Do guys experience 'manopause'?

Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed.



What happens when a man’s testosterone level starts to go south as he ages? Do guys experience their own version of menopause? Sort of, but not exactly.

Unlike women, men experience hormonal changes gradually over a period of many years. A man’s testosterone level peaks around age 20, and then steadily declines from about 40 on, so ultimately it’s about 50% less by the time he is 80 years old. The result can sometimes be a condition called “andropause,” which potentially affects millions of American men.

The symptoms – irritability, changes in sexual function and erectile quality, low desire – can have a very real impact on a guy’s sex life and his overall relationship.

But low testosterone doesn’t always signal a problem. There’s a huge range in what is considered "normal" for the sex hormone testosterone, according to my Good in Bed colleague and author of a woman’s guide to male sexual issues, psychiatrist Madeleine Castellanos. Testosterone levels fluctuate greatly throughout the day (they’re highest in the morning) and even during different seasons.

Life itself can also affect testosterone. When a man enters a steady relationship, his levels tend to drop somewhat, and then drop even further when he has small children. (This may be nature’s way of trying to ensure that fathers remain monogamous and supportive of their offspring.)

In fact, testosterone seems to respond greatly to different challenges as the body’s way of regulating its energy and resources. Any type of competition – from trying to pick up a woman at a bar, to playing a game of chess – will increase a man’s testosterone level to prepare him for the challenge.

“What is most fascinating is that if a man is victorious, his testosterone level gets a 20% boost,” says Castellanos in her guide to male sexual issues. “If he is not, he may experience up to a 90% dip in testosterone.”

To complicate matters further, two men of the same age may have exactly the same testosterone level but feel very different physically, emotionally, and sexually.

When andropause is diagnosed, the guy may be treated with testosterone replacement, depending on his health history. Just as there are various hormone replacement therapies for women, there's also testosterone replacement therapy for men – and research is still ongoing into potential side effects. These therapies should be explored cautiously. The male brain monitors the circulating level of testosterone in the body and will actually decrease production of testosterone if it determines it’s too high.

Says Castellanos, “Testosterone replacement is not without its side effects, such as decreased sperm production and shrinkage of the testicles. Also, it is contraindicated for men with prostate disease.”

There’s also much that men can do to boost testosterone on their own. Castellanos recommends keeping a regular schedule of both aerobic exercise and weight training, getting enough sleep, decreasing stress to manageable levels, having appropriate levels of zinc in the diet, and experiencing a sense of accomplishment and success regularly.

I generally recommend that all men, regardless of age, get their testosterone levels checked. That’s because there’s such a wide range in what’s considered a normal level, and ideally you’ll know your baseline and be able to better understand changes as you get older.

In youger men, a normal testosterone level is considered to be anywhere between 270-1030, which is quite a spectrum. The truth is that most doctors don’t check testosterone levels in younger men, unless specifically requested, so most men are unable to clearly know as they age whether they are experiencing symptoms that can be directly correlated to andropause.

But regardless of your age, it’s not too late to get your t-level checked and regularly monitored. Just as most people know their blood type, every guy should know his baseline testosterone level.

To each his own: Men and fetishes

lan Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed.
 

As a sexuality counselor and author, I’m often asked, “What’s the strangest thing you’ve ever dealt with?”

I wish I could tell them something really juicy, like naked clowns wrestling in Jell-O, for example, but the truth is that most sexual complaints tend to be rather common: sex ruts, mismatched libidos, erectile disorder and premature ejaculation in men, and orgasm problems and painful sex for women.

What people really want to know about are the unusual sexual fetishes of others (also known clinically as paraphilias), which affect a much smaller percentage of people.

Interestingly enough, most of those people happen to be men. That’s not to say that women lack their own unique turn-ons and turn-offs, their kinks and squicks (sexual repulsions), but when it comes to, say, having a favorite fantasy versus having an obsession in which all sexual pleasure is almost exclusively derived from a single object, body part or sex practice, more men seem to fall in the latter category.

In their compelling new book "A Billion Wicked Thoughts," (also discussed in this blog) neuroscientists Ogi Ogas, Ph.D. and Sai Gaddam, Ph.D., analyzed more than a billion Internet searches in order to learn about the differences between male and female sexual preferences, as well as what those differences tell us about how our brains are wired, and why, for example, men are more predisposed to have fetishes:

“The male sexual software is what a computer engineer would call an 'OR gate.' It is instantly aroused by any single cue. The male brain is turned on by deep décolletage or sashaying hips or the whisper of a sultry voice or two Applebee’s waitresses kissing. The female sexual brain is what a computer engineer would call an 'AND gate.' It requires input from multiple cues simultaneously to surpass a combined threshold of activation before arousal occurs. … Though for most men the OR gate can be triggered by any one of a variety of sexual cues, for some men one specific cue is essential. This necessary cue is a fetish.”

Although fetishes have been well-documented since the mid-19th century, and could easily fill an encyclopedia with thousands, if not tens of thousands, of entries (from agalmatophilia to zoophilia), the underlying mechanics of fetishes remain something of a mystery.

And while the American Psychiatry Association recognizes fetishes in its clinical bible, the "Diagnostic and Statistical Manual of Mental Disorders," there’s much professional dissent about how to treat fetishes and whether treatment can even be effective when a fetish is deeply ingrained in a person.

Freud believed (no surprise) that fetishes stem from issues such as a man’s universal fear of castration or his unconscious fear of his mother’s genitals, while many psychologists continue to believe that some sort of “sexual imprinting” must occur in the early childhood of the fetishist for sexual excitement and the fetish object to become so intricately enmeshed.

Today, fetishes are often treated with a combination of psychoanalysis (the search for deep unconscious meaning behind a fetish), cognitive behavior therapy (in which the fetishist’s thoughts are viewed as irrational ones that can be reversed with conscious mindfulness) and/or psychiatry, which seeks to alter the brain chemistry of the fetishist through drugs.

Even in our own expert-forum at Good in Bed, fetishes are a source of speculation. Recently, for example, a young woman complained of her boyfriend’s “freeze fetish” - his sexual propensity for immobility, statues and wax figures.

While her boyfriend didn’t seem to be exclusively turned on by the fetish, she nonetheless was confused and anxious. Our experts weighed in: “Fetishes don’t usually go away, but they can morph a little,” writes Dr. Madeleine Castellanos, author of "A Woman’s Guide to Men and Their Penis Problems."

“If people are disturbed by them, they could explore what the unconscious interpretation of the fetish is for them. Then they can experiment with another representation of that meaning that they can then assign erotic feelings.”

“The best way to treat fetishes is to identify the nonsexual meanings of the fetish and crack the erotic code by identifying what he is looking for unconsciously through the fetish,” adds psychotherapist Dr. Joe Kort. “Perhaps he was afraid of mannequins in retail stores or impressed with them or aroused by them as a child and now they have become part of this arousal template, or maybe he saw a movie or video about this as a child which caused it to become locked into his mind and now is eroticized. Whatever the case it could be helpful to understand the origins for both of you.”

Luckily, many people who would normally be distressed by a fetish are now finding like-minded peers via the Internet and/or some form of erotic stimulation (such as specialty porn) that caters to their specific interests.

Or they are fortunate enough to have sexual partners who, in the words of columnist Dan Savage, are sexually GGG (“good, giving and game”) and are willing to stretch their definition of the taboo and incorporate their partner’s fetish into their sex-play.

One single woman I know even joked that she’d love to meet a foot fetishist: At this point in her life, a good foot massage sounded better than sex. Perhaps the greatest goal for couples dealing with a partner who has a fetish is to decide how that fetish fits into their relationship.

