Power Up: A Physician's Plan For Renewing Your Energy And Feeling Ten Years Younger

Paperback | December 15, 2009

byWoodson Merrell

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Along with Drs. Oz, Weil, and Northrup, Dr. Merrell is a towering figure in integrative medicine. Power Up shows us how to "power up" our minds, bodies and spirits with this clinically proven, revolutionary program.

Exhaustion is epidemic in our society. Dr. Woodson Merrell shows readers how to transform themselves from energy consumers into energy creators in just twenty-one days, using the six essentials of energy creation: Power Mind, Power Food, Power Exercise, Power Detox, Power of Connection (or Spirit), and Power Rest. The book employs daily menus and recipes developed expressly for Power Up, exercises, and helpful charts and sidebars to show readers how incredibly easy it is to stop feeling exhausted and start feeling wonderful.

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Along with Drs. Oz, Weil, and Northrup, Dr. Merrell is a towering figure in integrative medicine. Power Up shows us how to "power up" our minds, bodies and spirits with this clinically proven, revolutionary program. Exhaustion is epidemic in our society. Dr. Woodson Merrell shows readers how to transform themselves from energy consumer...

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“Woody helped teach me integrative medicine, but I still took copious notes on his sensational 21-Day Program. Follow his six simple steps for healing your energy and you could feel more alive than ever before.” — Mehmet C. Oz, M.D., co-author of You: Staying Young and You: On a Diet“He’s been an enormous help to me and many of my frie...

Woodson Merrell, M.D., is one of North America’s pre-eminent Integrative Medicine physicians. He is Chairman of the Department of Integrative Medicine at Beth Israel Medical Center, Manhattan campus of Albert Einstein College of Medicine. He lives in New York City.From the Hardcover edition.

other books by Woodson Merrell

Format:PaperbackDimensions:400 pages, 8.91 × 6 × 0.84 inPublished:December 15, 2009Publisher:Random House of CanadaLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0307356728

ISBN - 13:9780307356727

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Dr. Merrell’s Morning ShakeServes two1 ½ cups mixed frozen berries (or fresh cut pineapple or papaya*)1 cup pineapple juice (or pomegranate or cherry juice)½ cup water¾ cup unsweetened soy milk or rice milk (for soy allergies use whey or organic brown rice protein powder**)1 ½ teaspoons fresh ginger root, peeled and minced (or ½ teaspoon ground cinnamon or turmeric)1 heaping tablespoon flax meal1 teaspoon flax oil1 tablespoon probiotic powder or liquid***Combine all ingredients in a blender and puree until smooth.* Can cut pineapple or papaya ahead of time and store in airtight container or bag in fridge for up to three days.** Combine 2 heaping tablespoons of powder with ½ cup water (use instead of soy milk).*** Make sure contains, at least, acidophilus and bifidophilus. Available in refrigerator section of most health food stores.Nutrition per ServingCalories: 193; Total fat (g): 5.2; Saturated fat (g): 0.6; Cholesterol (mg): 0.0; Monounsaturated fat (g): 1.1; Polyunsaturated fat (g): 3.5; Total carbohydrate (g): 33.3; Sugars (g): 21.3; Dietary fiber (g): 4.1; Protein (g): 4.6; Sodium (mg): 51.0Gym Toys 101If you’ve ever taken a peek at the strength-training section of a gym you’ve seen quite a few toys – sort of looks like the Polar Bear cage at the zoo. While I’m not a big fan of buying stuff for exercise – most stationary cycles in people’s homes turn mysteriously into clothing racks – some strength toys can be useful for working on those hard-to­reach and long-neglected-muscle groups.• Bands: Basically massive rubber bands that come in different tensile strengths to provide resistance. Hold the bands in front of you, core engaged, and stretch the ends of the bands in opposite directions to exercise the triceps and upper back muscles.• Balls: You can pimp your push-ups with an exercise ball. Push up with your hands on the ball to improve balance, or with your feet on the ball and hands on the floor, core engaged, to really ratchet up the level of difficulty. Sitting on a ball and trying to remain stable while doing any exercise – such as moving hand weights – engages the core, improves proprioception balance, and intensifies any exercise.• Weights: Handheld weights are still the standard for strength training. But I’m not taking about hulking up a 50-pound weight, which is invariably done with horrendous postural adjustments. Simple one- to five­pound hand weights are perfectly adequate training tools. I prefer exercises that mimic normal activities. Take a two-pound weight and, with your your core fully engaged, simply go through the motions of loading the car with groceries – lift and reach – or of putting away a carry-on bag in the overhead compartment – lift the weights from shoulder height to up over your head.