Stressed and Tired All the Time
Who would have guessed it? More than half the respondents said stress
and fatigue are their number one health concerns. And these top two got
almost an equal number of votes.
What is stress, how can we manage it and how does it relate to daytime
tiredness?
The term stress was taken from a metal-working model, according to Steven
Schleifer, MD, chair of psychiatry at UMDNJ-New Jersey Medical School,
and is used to refer to an external stimulus that puts strain on an object,
as in "stress and strain."
Metal can take stress and is bendable, but will eventually reach a breaking
point. So, too, a cell, a person, a family and a society are thought to
have a steady state where they can cope, be active, stimulated and relatively
comfortable.
"Until very recently, stress was perceived as something bad that
happened - an auto accident, the loss of a spouse, an earthquake - that
would push someone beyond the comfort zone," explains Schleifer. "Now
we know it's not that simple. Not everyone reacts similarly to the same
event."
He says that Post Traumatic Stress Syndrome (PTSS), for instance, was
thought to be an inevitability of certain combat, or other extraordinary
situations, but is no longer considered a necessary reaction. "Only
some people exposed to extreme stressors will react in this way."
Experts now say we have to take into account the individual's personality,
his or her ability to cope, and also what physical and mental state the
person is in. These are very variable, says Schleifer.
Take, for example, an intensive care nurse who may be able to stay awake
and alert through 20 hours on the job if there's a snowstorm that keeps
some co-workers home.
But now suppose the individual has been awake for 16 hours prior to
this unusual demand. Add to this, assigning her a task she doesn't know
how to do. And to top it off, the snow doesn't look like it's going to
let up and so she may be needed on the unit for another eight hours.
"People are adaptable within a certain range, but there's a point
when they can no longer cope," says the psychiatrist.
Look at the current work environment in many big
companies. "Downsizing" may mean that each person's work load
increases by 35 percent. That's doable for most people, even though it
may be fatiguing.
"But volume is not necessarily the issue," says Schleifer.
"Suppose you need to do twice the usual volume of work on Monday through
Thursday, but if you accomplish it, you can leave early on Friday. You'll
probably do fine because you know what's expected, have a sense of control
and you know what you can do to relieve the extra pressure.
"Now imagine that on days one, two and three, you get double your
usual volume of work. On day four, you expect it to let up but it doesn't.
On day five, the same situation continues. No one communicates with you
about what's going on, and you can't predict what's going to happen the
next day - or next week. You have no control over the situation. Most people
will find this stressful."
Your work performance and emotional state may start to suffer, then
your physical health. Add to that the feeling that no matter how much good
work you do, no matter how many extra hours you good-naturedly put in,
when push comes to shove, you might get shoved out anyway.
"Feelings of powerlessness have a proven negative impact on health,"
Schleifer states.
In an experiment where it was found that rodents subjected to stress
had an increased rate of tumor growth, two groups of animals were observed.
One group was stressed but had the capability to stop it, the other could
not. "The animals who had some control looked as if they were not
stressed at all," he says. "The ones with no control continued
forming tumors."
What physiological changes can stress produce in humans? According to
the stress expert, it can lead to changes in heart function, blood pressure,
intestinal activity, hormone levels and immune function, to name just a
few. "There's no end to the variety of effects stress can have,"
he says, "and we can't predict what will affect a particular person
or in what way."
Schleifer says that an individual suffering major stress at work may
take it out on his or her significant other, who may, in turn, cope with
the situation for a while, but eventually get worn down. "The family
support system can break down because it's no longer keeping people in
balance," he says.
So, in a world that's changing so rapidly and in so many ways, what
exactly can you do to keep the lid on stress?
"Start with an assessment of what the stress is," advises
the psychiatrist. "Sometimes it's not obvious. Ask yourself: 'What
is knocking me off balance? What's really bothering me? Why don't I feel
in control?' You might think it's your work situation when it's really
your home life.
"Then ask yourself: How am I trying to cope? Is it helpful or not?
How can I do better? If you can't answer these questions yourself, ask
for help from a good friend or a member of the clergy."