“If a man is able to have healthy and hot sex with his partner and have his fetish fantasies without her and enjoy them,” asks Kort, "What’s wrong with that?”

Is casual sex worth it?

Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed.
 

To do it, or not to do it: That is the question of casual sex - at least as depicted on film.

In both "Friends With Benefits" (currently playing) and the previously released "No Strings Attached," casual sex is anything but casual. It’s carefully weighed, hotly debated, methodically scrutinized and, of course, comically miscalculated. As in most romantic comedies, the casual sex turns out to be quite committed and just a part of falling in love and living happily ever after.

In the movies, blind lust and romantic love often intersect seamlessly, but in reality, casual sex is often an emotional dead-end rather than an on-ramp to relationship bliss.

Anthropologist Helen Fisher describes love as a three-phase system:

1) Lust, in which we can attach to anyone.

2) Attraction, in which lust finds its focus and blossoms into romantic love.

3) Attachment, in which romantic love matures into a long-term relationship.

Casual sex is often an expression of Phase 1 (lust at its most unfocused), but, unfortunately, many people go into it with the false hope that it will lead to romantic love. And that’s where life does not imitate the movies.

That’s not to say that casual sex is a bad thing. It can be loads of fun, as well as a way of trying out new things and practicing your sex skills for that future special person. But casual sex isn’t always so simple.

As my colleague Emily Nagoski, author of the Good in Bed Guide to Female Orgasms, writes, “Especially when it comes to having sex with someone for the first time, the question of what it is you actually want when you want sex is very complicated indeed. Because what do you want, when you want sex? Do you want to get laid? Do you want a relationship? Do you want love? Do you want revenge? Do you want to rebel? Do you want to get pregnant? ... Then there’s the question of whether or not (and what kind of) sex will get you what you want. Sex will get you laid. Whether or not it gets you a relationship or love or revenge or rebellion or a baby is less certain, and so the decision becomes complicated.”

Casual sex has its risks and rewards, although the movies tend to focus more on the risk of falling in love than, say, the very real consequence of contracting a sexually transmitted infection.

As the authors of "Sex in America" write of their interviews with more than 3,000 people, “Although we find that large numbers of Americans have had a sexually transmitted disease at least once in their lives, there is nothing random about where the diseases strike … the people who are most likely to be infected share one key characteristic: They have many sex partners.”

As it turns out, if a man has two to four sexual partners in his lifetime, his chances of ever having contracted a sexually transmitted infection are about 3%.

As the number of partners increases, so does the risk. With more than 20 partners, his risk is about 28%, almost a 1,000% increase. The same rough pattern is true of women, with the spectrum of percentages increasing from 5% to 35%.

It should therefore come as no surprise that the more partners a person has had, the more likely it is that he or she has engaged with those partners outside of a monogamous relationship, and that his or her partner falls into a similar pattern of casual sex, thereby greatly increasing the risk of having come into contact with a sexually transmitted infection.

Casual sex could trigger a domino effect of risky behaviors.

“The more partners an individual has,” according to "Sex in America," “the more likely he or she is to have sex with people who themselves have many partners, the more likely he or she is to have sex with virtual strangers, the more likely she or he is to have been under the influence of drugs or alcohol during some sexual encounters, and while it is more likely that a condom was used, the rate of increased use of a condom does not seem great enough to offset the higher risks of infection.”

I’m not trying to scare anyone out of casual sex. As Dr. Alex Comfort had to say in his book "The Joy of Sex," “There is no occasion for panic, or for losing out on the joy of sex - simply informed caution.”

So is casual sex worth it? You tell me. Like the recent spate of movies, does it ever have a happy ending?

Could I have been sexually abused?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Sarah from Chicago
I am wondering if I could have been molested as a child. I have this strong feeling that I was, but I can't remember anything. When I was young, 6 or 7, I used to make my dolls have sex. At 9, I began touching myself, even though I didn't know what it meant. I am now 29 and was diagnosed with borderline personality disorder last year. I know this condition often comes with a history of childhood sexual abuse. Could it be possible?

Expert answer:
Your question touches upon tricky terrain and an area of mental health that is fiercely debated.

On one side are people who believe that amnesia for childhood abuse is common and needs to be overcome through therapeutic interventions designed to "recover memories."

On the other side are people who insist that such buried memories are far rarer than are false memories induced by well-meaning, but misguided, clinicians.

Ask our expert doctors a question

As with most complex issues there is likely truth on both sides. We know that people can be abused and not remember it as adults.

This fact was disturbingly brought home a few years ago by the case of a man who had videotaped himself having sex with a young child. Do you remember the case? The video was discovered; the man disappeared and headed to the hills armed to the teeth, only to be captured eventually by law enforcement. The girl he'd abused was at the edge of her teen years and had no memory whatsoever of the abuse event.

On the other hand, I have seen many cases of people with psychiatric symptoms who recovered memories of abuse during therapy, only later to become convinced that the memories were created rather than actual.

More than one family with no clear evidence of an abusive atmosphere has been destroyed by this phenomenon.

I don't know, and I don't think anybody knows, the percentage of recovered memories of abuse that are true versus false, so I'm not able to speculate about the odds that your feelings and suggestive behaviors do in fact hide a history of abuse of which you are unaware. I can say in general, however, that the possibility you were abused increases as factors consistent with abuse also increase.

Here are a few questions relevant to potential abuse: Was anybody else in your family physically or sexually abused? Was your family environment chaotic and violent? Was drug or alcohol abuse a prominent feature of your family's life?

To the degree that these types of experiences were part of your childhood, the possibility of abuse increases to the same degree. To the degree that your early family environment was supportive, loving and peaceful, the odds of unremembered abuse go down to that degree.

Are you an exhibitionist?

Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed.
 

Are you an exhibitionist? Maybe even a little bit of one? Have you ever fooled around in the backseat of a taxi, or gotten it on at your parents’ house, or made out in an elevator or stairwell, or enjoyed some great sex amidst the great outdoors?

In my experience as a sexuality counselor, exhibitionism tops the list of frequent fantasies for both men and women and is also the inner desire that couples are most likely to translate into action. So what is it about being potentially caught in the act that’s such a turn-on?

On a simple level, the thrill of possibly being seen or heard while otherwise sexually engaged increases the brain’s transmission of dopamine, a neurotransmitter that’s a close cousin to adrenaline and plays a big role in sexual excitement.

As psychologist Elaine Hatfield says, “Adrenaline makes the heart grow fonder.” And for those couples whose hearts are already deep in the throes of infatuation, exhibitionist behavior may simply be a byproduct of that all-consuming, can’t-keep-your-hands-off-each-other feeling, in which love is not only blind to the opinions of others, but also to their gaze.

And of course, for some, exhibitionism is more a matter of practicality (like when you’re living at home or with roommates) than a function of actual desire.

But still, a propensity for exhibitionism runs far and deep and many psychologists theorize that its broad appeal may be strongly related to our first youthful experiences with the intense pleasure of orgasm, which most of us experienced (whether on our own or with someone else) when the possibility of getting caught was close by - say, in our parents’ house.

And, not unlike the development of a fetish, these formative experiences may establish a powerful link between the particular risk of getting caught and the singular pleasure of sexual gratification.

As a result, even years later, the possibility of getting caught as manifest in our exhibitionistic urges elicits powerful feelings of sexual desire. We may be far from our teenage years (and even have kids of our own), but that doesn’t mean we’re not above acting like horny, hormone-addled teenagers when home for the holidays.

