HEARTBURN- All You Need To Know About Heartburn

 OVERVIEW

The esophagus is a tube that connects the mouth to the stomach. It is made of muscles that work to push food toward the stomach in rhythmic waves Called peristalsis. Once in the stomach, food is prevented from refluxing (moving back into the esophagus), by a special area of circular muscle located at the junction of the esophagus and stomach, called the lower esophageal sphincter (LES). A pressure difference across the diaphragm, the flat muscle that separates the chest from the abdomen, also tends to keep stomach contents in the stomach.

 

The stomach combines food, acids, and enzymes together to begin digestion. There are special protective cells that line the stomach to prevent the acid from causing inflammation. The esophagus does not have this same protection, and if stomach acid and digestive juices reflux back into the esophagus, they can cause inflammation and damage to its unprotected lining.

Heartburn is actually a symptom of GERD (gastroesophageal reflux disease), and is caused by acid refluxing back into the esophagus. Risk factors include those that increase the production of acid in the stomach, as well as structural problems that allow acid reflux into the esophagus.

Causes of Heartburn

 

The pressure in the abdominal region is greater than that in the thorax. This pressure difference always tends to force contents from the stomach towards the esophagus but is prevented by the lower esophageal sphincter( a physiologic sphincter)

Some common foods that we eat and drink, stimulate increased stomach acid secretion setting the stage for heartburn. Over-the-counter medications also may precipitate heartburn. Examples of these irritants include:

• alcohol,
• caffeine,
• aspirin (Bayer, etc.),
• Ibuprofen (Motrin, Advil, Nuprin, etc.)
• Naproxen (Naprosyn, Aleve)
• carbonated beverages,
• acidic juices (grapefruit, orange, pineapple)
• acidic foods (tomatoes, grapefruit, and oranges), and
• chocolate.

Smoking and the consumption of high-fat content foods tend to affect function of the lower esophageal sphincter (LES), causing it to relax from the stomach and allow acid to reflux into the esophagus.

A hiatal hernia, where a portion of the stomach lies within the chest instead of the in abdomen, can affect the way the LES works and is a risk factor for reflux. Hiatal hernias by themselves cause no symptoms. It is only when the LES fails that heartburn occurs.

Pregnancy can cause increased pressure within the abdominal cavity and affect LES function and predispose it to reflux.

Obesity may also cause increased pressure in the abdomen, and thus reflux in the same way.

Primary diseases of the esophagus can also present with heartburn as a symptom. These include, among others, scleroderma and sarcoidosis.

Heartburn Symptoms

Gastroesophageal reflux disease (GERD), is a condition in which heartburn is a symptom. Stomach acid re-fluxes up into esophagus and causes pain. This pain can be felt as a burning sensation behind the sternum or breastbone, either as a spasm or a sharp pain. Many times the pain of acid reflux can be mistaken for the pain of a heart attack.

The pain of acid reflux (heartburn) can remain in the lower chest or it can radiate to the back of the throat and be associated with water brash, a sour taste in the back of the throat. If there is acid reflux near the larynx (voice-box) in the throat, it may cause coughing episodes or hoarseness. Reflux over prolonged periods of time can be severe enough that acid wears away the enamel on teeth and causes decay.

Symptoms are often worsened after heavy meals, leaning forward, or lying flat. Those affected may often awaken from sleep with heartburn.

Complications

Heartburn is not without complications. If ignored, recurrent irritation and inflammation of the esophagus can lead to ulcers, which are small areas of tissue breakdown. These can cause serious bleeding.

As well, scarring and stricture are other significant complications of GERD. Changes in the type of cells lining the esophagus may result from acid reflux, causing a condition known as Barrett's esophagus, which is associated with an increased risk of esophageal cancer.

Heartburn Diagnosis

Heartburn is a common complaint, though it can be confused with other chest-related illnesses, including:

• heart attack,
• pulmonary embolus,
• pneumonia, and
• Chest wall pain.