• Balance Boards: These add the element of balance to your strength training. New to the scene are microelectric balance boards, which provide a nearly infinitesimal electric vibration that requires your nervous and muscular systems constantly to work for balance• Jump Ropes: The sine qua non of aerobic and resistance training – jumping rope provides aerobic, core, and upper body training. But skipping rope is extremely rigorous – most people new to aerobic training will be exhausted after a couple of minutes.Eight Simple Energy­Generating ExercisesBrisk walk: If I had to choose one energy-generating activity to recommend above all, it is walking. Walk at a pace brisk enough to increase your heart and breath rates; maybe tackle a few flights of stairs while you are at it. As you walk, actively engage your core, monitor your posture, be aware of the range of motion in your hips and thighs, and breathe consciously, working your ribcage like a bellows. You might look a little strange to the casual observer, but you’ll feel so much better when you are finished. With a little practice (and creative visualization), you may even give the impression to others that you are expert enough to be counted in the ranks of professional walkers – after all, racewalking is an Olympic sport.Breath Work: Inhale quietly and slowly, allowing your abdomen to rise, to the count of 4, pause holding the air lightly to the count of 4, exhale slowly, allowing your abdomen to contract, to the count of 6. Repeat four times. The simple act of slow, deep breathing can be incredibly energizing – and relaxing (see Breath Breaks in the 21-Day Plan).Seated Warrior (Virasana): This is a very simple stretch and a phenomenal way to expand your breathing capacity (if you have trouble with your knees or back, do this sitting in a chair, not on the floor). Kneel on the floor, shoulders back and down, neck and spine in a straight line perpendicular to the floor. Lower your buttocks to your feet. Raise your arms in front of you to shoulder level, tightly interlock your fingers, palms facing you. Now rotate your wrists and forearms so that palms face out, fingers away. Maintain your posture. With fingers clasped and palms facing away, raise your arms until palms face the ceiling. Keep your shoulders pinched back, sternum lifted, chest expanded, relax throat and neck. Look straight ahead, body and neck in a straight line perpendicular to the ground – no tilting. Breathe evenly and hold the posture for one minute or as long as it’s comfortable. With time you can extend this to five minutes. Bring your arms gently down to your sides. Place palms on the floor, kneel, stand up first with one leg, placing hands on knee for leverage.Downward-Facing Dog (Adhomukha Svanasana): This simple yoga posture definitely gets your circulation going, but it’s not recommended for individuals with high blood pressure, frequent headaches, or who are pregnant. Stand with your feet hip-distance apart, core engaged, head in a straight line with your spine. Take an abdominal breath. Bend from the waist until your palms touch the floor (it’s OK to bend your knees). Place your right foot back about four feet from your hands. Now place your left foot alongside your right so that your butt is in the air, heels on the ground, and you are in an inverted “V” position (again, it’s OK to bend at the knees if it’s uncomfortable to straighten your legs all the way). Straighten your spine (no hunching over). I like Rodney Yee’s description in his book, Moving Toward Balance, “Practice with bent legs, emphasizing the lift of your sitting bones . . . Feel the integration between the length of the sides of your waist, the opening of your chest and the extension of your arms.” B.K.S. Iyengar further recommends tightening muscles at the top of the thighs and pulling in the kneecaps. Just hang out there for a moment, breathing quietly, arms and back straight, heels on the floor. Now bring your right foot back close to your hands, then your left foot, and slowly stand.Qi Gong Energy Ball: With this exercise, visualize yourself holding a large ball of energy, move slowly and focus on breathing – your arms should move with very little effort, almost as if they are moved by an invisible energetic force. Feet are parallel, knees slightly bent, butt tucked under, arms at your sides. Take a deep, abdominal breath in and out and continue to breathe consciously throughout the exercise. Begin by allowing your arms to float slowly up, shoulder-width apart, palms facing each other as though you’re holding a giant beach ball of energy, waist high in front of you. Bend your arms at the elbows, bringing the imaginary ball closer to you. Now slowly rotate wrists to face palms away from your body and push the ball away until your arms are straight, stepping forward onto your left foot (knee remains slightly bent). Allow arms to float wide apart so that you make a T, bring arms gently down to sides with palms facing each other as you step left foot back to its original place. Float arms upward again, in front of you, holding the ball of energy. “Lift” the ball over your head and let go, now allow your arms to slowly float back down to your sides, breathing quietly, core engaged, butt tucked under, shoulders down and back. Repeat, this time stepping right foot forward.Hopping: Jumping rope is the best, full-fitness, aerobic energy-generating exercise, but it’s not always convenient to whip out a jump rope. You can hop up and down just about anywhere – next to your desk, standing in line at the bank, waiting for a train. Hop thirty times; finish by standing for a moment with good posture and taking four slow abdominal breaths.Push­ups and core crunches (see above).Rock out with your iPod: No explanation