With rare exceptions, insomnia is a symptom of a problem, not the problem itself.
Insomnia can be linked with other sleep disorders such as sleep apnea, a common problem that causes breathing to stop for periods of up to 2 minutes, many times each night.

• Obstructive sleep apnea is an involuntary pause in breathing - air cannot flow in or out of the person's nose or mouth.

• Central sleep apnea is less common and occurs when the brain doesn't send the right signals to start the breathing muscles.

In either case, the sleeper is totally unaware of his or her struggle to breathe. Daytime sleepiness coupled with loud snoring at night are clues that you may have sleep apnea. A doctor specializing in sleep disorders can make a diagnosis and recommend treatment. Treatments include learning to sleep in the correct position, devices that help keep your airways open, medication, and surgery.

Suggestions for a Good Night's Sleep

A good night's sleep can make a big difference in how you feel. Here are some suggestions to help you:

If you are so tired during the day that you cannot function normally and if this lasts for more than 2 to 3 weeks, you should see your family doctor or a sleep disorders specialist.

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Skin Care and Aging

"Defy aging.""Tone and firm sagging skin.""Restore your skin's own wrinkle control."

Americans spend billions of dollars each year on skin care products that promise to erase wrinkles, lighten age spots, and eliminate itching, flaking, or redness. But the simplest and cheapest way to keep your skin healthy and young looking is to stay out of the sun.

Sunlight is a major cause of the skin changes we think of as aging — changes such as wrinkles, dryness, and age spots. Your skin does change with age. For example, you sweat less, leading to increased dryness. As your skin ages, it becomes thinner and loses fat, so it looks less plump and smooth. Underlying structures — veins and bones in particular — become more prominent. Your skin can take longer to heal when injured.

You can delay these changes by staying out of the sun. Although nothing can completely undo sun damage, the skin sometimes can repair itself. So, it’s never too late to protect yourself from the harmful effects of the sun.

Over time, the sun’s ultraviolet (UV) light damages the fibers in the skin called elastin. The breakdown of these fibers causes the skin to lose its ability to snap back after stretching. As a result, wrinkles form. Gravity also is at work, pulling at the skin and causing it to sag, most noticeably on the face, neck, and upper arms.

Cigarette smoking also contributes to wrinkles. People who smoke tend to have more wrinkles than nonsmokers of the same age, complexion, and history of sun exposure. The reason for this difference is not clear. It may be because smoking also plays a role in damaging elastin. Facial wrinkling increases with the amount of cigarettes and number of years a person has smoked.

Many products currently on the market claim to “revitalize aging skin.” According to the American Academy of Dermatology, over-the-counter “wrinkle” creams and lotions may soothe dry skin, but they do little or nothing to reverse wrinkles. At this time, the only products that have been studied for safety and effectiveness and approved by the Food and Drug Administration (FDA) to treat signs of sun-damaged or aging skin are tretinoin cream and carbon dioxide (CO2) and erbium (Er:YAG) lasers.

Tretinoin cream (Renova), a vitamin A derivative available by prescription only, is approved for reducing the appearance of fine wrinkles, mottled darkened spots, and roughness in people whose skin doesn’t improve with regular skin care and use of sun protection. However, it doesn’t eliminate wrinkles, repair sun-damaged skin, or restore skin to its healthier, younger structure. It hasn’t been studied in people 50 and older or in people with moderately or darkly pigmented skin.

The CO2 and Er:YAG lasers are approved to treat wrinkles. The doctor uses the laser to remove skin one layer at a time. Laser therapy is performed under anesthesia in an outpatient surgical setting.

The FDA currently is studying the safety of alpha hydroxy acids (AHAs), which are widely promoted to reduce wrinkles, spots, and other signs of aging, sun-damaged skin. Some studies suggest that they may work, but there is concern about adverse reactions and long-term effects of their use. Because people who use AHA products have greater sensitivity to the sun, the FDA advises consumers to protect themselves from sun exposure by using sunscreen, wearing a hat, or avoiding mid-day sun. If you are interested in treatment for wrinkles, you should discuss treatment options with a dermatologist.

