Q&A: Sleep; Congestive Heart Failure; Antidepressants

Q. How much sleep do I really need?  I’ve heard so many conflicting theories.

A. Some people need way more sleep than others, but most people need between seven and eight hours a night to function at their best during the day. However, it seems too few people get the right amount of sleep regularly, whether they have symptoms such as “excessive daytime sleepiness,” or a medical problem, or just a different biological clock. The real answer to how much sleep we really need varies with age. Both the National Sleep Foundation and American Academy of Sleep Medicine have recommended optimum amounts of sleep people should get, mainly based on age. But too little sleep increases the risk of poor health and affects quality of life. Sleep deprivation affects mood, which leads to irritability, anxiety, symptoms of depression, and lack of motivation. It also affects one’s performance because it negatively impacts concentration, energy, coordination, and attention. The National Sleep Foundation recommends that adults between 26 and 64 years of age get seven to nine hours of sleep a night, while adults over 65 years of age should get seven to eight hours of sleep a night. To improve your chances of a restful night, try going to bed at the same time every night in a cool, dark room; avoid eating a heavy meal, as well as alcohol, within two hours of bedtime; and, put away your electronics.

Q. What exactly is congestive heart failure, and what are the symptoms?

A. Heart failure is a condition in which the heart can’t fill with blood or pump it out adequately enough to meet the body’s needs. This causes blood to congest in the lungs and lower limbs, and causes such symptoms as breathing problems, coughing, wheezing, weight gain and swelling. It also can cause fatigue, an increased or irregular heart rate, nausea, and cognitive problems. These same symptoms also can result from some medications or upper respiratory infection. If you experience progressive shortness of breath or problems using stairs, it’s important to see your doctor to determine what is causing the symptoms. There may be other underlying causes, such as coronary artery disease, heart-valve dysfunction, poor blood pressure control, or heart-rhythm abnormalities. Treated soon enough, you may even be able to prevent or reverse disease progression. Meanwhile, follow a heart-healthy diet, manage your blood pressure, and consider a supervised exercise program, such as cardiac rehabilitation. Follow your doctor’s advice, and take your medications exactly as prescribed to help improve symptoms and quality of life.

Q. I’ve been feeling a little “low” lately, and my husband has suggested I consider taking antidepressants. What are the side effects of these drugs?

A. Until the last several years, physical side effects, such as headaches, nausea, and changes in sleeping and eating patterns were usually given more attention than the possibility of adverse psychological side effects. One UK study has shown that many people taking antidepressants experience emotional numbness, sexual difficulties, and sometimes thoughts of suicide. Unfortunately, antidepressant use has increased exponentially in the last three decades. The Centers for Disease Control and Prevention reports that antidepressant use increased about 400 percent between 1988 and 2011. There are several types of antidepressants; which kind your doctor will prescribe for you depends on how severe your condition is and other factors, such as insomnia, fatigue, or low energy. A common “starter” antidepressant that many doctors prescribe is in a class of drugs called selective serotonin reuptake inhibitors. They include sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac) and escitalopram (Lexapro). These medications are generally effective and well-tolerated, but your doctor should thoroughly explain the potential side effects. And you should report any physical or mental symptoms you experience after starting antidepressant therapy. In addition, you and your doctor might agree that you would benefit from “talk” therapy, either as your only therapy or as an adjunct to antidepressant therapy. If you are depressed, it’s important to treat your depression sooner rather than later.

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