The Complete Book of Men's Health - Part 3: Nutrition and Lifestyle

STRESS

Stress is a term used to describe the symptoms produced by our response to pressure. These symptoms result from high levels of circulating adrenaline hormone which are secreted in response to stressful stimuli.

A certain amount of stress is necessary to meet life's challenges. Too much is harmful, however, and is increasingly recognized as a contributory factor in disease. When we are under pressure, adrenaline puts our systems onto 'red alert':

• Blood sugar is raised to provide energy.

• The bowels empty, so we are lighter for running.

• The eye pupils dilate so we can see better.

• Pulse and blood pressure go up and we breathe deeply to increase oxygen supply to muscles.

• The circulation to some parts of the body shuts down, so that more blood can be diverted to muscles.

• The testicles are drawn up safely towards the abdomen.

In the old days, this helped cavemen survive by fighting or fleeing from dangerous animals. Nowadays we rarely fight or flee, and the effects of stress build up inside us rather than getting burned off. This can trigger a classic panic attack, with symptoms caused by overbreathing (hyperventilation) and the physiological effects of adrenaline:

Physical Effects of Stress

• sweating, flushing

• palpitations and racing pulse

• dizziness, faintness, trembling

• pins and needles, numbness

• stomach pain, peptic ulcers

• nausea, nervous diarrhoea

• insomnia, bad dreams, tiredness

• high blood pressure, headache

• stroke

• spasm of coronary arteries, angina chest pain

• heart attack

• depressed immunity, with increased susceptibility to infections and even cancer

Mental Effects of Stress

• overwhelming feelings of anxiety and panic

• inability to cope

• fear of failure

• fear of rejection

• loss of ability to concentrate

• loss of sex drive, impotence

• premature or retarded ejaculation

• reliance on alcohol, smoking, drugs

• obsessive or compulsive behaviour

• feelings of isolation from colleagues and friends

• a feeling of impending doom

Stress comes from two main sources: internal and external pressures.

Internal pressures would include forcing yourself to work long hours, lack of time off for relaxation, lack of sleep, physical unfitness, exhaustion and the effects of disrupted biorhythms (such as are caused by jet lag or working night shifts).

Other internal sources of stress include uncertainty of goals in life and having a negative self-image, which leads to constant questioning of your own self-worth. Certain personality traits lead to excessive stress due to competitive behaviour, a continual sense of urgency and an inability to slow down.

External pressures are mainly related to change. There may be changes in relationships, in the family or at work. Changes often bring feelings of frustration and of not being in control.

Most stress is self-generated, however, for although an external factor may be the stimulus, it is how you react to it that is important.

Coping with Stress

The best way to cope with stress is to adapt to it in a positive, constructive manner. Situations must be seen in perspective, problems analysed logically and plans made to resolve them. Psychologists recommend the following:

• Work out what situations and people cause you stress, and why. Often only a few sources are involved and you may be able to change or adapt to them in a positive manner.

• Change those things that can be changed, then learn to accept those that cannot be altered.

• Formulate decisions in unhurried circumstances, not under deadline pressures.

• Set realistic goals ­ tackle big problems one step at a time.

• Expect to make mistakes. Apologize then learn from them. Don't give up when the going gets tough ­ this is a waste of valuable experience.

• Learn to be patient and to lose your great sense of urgency, especially when driving. For example, let pushy drivers get in front of you rather than speeding up so they cannot get in; stop at amber lights instead of racing through just-red ones.

• Talk more slowly and listen without interrupting.

• Be assertive. Say 'No' and mean it. This will help prevent you being put-upon and overloaded with tasks.

• Identify and respect your good points. Improve your shortcomings as much as possible, then accept them as part of you.

• Don't compare yourself unfavourably with others.

• Don't expect others to change before you are prepared to change yourself.

Exercise

Regular exercise such as swimming, walking, cycling or other non-competitive sport is essential in overcoming stress. Adrenaline has primed you for activity: exercising will help you use this energy and reset your stress responses to a lower level.

Relaxation

Relaxation helps to switch off the body's stress responses. One of the most successful ways of dealing with stress is to learn to relax. Set aside an hour (or four periods of 15 minutes each) every day to sit down quietly and read, or just close your eyes and rest.

Many complementary therapies can help to overcome stress and encourage relaxation. These include massage, acupuncture, flotation therapy, herbal medicine, homoeopathy, yoga, reflexology, aromatherapy, and hypnotherapy. Experiment with a few until you find one that suits you and induces relaxation.

Diet and Stress

Caffeine and nicotine mimic the body's stress response and are best avoided when you are under real pressure. Limit tea and coffee to three cups per day. Better still, switch to decaffeinated brands.