Denial, he says, is sometimes a very effective coping mechanism if not
taken too far. Preliminary studies with cancer patients have shown that
those who use denial - who won't even say the word cancer but who still
take prescribed treatments - fare better than those who stoically accept
their plight. And since anxiety often goes hand-in-hand with stress, he
says learning relaxation techniques will often help, but can't replace
an assessment.
What should you do if everything you've tried is
backfiring, or if you really don't understand what's going on?
"Basically, it's not so different from dealing with a leaky pipe.
If you can't fix the situation with the resources at hand, then it's time
to call in a professional," Schleifer concludes.
You Can't Burn the Candle at Both Ends, Baby
The primary reason most of us are so weary is that we chronically deprive
ourselves of sleep, says Raymond Rosen, PhD, academic director of UMDNJ-Robert
Wood Johnson Medical School's Sleep Disorders Center. "The majority
of adults in our society sleep one or more hours less each night than they
physically need," he explains.
Why would we do such a thing? "Many people say they can't fit everything
they need to do into a 16-hour day. Some feel that being productive or
ambitious means denying themselves rest time. It seems to be macho to survive
on five or six hours sleep each night," says Rosen, who is also a
professor of psychiatry at the school. "Our society has a negative
bias toward sleep and it takes its toll."
And if you believe the common myth that as we get older, we need less
sleep, you've been duped. "You lose the ability but not the need for
sleep," he says. "You need at least as much, maybe more."
Of those who realize its necessity and carve out the requisite eight
hours for restorative zzz's, about one third either cannot get to sleep
or cannot stay asleep. Rosen says insomnia is like fever - a warning sign
that something is not right.
It can be as simple as drinking too much coffee, watching TV in the
bedroom or failing to establish regular sleep and wake times. Alcohol,
drugs, pain, apnea, or other breathing problems, and muscle jerks and twitches
can all interrupt sleep.
But when someone with insomnia seeks his help, Rosen says his first
question is always: Are you feeling sad, anxious, depressed?
"Sleeplessness is a major symptom of depression," he says.
Schleifer concurs. Depression can be precipitated by stress in someone
who is predisposed, he says. Other symptoms may include a decline in energy
and motivation and a preponderance of negative thoughts and feelings. "Medication
may be needed to reverse the situation," he advises.
Daytime sleepiness may be linked to stress in other ways. "For
some people under stress, sleep is a way of coping, a time out," he
explains. "They may sleep far more than their usual amount."
For others, anxiety causes tossing and turning at night, leading to
daytime wilting. Stress involving the family and home is also likely to
hinder sweet dreams.
And those who turn to alcohol or drugs for stress relief "beyond
narrowly prescribed boundaries" are treading dangerous waters, says
Schleifer, which will include night-time sleeplessness and daytime fatigue.
"There are many causes for daytime tiredness," concludes Rosen,
"and they are all important. If you don't feel refreshed in the morning,
if you feel you're not reaching the depth of sleep that you need, if your
fatigue is having an impact on your daytime function, first try to identify
the cause. You may be able to remedy it yourself."
Then, if simple measures fail and the pipes are still leaking, the experts
recommend you set up a consult with professionals.
It's a Mad, Mad, Mad, Mad World
Stress and fatigue are predictable concerns for baby boomers, but who
would guess that fear of violence is so much a part of our psyches?
"It's terrible to be a victim of violence. The effects can be permanent,"
comments Steven Simring, MD, clinical associate professor of psychiatry
at New Jersey Medical School. "But there's a difference between violence
and the perception of violence."
He says that most of those surveyed probably have
not been hit by brutality on the streets, the highways or in their homes,
and are actually worried about something that will never happen to them.
The big question, of course, is: Why so much worry?
"We all see a constant barrage of violent images transmitted by
the media," says the psychiatrist. "As a result, some people
become hyperalert and hyper-responsive, acting as if this turbulence is
always just a moment away." He explains that even those who are not
literally victims can overreact to the cues, suffering periodically from
broken sleep, nightmares and nervousness, or even rapid breathing and heartbeat
in response to loud noises.
