Wellness Wednesdays

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Throughout the 2017-18 NBA season, the Official Team Physicians of the Golden State Warriors, along with Chelsea Lane – the Warriors' Head of Physical Performance &amp; Sports Medicine – and various Physicians at Stanford Medicine provided input and suggestions on some of the most common health problems facing everyday people today. The season may be over with, but the NBA calendar stops for no one, so we continue with that series today.

Last time, we covered stress management, and the steps by which we can diminish or even eliminate stress. In this installment of Wellness Wednesdays, Lane and Drs. Fiona Barwick, Scott Kutscher and Clete Kushida tackle the subject of sleep.

For the Warriors and their fans, the last four years may feel like one super long, extended season, given that they've made four consecutive trips to the Finals and won three Championships in that span, including each of the last two. While thoroughly enjoyable and well worth the effort, the arduous journey the Warriors have been on over the last several years has been an exhausting one, and just like the rest of us, they require a certain amount of recuperation in order to operate at their best. Sleep is an essential part of that recuperation process, and equally important whether you're an NBA player or an everyday Joe.

"Sleeplessness can elevate anxiety, reduce motivation and impact our tolerance for stressful situations," says Lane. "Poor sleep can impair our attention, concentration and problem solving abilities. It also impacts on the ability to retain or remember what is learned through the day."

There are numerous methods by which we can all improve our sleep, or at least create a situation in which we're more likely to experience restful sleep. But before addressing those solutions, it's important first to understand the biological process of sleep and the phases that comprise it.

Sleep is divided into two distinct phases, being Rapid Eye Movement (REM) sleep and Non-REM (NREM) sleep. The majority of sleep is comprised of NREM sleep, which is further broken down into three stages: N1, N2 and N3. During NREM sleep, our heart rate, blood pressure and metabolism are at their lowest levels, while the brain and body recover. During REM sleep, otherwise known as 'dream sleep', those levels increase, which aids in learning and memory.

"A healthy adult will cycle through sleep stages throughout the night, starting in light sleep, going through moderate and deeper NREM sleep, and lightening again before entering REM for the first time, about 90 minutes after sleep onset," says Dr. Kutscher. "The process continues, with 4-5 cycles on average during a single night. Deeper N3 sleep, or slow wave sleep, occurs predominantly in the first half of the night, with progressively longer periods of REM sleep toward early morning."

Now that we have a basic understanding of the sleep process, let's discuss the various methods by which we can help ensure restful sleep. Just like an NBA player repeating the same motion to perfect their jump shot, the people that get the best sleep tend to be creatures of habit.

"There a lot of good habits you can adopt to help facilitate a good night's sleep," says Lane. "Some will have more impact than others, some will be more possible than others depending on your lifestyle. Incorporating as many as you realistically can will add up to more rest than not trying at all, so you've nothing to lose by giving some or all of them a go."

For starters, identify your 'sleep window', and do your best to keep a consistent sleeping schedule.

While most of us naturally feel sleepy and wakeful at specific times throughout the day, those times aren't consistent from person to person.

"Morning larks feel sleepy early in the evening (7:00-8:00pm) and wakeful early in the morning (3:00-4:00am)," says Dr. Barwick. "Hummingbirds feel sleepy later in the evening (10:00-11:00pm) and wakeful later in the morning (6:00-7:00am). Night owls typically do not feel sleepy until after midnight, often between 1:00-4:00am, and do not feel wakeful until 9:00am or later."

Once you identify your best sleep window, do your best to adhere to it.

"Going to bed at roughly the same time every night – with no more than a one-hour difference – and getting up at the same time every morning helps to set our 'internal clock', or the master pacemaker in our brain," says Dr. Barwick. "Once that master pacemaker understands our typical sleep-wake pattern, it can help us feel sleepy as bedtime approaches and wakeful as rise time arrives."

If you have trouble falling asleep, often it helps to develop a relaxing 'wind down' ritual that you can repeat each night. "It helps your mind recognize that sleep is on the way and also helps stick to your bedtime," says Lane.

Additionally, limiting your alcohol and caffeine consumption, as well as screen time before bedtime, are easy steps we can take to help prepare our bodies and minds for a good night's sleep.

"The blue light emitted from electronic devices can throw your biological clock, and your sleep out of whack," says Lane. "If you just can't find a way to cut out the screen time, consider wearing glasses that filter your exposure to blue light."

