Javier Garcia Lopez, Paula Benedetti, Luis Puente Maest and Javier de Miguel Diez.

The Volume reduction in COPD (COPD) ‘Effective in all variants’. However, it does require a comprehensive study of patients who can benefit from these treatments, as explained by pulmonologists in Gregorio Maranon Hospital Who participated in the new Interhospital conference on pulmonology in Madridorganized by medical writing.

During the meeting, sponsored by Neumomadrid Foundation In cooperation with GSK s Oxymsa Nippon gasesA review of treatment options for patients with severe COPD, whose daily habits are limited, was conducted. He explained that “the patient expresses this great feeling of lack of air and the need to breathe very superficially.” Paola BenedettiDr., a medical specialist in the Respiratory Service of the Gregorio Marañone Hospital, has focused on the basics and indications for these alternatives.

Discussion table on volume reduction in severe COPD.

The main goal, as explained by the expert, is “a little more help” to the patient, that is, Reduce hyperinflation Improve respiratory mechanics and diaphragm muscle function. Also, improving the elastic contraction of the lung, favoring the gas exchange capacity of the remaining lung tissue or reversing the chronic decrease in the supply of tissues with oxygen.

Like all treatment, Benedetti warned, Size reduction has indications and contraindications. The first is that he is a patient with severe emphysema, with “severe” shortness of breath or who meets certain functional criteria. Among the contraindications, on the other hand, we find the presence of bronchiectasis or cancer as well Continuation of the tobacco habit or treatment with prednisone, among others.

The specialist explained that the types of lung volume reduction Valves for acute emphysema with intact incisionsAnd steam in acute emphysema with attached fissures.

One of the primary advantages of valves, the pulmonologist emphasized, is that they are reversible, while steam is “not a reversible option.” At this point, the expert indicated the speed with which this technique is being applied, not the exception to it Possible complications such as shortness of breath, fever or severe pneumonia.

“An essential thing is Careful selection of patientsthe main candidate to refer to these treatments, “notes the specialist, who emphasized that it is necessary”Offer benefit over risk. Another important aspect, he added, “is that there is no age limit and does not interfere with lung transplantation.”

Javier García-López, Paola Benedetti during the Inter-Hospital Conference on Pulmonology.


The experience of cashew nuts in reducing volume in chronic obstructive pulmonary disease

On the table, runs it Luis Puente MaestoHead of the Department of Pulmonology; s Javier de Miguel DiezHead of the Respiratory Service Division. I also intervened Javier Garcia Lopezwho is also the center’s chief of pulmonology services, which chronicled the hospital’s experience with this technology through a clinical case that demonstrated how the specialists worked.

In this case a 71-year-old woman, a former smoker, with a Long-term chronic obstructive pulmonary disease And that he has had two incomes in the past three years. With her, and with any patient, “the potential causes of exclusion must be carefully evaluated,” Garcia explained, emphasizing that “The patient must know the risks before deciding whether to seek treatment“.

After evaluating a file Emphysema via computed tomographyAn echocardiogram, which cannot be evaluated, is performed Pulmonary arterial hypertension Very concretely, the specialist recalls. At this point, he highlights that one of the contraindications, pulmonary hypertension, is the only one available to the patient, so “you have to go further and have a catheterization”, as pulmonologists assure it is neither severe nor moderate, so you can continue with treatment .

“Knowing that it’s a filter, we have to choose how we handle it: whether with valves or steam,” says the specialist. “We always prefer valves because they are reversible in case of complications,” he adds. The patient, remember, was laid Three valves four millimeters. All this just three months after he went to counseling. He remembers that after four days without immediate complications, he was discharged from the hospital. However, ten days after discharge, the patient went to the emergency department referring to a Source That after conducting a study, it was confirmed that it was LSD . atelectasisAlthough his shortness of breath improved.

Since 2015, the specialist noted, The hospital treated 21 patients through coils, valves and steam; With subjective improvement in 80 percent of patients, even after 5 years. However, these procedures “are not free,” Garcia emphasized, so they are associated with risks. In the hospital experience, there was a case of pneumothorax, a massive hemoptysis patient And three patients with serious infections. However, the pulmonologist stressed that “volume reduction is effective in all of its variants,” noting the need for a “comprehensive study” of each case because they are very fragile patients.

Javier de Miguel Diez, Luis Puente Maisto, Paula Benedetti and Javier Garcia Lopez.

Although it may contain statements, statements, or notes from health institutions or professionals, the information in medical writing is edited and prepared by journalists. We recommend the reader to consult a health professional for any health-related questions.

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Katie Guttenberg, MD

With rising costs for gas and food, 2 years of the COVID-19 pandemic, global uncertainty, and the ongoing war in Ukraine, it is hardly a surprise that more than 70% of American adults report feeling stressed.

The Stress in America survey, which was conducted by the American Psychological Association in partnership with The Harris Poll, also found that a growing number of Americans report money as a source of stress, peaking at two thirds of adults in 2022, the highest reported level in 7 years.

Confronted with multiple stressors, many Americans have adopted unhealthy behaviors. More than half of Americans report weight gain, with an average of 26 pounds in the past year.

Stress affects our emotional and physical well-being. Let's examine the body's response to stress and review techniques to reduce cortisol, known as the stress hormone.

The Stress Response

In 1953, Lewis and colleagues developed the first protocol for the perioperative management of patients with adrenal insufficiency. We now have a more nuanced understanding of cortisol production and the effects of stress on the hypothalamic-pituitary-adrenal axis.

A 2020 study sought to determine the best treatment modality for patients with adrenal insufficiency exposed to major stress. The authors measured cortisol production in nearly 300 participants with normal adrenal function exposed to a variety of stressors, including sepsis, major trauma, elective surgery, and the war in Afghanistan.

Serum cortisol was highest and most variable in patients with sepsis. Cortisol levels were elevated in military personnel within 4 weeks of deployment, and production appeared similar to that of surgical patients, illustrating the body's response to both emotional and physical stress.

Cortisol and the Sleep-Wake Cycle

The COVID-19 pandemic has disrupted our lives and our sleep. Cortisol production is closely tied to the sleep-wake cycle. Levels increase in the early morning and decrease in the evening. This pattern is often disrupted in shift workers, with a blunted response upon waking and increased cortisol production in the evening.

This may have implications for long-term health. One study found higher levels of cortisol in the hair of young shift workers compared with their day worker peers. Cortisol levels correlated with BMI. Levels were lowest in participants with a BMI < 25 and highest in participants with a BMI > 30. This highlights the important relationship between disrupted sleep at a young age, cortisol production, and obesity, increasing the risk for cardiovascular disease later in life.

The Impact of Stress on Health

The Whitehall II study, a large, prospective cohort study in the United Kingdom, explores the relationship between the work environment, stress, and health. A subset of participants was selected to evaluate the relationship between stress and hypertension. Salivary cortisol was measured after participants completed stress-inducing activities. Approximately 40% of participants demonstrated a significant increase in cortisol production, highlighting variability in the stress response. Participants with a heightened stress response were more likely to develop hypertension during the 3-year follow-up period.

A separate study found that Whitehall II study participants with higher evening cortisol levels were more likely to develop diabetes.

What can your patients (and you) do to combat stress?

Get Active — Exercise Builds Resilience

Like many Americans, physicians report high rates of burnout. Many medical schools have tried to address this issue by developing curricula that teach skills to cultivate resilience, particularly among postgraduate trainees.

Exercise is key to maintaining physical and emotional well-being and has been shown to moderate the body's response to psychosocial stress. Engaging in regular exercise leads to a reduced stress response to physical activity.

Repeated activation of the hypothalamic-pituitary-adrenal axis appears to prime the body for future stressors.

Martikainen and colleagues explored the relationship between physical activity and the stress response in healthy 8-year-old children. Children participated in the Trier Social Stress Test, which reliably induces stress with storytelling and mental arithmetic activities. Children with the highest levels of physical activity exhibited the smallest increase in salivary cortisol in response to stress. These findings appear to persist across the lifespan.

College students and older adults who participate in high levels of physical activity develop an adaptive response to stress, producing lower levels of cortisol compared with their less-active peers (Gerber et al; Pauly et al). These studies highlight the role that exercise plays in moderating the stress response and building emotional resilience.

Be Mindful — Meditation Reduces Stress

Practicing mindfulness in everyday life has been shown to reduce stress, but the effects of mindfulness on the body's physiologic response, including cortisol production, is unclear.

Most medical schools in the United States offer mindfulness-related activities, according to Barnes and colleagues. Nearly a third of schools embed these activities in their curriculum.

A 2021 study assessed the impact of two mindfulness-based interventions on heart rate and cortisol secretion. In focused-attention meditation, participants were instructed to center their attention on their breath. This activity improved concentration and reduced distraction.

In open-monitoring meditation, participants were instructed to be aware of their physical sensations and explore the impact of distracting thoughts and emotions on the body. These mindfulness-based interventions appear to have affected the body in different ways: Salivary cortisol levels decreased significantly following open-monitoring meditation, and heart rate decreased significantly following focused-attention meditation. In contrast, there was no difference in salivary cortisol levels following focused-attention meditation and no difference in heart rate following open-monitoring meditation.

Looking Ahead

In the past 70 years, we've gained a better understanding of the hypothalamic-pituitary-adrenal axis and the impact of stress on health. How can we apply this knowledge in daily life?

A group of researchers at UCLA developed a smartwatch that can measure cortisol levels in sweat. A growing number of Americans use smartwatches to monitor their activity, sleep, and a variety of health parameters, including heart rate and function as well as oxygen saturation. Expanding these capabilities to include cortisol levels has implications for patient care and possibly for everyday life, allowing us to gain insight into our body's response to stress and learn techniques to effectively manage the stress hormone.

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Introduction

Sleep-disordered breathing (SDB) is characterized by multiple episodes of airflow reduction and cessation during sleep.1,2 SDB is a common sleep disorder with estimated prevalences of 49.7% and 23.4% in men and women, respectively.3 In the Wisconsin Sleep Cohort Study, the prevalences were 24% and 9% in men and women aged 30–60 years, respectively.1 However, many patients with SDB, including severe SDB, remain undiagnosed. In the Wisconsin Sleep Cohort Study, 93% and 82% of women and men with moderate-to-severe sleep apnoea, respectively, had not been diagnosed.2 In addition, according to a database study, over 90% of women and over 80% of men with SDB have not been diagnosed.4

Polysomnography (PSG), the “gold standard” investigation for SDB, is expensive and time-consuming, which may delay the diagnosis of SDB. Thus, home-based portable devices for sleep studies are essential to diagnose SDB. Moreover, home monitoring systems using oxygen saturation (SpO2) to screen for SDB increase the testing capacity and simplify the interpretation of prolonged recordings. Thus, the use of a simple device may ensure timely and accurate diagnosis of SDB.