Vitamin C and the vitamin B complexes are depleted under stress as they are rapidly used up in the metabolic reactions associated with the fight-or-flight response. Vitamin B is further depleted by the metabolism of alcohol and sugary foods, often resorted to in difficult times. Vitamin B deficiency in itself leads to symptoms of anxiety and irritability, so a vicious circle is propagated. Dietary tips that will help you fight the effects of stress include:

• Eat high-fibre whole foods.

• Decrease your intake of sugar, salt and saturated fats.

• Eat little and often to prevent hypoglycaemia (low blood sugar levels), which also trigger the release of adrenaline and heighten the symptoms of stress.

• If you smoke, try to stop. In the short term smoking may seem to quell your stress, but in the long term it will magnify the harmful effects of stress on your health.

• Keep alcohol intake to within the safe maximum.

• Above all, learn to relax. Go swimming, cycling or play a non-competitive sport. Take a stroll round the park during your lunch break. Treat yourself to half an hour in a jacuzzi, or to an aromatherapy massage. Whatever you do, allow some time to yourself to relax fully.

A Simple Relaxation Exercise

Find somewhere quiet and warm to lie down. This exercise is especially beneficial after a long soak in a warm bath.

Remove your shoes and loosen tight clothing, especially your belt and tie. You are going to work round your body, tensing and relaxing different muscle groups to relieve tension. Close your eyes and keep them closed throughout the relaxation exercise.

First, lift your forearms into the air. Bend them at the elbow and clench your fists hard. Concentrate only on the tension in these muscles.

Breathe in deeply and slowly. As you breathe out, start to relax and let the tension in your arms drain away. Release your clenched fists and lower your arms gently down beside you. Feel the tension flow out of them until your fingers start to tingle. Your arms may start to feel like they do not belong to you. Keep breathing gently and slowly.

Now tense your shoulders and neck, shrugging your shoulders up as high as you can. Feel the tension in your head, shoulders, neck and chest. Hold it for a moment. Then, slowly let the tension flow away. Breathe gently and slowly as the tension flows away.

Now lift your head up and push it forwards. Feel the tension in your neck. Tighten all your facial muscles. Clench your teeth, frown and screw up your eyes. Feel the tension on your face, the tightness in your skin and jaw, the wrinkles on your brow.

Hold this tension for a few seconds then start to relax. Let go gradually, concentrating on each set of muscles as they relax. A feeling of warmth will spread across your head as the tension is released. Your head will feel heavy and very relaxed.

Continue in this way, working next on your back muscles (providing you do not have a back problem) by pulling your shoulders and head backwards and arching your back upwards. Hold this for a few moments before letting your weight sink comfortably down as you relax. Check your arms, head and neck are still relaxed, too.

Pull in your abdomen as tightly as you can. Then, as you breathe out, slowly release and feel the tension drain away. Now blow out your stomach as if tensing against a blow. Hold this tension for a few moments, then slowly relax.

Make sure tension has not crept back into parts of your body you have already relaxed. Your upper body should feel heavy, calm and relaxed.

Now, concentrate on your legs. Pull your toes up towards you and feel the tightness down the front of your legs. Push your toes away from you and feel the tightness spread up your legs. Hold this for a few moments, then lift your legs into the air, either together or one at a time. Hold for a few moments and then lower your legs until they are at rest.

Relax your thighs, buttocks, calves and feet. Let them flop under their own weight. Feel the tension flow down your legs and out through your toes. Feel your legs become heavy and relaxed. Your toes may tingle.

Your whole body should now feel very heavy and very relaxed. Breathe calmly and slowly and feel all that tension drain away.

Imagine you are lying in a warm, sunny meadow with a stream bubbling gently beside you. Relax for at least 20 minutes, checking your body for tension and repeating the tensing-and-relaxing sequence as necessary.

Sleep

Stress is a common cause of difficulty sleeping. Research shows that:

• On average, we spend one third of our life asleep.

• One third of adult males have difficulty falling asleep or staying asleep.

• Four out of 10 adult males do not get a regular good night's sleep and consequently function at impaired levels of alertness the following day.

• 27 per cent of road traffic accidents and 83 per cent of road deaths are associated with lack of sleep.

• Long-distance drivers are more likely to crash between 2 a.m. and 6 a.m., when they have been trying to stay awake for too long.

• 20 per cent of middle-aged men and 60 per cent of elderly men snore enough to disturb their own sleep.

• Over two million men in the UK suffer from insomnia.

The commonest causes of insomnia are:

• stress

• anxiety

• excess alcohol

• nicotine

• excessive intake of caffeine

• poor sleeping conditions (e.g. noise, light, cold)

• pain

• shortness of breath due to lung or heart problems

• urinary problems (e.g. prostate disease)

• depressive illness

• biorhythm disturbances (e.g. shift work, jetlag)

• increasing age

• prescribed drugs.