If you find that you're having trouble staying asleep, consider altering your environment to make it more conducive to sleep.

"Sleep leaves us vulnerable," says Dr. Barwick. "It is risky to be unaware of what is going on around us for hours at a time. That is why our sleep environment must feel safe and comfortable. If possible, banish any sources of stress from the bedroom. Keep only things that you find soothing close by, whether music, pictures, games, or anything else that is relaxing and not too stimulating."

In general, an environment conducive to sleeping often features any combination of factors, including comfortable mattresses and pillows, the absence of light and noise, and a cool temperature. This is particularly relevant to NBA players, who spend a considerable amount of the season on the road, traveling from hotel room to hotel room.

"I also like to encourage people to turn their clocks away," says Lane. "Knowing how many hours you have left until you wake up will not make you feel any more rested in the morning. Clock watching will only induce anxiety and frustration and worsen your chances of sleep."

With the advances of modern technology, we have options at our disposal that can aid in tracking our sleep patterns. Wearable devices such as a Fitbit or Apple Watch are helpful for setting goals and tracking progress, but their applicable use remains somewhat limited.

"These devices are convenient to use because simply wearing them allows you to track a behavior of interest," says Dr. Kutscher. "However, these devices at the present time are not able to accurately measure sleep since they do not monitor brain activity."

In some cases, over the counter and prescription sleep aides may be useful, but they are not intended for long-term use, and your best sleep will always be that which comes naturally. In general, if you have concerns or questions about sleep, raise them with a qualified health care professional.

Despite all these recommendations and more, the reality is that even with them, there will be occasions in which we get poor sleep. That will happen to even the healthiest of sleepers, and it's important to not dwell on that 'failure', but rather, learn from it and adapt.

"Just as a professional athlete needs to shake off a loss or poor performance and focus on the next game, it's best not to dwell on one bad night," says Dr. Kutscher. "If you listen to your body and trust the process, you can achieve better sleep health."

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Wellness Wednesdays, presented by Stanford Health Care

Throughout the remainder of the 2017-18 NBA season, the Official Team Physicians of the Golden State Warriors, along with Chelsea Lane – the Warriors' Head of Physical Performance &amp; Sports Medicine – and various Physicians at Stanford Medicine will provide input and suggestions on some of the most common health problems facing everyday people today.

Last time, we covered cardiovascular health, and the steps we can take to ensure we're living a heart-healthy lifestyle. In this installment of Wellness Wednesdays, Lane and Dr. Valerie Hoover tackle the subject of stress management.

In less than a month, the Warriors will enter the postseason, and along with greater stakes comes greater stress.

The players feel it, but so can the fans. It's that palpable tug on your heart, the anxiousness of caring so much, yet being in control of so little. It's the part of being a sports fan that makes everything seem so worth it in victory, and so gut-wrenching in defeat.

But as we know, stress is not limited to playoff games, or even sports for that matter. Stressors are incorporated into our daily lives, affecting what we do, when we do it, how we do it and why. They can be subtle or obvious, easily managed or a constant detriment, and the fact that all people experience stress to some degree speaks to why stress management has become such an important topic in our modern world.

In order to understand how to deal with stress, we must first understand the nature of stress and how it manifests:

"Excessive stress is incredibly pervasive," says Lane. "It can show up in your body, with things like elevated blood pressure, stomach pain and nausea, difficultly sleeping or headaches. But it can also affect your behavior and mood, for example increasing your tendency to drink or smoke or reducing your desire to exercise, or making you feel anxious or withdrawn."

And, as Dr. Hoover explains, not all stressors are created equal. In fact, stress – to a certain extent – can be a good thing:

"A certain amount of stress is a good thing and can actually enhance performance (called ‘eustress'). Physiological arousal increases and with it our thinking and senses become more engaged and our reaction time is quicker. This is true whether you're a professional athlete, or giving a presentation in class or at work. However, when stress increases past a certain point it can impair performance (called ‘distress'). In this state performance can break down and we may feel burned out or fatigued."

Once we recognize that we are stressed, we can then get to the bottom of discovering its source. "It's much easier to tackle a problem if you know what it is," says Lane.