An ideal system would make an accurate diagnosis on the basis of a few easy-to-collect signals. Many studies have addressed these issues by using signals from audio recordings,5 plethysmography,6 respiratory movements,7,8 oximetry,9–16 electrocardiogram (ECG),17 or a combination of such methods.18,19 The SpO2 signal can be easily collected, and a large number of wearable pulse oximetry devices are available in the market at a low cost.20–22 The SpO2 signal represents the oxyhaemoglobin concentration in blood. The apnoea–hypopnea index (AHI) score is associated with oxygen desaturation23; therefore, screening for SDB on the basis of the SpO2 signal is convenient and accurate, and also diagnosis for SDB with automatic detection assistance is potential.

The aim of our study was to establish a novel apnoea-related desaturation segments generation method to achieve variable length proposal; an efficient fusion method for the classification of apnoea-related desaturation using a combination of whole night features and desaturation segments; and an automatic feature extraction method to select effective global whole night features. Compared to previous studies in terms of complexity of model construction, our study does not use complex manual feature extraction and utilizes sufficiently powerful deep learning for feature extraction to reduce the complexity of construction. In addition, compared to the current method of direct fragment analysis by deep networks, we designed the overall night features with reference to the clinical medical process to improve the accuracy of the model.

Materials and Methods

The study was performed in accordance with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all participants. The study protocol was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, China, under the identifier 2019-KY-050 (K).

PSG Assessment and SDB Classification

The physiological signals of PSG (eg, electroencephalogram, ECG, thoracic and abdominal movements, airflow, electrooculogram, electromyogram, and SpO2) were recorded to analyse the sleep architecture, duration, and quality during overnight PSG.24 The 2012 American Academy of Sleep Medicine criteria were used to diagnose apnoea events:25 peak signal excursion decrease by ≥90% of pre-event baseline using an oronasal thermal sensor (diagnostic study); and duration of drop in sensor signal ≥10s. Hypopnea was diagnosed if the peak signal excursions decreased by ≥30% of pre-event baseline using nasal pressure (diagnostic study); duration of drop in sensor signal ≥10s; and oxygen desaturation ≥3% from pre-event baseline or an arousal. The number of apnoea and hypopnea events in the whole night PSG was used to determine the SDB severity. The AHI score (total number of apnoea and hypopnea events divided by the hours asleep) was computed to classify the SDB severity into normal (0–5), mild (5–15), moderate (15–30), and severe (>30).26

Data Source

Three datasets were used for algorithm development and validation: Apnoea-ECG dataset (Physionet),27 SHHS,28 and No. 6 People’s Hospital (Shanghai Jiao Tong University Affiliated Sixth People’s Hospital). The SHHS dataset contained two datasets, SHHS1 and SHHS2, which were used as the training and testing sets, respectively (Table 1).

Table 1 Patient Characteristics for the Different Datasets Age, BMI and AHI are Presented as Mean ± Standard Deviation, with the 25% and 75% Quantile Values Underneath

Apnoea-ECG (Physionet): The Apnoea-ECG (Physionet) database contains eight night-time records, including ECG, oxygen saturation levels, and three respiratory signals.27 The SpO2 sampling frequency was set at 100 Hz. The AHI scores and minute-level apnoea annotations are available for each 1-min interval. Four participants did not have SDB, whereas four participants had severe SDB.

SHHS (Sleep Heart Health Study): SHHS is a multi-centre cohort study of the cardiovascular and other consequences of SDB.28 SHHS contains two datasets with PSG results: SHHS1 contains data from 5793 participants tested between 1995 and 1998, whereas SHHS2 contains data from 2651 participants tested between January 2001 and June 2003. The SpO2 signal recording lengths were > 3 h. The SpO2 signals were recorded using Nonin XPOD 3011 sensor and sampled at 1 Hz. In accordance with the 2012 American Academy of Sleep Medicine guidelines, we rechecked the start and end times of apnoeic events in the SHHS training dataset.25 The SHHS training dataset contains 500 records selected from SHHS1 for algorithm training. Because rechecking records is complex and time-consuming, only 500 records were used for training. The remaining SHHS1 records were included in the SHHS1 test dataset. The SHHS training dataset was constructed using patients who had been randomly selected from the SHHS1 dataset to maintain similar proportions of men and women in apnoea severity categories.

No. 6 People’s Hospital: No. 6 People’s Hospital dataset contained 179 PSGs: 11 were normal, while 72, 49, and 47 had mild, moderate, and severe SDB, respectively. The dataset was collected from Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. The dataset was scored in accordance with the 2012 American Academy of Sleep Medicine guidelines by sleep specialists.25 Alice 4, Alice 5, and Alice LE systems were used to score and store the SpO2 signals at sampling rates of 10 and 100 Hz.

Data Processing

The algorithm generated the apnoea-related SpO2 segment proposals. Then, the whole night features of SpO2 signals were extracted. The apnoea-related blood oxygen segments were classified using a bi-directional long short-term memory convolutional neural network (Bi-LSTM-CNN) model according to both whole night features and apnoea-related SpO2 segment proposals. Furthermore, the algorithm used a linear regressor to simulate the relationship of the apparent number of apnoeic events in the whole night SpO2 and the real number of apnoea events.

Before the preprocessing of the data, we took blood oxygen below 50% as artifacts for all data sets due to artifacts caused by the loss and interference of blood oxygen signals in the data set. Moreover, during processing, the signals at both ends of the artifacts were connected using linear interpolation to ensure the continuity of the signals.

Generation of SpO2 Desaturation Segment Proposals

Apnoeic events are often associated with a decrease in blood oxygen level (ie, desaturation). The numbers of apnoeic events were calculated by identifying the desaturation segments and identifying the apnoea-related segments. This process required the identification of all desaturation segments.

However, the noise and sampling roughness of raw SpO2 signals complicate the detection of desaturation segments. Therefore, a wavelet processing algorithm was selected for signal denoising and the identification of desaturation segments. First, denoising was performed by discarding the approximate coefficients of the wavelet Daubechies 8 decomposition. Then, threshold filtering and reconstruction were performed. Therefore, a 3-second moving average filter was applied as a smoothing method after signal denoising.29 Moreover, high sampling rates were resampled at 1 Hz to ensure standardisation and speed computations.29 Then, linear interpolations were used to replace the desaturation signals that decreased below 50% of the baseline. Figure 1 shows the signal after preprocessing. Preprocessing generated a smooth signal and simplified the identification of desaturation events.

Figure 1 A portion of pluse oximetry signals under preprocesing. The four diagrams from top to bottom show four intermediate results of data preprocessing: Raw SpO2 signal, Denoised signal under Daubechies 8 wavelet transform, smoothed signal based on 3-seconds MA filter, and resampled signal after resampling and linear interpolation for SpO2 signal drop below 50%.

After preprocessing, the signal data were used to generate the desaturation segments (Figure 2). First, the signal peaks and troughs were identified by derivative filtering to select the extremum points. To preserve the completeness of desaturation segments, successive desaturation segments were linked when the total length of the linked segments was <30 s. Furthermore, the start and end point pairs of a desaturation segment were extracted.12 Desaturation segments were identified by a decrease in SpO2 of at least 1% from the beginning to the end of a segment with a total segment length <120 s.29,30 Then, segments were generated from raw data using the start and end points of the segment. All desaturation segments possibly related to apnoea were identified. The generation of desaturation segment proposals is shown in Figure 2.

Figure 2 Overview of generation for desaturations segments in the SpO2 signal. (A). Graphical overview: on top the under preprocessing signal is plotted. Next, the peaks and troughs that are shown in dark blue dots of this handled signal is plotted. Moreover, the start and end point pairs is in red and blue colors relatively. On the bottom, the desaturation segments of the raw signal are detected. (B). Overview of desaturation segments generation procedures.

Whole Night Feature Extraction

The whole night SpO2 signal can be characterised by specific features. Time and frequency domain features were extracted from the SpO2 signal to determine the signal properties. Table 2 shows 16 features obtained from the SpO2 signal that have been evaluated in previous studies of patients with obstructive sleep apnoea (OSA).31–35

Table 2 Time and Frequency Domain Feature Extracted from Whole Night Signal

Bi-LSTM-CNN for SpO2 Segment Classification

To avoid complex manual feature extraction and ensure good performance of the classifier system, a state-of-the-art model, Convolutional Bidirectional Long Short-Term Memory (CBLSTM), was used for classification.36 This model contains four parts: a temporal encoder (bi-directional long short-term memory [Bi-LSTM]), a local feature extractor (convolutional neural networks [CNNs]), whole night feature fusion, and a connector and linear regressor (Figure 3).37

Figure 3 Framework of Bi-LSTM network for temporal information extraction.

A Bi-LSTM network was used to manage the temporal information. Bi-LSTM network is an elegant solution to capture the bidirectional (ie, forward and backward) information.12 This model can access complete, sequential information before and after each time step in a specific sequence. In the present study, a well-known Bi-LSTM framework was used (Figure 3). In Bi-LSTM, at each time step , forward hidden state and backward hidden state were updated using the current data from the same time step , the hidden state at the previous time step and , the input gate and , the forget gate and , the output gate and , and a memory cell and . The following updating equations were used:

(1)

where and are the weight matrices for different gates for input and hidden state and , while * is the element-wise multiplication, and are the element-wise activation functions, and can be the dimension of the word vector or the size of the hidden state in the lower layer. The framework of this network is shown in Figure 4.

Figure 4 The structure of local extractor: Convolutional neural network for 1-D signals.

After Bi-LSTM network, the output of Bi-LSTM is given by

(2)

where represents a window of m continuous time steps beginning from the th time step. The CNN feature extractor contains two layers: convolutional and max pooling layers. The convolutional layer slides the filters over the whole input sequence to generate feature maps. Each feature map can be regarded as the convolutional activation of the corresponding filter over the whole sequence. A convolutional filter is used to obtain the feature map . The th element is calculated as

(3)

where is the activation function, is the weight matrix of the convolution filter, is a bias, is the length of the filter, and is the dimension of the word vector. The convolutional layer uses multiple filters in parallel to obtain feature maps. It also can use convolutional filters of various lengths to extract feature information.

In addition, the pooling layer is applied to compress each generated feature map to produce significant features. The feature maps gained from the convolutional layer are shown below:

(4)

where index denotes the th filter; it corresponds to multi-windows as . These windows are fed into the max-pooling layer to obtain the compressed feature vector, which can be calculated as

(5)

where . Multiple filters are applied with different initialised weights to derive the output of the CNN layer. The framework of the CNN is displayed in Figure 5.

Figure 5 Structure of whole night feature infusion and selection. (A). Layers structure of whole night feature infusion. (B). Procedures in selecting whole night features.