With exhibitionism, there is also an underlying sense of power that comes from being observed - a power in knowing that we may be arousing the watcher(s).

In their recent book on the Internet and sexual desire, authors Ogi Ogas, Ph.D., and Sai Gaddam, Ph.D., note that “one in four webcams on the free webcam network ChatRoulette are aimed at a penis.”

This strong compulsion to experience power through the premise of arousing others would explain why guys like Anthony Weiner “sext” photos to women they’ve never even met. It’s not about specific sexual gratification, but more about a general feeling of power.

While most women probably don’t get turned on by random photos of guys’ genitals, that’s not to say that women don’t also experience a power and pleasure in being desired, hence the female propensity to engage in other acts of exhibitionism just as much as men.

Classical paintings of nudes often featured women who were more interested in soliciting the sexual gaze of the disembodied spectator than anyone else with whom they happened to be depicted, and today much amateur porn features women who are often making love as much - even more - to the person on the other side of the camera as the person they’re actually with.

Exhibitionism is not just about the thrill of getting caught, it’s about being seen, admired, loved and appreciated. Not long ago there was a spate of Hollywood starlets — Britney Spears, Paris Hilton, Lindsay Lohan — who were exposing themselves “accidentally” while wearing short skirts with nothing on underneath.

Clearly, this could have just been their desperate ploy for press, but it also felt like their desperate attempt to be wanted and sexually craved by one and all.

In the end, a little playful exhibitionism can be fun and exhilarating and may well be part of our innate sexual psychology—but remember, it can also get you arrested. While you may enjoy drinking a fruity cocktail like Sex on the Beach, don’t take that as a suggestion to actually have sex on the beach, as one young couple recently did. You could end up in jail.

It’s one thing not to be able to keep your hands off each other in public; it’s quite another when you can’t keep your genitals off each other. In that case, go get a room. Odds are you can find one with a view.

Is the economy downgrading your sex life?

Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed.
 

All of the economic turbulence of the past few years has resulted in couples seriously cutting back on things like date nights, babysitters, gifts to each other, short trips and, of course, longer vacations.

Yet for all their thriftiness, couples are more anxious and stressed-out than ever about personal finances, and arguments over money remain one of the leading causes of marital strife. While it may seem counterintuitive to add to your expenses when going through your budget of must-haves and nice-to-haves, I implore you to find a way to put relationship satisfaction at the top of your priority list.

Things like date nights may not seem like necessities, but like trickle-down economics, a strong relationship feeds into personal and professional success. In fact, according to anthropologist Helen Fisher, people with healthy sex lives may even do better at work.

And a healthy sex life requires a strong underlying relationship to support it.

Financial stress is also a leading cause of low libido and sexual dysfunction, especially in men. Desire and sexual confidence are rooted in self-esteem, and - maybe it’s evolutionary - men derive so much of their sense of self-worth from their jobs and status as providers.

Normally in my practice, I tend to see men who suffer from sex issues that are more chronic than “situational,” meaning that the person generally has a long history with the problem and that it has a basis in underlying biological, psychological or relationship issues. But with the volatile ups and downs of the economy, many men are reporting the first-time occurrence of an issue - such as premature ejaculation, erectile disorder, delayed ejaculation and low desire – or that an occasional issue is suddenly becoming an ongoing problem.

When asked to discuss what’s going on, almost all of the men cite their anxiety over work (or lack thereof), mounting debt or arguments over money as a main source of their bedroom difficulties. In some cases, these concerns have caused men to go on anti-anxiety medications (which tend to have their own sexual side effects), but more often the men just feel anxious, distracted, depressed and/or have generally lost their mojo.

Sexual dysfunctions are a bit like bedbugs: Once they appear, they’re awfully hard to get rid of. Worrying about an issue often becomes a self-fulfilling prophecy. No wonder a recent study in the Archives of Sexual Behavior found that sexual performance anxiety plays a role in male infidelity.

Writes study co-author Robin Milhausen, a professor and sexuality researcher at the University of Guelph, “People might seek out high-risk situations to help them become aroused, or they might choose to have sex with a partner outside of their regular relationship because they feel they have an ‘out’ if the encounter doesn't go well - they don’t have to see them again.”

Although this also may sound counterintuitive - wouldn’t a guy who suffers from a sexual issue be less likely to cheat? - I’ve seen this dynamic play out many times, especially when a guy blames his partner for the issue or his feeling about the issue is enmeshed with his relationship.

This same study also suggests that women are more likely to cheat because of
With the threat of a double-dip recession looming, I’ve been encouraging couples to extend their own personal debt ceilings (so to speak) and start reinvesting in their relationships.
relationship issues. When a guy is tuned out, turned off, irritable and critical — as men often are over money issues - a woman is more likely to develop her own doubts about the relationship. Says Madeleine Castellanos M.D., author of "the Good in Bed Guide to Male Sexual Issues," “The economic downturn has sent lots of men into a funk: Job changes or loss, financial worries, and depression can all add up to a low libido. He may feel like less of a man, no matter how much you tell him that money doesn’t matter.”

Will money issues lead to infidelity in your relationship? Will they create sexual issues? We can hope not. But in my experience, financial issues are about more than just dollars and cents. Money is about emotions and family history, and just going through a credit card bill can lead to accusations, generalizations, outbursts, lies and ultimatums.

Our government often takes emergency action to create liquidity and protect the economy, and I think people need to do the same to protect their relationships. Call the babysitter and go on a date night; take that weekend getaway - it’s worth it.

A double dip-recession doesn’t have to mean a dip in your love life, and if you invest in your relationship, the return is virtually guaranteed.

Modern life rough on men

Didn’t men use to be more masculine? They were more ready to fight back, right? They walked with more swagger, and just did more things their way.

Researchers can’t measure swagger – but they can measure testosterone, the male sex hormone most responsible for masculine behaviors – and studies show that testosterone levels in men have been on the decline for decades.

Two major studies have confirmed the phenomenon, one in U.S. men and another in Danish men. In the U.S. study, the total testosterone levels measured in men’s blood dropped approximately 22% between 1987 and 2004.

Of course testosterone levels drop as men get older, but what makes the study shocking is that men today actually have less testosterone than men used to have at the same age.

The challenges to men’s health may not be limited to testosterone levels. The amount of sperm in ejaculated semen may be falling too.

A 1992 Danish analysis of sperm quality from other studies concluded that sperm quality has been dropping for decades, and a 1997 reanalysis using different mathematical modeling confirmed the decline, estimating a drop in sperm levels of about 1.5% per year in the United States.

But researchers have been gathering new data since 1996, this time using semen from Danish 18-year olds testing for military service.

That data shows no such decline at all. Oddly, the results have not been published in a peer-reviewed journal, but were instead released early to the Danish government, which then published them online.

If there’s strong evidence that testosterone is dropping, and the jury is still out on the decline of sperm, what other health challenges are men facing?

Male sex organ malformations are certainly among them. Hypospadias for example, a condition in which the man’s urethra opens somewhere before the tip of the penis, nearly doubled in prevalence from 1970 to 1993 according to national Birth Defects Monitoring Program.

Another study found that the percentage of babies in neonatal intensive care units with hypospadias jumped from just .4% in 1987 to 4% in 2000.

Boys also suffer higher rates of once-rare disorders like ADHD and autism. A comprehensive study of South Korean schoolchildren published earlier this year estimates 3.74% of all boys in that country have some form of autism, compared to 1.74% of girls.

To top it all off: there’s evidence that the percentage of babies born male is declining.