And when that source is identified, we can curtail our behavior to address that stressor, and with any luck, diminish or even eliminate it:

"Identify what sources of your stress you can actively change, and set yourself achievable steps to work on reducing those stressors," says Lane. "Understand that not all sources of stress are within your control, however. In those situations, while you may not be able to remove the stressor, you can make yourself more resilient and capable of coping with the stressor."

So, what actions can we take to be more resilient to and capable of coping with our stress? The opportunities are actually bountifully present throughout our daily routine, and Dr. Hoover has a few specific recommendations to counteract the negative effects of stress.

For instance, exercise can be an effective de-stressor, particularly when it involves the outdoors: "Move your body," says Dr. Hoover. "Go for a walk or jog, head to the gym, whatever you most enjoy.  To reap extra emotional benefits take your exercise outdoors...spending time in nature is associated with enhanced feelings of well-being."

A by-product of exercise is fatigue, and on the subject of sleep, Dr. Hoover suggests not only being consistent with our sleep patters, but also maintaining our bedrooms as de-stressed sanctuaries:

"Prioritize sleep. Get up and out of bed at the same time to build consistency in your sleep schedule. Keep the bedroom for sleep and sex only, and do any other activities (especially those involving technology or work) in another room."

Finally, the concept of mindfulness – the psychological process of bringing one's attention to experiences occurring in the present moment – has proven to be an effective method of minimizing stress:

"Just be," urges Dr. Hoover. "There's a lot of talk in the media about being ‘present' and ‘mindful.' And research supports taking time to practice mindfulness and the benefits for our emotional and physical well-being. One simple way to be present is to check in with your senses moment-to-moment. What do you see...hear...feel...smell? When thoughts cross through your mind, just say to yourself ‘thinking' and return your attention to your senses. Repeat this again...and again...and again."

So, whether you're shooting a free throw with the game on the line, finishing a term paper or simply just trying to get the house in order ahead of a family visit, stress comes for all of us, and it always will in some form or another. But by diagnosing the causes of our stress and developing a better understanding of where it comes from and why we're experiencing it, we can counteract the stress in healthier, more effective ways that can improve how we see and interact with the world around us.

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Last time, we covered New Year’s Resolutions, and how to approach and maintain them. In this installment of Wellness Wednesdays, Lane and Dr. Victor Froelicher, Director of the Sports Cardiology Clinic at Stanford University, tackle the subject of heart health.

Since 1964, February has been designated as American Heart Month in the United States, and for good reason. Heart disease is the leading cause of death for both men and women in the U.S. As such, "American Heart Month – a federally designated event – is a great way to remind Americans to focus on their hearts and encourage them to get their families, friends and communities involved," says Dr. Froelicher.

Both the Warriors’ physicians and the players themselves understand the importance of serving as role models when it comes to cardiovascular health.

"Athletes represent to the public optimal health and fitness," says Dr. Froelicher. "They are role models both for standards of behavior and health.  The public wears what they wear and tends to buy what they promote. Thus, our athletes’ embrace and support of the American Heart Month can have a large effect on the public."

Now, you may be thinking, the athletes these doctors deal with on a daily basis are in such peak physical shape that they aren’t the ones who should be worried about heart health. However, Lane explains that’s not the case; this is a health issue relevant to any and everyone:

"So whilst our players are fit and healthy men themselves, it is likely in their lifetimes, just like you and I, that someone they know or love will be affected by heart disease," Lane says. "The great news is many of these deaths are preventable, so any encouragement or inspiration our players can give to the wider community to take on heart-smart practices is valuable."

As far as heart-smart practices go, both exercise and nutrition play important roles. For exercise, Lane recommends a gradual build-up:

"For those new to physical activity, work to build up to at least two hours of moderate exercise, like walking, a week," she says. "A combination of a couple of hours of moderate and more vigorous cardiovascular activity, like jogging or spinning, in a week is a good goal to work up to. Ideally, finding a way to add a couple of sessions of whole body resistance/strength exercise to your weekly cardiovascular exercise would help round out your overall heart-smart conditioning plan."

Then, when it comes to diet, Lane insists you can’t go wrong with more vegetables:

"Veggies, veggies and more fresh veggies!" she pleads. "A vegetable-heavy diet adds lots of fiber to your day, helping to control cholesterol. Try throwing one or two vegetarian meals into the mix each week to cut down on your overall meat intake, and bring more fish (like tuna and salmon) into your regular rotation. Take a closer look at the sodium content of sauces and condiments you add to your food, and choose low sodium options to help keep your blood pressure in check. Learn more about the difference between good and bad fats, and do whatever you can to cut the bad fats out of your week and boost up your good fat intake."