The diagnosis begins with a complete history and physical examination. In many cases that provides enough information for the health care professional to make the diagnosis and begin a treatment plan. In some instances, further testing may be required:

X-ray: The patient may be asked to swallow barium or Gastrografin (two types of contrast materials) while a radiologist, using an X-ray or fluoroscopy machine, watches the contrast material travel down the esophagus and enter into the stomach. Aside from looking for irregularities or inflammation within the esophagus and of the esophageal walls, this test can determine if the esophagus muscles are working properly in a rhythmic fashion to push the contrast material into the stomach.

Endoscopy: In this test a gastroenterologist uses a flexible scope and with a fiberoptic camera to look at the lining of the esophagus and stomach. Inflammation and ulcers can be identified. Biopsies and small bits of tissue can be obtained to look for cancerous or pre-cancerous cells.

Manometry and pH testing: Less commonly, when conventional therapy has failed to confirm the diagnosis, or when symptoms are atypical, use of pressure monitors and acid measurements.

Lifestyle changes

• Eat smaller, more frequent meals
• Avoid eating before bedtime
• Avoid alcohol, aspirin, ibuprofen, and caffeine
• Stop smoking

Elevate the head of the bed (or use two or three pillows) to allow gravity to keep acid in the stomach and avoid acid reflux.

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 WebMD

HOW TO FIGHT DROWSINESS NATURALLY

How to Fight Drowsiness Naturally

So, you have been feeling sleepy and lethargic all the time! You are not alone. More and more people are joining this ever increasing community of drowsiness. This sleepiness during the day can make you irritable and hamper your normal routine. Most of the people look for coffee and energy drinks to fight off drowsiness. Caffeine may help you stay awake for a while but what about all those side effects that it brings on with it? You are becoming unhealthy by fighting your drowsiness this way, with caffeine! Let’s find out the healthier ways to fight drowsiness. But stop! Let’s first have a look at causes of drowsiness.

Causes of Drowsiness

These are the common causes of drowsiness in daily life:

• Sleeplessness (due to stress, depression or other medical condition or any other reason)
• Sleep disorders (such as sleep apnea and narcolepsy)
• Insomnia
• Hypercalcemia (too much calcium in blood)
• Hypothyroidism
• Hyponatremia (low blood sodium)
• Diabetes
• Odd working hours (night shifts, working at weekends or for continuous long hours)
• Migraine
• Other body pain
• Medicines (such as tranquilizers, sleeping pills, antihistamines)

Apart from the above causes of drowsiness, there are certain serious causes too that need immediate medical attention such as head injury, hypovolemic or hemorrhagic shock, meningitis, stroke etc.

How to Get Rid of Drowsiness

Now comes the obvious question, how to fight drowsiness! The first step towards this is treating the cause of your drowsiness. See the above list of causes of drowsiness and determine what can be the cause for your drowsiness. Is it stress, insomnia or odd working hours? Or something else?  If you can’t get the clue, take help of your health care provider and discuss your routine as well as any other problem that you might be facing. If your drowsiness is caused by certain drugs, they can be changed by your doctor. Once you have identified the cause for your drowsiness, take help of the below remedies to combat drowsiness.

1. Follow a regular sleep schedule

This is a must. Because you are not sleeping enough or not sleeping at the similar time everyday, your body rhythm is getting disturbed. Adequate sleep and undisturbed sleep are the key to stay refreshed throughout the day. This will help you keep away low energy, fatigue, depression and stress.
So, how much to sleep and when?
You need between seven to nine hours of sleep every night. This will make you function at your best and will not make you sleepy during daytime.