In the general population the difference is slight, but statistically relevant. One group of epidemiologists found that in the United States, the percentage of Caucasian babies born male decreased from 51.43% in 1970 to 51.22% in 2002. That’s equivalent to about 21 fewer men per 10,000 births.

In some populations, the drop is far more significant.

A group of Native Americans – the Chippewas of Aamjiwnaang – live on a reserve surrounded by large industrial chemical plants in Ontario, Canada. The percentage of male births there dropped from a normal rate of 55.1% in the years 1989-1993 to just 34.8% in the years 1999-2003.

Why is this happening?

Many researchers cited here mention changes in our environment, like an increase in the number of chemicals we’re exposed to in the womb, and throughout life.

Precisely how it all happens though is somewhat outside our scientific understanding, and of course something like testosterone levels affects each man very differently.

“Two men of the same age may have exactly the same testosterone level but feel very different physically, emotionally, and sexually,” says Ian Kerner, CNN’s sex counselor. “I try to work with men to re-define sex in a way that works with their situation.”

What is clear is that for whatever reason – men are taking some big biological punches from modern life.

Is charity sex better than no sex?

an Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed. 

Is pushing yourself when you’re not in the mood an investment in your relationship?
You may be bristling at the phrase “charity sex.” If you’re a woman, perhaps it brings to mind past, award-worthy, faked orgasms. Or maybe it reminds you of that time you bit your tongue and had sex because you were sick of hearing him ask for it. If you’re a guy, you might be thinking, “better than nothing.”
Or possibly, just possibly, you assume I’m referring to guilt-induced sex…... the sort you engage in because you feel bad for not throwing your partner a bone lately... the sort you suffer through, only to feel resentment later on.

But don’t equate charity sex with pity sex. Rather, see charity sex as a means of reestablishing a connection with your partner, and of making an important investment in your relationship.

Think of it as a donation, rather than an assessment. As blogger Heidi Raykeil has written, “The other night I was enjoying some “me” time, curled up on the couch watching the latest episode of "Grey’s Anatomy." Meanwhile, my husband was tossing and turning in bed, stressed out over his latest work project.

Frankly, between McDreamy and McSteamy, I was already pretty satisfied. But if I know one thing about my husband, it’s that sex helps him sleep. So I put down the remote and headed upstairs to take one for the team. That’s right: I had charity sex. And you know what? It was actually pretty hot.”

Pity sex is about checking sex off your to-do list. Charity sex is about checking in with each other. It’s not about meeting someone else’s physical needs—it’s about meeting your relationship’s emotional ones. It’s about opening up, quite literally, to each other.

Why might you engage in charity sex? You might do it because your partner is all wound up from work, and sex relaxes him or her. You might do it because she’s feeling a little down, and sex gives her a boost. Or maybe you do it because —- like some 41 million Americans - you’ve both gone too many days, weeks, or even months without sex.

It’s easy for sex to fall to the bottom of your to-do list when you have so many other things on your mind. The bills? The housework? The kids? The latest episode of "Breaking Bad"? Who has time for sex!? Unfortunately, the less often you have sex, the harder it is to get back into the groove. Testosterone levels drop and, as a result, libido levels drop, too. Before you know it, you’re experiencing the longest dry spell of your life.

Charity? You feel you don’t have enough to give! Fortunately, if you dig deep, you can still do your relationship some good. How?

Fake it ’til you make it. No. I’m not advocating fake orgasms. But there’s definitely something to be said for putting in a little effort. With charity sex, you may not initially feel as if you’re in the mood, but if you start going through the motions, your desire will likely catch up.

As Emily Nagoski has written in the "Good in Bed Guide to Female Orgasms," “Putting your body through the moves of faking one could actually lead to having one.” So start slowly, with intimate touching. Allow yourself to enjoy some pleasurable sensations. Try not to think about anything —- your to-do list; that meeting tomorrow morning -— but how it feels when the two of you touch. Before you know it, that offering of charity sex will start to feel like a gift to both of you.

Take away the pressure. When you’re not in the mood for sex, an orgasm may seem out of the question. And you may ask yourself: Why even have sex if I’m not getting the big payoff? But there’s a lot to be said about the stuff that happens before the orgasm. So don’t fixate too much on the end result. Rather, enjoy those moan-inducing caresses and toe-curling nibbles as they’re happening. Remain in the moment. You never know. Your body may surprise you.

Remember how good it was. Remember all the reasons you’re together. Remember what things were like when they were still new and undeniably hot. And then think of how much things have changed. How can you give back to that relationship? What are you willing to do to revitalize it?

Is charity sex better than no sex? And can it be a good thing for your relationship? You tell me.

Bisexual men: Science says they're real

 

Plenty of people identify as bisexual, but scientists are still trying to figure out what that means in terms of physiological arousal and attraction.

A new study in the journal Biological Psychology claims to have at least shown that some men who say they're bisexual actually get aroused by both men and women. And that's a new result; a controversial 2005 study could not demonstrate bisexuality.

This study does find it, perhaps because of the way researchers recruited participants. The new research focuses on self-identified bisexual men who'd had a romantic relationship of at least three months with at least one person of each sex, and at least two sexual partners of each sex - much more specific criteria than previous research used.

"The fact that we found it, especially using this kind of methodology, confirms that men with bisexual arousal patterns and bisexual identity definitely exist," said Allen Rosenthal, lead study author and doctoral student at Northwestern University.

Still, only 35 bisexual men, 31 homosexual men and 34 heterosexual men from the Chicago area participated in the study, which is a relatively small sample size and geographically restricted. More research must be done to confirm these findings, and to see if they apply to a wider group of self-identified bisexuals.

Participants watched a series of three-minute videos, which included two videos depicting two women having sex and two videos depicting men having sex. While viewing these, the volunteers wore penile strain gauges to measure erectile response.

Results showed that men in the bisexual group showed bisexual patterns of arousal, both in terms of their subjective rating of the videos and the measured genital response. They were aroused by watching erotic videos of both male and female same-sex partners.

But the bisexual men's responses also tended to suggest a preference for stimuli of one sex. It's possible that generally bisexual men are attracted to both sexes, but to one more than the other; it's also possible that they are more aroused by women sometimes and men other times.

The study falls short of determining whether most men who say they are bisexual have these arousal patterns; more research is needed in that area.

It also does not look at bisexual women. Other research on women's arousal patterns, however, suggests that regardless of a woman’s self-reported sexuality, she tends to show a certain amount of physiological arousal when viewing erotica involving men, women and men with women.

When the playground becomes a pick-up zone

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Hammocks make for deeper sleep

Babies aren't the only ones who benefit from gentle rocking. A new study suggests that when you lie down for some shut-eye, swaying in a hammock will help you fall asleep faster and make you sleep more deeply than napping on a stationary bed or couch.

Swiss researchers monitored the brain activity of 12 men during a 45-minute nap on a stationary bed and a nap of the same length on a gently rocking bed designed to simulate a hammock.

When they were in the "hammock," the men drifted off to sleep one minute faster, on average, and entered a deeper stage of sleep more than three minutes faster than when they napped in the still bed, the researchers found.

In addition, the researchers were surprised to discover that the men, while rocking, spent nearly five more minutes in that second stage of sleep (known as N2), which typically makes up about half of a normal night's rest. They also spent less time in the initial stage that serves as a transition between wakefulness and sleep.

Health.com: Seven tips for the best sleep ever

Although the study is small - even for brain-monitoring research - and the results will need to be confirmed in future experiments, the researchers say their findings could lead to novel treatments for insomnia and other sleep disorders.

"This (research) could be helpful in terms of patients who typically suffer from sleep-onset difficulty and sleep-maintenance difficulty," says Sophie Schwartz, Ph.D., one of the study's authors and a professor of neuroscience at the University of Geneva.