Simring theorizes that some of the concern may be based on a sense that
the environment of certain cities seems disorderly. "Many times the
police say they can not deal with the small stuff - graffiti, broken windows,
damaged cars - because there's murder and rape out there."
He says,"Everyone gets the sense that the best cops can do is deal
with the worst, and they become acclimatized to a sense of disorder."
Simring points to the book, "Fixing Broken Windows," which
proposes that allowing minor offenders to get off encourages disrespect
of the law, while punishing them - even those who just break windows -
gives the message that lawlessness is not tolerated.
"People who live or work in a city need to feel that there is respect
for the law and that a sense of order prevails," says the psychiatrist.
Simring also suggests a personal safety defense course for those who
feel threatened by violence. This is very different from judo or karate,
which are martial arts, he says.
"You won't necessarily remember the physical techniques you practiced
using on a pretend mugger," he explains, "but you will remember
the psychological techniques. Many victims are just too polite. You walk
away from a good personal defense course with an attitude of empowerment."
Of Dinosaurs and Other Extinct Creatures
So you're turning 50 and facing the job market once again. You have
skills and experience, you look good, you feel good. You're at least 10
times wiser than when you landed your first big job 20 years ago. Why aren't
you getting any offers?
According to Simring, ageism is and always has been part of our culture.
He says that because of economic hard times, the bias against older people
is no longer swept under the rug the way it once was.
"It used to be unthinkable to let people go 10 years before retirement
even though you might have preferred a younger employee," he comments.
"When there's not enough to go around, the real attitudes surface."
He points out that of the generation turning 50, most men have been
in the job market for at least 25 years. "They're at the top of the
salary range, they have expensive benefits packages, but they may not be
hustling quite as much as they once did," he observes. "For many
professional women in this age group, the situation is somewhat different.
They came into the job market later - around age 35 - and are just getting
into high gear. They're not yet being paid top dollar and are still quite
ambitious and enthusiastic."
Simring suggests that everybody in their 30s and 40s - men and women
- really think about what they would do without their job. "Wrestle
with it at 35 while you're still employed," he suggests. "Start
preparing yourself mentally for what is probably inevitable. Being heart
and soul for the corporation doesn't work anymore. The issue is no longer
how you will spend your retirement."
The psychiatrist counsels: "Don't just sit there and worry. Find
a niche - one in which age and wisdom are assets. Do something where grey
hairs will count for you. Get additional training and skills to make yourself
marketable. Work for the company, but don't let yourself be owned."
Above all else, don't buck technology, he advises. "Don't be the
one who says, 'I've been successful for 30 years without computers. Who
needs them now?' That's like bragging about illiteracy."
Simring also warns against becoming a sour, grumpy old man or woman,
harping on past glories, or being someone who spouts embarrassing, outmoded
ideas.
"Keep current in both substance and attitude. You can't avoid getting
old," he concludes, "but you can avoid becoming a dinosaur."
Remember Me?
If you're a baby boomer in your 40s with a sense that your memory might
be slipping, the experts say you're not imagining things.
"Yes, it's happening," says John DeLuca, PhD, associate professor
of physical medicine and rehabilitation at New Jersey Medical School, "and
that's normal. Memory decline often begins in your 20s."
So when you reach 48, what can you expect? According
to the memory expert, most 48-year-olds who express worry about forgetfulness
are usually saying something quite different. Even when they make themselves
the butt of jokes and funny stories, he says they're really asking: Am
I getting Alzheimer's?
If memory loss is starting to adversely affect your family life and
happiness, if you have difficulty doing basic tasks, if your job performance
is suffering, then worry, he advises. "But one of the key signs of
early Alzheimer's is that those affected are rarely aware of the problem.
The early signs are usually recognized by the family, not by the individual."
So, while most of us can scratch Alzheimer's off our list of top 10
health worries, what the heck is going on when we can't remember the title
of that great mystery book we finished just two days ago or the name of
that wonderful restaurant in Manhattan where we ate last weekend?
The word memory, which connotes the ability to retrieve information,
is used by many people to mean cognitive performance in general, says DeLuca,
who is director of neuroscience research at Kessler Institute for Rehabilitation.