necessary. Freeform dancing is not only fun, but allows you to log an aerobic workout without the psychic pain.Bad Sleep: The Causes and CuresPoor sleep can be a function of inferior quality (having your sleep stages out of sync for any number of reasons), or inadequate quantity (getting too little sleep, which cuts off sleep stages), or it can be a function of both, which is absolutely the worst-case scenario. No matter what the cause, however, you can get your sleep problems under control and it is vitally important that you do so. I find that the best way to encourage my patients to practice better sleep habits is to let them know exactly what conditions and choices have a negative impact on sleep.Aging – It turns out that the definition of normal sleep goes out the window as we age. Much of the trouble has to do with shifting hormones at midlife – for men, too! – that affect the amount and type of rest you get. Chronic conditions that often come with age such as arthritis, sinus congestion, and acid reflux can also disrupt sleep. With age, there is a decrease in growth hormone and evening elevations of the stress hormone cortisol as well as an increase of the immune system messengers called inflammatory cytokines (especially interleukin­6) – all of which negatively affect sleep and reduce the amount of time spent in the more restora-tive stages 3 and 4 of non-rapid eye movement. This means that older people are predisposed to have problems not only with sleep quantity but sleep quality – with inevitable consequences for both their health and energy.Some of the trouble with aging can be addressed with better stress management. By age forty, levels of the stress hormone, cortisol, tend to be elevated for most people, which scientists now believe may be a result of that hormone not reaching its low point at night. Managing stress during the day so that you are able to get to sleep earlier and sleep longer may promote beneficial declines in cortisol at night. In some cases sleeping more can be seen as an anti­aging potion – circulating testosterone levels in healthy men are known to decline with advancing age, but when men sleep longer they are able to make more testosterone. Which just goes to show sleeping is not for sissies!One of my favorite observations from sleep medicine labs is that people of a certain age (65 and up) tend to believe that their sleep is worse than it actually is. Much of the trouble has to do with attitude. With meticulous psychological surveys, scientists have determined that whether a person views getting less sleep as insomnia or merely accepts it as a normal part of aging depends largely on his individual attitude about growing old. One of my longtime patients who cruised into her seventies with abundant energy once told me that she had learned to accept getting less sleep as “No big deal.” I’m not suggesting you ignore a sleep problem, but I am encouraging you not to become one of those folks of an advanced age who sit around complaining about sleep – that’s a sure energy-draining activity.Stress – Unbridled stress causes difficulty falling asleep as well as sleep disruption (waking in the middle of the night with trouble getting back to sleep). People wracked with stress can’t turn off the worry: when they lay down their minds race; or when they wake up in the middle of the night, their worries take hold and keep them awake. Researchers have begun to follow the destructive path of the stress hormones and other biochemical messengers that keep your neuroendocrine system hyperactive, even into the middle of the night.Stress per se doesn’t necessarily keep you awake, but worrying about stressful things can keep you awake. And because sleep deprivation mimics the effects of stress by elevating stress hormone levels and activating anxiety-promoting areas of the brain, you set up a vicious cycle: you’re stressed so you can’t sleep; then the lack of sleep makes your stress worse. You quickly become perpetually exhausted. Unremitting stress has also been shown to trigger nightmares, increasing demands on your nervous system. This is why I strong recommend night-time relaxation exercises in the 21-Day Plan.The many negative effects that unbridled stress produces in your nervous system can have serious consequences during sleep. The early morning between 4:00 and 8:00 a.m. – when rapid eye movement (REM) is at its peak – is the time of day with the highest incidence of heart attacks (and this doubles on Monday mornings). This is largely due to stress-induced declines in your heart’s ability to handle the shift from the calming, parasympathetic nervous system dominance of non-REM sleep to the stimulating, sympathetic nervous system dominance of REM sleep. As your nervous system starts to wake up, a stressed heart sometimes just can’t take it. Clearly, cardiovascular problems need to be diagnosed early and treated by a specialist. Along with proper treatment, a conscious stress reduction program coupled with regular moderate exercise will help to protect the heart during times like the early morning when nervous system shifts require healthy flexibility of the heart muscle.One further caveat has to do with managing stress when you actually do wake up. If you wake up, jump out of bed, and go straight into panic mode over your work responsibilities it can be tough on your ticker. This is why I strongly recommend you start your day with the