The output representation of the local extractor represents related information concerning each desaturation segment. However, the severity of desaturation and disease may be helpful for the identification of desaturated fragments. Thus, , the whole night feature of extracted from full night PSG, is given as

(6)

where , , , …, are time and frequency domain features of whole night signal extracted in the previous step. The whole night fusion feature combines features extracted from fragments and whole night features from overnight records. The feature is fed into a two-layer full connection layer to gain the prediction of the whole model, as shown in the following equations:

(7)

where , , and . In addition, is the number of hidden states in the first layer of full connection layers and is the dimensionality of the output. Because the objective problem in our task is a bi-classification problem, . The structures of the two-layer full connection and softmax layers are shown in Figure 5A.

In this study, focal loss is used as a model loss between the predicted classification results and real class labels because of the uneven distributions of the two types of data38,39:

(8)

where represents the real class label and represents the probability that the class of the output of the model is 1.

Whole Night Feature Selection

The weights of the fusion full connection layer for the 16 whole night features were used for feature selection. The gradient-weighted class activation mapping (Grad-CAM) method was used to create a weight map with higher-value weights. Low-value weights were considered redundant.40 The feature selection process is shown in Figure 5B.

Statistical Analysis of Classification

Accuracy, sensitivity, specificity, positive predictive value, area under the receiver operating characteristic curve, and Cohen’s kappa were used to analyse the classification performance.

AHI Estimation

The AHI was calculated using a linear regressor, which simulated the relationships between the predicted and real numbers of apnoea-related desaturation events. Moreover, the identified AHI was within the annotated range to avoid the influence of non-sleep time.

Experimental Setup

The dataset included data from 500 individuals, which were used for model training because of the complexity and time-consuming nature of extensive review for additional data. The original apnoeic events recorded by PSG were based on the respiratory signals. The apnoea event markers from the SHHS training dataset were manually converted to desaturation event markers. We performed two major experiments as part of this study. First, we used our method to test well-known datasets and compared the findings to the results of other methods in terms of recognition accuracy. Second, we analysed the fusion method using whole night features and desaturation segments.

Results

Comparison of Methods and Datasets

Segment Classification Performance

Table 3 shows the mean performance of segment classification for each dataset. The mean performance was 84.3% for the test set. The model was validated on the Physionet dataset with an accuracy of 94.5%, an improvement over the previous study (93.0%).40 Table 4 presents the performance indicators for the classification of desaturation events detected by the generation method using different classifiers. These indicators were averaged on all test datasets. As shown in Table 4, the accuracy of the Bi-LSTM-CNN classifier was superior to the accuracies of other classifiers for the complete training dataset. Therefore, only the Bi-LSTM-CNN classifier was used for subsequent experiments.

Table 3 Overview of the Averaged Classification Performance of Bi-LSTM-CNN Model on Each Set

Table 4 Overview of the Averaged Classification Performance of Different Method on the Validation Set

AHI Estimation

Desaturation events were detected by the segment generation method using SpO2 signals from full night PSG. The Bi-LSTM-CNN classifier model was used to divide the signals into apnoeic and non-apnoeic events. The AHI is computed as the number of desaturation events divided by the total recording time. Figure 6 shows a comparison of the predicted and real AHIs for each dataset. The training set had greater variance than did the predictive AHI in the verification set for all datasets. For SHHS and No. 6 People’s Hospital datasets, this discrepancy was limited, but it was higher for AHI; thus, the discrepancy led to insufficient representation of SDB in the test set. In the Physionet dataset, desaturation was absent in only 5.3% of the apnoea-related time; therefore, the predicted AHI was closer to the real value. To ensure the independence of the test dataset, the SHHS1 train dataset was used as the training set, while SHHS1 test, SHHS2, Physionet, and No. 6 People’s Hospital datasets were used as validation sets. The desaturation events in the validation set were divided into apnoeic-related (77.8%) and non-apnoeic-related (22.2%) events. The R2 coefficients of the predicted AHIs for the datasets were 0.87–0.94.

Figure 6 Scatter plot of the computed and annotated AHI for all data sets, R2 values are given. Regressions based on the training (SHHS1 train) and test data (SHHS1 test, SHHS2, No. 6 People Hospital, and Physionet) are also plotted.

OSA Screening and Grading

Based on the AHI, participants were divided into patients with (AHI ≥ 15) and without (AHI 15) OSA. Furthermore, participants were classified into patients without OSA and patients with normal, mild, moderate, and severe OSA. The results of the SDB classification (AHI > 15) were compared with the results of other studies conducted on the SHHS2 dataset.10–12,41,42 Table 5 shows the comparison of the results of a subset of 995 individuals. Our classification method was superior to the methods used in other studies, showing an accuracy of 88.95% and an area under the curve of 0.961. Because the SHHS2 dataset was not used to train the model, these results are meaningful.

Table 5 Comparison of SDB Patient Screening Results for SHHS2 Dataset (AHI >15)

Figure 7 shows the SDB classification accuracy in each dataset. In the SHHS1 test dataset, the accuracy was significantly lower for normal individuals than for SDB patients, which may be explained by the difficulty in distinguishing between normal and mildly affected individuals. Figure 8 shows that the accuracy and specificity of SDB classification decreased and sensitivity increased with increasing SDB severity. Only 17% of the patients in the SHHS1 and SHHS2 test datasets had severe SDB (AHI ≥ 30), leading to low sensitivity and high specificity. The confusion matrixes of the estimated and true class labels for the SHHS and No. 6 People’s Hospital datasets are shown in Figure 8. Outstanding classification performance was observed in the training set, such that 84.2% of the individuals were classified correctly and the remaining 13.8% of the individuals were classified in closely related classes. The classification accuracies were 4.2%, 67.1%, and 72.5% for the SHHS1 training, SHHS1 test, and SHHS2 sets. An AHI threshold of 15 is often used in SDB screening. Screening individuals for SDB based on an AHI threshold of 15 resulted in accuracy of 95.4% for the training set and accuracies of 88.4%, 88.9%, and 93.9% for the SHHS1 test, SHHS2, and No. 6 People’s Hospital datasets. In the Physionet dataset, SDB was accurately classified in 100 individuals with an accuracy of 100%.

Figure 7 The bar chart of the accuracy for each dataset in each class of severity of SDB.

Figure 8 Confusion matrix for SDB severity classification based on computed AHI of four datasets (SHHS1 train, SHHS1 test, SHHS2 and No. 6 People Hospital).

Whole Night Feature Infusion Experiment

We added whole night features to determine the performance accuracy for whole night PSG. Whole night feature infusion improved the accuracy by 1.6 (Table 6). In the SHHS1 test and SHHS2 datasets, models with whole night features were more accurate (84.9% and 83.7%, respectively) than were models without whole night features (84.0% and 83.5%, respectively).

Table 6 Overview of the Averaged Classification Performance of Method Using or Not Using Whole Night Feature on the Validation Set

Discussion

The detection of respiratory events, particularly apnoea-related respiratory events, is tedious and time-consuming because it requires the clinician or sleep technologist to manually examine each event. Therefore, an automated system that can accurately assess individual respiratory events and provide an accurate diagnosis will be extremely useful. Based on the detection and classification of desaturation events associated with apnoea, a method is proposed for the automatic detection of respiratory events using SpO2 signals and AHI data. Use of the Bi-LSTM-CNN classifier was associated with the best accuracy for desaturation classification.1 The mean accuracy of independent test sets was 84.3%. AHI was calculated by dividing the number of events by the duration of the record. Estimated AHI was used to screen and grade SDB, based on an AHI threshold of 15. The accuracy of the screening method was 89% on the SHHS2 dataset, which is better than the accuracies of SpO2-based methods.

Currently available portable home monitoring systems based on SpO2 signals include traditional methods that involve feature extraction,11,12 as well as deep learning methods.13,16 Some previous studies used traditional methods to manually extract the features from whole night records, then determine the presence and severity of SDB.11 Compared to portable home monitoring, PSG can help better diagnose SDB by obtaining more accurate respiratory and sleep conditions through a full range of signal monitoring, but the convenience and ease of use of portable monitoring also provides an efficient means of mass screening for SDB on a large scale. The classification models based on whole night records, such as the work by Di Persia,11 have good performance; however, they cannot recognise apnoeic events and are time-consuming to use for the extraction and selection of artificial features. In addition, detection models using desaturated fragments are well known, but the segment classification does not consider the impact of SDB severity.12 The classification of desaturated fragments corresponding to undetermined apnoea only considers the signal characteristics of the specific fragment, instead of the overall disease severity. Other studies using deep learning methods, such as Recurrent Neural or Deep Brief Networks,13,16 have demonstrated the potential usefulness of such methods. Although deep learning can determine whether apnoea has occurred in the segment, the events cannot be predicted and the exact number of apnoeic events cannot be determined if multiple apnoeic events occur in the segment. Thus, we propose a Bi-LSTM-CNN model to classify the event type and severity. This model uses a novel apnoea-related desaturation segment generation method to achieve variable length proposal. We introduced an efficient fusion method for the classification of apnoea-related desaturation events using the combination of whole night features and desaturation segments. We found that an automatic feature extraction method was most suitable for global whole night feature extraction.

Some practical considerations require further investigation. First, this study used suitable datasets for training and testing, including both public and private datasets. The public dataset may produce inadequate training results because of poor data quality. Future studies can improve the effectiveness of model performance validation by using larger private datasets. Second, the proposed Bi-LSTM-CNN classifier and its training process are complex; extensive data preprocessing is required. Data preprocessing significantly affects the performance of the model. In addition, the model integrates whole-night and fragment features using fully connected layers; significant differences between them may affect the final performance of the classifier. Third, annotation of the event-related respiratory events requires significant human resources. Therefore, further research concerning advanced enhancement techniques is needed to create better models, as well as a system that does not require large amounts of training data for the generation of reliable statistical models. In addition, the blood oxygen signal used for PSG during the training of this model may differ in the application of actual at-home portable devices, and a dataset of blood oxygen signals collected by portable devices may be a direction for further exploration of the study.

Conclusions

Based on the detection and classification of desaturation events associated with apnoea, an automatic detection method (Bi-LSTM-CNN) of respiratory events using SpO2 signals is proposed. The Bi-LSTM-CNN classifier was associated with the best accuracy for desaturation classification. The mean accuracy of different independent test sets was 84.3%. AHI was calculated via division of the number of events by the duration of the record. Estimated AHI was used to screen and grade SDB (AHI threshold: 15). The screening accuracy was 89% on the SHHS2 dataset, which is superior to the accuracies in previous studies conducted on the SHHS2 dataset. The current results support the effectiveness of a wearable SDB monitoring system based on SpO2 signals.

Data Sharing Statement

The datasets used and analyzed in this study are available from the corresponding author, on reasonable request.