Now comes the question, when to sleep for having that quality sleep which will not bring in drowsiness during day! It is said that you should aim at going to bed somewhere between 8 PM to 11 PM depending upon whether you are a night owl or a morning lark! However, don’t go to sleep after midnight because till few hours before midnight, your body gets the best deep sleep. As you move towards morning hours, your sleep becomes lighter. It doesn’t matter whether you have slept at 10 PM or 3 AM, you are bound to get lighter sleep in the ‘near morning hours’!
This may be a bad news for workers who have to do night shifts, but that’s what nature has ruled for us!
Go to sleep between 8 PM to 11 PM, not later than that.
Sleep for at least 7-8 hours every night.
Maintain a regular wake up time on weekdays as well as weekends. You may get up an hour later on weekends but don’t make it too late. If you everyday get up at 6 AM, you may afford to get up at 7 on Sundays but not at 10 AM! This disturbs your body’s rhythmic sleep cycle.
If you are a night shift worker, the above might seem to be impossible for you. What to do then? The next remedy is for you!
Sleep tips for night shift workers
If you are among those who have to be alert at night so that others can sleep peacefully, congratulate yourself for doing such a noble task! But that doesn’t mean that you need to suffer from health disorders or face drowsiness on days when you are lucky to have a day shift! Here are some sleep tips for night workers so that they may have a regular sleep schedule adjusted to their body rhythm.

Change your sleep schedule three days before your work schedule changes.
Suppose you work from 4 pm to 12 am, and after three days, your work shift will change to 10 pm to 6 am. Now, if you sleep from 2 am to 10 am, postpone your sleeping hours for 2 hours, three days before your new work schedule starts

1. On first day, go to sleep at 4 am and sleep till 12 pm.
2. On second day, go to sleep at 6 am and sleep till 2 pm.
3. On third day, go to sleep at 7 am and sleep till 3 pm.
4. On fourth day, when you start working from 10 pm to 6 am, go to sleep at 8 am and sleep till 4 pm.

Now, sleep everyday at 8 am and wake up at 4 pm. When your work schedule changes after a month or so, again change your sleeping schedule by changing your sleeping hours three days in advance.

Maintain regular sleeping schedule on weekly off days
Your weekends may not match the weekends of other members in your family. But the rule is the same for all. Maintain the usual sleep and wake-up schedule on these days too. This tells your body when to feel sleepy and when not to. If you, the night shift worker too, maintain a regular sleep schedule, you will not feel drowsy during your working hours.
Take help of your family and tell them not to disturb your sleep due to phone calls and visitors when you sleep.

Rotate your shift duty clockwise
First of all, try to avoid frequently rotating shifts. However, this can’t be always done when in job. But try to convince your management about rotating your shifts clockwise. This means your shift should rotates from day shift to evening to night rather than rotating in a reverse order.
Request your manager to schedule your next shift in a manner that it starts later than your present one. This will help you sleep better in coming days and you will also be able to stay alert during work.

2. Get sunlight or bright light

Sunlight regulates your biological clock; it makes your body alert about work time. However, it might not be always possible for you to get sunlight, thanks to your ever shifting duty times. In such times, keep your workplace brightly lighted. This will fight off drowsiness and keep you alert. Circadian rhythms or the body’s internal clock control our sleeping and waking cycle. These rhythms are in turn, controlled by a part of our brain which is influenced by light.
However, on the way home from work, you should try to avoid bright light so that you may fall asleep easily once you reach home. Also, use blackout blinds or heavy curtains so that sunlight gets blocked when you sleep during the day.
Uninterrupted quality sleep is essential to fight off drowsiness.

3. Exercise to avoid drowsiness

Get some exercise daily, preferably in the morning. The adrenaline rush will help you stay more alert. One of the major causes of drowsiness is not getting sufficient physical activity. Our body is made to work and rest and not to rest always. When you do not move your muscles and all that’s inside your body, you become sluggish. So, make it a habit to exercise daily for at least 30 minutes. This will also make you sleep better at night. Avoid exercising close to bed time though! This will hamper your sleep and make you more sleepy the next day. But what exercises to do?