Health.com: Take a backyard vacation

Schwartz and her colleagues aren't certain why hammocks help put us to sleep. One explanation may be simply that people associate the gentle to-and-fro of a hammock with relaxation, leading them to drift off more easily.

But other brain processes may also be at work. Directly or indirectly, the rocking motion may activate regions of the brain that are involved in sleep, such as the amygdala. In fact, the authors say, rocking back and forth may actually "synchronize" brain waves in a way that promotes deeper sleep.

Health.com: Which sleep position is healthiest?

The researchers measured brain activity with electroencephalography (EEG), which uses electrodes placed on the scalp to gauge brain activity. When the men were rocking, the researchers found a higher concentration of "spindles" on their EEG readouts - the defining characteristic of N2 sleep - and evidence of more slow-wave brain activity, an indicator of deep sleep.

The effect of rocking on the brain may even play a role in brain functions besides sleep, such as memory and healing after brain damage, according to the researchers.

"Rocking during a nap or night of sleep might be good for other cognitive functions," Schwartz says.

Gupta: Becoming heart attack proof

Editor's note: Watch Dr. Sanjay Gupta Reports: The Last Heart Attack at 8p and 11p ET on Saturday, September 3rd.

While working on “The Last Heart Attack,” I had a chance to interview some extraordinary people around the country. Patients struggling with heart disease provided lessons that can sometimes be taught only after being smacked in the face with their own mortality. For example, I have never seen former President Clinton so candid. He was convinced he was going to die back in 2004, after feeling chest tightness during a flight back to New York on a small plane.

I interviewed cardiologists who believe we are so darn close to virtually eliminating heart disease. And, the truth is, it doesn’t involve spending any more money, investing in any more research or creating anymore tests. Rather, it will take a strict implementation of what we already know about diet and nutrition. It will also take brave champions to navigate through the clutter of confusing counsel, special interests and shoddy science.

One day, I had a chance to speak to a couple of those champions candidly while waiting for a shoot to begin - Dr. Caldwell Esselstyn and T. Colin Campbell, Ph.D. I had read Campbell’s book, "The China Study," years ago and remember how audacious he was in telling readers that most of what they believed about food and its relationship to health and disease was plain wrong. His findings changed the way people all over the world eat, including me.

And, I will admit, while I had trained my whole life to treat disease after it developed, I wasn’t medically trained in nutrition to be able to help prevent some of these diseases in the first place. Most of what I have learned has been on my own, since leaving medical school, and I think that is true for many doctors of my generation.

Simply put, Campbell’s research team found people who ate the most animal-based foods also had the most chronic disease. As important, people who ate the most plant-based foods were the healthiest. Campbell went on to describe the specific connections between nutrition and heart disease, diabetes and cancer. He also wrote of the ability to use nutrition to reverse these conditions – something that can start at almost any age.

Esselstyn took it a step further. “Sanjay, we want to make you heart attack proof.” Pretty audacious, I thought, but I couldn’t help but be engaged by this Cleveland Clinic surgeon, who was now devoting his life to preventing the diseases he made a living treating.“We are never going to end the epidemic of heart disease with stents, bypasses and medications,” he told me. That was music to my ears, because I didn’t want any of those things. Of course, it would involve essentially eliminating meat, dairy, eggs and oil – even olive oil. “Nothing with a mother, and nothing with a face,” the good doctor added.

Honestly, over the years, I have practiced the adage “eat to live,” not “live to eat.” Still, I knew it was going to be tough to carry out what he was asking. I started with a practical question for him. He was on the road traveling, and I was curious what he ate. “Thai food is always a good bet,” he told me. Sharon Kintz, who is a 66-year-old heart patient, joined me in Times Square to prove she could find a meal that satisfied her vegan requirements. Even former President Clinton says he is a vegan nowadays, and doesn’t at all miss the fast food for which he was once famous.

Virtually eliminating heart disease – it can be done, and truth is, we have known for a very long time how to do it. People have said to me as I was preparing this documentary – “Sanjay, you are advocating a radical change to the way we eat.” Perhaps, but if you really think about it, the way we eat now is in fact more radical. And when we look back on this time, a couple of hundred years from now, I guarantee you that our diet of today will be considered one of the most radical in history.

If we collectively ever want to get to the point where we have “The Last Heart Attack,” a good start would be to stop ignoring what we already know to be true.

Get Some Sleep: Are your kids night-time head-bangers?

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

We were supposed to be talking about Kathy’s insomnia, but, as is often the case, she was wanted to tell me about a loved one’s sleep problem, in this case, her grand-daughter’s.

“She is banging her head up and down every night, sometimes hitting the headboard. It is scaring her parents to death because, well, it is kind of creepy, and they are afraid that she has psychiatric problems, not to mention, they are worried she could hurt herself.”

She nailed every concern that parents have when a child displays rhythmic movements. Sleep-related rhythmic movements are very common; at nine months, research shows that 59% of all infants have rhythmic movement disorder (RMD); by 18 months, the prevalence is 33%; and by age 5, the prevalence has declined to 5%.

Technically speaking, we label these rhythmic movements as a disorder only if they: 1. Cause injury; 2. Interfere with sleep; 3. Result in significant impairment in daytime function. However, for simplicity’s sake, I will use the acronym, RMD to describe the whole phenomenon.

In most cases, RMD occurs, as stated above, in pre-school children who are neurologically normal. It is very unusual to have RMD present in adulthood, and when it does, there is serious concern for seizure disorder. Even in children who present at the classic age, we are careful to keep seizure in mind, and for that reason, an overnight polysomnogram (sleep test) is recommended.

The rhythmic movement usually occur at the transition from wake to sleep, but can continue into sleep. They can occur when children are drowsy. They involve stereotyped, repetitive movements that involve large muscle groups, for example, head banging, head rolling, rocking on hands and knees, body rolling, leg banging or rolling. One way to be sure that this is not seizure is to gently ask the child to stop doing it. In RMD, if the child is awake, she will be able to stop, whereas in seizure, she will not.

We do also see RMD in children who have autism or other developmental delay, but the difference is that they will do the movements while fully awake as well as while drowsy. For this subgroup of patients with RMD, the disorder often persists into later childhood and indeed adulthood.

Some research does show an increase in anxiety levels among children with RMD, but there is little evidence that serious psychiatric problems are a cause. Experts believe that these behaviors are likely a form of self-soothing or self-stimulation if there is a lack of it in the environment. Some studies suggest that for some children there might be an element of attention-getting behavior or passive aggression.

It can run in families, but the genetics have not been described. There seems to be no gender difference and so is just as likely to occur in boys as well as girls.

We diagnose it by clinical history and overnight sleep study. It is important that a sleep center know that there is a specific protocol that needs to be followed as well as specific scoring criteria.

The main reason we treat RMD is real or potential self-injury. It is usually the head banging that poses danger. Medications such as benzodiazepines or tricyclic antidepressants have been tried, but are not well studied, not approved for use in children, and should be considered a last-ditch therapeutic option.

A more creative approach to mitigate the danger of head banging is to have the child practice the movement in the daytime with the difference being that the “game” is to stop just short of the pillow or headboard. Often, the new learned behavior will persist into drowsiness and sleep. Another non-pharmacologic approach that shows promise is hypnosis.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

TV affects sleep of preschoolers

Watching violence on television or TV before bedtime can lead to sleep problems for preschoolers, according to a new study in the journal Pediatrics. Experts have known for some time that too much TV time can negatively impact our sleep, but this new research finds that what young children watch and when they watch it can make a difference as well.