Ethics Approval and Statement of Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and were approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. Informed consent was obtained from all individual participants included in the study.

Acknowledgments

The authors are grateful to the staff in our sleep center and all of the patients who participated.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The study received grants from the Shanghai Municipal Commission of Science and Technology (Grant No. 18DZ2260200), Shanghai Shen-Kang Hospital Management Center Project (Grant Nos. SHDC2020CR2044B, SHDC2020CR3056B), Shanghai Jiao Tong University Affiliated Sixth People’s Hospital College-level Project (X-2296).

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Few can deny that the BBC’s ‘Fight the Freeze’ is one of the toughest physical endurance shows to hit our tv screens.

The contestants are being subjected to the most vicious of challenges as they sit in barrels of ice, endure snow blizzards wearing only their swimsuits and jump into lakes covered in dense layers of ice.

But for Ammanford weatherman Owain Wyn Evans, the task is even tougher.

Owain suffers from Raynaud’s Syndrome, which is a blood circulatory disorder affecting his fingers and toes. And when temperatures drop, his hands and feet change colour, they become extremely sore, and eventually they turn numb.

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“Often in the winter when I get into my car I scream, just because of the pain I feel in such cold temperatures,” he said.

So the question has to be asked: Why in the world did Owain decide to take part in such a gruelling programme?

His answer is an interesting one.

“I first met Wim Hof (the iceman who features in the programme) several years ago when I was filming for The One Show.  And I was absolutely intrigued by him

"His method is to overcome incredible feats of endurance by developing command over the body, breath and mind through specific breathing techniques and by tolerance to extreme temperatures. And I really wanted to find out more about this and use it as a tool to help me with my own mental health.

“Anxiety has been a constant battle throughout my life which is why my drumming is so important to me. Growing up as a young gay man in the '80s and '90s was at times terrifying.  We were hearing so much about HIV and Aids and the way gay people were being portrayed was as sad, lonely souls who were really struggling. Of course none of this was true for me because I had a loving family, but it still made me feel anxious and I sometimes felt that people were inadvertently trying to shame me.”

Owain and his ‘Fight the Freeze’ colleagues are now nearing the end of the six-part series.

“I can honestly say I’ve learnt so much from what I’ve done. Yes, it’s been tough and there’ve been times when I’ve found it extremely difficult to attempt the challenges before me, but I can honestly say that to have had this opportunity to be taught how to remove myself from the depths of my mind and remain focussed on the present is totally incredible. The breathing technique and even the occasional cold shower is something I shall continue doing for a very long time to come.”



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ROTTERDAM, Netherlands--()--Somnox today announced the U.S. launch of their science-backed sleep companion, shown to improve breathing and settle the mind for better sleep, recovery, and quality of life. Somnox is a category-carving company known for developing the first smart sleep companion to improve quality of rest via built-in sensors that detect respiratory rate and sync with the user to gradually slow the cadence of breath and empower a good night’s sleep. Somnox’s Haptic Breathing™ technology guides breath using a pneumatic system and incorporates an air-bladder, which inflates and deflates to simulate natural inhalation, exhalation and breath holding rhythms.

The proprietary, patented technology embedded in the Somnox encourages better sleep by guiding users’ breathing, thereby relieving feelings of stress and anxiety, while the Somnox App coaches and evolves with the user over time to improve overall rest and recovery. The Somnox sleep companion offers multiple options when incorporating the device into one’s sleep routine. Somnox is multi-functional and can be incorporated into many different parts of a user’s daily ritual. Some use Somnox fifteen minutes before bedtime to help calm the body and mind, while others enjoy it as a true sleep companion in bed throughout the night, in which case the proprietary technology further personalizes and improves future experience. The companion can also be utilized as part of one’s daily self-care routine, accompanying the user during breathwork, meditation, and intentional relaxation.

Boasting plush fabric and memory foam components to comprise the cushion, the Somnox sleep companion easily adapts to any sleeping style and includes enhanced sensors and algorithms to accurately measure breath and encourage sleep. The Somnox is also equipped with WiFi and Bluetooth to allow users to stream their choice of music and ambient sound for a multisensory experience. The Somnox sleep companion is light and compact at 3.75 pounds, making it easy to hold close and suitable for people who toss and turn in their sleep. It is equipped with a USB-C compatible, lithium ion battery that fuels an average of five nights on just one charge.

Somnox is coming off an impressive year in which the company has experienced significant traction and growth, including a 150% year over year increase in revenue and more than 12,000 satisfied (and well-rested) customers. In fact, Somnox users have reported 85% better sleep in the first weeks and 75% continue to use Somnox on a nightly basis two months post-purchase.

“Sleep is more than a pillar of good health, it is the foundation on which the bastions of exercise and diet are built,” said Julian Jagtenberg, CEO and co-founder, Somnox. “Compromising the bedrock of sleep lessens the efficacy of an otherwise healthy diet and lifestyle. Somnox aims to tackle the root-cause of sleep issues: feelings of stress and anxiety. The breathing guidance of Somnox helps people experience the profound power of breathwork and the benefits of quality sleep and overall calm. Sleep is a complex activity, so it's not surprising that external aids like the thousands of pillows and weighted blankets on the market haven't done much to reverse the growing sleep epidemic. We set out to create a safe, comfortable, and science-backed sleep aid that improves sleep through the power of breath and its impact on the autonomic nervous system. Somnox is proven to help people fall asleep faster by reducing feelings of stress and anxiety while also improving mood and energy levels the next day.”

When stressed, our sympathetic nervous system (the one responsible for the “fight or flight” response) becomes overactive. This causes blood pressure and heart rate to increase, which makes relaxing and sleeping more difficult. By breathing slower, the parasympathetic nervous system (which is responsible for our body’s unconscious actions) becomes activated. Blood pressure lowers, heart rate slows, and muscles relax. Somnox's breathing and sleep technique guides users to breathe slower, which has been scientifically proven to activate the body's natural relaxation response.

“Somnox understands that good sleep is all about feeling relaxed, safe and secure,” said Roy Raymann, PhD, sleep scientist, and SleepCzar founder. “The Somnox sleep companion has implemented state of the art science on the effects of breathing and sleep, inventing an intelligent product with exceptional tech to help users feel at ease and smoothly transition into sleep. Ultimately, a good night's sleep is the most effective form of preventative health care and Somnox can effectively empower optimal rest and recovery.”

Quality sleep improves nearly all aspects of life including immunity, performance, and mental health. Current sleep solutions are limited or consist of trackers that simply measure various biometrics without offering any advice on how to improve sleep. Somnox believes it is time to learn what truly works for everyone’s unique physiology and psychology, leveraging personalized biometrics. Somnox helps users sleep better by working effortlessly in the background, physically guiding the breath.

The Somnox sleep companion is made in the Netherlands, retails for $599 USD, and is now available for purchase at somnox.com/usa with free shipping, a 30-night trial with money-back guarantee, and financing options from as low as $55/month via Affirm. For more information, please visit somnox.com.

About Somnox

Somnox is on a mission to help 100 million worldwide achieve better sleep by 2030. Their patented technology provides users with a science-backed sleep companion to relieve feelings of stress and anxiety, resulting in deeper, more restful sleep. Somnox is known for inventing the world’s first technology that leverages biofeedback and breathwork to accelerate the process of falling asleep. CEO and co-founder Julian Jagtenberg conceptualized Somnox while researching sleep as a robotics engineer at the University of Technology Delft in the Netherlands. Somnox has received much acclaim for its innovative design, including the Red Dot Design award and the iF Design award. For additional information, please visit somnox.com.

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Imagine if the one thing you cannot think about is the exact thing that your life, literally, depended on. That's precisely the relationship that veteran freediver Fred Buyle has with time and breath during his decade-long pursuit of underwater world records.

Born in Belgium, Buyle began diving at the age of four- for him, being underwater is as natural as breathing. But not breathing was what he had to refine and perfect when he immersed himself in the sport professionally at the age of 20. "That's when I decided to do competition and set records." 

Fred Buyle wears new Ulysse Nardin Hammerhead Shark diver watch. Photo: Ulysse Nardin

Fred Buyle wears new Ulysse Nardin Hammerhead Shark diver watch. Photo: Ulysse Nardin

And that's exactly what he did. Aside from three world records in the variable-weight and the constant-weight freediving categories, Buyle became the eighth person to reach 100-metres underwater in a single breath in 1999.

Though he's been freediving from a young age, pivoting to a professional level was not without its physical and mental challenges. "Like any other athlete, it requires a lot of practice. I was training; a lot of running, time at the gym, six hours a day."

Conditioning the mind to stay calm and focused is a significant contributor to underwater success. For Buyle, there are two folds to the process that, over time, allow a freediver to thrive in the deep abyss. "First, you dive into yourself; you make yourself calm and relaxed. And then you need to understand the environment." 

Buyle likens the experience to entering a meditative state. "You have to be inside yourself to understand your body. But you also have to totally open yourself up to the surroundings- you have to be able to get inside and outside to understand both sides." 

Fred Buyle. Photo: Ulysse Nardin

Fred Buyle. Photo: Ulysse Nardin

Some of the mental tools he uses to get into the zone include visualising the dives themselves. "It's one of the things you do during training– doing the dive again and again in your head, so it's like you've done it already."

Visualising the experience is just one aspect. A freediver’s success depends on their ability not to breathe for as long as possible while disconnecting from time. "Time is a very special concept when we hold our breath. We cannot think about time; when you start to think about time, you won't be good. 

As much as it was crucial to not think about time, precision is a matter of life and death for freedivers. "To know the time passing is important, and I also need to know the relapse time between two dives."

Buyle, an ambassador of Swiss watch brand Ulysse Nardin, relies on another visualisation technique that's helped him thrive since childhood to deal with this. "I've always had mechanical watches with hands to help visualise time. In my mind, I'm able to see the time passing; to see the hands of a mechanical watch helps me understand how long I've been in the water."

The sport pushes both an athlete's physical and mental limits, but Buyle says it's never about making big leaps. "You don't have the feeling of pushing the limit that much because you do things step by step. And you only take the next step when you're totally ready. You don't drive down to 200 metres in one day.," he says. "I never felt I was pushing my limit because I knew it was always within reach."

Fred Buyle. Photo: Ulysse Nardin

Fred Buyle. Photo: Ulysse Nardin

While Buyle spent the bulk of his efforts refining his physical and mental fitness, other aspects of freediving came much more naturally to him. "When you freedive, you can approach the animals more easily than if you were scuba diving where there are lots of bubbles and noises that keep the animals away.”

Raised in a family of professional photographers, Buyle began bringing a camera on dives in 2002 to capture other divers and the underwater world. Towards the end of his professional career, magazines started picking up his photos, and he made the natural transition into a new career. 