• Walk for 30-40 minutes daily
• Jog for half an hour or hit the gym and use an elliptical trainer
• Swim for 20-30 minutes
• Running is a good exercise
• Cycling too can help
• Do aerobics or yoga
• Dance to your heart!
• In short, do whatever you feel like but move your body for at least 30-40 minutes a day.

4. Use Acupressure Points for Sleepiness, Drowsiness

When you feel sleepy and need to become alert, you may also take help of acupressure along with right breathing. This stimulates your nervous system and makes you alert almost instantly.

Press GV 26 Acupressure point

It is situated at philtrum- the vertical groove between the base of your nose and the border of the upper lip.

• Press the center of this point with your index finger firmly
• While holding the point, inhale deeply, hold for a couple of seconds and exhale slowly.
• Repeat this three times.

Press GB 20 Acupressure point

It is situated underneath the base of your skull, at the back of your head.

• Bring your thumbs underneath your skull bones at both ends
• Tilt your head back while inhaling deeply
• Again inhale deeply and tilt your head back, some more
• Do this third time, taking the head a little more backwards
• This makes three repetitions with head tilting a little more each time while you inhale thrice.
• Relax
• Scratch these points for a couple of minutes using your nails. Keep inhaling deeply while scratching

Rub B 23 and B 47 Acupressure points
These points are situated at lower back.

• Take your hands to your lower back.
• Now briskly rub the points at your lower back with your thumbs, up and down
• Do this for a minut

Press and Rub St 36 Acupressure points

• It is located four finger widths down from the bottom of the knee cap, along the outer boundary of your shin bone in the leg. This is also called the energy point and rejuvenates you.

• Hold the point with both your hands and press firmly.
• Using your knuckles, briskly rub up and down.

You can do either of the above.

You need not stimulate all the acupressure points discussed above. Do any one or two, or all, whatever makes you alert and fights your drowsiness. You can do them in any order.

5. There’s nothing wrong in a cup of coffee or tea

Caffeine is bad but only when taken in excessive amounts. If you feel drowsy after lunch, there’s no harm in having a half a cup of coffee or black tea. However, some people report problems in falling asleep at night due to tea or coffee taken in the afternoon. So, check by taking only a little amount for a day or two. If you can’t sleep properly due to this caffeine intake, discontinue having it in the afternoon. You may also have a cup in the morning but not in the evening or late evening as it might hamper your sleep at night.
The best thing would be to have a cup of green tea instead of coffee or black tea. Green tea too boosts energy for hours and help you fight drowsiness.

6. Don’t skip breakfast

This is the most common reason of feeling drowsiness due to low energy levels. You don’t eat for almost 10-12 hours after your dinner and if you skip breakfast in the morning, how’s your body going to get its fuel! However, don’t just overload yourself with heavy foods.
Have a balanced breakfast consisting of fruits, cereals, lean protein and some really energetic foods such as nuts. All this will help you get the required energy to survive the day without sleepiness!

7. Avoid having heavy lunch to fight drowsiness

Always have healthy and balanced diet
Junk food, spicy and fatty foods make you feel sleepy. They are also harmful for your health. Have healthy foods always. Include more fruits and vegetables in your diet. Cut back on simple carbohydrates like refined flour and white rice. Instead of these, have complex carbohydrates like whole grains and brown rice and that too in limited amounts.
Your snacks should also be healthy. Have nuts, fruits, peanuts, dry fruits, salads, sprouts and other such healthy foods as snacks. Make it a point not to have a heavy lunch. This will help you in a major way to avoid drowsiness.

8. Keep your work interesting

When you do the same thing for a long time, it becomes boring and you feel sleepy. Change your activities several times. You might be having different types of works to do during the day. So, mix them all up. Whenever you feel bored while doing a work, switch to another and come back to the previous work after some time to complete it.
If, however, you have only one type of work to do, try taking breaks in between. A chat for couple of minutes with your colleague, a short walk for 5-10 minutes, splashing cold water on your face, reading an interesting thing for few minutes, all can help you break the mundane feeling of a routine work. This helps fight off drowsiness.