Many older people suffer from dry skin, particularly on their lower legs, elbows, and forearms. The skin feels rough and scaly and often is accompanied by a distressing, intense itchiness. Low humidity — caused by overheating during the winter and air conditioning during the summer — contributes to dryness and itching. The loss of sweat and oil glands as you age also may worsen dry skin. Anything that further dries your skin — such as overuse of soaps, antiperspirants, perfumes, or hot baths — will make the problem worse. Dehydration, sun exposure, smoking, and stress also may cause dry skin.

Dry skin itches because it is irritated easily. If your skin is very dry and itchy, see a doctor. Dry skin and itching can affect your sleep, cause irritability, or be a symptom of a disease. For example, diabetes and kidney disease can cause itching. Some medicines make the itchiness worse.

The most common treatment for dry skin is the use of moisturizers to reduce water loss and soothe the skin. Moisturizers come in several forms — ointments, creams, and lotions. Ointments are mixtures of water in oil, usually either lanolin or petrolatum. Creams are preparations of oil in water, which is the main ingredient. Creams must be applied more often than ointments to be most effective. Lotions contain powder crystals dissolved in water, again the main ingredient. Because of their high water content, they feel cool on the skin and don’t leave the skin feeling greasy. Although they are easy to apply and may be more pleasing than ointments and creams, lotions don’t have the same protective qualities. You may need to apply them frequently to relieve the signs and symptoms of dryness. Moisturizers should be used indefinitely to prevent recurrence of dry skin.

A humidifier can add moisture to the air. Bathing less often and using milder soaps also can help relieve dry skin. Warm water is less irritating to dry skin than hot water.

Skin cancer is the most common type of cancer in the United States. According to current estimates, 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. Although anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily.

UV radiation from the sun is the main cause of skin cancer. In addition, artificial sources of UV radiation — such as sunlamps and tanning booths — can cause skin cancer. People who live in areas of the U.S. that get high levels of UV radiation from the sun are more likely to get skin cancer. For example, skin cancer is more common in Texas and Florida than in Minnesota, where the sun is not as strong.

There are three common types of skin cancers. Basal cell carcinomas are the most common, accounting for more than 90 percent of all skin cancers in the United States. They are slow-growing cancers that seldom spread to other parts of the body. Squamous cell carcinomas also rarely spread, but they do so more often than basal cell carcinomas. The most dangerous of all cancers that occur in the skin is melanoma. Melanoma can spread to other organs, and when it does, it often is fatal.

Both basal and squamous cell cancers are found mainly on areas of the skin exposed to the sun — the head, face, neck, hands, and arms. However, skin cancer can occur anywhere. Changes in the skin are not sure signs of cancer; however, it’s important to see a doctor if any symptom lasts longer than 2 weeks. Don’t wait for the area to hurt — skin cancers seldom cause pain.

All skin cancers could be cured if they were discovered and brought to a doctor’s attention before they had a chance to spread. Therefore, you should check your skin regularly. The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn’t heal. Skin cancers don’t all look the same. For example, skin cancer can start as a small, smooth, shiny, pale, or waxy lump. Or it can appear as a firm red lump. Sometimes, the lump bleeds or develops a crust. Skin cancer also can start as a flat, red spot that is rough, dry, or scaly.

In treating skin cancer, the doctor’s main goal is to remove or destroy cancer completely, leaving as small scar as possible. To plan the best treatment for each person, the doctor considers the type of skin cancer, its location and size, and the person’s general health and medical history. Treatment for skin cancer usually involves some type of surgery. In some cases, radiation therapy or chemotherapy (anticancer drugs) or a combination of these treatments may be necessary.

Age spots, or “liver spots” as they’re often called, have nothing to do with the liver. Rather, these flat, brown spots are caused by years of sun exposure. They are bigger than freckles and appear in fair-skinned people on sun-exposed areas such as the face, hands, arms, back, and feet. The medical name for them is solar lentigo. They may be accompanied by wrinkling, dryness, thinning of the skin, and rough spots.