two-minute meditation, the Early Morning Wake Up Call, detailed in the 21-Day Plan (see Part Two). Starting your day with your stress under control will keep it in better control all day and give more consistent energy.Sleep Apnea – Sleep apnea is a condition in which breathing stops for at least 10 seconds at least 15 times per hour during sleep. It’s often accompanied by loud snoring and is considered to be a major cause of exhaustion during the day. Short of your spouse guessing that you have the condition, daytime sleepiness is one of the biggest symptomatic tip-offs to sleep apnea. On the extreme end, sleep apnea can cause you to wake abruptly gasping for air. In some cases it does not wake you but continues to cause blood oxygen levels to decline – often significantly – throughout the night; suffocating the heart, the brain, and all of the body’s cells. Each spell sets off alarms (take a breath!) making it all but impossible to move beyond the very lightest stage of non­rapid eye movement sleep – forget about vivid dreaming! Studies of apnea demonstrate that it’s associated with dominance of the sympathetic nervous system, which places stress on the heart, too. The causes of sleep apnea are varied. It has a strong genetic component (if a parent has apnea, you have a 40 percent chance of getting it), most likely due to inherited traits in the anatomy of the neck and pharynx that make it harder to keep the airway open during sleep. It’s more common in men and its frequency rises with age. Drinking alcohol and sleeping on your back can trigger the problem. By far the most common cause is obesity, which increases the risk of developing apnea by more than 1000 percent! Excess body weight puts pressure on the throat and prevents it from opening enough to facilitate breathing. Up to 70 percent of people with obesity have sleep apnea. Having an underactive (hypo)thyroid can be a hidden cause of sleep apnea, and when treated, sleep apnea often also clears.The symptoms of apnea are pretty far-ranging, from frequent awakening, daytime exhaustion, poor memory, and loud snoring (about 10 percent of habitual snorers have apnea). The health consequences can be devastating, including a significant increased risk of hypertension and heart attacks. For example, many people who have uncontrolled high blood pressure – for which medications seem not to work well – actually have sleep apnea as the cause. A continuous lack of oxygen during sleep can precipitate an acute heart attack. If you have any of the symptoms of apnea you should consider being evaluated by a sleep medicine specialist – hopefully before you have a heart attack.If you have sleep apnea, it is possible to receive a prescription for a continuous positive airway pressure device (CPAP). This device is placed over your nose and mouth and produces positive pressure (like a vacuum cleaner on reverse) that forces open your airway and causes more oxygen to flow into your upper airways and lungs. By stopping the drop in oxygen levels and frequent wakening, the device allows your body to pass through all the cycles of sleep. CPAP has been shown to conserve sleep energy and improve daytime energy levels. Oral appliances – which you can obtain from a dentist – to reposition the jaw muscle and tongue and increase the airwave space can be almost as effective as CPAP in moderate apnea; and people tend to prefer the less invasive nature of an appliance compared to the CPAP device. Surgery should be the last option, and would only be useful for anatomical defects of genetic origin.Before going for these big-gun prescription devices, however, there are a few changes you can make in your sleep habits that may reduce, or even resolve, sleep apnea.• Lose weight. It is dramatically beneficial for sleep apnea; a 10 percent weight loss produces a 26 percent reduction in apnea.• Reduce alcohol intake, especially later in the evening. Alcohol can over-relax the muscles in the throat and pharynx and contribute to their collapse.• Elevate your head by 30 degrees (pillow specialty stores sell wedges to place under your head) to reduce the force of gravity on your throat.• Switch to sleeping on your side instead of your back, again to avoid the forces of gravity. Use a pillow as a bolster to hold onto and help keep you in the side sleeping position.• Tenacious back sleepers can try the sleep ball technique, in which you actually attach a tennis ball to the seat of your pajamas to prevent you from sleeping on your back.Snoring – Scientists are undecided about the health consequences of general non­apnea snoring. Light to moderate snoring is not caused by any abnormality, but rather originates from vibrations of tissue in the throat and air passageways. Your own snoring episodes can cause blood pressure to rise (not to mention what it does to your spouse), but snoring is not considered a cause of daytime hypertension. My primary concern is what snoring does to your ability to get a good night’s rest: The resistance that snoring produces in your airways can cause frequent arousal and fragmented sleep. It can throw off the normal balance of calming, parasympathetic nervous system domination during sleep. Snorers have an increase in stimulating sympathetic nervous system dominance during sleep, which consumes energy and can lead to daytime fatigue.Snoring solutions are the same as for sleep apnea. Try reducing alcohol intake