9. Drink plenty of water

Dehydration can make you feel tired. And when you are tired, you ought to feel sleepy. So, drink enough water throughout the day. If you can’t have lots of water, substitute it with healthy drinks.

• Plain water
• Flavored water made with a dash of lemon juice or mint leaves or both!
• Herbal tea
• Clear soups
• Coconut water
• Watery fruits and veggies like watermelon, cucumber, tomatoes etc. They also serve as healthy snacks!
• Fruit juices

10. Stretch your body
This is not similar to your daily exercise. Stretching your body when you are feeling sleepy in the office will instantly make you alert. You don’t need to get a yoga mat or to go outside to do these stretches. Just do simple stretches while sitting on your chair or standing for a minute or two.

 Pull your hands together behind your back and while doing so, stretch out the front of your body. Breathe deeply for sometime and let go of your hands. Do this a couple of times and you will no more feel drowsy.
Stretch your legs straight while sitting straight.
Stand up and sit down without using your hands. Do it over and over again for a few minutes.

Shrug your shoulders while inhaling deeply. Lift them high up to your ears, hold for few seconds and release them. Do this for a few times.

Make air circles with hands. Clench both of your fists while stretching both the hands out in front of you. Make circles in the air clockwise and then anti-clockwise. Shake out the hands.
Release your upper body. Inhale deeply. While you exhale, turn to your right and grab the back of your chair with your right hand and grab the arm of the chair with your left hand. Use your grasp on the chair to help twist your torso around as far to the back of the room as possible. Hold the position for few seconds then come back and face forward. Repeat with the other side.
Hug yourself. Place the right hand on your left shoulder and the left hand on your right shoulder. Breathe deeply while releasing the area between your shoulder blades.

11. Keep your surrounding interesting

So that whenever you feel drowsy, you can look at those things which make you alert and happy. For example, keep the photographs of your loving family on your desk. Look at the photograph and think about your kids or wife. How you will meet them in the evening or what special can you do for them later in the evening to make them happy. As soon as you engage your mind in something that makes you happy, you will become alert. You can also hang beautiful pictures of fascinating cars, flowers, scenery or whatever makes you feel happy.

12. Use aromatherapy to fight drowsiness

Scents can keep you alert. You may use wax melt warmers to keep yourself refreshed with your favorite fragrance or use essential oils. Sprinkle a drop or two of some scented oil on to your handkerchief and sniff it. Such fragrances as of peppermint, eucalyptus, and lemon can help keep you alert.

13. Try taking a quick nap

If nothing helps you beat the drowsiness, try a quick nap. It can dispel drowsiness and get you back on track.  However, it can be done only if you have some space or time in hand. Taking a short 10 minutes nap can make you more alert and it also improves your performance. Its a myth that taking a nap makes you sleep for hours, or you may wake up feeling even worse. The fact is that naps taken for too long or too late in the day can disturb your body’s inner clock and make you feel awful. If you nap for only 10 to 20 minutes, you stay in a lighter phase of sleep and wake up without feeling groggy.

14. Listen to music

The music that charges you up. Listen to some upbeat music while you work. This will not let you feel drowsy. It can be anything- a dance number, rock or pop music. But avoid listening to soothing and relaxing music. These kind of music makes you feel sleepy as you get relaxed.
15. Quit smoking and alcohol
Nicotine and alcohol, both are stimulants that can affect your quality of sleep. When you don’t sleep properly at night, you are bound to feel drowsy during the day. So quit smoking. Limit your consumption of alcohol and better avoid having alcohol on weekdays.

16. Check your medicines

Some medicines can affect the quality of sleep at night. Talk to your doctor and see if your pills could be keeping you up at night. Getting restful sleep at night is essential to fight daytime drowsiness.
There are so many ways to fight drowsiness. Find out the one that suits you the most and get rid of your daytime drowsiness.