Though his 'office' remained much the same, his work became vastly different, and it took some getting used to. "It was difficult to go from a life where you train six to eight hours a day to not having to train at all." 

The medication and visualisation techniques that helped him reach his peak continue to be valuable today. It's so ingrained that he can get immediately into the right headspace with little mental prep work when he dives. 

At 50 and living in the Portuguese archipelago Azores, there are plenty of opportunities for interaction with the ocean. He’s been working with marine biologists since 2005 to tag and track sea life like sharks and whales. 

Fred Buyle. Photo: Ulysse Nardin

Fred Buyle. Photo: Ulysse Nardin

The work has allowed him to interact with wildlife in ways that few humans have ever experienced, like witnessing a birth together with a pod of 30 sperm whales off the coast of Portugal eight years ago. 

“The mother brought the baby to the surface and then showed it to the pod. The mothers are very productive; but she pushed the newborn towards me,” It remains one of his most rewarding experiences. It is experiences like this that inspire him to take part in conservation efforts and research. He works with Azores University to track sharks using non-invasive pop-up satellite tags, a project supported by a grant from Ulysse Nardin.

Along the way, he’s captured some stunning underwater images. He witnessed first-hand how a pause in tourism and fishing during Covid has allowed reefs to thrive again and hopes that the glimpses of the underwater world he shares with the world will be the beginning of more aggressive conservation efforts. 

Also see: Adriana Brownlee slated to be youngest woman to summit Annapurna, the 21-year-old chats with Annabelle Bond at basecamp



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The typical symptoms of this disease are usually chronic or intermittent and involve the bronchi, with a sudden narrowing of the airways (bronchospasm) and excessive mucous production.

The two phenomena, singly or together, make breathing difficult, create an air ‘hunger’ (dyspnoea), cause wheezing, with a typical whistling or wheezing sound, and often lead to coughing fits that make breathing even worse.

Its symptoms vary greatly from person to person.

Asthma is a chronic disease that cannot be cured, but is fairly effectively controlled in both children and adults.

What is allergic asthma?

It is a disease of the respiratory system caused by allergens that cause inflammation of the bronchial tree.

The basic mechanisms of this disease are not yet fully understood, but are attributed to a reaction of the immune system caused by inhaling allergens, particles dispersed in the environment to which the body is sensitive: pollen, dust, mites, pet dander.

The effects of this sensitivity affect the bronchi, structures of the respiratory system that are indispensable for the passage of air into the lungs.

In this type of asthma, the bronchi become inflamed, making breathing difficult.

What are the causes of allergic asthma?

Asthma is triggered by allergens, usually protein substances present in certain particularly volatile and easy to inhale agents such as pollen, dust, pet dander, but also mites and other insects.

Most people do not complain of any problems in the presence of these factors in the environment in which they live and breathe, while others, asthmatic subjects, probably due to a genetic and hereditary predisposition, suffer an abnormal and excessive reaction of the immune system.

A chain of factors eventually produces the inflammation of the bronchi and the alteration of their normal function.

What are the symptoms of allergic asthma?

Asthma symptoms vary from person to person.

They can be mild or more severe.

They can occur continuously (chronic), acutely or intermittently and temporarily, even a long time from one crisis to the next.

Generally, the symptoms of the disease are

  • coughing fits, often violent and generally dry;
  • shortness of breath or laboured breathing (dyspnoea);
  • a weight on the chest;
  • wheezing, characterised by whistling and moaning;
  • sleep disturbances;
  • difficulty performing everyday actions, such as climbing stairs or walking, and all strenuous physical activities.

How to prevent allergic asthma?

Prevention is an essential weapon in the control of allergic asthma.

It consists of taking all possible precautions to avoid contact with allergens known to sensitise the asthmatic’s bronchi and mucosa.

Frequent cleaning of home and work environments should be observed, paying attention to objects such as armchairs, sofas, carpets, pillows, beds and linen, and air conditioners.

Optimal humidity should be maintained in the living environment, avoiding climates that are too dry or too humid.

Outdoors, it is useful to cover your mouth and nose with a scarf if it is cold or a mask if it is hot or the place is particularly polluted.

Absolutely avoid smoking, eat a balanced diet, and do not gain excess weight.

Diagnosis of allergic asthma

The diagnosis of allergic asthma is obtained by the following standard examinations:

  • Allergy skin test (Prick test);
  • Rast test, a serological test for IgE immunoglobulins responsible for the allergic reaction;
  • Respiratory function test, to measure lung capacity;
  • Spirometry, to measure the amount of air entering the lungs;

Allergic asthma can also be diagnosed through more specific tests such as:

  • Bronchial provocation test, to measure the nitric oxide present in the emitted (exhaled) air, which indicates the level of inflammation;
  • Diagnostic imaging, X-rays and CT (computed tomography) scans that can highlight any abnormalities of the lungs and airways in general;
  • Bronchial provocation test with methacholine;
  • Peak expiratory flow measurement;
  • Carbon monoxide diffusion test;
  • Sputum examination;
  • Arterial haemogas analysis.

Treatments

The treatment of asthma depends very much on the severity of the symptoms, age, duration of the disease and the presence of other diseases.

The first treatment consists of avoiding, whenever possible, the allergen(s) responsible for the pathology.

In the event of a crisis, but not only, allergic asthma is treated with bronchodilators and corticosteroids, nebulised through inhalation dispensers.

The same drugs, if used correctly and continuously, effectively control the symptoms.

Antileukotrienes are a class of drugs for oral use that can help rapidly relieve asthma symptoms, but unlike other molecules have more side effects.

Desensitising therapy or specific immunotherapy with allergenic extracts is a treatment that gradually trains the immune response typical of an allergic reaction, reducing the number and intensity of acute episodes.

It has a long duration.

Read Also:

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Adverse Drug Reactions: What They Are And How To Manage Adverse Effects

First Aid: 6 Must-Have Items In Your Medicine Cabinet

Allergies: Antihistamines And Cortisone, How To Use Them Properly

Asthma, The Disease That Takes Your Breath Away

Asthma: From Symptoms To Diagnostic Tests

Severe Asthma: Drug Proves Effective In Children Who Do Not Respond To Treatment

Asthma: Tests For Diagnosis And Treatment

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Humanitas



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With considerable increase in hypertension or high blood pressure among a number of people across the globe, May 17 is observed as the ‘World Hypertension Day’ to spread awareness. Around 46 per cent people in the world are suffering from hypertension which is really alarming.

What is hypertension?

Hypertension occurs when the blood pressure abnormally surges to undesirable levels. It is an increased force exerted by blood against the artery walls. While normal blood pressure is 120/80 mm Hg, high blood pressure is defined as a level greater than 130/80 mm Hg or 140/90 mm Hg as per the guidelines. 

Silent killer

Hypertension is also called ‘the silent killer’ as there are no noticeable signs of it most of the time.  There is a significant risk of brain damage, heart, kidneys, and blood vessels ailments due to hypertension. Ignoring it for a long period of time could be fatal as it leads to stroke, heart attack and kidney failure. High blood pressure should be diagnosed early and treated appropriately.

Accurate measurement

As per a survey, one in every three Indian adults above the age of 60 is being affected by high blood pressure. It is pretty vital to regularly monitor blood pressure and undergo treatment to evade the risk of serious ailments. Monitoring blood pressure is important, but measuring it in an accurate way is also crucial. Accurate measurement of high blood pressure in people gives a clear picture of the cardiovascular risk. This is also very helpful for the people with borderline blood pressure who need proper diagnosis and treatment with right kind of medication. A small error in the measurement of blood pressure has the danger to mislabel someone as having high blood pressure and hence resulting in unnecessary medication.  

Warning symptoms 

Headaches: If someone is suffering from severe headache too often, it could be a symptom of high blood pressure.

Nose bleeding: If someone’s nose is bleeding, it could be a sign of high blood pressure.

Shortness of breath: Difficulty in breathing and shortness of breath is also an indication of high blood pressure.

Irregular heartbeat: Hypertension patients are often found with irregular heartbeats due to uncontrolled pressure in which blood exerts force against walls of the artery.

Chest pain: Hypertension patients often suffer from chest pain due to shortness of breath.

Accurate measurement

When you are measuring your blood pressure, the correct sized blood pressure cuff needs to be put on the bare arm. An empty bladder is advisable as a full bladder can increase readings. One should avoid talking while measuring blood pressure and the arm should be supported at the level of the heart. Consuming food, caffeine and alcohol should be avoided for 30 minutes before measuring. While monitoring blood pressure at home, minimum of three readings should be recorded and the average of the last two readings should be considered for the reading.

Lifestyle changes

There is probably no cure of hypertension. However, lifestyle changes matter a lot to keep it in check. Quality of life should be enhanced by eating a well-balanced diet and limit salt. Alcohol consumption and smoking should be totally avoided. One should do regular exercise to maintain a healthy weight and manage stress. Hypertension patients should take their medications properly and work together with their doctors to minimize the health risks.
 

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Stress is something that everyone deals with from time to time. Whether you’re stressed out at work or dealing with family issues, learning how to relax can be helpful. It has been proven that breathing exercises can relieve stress and anxiety levels and improve overall health. The key is to practice them regularly. Breathing exercises help us to cope with stressful situations and boost our self-confidence. They also improve concentration, memory retention, and even mood.

Rapid breathing can cause a quicker heart rate, dizziness, muscular tension, and other symptoms during a panic attack. These sensations may then add to increased anxiety. This thoracic (chest) breathing varies from diaphragmatic breathing, an abdominal rhythm that occurs when people are calm or asleep. Stress, especially among Americans is rising rapidly too.

This article explains how changing your breathing pattern consciously may help you regulate your stress and anxiety. 

Symptoms of a Panic Attack

The symptoms of panic attacks vary from individual to individual.  Among the most prevalent symptoms are:

  • Tension, nervousness, or dread
  • Oxygen deprivation, often known as quick breathing
  • Insomnia, or the inability to sleep
  • agitation or restlessness
  • trembling and/or sweating
  • Concerned about the past or the future

Top 10 ways to relieve stress with exercise

Inhale deeply. Now let it all out. You may have already noticed a difference in how you feel. Your breath is a wonderful tool for relieving tension and making you feel the least nervous. If you include these easy breathing exercises in your daily practice, they can make a significant impact and relieve stress and anxiety.

Before you begin, keep the following suggestions in mind:

  • Select a location for your breathing workout. It might be in your bed, on the floor of your living room, or in a comfy chair.
  • Don’t push it. This might exacerbate your tension.
  • Try to perform it once or twice a day at the same time.
  • Put on something comfy.

Diaphragmatic Breathing

The diaphragm is the dome-shaped muscle utilized in breathing that is placed directly beneath the lungs. This is one of the best ways to relieve stress and anxiety. Diaphragmatic breathing, also known as belly breathing or abdominal breathing, develops this muscle, and this deep breathing method fills the entire lungs with air.