So, no matter who you are, heart health is something to be taken seriously. Luckily, no matter who you are, there are plenty of easy things, like eating more nutritiously and exercising more often, that you can do to live a healthier lifestyle. While heart disease affects millions of people around the world, the preventative measures are often right at our disposal.

"How wonderful that something so debilitating and deadly as heart disease can largely be prevented with education, some regular exercise and taking care with what we eat!" Lane exclaims. "We can put ourselves in the driving seat on this one and take control with the power of good choices."

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NBA players are some of the top athletes in the entire world, and that doesn't happen by accident. Maintaining physical health is a large and vital part of any professional athlete's daily lifestyle, and they have resources at their disposal to ensure they're operating at an optimum level of performance.

While you might not be an NBA player, we're now bringing some of those resources to you.

In this first installment of Wellness Wednesdays, Lane and Dr. Megan Ruth Mahoney will tackle the subject of New Year's Resolutions, and how to approach and maintain them.

First things first: when it comes to deciding on a resolution to pursue, Lane recommends choosing one that is realistic:

"If you are going to have a New Years Resolution, don't limit yourself, but do be realistic," Lane says. "Break your goals into achievable tasks that build toward the end goal over a realistic time period. It helps keep you on task and helps to reduce feeling overwhelmed by the project."

Dr. Mahoney similarly stresses the importance of being smart when deciding on a goal:

"I have noticed that when people lack intrinsic motivation and do not set a goal that is an achievable and incremental step toward health, they often cannot continue with their resolution for more than a few weeks," says Dr. Mahoney. "Those who have specific, measurable, achievable, relevant and time bound goals – a.k.a SMART goals – are more likely to sustain their commitment throughout the year until their target is met."

A quick glance at the calendar will indicate we're midway through February, so perhaps you've already encountered some adversity in building towards your goal. No matter, says Lane: "Let's not focus on people losing their way; let's talk about ways to help people make good choices more often."

Both Lane and Dr. Mahoney stress the importance of holding yourself accountable to the resolutions you make, and offer a couple suggestions as to how to do so, including tracking and support systems:

"Tracking progress in a personal log is an effective foundation for self-efficacy," says Dr. Mahoney. "Social supports can facilitate attainment of health-related goals. A social support can be a family member, friend, trainer, and even an online health coach."

Lane also sees the benefit in tracking progress: "Keep a diary so you can track your progress and mark off your achievable tasks as you achieve them," she says. "Write down your reasons and motivations for wanting to achieve your goal and keep them handy. On the tough days, it's good to have a reminder of why making good choices is important to you."

Now, you may be sitting there thinking, it's easy for doctors and trainers to give that advice, but it's an entirely different task to follow it. Well, believe it or not, they deal with their own health-related resolutions, too. They – like the Warriors – are human after all, and therefore face many of the same kind of daily challenges as the rest of us.

For Lane, the heavy travel involved in her personal schedule poses a constant challenge to her healthy lifestyle:

"In my role, I am on the road more often than I am at home, but I am also very time-poor even when I am home," shares Lane. "One of my current ‘work-ons' is trying to prioritize getting quality sleep and allowing myself 30 minutes of daily meditation, so that I can be a happier and kinder person when I am lucky enough to spend time with my family.  Realistically, I can't be at home more often, so my goal is to make the time I am at home more enjoyable by being a healthier, calmer person."

And, as Dr. Mahoney details, you don't have to be flying cross-country constantly be presented with a challenge to live healthier. Often the opportunities are right there in front of us:

"Last year I committed to not taking the elevator," relates Dr. Mahoney, "and instead climbed the stairs, for the year. It was rewarding to see how I could challenge myself and reap the benefits of my sustained effort."

So, whether it's losing weight, improving sleep or simply electing to do the work rather than have a machine do it for you, there are little things we can do everyday to live a healthier lifestyle. If you're setting a goal, make sure it's both realistic and measurable, and don't get down on yourself if you stumble. Track your progress, and share it with your support system as a mechanism for both positive feedback and accountability. And as Lane reminds us, the decision to be healthier can be made at any time.

"Recognize that a New Year's Resolution is just a framework for making better choices," she says. "You don't have to wait for January 1st to make better choices."