the ear is responsible not only for hearing but for maintaining balance as well.

The outer ear captures sound waves which are converted into mechanical energy by the ear drum and the tiny muscles and bones in the middle ear. The inner ear changes this mechanical energy into nerve impulses which are then transmitted to the brain. These nerve impulses are the messages we decipher as different sounds.

Semi-circular tubes or canals within the inner ear, acting like a series of spirit levels, also give us our sense of balance.

It’s not surprising that with such a complicated system things might go wrong. In fact, ear problems are very common and they can be due to many causes. Some causes are very much self-inflicted.

Research undertaken a couple of years ago by the National Acoustic Laboratories found that up to a quarter of users of iPods and other portable music devices will suffer hearing problems. And it’s not the quality of the music but the quantity that’s causing the damage.

Industrial deafness has long been recognised as an occupational health hazard; but researchers have now shown that whether it’s a power tool or loud music the adverse affects on the ear are just the same. In the study conducted outside Flinders St Railway Station in Melbourne and the Sydney Town Hall, a quarter of people listening to iPods were doing so at a volume which exceeded the safety level at construction sites.

Consistent exposure to loud music is the most common cause of hearing loss; an easily preventable cause, but as the deafness may not become apparent for some years, treatment is often initiated far too late.

“Noise destroys – turn down the volume” is also the message to come from the Australian Tinnitus Association. Tinnitus literally means ringing or tinkling in the ears, but the constantly annoying sound that many sufferers live with 24 hours a day takes many forms. It might also be a hissing or whistling sound. It might be like living with the summer sound of cicadas all year round.

Many of us, perhaps 20% of the population, experience tinnitus from time to time; but for maybe 2% it can be severe and quite disturbing.

Apart from noise there are some other aggravating or risk factors. Some medicines – notably quinine and possibly anti-inflammatory medicines – may cause tinnitus. Caffeine (in tea, coffee, cola or chocolate) and alcohol may worsen tinnitus in some people. And smoking, which narrows the blood vessels which supply vital oxygen to the ears, can make tinnitus worse. Check out the website www.tinnitus.asn.au for more information.

Tinnitus can often be managed or controlled reasonably well; even so, a cure doesn’t really seem close at hand. However, treatment for some other common ear problems is often much easier, provided the cause can be identified early on. The recently up-dated Ear Problems Fact Card will help with some hints on how to reduce the risk of ear problems and treat those problems effectively when they do occur. The Card is available from pharmacies throughout Australia providing the Pharmaceutical Society’s Self Care health information.

Inflammation, infection or a build-up of wax can affect the ears. Production of ear wax is quite normal. Excess wax can be wiped away with a cloth or a tissue wrapped over your finger; but nothing smaller than this should go anywhere near the ear canal. Hairpins, matches and cotton buds may actually cause more damage.

“Swimmer’s ear” is the name given to an infection or inflammation of the outer ear canal – the tube which runs from the outside as far as the ear drum. Known medically as otitis externa, “swimmer’s ear” doesn’t only occur in swimmers, but when it does, the use of drying ear drops before and after swimming is a good prevention strategy.

Otitis media is the term used to describe an infection on the other side of the ear drum. The condition is especially common in children and antibiotics are sometimes necessary to clear the infection.

Ask at your local Self Care Pharmacy for more advice and while there, pick up a copy of the Ear Problems Fact Card. You can call the Pharmaceutical Society on 1300 369 772 for the nearest location.

©2008 Pharmaceutical Society of Australia