Here is how it’s done:

  • Place one hand on the stomach and the other on the chest.
  • Inhale for 3-5 seconds via your nose, feeling your abdomen rise as you breathe in. The hand on the chest should not move.
  • Exhale through the nose for 3-5 seconds, feeling the belly return to its natural position.
  • Continue this breathing practice for 5 minutes every day.

Coherent Breathing

The purpose of coherent breathing is to limit the breathing cycle to only five breaths per minute. This breathing pattern lowers heart rate and blood pressure, soothing the nervous system.

  • Inhale via the nose, extending the belly to a count of five.
  • Exhale to a count of 6 without halting at the peak of the inhalation.
  • Repeat at least five times to complete a full minute cycle.
  • If you find it difficult to inhale or exhale for this long, begin with a 3-count and gradually work your way up.

Victory Breath 

In Sanskrit, victory breath is called Ujjayi Breath. It’s also known as ocean breath because the sound generated by closing the throat sounds like waves smashing on the coast.

  • Sit up straight, with your spine straight and your hands in your lap.
  • Inhalation through the nose to a count of four, somewhat limiting airflow to the back of the throat on the inhale. If you execute this correctly, you will hear a sound that sounds like waves or light snoring.
  • Pause for a second at the peak of the inhale before beginning the exhale.
  • Strive to keep your throat contracted and exhale gently to a count of six. Pause for a moment before inhaling again.

Straw Breath

This technique includes breathing through a straw to relieve anxiety and fear. If you don’t have a straw, you can pursue your lips on the exhale instead.

  • Make sure you have a straw on hand for the workout.
  • Inhale softly via the nose, filling the abdomen to a count of four.
  • Take a short pause at the peak of the inhalation to insert the straw into your mouth. Alternatively, you can pucker your lips as if you have a straw in your mouth.
  • Exhale slowly and softly through the straw until you reach a count of six.
  • Pause at the bottom of your exhalation and remove the straw.
  • Do this workout for 5 minutes every day.

Box Breathing

Box breathing, sometimes known as square breathing, is a basic breathing exercise that comprises inhaling, exhaling and holding one’s breath. This approach is used by the Navy Seals to relieve tension and anxiety during warfare.

  • Inhale deeply through your nose, extending your belly to a count of four.
  • Hold the breath for a count of four at the peak of the inhale.
  • Exhale via the nostrils for a count of four before releasing the breath.
  • Hold the breath until a count of four at the bottom of the exhale.
  • Repeat 5-10 times.

The Yogic Breath

The three-part breath, also known as yogic breath, is a great grounding method that occupies the full lungs. The belly, ribs, and upper chest are referred to as the three sections of the breath.

  • Sit up straight with your spine straight.
  • Begin by laying your palm on your tummy. Slowly inhale and exhale through your nose into your abdomen, feeling it rise and fall with the breath.
  • Place your palm on your ribcage and slowly inhale and exhale through your nose into the ribcage, noting how the ribs expand with air.
  • Finally, lay your palm on your upper chest and inhale and exhale gently through your nose into the chest cavity, feeling it rise and fall with the breath.
  • Breathe into each location independently until you feel comfortable with each approach.
  • Fill up the belly first, then the ribs, and lastly the chest on the following inhalation. At the apex of the inhale, pause for a second.
  • Reverse the flow on the exhale, releasing the air first from the upper chest, then the ribcage, and finally the belly.
  • Repeat this breathing exercise 5-10 times.

Conclusion:

These are just some of the many ways you can use yoga techniques to help you relax and relieve stress and anxiety. You may find other methods more effective than others, but these should be enough to get started. Check out how Katrina Kaif battled her anxiety during the lockdown.

If you want more such insightful health & lifestyle tips delivered straight to your inbox, subscribe to the monthly Clout Newsletter and never miss an update.

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World Hypertension Day 2022: Be Aware Of Warning Symptoms And Know How To Accurately Measure Blood Pressure

World Hypertension Day: Throbbing headaches could be a sign of high blood pressure

Hypertension or high blood pressure occurs when the blood pressure abnormally rises to undesirable levels. It is the increased force exerted by blood against the walls of the artery. Normal blood pressure is 120/80 mm Hg. High blood pressure is defined as a level greater than 130/80 mm Hg or 140/90 mm Hg according to various guidelines. As most of the time, there are no noticeable signs of hypertension, it is also called ‘the silent killer'. Thereby, raising a significant risk to damage the brain, heart, kidneys, and blood vessels. Ignoring blood pressure symptoms can prove to be fatal and lead to a stroke, heart attack including heart failure and kidney failure, if not diagnosed early and treated appropriately.

It is being estimated that one in every three Indian adults above the age of 60 is being affected by hypertension. This shows how vital it is to regularly monitor blood pressure to treat and evade the risk of serious illnesses. Although, monitoring blood pressure is important, but measuring it in a correct way is also crucial as accurate measurement in hypertensive people gives a clear picture of the cardiovascular risk. This is also very helpful to those who have borderline BP and are in need of a proper diagnosis and treatment with the right medication. A small error in BP measurements has the potential to mislabel someone as having high BP, resulting in unnecessary medication.   

This World Hypertension Day, take note of these warning symptoms that one should never ignore and  a few key tips to ensure accurate BP measurement.

Symptoms:

  • Headaches: Sometimes these could be triggered by lack of sleep. However, if you are suffering from a throbbing headache way too often, it could be a sign of high blood pressure.
  • Nosebleeds: If your nose bleeds not due to sinusitis, then it could be a sign that you your blood pressure is high and needs to get levels checked.
  • Shortness of breath: Difficulty in breathing and shortness of breath is also an indication for hypertension.
  • Irregular heartbeat: Arrhythmia or irregular heartbeats can also occur in hypertension patients. This happens due to uncontrolled pressure at which blood exerts force against artery walls.
  • Chest pain: Due to shortness of breath in hypertension patients, in extreme cases, it could also lead to chest pain.

Tips for accurate BP measurement:

  • The correct sized BP cuff needs to be put on the bare arm
  • Having an empty bladder is advisable, a full bladder can increase BP readings
  • Patients should sit still with back support and feet on the floor 
  • Avoid talking while measuring BP readings
  • The arm should be supported at the level of the heart 
  • Avoid consuming food, caffeine, alcohol 30 minutes before measuring 
  • If monitoring blood pressure at home, minimum of three readings to be recorded and the average of the last two readings can be considered for the reading

While there is no cure, make lifestyle changes that matter. Enhance quality of life by eating a well-balanced diet, limit salt and alcohol consumption, regular exercise to maintain a healthy weight, manage stress, quit smoking, take your medications properly, and work together with your doctor. These protocols can go a long way and reduce health risks.

(Dr. Sunil Wani, Consultant, Cardiology at Kokilaben Dhirubhai Ambani Hospital, Mumbai)

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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PEOPLE living in Scotland's most deprived neighbourhoods account for one in three emergency hospitals due to asthma, according to new research.

Factors such as air pollution, exposure to tobacco smoke, and breathing difficulties exacerbated by mould or damp in poor quality housing have been blamed, although analysis by charity Asthma & Lung UK Scotland found that patients on lower incomes were also less likely to be receiving adequate health checks.

The charity compared the incidence of life-threatening asthma attacks based on patients' deprivation status.

It found that people living in the poorest fifth of postcodes had made up almost 33 per cent of asthma-related emergency hospital admissions over the past five years, compared to 11.6% of patients in the most affluent areas.

READ MORE: Women in Scotland nearly twice as likely to die of asthma attacks as men

The charity also found that only 25% of patients in Scotland are receiving basic asthma care, compared to 30% for the UK as a whole.

It is the first time since it began collecting this data in 2013 that the figure for Scotland has been worse than the UK average.

In 2017, the figure for Scotland was 43% but it has been declining since then.

The basic health checks for asthma patients are supposed to include an annual asthma review, an inhaler technique check, and a written asthma plan.

Asthma & Lung UK Scotland said the findings were "especially concerning" when it is known that more than 60% of asthma deaths could be prevented with better routine care.

The charity also found that, for lower income groups, the quality of the asthma reviews they received was poorer.

For example, patients were less likely to have been asked about their symptoms or have their inhaler usage assessed, and their adherence to their preventer inhaler – essential to stop symptoms occurring - was not discussed as often.

Research has previously established clear links between poverty and common asthma triggers, including higher exposure to air pollution, tobacco smoke, domestic damp and mould, and potentially hazardous working environments in more deprived areas.

READ MORE: First person to test asthma inhaler drug was a young Scot - and he nearly died 

The charity is calling for urgent action to tackle health inequalities for asthma sufferers amid fears that the gulf will be made even worse as Scots begin to feel the squeeze of the cost of living crisis.

Joseph Carter, head of Asthma and Lung UK Scotland, said: “It is shocking that people with asthma in Scotland are fighting for breath, having life-threatening asthma attacks and repeated trips to hospital because of where they live.

"Everyone should be entitled to basic asthma care such as a yearly check-up and help using their inhaler so they can manage their condition.

“These statistics highlight the need to make lung health a priority in plans to tackle health inequalities, given its significant role in fuelling poor health outcomes in Scotland. In particular, we need a focus on prevention, including plans to driving down smoking rates and reducing air pollution and targeted awareness campaigns for the communities that need it most."

The findings will be discussed with MSPs at the Scottish Parliament today when Asthma and Lung UK Scotland hosts an event led by Mr Carter and the charity's UK chief executive, Sarah Woolnough, along with guests clinician, Dr Tom Fardon and asthma patient, Linda McLeod.

READ MORE: Two new Covid strains upgraded to 'variants of concern' amid warning they could drive 'significant' spike in cases

Mr Carter added: "Lung conditions need to be taken as seriously as other major illnesses such as cancer and heart disease.

“With Scotland lagging behind other UK nations for the first time in delivering basic asthma care, we also need to see radical improvements in the way health services diagnose, treat and help people manage asthma.

"This starts with health services doing much more to ensure everyone with suspected asthma gets a timely and accurate diagnosis, and access to basic asthma care once they are diagnosed.”



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According to WHO, the number of people living with hypertension has doubled since 1990s and currently stands at 1.28 billion

World Hypertension Day: Some yoga asanas to lower blood pressure

Representational Image. Shutterstock

Hypertension or elevated blood pressure is a serious medical condition that increases the risks of heart, brain, and other diseases. Hypertension is often called a silent killer, one that usually doesn't have many symptoms but can have the most impact on an individual's health.

To raise awareness about Hypertension and how deadly this disease is, 17 May is marked as World Hypertension Day. The day aims to not only spread awareness about the disease but also ways to keep your blood pressure levels in check and ways to treat it. The annual event was created by World Hypertension League.