and changing your sleep position before making the bigger financial and lifestyle commitment of obtaining a prescription device like the CPAP. Sometimes helpful is a surgical procedure called a uvulectomy, removal of the small punching bag (uvula) that hangs at the back of the throat to prevent it from obstructing the airway.Chronic sinus congestion – The common cold or chronic stuffiness from allergies can pose a real challenge to a good night’s sleep and can even lead to sleep apnea. You really do need the full cooperation of your nose to get adequate oxygen during sleep. A stuffy nose reduces the capacity of your major air passageway; and it forces you to work harder for air, which can make it easier for the back of the throat to collapse. Scientists even believe nasal congestion can block receptors in the nose that signal the brain that it needs air. A bout of a cold virus is not a big deal, but if you’re routinely stuffy, I highly recommend working with an ear, nose, and throat doctor to determine the cause of chronic congestion and eliminate it. A 1998 study at Penn State University’s Division of Allergy showed that targeted use of nasal steroids (like Nasonex) to quell inflammation improved sleep and reduced daytime fatigue for people with chronic sinus congestion. But there are remedies you can try short of using steroids.Amazingly, the simple little device called a Breathe Right Strip – a stiff Band-Aid that sits on the bridge of the nose and physically pulls the nostrils open – can be a big help for congested sleepers. More permanent remedies – such as identifying subtle food allergies – that target the source of congestion are key. By following the elimination diet of the 21-Day Plan, you may find that congestion starts to clear up, as wheat, dairy, and other allergies can cause chronic sinus congestion. Getting acupuncture and chiropractice treatments from experienced practitioners can often help chronic sinus problems.Gastro­Esophageal Reflux Disease (GERD) – The reflux of stomach acid into the esophagus – which is increasingly recognized as the cause of a wide range of problems including chronic sinusitis, asthma, bronchitis, and chest pain – does much of its dirty work during sleep and can be a major factor in sleep apnea. In a November 2007 study at Chicago Rush Medical Center’s Department of Ear, Nose, and Throat Medicine, correcting the hyperacidity of GERD significantly improved sleep apnea, sleep quality, and daytime fatigue of 70 percent of patients.The classic conventional remedy for GERD is acid-blocking medications. These certainly work. I recommend using antacids to get the problem under control if it’s bad, and then targeting the causes of acidity. If necessary, have an endoscopy by a gastro­intestinal specialist or ear, nose, and throat doctor to rule out significant anatomic abnormalities. Remedies other than antacids include elevation of the pillow, so that by decreasing the force of gravity, stomach acid doesn’t backflow into the esophagus; and eliminating night­time acidic foods (especially tomatoes), spices, caffeine, and alcohol.Chronic Pain – Chronic pain is a double­edged sleep sword: it can interrupt sleep, which degrades pain-inhibition processes in the brain, making pain worse the next day. Sleeping less doesn’t affect pain as much as sleeping poorly does. A 2006 study at Walter Reed Army Hospital found that pain reduced the quality of sleep in 55 percent of patients, poor sleep worsened the pain, and a poor quality mattress magnified both problems. Evaluate your mattress (see below) and don’t just live with pain. There are a number of avenues to explore including working with a pain specialist (often resulting in the use of stronger pain medications), a physical therapist, hypnosis, acupuncture, and working to reduce inflammatory elements of the diet (see Chapter 2).Inflammatory Conditions – In conditions like arthritis, autoimmune diseases, multiple sclerosis, Lyme disease, even during a bout of influenza, the balance between proinflammatory and antiinflammatory chemicals (especially cytokines such as interleukins, TNF­alpha and others) that are produced by white blood cells of the immune system plays an essential role in regulating how well you sleep. These chemicals are produced during infections as important signaling messengers, but in chronic inflammation a steady stream of them can wreak havoc on your sleep and energy. In a study of elderly folks, higher evening levels of pro­inflammatory cytokines (especially Interleukin 6) were related to getting less sleep. A very slight increase was associated with an increased waking time of about 20 minutes. Obesity also results in a chronic inflammatory state – visceral fat is highly active in producing harmful cytokines that can interfere with sleep.The single most important solution for reducing inflammation is life­style change: reduce weight and stress, exercise and sleep more, and eat an antiinflammatory diet (see Chapter 2). Cut out sugar and processed foods especially, reduce meat consumption, and incorporate antiinflammatory foods such as fish oil, spices, and herbs.Alcohol – If you’re having problems with sleep or insomnia, you should consider cutting back on alcohol. When you drink alcohol as long as five hours before falling asleep, it can make sleep apnea or snoring worse (even if you don’t normally have those problems). Alcohol triples the tendency