A number of treatments are available, including skin-lightening, or “fade” creams; cryotherapy (freezing); and laser therapy. Tretinoin cream is approved for reducing the appearance of darkened spots. A sunscreen or sun block should be used to prevent further damage.

Shingles is an outbreak of a rash or blisters on the skin that may cause severe pain. Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After an attack of chickenpox, the virus lies silent in the nerve tissue. Years later, the virus can reappear in the form of shingles. Although it is most common in people over age 50, anyone who has had chickenpox can develop shingles. It also is common in people with weakened immune systems due to HIV infection, chemotherapy or radiation treatment, transplant operations, and stress.

Early signs of shingles include burning or shooting pain and tingling or itching, generally on one side of the body or face. A rash appears as a band or patch of raised dots on the side of the trunk or face. The rash develops into small, fluid-filled blisters, which begin to dry out and crust over within several days. When the rash is at its peak, symptoms can range from mild itching to intense pain. Most people with shingles have only one bout with the disease in their lifetime. However, those with impaired immune systems — for example, people with AIDS or cancer — may suffer repeated episodes.

If you suspect you have shingles, see a doctor right away. The severity and duration of an attack of shingles can be reduced significantly by immediate treatment with antiviral drugs. These drugs also may help prevent the painful aftereffects of shingles known as postherpetic neuralgia. The National Institute of Allergy and Infectious Diseases currently is testing a shingles vaccine at the National Institutes of Health in Bethesda, Maryland. The vaccine they are testing is similar to the one used to immunize against chickenpox. After the shot, some people have had some discomfort around the area of the injection. In addition, a few people have had a low-grade fever. For more information about this study, call 1-800-411-1222.

Many older people notice an increased number of bruises, especially on their arms and legs. The skin becomes thinner with age and sun damage. Loss of fat and connective tissue weakens the support around blood vessels, making them more susceptible to injury. The skin bruises and tears more easily and takes longer to heal.

Sometimes bruising is caused by medications or illness. If bruising occurs in areas always covered by clothing, see a doctor.

The best way to keep your skin healthy is to avoid sun exposure.

• Stay out of the sun. Avoid the sun between 10 a.m. and 3 p.m. This is when the sun’s UV rays are strongest. Don’t be fooled by cloudy skies. Harmful rays pass through clouds. UV radiation also can pass through water, so don’t assume you’re safe if you’re in the water and feeling cool.

• Use sunscreen. Sunscreens are rated in strength according to a sun protection factor (SPF), which ranges from 2 to 30 or higher. A higher number means longer protection. Buy products with an SPF number of 15 or higher. Also look for products whose label says: broad spectrum (meaning they protect against both types of harmful sun rays — UVA and UVB) and water resistant (meaning they stay on your skin longer, even if you get wet or sweat a lot). Remember to reapply the lotion as needed.

• Wear protective clothing. A hat with a wide brim shades your neck, ears, eyes, and head. Look for sunglasses with a label saying the glasses block 99 to 100 percent of the sun’s rays. Wear loose, lightweight, long-sleeved shirts and long pants or long skirts when in the sun.

• Avoid artificial tanning. Don’t use sunlamps and tanning beds, as well as tanning pills and tanning makeup. Tanning pills have a color additive that turns your skin orange after you take them. The FDA has approved this color additive for coloring foods but not for tanning the skin. The large amount of color additive in tanning pills may be harmful. Tanning make-up products are not suntan lotions and will not protect your skin from the sun.

• Check your skin often. Look for changes in the size, shape, color, or feel of birthmarks, moles, and spots. If you find any changes that worry you, see a doctor. The American Academy of Dermatology suggests that older, fair-skinned people have a yearly skin check by a doctor as part of a regular physical exam.

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Preventing Falls and Fractures

A simple fall can change your life. Just ask any of the thousands of older men and women who fall each year and break (sometimes called fracture) a bone.