According to the World Health Organization (WHO), the number of people living with hypertension has doubled since the 1990s and currently stands at 1.28 billion. Given that the number is alarming, it is imperative to note that while there are no noticeable signs of hypertension, many people try to brush away whatever symptoms they have under the garb of work pressure or stress.

Early detection and treatment of hypertension can save you from succumbing to heart diseases. Exercising and working out is the best way to keep your blood pressure levels in control.

As the world observes Hypertension Day today, here are some yoga asanas which you can try to lower blood pressure:

Balasana or child's pose: Keep your legs wider than hip-distance and place your hips your hips towards your heels, bringing your arms forward and chest resting on the mat. The pose helps with movement and provides openness and length, thereby, helping with high blood pressure.

Paschimottanasana or seated forward bend pose: Practice this pose by sitting straight on a mat with your feet spread out in front of you. Press your heels away from your body and inhale. With every exhale, bend forward from your hips, keeping your torso and spine long.

Bhujangasana or cobra pose: This pose helps circulate blood and oxygen. It also helps in relieving stress and promoting the health of your heart. To perform Bhujangasana, lie down on your stomach with your toes flat on the floor. Keep your palms touching the ground and place them under your shoulder. Take a deep breath in and slowly lift your head, chest, and abdomen.

Setu Bandha Sarvangasana or bridge pose: This yoga pose helps in regulating blood pressure. Lay flat on the floor with your knees bent, and keep your legs and feet parallel and hip distance apart. Move your feet closer to your hips and raise your hips while inhaling, lifting your pelvic bone.

Sukhasana or easy pose: To practice Sukhasana, you can sit in any seated comfortable position. This asana helps in regulating breathing and provides relief from high blood pressure, as it reduces stress and promotes a peaceful mind.

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High blood pressure or hypertension is a 'silent killer' that is preventable yet a leading cause of death worldwide. High blood pressure can cause cardiovascular diseases like a heart attack, panic attack or a stroke, if left untreated. World Hypertension Day is observed on May 17 to raise public awareness about hypertension and ways to prevent it.

Most often, there are no noticeable signs of hypertension, and even if you have some symptoms, you may not immediately act upon it. However, ignoring high BP can be deadly and lead to a heart attack, heart failure, aneurysm, stroke, memory problems or dementia. Therefore, monitoring blood pressure regularly and seeking medical help upon encountering symptoms is the key to evade risk of serious illnesses.

Here are the seven signs of high blood pressure/hypertension that you should not ignore:

Chest pain of any kind should be taken seriously and never be dismissed as heartburn or indigestion. Pain in the chest can be an indication of many different serious medical conditions, including high blood pressure. If you experience chest pain, seek medical help and get yourself evaluated by a doctor.

Nosebleeds may occur due to sinusitis or blowing the nose constantly. However, they can also occur when one’s blood pressure is high. If you encounter nosebleeds frequently, then you should report it to the doctor.

High blood pressure can affect the blood vessels in the eyes. Therefore, it can cause a sudden change in vision, blurriness, blindness, loss of vision in one eye and changes in part of your field of vision. If this happens to you, immediately seek medical attention. If high blood pressure is the cause, then doctors will treat you with medicine to reduce your blood pressure and protect your vision.

Acute feeling of exhaustion and fatigue might be related to high blood pressure. If you are encountering such a feeling, then consult your regular doctor for further evaluation.

Shortness of breath and dizziness

High blood pressure can also cause difficulty in breathing and dizziness. This is one of the common symptoms of hypertension and one should immediately seek medical attention.

Throbbing headaches, especially in the back side of the head, is an indication that your blood pressure may be high. If you frequently experience severe headaches at the back of your head, then immediately get your BP checked.

High blood pressure can cause nausea and even sudden vomiting. If you experience this without an obvious cause for vomiting, then seek medical attention. Sudden vomiting in any case would require medical attention even if you don’t suspect high blood pressure to be a cause.

A key part of healthy living is communicating your health concerns to your doctor or healthcare provider. Therefore, you should not self-evaluate, instead seek immediate attention for the test and treatment if required.

(Edited by : Shoma Bhattacharjee)

First Published:  IST

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The healthcare vertical is expected to accelerate based on IoMT (Internet of Medical Technology). The key players in IoMT help in designing and tuning to sophisticated custom software. Also, iTunes or Google Play catalogs have encompassed healthcare and wellness mobile apps. With synchronization with wearables like fitness trackers or pulsometers for using data collected via sensors placed on body for reporting/analysing health conditions, the Oxygen Therapy Market is there to take the healthcare vertical by storm in the next 10 years.

Oxygen therapy is administered by use of oxygen gas as a medical intervention given acute or chronic patient care as it is essential for various cell metabolism whereas tissue oxygenation is essential for normal physiological function. Oxygen therapy is administered when the oxygen levels in blood is low.  It can be administered in various ways from nasal to hyperbaric oxygen in a closed chamber.To understand how oxygen therapy is implemented in use, we need to understand the respiratory system. The respiratory system is a group of organs and tissues that help in breathing. The lungs and the nasal tract along with the wind pipe together form the respiratory system.

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The air enters the body through nose or mouth through the wind pipe to the lungs via bronchi. The bronchi branches out into several tubes called bronchioles, which further branch out into tiny air sacs known as alveoli. These tiny air sacs are covered with a mesh of blood vessels called capillaries, which are connected to several arteries and veins which transfer oxygen throughout the body.

Certain acute or chronic disease conditions, which affect the transfer of oxygen from alveoli to the blood, such a pneumonia, cystic fibrosis, asthma, dysplasia, heart failure, sleep apnea, lung disorders, and COPD (chronic obstructive pulmonary disease). Oxygen therapy is administered on the basis of arterial blood gas test and a pulse oximetry test.

According to the World Health Organization (WHO), total deaths due to COPD is expected to rise approximately by 30% in the next decade, thereby driving the need to incorporate oxygen therapy as a treatment option. However it is estimated that COPD will be the third most fatal disease worldwide by 2024, thereby widening the consumer base for oxygen therapy market.

The growing demand for technologically advanced system, such as portable oxygen concentrator system has also boosted global oxygen therapy market growth. Some of the major advancements include pulse oximetry devices, and nasopharyngeal oxygen therapy.

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The global Oxygen Therapy market is segmented on basis of product type, disease, administration device, end user, and geography:

by Product type
  • Compressed oxygen
  • Liquid Oxygen
  • Oxygen Concentrates
by device
  • Hyperbaric oxygen chamber
  • Nasal Cannula
  • Face mask
  • Trans-tracheal therapy
by basis of disease
  • Respiratory Disorder:
    • Asthma
    • Dysplasia-Pacific
    • Cystic Fibrosis
    • COPD (Chronic Obstructive Pulmonary Disease)
  • Cardiovascular Disease
  • Pneumonia
  • Sleep Apnea
  • Others
by end User
  • Hospitals
  • Clinics
  • Rehab Centers
  • Home Healthcare

Major benefits of oxygen therapy are decreasing shortness of breath and fatigue, it helps people with sleep disorders and increases the lifespan of individuals with COPD. Depending on the need, oxygen therapy devices can purchased through insurance companies.

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On the basis of regional presence, global oxygen therapy market is segmented into five key regions viz.  North America, Latin America, Europe, Asia-Pacific-Pacific, and Middle East & Africa. North America is expected to lead the global Oxygen Therapy testing market due to high prevalence of respiratory related diseases, increase in number of product approval, increase in aging population, increase in vulnerability to respiratory conditions, innovation in portable oxygen concentrators, rise in number of untreated sleep apnea cases, growing demand for oxygen filling devices and high RnD investment are driving the growth of oxygen therapy market in the region.

European market is also closely competing in terms of revenue generation because of favorable government initiatives taken for respiratory care.

The oxygen therapy market in Asia-Pacific Pacific region is expected to witness a rise in growth opportunities due to an increase in geriatric population requiring home-based oxygen therapy, and rising healthcare expenditure.  The other major restraining factor for growth of oxygen therapy market have been strict regulatory approval policies and complicated reimbursement process.

Some key players involved in oxygen therapy market are Care Fusion Corp., GE Healthcare, Hersill, Philips Respironics, Inc., De-Vilbiss Healthcare, MAQUET Medical Systems, Smiths Medical, Allied Healthcare Products, Fisher & Paykel Healthcare Limited, Teleflex Incorporated, and Invacare Corporation.

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Stress is an integral part of life these days. While it is good in moderate amounts, it becomes very costly when it becomes chronic and omnipresent. Chronic stress leads to burnout, depression, and fatigue. It also manifests as many health ailments related to metabolism and stress hormones like Type II Diabetes, PCOS/PCOD, Heart issues, etc. That is why it has become almost urgent that we regularly make time for stress recovery and relaxation to improve our quality of life and longevity.

One of the best ways to recover from the physical and mental stresses of the workplace is Yoga. It offers a holistic solution that includes postures, breathwork, and meditation. All three combined help you achieve a complete mind-body. Namita Piparaiya, Yoga and Ayurveda lifestyle specialist, suggests ways Yoga and medication can help in recovering from stress.

1. Postures / Asana

Regular practice of Yoga asana helps release tension and stiffness from the body while also helping you calm down the mind. In addition, you can derive significant benefits from simple yoga stretches that can be done while at work. The most important ones are the shoulders and hip flexors. Stretching these two areas during the workday is excellent for posture and energy levels.

2. Breathwork / Pranayama

This is even more accessible and powerful than postures. As anyone can do this while sitting at their desk. Breath is one of the most powerful tools to directly influence our state of mind. Yogic breathing practices are beneficial for anxiety and anger management. Even 5-10 breaths can have a profound influence on mood. Equal Breathing and Box Breathing are two techniques that executives must learn and practice regularly.

3. Meditation / Dhyana

Last but not least is a meditation practice that is also the most powerful form of Yoga. Asana works on the body, Pranayama on the breath, and Meditation on the mind. It helps us improve our cognitive skills, focus, concentration, and creativity and can even help us change old habits and behaviour patterns. So, if you're looking for true transformation and improved performance, you must incorporate Meditation into your routine. Even if you don't enjoy Meditation, you can do guided practices like NSDR, Yoga Nidra, or Body Scans.

Yoga is a very carefully crafted ancient system that starts with the body, progresses to the breath, and finally to the mind. The best part is that you don't need to learn complicated things to get all the benefits of this practice. You simply need to be consistent with what you like and enjoy. Even if of short duration or mild in nature, the regular practice has a great capacity for transformation and stress management. It empowers you to take charge of your mental and physical health and gives you the necessary tools to navigate our highly stressful modern lives.