for restless limb movement that causes frequent awakening. When you drink, you can fall asleep quicker and get to a deeper, slow-wave sleep faster (you pass out), but as the alcohol is metabolized by the middle of the night (usually after the first two 90-minute sleep cycles), sympathetic nervous system activity increases, which produces fitful sleep (you wake up in the middle of the night with a parched mouth, feeling lousy). Alcohol increases your deeper sleep at the beginning of the night and causes more restless sleep in the last portion of the night, so it can have an overall negative effect on sleep. While a glass of wine with dinner is ok. Bottom line: For anyone having trouble sleeping, imbibing a couple of nightcaps is not the cure.Caffeine – America’s favorite drug, the chemical stimulant caffeine can contribute to insomnia – even in your morning cup of Joe. The half­life of caffeine is three to six hours, meaning that if you have a cup at noon, a quarter­cup’s worth could still be in your system at midnight (as it could if you drink a larger dose, says, a two-cup sized Grande, at 6:00 a.m.). Caffeine has been shown to block the adenosine receptors. (As discussed in the Box above, accumulating adenosine during daytime is one of the triggers for getting to sleep at night.) Studies have shown that caffeine blocks this mechanism and disturbs proper sleep. As with its distant cousin, amphetamines, caffeine can cause significant withdrawal symptoms when eliminated – fatigue and headaches can develop after stopping even a one-cup per day habit. If you have insomnia and consume daily caffeine, wean yourself off slowly and stop for two full weeks to see if you sleep better and have more overall energy. The Power Up! 21-Day Plan walks you through this process.Medications – It is truly shocking when you look at the list of medications that negatively affect sleep. Insomnia is a commonly listed side effect of numerous prescription and over-the-counter drugs; they can cause a wide variety of disruptions in the sleep cycle including nervous system overstimulation in the early stages of sleep and nightmares in the later stages (see box). Drugs affect the chemicals called neurotransmitters, which govern brainwave activity. Pseudophedrine (in Sudafed and other cold medicines) is a good example of how medicines affect sleep; many people using it regularly suffer unwittingly from debilitating over-stimulation – including insomnia from even a small daytime dose of decongestants. Antihistamines in cold remedies, on the other hand, actually make you drowsy. Many of the most commonly prescribed medications in America are on the list of drugs that affect sleep (unbeknownst to patients and, usually, their doctors, as well) including blood pressure medications, antiseizure medications, anti­histamines, decongestants, and antidepressants. This is just one of many reasons that my goal for all patients is to reduce the number of medications they take by implementing lifestyle changes whenever possible.Sleeping Pills – Sleeping pills are useful when acute stress or health conditions occasionally interfere with falling or staying asleep. They can also be used to reset the circadian rhythms of your biological clock when you’re traveling. They become a problem when people use them chronically. First of all, sleeping pills do not guarantee healthy sleep architecture or complete elimination of daytime sleepiness. To do that, you need to treat the underlying condition and get to the source of the problem that causes insomnia (i.e., daytime anxiety). You will not get a magic, permanent fix from a pill. The quick-fix mentality can actually lead to a worsening of the sleep problem over time and to the appearance of other problems related to lack of sleep. Polypharmacy – the prescribing of multiple medications, often for the same conditions – has been an increasing problem, occasionally with tragic consequences, from the 1962 death of Marilyn Monroe to 2008’s Heath Ledger.A brief synopsis of medicinal sleeping aids contains two broad categories: those that leave you drowsy in the morning and could become habit forming, and those that produce addiction and/or dependency. The former group includes soporific antidepressants (tricyclics such as Elavil and SSRIs such as Paxil), the newer melatonin receptor agonist Rozerem, and OTC antihistamines (Sominex, Benadryl). The other group contains solely prescriptive sleeping medications that can be addictive – such as barbiturates (phenobarbital, Seconal), benzodiazepines (Dalmane, Valium, Klonopin), and narcotics (codeine, hydrocodone) – or can produce dependency such as Ambien, Sonata, and Lunesta.I am not dismissing the use of prescription sleeping pills: I prescribe them myself sometimes (though rarely compared with most other physicians). Judicious occasional use of these powerful medications can be helpful for acute distress or jetlag, and are necessary for others with more severe medical conditions or severe sleep disorders, especially when overseen by a sleep disorders specialist. But there are many other ways, detailed in the following section, that sleeping problems can and should be addressed.My Favorite Sleep RemediesMake an effort to maintain a consistent pre-bedtime routine. This can include turning off stimulating activities (including electronic gadgets) at least an hour before sleep; utilizing relaxation rituals, such as