The study looked at the television viewing habits and sleep problems of more than 600 preschoolers in Seattle, Washington. When children watched age appropriate TV in the morning or afternoon, they didn't have problems with their sleep, but when the shows contained violence, young people were more likely to experience nightmares and walk up feeling tired.

Part of the problem, researchers say, is that younger children are watching shows meant for older kids, and preschoolers can't yet distinguish fantasy from reality.

"For a 7- to 10-year-old they are really at a point where cognitively they can grasp that that's not real violence and they can see the humor in it – it's not frightening for them. But 3- to 5-year-olds just aren't developmentally there yet," explains study author Michelle Garrison, Ph.D., with the Seattle Children's Research Institute.

Garrison also found that watching television right before bedtime made it more difficult for children to get to sleep, meant more nightmares and waking up during the night, even if the shows were educational and geared specifically for young children.

"Screen time during the hour before bed can get kids more aroused and then they're going to have a harder time falling asleep," explains Garrison.

She suggests parents turn the TV off at least 60 minutes before kids get tucked in.

Shows that are meant for adults carry risks as well, she says, and she advises parents not to watch potentially violent programs such as the evening news when children are in the room.

"Even if they think the child isn't paying attention, the child is absorbing it and they'll see shootings and war footage and they really don't have the capacity to understand that that's not necessarily happening right there is their neighborhood right now," says Garrison.

Children who had televisions in their rooms tended to watch more than other children and saw more violent programming. When parents were asked about having a set in the bedroom, many said they thought it would help their child sleep, but this is not what the research shows.

"Sometimes parents will look at their child zoned out in front of the TV and think they are really relaxed. But often when kids get that glazed over, zoned out look they are actually over stimulated and not relaxed," explains Garrison.

The American Academy of Pediatrics recommends that preschoolers watch no more than two hours of television a day. High quality programming geared for this age group offers not only educational benefits, the Academy points out, but can help with building social skills as well.

"It can help children learn about cooperative problem solving, about how to negotiate things, help them learn empathy," says Garrison.

Experts offer these tips to help parents with their children's viewing habits. First of all, take the television out of the bedroom and watch TV with your child whenever you can.

"And watch what you watch; in other words, is that something that you think is appropriate for your child. You may want to watch the program first to see if it's ok for your child to watch or if it's too intense. And finally, don't be afraid to turn the TV off," says Pediatrician Don Shifrin, former Chair of the American Academy of Pediatrics' Committee on Communications

Another good source for families is Common Sense Media, according to Garrison. This website offers reviews on TV programs and movies, looking at the levels of violence, scary content and educational value.

Get Some Sleep: Why do we have REM?

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog


It seems that the public is just as fascinated with REM sleep. So are sleep physicians and researchers. But fascination often leads to confusion and controversy, and a lot of both surround the subject of REM sleep.

First, to give a brief history lesson, it is important to understand that REM, or rapid eye movement sleep, was discovered and described only in 1953, so it makes sense that there is still much to learn.

One key aspect of REM sleep is that all physical characteristics studied to date are different in REM when compared with non-REM. In fact, REM sleep more closely resembles the waking state. That is likely why people are more alert when they are awakened out of REM compared with other sleep stages.

REM sleep is when we do most of our dreaming, but not all, as researchers thought in the past. Most scientists agree that it is in REM that we have our most vivid, what I call, our magic-carpet-ride dreams, whereas the mundane kind of dreams can happen in non-REM.

Now, the question of why we dream is a whole other matter that deserves its own discussion. Suffice to say that there are many different theories at this time.

There is some debate as to whether all birds and mammals display REM sleep. Most do, so the important thing to remember is that it is not uniquely human.

Interestingly, the average daily amount of REM sleep for a given species appears strongly correlated with how immature the young are at birth. Animals that born in helpless state, such as the platypus and the armadillo, have high amounts of REM sleep at birth and indeed a high amount in maturity.

But the dolphin, which is born able to swim, feed and defend itself, has such little REM sleep that it has been questioned whether it has any at all. Humans fall somewhere in the middle in terms of amount of REM sleep, even though it strikes me that a human baby is pretty helpless for a long time.

REM sleep is present at birth in humans and it is the non-REM sleep stages that take 2-6 months to distinguish themselves. From 6 months until well into old age, REM sleep remains stable in healthy people and makes up 20-25% of the total sleep time.

REM occurs at the end of the 90-minute sleep cycles that characterize normal human sleep. The amount of REM increases as the night progresses and as one goes through repeated cycles so that although REM might only make up 10 minutes of the first cycle, it can last for 30 minutes during the last cycle.

As I stated earlier, the physiologic changes that occur during REM are closer to wake than to non-REM, with a couple of interesting exceptions. Mammals, including humans, can regulate their body temperature except in REM sleep.

During REM, we all turn into lizards and our body temperature drops or rises with the temperature of the surrounding environment.

The other unusual change is that in REM our large muscle groups are almost paralyzed. We think that this is protective mechanism so that when we are having those wild dreams about running away from the big bad wolf we can’t actually get up and start running in our sleep.

There is a disorder, called REM Behavior Disorder, where people lack this muscle weakness in REM and indeed they often hurt themselves or others.

So why do we have this unusual type of sleep? Briefly, today there are two main theories.

One is that we have sleep that resemble wake so that we can still get the benefits of sleep, but if we need to awaken quickly and be alert and ready to defend ourselves, then we can.

The other, and they are not mutually exclusive, is that because certain neurotransmitters, such as serotonin, histamine and norepinephrine are turned off during REM, then perhaps REM represents the down time that these important substances need in order to replenish themselves or reset their receptors.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

Get Some Sleep: Tips to combat the heat

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays
 (or this week, on Wednesday) on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

The recent heat wave across many parts of the country has been disturbing the sleep of many people who are not fortunate enough to have air conditioning.

This makes perfect sense because sleep is associated with a steady decline in our core body temperature. It should reach its lowest point approximately three hours before we wake.

Therefore, when we are overheated and this natural temperature drop is impeded, then sleep is disrupted.

There is research showing that melatonin has a direct effect on body temperature and that it reinforces the nocturnal decrease in the core body temperature thereby inducing sleep. Melatonin has shown mixed results as a sleeping agent in most studies, but it could be worth a try if you having trouble sleeping specifically because of the heat.

Before starting melatonin, young men and teens should always discuss its use with their physicians because there is some research showing decrease in testosterone as well as decrease in sperm count.

A bath or shower before also might help. It's not so much that hot water is relaxing as the fact that the cooling that takes place afterwards is conducive to sleep. So if your bedroom is like a sauna, it is best to try taking a cool shower before bed.

Another trick to aid sleep in these hot times is to get a small, tabletop water feature and keep it in your bedroom. It is true that the sound of running water makes people feel cooler. Of course, you can use a sound machine, but there is nothing like the real trickle.

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The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

Get Some Sleep: Avoid frequent leg cramping

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs regularly on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

It is frustrating, to both patients and doctors, that modern medical science often lacks understanding of or treatment for common, everyday ailments.

One such ailment, leg cramps, is very common and yet poorly understood. It often plagues people at night, and therefore “sleep-related leg cramps” is recognized as a bona fide sleep disorder by the International Classification of Sleep Disorders.

Most people have had a “charley horse” and know that leg cramps can be quite painful. Leg cramps result from the sudden, intense and involuntary contraction of a muscle or muscle group. They usually occur in the calf muscle or the small muscles of the feet.

