Ask the Doctor: Worrying Too Much; Sleep Hours; Heredity and Stroke Risk

Q: I tend to worry a lot about things that are out of my control. I tell myself that my worries are unrealistic, but I can’t always help myself. Why does this happen?

A: Worrying can be a way we try to solve problems. In our worry, we search for solutions and alternative courses of action, while hoping for positive outcomes. When an outcome is uncertain—even if you’ve taken as many precautions as possible to help ensure a desired result—you may find yourself focusing on the unlikely (but still possible) outcome. If worrying doesn’t seem rational, it’s because when you worry, you activate the amygdala, which is a part of the brain that affects emotion and your “fight or flight” response. This heightened activity is sometimes referred to as “hijacking the amygdala,” a temporary condition that reduces the influence of your prefrontal cortex. This is the part of your brain that focuses on logic and decision-making. As you might expect, your emotions start dictating your thoughts and behaviors. And with rational thought essentially shut down, ironically, worrying can make you less equipped to solve your problems rationally and calmly.

As much as possible, think about what you can actually do to help. Worrying about a friend who has just gone through a divorce isn’t as helpful as taking that friend to lunch. Worrying about your heart health won’t help as much as taking a brisk walk. You may find that being proactive in some way can ease your worry and make you feel as though you are really working toward a solution. Also, it may be difficult at first, but try to focus on the present, rather than an uncertain future. The more aware you are of your current situation, the less energy and time you’ll spend on things beyond your control.

Q: Does it matter what time I sleep as long as I still get seven or eight hours a night?

A:  While it’s ideal for most people to get at least seven hours of sleep, the time you go to sleep does seem to matter. Studies of people who work overnight shifts have found that going to bed at 5 or 6 a.m. and sleeping until noon or so can have some unhealthy consequences. They include obesity, cognition and memory problems, and a shorter lifespan.

Part of the problem is that the quality and structure of your sleep cycles are different throughout the night. As you get closer to daybreak, you spend more time in rapid-eye movement (REM) sleep, which is lighter and less restorative. In the hours before and around midnight, however, you spend more time in deeper, non-REM sleep. Your brain and overall health benefits from plenty of non-REM sleep. So if you can help it, try to start your seven or eight hours of sleep before midnight.

Q: My father suffered a stroke and my grandmother (on my mother’s side) died of a stroke. I’m worried about my family risk. Does heredity affect stroke risk?

A:  Your genetic history can affect your risk of high blood pressure and other conditions related to stroke. However, the family history connection to stroke risk isn’t as well understood as the role of heredity in your risk of other conditions.

But it’s not just genes that get passed down in families. Your family’s lifestyle and the environment in which you grew up can have far-reaching impacts on your health. People who grew up in a house of smokers are more likely to smoke, which can greatly increase your risk of stroke and heart disease. An adult’s food preferences are influenced by the foods they ate growing up.

You’re wise to be aware of your family’s health history and to use that as motivation to adopt a lifestyle that will reduce your odds of a stroke. This means managing your blood pressure and cholesterol, exercising regularly, not smoking, and eating a varied and healthy diet that helps you manage your weight.

—Editor-in-Chief Maurizio Fava, MD

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