breath work and progressive relaxation techniques (see below). Keep a regular, reasonable schedule – get to bed as close as possible to the same time every night (ideally by 10:00 p.m.) and wake up at roughly the same reasonable time each morning. Sleep docs actually do call this consistency “good sleep hygiene.” Of course, everyone knows that mothers are the best sleep hygienists in the world, but what follows are my best tips that even your mother may not know.A Good Pillow – This is an easy change that can make a huge difference. The first thing I tell everyone to do is evaluate the pillow situation. A pillow is supposed to support your head so that your neck, airways, and spine remain in a natural position with good alignment throughout the night. A very convincing 2001 German Sleep Medicine Lab study found that changing to a medium­firm pillow (the firmest was of no advantage) significantly improved both non-REM and REM sleep for people who have trouble sleeping without other underlying conditions or causes. Bottom line: A pillow should support your head, not bury it.Pillows also frequently contribute to allergies, which is a big no-no when it comes to getting a good night’s sleep. A crucial first step in improving sleep is to scrutinize your pillow for allergens, the source of which can be the filling (down and feather allergies are very common) or it can be dust mites inside the filling. I highly recommend that you examine the range of nonallergenic foam pillows on the market and get one. When you find one that suits you, place it inside a dust-mite blocking pillow protector that goes under the pillow case (www.greenguide.com is a great source for information on pillow allergies). But you also want to toss your pillow in the dryer every few months to kill dust mites. Change your pillow every couple of years as its unwavering service of eight hours each day gives it a relatively short life span.A Better Mattress – When it comes to mattresses, observe the Goldilocks imperative (not too hard and not too soft); medium­firm is your best bet. If a mattress is too hard it bites back and can cause pain and even numbness (limbs falling asleep) at pressure points; likewise, if a mattress is too soft it becomes more work to move around and can cause muscle and joint strains. The best mattresses support all of your body parts equally; even at the heaviest points, your hips and shoulders.Unfortunately, couples often have different mattress preferences, primarily because body weight is a big factor in mattress support. Sometimes the issue can be resolved with a topper. You can actually have a firmer mattress with a soft feel by purchasing a bed with large quilting on the surface or by using a cushioned mattress pad. Because people over the age of 40 lose elasticity in their skin, they have less tolerance for a firm mattress surface. Memory foams, the current darlings of the market, can bring harmony to the bedroom by adjusting for the individual body type, but many people find these mattresses to be exceptionally warm, which is especially unwelcome if you’re suffering hot flashes.As much as I hate to break this news, a recent study from the Musculoskeletal and Human Physiology Research Lab at Oklahoma State University showed that price does make a difference. Changing from a cheaper to a moderately high-priced mattress significantly improves sleep quality. Another similarly rigorous study showed that by switching to a better mattress (in this case an adjustable air-spring/box-spring combination) a full 95 percent of study participants with chronic low back pain reported reduction in pain, and 88 percent reported a better night’s sleep. This data was supported by a Consumer Reports survey that found more than two­thirds of people with high-end mattresses were “very or completely” satisfied with their purchase compared to one­third of conventional mattress owners. You may want to take a look at spending priorities: Spending less on bedding and more on the mattress could be a sleep-inducing strategy.Light therapy – You can use artificial full-spectrum lights in the morning to help reset the body clock so you can get to sleep at a more appropriate time in the evening. In the past decade, pioneering research lead by Columbia University investigator Michael Terman, Ph.D. established that the circadian rhythms that help set your sleep patterns are highly susceptible to changes in exposure to light rays – whether from the sun or from bulbs that mimic the full-spectrum of sunlight. By exposing the eyes to specially designed full­spectrum lights (10,000 lux fluorescent bulbs) for 30 minutes in the early morning, scientists have helped people get to sleep earlier and stay asleep longer. It is thought that regular exposure to such light in the morning triggers a more advantageous nighttime release of melatonin, the hormone that governs your body clock, but the mechanisms are not fully understood. You may be more familiar with light therapy for its use in treating seasonal affective disorder (SAD), a type of depression that shows up in winter months and stems from sunlight deprivation. Studies have shown that a course of light therapy treatments can have a dramatically positive effect on both sleep and symptoms of depression.Light therapy can truly work wonders for people who find it difficult to fall asleep before midnight and are sluggish in the morning. Rapid