If this happens once a year, few people think of this as a medical condition, but there are people who have leg cramps every night, sometimes several times a night. The cramps can prevent people from falling asleep or can awaken them many times during the night, and therefore leg cramps can lead to chronic sleep deprivation.

The painful sensation is usually relieved by strenuous stretching of the affected muscle. Often, people jump out of bed in their attempt to stop the searing pain. Both the prevalence and frequency increase as people age. There is research showing that approximately one-third of all people over the age of 60 and one-half of those over the age of 80 reported having sleep-related leg cramps once in the previous two months. Six percent of adults over the age of 60 have reported having leg cramps that disturb them every night.

Leg cramps are sometimes confused with restless legs syndrome (now known as Willis-Ekbom disease), but the two disorders are quite different, although patients can have both problems.

RLS is not commonly described as a sudden, intense pain. Also, people who suffer from RLS usually have a steady, uncomfortable feeling in the legs that lasts for hours, and this maddening feeling is only temporarily relieved for a few minutes while they move or rub their legs.

There are some medical conditions that seem to predispose people to leg cramps such as diabetes, peripheral vascular disease and neuromuscular disorders. Medications such as oral contraceptives have been associated with leg cramps. They occur in approximately 40% of pregnant women and usually resolve after birth.

If leg cramping is frequent and intense, people should not assume that they have benign, idiopathic (of unknown cause) leg cramps. It is advised to consult a physician in order to differentiate leg cramps from more serious medical conditions such as akathisia, myelopathy, peripheral neuropathy and disorders of calcium imbalance.

There are numerous theories about the cause of leg cramps but little evidence supporting the veracity of any given theory. One common notion is that they result from dehydration, but the little research done does not support this.

Also common is the idea that there is a relative electrolyte imbalance. Magnesium and potassium are popular culprits. Again, there is little research on this. One study attempted to treat leg cramps in a group of pregnant women and found that magnesium was no better than a placebo.

The same is true for potassium deficiency; there is no research showing that low potassium causes leg cramps or that taking extra potassium prevents them. That said, I have patients who swear that a banana before bed takes care of the leg cramping problem. I also know people who report that sitting in a bath of Epsom salts right before bed helps ward off nocturnal leg cramps.

I have patients who think that the leg cramps come upon them only when they exercise strenuously, and then there are those who associate the cramps with lack of exercise. The best theory is the “squatting hypothesis,” which speculates that leg cramping is associated with the modern habit of sitting on chairs and on the toilet instead of squatting as our forebears would have done.

I believe that is just another way of saying that leg cramps could be caused by a lack of strengthening and stretching of the calf and feet muscles.

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The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

Can melatonin prevent jet lag?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

'm about to travel to the other side of the world for a week and have to work the day after I get back. I've heard melatonin can help prevent jet lag when I return and would rather take that than medicine. What else can I do?

Expert answer:

Thanks for your question. Traveling across the world and turning your biological clock essentially upside down can definitely cause problems with sleep, both while you are away and when you return.

Melatonin is a hormone found in the body that is also available in synthetic form as a supplement that may help stimulate sleep. As with medications, there may be side effects when taking supplements.

Question asked by Ken from Palm Springs, California:

For melatonin, these can include nausea, headaches, dizziness, confusion and nightmares. Also, supplements may interact with any medications you may be taking. Before your trip, your doctor can advise whether melatonin is a good option for you and if so, the appropriate amount to take and when to take it (usually about an hour before the desired sleep time and either upon your return, during your trip, or both).

Some nonmedical options to try include staying hydrated, exercising or being active during the time you are supposed to be awake, and getting enough overall sleep before, during and after travel if possible.

Using eyeshades or room darkening curtains or blinds and a white noise machine may help you sleep better when you want to. Light therapy (such as from exposure to the sun or another bright light) may also help get you back on track.

Some people find that either increasing or avoiding certain foods (such as eating more protein to stay awake or more carbohydrates when trying to sleep) can help them recover more quickly from jet lag.

Readers, if you have any other tips, please feel free to comment below. Thanks!

Get Some Sleep: Bang in your head waking you? It has a name

 
 


Most of us have drifted off to sleep, only to awaken with a sudden start. This is a benign occurrence known
as a hypnic jerk.

There is a similar condition in which people awaken suddenly because they hear a loud noise in their head. They usually describe it as a loud bang or an explosion. In fact, this phenomenon is called exploding head syndrome.

Like hypnic jerks (or sleep starts), this is a completely benign condition. A hypnic jerk can accompany the clash of cymbals that people hear. Even though benign, it can be very disturbing to experience, and people often think that they are having a stroke.

It is certainly wise to seek medical attention the first time this occurs, especially if it is associated with a headache, because headaches are not a common feature of this disorder. In fact, to make the diagnosis, there should not be a significant pain component. Patients do sometimes report a flash of light occurring simultaneously with the loud bang.

If the headache is severe and persists, then indeed hemorrhagic stroke is a possibility and emergency services should be sought.

When patients bring this to a doctor’s attention, it is usually because it occurs frequently. Patients become concerned that even if the bomb in their head was not a stroke in the past, perhaps it is a symptom foretelling a stroke. There is no evidence that this is the case, even when the awakenings happen frequently.

It could be a sleep-related migraine (even without pain), and simple partial seizures can present with sensory symptoms. However, the symptom would usually not occur only at sleep onset or when awakening, as is the case with exploding head syndrome.

This can present at any age but is most common in people older than 50. Women report it more than men, but as is often the case, it may be that they are more likely than men to seek medical attention.

If many episodes occur in a night or if they are clustered in a time period of days or weeks, then patients can have disrupted sleep and insomnia. Usually, exploding head syndrome has a spontaneous remission. I know of no cases in the literature where this continued relentlessly, although there are reports of cyclical reoccurrence.

As with many medical problems, people report a worsening of attacks when they have an increase in stress or a decrease in sleep. There is a report that a medication used for seizures and migraines, topiramate, was useful in controlling this unpleasant symptom. Again, the first time this happens, it is important to receive a thorough medical evaluation just to be sure that other disorders are ruled out.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

Quiz: August is Immunization Awareness Month

This week's Health Quiz: Steve Jobs' health, premature babies, child window accidents, vaccines and more.

Semi-sweet news for chocolate lovers

 
Editor's note: Watch Dr. Sanjay Gupta Reports: The Last Heart Attack at 8p and 11p ET on Saturday, September 3rd.

If only everything that looked good, felt good, or tasted good was good for us too. It comes as more welcome news for chocolate lovers, then, that yet another study has linked chocolate consumption with improved heart health. Maybe.

Researchers at the University of Cambridge analyzed the results of seven existing studies and concluded that high levels of chocolate consumption might be associated with a notable reduction in the risk of developing heart disease. Five of the seven studies reported a beneficial link between higher levels of chocolate consumptions and the risk of cardiovascular events. They found that “the highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke, compared with the lowest levels [of consumption].”

The studies, notably, did not differentiate between dark or milk chocolate and included consumption of different types of chocolate (bars, shakes, etc.)

"The observations represent associations, not cause and effect," says Alice Lichtenstein, director and senior scientist at Tufts University's Cardiovascular Nutrition Laboratory. "The results of the evidence review provide support for conducting controlled intervention trials using well-defined preparations of chocolate before we can determine the actual effect of chocolate on heart disease risk."

By the year 2030, the World Health Organization estimates that nearly 23.6 million people will die from heart disease. In CNN Chief Medical Correspondent Dr. Sanjay Gupta’s documentary “The Last Heart Attack,” Dr. Caldwell B. Esselstyn, Jr. asserts that simply modifying one’s diet can make a person heart attack-proof in just one month. Should chocolate then be prescribed as part of this diet, which advocates the consumption of a plant-based food plan?