What Is Sleep?

Sleep is a specialized form of unconsciousness. Two different types of sleep occur:

1. Rapid Eye Movement (REM) sleep, during which the eyes are constantly on the move.

2. Slow Wave (or non-REM sleep), during which the eyes are relatively still. There are four stages of slow-wave sleep. We enter light, Stage 1 sleep first, then work through to the deepest sleep, Stage 4.

When we first fall asleep we spend around 90 minutes in slow-wave sleep, then 10 minutes in REM sleep. Throughout the night this cycle repeats itself four to six times, with more and more time being spent in the REM stage, until just before waking when we experience around an hour of REM sleep. As a result, men who only sleep five hours per night get a similar amount of slow-wave sleep as those who regularly sleep eight hours per night.

Researchers do not know for certain why we sleep, but there are lots of theories. Sleeping rests the body and allows muscles to recover from constant use during the day. It allows the metabolism to slow down and the immune system to repair damage and fight infections. The secretion of growth hormone is triggered by going to sleep, and this may stimulate repair processes.

During REM sleep we have dreams, which seems to be important in maintaining mental health.

The pineal gland in the middle of the brain is significant in synchronizing our biorhythms and controlling sleep. By reacting to light signals received from the eyes, the pineal gland secretes high levels of the hormone melatonin when it is dark. Very little is made during daylight hours. Melatonin seems to trigger sleep and may provide a natural and non-addictive cure for insomnia. Researchers have found that volunteers fall asleep within eight minutes after receiving a small dose of melatonin via a nasal spray, compared with an average of 25 minutes for people given an inactive placebo.

Another hormone, ACTH, is secreted by the brain in a large surge just before waking up to prepare us for the stresses and strains of living. Waking up, at whatever time of day or night, is potentially harmful as blood pressure and pulse rate suddenly soar. This is thought to be why men with high blood pressure or angina are more likely to have a heart attack within the first hour of waking.

Experts now believe that people with high blood pressure need to have it controlled 24 hours a day, and that patients who suffer from early morning angina might benefit from putting a GTN tablet (or spray) under their tongue a few minutes before getting out of bed. If you suffer from high blood pressure or early morning angina, have a check-up with your doctor to make sure your condition is well controlled.

How Much Sleep Do We Need?

We need less sleep as we get older. A baby needs 14­16 hours of sleep a day, a five year old about 12 hours. Young adults sleep for an average of 7.5 hours per night, and 95 per cent of the population get between 5.5 and 9.5 hours every night. Some people seem to thrive on only a few hours each night, while others need much more.

The elderly need the least sleep of all ­ often as little as five hours ­ but often snooze during the day as well. The elderly naturally take longer to fall asleep, suffer from more night-time waking and tend to wake earlier in the morning. You must expect to sleep less as you get older. Make good use of the extra hours in the day rather than taking sleeping tablets to induce an artificial sleep you do not need.

Tips to Help You Have Good Night's Sleep

1. Try to go to bed at a regular time each night and get up at the same time each morning.

2. Make sure your bed is comfortable, the room warm, dark and quiet.

3. Get into a bedtime routine ­ brushing teeth, bathing, setting the alarm ­ to 'set the mood' for sleep.

4. Avoid things that interfere with sleep (e.g. caffeine, nicotine, alcohol, rich and heavy foods) ­ especially in the evenings.

5. Don't drink too much fluid in the evening ­ a full bladder is guaranteed to disturb your rest.

6. If you can't sleep, don't toss and turn. Get up and read or watch television for half an hour. When you feel sleepy, go back and try again. If sleep does not come within 15 minutes, get up and repeat this process.

7. Avoid napping during the day if you have difficulty sleeping at night.

8. Regular exercise every day will help. Active people sleep more easily ­ but don't take strenuous exercise late in the evening. Gentle exercise such as walking an hour or two before bedtime is fine.

Alternative therapies for encouraging a good night's sleep include a course of acupuncture, reflexology, flotation therapy or massage.

Many soothing herbal infusions (tisanes, teas) containing sleep-inducing herbs such as valerian, hops and passionflower are widely available. Homoeopathic remedies including coffea, pulsatilla and rhus tox can be helpful (taken before midnight). After midnight, try arsenicum, nux vomica or silicea instead. Audio tapes that contain soothing, lulling sounds are also on sale.

Sleep Apnoea Syndrome

Snoring is now known to be detrimental to health. It is linked with the sleep apnoea syndrome and most commonly afflicts middle-aged, overweight males (85 per cent of sufferers are male, with at least half being clinically obese). Early estimates suggested that 1 per cent of men aged 30 to 50 were affected, but the latest research suggests the figure is at least five times higher than this.