He goes on to explain that it's the speed and efficiency of information
processing, not memory, that's often touched by aging. He says when individuals
complain about memory problems they often tack on statements like: "It
takes me a much longer period of time to do the same things I did 10 years
ago," or "I used to pride myself on doing three things at once
at work, but I can't do that any more."
A child's memory is far superior to an adult's, he states. "Think
of what kids have to learn - language, motor skills, everything - in their
first few years of life. An adult would probably not be able to do it."
There's great variability as to when the decline
in what we call memory is first noticeable. "For some, it's in their
late 30s. For others, it's not until their 50s," says the neuroscience
researcher. "But on average, people will notice that their memory
is not quite what it used to be sometime in their 40s."
Memory is a very complex construct, he explains, but it can be broken
down into three basic processes: the acquisition or encoding of information;
the storage or consolidation of data; and the retrieval of that material.
"Research has found that the breakdown is very often in the acquisition
of information," he explains. If you didn't acquire it, you can't
remember it. On the other hand, if you got the data and stored it, then
generally you'll be able to retrieve it."
It's normal to write lists, he says, and it's even normal to forget
you wrote the list. It's quite okay to wrap a rubber band or tie a ribbon
around your finger to remind yourself about the list in your pocket, he
counsels. You might also be relieved to know that intelligence - broadly
defined as the ability to think analytically - doesn't begin to decline
until much later.
DeLuca and Benjamin Natelson, MD, professor of neuroscience at the school,
have begun to investigate the specific nature of impaired memory in multiple
sclerosis, stroke, amnesia, chronic fatigue, and Gulf War syndromes and
trauma. The inability to concentrate and difficulty in remembering are
major complaints of those affected by these varied disorders.
"But most boomers - like myself - should just accept the natural
process of aging and use whatever tools seem to work," DeLuca concludes.
"And please refresh my memory - what magazine did you say you're
writing this article for?"
Where Do We Go from Here?
There's no quick fix for mid-life concerns, but getting a perspective
on one's woes can certainly lighten the load.
Jacob Lindenthal, PhD, professor of psychiatry at New Jersey Medical
School, points out that the majority of HealthState surveys were filled
out in the week following the elections, when some respondents may have
been feeling slightly more down than usual. It's also the time when the
weather turns cold and daylight saving time departs, a reminder that the
hours of light are diminishing and winter is imminent. People tend to feel
more tired and duller than at other times of the year, he says.
Lindenthal also reminds us that we're tired and
stressed because there's a lot of work to get done, the economy is less
predictable than ever before, and that this is a "time of intense
moral confusion - such as we witnessed during the O.J. trial."
The constant bombardment by TVs and computers, telephones that go wherever
we go, beepers that call us from our reveries, and e-mail that must be
answered quickly is also fatiguing. And then we're flooded with advertisements
for exercise devices, soporifics, analgesics and other over-the-counter
drugs that are supposed to de-stress us and make us happy, he says.
"But living is stress," he comments. "It's what keeps
us going. It's only a problem when it's causing distress."
Lindenthal suggests that many boomers may be distressed because they
don't realize they are no longer 20. "Maybe they're exhausted because
they've taken on too much work or too many activities and should be slowing
down a bit. Growing older means you get more tired," he says.
Violence, he states, is a real concern, not a fantasy. "We're constantly
reminded by TV of what goes on inand out of urban areas. Also, as people
get older, they generally get weaker and more fearful of violence. We all
worry about teenagers who are drugged - whose judgment may be impaired."
About ageism in the workplace, he says it's a fact of life that your
age will count against you when you're looking for a job.
"But each age has its pleasures and its pains," Lindenthal
states. "First know your legal rights. Then ask yourself, 'What are
my strengths? What qualities and skills have I acquired over the years?'
Look for a good fit between your hopes and beliefs, your age - that will
march inexorably on - and your next position.
"We can become obsessed with freezing ourselves at certain ages,"
he concludes. "Above all else, cultivate the ability to leave certain
things behind gracefully and move on."
Note: Since this article was getting longer than we felt any boomer
had the time or mental fortitude to handle, we concentrated on the mental
health concerns and will address some of the other major worries in our
spring issue.