A number of recent studies have shown that eating chocolate has a positive impact on human health, thanks to its antioxidant and anti-inflammatory properties, namely reducing blood pressure and improving insulin sensitivity.

But here’s the caveat. Chocolate, as we all know, is full of calories, and eating too much of it could lead to weight gain, diabetes, or even heart disease – the very ailment some believe chocolate is working to prevent in the first place.

The authors of the study stress that further testing is needed to determine whether chocolate actually causes this reduction in heart problems, or if the health benefits are instead better explained by some other unmeasured factor.

"Were there compounds in cocoa that decrease heart risk," says Lichtenstein, "it will be important to identify them, isolate them, and determine the optimal dose and best route to administer them."

One thing is clear. Chocolate does far more for our bodies than activate our taste buds. Given its apparent health benefits, some resources might now be shifted to exploring the fat and sugar contents of chocolate, and how we might go about lowering them. This new “superfood” would be quite sweet indeed.

Study: Lipitor lowers more than cholesterol

Cholesterol-lowering medications like Lipitor seem to protect the body against more causes of death than just cardiovascular disease.

According to a retrospective study published Sunday in the European Heart Journal, the popular drug atorvastatin – sold by Pfizer under the name Lipitor – can also prevent death from infection and respiratory illness.

A clinical trial measuring the drug’s effectiveness ended in 2003 after having successfully shown to help prevent heart attacks and strokes.

Since then, the group taking atorvastatin has continued to experience “legacy effects” from that study – a 14% lower mortality rate compared to the group taking a placebo for the study.

“The result is very unexpected,” said Peter Sever, the study’s main author. “The benefits of statins for preventing heart attacks and strokes are well-established, but after long-term follow-up the most significant effects seem to be on deaths from other causes. It’s quite remarkable that there is still this difference between the two groups, eight years after the trial finished.”

The lower mortality rate in the atorvastatin group is due largely to a 36% reduction in deaths specifically from infection and respiratory illness, according to the study based on 4,605 participants in the United Kingdom.

Sever receives money from one or more pharmaceutical companies, including Pfizer.

According to the Wall Street Journal, Pfizer wants FDA approval to make Lipitor an over-the-counter medication, which could generate new sales after the company loses U.S. patent protection on the drug in November.

Retrospective studies like this one have their limits.

“It doesn’t sell me that 'Wow, this is now going to prevent infections,' it just doesn’t,” says Dr. Vincent Bufalino, a cardiologist and national spokesman for the American Heart Association.

“I think this is going to need some thought now. It raises a question and what it probably needs now is a go-forward randomized trial to say: is this true?”

Lack of deep sleep contributes to high blood pressure

Alack of deep sleep may be one of the reasons why people develop high blood pressure. A study of older men published Monday found that those who got the least amount of deep sleep were 80% more likely to develop high blood pressure, compared to those who got longer, less interrupted sleep.

Researchers studied almost 800 men over the age of 65 who didn't have hypertension when the study started. They were given at-home sleep tests that looked at their sleep patterns and measured their non-rapid eye movement sleep, also known as "slow wave sleep," or deep sleep. Researchers monitored the men's blood pressure changes for a little more than 3 years. Results were published in Hypertension, a journal of the American Heart Association.

Previous studies have shown that when people get less than 6 hours of sleep per night, it can increase the risk of high blood pressure. If people wake-up frequently, due to sleep apnea, medications, or other health issues and cannot fall back asleep quickly, this can also negatively affect blood pressure.

"Our study shows for the first time that poor quality sleep, reflected by reduced slow wave sleep, puts individuals at significantly increased risk of developing high blood pressure, and that this effect appears to be independent of the influence of breathing pauses during sleep," explains study author Dr. Susan Redline, Professor of Sleep Medicine at Brigham and Women's Hospital and Beth Israel Deaconess Medical Center at Harvard Medical School in Boston.

Experts often refer to slow wave sleep as the time when the body is restoring its energy reserves: Blood pressure goes down, breathing slows and the heart rate drops. People usually fall into deep sleep during the early part of the night.

Redline says this new research suggests that if your blood pressure doesn't drop sufficiently while you're sleeping, it may damage your blood vessels. Too little deep sleep may also cause parts of the brain that control the release of a number of hormones and other substances related to maintaining proper blood pressure to work less efficiently.

So how do you know if you're getting too little deep sleep? First of all, listen to your body and your family.

"If you don't sleep properly, are tired during the day, you snore or your wife or husband says you don't breathe [while asleep], get it checked out to see if you have a sleep problem," explains Dr. Donald LaVan, National Spokesman for the American Heart Association. One way to determine this is by entering a sleep study.

Redline says there are a number of things people can do to increase the likelihood of getting enough deep sleep. Ask your doctor if any of your medications can interfere with your sleep and if there are any alternative drugs you can take. Redline also says there's some evidence that being physically and mentally active may help.

High blood pressure has been called the silent killer and puts people at increase risk for heart disease and other illnesses.

When it comes to your blood pressure, "sleep quality is something to pay attention to," explains Redline, "just as one would pay attention to your diet and physical activity levels."

Get Some Sleep: Back-to-school bedtimes

It is that time of year again. It is starting to get dark earlier. In some parts of the country, there's a chill in the air at night. And the kids have to go back to school.
For many families, there are some rough days and maybe even weeks ahead as they help their children transition back to a schedule that requires them to get up earlier than they did in the summer.

School-aged children need between 10 and 12 hours of sleep a night. If kids have been going to bed at 10 or 11 p.m. in the summer, it is unlikely that they can suddenly fall asleep at 8 p.m. the night before school starts back. It is best to gradually readjust the bedtime one to two weeks before school starts so that the kids are going to bed 15 minutes earlier every couple of nights until the desired bedtime is reached.
If bedtime routines have fallen by the wayside, it is time to reintroduce them. I recommend that the hour before bed be a buffer zone between the hectic day and what we hope is a peaceful night. Homework should be completed by this time.

Although it can be hard to achieve these days, ideally there would be no use of electronics in that hour. And electronics, including cell phones, should be kept out of the kids’ bedrooms. This should be a time for hanging out as a family and then most routines end with bathing and reading.

It is important to keep lights low in that hour before bed. This allows melatonin to be released. It also prevents wake-promoting neurotransmitters from being triggered by the light. Light is the most powerful signal to which the brain responds to know when to be awake and when to be asleep. It is primarily because of our concerns about the wake-promoting properties of light that sleep doctors recommend no electronics near bedtime.

For the same reason, we recommend bright, preferably outdoor light first thing in the morning for one to two hours. Sitting by a bright window can be just as effective.

For many health reasons, it is important for children to have lots of physical activity to regularize their sleep/wake patterns. But again, there should be that downtime before bed. We recommend no strenuous exercise two to three hours before bed.

Remember that any habit you instill or encourage to help your child drift off to sleep should be something that she can do on her own when she awakens in the middle of the night. It is normal for a child to awaken for a few minutes several times during the night, but if the only way he can get back to sleep is to have you rub his back, that is a problem, at least for most parents who are trying to get their own quality sleep.

The start of a new school year is a good time to review your children’s use of caffeinated drinks, and don’t forget to include chocolate on the list. For myriad health reasons, soda should be avoided and certainly children should have none past lunchtime in order to avoid insomnia. Even if it is diet and decaffeinated, it is a bad habit to encourage. Cutting out soda is perhaps the single, easiest health decision that you can make for your kids and yourself.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.