improvement in falling asleep earlier is often experienced after just a few days of 30 minutes of exposure to a light therapy box upon awakening in the morning (see www.cet.org for more information on the boxes). For people (even teenagers) with more severe insomnia, who regularly stay awake until 1:00 a.m. or longer, shifting sleep patterns can involve sensitive timing. So while the procedure can be done at home, it is a better idea to work with a sleep specialist to devise the treatment program for serious insomnia. The treatment also usually requires waking up a little earlier each morning, which takes real commitment. But if you are miserable from insomnia, it’s worth trying.On the research forefront are special dawn-simulating sleep masks with embedded lights that turn on gradually four hours before the end of sleep. One might think leaving the shades open will do the same thing, but bare windows raise the possibility that your bedroom will be flooded with ambient nighttime light, which poses its own set of problems that are conveniently the subject of the next discussion, Dark Therapy.Dark Therapy – If exposing your eyes to light in the morning helps you fall asleep earlier and sleep longer, it should come as no surprise that blocking exposure to light at night can positively influence sleep. Scientists digging further into the sunlight-melatonin connection have discovered that the blue spectrum of light has the greatest impact on melatonin and circadian rhythms. If you are exposed to blue light late at night – from a computer or television screen or a digital clock near your bed – it can wreak havoc with your body clock making it harder for you to get to sleep and to get up in the morning. Keep your room pitch dark at night, covering all digital clock or DVD player readouts. Interestingly, a 2008 study from the Corvallis Psychiatric Clinic in Oregon showed that using amber­tinted glasses blocked the excitatory blue spectrum of light commonly encountered during television and computer viewing. Using amber glasses during evening screen-watching time had a significant effect in inducing and promoting a good night’s sleep.Behavioral Therapy – Here’s the Catch-­22 of sleep psychology: worrying about not getting enough sleep can stop you from getting enough sleep. Sleep docs have even developed a protocol of behavioral modification that’s been shown to work 70 to 80 percent of the time for people who can’t sleep because of excessive preoccupation with, or apprehension about, falling sleep. Here’s the drill:• Go to bed only when sleepy.• Get out of bed if you haven’t fallen asleep in 20 minutes.• Curtail all nonsleep activities in bed (no watching TV, eating, planning, or problem solving).• Arise at the same time every morning.• Avoid daytime napping.• Don’t get attached to unreal expectations about getting a perfect sleep every night.• Do not blame insomnia for all daytime problems.• Do not catastrophize (imagine all the bad things that will happen as a result) after a poor night’s sleep.• Finally, if this chapter is making you worry too much about sleep, put it down and go out for a walk in the sunshine!Relaxation Exercises – Throughout the night, your brainwaves are continually cycling between slow­wave activity of non-rapid eye movement, and fast­wave activity of rapid eye movement. Meditation and relaxation exercises can significantly help you get back into slow­wave activity if you are awakened in the middle of the night. For getting to sleep faster or for falling back to sleep in the middle of the night try meditation or relaxation exercises found in the 21-Day Plan as a way of hopping onto the slow­wave sleep train that pulls you into the deepest stages of regenerative rest.Acupuncture – Acupuncture, discussed in Chapter 1 as an aid to relaxation, is a helpful adjunct for treating insomnia. Thousands of research articles attest to the neurochemical effects of acupuncture, which significantly elevates endorphins to block pain pathways, promotes the production of chemicals that reduce inflammation, enhances circulation, and reduces the activity of neuromuscular spasm. Inasmuch as acupuncture balances the nervous system and neurotransmitters, there’s a logic for its use in promoting relaxation, which results in a better quality sleep. In China acupuncture has been used successfully for two thousand years to treat sleep problems, though this effect has yet to be studied in controlled trials that are considered the gold standard in Western medicine. In my own practice I use acupuncture as part of a comprehensive approach to insomnia in conjunction with other treatments based on the underlying causes of the sleep problem.From the Hardcover edition.

Editorial Reviews

“Woody helped teach me integrative medicine, but I still took copious notes on his sensational 21-Day Program. Follow his six simple steps for healing your energy and you could feel more alive than ever before.” — Mehmet C. Oz, M.D., co-author of You: Staying Young and You: On a Diet“He’s been an enormous help to me and many of my friends, and I’m sure he will be helpful to many others. Give this book a try.”— Richard Gere“Woody Merrell, M.D., is the doctor of the future. And The Source is packed with exciting, health-enhancing secrets that you can begin using immediately. Great stuff!” — Christiane Northrup, M.D., author of The Wisdom of Menopause, and Women’s Bodies, Women’s Wisdom