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This week marks the start of the first formal examinations since the pandemic began, with pupils across Northern Ireland sitting their A-level AS-levels and GCSEs.

or the last two years, exams were replaced by grades calculated by individual schools, but now the likes of English, maths, geography, history and Irish are among the subjects being sat this summer.

The Council for the Curriculum, Examinations and Assessment has said papers will be graded more generously than in pre-pandemic years, but it will be the first time many pupils have sat formal examinations. Mental health charity Extern has provided the Belfast Telegraph with tips on how to cope with any stress that students may be feeling.

Here are some of the signs to look out for:

• Feeling overwhelmed

• Trouble sleeping

• Feeling confused

• Losing touch with friends

• Having trouble making decisions

• Upset stomach or feeling sick

• Fidgeting, nail biting, teeth grinding

Extern said: “Sometimes we need to take a minute to just breathe. Find somewhere comfortable to sit or lie down and close your eyes. Take a minute to focus on your breathing - is it fast or slow?

“Regulate your breathing to a comfortable pace, allowing any thoughts or feelings to come and go. Just relax and breathe, you may feel it helps. Try to do this every day, for as long as you need to. Good exam preparation is key to helping you to reduce your exam-related stress”.

Here are some tips from Extern when you are studying for your exams:

• Find a quiet place to study

• Organise your space so it is not cluttered and is without distractions.

• Find out as much as you can about your exam so you can prepare.

• Ask your teacher if you’re unsure what course content to focus on.

• Make a ‘mind map’, using bright colours and images. There are many different learning techniques, so finding which works for you will really help.

• Make a plan for your study sessions, set a time with short breaks included to get fresh air.

• Divide your session into blocks. Focus on one block at a time.

• Ask for help if you need it. That includes if you’re feeling stressed, as sometimes talking to a teacher, friend or someone you trust can be reassuring.

• Eat well, prepare yourself nice evening meals and try not to skip breakfast.

When exam day finally arrives, pupils may still feel stressed about what they’re ready to face. Here is a useful checklist to help you cope:

• What do you need to bring with you? Organise this the night before.

• Eat breakfast, this will help your energy and concentration.

• Go to the toilet before the exam starts.

• When you sit down before you begin your exam, take a long deep breath. You’ve got this!

• When you receive your exam paper, read through it carefully. Underline or highlight any key information.

• Work out how much time you can spend on each section.

• Work on the questions that you find easiest first.

• When you have completed all the questions, take a minute to go back and re-read your answers, starting with the most difficult questions first.

• Don’t overthink your answers once you have left the exam hall – turn your thoughts to something else.

• Don’t be afraid or embarrassed to reach out to others for help and support, whether that’s friends, family or flatmates.

• Most schools and colleges have dedicated counselling supports in place for students. Ask about these at your place of learning.

Further resources and help are available by visiting www.extern.org.

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Around 5.4 million Brits are affected by asthma and experts have now highlighted some of the more “unusual” symptoms that may not initially appear to be a sign of the condition

Older woman having asthma attack due to her allergies
Experts have highlighted some of the more unusual symptoms of asthma

Asthma is a common lung condition that affects the airways causing occasional breathing problems, and impacts around 5.4 million Britons in the UK. While many are aware of the main symptoms of asthma, which typically include wheezing and shortness of breath, some go under the radar.

The WebMB experts revealed: “Not everyone with asthma has the usual symptoms of cough, wheezing, and shortness of breath. Sometimes individuals have unusual asthma symptoms that may not appear to be related to asthma.”

Anxiety and sleeping difficulties are listed as some of the most unusual asthma symptoms to look out for.

Unusual symptoms of asthma to look out for

Experts have highlighted some of the most “unusual” symptoms of the condition to look out for, these include:

  • Rapid breathing
  • Sighing
  • Fatigue
  • Inability to exercise property (called exercise-induced asthma)
  • Difficulty sleeping or nighttime asthma
  • Anxiety
  • Chronic coughing without wheezing

It is important to note that these symptoms are not always the result of asthma.

WebMD explained: "Asthma symptoms can be mimicked by other conditions such as bronchitis, vocal cord dysfunction, and even heart failure."

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Fatigue has been recognised as an “unusual” symptoms of asthma
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Common symptoms of asthma

If you are concerned you may have a lesser-known symptom of asthma, you should also check whether you are experiencing any common symptoms of the condition.

According to the NHS : "The most common symptoms of asthma are wheezing (a whistling sound when breathing), breathlessness, a tight chest – it may feel like a band is tightening around it and coughing."

These symptoms are more likely to be asthma if they worsen at night or early in the morning, or happen frequently and recurrently.

Asthma can also be triggered by exercise and allergies.

An asthma attack occurs when the condition gets worse for a short period of time, this can include wheezing and coughing, being too breathless to eat, speak or sleep, or breathing faster.

In severe cases, a person may experience a rapid heartbeat, drowsiness, confusion, exhaustion or dizziness and blue lips or fingers.

What to do if you think you have asthma

The best thing to do if you are concerned that you or your child has asthma is to visit your GP.

Your GP will likely ask a series of questions, including notes on any family history or allergies.

They may suggest doing some tests to confirm whether or not you have asthma.

According to the NHS: "A GP will probably be able to diagnose it, but they may refer you to a specialist if they're not sure."

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It’s probable that you’ve looked for and found at least some tricks to help you fall asleep in record time. But it never hurts to add more tools to your sleep-habits arsenal. After all, when we’re not getting enough sleep, we put ourselves at risk for life and real-deal health concerns, like disrupted concentration and a weakened immune system. To avoid those sleep deprivation effects, three sleep experts say it's a good idea to become familiar with and practice the lengthened breath technique, which is essentially inhaling through your nose for a few seconds and then exhaling through your mouth for twice as long. Practicing it, they say, can help you drift off to sleep effortlessly by facilitating a state of calm.

In general, breathing techniques support quality sleep because they slow down your breath, which increases comfort and relaxation while reducing stress and anxiety, says Martin Seeley, CEO and sleep expert at Mattress Next Day, a UK-based bed, mattress, and sleep-accessories retailer. When you’re intentional about calming your stressors or anxiety triggers by using the lengthened breath technique, your mind might just quiet down enough to get good-quality shut-eye.

Additionally, Raj Dasgupta, MD, FAASM, sleep expert and spokesperson for the American Academy of Sleep Medicine, says that breathing in deeply and calmly through the nose and out through the mouth signals to your parasympathetic system, which helps you calm down, that "it’s time to transition into sleep."

When you don't pay attention to your breath, it can become shorter and faster, which increases heart rate—and that’s not exactly ideal for falling asleep.

According to Rebecca Robbins, PhD, sleep expert at sleep-tech company Oura, there’s also something to be said about what happens when you're not fully aware of how you're breathing. “Our breaths can become short and fast, which increases our heart rate and creates an unideal state of mind before bed,” she says.

How to practice the lengthened breath technique to fall asleep in minutes

Start by relaxing into a comfortable position, says Seeley. From there, he suggests breathing in for two seconds through your nose, then breathing out for four seconds through your mouth. To get the best results, you’ll want to repeat this for a couple of minutes.

Once you’ve noticed that you’re calmer than you were before you laid down, increase the length of your inhales to three seconds (still through your nose) and exhales for six seconds (still through your mouth), Seeley says. Continue doing this for a few minutes, ensuring that your exhales are twice as long as your inhales, even if you extend the length of your inhales further. So, if you’re inhaling for four seconds, you’d exhale for eight. If it’s a five-second inhale, you’d have a 10-second exhale.

That said, do “be mindful of your own abilities,” Seeley says. “If you extend your exhalation further than your capacity allows, your body will go into survival mode,” which might undo the work that you’re trying to do. To avoid this, start off slow and gauge how long you can inhale and exhale.

The reason for the twice-as-long exhale is that practicing the lengthened-breath technique to help you fall asleep sooner is all about controlling your breathing. The benefits from this technique are at their peak when you’re intentionally breathing this way to calm yourself down.

Moreover, says Dr. Robbins, “adding the complexity of ‘in for two and out for four’ helps us to focus on the breathing and keeps our thoughts at bay.” So the next time you feel like you can’t get any sleep because of anxious thoughts or any other reason, try the lengthened-breath technique to see if it does the trick for you.

Looking for other ways to fall asleep faster? Watch this video to get an herbal tea recipe that'll help you snooze like a baby

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  • Getting enough sleep
  • It is well known that lack of sleep can make us feel moody and irritable, therefore inducing the state of anxiety. So, keeping a healthy and organized sleep schedule can do wonders for you.

    1. Working out

    Working out is also a very good way to chase away the unpleasant effects of anxiety. Physical exercise leads to the release of endorphins, which are known as feel-good chemicals, which flood your system and give you a sense wellbeing post-exercising.

    1. Journaling

    Although it might not work for everyone, putting your feelings on paper can have a therapeutic effect if you are battling with anxiety. After writing down your worries and concerns, you can also try writing a short list of things you are grateful for, which can help shift your perspective and make you focus more on the things worth appreciating in your life, giving you a pleasant feeling.

    1. Meditating

    You don’t have to go to an ashram or a retreat in order to make meditation your ally. Although it is perceived as a hip millennial concept, in reality, meditation can mean focusing on you breath and deep-breathing for a few minutes, or taking some time to just relax and let your mind wonder, really anything that can make you reach a state of mindfulness.

    These are just a few examples of what you can do to minimize the effects of anxiety. However, in the end, you need to sit down with yourself and find out exactly what works for you. Once you identify one or more methods which enable you to reclaim your calm, then you can start practicing them regularly, so you can fully benefit from the results.

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    There are several ways one can spot long COVID. Here's the step by step guide on how to know if you have long COVID:

    1. You might not be feeling right even weeks after recovering from COVID infection. You would still be as listless as you were during the COVID infection.

    2. There is no medical test to diagnose long COVID. Keep a track of symptoms and signs three months after the COVID infection. These symptoms persist in an individual for a minimum of two months. If you notice a symptom which has been there for weeks it is advisable to contact a doctor.

    The WHO says, "Post COVID-19 condition is usually diagnosed three months after COVID-19. This allows the healthcare provider to rule out the normal recovery process after illness. The symptoms and effects last for at least two months."

    3. Symptoms like fatigue, shortness of breath are commonly seen in long COVID patients. These signs are likely to interfere in the ability to perform daily activities such as work or household chores. If you are unable to carry out low intensity work even months after recovering from the COVID infection, you should check yourself for long COVID.

    4. Do not ignore the signs if you have had mild COVID. Experts have said that there is no relationship between the severity of the COVID infection and the occurrence of long COVID conditions.

    5. It is likely that the long COVID symptoms will fluctuate and relapse over time. "Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time," the WHO says.

    In addition to the symptoms mentioned above, people also experience signs which are difficult to explain.

    Any such condition which starts 3 months after the COVID infection should not be ignored.

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