Getting older can bring lots of changes. Sight, hearing, muscle strength, coordination and reflexes aren't what they once were. Balance can be affected by diabetes and heart disease, or by problems with your circulation, thyroid or nervous system. Some medicines can cause dizziness. Any of these things can make a fall more likely.

Then there's osteoporosis—a disease that makes bones thin and likely to break easily. Osteoporosis is a major reason for broken bones in women past menopause. It also affects older men. When your bones are fragile even a minor fall can cause one or more bones to break. Although people with osteoporosis must be very careful to avoid falls, all of us need to take extra care as we get older.

A broken bone may not sound so terrible. After all, it will heal, right? But as we get older a break can be the start of more serious problems. The good news is that there are simple things you can do to help prevent most falls.

Take the Right Steps

Falls and accidents seldom "just happen." The more you take care of your overall health and well-being, the more likely you'll be to lower your chances of falling. Here are a few hints:

• Ask your doctor about a special test—called a bone mineral density test—that tells how strong your bones are. If need be, your doctor can prescribe new medications that will help make your bones stronger and harder to break.

• Talk with your doctor and plan an exercise program that is right for you. Regular exercise helps keep you strong and improves muscle tone. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing exercise—such as walking, climbing stairs—may even slow bone loss from osteoporosis.

• Have your vision and hearing tested often. Even small changes in sight and hearing can make you less stable. So, for example, if your doctor orders new eyeglasses, take time to get used to them, and always wear them when you should or, if you need a hearing aid, be sure it fits well.

• Find out about the possible side effects of medicines you take. Some medicines might affect your coordination or balance. If so, ask your doctor or pharmacist what you can do to lessen your chance of falling.

• Limit the amount of alcohol you drink. Even a small amount can affect your balance and reflexes.

• Always stand up slowly after eating, lying down, or resting. Getting up too quickly can cause your blood pressure to drop, which can make you feel faint.

• Don't let your home get too cold or too hot...it can make you dizzy. In the summer—if your home is not air-conditioned—keep cool with an electric fan, drink lots of liquids, and limit exercise. In the winter, keep the nighttime temperature at 65° or warmer.

• Use a cane, walking stick, or walker to help you feel steadier when you walk. This is very important when you're walking in areas you don't know well or in places where the walkways are uneven. And be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas.

• Wear rubber-soled, low-heeled shoes that fully support your feet. Wearing only socks or shoes with smooth soles on stairs or waxed floors can be unsafe.

• Hold the handrails when you use the stairs. If you must carry something while you're going up or down, hold it in one hand and use the handrail with the other.

• Don't take chances. Stay away from a freshly washed floor. And don't stand on a chair or table to reach something that's too high—use a "reach stick" instead. Reach sticks are special grabbing tools that you can buy at many hardware or most medical supply stores.

• Find out about buying a home monitoring system service. Usually, you wear a button on a chain around your neck. If you fall or need emergency help, you just push the button to alert the service. Emergency staff is then sent to your home. You can find local "medical alarm" services in your yellow pages.

Most medical insurance companies and Medicare do not cover items like home monitoring systems and reach sticks. So be sure to ask about cost. You will probably have to pay for them yourself.

Make Your Home Safe

You can help prevent falls by making changes to unsafe areas in your home.

In stairways, hallways, and pathways:

• Make sure there is good lighting with light switches at the top and bottom of the stairs.
• Keep areas where you walk tidy.
• Check that all carpets are fixed firmly to the floor so they won't slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
• Have handrails on both sides of all stairs—from top to bottom—and be sure they're tightly fastened.

In bathrooms and powder rooms:

• Mount grab bars near toilets and on both the inside and outside of your tub and shower.
• Place non-skid mats, strips, or carpet on all surfaces that may get wet.
• Keep night lights on.

In your bedroom:

• Put night lights and light switches close to your bed.
• Keep your telephone near your bed.

In other living areas:

• Keep electric cords and telephone wires near walls and away from walking paths.
• Tack down all carpets and area rugs firmly to the floor.
• Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
• Make sure your sofas and chairs are a good height for you, so that you can get into and out of them easily.

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