Apnoea literally means without breathing. Sufferers temporarily stop breathing for 10 seconds or longer while asleep due to partial obstruction of the upper airways.

The commonest cause of airway obstruction is over-relaxation of airway muscles. These sag and the throat partially collapses or the tongue falls backwards. Other causes of airway obstruction are enlarged tonsils, adenoids, an enlarged thyroid gland or excessive layers of fat around the neck. In all cases the blocked airway results in loud snoring. It is only when complete obstruction occurs that breathing stops. Failure to breathe reduces the oxygen supply to the lungs and causes a build-up of carbon dioxide in the blood.

The combination of oxygen starvation and carbon dioxide build-up triggers the brain to restart the breathing process. As the airway is jerked open, a gasp occurs and the sufferer may briefly wake up. In extreme cases this happens a thousand times per night ­ resulting in disturbed sleep and daytime symptoms of drowsiness.

Apnoea gets increasingly common with advancing age and is made worse by drinking alcohol. If the problem becomes severe, high blood pressure, heart failure and even a heart attack or stroke can result. Sleep apnoea may also be linked with an increased loss of brain cells, resulting in early senility.

Men suffering from sleep apnoea may notice daytime symptoms of:

• headaches soon after waking

• waking up feeling drunk despite having had no alcohol

• waking up with a frightening sensation of choking or fighting for air

• excessive sleepiness or falling asleep

• lack of concentration

• poor memory

• difficulty finishing sentences

• constant yawning

• deteriorating driving skills

• lowered sex drive.

If you suffer from any of these symptoms, consult your doctor for advice, especially if you have been told you snore.

A diagnosis of sleep apnoea is usually made by monitoring patients in a special sleep laboratory. Brain wave tracings, muscle tracings and observation of the eyes, breathing patterns and blood oxygen concentrations are recorded along with breathing patterns and movements of the diaphragm. A diagnosis of sleep apnoea is made if there are more than 15 episodes of apnoea or diminished breaths per hour of sleep.

Ninety-five per cent of patients are treated successfully by a system known as continuous positive airway pressure (CPAP) in which air is forced into the airway through a mask worn tightly over the nose.

The latest procedure involves laser treatment used to make an inch-long burn down the middle of the soft palate. As this burn heals, scar tissue forms which stiffens and splints the palate, stopping it from collapsing and vibrating.

More extensive surgery may be required, such as removing and shortening the soft palate. In extreme cases, an artificial opening (tracheostomy) is made in the windpipe (trachea) at the front of the neck to allow assisted ventilation at night.

No drugs are yet available to treat sleep apnoea, but there are several things you can do to minimize the symptoms:

• Lose any excess weight.

• Avoid alcohol and sleeping tablets as both drugs interfere with the breathing mechanism and will prolong periods of apnoea.

• Make sure you get plenty of sleep ­ go to bed as early as possible.

• Wedge yourself onto your side with a pillow or traditional bolster so you cannot turn onto your back (lying on your back makes the collapse of the airway more likely).

• Sew a pouch containing a cork or a walnut into the back of your pyjamas. This prevents you lying on your back.

• Raise the head of your bed up on four-inch blocks to lessen the effects of gravity on your tongue.

• Special clips designed to dilate the nostrils can be bought (e.g. Nozovent) but these take time to get used to. They can also fall out during sleep.

• Special pillows that hold the head in the correct position during sleep (e.g. Snorestop) are available.

Depression

Difficulty sleeping is one of the important symptoms of biological depression. This occurs when the levels of chemical transmitters in the brain are made in abnormal amounts. Levels of one transmitter, serotonin, fall significantly and there are changes in brain levels of other chemicals such as dopamine.

The most common age for depressive illness to strike in men is 45­65 years, but unfortunately over 50 per cent of cases remain undiagnosed and untreated.

As well as feeling low and depressed, other signs of a bio-logical depression include:

• altered appetite (usually a complete loss of appetite)

• weight loss

• difficulty getting to sleep

• early morning waking ­ typically between 2 and 4 a.m.

• loss of sex drive

• slowing down mentally and physically

• loss of interest in your surroundings

• bursting into tears

• feeling unable to cope

• feeling unworthy

• feeling life isn't worth living.

Depression is a serious problem that needs urgent medical intervention. Treatment usually involves counselling and antidepressive drugs which are effective if administered in an adequate dose for a sufficient period of time. Unfortunately, almost four out of every five people believe, wrongly, that antidepressants are addictive. They are not.

If you suffer from any of the symptoms of biological depression it is important to consult your doctor straightaway ­ especially if you live alone and have no one to keep an eye on you.